------------------------------
PAHO Basic Health Indicator Data Base This is a multidimensional query tool that offers a collection of 108 indicators from 1995 to 2005. The system presents data and indicators on:
- demography
- socioeconomic
- mortality by cause indicators
- morbidity and risk factors
- access, resources and health services coverage.
Selected indicators are disaggregated into age groups, sex and/or urban/rural region. Generated tables can be exported and printed.
The data presented is updated annually with the latest country information.
GENERAL SITUATION AND TRENDS Demography:
Panama has an area of 75,517 km2 and a population of 2,815,644 according
to the 2000 census, for a population density of 37.2 inhabitants per km2. The
average annual population growth rate during 1991-2000 was estimated at 1.91
per 100 inhabitants. The Cordillera Central divides the isthmus lengthwise:
on one side, the terrain slopes toward the Atlantic Ocean and the land is sparsely
inhabited; the other side slopes toward the Pacific and is occupied by approximately
75% of the Panamanian population. The country is divided politically and administratively
into 9 provinces, 74 districts or municipalities, 592 mayoral jurisdictions
( corregimientos ), and 4 indigenous territories ( comarcas ). Presidential
elections were held in May 1999, and the president-elect took office the following
September. On 31 December 1999 , the United States turned over administration
of the Panama Canal , and that country's military presence in the national territory
came to an end.
Economy:
According to the 1999 household survey, Panama's economically active population
(EAP) came to 1,086,598, and of this number, 672,973 (62%) were concentrated
in Panama City . Women represented 24.5% of the total EAP. Open unemployment
was 13.5% in 2000 (10.8% for males and 17.9% for females). The population covered
by social security was estimated at 1,947,882 in 2000 (69% of the total), and
40% of those covered were paying quota contributions. The basic food basket
for a typical family of five persons cost US$ 222.70 per month in January 2001,
while the minimum wage was US$ 253. Women in the private sector, when performing
the same work as men, earned US$ 80 less per month. However, the disadvantage
was not as great in the public sector, where they received only US$ 28 less.
37% of the population (1,005,914 people) were below the poverty line and more
than half that number (516,550, or 19% of the total population) were living
in extreme poverty. According to the Ministry of Economics and Finance , Panama
's level of economic activity was reflected in a 4.1% rise in GDP in 1998, followed
by an estimated 3.2% increase in 1999. The balance owed on the national foreign
debt was US$ 5,568.1 million as of December 1999 (4.5% more than in December
1998), an amount equivalent to 58% of GDP. In 1996, more than 7% of GDP-15%
of public spending that year-went to the health sector. Indigenous peoples represent
approximately 9% of the total population and comprise several clearly defined
ethnic groups. Between 1980 and 1990, the average annual birth rate was 26 per
1,000 population, and for 1999 the projected rate was 21.9 per 1,000 (19.9 per
1,000 in the cities and 26.8 per 1,000 in the countryside). The total fertility
rate show an average of 2.6 children per woman for 1999. Life expectancy at
birth has been rising steadily, from 59.3 years in 1960 to 74.3 years in 1999
(71.8 years for males, and 76.4 for females). The general mortality rate was
estimated at 5.1 per 1,000 population in 1998.
Mortality:
The infant mortality rate was down to 16.6 per 1,000 live births, but when adjusted
for underregistration , it was 21.3 per 1,000. In 1999, the estimated infant
mortality rates for Bocas del Toro (39 per 1,000) and Darién (43 per 1,000)
were comparable to the national rate at the beginning of the 1970s. Maternal
mortality dropped from 200 deaths per 100,000 live births in 1980 to 80 per
100,000 in 1998, and the rate for 1999 was 70 per 100,000, representing 5.7%
of all deaths in women of reproductive age and 13.9% of all female deaths.
SPECIFIC HEALTH PROBLEMS Analysis by population group Children (0-4 years): In
the 1960s and 1970s, infectious and contagious diseases accounted for 60% of
deaths. By 1999, conditions originating in the perinatal period headed the list
at 43.7% of deaths, followed by congenital anomalies, with 25.3% of deaths.
Of the 41,773 live born infants registered in 1999, 6.7% had low birthweight.
Schoolchildren (5-9 years):The mortality rate
in 1997 was 0.4 per 1,000 children 5-9 and the leading causes of morbidity are
acute respiratory infections and gastrointestinal infections.
Adolescents (10-14 years and 15-19 years):
The age-specific fertility rate in the population 10-14 years old was 3.1 per
1,000 in 1998. For those aged 15-19 years, the fertility rate was 91.1 per 1,000
in 1998. The leading cause of death in both age groups was accidents, self-inflicted
injuries, assaults, and other forms of violence.
Adults (20-59 years): In
1999, the rate of registered deaths in the adult population was 63.7 per 100,000,
and the leading cause was accidents, selfinflicted injuries, assaults, and other
forms of violence. During 1998-1999, there were 46 maternal deaths in this age
group and 82% of these deaths were in women from marginalized areas.
The elderly (60 years and older):The
mortality rate for this age group in 1999 was 554.8 per 100,000, and the leading
cause of death was malignant neoplasms.
Family health: In
Panama , 27% of the households are headed by women. In rural areas, 71% of female-headed
households live in poverty, and in the cities, 48% live in poverty.
The disabled:According
to the 2000 census, 31,111 Panamanians had some form of disability, 56 % of
them were males.
Indigenous groups: The
health situation of the indigenous groups stands in marked contrast to that
of the rest of the Panamanian population. For example, life expectancy in the
country as a whole was 74.3 years in 1999, whereas in the province of Bocas
del Toro, which has one of the largest concentrations of indigenous population;
that same year, the infant mortality in this province was more than twice that
of the country.
Analysis by type of health problem Vector-borne diseases: Between
1996 and 1999, a total of 880,743 blood samples were examined and 0.3% of them
were found to be positive for malaria; in all, 3,993 cases of the disease were
detected in Panama . In 1999, most of the malaria cases were concentrated in
Darién and Bocas del Toro. In 1993, there was a dengue epidemic in Panama ,
and between that year and 2000, a total of 13,245 cases were reported. All four
serotypes of the dengue virus have been found in circulation. In 2000, there
were a total of 317 cases of classic dengue, 88% fewer than the year before.
In 2000, the Aedes aegypti infestation index for dwellings was 1.5%. The highest
indexes were in the Metropolitan Region (3.2%), San Blas (3.1%), San Miguelito
(3%), and Western Panama Province (3%). Between 1987 and 1996, a total of 24
cases of Chagas' disease were reported. In 1990-1998, the highest cumulative
rates were seen in the districts of La Chorrera and Arraiján , where they ranged
between 7 and 19 cases per 100,000 population . The blood banks screen only
22% of their donations for Chagas ' disease. There have been no cases of yellow
fever in Panama since 1974. In 1999, there were 1,873 cases of leishmaniasis
(66.7 per 100,000 population). The population under 15 years of age is most
affected, with 70% of the cases in 1999. In 2000, there were 2,435 cases.
Diseases preventable by immunization: Panama
has not had a single recorded case of polio since 1972. There have been no cases
of diphtheria since 1981, and since December 1994, there have been no cases
of measles. One case of neonatal tetanus was reported in 1999, but in 2000,
there were none. Outbreaks of pertussis continue to occur in the province of
Bocas del Toro (66 cases in 2000). Also in 2000, there were 308 cases of mumps
and 941 of rubella.
Intestinal infectious diseases: There
were no cases of cholera from 1994 until 2001.
Chronic communicable diseases: The
incidence of pulmonary tuberculosis was relatively stable during 1996-2000:
the rate was 50.2 per 100,000 population in 1996, 54.2 per 100,000 in 1997,
51 per 100,000 in 1998, 48.6 per 100,000 in 1999, and 40.2 per 100,000 in 2000,
with consistently higher morbidity rates in men (52.7%). The mortality rate
in 1999 was 8.2 per 100,000 population . AIDS was associated with tuberculosis
in 3% of the cases. Four new cases of leprosy were registered in 1996 and 1997;
there was one new case in 1998, seven in 1999, and none in 2000. At the end
of 2000, there were 37 cases on record, two of them (5.5%) in persons under
15 years of age.
Zoonoses :Panama
has been free of canine rabies since 1972 and from human rabies since 1973.
However, bat-transmitted rabies continues to occur, mainly affecting cattle.
In 1998, there were 36 reported foci of equine encephalitis, but by 1999, the
number had declined to 15. All the cases were Eastern equine encephalitis.
HIV/AIDS: The
country's first two cases of AIDS were registered in September 1984, and by
2000, a total of 3,241 had been reported, 60% of them in the last four years.
The greatest risk of developing the disease occurs between the ages of 35-44
for both men and women. There have been 2,670 deaths since the onset of the
epidemic. Data for the year 2000 show that sexual transmission accounted for
the majority of cases (63.5%). Intravenous drug use was responsible for transmission
in 3.1% of the cases and was the pr them government-run and two of them private.
Food aid programs:
The Ministry of Health's Food Supplementation Program, started in 1995, is for
malnourished children from 6 months to 5 years old and underweight and lactating
pregnant women. There are two main school-based feeding programs in effect:
one of them, run by the Ministry of Education, furnishes midmorning snacks,
and the other, managed by the Social Investment Fund, provides school lunches.
RESPONSE OF THE HEALTH SYSTEM Organization of individual health care services:The public hospital network includes five national
hospitals, 14 regional hospitals, and 17 area hospitals, which together have
5,936 beds. For the 3,709 beds in the hospitals under the Ministry of Health,
there were a total of 141,345 discharges in 1999, with an average stay of 7.2
days and an occupancy rate of 67%. The private sector had 989 hospital beds.
A hospital management information system that gives information on production,
performance, resources, and costs was tested in the public hospitals in a pilot
project carried out during 1998-2000. Auxiliary diagnostic services and blood
banks:Panama
has a National Public Health Laboratory, which serves as a reference and quality
control center for the national laboratory network. In 1999, the laboratories
in this network were operating in 36% of the 776 national health establishments.
Health supplies:Most
of the drugs procured by institutions are imported , since there are only two
drug manufacturers in Panama. The Ministry has established a Pharmaceutical
Surveillance System, which monitors drug quality, treatment failures, and adverse
reactions. The vaccines used in the Expanded Program on Immunization (EPI),
paid for out of the national government budget, cost an average of US$ 2 million
per year and are supplied to the country through the PAHO Revolving Fund for
Vaccine Procurement. It is estimated that the Ministry of Health has about US$
100 million invested in biomedical equipment, but preventive maintenance is
not carried out on a regular basis. The Ministry allocates 1.6% of its operating
budget to conservation and maintenance, which does not include personnel costs.
In 1997, the Ministry conducted a qualitative inventory of its facilities and
equipment; approximately 71% of the facilities evaluated had electrical power
service and 32% of them had a sterilization system in good or average operating
condition.
Human resources:There were 11.7 physicians, 2.4 dentists, and
10.7 nurses per 10,000 population in 1996.
Health research and technology: The
Ministry has defined a policy aimed at promoting research and technological
development needed in order to improve the health situation in Panama . The
ICGES has prepared a list of research priorities for the health field and drawn
up a set of working strategies, and it has also outlined the concept and organizational
structure for a national health research system.
Health sector expenditure and financing:The figure for total expenditure on health
is incomplete because of lack of information from the private subsector , but
it was estimated at US$ 241 million in 1997. According to the National Accounts
System maintained by the Office of the Comptroller General of the Republic,
there is no organized information available on direct expenditure incurred by
individuals who pay for medication and other health services. In parallel with
social expenditure in general, Panama's public expenditure on health has been
rising steadily since 1990, reaching an estimated total of US$ 656.4 million
in 1999 (equivalent to US$ 234 per capita). This sum represents about 6.5% of
the GDP and 17.1% of all public spending. The CSS accounted for approximately
60% of public expenditure on health and the Ministry of Health for most of the
rest, since the health expenditures incurred incurred by other ministries are
minimal. The Ministry of Health budget for 1999 was US$ 192.5 million, of which
US$ 162.5 million was spent on operations and the rest on investments.
External technical cooperation and financing: External
financial cooperation funds about 2% of the health expenditure. Among the international
organizations that provide technical and nonreimbursable financial cooperation
are PAHO/WHO,UNICEF,UNDP,UNFPA, the European Union, AECI, JICA, and the governments
of South Korea and Taiwan. The IDB and the World Bank have granted long-term
and "soft" loans, mainly for reform of the health system, adaptation of the
health care model, further extension of service coverage, construction of aqueducts,
modernization of the health sector, and building of infrastructure. Also , several
projects have been executed within the framework of binational technical cooperation
agreements with other countries of the Region. In addition, international nongovernmental
organizations such as Doctors Without Borders and Caritas Internationalis carry
out health activities in remote areas.
