El Salvadoran health care workers resist privatisation of health industry 1999-2000


Retraction of plans to privatise health care system, raise in doctors' salaries, rehiring of workers that were fired as a result of the strikes.

Time period notes

SIMETRISSS conducted strikes demanding salary increase and greater representation in liberalisation of health industry since first half of 1998. The 1999-2000 strike also preceded the first marcha blanca of 19th March 1998, to date, the biggest popular protest against privatisation of health systems in El Salvador.

Time period

16th November, 1999 to 10th March, 2000


El Salvador

Location City/State/Province

Jump to case narrative

Methods in 1st segment

  • SIMETRISSS and STISSS signed agreement to have joint labour strikes; public sectors in MOLI also signed as supporters
  • "O paga, o se muere" (either pay or die)

Methods in 2nd segment

  • "O paga, o se muere" (either pay or die)
  • to Casa Presidencial by MOLI, peasant associations, and community groups

Methods in 3rd segment

  • "O paga, o se muere" (either pay or die)
  • incl. ANDES-21 de Junio, AGEPYM, and STSEL
  • by MSCCP and 25 NGOs in San Salvador, Chalatenango, San Vicente, and La Libcare
  • by MSCCP on 7th January
  • by power workers on 10th of January
  • by newly formed Frente Sindical contra la Privatizacion

Methods in 5th segment

Methods in 6th segment

Segment Length

19 days

Notes on Methods

I suspect that marches and rallies with banners and slogans would have been held in the 5th segment also, but have not been able to find sources explicitly stating this.




Colegio Medico, MOLI, FMLN, Peasant associations, Community groups, Frente Sindical contra la Privatizacion, Movimiento de la Sociedad Civil contra la Privatizacion (MSCCP), public school teachers in ANDES-21 de Junio, municipal workers in AGEPYM, power workers in STSEL, MSPAS doctors and workers, doctors in private clinics, Las DIGNAS, Las Melidas (MAM), ORMUSA, Comunidades Rurales para el Desarollo de El Salvador (CRIPDES) (all four were women's organisations).

External allies

Human Rights Ombudsman's Office

Involvement of social elites

Jorge Schafik Handal, Huberto Centeno (FMLN legislative deputies)


ARENA government led by Francisco Flores

Nonviolent responses of opponent

Blocking of road to President's home by police

Campaigner violence

Not known.

Repressive Violence

Tear gas, pepper spray, water cannons, and rubber bullets


Economic Justice



Group characterization

Health care unions
public sector labour
women's organisations

Groups in 1st Segment

Public sector unions in MOLI
Jorge Schafik Handal
Huberto Centeno (both on behalf of FMLN)
SIMETRISSS (Doctors' union)
STISSS (Workers' union)
Las Melidas (MAM)

Groups in 2nd Segment

Peasant associations
community groups

Groups in 3rd Segment

Movimiento de la Sociedad Civil contra la Privatizacion (MSCCP)
public school teachers in ANDES-21 de Junio
municipal workers in AGEPYM
power workers in STSEL
Human Rights Ombudsman's Office
Frente Sindical contra la Privatizacion

Groups in 4th Segment

MSPAS doctors and workers
doctors in private clinics

Segment Length

19 days

Success in achieving specific demands/goals

0 out of 6 points


0.5 out of 1 points


3 out of 3 points

Total points

3.5 out of 10 points

Notes on outcomes

Government reneged on its promises to withdraw partial privatisation of hospitals less than five months after agreement was struck on March 2000.

Database Narrative

Neo-liberalisation policies were central to the economic development
plans of El Salvador since the 1980s.  In the mid 1990s, the El
Salvadoran government agreed to allow greater privatisation in basic
social services in return for loans from the World Bank and the
Inter-American Development Bank (IADB). In the late 1990s, El Salvador
introduced the Salvadoran Institute of Social Security (ISSS) as part of
the second phase of El Salvador’s liberalisation policies. In response,
the public sector doctors’ part of the ISSS (SIMETRISSS) conducted
strikes in the first half of 1998, demanding higher wages and greater
voice in influencing the restructuring of the health system. SIMETRISSS
gathered wide support for their 1998 strikes, enlisting enough
protesters to fill ten blocks in the first marcha blanca (white march –
demonstration where protesters wore white to support medical workers) on
19 March 1998. The main political opposition, the Farabundo Marti
National Liberation Front (FMLN) also lent strength to the protests by
actively bringing the health privatisation issue into the Health and
Environmental Commission within the legislative assembly. The government
eventually acceded to the doctors’ demands and allowed greater
participation in health policies.

El Salvador’s new president in 1999, Francisco Flores, attempted
privatisation of the public health system again. He announced plans to
allow outsourcing of two hospitals as part of a pilot program. The
government did not consult the doctors before making these plans. In
response, almost 12,500 workers in the SIMETRISSS and the workers union
under the ISSS (STISSS) agreed to strike on 14 November 1999. Under the
strikes, the workers admitted no new patients and only treated emergency
cases. The unions called for the retraction of plans for health care
privatisation, increase in salaries of doctors, and later, the rehiring
of health workers laid off as a result of the ensuing strikes. Eighteen
public sector unions under the Movement of Integrated Labor
Organizations (MOLI) also signed in support. One week after the strikes
began, FMLN legislative deputies, Jorge Schafik Handal and Humberto
Centeno, expressed their public support for the strikes.

In the midst of the strikes, STISSS and SIMETRISSS organised marches with greater participation from unions and community groups.
On 8 December 1999, the unions, with the support of peasant
organisations, community groups, and NGOs, held a march towards the
presidential residence. The protesters flew banners with slogans “O Paga
o se muere” – “either pay or die.” The protesters’ slogans made the
issue of health privatisation real for many members of the public which
helped galvanise a broader public appeal. President Flores refused to
meet with the marchers. On 4 January, unions within MOLI formed the
coalition Frente Sindical contra la Privatizacion to better coordinate
protest against privatisation and outsourcing of public services. The
coalition held work stoppages in seven government departments on 13
January 2000. In addition, NGOs founded the Movimiento de la Sociedad
Civil contra la Privatizacion (MSCCP) on 7 January. This coalition
included workers from the treasury department, water and pension system
services, and the energy sector, all of which held solidarity strikes
and work stoppages. The MSCCP also organised protest caravans in San
Salvador, Chalatenango, San Vicente, and La Libertad. The protesters
held a second mass march on 14 January, and they were joined by the
public school teachers in the organization ANDES-21 de Junio and workers
in the General Association of Public and Municipal Employees (AGEPYM)
and the Union of Electrical Sector Workers (STSEL). Peasant
organisations from major cities of El Salvador were also able to
participate after the Human Rights Ombudsman’s Office helped marchers
reach the rally by removing police road blockades.

By February, the campaign against health privatisation included not just
the unions, but also doctors and medical workers in private clinics.
The coordination of the strikes by workers  in the two fields shut down
hospitals nationwide, affecting all fourteen departments. Unionists
continued to hold rallies and marches continued to be held in major
towns and cities, including San Vicente, San Salvador, Santa Ana, San
Miguel, and Zacatecoluca.

In early March, workers from eighteen public hospitals in the Ministry
of Public Health and Social Service (MSPAS) joined in the campaign. Then
on 6 March, riot police attacked protesters staging a sit-in in front
of the largest public hospital in El Salvador (ISSS Surgery Hospital and
Hospital Rosales). The police fired tear gas, pepper spray, water
cannons, and rubber bullets. When tear gas entered the hospital, some
patients suffered cardiac seizures. The health care unions responded
with a mass demonstration on 8 March. Approximately 50,000 marched to
the home of the president. The police stopped the marchers a few blocks
before they reached their destination.

Finally, on 10 March, the government explicitly agreed not to continue
its privatisation plans in an agreement with the health care unions. The
FMLN went on to achieve their greatest electoral victory in the
following elections on 16 March for their support of the strikes,
winning the most parliamentary seats and eight provincial capital
elections out of fourteen. Although the workers managed to extract
privatisation concessions, the government reneged on the deal three
months later. The government also refused salary raises for health care
workers, and did not rehire the workers fired as a result of the


SIMETRISSS also held strikes in 1998 protesting the low salaries of doctors and the insufficient doctors' representation in privatisation policies (1).
The strikes of 1999-2000 laid foundation to the major health privatisation strikes held in 2002-2003 (2).


Almeida, Paul. 2008. “Mobilization by Globalization: El Salvador Under Neoliberalism.” Pp. 174-208 in Waves of protest: popular struggle in El Salvador, 1925-2005. Minneapolis: University of Minnesota Press.

Almeida, Paul and Roxana Delgado. 2008. “Gendered Networks and Health Care Privatization.” Advances in Medical Sociology 10:273-299.

Anon. 2000. “Riot Police Confront Strikers in El Salvador.” NewsBank. Retrieved March 22, 2015 (http://infoweb.newsbank.com/resources/doc/nb/news/0F89B683F774DF9A?p=AWNB).

Anon. n.d. “The History of Public Healthcare Workers in El Salvador.” The history of public healthcare workers in El Salvador. Retrieved March 22, 2015 (http://web.archive.org/web/20150322050738/http://www.hartford-hwp.com/archives/47/index-ddb.html).

Bounds, Andrew. 2000. “WORLD NEWS: LATIN AMERICA & CARIBBEAN: Salvador Violence Flares as Poll Nears.” NewsBank. March 7, 2000. Retrieved March 22, 2015 (http://infoweb.newsbank.com/resources/doc/nb/news/113D6F556F337348?p=AWNB).

Nichols, John. 2000. “MADISONIAN IN MIDST OF SALVADOR VIOLENCENewsBank. March 7, 2000. Retrieved March 22, 2015 (http://infoweb.newsbank.com/resources/doc/nb/news/0EAEFD9133DB5400?p=AWNB).

Smith-Nonini, Sandra C. 2010. “The White Marches: Healing the Body Politic.” Pp. 237-256 in Healing the body politic: El Salvador's popular struggle for health rights--from civil war to neoliberal peace. New Brunswick, NJ: Rutgers University Press.

Name of researcher, and date dd/mm/yyyy

Dong Shin You, 22/03/2015