The Venezuelan health system is experiencing an unprecedented humanitarian crisis. There has been a reappearance of endemic diseases, medicine shortages, a mass exodus of medical professionals and the collapse of hundreds of clinics and hospitals unable to attend to a single patient because of their poor conditions.

The most serious consequences of the health crisis are a dismantled primary care system and a lack of policies for disease prevention. Governance in Venezuela is decentralized and each level of power has a basic role and clear competencies with regards to public health management.

At a municipal level, the theory is that developing programmes and services oriented towards education, promotion and disease prevention is the priority. However, this objective is utopic when regional and national governments have lost the ability to address and solve public health issues, forcing local governments to take on a larger load of attention and medical assistance.

Giving this crisis serious consideration, we decided to reinvent the way public health is managed in our municipality, El Hatillo. We accepted the challenge to innovate our services and boldly defined our priority as providing attention to vulnerable groups such as kids, adolescents, pregnant women, women at a reproductive stage, and patients with chronic diseases. In order to reach a population of 100,000 people within a 114㎢ radius, we focused on increasing the quality and coverage of our services. How? By improving existing infrastructure and promoting strategic alliances with organizations that could help us create new programmes to attend our communities.

Through our health department, our municipality counted four rural health centres and one urban centre, offering free medical consultations for services such as dentistry, paediatrics, gynaecology, obstetrics, traumatology, lab testing and emergency rooms. All of these services were strengthened with human resources, technology and supplies. The best example was the effort invested to recuperate a mobile clinic van, thanks to an alliance with the private sector. This vehicle helped expand the municipality´s primary care network since medical aid was able to arrive “on wheels” to the most distant communities.

The grave humanitarian crisis in our country has caused a substantial increase in demand for medical attention in our healthcare centres with appointments and consultations reaching 80,000 a year. In turn, this has led to increased operating expenses and medical supplies that were impossible to cover with a lack of budget. This is why public-private partnerships between different companies and NGOs have become the most important resource and asset in order to keep our health centres fully equipped and open 365 days a year.

Regrettably, the official epidemiological bulletin issued by the Venezuelan government is not published on a regular basis (despite the recommendations of international standards). However, in May 2017, the Ministry of Health shared two shocking figures: in 2016, child mortality increased by 30% in 2016 and maternal mortality increased by 65%. These figures were so alarming because teenage pregnancy in Venezuela is on the rise owing to inadequate reproductive healthcare provision.

Our team acted quickly to create the Healthy Pregnancy Initiative, a programme that rewarded women who completed a nine-month prenatal control with gifts. Thanks to this effort, prenatal control duplicated to 300 appointments a year and consultations within our Health Woman Program increased, helping us reach more adolescents and young adults to offer sexual education, gynaecological checkups and family planning advice.

Kids are probably the most affected by the current humanitarian calamity. As a local government, we started to notice the impact of the crisis when student absenteeism rose to 25% in our public schools. Among the reasons for this, parents who were unable to feed their children because of food scarcity and high costs was the most disturbing.

We therefore decided to plan and execute a school health programme to oversee 1,100 kids during our four-year term. Thanks to the DIGISALUD Foundation, we were able to use an app to build a medical history for each child, recording data on areas such as nutrition, dental health, ophthalmology and parasitology. This allowed us to study their individual evolution. For example, we were able to identify that 70% of the kids examined had cavities so we partnered with a company to apply treatment for all in order to reduce the rate of this health problem. We were also able to offer a daily nutritional supplement to all kids after establishing alliances with NGOs that had the capacity to prepare and distribute food to all schools. Our school health programme soon became the best reference for how local government, the corporate sector and communities can work together to achieve the best results for school attendance and family well-being.

El Hatillo is the only municipality within the capital city of Caracas which does not have hospitals or private clinics. As such, our urban health centre became the only option for our population during a medical emergency, as well as for patients from other municipalities that didn’t have nearby medical attention because of clinic closures. The most common emergencies were asthma attacks, severe respiratory infections, heart attacks, women in labour, polytraumatized injuries and convulsions. Understanding this harsh reality, in 2016 we were bold enough to launch the programme Hatillo Health to offer in-home healthcare services, emergency response with ambulances and a 24-hour, medical health phone line. This was thanks to an alliance with the private sector, which permitted the incorporation of two ambulances, two motorbikes and 12 paramedics. Rapidly, this local effort became the most popular health service in the city, delivering more than 100 consultations a month.

No one could ever imagine that a local government could guarantee public health services under the context of a national humanitarian crisis, let alone increase its impact. But we were able to offer a doctor at your doorstep. This was all thanks to the efforts of a committed health department team, volunteers, and allies who decided to keep investing in Venezuela. El Hatillo has not only become a positive reference for the management of public health services at a municipal level, but also an example of true dedication towards Venezuelan public service.