Rural dental clinic in Los Encinitos
Courtesy Bryan Fung (top) and Lynn Meltzer (bottom)

In Honduras the quality of and access to health care are directly tied to income levels. Adequate health care is available to those able to pay the high cost. Health care for the urban and rural poor is extremely limited. The lack of health care for the majority of the population is starkly apparent in its poor health. Widespread malnutrition is responsible for 34 percent of children experiencing stunting when they are between two and five years of age. In addition, most of the population lacks access to running water and sanitation facilities--all key contributing factors to the country's high infant mortality rate (63 per 1,000 live births) and to a relatively low life expectancy rate (64.9 years) in 1992.

Health services are not readily accessible to a majority of the population. An estimated 1.3 million Hondurans were without access to health care in 1990. In the isolated regions of Honduras, there are almost no physicians. The ratio of doctor to population in 1984 was one to 1,510. Government clinics often are empty shells lacking adequate personnel, equipment, and medicines.

Infectious and parasitic diseases are the leading causes of death. Gastroenteritis and tuberculosis are serious problems. Diseases such as influenza, malaria, typhoid, and pneumonia, once believed to be under control, have returned in force because of a lack of preventive measures. The foreign-exchange crisis of the 1980s has resulted in periods when vaccines and other preventive medicines were not available. Alcoholism and drug addiction are other health concerns mentioned by the Ministry of Health. The rapid spread of acquired immune deficiency syndrome (AIDS) is also of great concern to Honduran health authorities. The incidence of AIDS appears to be particularly high in San Pedro Sula.

The cholera epidemic that originated in Peru hit Honduras in late 1991. Because of poor sanitation conditions, health officials were frightened that the disease would quickly spread throughout the country. The government launched an educational campaign months before the first case was reported, stressing personal hygiene as a prophylaxis against cholera. By the middle of 1992, however, more than 100 people had been diagnosed as having cholera.

Although the country's national public health system was created in 1959, the date when the Honduran Social Security Institute (Instituto Hondureņo del Seguro Social--IHSS) began to operate, the proliferation of health services to all regions of the country has been painfully slow. For years, people have had to travel to Tegucigalpa to avail themselves of public health service. During the 1970s, when the government made an effort to expand health services, the INSS opened a medical center in San Pedro Sula. However, in El Progreso, only fifty kilometers away and the third largest city in the 258 e country, IHSS services were not available until 1992. Population growth, the implementation of economic austerity measures by the government in the 1990s, and the present lack of facilities seem to suggest that public health services in Honduras are likely to remain inadequate in the near future.

Data as of December 1993