Charles Briggs and Clara Mantini-Briggs “Social Movements, Cuban Doctors and New Definitions of ‘the Political’ in Venezuela” February 5, 2007

Clara Mantini-Briggs and Professor Charles Briggs discuss some of Venezuela's health initiatives, which are aimed at a wider distribution of health services.

Revolutionizing Public Health in Venezuela
By Emily Roberts and Christene DeJong

For the first time, Venezuela’s poor majority has quality health care right in their barrio. From new local community clinics to high-tech diagnostic centers, public health in Venezuela has experienced unparalleled, revolutionary change. Even more importantly, this revolution began not on the eighth floor of the Ministry of Health but in the barrios themselves. The case of Misión Barrio Adentro tells the story of how a local fight for health care was transformed into a comprehensive national public health program and, more broadly, illuminates the crucial role that health practices play in local politics. The evolution of Misión Barrio Adentro transformed the relationship between the state and its citizens and reflects how power and politics work inside Venezuela’s Bolivarian Revolution.

This was the argument put forth by Charles Briggs and Clara Mantini-Briggs during their CLAS talk which was based not only on their most recent research but also on years of experience living and working in Venezuela . During the summers of 2005 and 2006, the Briggs studied the Misión Barrio Adentro program in four sites around Venezuela . With a team of graduate students they interviewed officials, community members and clinic patients and conducted random-sample surveys of barrio residents. Their research not only revealed a drastic improvement in healthcare access, utilization and provision within poor communities but also found a synergy between community involvement and the new national health infrastructure funded by Venezuelan oil revenue.

Professor Briggs talked about the history of the current initiatives, emphasizing their "bottom-up" nature.

The Briggs began their story well before Hugo Chávez took office and launched his Bolivarian Revolution. In the 1980s and 1990s, as the Venezuelan economy faltered and poverty increased, the poor suffered the effects of limited access to health care. As a case in point, the Briggs highlighted their research on the cholera epidemic of 1992–93 that demonstrated the link between social inequality and the spread of infectious diseases among the poor. Throughout the 1990s, barrio residents, who comprised 60 percent of the Venezuelan population, received limited, poor-quality health care. Most Venezuelan physicians, trained for employment in the private sector, resisted working in poor communities. In addition, medical facilities were typically located far from the barrios and limited transportation, poorly lit neighborhoods and long, dilapidated stairways leading to roadways made these services virtually inaccessible. Even when residents managed to get to private clinics, or even public hospitals, they faced discrimination, were refused service or lacked the means to afford care or necessary medications.

By the 1998 presidential election, health had become a critical issue for the poor, who made up 80 percent of the population. Chávez championed health as a crucial means to achieve collective well-being and expand social and economic development. These ideals were translated into the new constitution passed in 1999, which declared health care a human right and called for an intersectional, decentralized and participatory public health system grounded in equity and social integration.

Even with visionary new Ministers of Health and a progressive public health agenda grounded in the principles of Latin American Social Medicine (a discourse that recognizes social inequalities as crucial barriers to access), the first programs to come out of the revamped ministry failed miserably. As a result, by 2003 public health services remained as unequal and exclusionary as ever.

Yet, by 2004, Misión Barrio Adentro had taken off throughout the country. The Briggs traced the program’s success to a health care movement that began in 1997 in 23 de Enero, a Caracas barrio. When poisoned children were refused care at a local clinic, angry teachers and family members took over. Demanding care and evicting the Ministry of Health, they declared the clinic the property of the community.

Dr. Martini-Briggs spoke from her own experiences as a public health physician in Venezuela.

The Briggs argue that this bottom-up movement was transformed into a national program through intervention and innovation from a complex array of actors. Barrio residents with university training became integral liaisons between the neighborhood and municipal officials. After conducting surveys that revealed health as the main problem in the community, the mayor arranged for 60 Cuban doctors, who were already in Venezuela to aid victims of the 1999 Vargas mudslide tragedy, to live and work in the neighborhoods. Barrio residents rallied together and formed health committees that spontaneously organized housing, food and other resources for the new physicians. The doctors, in turn, provided top-quality health care, visited residents in their homes and developed community solutions to health problems. The experiment proved a success and caught the eye of President Chávez.

Three weeks after Chávez told the health minister, “Get me that program!” Misión Barrio Adentro was nationalized. Although Chávez did not initiate the Barrio Adentro movement, his leadership proved instrumental and led to a rollout of resources to build, stock and staff the clinics. Thirty thousand Cuban health professionals were brought over to take posts across the country. The implementation of Misión Barrio Adentro sparked new ideas for locally-based social programs which in turn led to the reallocation of millions of dollars in oil revenues to finance the wide array of education, health, social and cultural programs visible in Venezuela today.

The Briggs credited Misión Barrio Adentro’s success to the coupling of grassroots innovation with national support and resources. Prior to 23 de Enero’s community mobilization, few health planners had ventured into poor communities to see what people really needed. Today, government officials hold posts within the barrio and continue to deepen their collaboration.

Patient interviews conducted by the Briggs’ team of researchers clearly demonstrate the effectiveness of Misión Barrio Adentro. According to the data, 62.6 percent of patients rate their care as “good” or “very good,” while only 11.9 percent rate it “average” or “poor.” While the Cuban doctors uphold high biomedical standards of care, the qualitative data indicates that patients respond most to the respect and attention they receive at the clinics. This doctor-patient relationship marks a shift from the poor as invisible to the poor as respected citizens and point to the importance of health practice as an avenue for political empowerment.

Although Misión Barrio Adentro receives widespread support, it is not without its critics. Some worry that Cuban doctors have taken jobs away from Venezuelans, even as statistics show 17,000 native medical professionals currently training or practicing in Misión Barrio Adentro clinics. Local variations in quality and access to care are also criticized with some legitimacy as these vary according to the community’s ability to organize and garner state resources. According to the Briggs, rural and jungle areas of Venezuela exist outside of the Misión Barrio Adentro framework because they have “no barrio and no adentro,” and, therefore, continue to face barriers to access.

Yet, even with these limitations, many view Misión Barrio Adentro as a tremendous success. The Briggs contend that the program has not only improved health standards and quality of life for barrio residents but has also positioned them as citizens capable of claiming rights within the new Bolivarian state.

Charles L. Briggs is a Professor of Anthropology at UC Berkeley and Clara Mantini-Briggs is a Venezuelan public health physician and Associate Researcher in the Department of Demography at UC Berkeley. They presented their research on “Social Movements, Cuban Doctors and New Definitions of ‘the Political’ in Venezuela” on February 5, 2007 as part of the Bay Area Latin America Forum.

Emily Roberts is a master’s student in the Schools of Public Health and Social Welfare, and Christene DeJong is a master’s student in the Latin American Studies program at UC Berkeley.

A student talks with the two speakers after the event.