Venezuela's Barrio Adentro: participatory democracy, south-south cooperation and health care for all


  • Carles Muntaner University of Toronto; Center for Addictions and Mental Health, Canada
  • Francisco Armada University of Toronto
  • Haejoo Chung University of Toronto
  • Mata Rosicar Ministerio Del Poder Popular Para La Salud, Caracas Venezuela
  • Leslie Williams-Brennan University of Toronto
  • Joan Benach Universitat Pompeu Fabra, Spain


Preface In the 1990s Latin American countries, with the exception of Cuba, undertook reforms in their health systems. In general, they followed a pattern similar to that adopted in other parts of the world by pursuing a neoliberal agenda that included the promotion of changes designed to achieve greater participation of the private sector in the funding and delivery of health services. Despite the different modes of reform, all strengthened the view of health as a consumer commodity and favored abandonment of the concept of health care as a right guaranteed by the state. Most of the changes implemented corresponded to the policies of structural adjustment, in accordance with the neoliberal paradigm recommended by international financial institutions with the aim of guaranteeing payments of the external debt (1-4). After several years of application, the negative impact of neoliberal health policies has been demonstrated by its inability to improve coverage or access to health services. These consequences coincide with the general failure of neoliberalism to improve quality of life; thus, Latin America remains the region of the world with the greatest inequalities between social classes. These persistent inequalities have motivated a variety of political responses in Latin America, including proposals advocated by liberal left-wing sectors in various countries of the region that are contrary to neoliberalism and include the promotion of policies to reverse privatization of health care while asserting it as a right guaranteed by the state. The amendments to the Venezuelan health system are one of the earliest examples of this type of reform. From 1999 onward, after a decade of implementing neoliberal policies, a marked adjustment in the health system was initiated to establish health as a fundamental right guaranteed by the state in a context of broad participation of organized communities and international (“South-South”) cooperation. This article describes the primary health care reforms in Venezuela, formalized as “Misión Barrio Adentro” (Inside the Neighborhood) from 2003 onwards. We begin with an analysis of the neoliberal model that existed in Venezuela at the time changes in health policy were initiated. This is followed by an explication of Barrio Adentro in its historical, political and social context, pointing to the central role played by popular resistance to neoliberalism. We continue with a description of its operation, consolidation, analysis of the first indicators of the program’s impact on health, and the discussion of the main challenges to a guarantee of sustainability. We conclude by suggesting that Barrio Adentro not only provides a model for health care reform in other countries of the region, but that it also offers important lessons for countries throughout the world, including those with the most powerful economies.

Author Biographies

Carles Muntaner, University of Toronto; Center for Addictions and Mental Health, Canada

Carles Muntaner MD, PhD is the chair in psychiatry and addictions nursing research in the social equity and health and work and well being research programs in the social policy and prevention research department of the Centre for Addictions and Mental Health (CAMH). He is also a professor at the Faculty of Nursing and in the Departments of Public Health Sciences and Psychiatry, Faculty of Medicine, University of Toronto. Since the 1980s Dr. Muntaner has conducted research on the social inequalities in the US, the European Union, Latin America and Western Africa, integrating the public health fields of occupational health and social epidemiology. He also focuses on the study of work organization in relation to psychiatric disorders, the conceptualization and measurement of social class and racism, comparative politics, welfare state, labour markets. precarious employment and health, and philosophy of epidemiology. He has been funded by NIH, CDC, NIOSH, CIHR, WHO and several EU agencies. He has worked with the WHO, PAHO, US and Spanish unions, and the ministry of health of the Bolivarian Republic of Venezuela. In 2004 he was awarded the Wade Hampton Frost Award of the epidemiology section of the American Public Health Association for his contributions to social epidemiology. He is currently Co Chair of the Employment Conditions Network of the WHO Commission on Social Determinants of Health.

Francisco Armada, University of Toronto

Dr. Francisco Armada is a health officer in the Ministry of Health and Social Development in Venezuela and a Ph.D. candidate in the Department of Health Policy and Management at the School of Public Health of the Johns Hopkins University, Baltimore, where he also received his M.P.H. His doctoral research focuses on the political determinants of the relationship between income inequality and health in Latin America.

Haejoo Chung, University of Toronto

Haejoo Chung acquired Bachelor's in 1999 and Master's in 2001 degree at Department of Pharmacy, Seoul National University. She acquired her PhD degree in Health and Social Policy from Department of Health Policy and Management at the Johns Hopkins School of Public Health in 2006. Her research deals with the political economy of health, especially the impact of welfare states on healthcare systems on population health. She is currently a research scientist for the employment relations HUB of the WHO commission on Social Determinants of Health. Her most recent contributions include an analysis of the effects of welfare state regime type on population health.

Leslie Williams-Brennan, University of Toronto

Leslie Williams-Brennan is a registered nurse who graduated from McMaster University with a Bachelors of Science in 2000 and a Bachelors of Science in Nursing in 2005. During her undergraduate studies she volunteered extensively through rural communities in Central and South America working on disaster relief projects and in orphanages. This experience sparked her interest in international health and poverty and inspired her desire to pursue graduate studies in this area. She is currently completing a PhD in nursing at the University of Toronto. Her thesis will explore barriers affecting access to health care services by poor and non-poor households in rural communities in developing counties.

Joan Benach, Universitat Pompeu Fabra, Spain

Dr. Benach is a Doctor of Medicine (UAB), Master in Public Health (UB), Doctor in Public Health (Johns Hopkins) and a specialist in Preventive Medicine and Public Health. He is a Vice President of the committee that drafted the report “Social Inequalities in Health in Spain” (Ministry of Health, 1996) and a Director of the Atlas of Mortality in Small Areas of Spain (2001) and Catalonia (2004), co-coordinator of the reports on Inequalities in Health in Spain (2003 and 2005). He has also collaborated in numerous national and international books, reports and has taken part in several national and international research projects, and directed several doctoral theses.






Venezuelan Health Reforms