A rural health clinic near Villarrica
Courtesy Inter-American Development Bank

Construction of a water treatment plant at Coronel Oviedo
Courtesy Inter-American Development Bank

The Ministry of Public Health and Social Welfare was responsible for approving and coordinating all public and private activities and programs dealing with health. Other agencies involved in the health sector included the Social Insurance Institute, the Military Health Service, and the Clinical Hospital of the National University. Health services were organized through a system of four hierarchical levels, each of increasing complexity and sophistication. Health services at the first level aimed at providing basic care for the community. Intermediate levels offered services of greater complexity to towns and cities, whereas the fourth level provided specialized services to the entire nation.

Paraguay recorded impressive gains in health-care delivery in the 1970s and early 1980s. Following the government's launching of a massive immunization campaign in the late 1970s, the percentage of infants vaccinated against diphtheria, pertussis, tetanus, and measles went from 5 percent in 1977 to over 60 percent in 1984 (see table 5, Appendix). From 1973 to 1983, the proportion of infants receivings medical care rose from 51 percent to nearly 75 percent, and prenatal care from 53 percent to nearly 70 percent. The supply of nurses relative to the population more than doubled between 1965 and 1981. By the early 1980s, surveys indicated that 60 to 70 percent of the populace had easy access to health care.

Despite these achievements, the health-care system was beset by a number of problems. First of all, the proportion of the national budget allocated to health decreased as a result of the economic downturn of the early 1980s. In addition, international health agencies noted a lack of coordination among the agencies and institutes whose work affected health. Mechanisms for gathering information about the delivery of health services were inadequate even the reporting of vital events and infectious diseases was limited. Government health services also lacked many necessary supplies. Finally, the heavy concentration of doctors and other health providers in urban areas resulted in a shortage of personnel for rural residents.

In response to these problems, the government designed a broadly based program to augment community health organization and increase community participation. The program's objectives included upgrading the training of lay midwives, expanding health education, training traditional health practitioners and other volunteers, increasing the number of health centers in rural areas, and integrating health-care services with existing community organizations. Other priorities included lowering the morbidity and mortality r 1000 rates among mothers and young children, controlling iÍÍÍÍÍÍÍÍnfectious diseases and diseases that could be checked through vaccination, and improving child nutrition.

The Sanitary Works Corporation (Corporación de Obras Sanitarias- -Corposana) provided drinking water and sewage disposal services for towns of more than 4,000 inhabitants. The National Service for Environmental Sanitation (Servicio Nacional de Sanitaria Ambiental- -Senasa) provided the same services for smaller communities and also dealt with issues relating to national environmental health. By the mid-1980s, however, only 25 percent of the population had easy access to potable water. Like other health-related services, potable water was far more available in urban areas. About half the urban population had drinking water, whereas only 10 percent of rural residents did. Approximately half the population had access to sewage disposal services.

Sanitary conditions were not adequate to ensure proper food storage and processing. The main sources of contamination were unpasteurized milk and meat products processed in poorly refrigerated slaughterhouses.

Housing was rudimentary in much of the country some 80 percent of Paraguayan homes were owner-built. Flooding along the country's major rivers (Río Paraguay, Río Paraná, and Río Pilcomayo) and their tributaries in 1982 and 1983 destroyed much housing around Asunción and other river cities. Many residents continued to live in ramshackle huts years after the floods. Provision of services in such settlements was typically inadequate. The presence of rodents and insects represented a significant health risk.

In the late 1980s, life expectancy at birth was sixty-nine years for females and sixty-five for males--an increase of two years for each sex from 1965 to 1986. General mortality was 6.6 per 1,000 inhabitants in the mid-1980s (see table 6, Appendix). Experts projected the death rate to continue its decline to a low of approximately 5.2 per 1,000 inhabitants by the turn of the century. Heart and cerebrovascular diseases, diarrhea, cancer, and acute respiratory infections were the main causes of mortality among the population. The main infectious and parasitic diseases were malaria, Chagas' disease, diarrhea, and acute respiratory infections. Rabies was the most damaging of diseases transmitted by animals. In late 1987 Paraguay reported a total of seven known cases of acquired immune deficiency syndrome (AIDS), which had resulted in four deaths.

Although Paraguay recorded notable declines in its infant mortality rate (IMR) and postneonatal mortality rate in the early 1980s, significant regional disparities occurred. From 1981 to 1984, the IMR in Asunción declined by more than 25 percent in contrast, the drop was less than 15 percent in the rest of the country. The picture for postneonatal mortality was similar: the rate in the capital declined by nearly 30 percent, whereas the rate for the rest of Paraguay fell only about 10 percent.

Through the mid-1980s, diarrhea, pneumonia, and malnutrition remained the principal threats to the health of infants and children. Among infants the death rate from malnutrition was 1.6 per 1,000 nearly 10 percent of early childhood deaths were caused by nutritional deficiencies.

In the late 1980s, Paraguay had a social security system that had been established and modified by laws in 1943, 1950, 1965, and 1973. The system, administered by the Social Insurance Institute, offered old-age pensions, invalidity pensions, survivor settlements, sickness and maternity benefits, and work-injury benefits for temporary or permanent disabilities to employed persons and to self-employed workers who elected voluntary coverage. Railroad, banking, and public employees had special systems. Both employers and employees contributed a percentage of salaries to fund the program. Employees generally contributed 9.5 percent of earnings (except, for example, pensioners who contributed only 5 percent, and teachers and professors, who 9fe contributed only 5.5 percent), employers 16.5 percent, and the government, 1.5 percent. The Social Insurance Institute operated its own clinics and hospitals to provide medical and maternal care.

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In the late 1980s, there was a dearth of current, Englishlanguage studies on Paraguayan society. Elman R. and Helen S. Service's Tobatí: Paraguayan Town, although dated (1954), contains valuable information on rural Paraguay. Paul H. Lewis provides useful data on contemporary social relations in Paraguay Under Stroessner. Guillermina Engelbrecht and Leroy Ortiz's "Guaraní Literacy in Paraguay" and Joan Rubin's National Bilingualism in Paraguay examine the role of the Guaraní Language in national life. Fran Gillespie and Harley Browning's "The Effect of Emigration upon Socioeconomic Review: The Case of Paraguay" deals with migration and urbanization in Paraguay. David Maybury-Lewis and James Howe's The Indian Peoples of Paraguay: Their Plight and Their Prospects and Harriet Manelis Klein and Louisa R. Stark's "Indian Languages of the Paraguayan Chaco" provide an excellent overview of the status of Indians. R. Andrew Nickson's "Brazilian Colonization of the Eastern Border Region of Paraguay," Calvin Redekop's Strangers Become Neighbors: Mennonite and Indigenous Relations in the Paraguayan Chaco, and Norman R. Stewart's Japanese Colonization in Eastern Paraguay all describe the experience of some of Paraguay's immigrants. (For further information and complete citations, see Bibliography.)

Data as of December 1988