Salvadoran health professionals prevent privatization of health care, 2002-2003

In 2002, El Salvador was under intense pressure from the International Monetary Fund and the World Bank to privatize its healthcare system, which had up until that point been controlled by the government and available to all legally employed Salvadorans.  The system, while admittedly seriously lacking in the services that it provided to the typical Salvadoran, had shown marked improvements over the past few years.  A widely popular 1999 strike by the ISSS, the healthcare workers union, had prevented the country from privatizing healthcare and since that point services had gradually improved. Despite this, president Francisco Flores was heavily in favor of privatization and actively spearheaded efforts to privatize and contract out healthcare.

In opposition to the potential privatizing of Salvadoran healthcare, on September 17, 2002, seven hundred doctors affiliated with the national social security system and the Citizen Alliance Against Privatization went on strike.  People began protests in support of the doctors the next day, in the first of what would be called the “Marchas Blancas” (white marches) thus named because protesters dressed all in white as a sign of support for healthcare professionals and peaceful intentions.  These protesters were generally from the middle and lower classes, and highly resistant to the concept of losing their guaranteed healthcare. Despite the strong show of public opposition, on October 16 President Flores sent a bill to the National Assembly that would in effect privatize national healthcare. The Assembly generally voted with the president and followed his recommendations, yet the opposition parties were able to block the bill in an enormous show of support for the protesters, the strikers, and national healthcare.   

In an even more monumental show of support, perhaps promoted by the ongoing lobbying which the protesting groups sustained throughout the campaign, the very next day the National Assembly passed a decree prohibiting the privatization of healthcare.  The president responded by announcing that he intended to veto the decree on grounds of unconstitutionality.  

On October 23, between 50,000 and 80,000 people rallied on the streets of San Salvador in a public protest against the president’s veto threat and in support of the strikers.  This was the second and largest of the eight Marchas Blancas.  Health workers organized the protest, but the extraordinary turnout demonstrated that the general populace was unwilling to accept any attack on nationalized healthcare.  

The president responded to the protests and the ongoing strike by agreeing not to veto the bill, instead stating that he would make substantial changes to it.  After consideration, the activists and striking doctors decided that this was not an acceptable solution and continued their strike.

The groups continued their protests, including one notable rally attended by thousands of doctors and healthcare workers on November 15.  Yet over the course of that month, the situation began to deteriorate.  The police met at least one protest with violence against the protesters, using tear gas and water cannons as well as rubber bullets to disperse the crowd. At least 15 people were injured.  In a dramatic turn, on December 19 the National Assembly overturned the October 17 bill prohibiting privatization.  The government made no move to privatize; yet the option of doing so was suddenly available.

By the end of January, the government had done its best to replace all striking doctors.  It stated publicly that it would no longer negotiate with the strikers, despite the fact that often the replacements that had been brought in were not specialists in the same areas as the doctors they were replacing and provided vastly inferior care to their patients.  When the last approximately five hundred and fifty striking doctors decided to attempt to fight privatization through new methods and to leave the strike, the government would not allow them to take back their government jobs.

As a last-resort measure to regain their jobs, on April 1 seven of the remaining strikers began a hunger strike in order to be allowed to return to work.  This lasted for 11 days before, finally, on April 12, the Legislative Assembly officially reinstated all strikers and promised that they would face no penalties for their nearly seven-month strike.

Although the strike had dissolved, pressure and the ongoing lobbying against nationalization continued. It was clear to the president and the National Assembly that there was an enormous amount of public opposition to privatizing the national healthcare system, and, after a few weeks, the National Assembly, the Social Security workers, the unions and the government met to negotiate on May 28, 2003.  In June of the same year all parties involved in the negotiations signed an agreement officially ending both the strike and the president’s attempt to privatize the Salvadoran healthcare system.  This was an extraordinary victory for the Salvadoran people, and sent a strong message to all those attempting to privatize healthcare or any other sector in El Salvador.