Tuesday will mark three years of the decree of the state of alarm for the covid. Three years from that day in which our reality changed completely, from a confinement that locked us up at home for long months, from empty cities, from fear, much fear, and even more death. Three years that seem like a world and that take us back to a phantasmagorical spectacle, in which we became aware of what the word uncertainty means in all its dimensions. It seems far away, once Spain has returned to normality, but there are sectors that have not yet been able to overcome and that require immediate political action, such as the health system.
On March 14, 2020, the Prime Minister, Pedro Sánchez, who had only been in Moncloa for a few weeks, appeared to announce the state of alarm. The covid virus, which at first was equated with the flu, was already circulating freely, fully reaching the elderly, highlighting the serious deficiencies in the health and care system.
“What we should have learned is that health is essential and public health must be promoted because, among other things, we will again experience international health alerts that can generate new pandemics,” says José Martínez Olmos, former Secretary General of Health who in In 2009 he had to deal with influenza A at the Ministry of Health, a preview of what came next. And what came was an unprecedented global health crisis that in Spain has led to 119,618 deaths and almost 14 million cases (data from last Friday).
Some deaths that would have been more if the state of alarm had not been applied. “Many people still do not understand that this was the only effective measure to stop infections and to put a dam on mortality. They acted with determination and tens of thousands of lives were saved”, explains Daniel López-Acuña, former director of Health Action in Crisis Situations of the WHO.
Three years later, Spain has recovered normality in almost all sectors. Except, precisely, the one that was, together with science, the great protagonist of the pandemic, health. Because one of the pieces of evidence that this crisis revealed is that the mantra that Spain had one of the best health systems in the world was not such and that it had deficiencies, as the health workers had pointed out with their multiple manifestations during the 2008-2014 crisis ( the so-called white tide).
The pandemic evidenced the lack of material and human resources in the health system, especially at the level closest to the citizen, primary care. Afflicted by a lack of investment for decades (Spain allocates 15% of the funds to this service when, according to the WHO, it should be 25%), the covid showed a starving primary care, which survived thanks to the efforts of few professionals valued.
It also revealed the zero investment in public health, the pillar for preventing and dealing with any health crisis, as the epidemiologist Fernando Simón, head of the Health Alerts and Emergencies Coordination Center of the Ministry of Health, reiterated whenever he could, who faced the fight the pandemic with a dozen professionals.
Spain faced the covid with an exhausted primary care and that, after the titanic effort made, has said enough with strikes, demonstrations and concentrations that have spread throughout the territory. Its professionals are no longer worth the recognition in the form of daily applause at eight in the afternoon that took place during the confinement or the exalting words of political leaders. They want more hands, that the work of health centers be valued, time to care for their patients and respect for a specialty so reviled that few choose it.
The panorama drawn by health workers (and corroborated by studies) is bleak, and it will be even more so if a remedy is not already taken in the face of an aging society with an increasing number of chronic patients. There is a lack of primary care doctors and paediatricians and there will be more in the coming years (manufacturing a specialist doctor takes ten years, the shortage of physicians today stems from decisions not adopted a decade ago).
In 2021 there were 136,344 doctors working in the National Health System, of which 31% of them (42,112) were assigned to primary care, 2.14% less than in 2018, according to the report that the experts delivered. last year to the minister and the directors of the branch.
Fewer professionals at this care level despite the fact that it is the second specialty with an older age pyramid, with the highest percentages of professionals over 60 years of age (33.2%) and 50 and over (60.2%) . This means the retirement of 12,034 doctors in four years, according to the Spanish Society of Family and Community Medicine.
Few and overloaded. The ratio of individual health cards (TSI) for each professional ranges from 1,538 in Madrid to 909 in Castilla y León. “The percentage of professionals with more than 1,500 TSI is high (37.1%) and hardly tolerable, and in some communities it is scandalous (Baleares, 82.7%; Madrid, 53.5%). In Madrid, 52.2% of doctors have more than 2,000 citizens assigned to them”, indicates the Federation of Associations for the Defense of Public Health (FADSP).
What does this mean? Well, many doctors have between 50 and 60 patients a day, at a rate of between three and five minutes each consultation. And that in half of the health centers in Spain it takes an average of seven to ten days to have an appointment, according to the CESM medical union.
And so it is impossible not only to address a new future health crisis, but today.
