In 2008, some years after the SARS crisis and in the face of environmental threats, WHO warned states in its annual report that health problems were changing “in an unpredictable sense”, that poor management of urbanization and aging could take its toll on the spread of communicable diseases and emerging, and that it was important to promote Primary Care and its preventive approach against “hospitalocentrism”. In 2015, after the Ebola crisis, the UN Special Rapporteur on the right to health asked the countries to strengthen Primary Care to fulfill its role of addressing social determinants in epidemic contexts. Despite this, Spain reached 2018, the last year with data analyzed and two of the worst pandemic in a century, with a ratio in Primary Care of 0.66 nursing professionals per 100,000 inhabitants, and 0.77 doctors, practically the same as in 2009. Below the European average and far from Portugal (2.6), Ireland (1.82), the Netherlands (1.61), Austria (1.56) and France (1, 42).
Stagnant cuts and staff ratios: this is the map of the “lost decade” in healthcare, community to community
All this is told and denounced by Amnesty International (AI) in a report presented this Wednesday. It is focused on Madrid, Catalunya and Castilla-La Mancha, on what happened before the COVID-19 pandemic and during the first two waves, from March to the end of 2020. Amnesty International points out the consequences that neglect of Care Primary can carry and has carried. “It is still premature to draw conclusions about the impact of pandemic management on health indicators of other pathologies,” they say, but the excess mortality recorded by the Daily Mortality Monitoring System (MoMo), on deaths that are have produced in one year above the average of the previous five, and can be related in part to pathologies not treated in time, delayed treatments or administered without sufficient resources. A diagnosis that they also cite from organizations such as the Spanish Group of Lung Cancer. Between March 2020 and February 2021, this excess of deaths was 81,608 people; the deceased with confirmed COVID-19, 68,079.
They also collect testimonies to accompany the data collected: “I have a colleague who went to her doctor’s office for a lump and when she did the ultrasound they told her that a more specific study was necessary. But when she made an appointment they gave her for six months later This colleague of mine has aggressive breast cancer with three tumors in three different parts. If we wait until April, I don’t even want to talk about what happened, but she had to go to a private consultation to get the tests done. This cannot be allowed. The health system is playing with the lives of patients with other non-COVID diseases and patients are not willing to contribute to this game, “says Maria Luisa, cancer patient and president of the ROSAE association.
Amnesty International already released last summer a study on the lost decade in healthcare in Spain. It was an X-ray of all the Autonomous Communities, in which they calculated that only the Balearic Islands, Melilla and Ceuta exceeded the 2009 investment in this area in 2018. And in that study, which they now also cite, they described Primary Care as the “great forgotten” of the decade: investment in 2018 had decreased in both real and inflation-adjusted terms. With this last mechanism, which the NGO considers more rigorous, public spending on Primary Care has decreased by 13%, from 9,346 million in 2009 to 8,122 in 2018. A little more than health spending in general, which fell 11.21%; and while the Gross Domestic Product increased in those years by 8.6%.
More than 400 closed centers, 100 patients a day
The NGO has made a recapitulation of data of what happened in the middle of the pandemic. During the first wave, in Catalonia 39 centers and 362 local clinics were closed; in Madrid 21 centers (7 only in the afternoon) and 87 local clinics. Castilla-La Mancha tells Amnesty International that it has not officially closed any center or clinic, but the NGO reports having received information about the closure of at least two local clinics. In addition, health professionals have come to have to attend to 100 patients a day during 2020. Before the pandemic, the Ministry of Health already recognized that 41% of doctors and family doctors had excessive quotas, which then placed it at 40-50 patients a day, AI appointment.
In addition, the formula and the relationship between patient and doctor have changed. The Forum of Primary Care Physicians warned that, from March to September, telephone calls multiplied more than 400% compared to the previous period, at a time in addition to greater demand. Amnesty International highlights how the mental health of professionals has deteriorated. They include, for example, the statements of Alda Recas, president of the Madrid Association of Independent Nursing: “It is hopeless to know that the population suffers and that you cannot do anything because the authorities do not give you the mechanisms and resources. every day your colleagues cry, say ‘I can’t take it anymore’. It’s horrible. ” And in the lack of professional teams to work in decent conditions during the first phase of the crisis. At the end of April, Spain was the country in Europe with the most infections in the sector, reaching 24.1% of the total positives in the country, according to reports from the Carlos III Health Institute. Almost 125,000 professionals have been infected since March 2020, 78% women, and 89 have died.
For all this, the NGO concludes that “although no health system could be prepared for a pandemic of such magnitude” as the one that struck us a year ago, “the country faced the crisis with a very weakened health system – so especially, primary care – due to the austerity policies carried out in recent years “. They consider that “Spain has violated the right of everyone to enjoy the highest possible level of physical and mental health” and that two pandemics have been experienced here: that of COVID-19, and that of mismanagement by the authorities. From now on, they recommend that the Ministry and Communities finally increase investment, design indicators that assess the situation of care capacity and a Plan of substitutions and measures to relax the bureaucracy. Also pay special attention to guaranteeing the care of the most vulnerable people and establishing mechanisms of transparency, participation, accountability, and that correct gender inequalities.