National Health Superintendence oversees patients’ rights and regulates EPS insurers, a key pillar of the system that President Petro has sought to eliminate in his reform efforts

Former Medellín mayor and former presidential pre-candidate Daniel Quintero has been appointed as Colombia’s new National Superintendent of Health, a decision that has sparked controversy across political and social sectors due to ongoing judicial and disciplinary investigations against him.

The National Health Superintendence is responsible for safeguarding the rights of users within the health system, overseeing Health Promoting Entities (also called EPS) and Health Service Providers (IPS), and monitoring the use of public finances allocated to the sector, areas that President Gustavo Petro has sought to reform during his administration.

The appointment comes amid a complex situation in Colombia’s health system. During his administration, President Petro presented two structural reform proposals aimed at reshaping the system, including major changes to the role of EPS. Both initiatives were rejected by Congress.

Following these legislative setbacks, the government has pursued reforms through administrative measures and decrees, including the intervention of several of the country’s largest EPS, which together serve more than 23 million affiliates (More information: Colombian President Gustavo Petro Seeks To Restructure Colombian Health Care Despite Congressional Rejection by Finance Colombia).

During his swearing-in, Quintero said his administration would strengthen oversight of the system. “It is time to put an end to abuses by the EPS,” he said.

Criticism over qualifications and legal cases

The appointment has drawn criticism from organizations and political figures who question both his background as an electronic engineer and his legal situation. Transparency for Colombia said the designation “is inappropriate because it places a political figure widely questioned for using public office to favor private interests in charge of addressing the health crisis, instead of appointing individuals with the training, knowledge, and experience required to resolve it.”

The organization also called on the Attorney General’s Office to expedite ongoing investigations. “We respectfully call on the Attorney General’s Office (FGN) to ensure that cases involving Daniel Quintero move forward swiftly, respecting due process guarantees while delivering results in light of the seriousness of the allegations,” it said.

Quintero, who served as mayor of Medellín from 2020 to 2023, faces more than 40 criminal and disciplinary complaints related to alleged corruption during his administration. Among them is the “Aguas Vivas” case, involving the sale of a forest reserve land plot exceeding 140,000 square meters. In that case, prosecutors have already filed charges for alleged embezzlement, undue interest in public contracts, and misconduct in office, although no conviction has been issued.

Criticism has also emerged from within the government. Carlos Carrillo, head of Colombia’s National Unit for Disaster Risk Management, said that “Quintero is currently on trial for crimes against public administration. He has the right to defend himself, but the Pacto Histórico has no reason to bear the political cost of his legal troubles; we owe him nothing and he brings us nothing.”

Quintero will be the fifth health superintendent appointed during Petro’s administration. His tenure is expected to be temporary, as a new president will take office on August 7, 2026, and will have the authority to appoint a new head of the agency.

One of my best friends for many years was a Cuban fellow named Miguel Cárdenas who left the island much later than the Mariel boatlift, and somehow ended up in Ohio. At first he did very well for himself, but eventually got in trouble and lost his US residency privileges and was returned to Cuba. I was able to talk to him a couple of times after he was back in Cuba, but also stayed in touch with his family.

Once I visited Miguel when he was in Cali (long before I lived in Colombia) where his sister, an official in the Cuban government, was allowed to travel. At the time, a rendezvous in a third country was the only way they could meet. His sister, who had achieved a prominent position in the agriculture ministry, eventually left and resettled in Miami. She now tells me that her quality of life working at Walmart in Miami is much better than when she was a government bureaucrat in Havana. Because of her position, she was one of the first Cubans allowed to have an internet connection and actually had a Facebook account before everyday Cubans even had internet.

After Miguel was back in Cuba, he got in an auto accident, and was in pretty bad shape. This was around 2011. I remember getting a call from his sister (she was still in Cuba). Miguel was in the hospital, but there was no medicine, no bandages, no supplies, and and she asked me to find these items in the US and send them to her in Cuba for his treatment. What many people don’t realize is that medicines and food can be sent to Cuba from the United States, and that in any case, the US trade embargo does not prevent commerce in medical goods-or any products from any other countries. Cuban hospitals, like Cuban grocery stores are empty because their totalitarian, communist system is a failure.

My friend died shortly after I spoke to his sister, before I was able to ship medical supplies for his treatment. The “revolucionario” Cuban medical system cannot provide basic supplies; not because of any US embargo—remember during the COVID pandemic, all the supplies were coming from China?—but because the Cuban economic, political and health systems are BANKRUPT.

“There is all the difference in the world between treating people equally and attempting to make them equal.”—F.A. Hayek

Is this Francia’s idea of “vivir sabroso?”

Colombia’s Vice President Francia Marquez was in Cuba last week, where she continued to trash Colombia’s health system and pour accolades on the Cuban system.

“We are proposing a health reform where it is once again administered by the State. Of course, this is not going to be easy because there is a very strong dispute. It is taking away the business of the elite and private sectors that have turned health into a commodity and not a fundamental right. The preventive health that you (Cubans) have maintained as a central axis is what we want to do in Colombia today,” said Vice President Márquez.

Francia Márquez en ?? dijo que estamos proponiendo una reforma a la salud donde el Estado recupere su manejo y que se le quite a las “élites”que se han enriquecido. Alaba el sistema cubano y busca que aprendamos de su experiencia.

Es una vergüenza. pic.twitter.com/jwrxzav5D0

— Ani Abello (@ANIABELLO_R) February 13, 2023

Colombia has a mix of public and private hospitals and clinics, with many doctors in private and specialty practice. Doctors have a choice of participating in public or private healthcare plans or participating in no plans at all. The vast majority of doctors participate in the country’s EPS system.

In Colombia, clinics, or points of care where patients are seen, are called IPS – Institución proveedor de Salud, or health providing institution, in English. Colombians with formal employment choose from a number of health plans, called EPS – Entidad proveedor de Salud, which serve as intermediaries. EPS plans may be private businesses, for example the insurance giant Sura, or they may be government owned, like the city of Bogotá’s Capital Salud. Some EPS systems are poorly managed, corrupt and insolvent, others are very well managed. Doctors and IPS facilities can choose to accept one or more EPS plans, or accept none. Most accept multiple EPS providers. Some EPS providers are notoriously slow payers.

Colombians below a certain income level also qualify for Sysben subsides designed to allow those of the lowest income levels to access the same health care benefits as the rest. Victims of auto accidents are also covered by mandatory SOAT insurance, which covers death, injury, lost wages, and physical therapy due to vehicular accidents.

Colombian President Gustavo Petro presents his proposal for reworking the Colombian health system (photo

Higher income Colombians may also pay cash for services, or purchase a private, prepaid medical plan that usually, but not always, sits atop an EPS plan. The government mandates that all employees and independent contractors participate in EPS. There is also a worker’s compensation system called ARL that covers workplace accidents.

Doctors generally make a good living in Colombia, though the pay is not exorbitant. You might see a typical doctor making between the equivalent of $40,000-$60,000 USD which in Colombia is quite a bit. Specialists and aesthetic surgeons can make quite a bit more, with owners of successful practices pulling in several hundred thousand dollars per year, but this is the tiny exception. In Cuba? $32 USD per month.

No health system is perfect. In the US, there is groundbreaking treatment, but heartbreaking prices. Canada and the UK claim to offer “free” health care, which of course is not free, but disguised through taxation, and patients often have to wait years suffering painful conditions before treatment. Treatment may also be rationed based on cost and staffing limitations.

In Colombia there are several inadequacies, but the biggest is an unequal availability of services based on geography. Bogotá, Medellín and Cali all boast world class hospitals, and many modern specialized treatment centers. MRI, CAT scans, even PET scans are available. Many foreigners come to Colombia for knee replacements, back surgery, and of course, cosmetic surgery. The cost of the entire procedure might be less than the co-pay plus deductible in the patient’s home country.

On the other hand, travel to rural regions of Colombia, or tertiary cities, and it is a different story. Not only is there a lack of facilities, but a lack of medical professionals, especially specialists. Add to this a high incidence of corruption in regional EPS providers and local governments. This stark inequality means that in the same country, one may receive world-class treatment, or practically no treatment at all based on a combination of one’s income and geography.

Meanwhile, there is no shortage of medicines or durable medical supplies. Pharmacies are plentiful and well stocked, and most medicines are affordable. The government maintains a list of critical medicines and has measures in place to assure that these critical medicines are available and affordable.

Marquez has been explicit in her desire to destroy the concept of healthcare as a business in Colombia. But fortunately, it is unlikely that she will ever get the chance. Grocery stores and pharmacies in Colombia are full, and there are mobile phones in every pocket in Colombia, because they are provisioned by businesses. Overall, Colombia has an excellent electrical grid compared to many other Latin American countries, and much of the electricity is provided by private businesses. Even the utilities like EPM or EEB that have government involvement are indirectly owned and must follow corporate government best practices. For example, petroleum giant Ecopetrol is between 80-90% owned by the Colombian government, but because a minority of shares are traded on the New York Stock Exchange (NYSE: EC), the company must behave as a corporate citizen and cannot be treated by the Colombian government as a sinecure for friends and cronies. Voluntarily trading on the NYSE, the company, its employees and directors are subject to US securities law.

The good news

Leftist President Gustavo Petro, formerly a militant guerilla, would surely love to have an entirely government-controlled health system—an entirely government controlled economy if his wishes came true—but fortunately Colombia has enough institutionalism to prevent a Venezuela-style usurpation, or Cuban style “revolución,” though groups like the FARC and ELN did try.

Petro wants to get some kind of reform passed, and that still may be difficult. However, the president has pledged via the country’s official presidential website that:

“Complementary plans, prepaid medicine or health policies will continue to function normally and will not be affected by the project.”

This is critical. And let us also be clear, one of President Petro’s stated objectives to provide an equal basic level of care throughout the country is a very good thing. This is something the country currently lacks. People in Tumaco or Catatumbo do not have the same access to healthcare as people in the south of Cali or the north of Bogotá. However, increasing the quantity of health care throughout the country, should not come at the expense of the quality of health care.

Colombia is in fact a very unequal country, and this inequality should be addressed by creating more opportunities, providing better, more universal education, and yes, challenging the pretty awful class hierarchy that exists in Colombian society. However, Friedrich August Von Hayek admonished us all that:

Even the striving for equality by means of a directed economy can result only in an officially enforced inequality—an authoritarian determination of the status of each individual in the new hierarchical order.

Headline photo: Vice President of Colombia, Francia Márquez Mina (left) with Cuban President Miguel Díaz Canel (Photo: Colombian Government) during her visit last week.

Flora Growth (NASDAQ: FLGC) is one of the companies at the vanguard of formulating new products, but the company has also been financially innovative, listing on NASDAQ in the US rather than following most other sector companies with operations based in Colombia that list on Canada’s TSX.

With legal headquarters in Fort Lauderdale and almost 500 acres for cannabis cultivation in Colombia, Flora Growth’s business model spans consumer goods and medical formulations. Finance Colombia’s Executive Editor Loren Moss caught up with Flora Growth CEO Luis Merchan to discuss some recent developments with the company, and the significance of the decision by Colombia’s health ministry to Flora Growth, and to the sector more broadly.

Finance Colombia: One of the things I wanted to start with is that I noticed that you signed a distribution agreement for some of your products, is that correct?

Luis Merchan: That is correct. There are several of them that have been signed over the last couple of months. My team continues to expand not only on the wholesale side of our operations but also on the CPG side of the operation in terms of distribution and revenues.

“The change by the Secretary of Health, by the Ministry of Health, puts Colombia at the vanguard in terms of regulatory and legal framework for medicinal cannabis in the world. “

Finance Colombia: Can you tell me a little bit about the distribution deals? I think I saw that some of your products are going to go into Mexico and some other markets.

Luis Merchan: Yes, as you know Loren, Mexico is a very active cannabis market. There’s a new law that is being evaluated as of today that would allow several categories of products with less than one percent THC to be sold as normal, non-regulated CPG products, which would be an incredible step towards the distribution of wellness products in the country. Our agreement was for distribution initially of our floral beauty products. Those products are actually being sold already in major retailers in Mexico like Walmart.com and Coppel, which is a massive store chain with over 300 distribution points across the entire country, so clearly we continue to make inroads, not only from a distribution and sales standpoint but also from the regulatory standpoint.

Finance Colombia: I saw that the stock took a nice bump when that news was announced. Now, here in Colombia, we recently published an article and we see where the Ministry of Health, they issued a…in the US, we call it something like a pharmacopeia, but they issued updated guidelines for what medicines and treatments are covered by the EPS, by Colombia’s publicly supported health insurance providers or healthcare providers that are known here locally as EPS (Entidad proveedor de salúd, or Healthcare provider entity), and it’s interesting because one of the things that caught our attention was that they added cannabis, both CBD and also THC products to their list of medicines that insurance companies not only can cover but actually must cover. So I wanted to get your input on how impactful that is and what that means for the industry, specifically for patients, but then also specifically for Flora Growth.

Luis Merchan: Yes, Loren. It’s a significant change. I think there’s three major topics to cover here. First, the change by the Secretary of Health, by the Ministry of Health, puts Colombia at the vanguard in terms of regulatory and legal framework for medicinal cannabis in the world. This move is very meaningful; it allows patients that are suffering from major ailments such as anxiety, depression, pain, insomnia, all these ailments, they have access now to cannabis molecules. The doctors also now have the ability to prescribe such cannabis formulations, which is a very meaningful step, and also of course puts Colombia in a very strong position in terms of how to approach the medicinal regulatory environment.

For the patients, it’s significant, and obviously patients today have for long talked about the empirical benefits of cannabis and they secure most of their cannabis formulations from the black market today, and they do it because they have to. And of course what happens with those types of formulations is that they do not have the quality standards that medical formulations should have, so they inadvertently are putting themselves at risk. Now they are not going to have to do that, they can go to their doctor, they can ask for the formulation and the doctor can give them a prescription, and so it makes it safer for patients to have access to medicinal cannabis.

And for companies such as mine, it’s a major step towards not only broadly distributing products and formulations that are already in existence, but also a significant economic revenue that can be guaranteed, almost guaranteed in an environment like Colombia where you can actually bill public entities for the formulations that are being given to patients.

Finance Colombia: I know that there are all kinds of different treatment options. There are traditional hospitals, there are doctors that are private practitioners, there are clinics that are also known as IPS down here, which are obviously different than the EPS, which are more of like what we would call a PPO back in the States. But then I see that there have also been, on a limited basis, treatment clinics that have opened up, kind of for palliative care and for treating other different things. Now, one of the interesting things about Flora, about your company, is that you guys have a really interesting distribution model because you have cannabis derived products, you have things like cosmetics, you have health foods, you have hemp textiles. One of the things I don’t remember us talking about is pharmaceutical products or medicines. How are you involved in this space when it comes to healthcare or prescription medication?

Luis Merchan: Actually, our laboratory has the ability to manufacture a wide array of products including phytotherapeutics, dietary supplements and capsules. We today manufacture skincare solutions for almost a thousand doctors that develop custom formulations for their patients and distribute them on a one-to-one prescription basis, so for us it’s a plug-and-play move. We are going to now be able to manufacture our cannabis formulations, what in Colombia’s called magistral custom formulas, and be able to plug in to that network of doctors that is already in existence. So, that would be the easier shorter route to gain access, to give access to patients and doctors to our products and formulations.

Luis Merchan, the CEO of Flora Growth.

But as you mentioned, I think the bigger play here is to plug into the broader EPS network; educate doctors on the benefits of each one of the formulators that we have available so then they are comfortable prescribing patients when they’re coming, to treat a number of ailments. So, this is going to be a campaign that is going to take some time, but our intent is to educate the medical community in Colombia with the many partnerships that we have, and we actually have developed this very robust cannabis education programs for doctors and ensure that then they in turn start prescribing these safe formulations for the treatment of the many elements that patients are looking for today.

Finance Colombia: Like you mentioned, you have your laboratory. You guys have your INVIMA registration…INVIMA, for those who don’t know, is kind of like the Colombian version of the FDA, the Food and Drug Administration back in the States. You mentioned the magistral, the custom formulas. Now, I noticed that you have on your website, which is floralgrowth.com, where it talks about the laboratory, there’s a place for people that are interested in becoming Flora Lab distributors. What kind of companies are the good candidates for distribution? Pharmacies? CPG (Consumer Packaged Goods)? Are there maybe other companies that use the ingredients? How does your distribution model work in that respect?

Luis Merchan: When it comes to Flora Lab, we offer a broad array of products. There are branded products, over 65 of them that are INVIMA registered that we distribute worldwide, and any company that is a major distributor, that has access to points of sales in Latin America, in Central America, or all over the world can reach out to us and can become a distributor for those products. But there are other categories of products that are manufactured and sold at Flora. One of those is, of course, a prescription medication. We have a number of molecules that we plug into pharmacies and drug stores. We have, as I mentioned, phytotherapeutics, which is a very specialized area of therapy and treatment, and doctors and pharmaceutical distributors can reach out to us to plug into those categories of products. And then, lastly, we also have wholesale ingredients that we sell, and distributors that are interested in the wholesale side of distribution can also reach out to us and can become a part of the Flora distribution network.

“In North America we’re selling some of our products in 48 out of the 50 states, in Mexico, in Costa Rica. We are already selling some products into Canada. When you’re in Europe our footprint expands into Portugal, Malta, England…”

Finance Colombia: What markets, what countries have you guys expanded to so far? Where do you have a presence? I know you have different brands in different locations, but obviously you’re here in Colombia. But what other countries, obviously I think Mexico, I think Spain, but let me understand now what countries have Flora Growth products across your CPG and the pharmaceutical brands. Where can your products be found?

Luis Merchan: The list is exceptional, continues to grow, Loren, from a CPG perspective. We’re in the majority of Latin America as of today and at least the markets that are the most meaningful. I think the one market that is not there…It’s probably easier to tell you what market that we haven’t penetrated yet but we’re looking to, in South America is Brazil, because of the strict rules that they have in terms of distribution, but for the rest, in North America we’re selling some of our products in 48 out of the 50 states, in Mexico, in Costa Rica. We are already selling some products into Canada. When you’re in Europe our footprint expands into Portugal, Malta, England. We have now activated these distribution agreements in several countries across the globe, like Israel, like South Africa, Germany and Australia. Those contracts will activate this year so that the flag has been planted but the revenue generation will not start until 2022, and the good news here is that our team is a global team in terms of distribution, sales and regulatory, so we’ll continue to evaluate which opportunities are opening up in terms of the regulatory framework and when those do, then we are ready to very quickly enter the market, and that’s what happened for example in Mexico, and that’s what will probably continue to happen in other countries around the world, so look forward to more countries being added to this list.

Finance Colombia: That’s great to hear. Obviously, we want you to keep us posted as we continue to cover, not just obviously the stock from a financial perspective, but also your growth as a company and your product line. It’s really good to see Colombian companies becoming true multinationals and becoming companies that are expanding into markets, not just here in Latin America, but in North America and in Europe and beyond, so it’s really impressive what you’ve been able to do in such a short time.

Those Colombians who are not covered by one of these heath systems, such as members of remote indigenous communities, may manually register for a vaccination.

The Mi Vacuna portal is located at: https://mivacuna.sispro.gov.co/

“More than an application, it will be a portal within the entity’s website. They will be asked for their identification number and the EPS to which they belong, and they will be able to see if they are in the prioritized populations to be programmed,” said minister Ruiz Gomez.

“We will articulate our work with EPS and territorial entities to vaccinate them, later we will register them and thus consolidate the information of which Colombians have been vaccinated,” explained Ruiz, who added that vaccinations will begin February 20, prioritizing adults 80 years of age and older, along with health care workers.

“We will begin the immunization process in hospitals for all those who are on the front line, because that is the list that is most defined and structured. We will also do an active search of the elderly population in order to schedule or vaccinate them at their homes; work coordinated between mayors, territorial entities and IPS (clinics),” said Ruiz.

“The programming that we have now is adjusted to the fact that between now and July we will apply more than 10 million vaccines, which would be more or less 20 million doses,” the minister concluded.

Colombia vaccination sequence

Photo courtesy of Minsalud Colombia

President Duque explained that “we began this technical, scientific, specialized exercise, months ago, so that, with a technical team of experts, the evolution of the processes could be evaluated worldwide. vaccine development scientists.”

“That allowed us, as a country, to identify which were the vaccines that we could acquire bilaterally and, obviously, supported by good evidence and seeking greater efficacy,” he said, complementing that “we also told the Colombians that we were going to address the acquisition of vaccines through two schemes: the multilateral Covax scheme, and bilateral negotiations.”

Colombia’s vaccine purchases according to the presidency include:

• Pfizer: 10,000,000 doses for 5,000,000 people.
• AstraZeneca: 10,000,000 doses for 5,000,000 people.
• Janssen: 9,000,000 doses for 9,000,000 people.
• Moderna: 10,000,000 doses for 5,000,000 people.
• Sinovac: 2,500,000 doses for 1,250,000 people.
• Covax: 20,000,000 doses for 10,000,000 people.

Some doses are single-dose and others require two injections, spaced apart. Some require deep freezing, and others require either normal freezing or can be transported at ambient temperature, making them suitable for use in Colombia’s extensive rural and remote areas.

According to Duque, Colombia has acquired the necessary freezers, syringes and diluents, as well as prepared the logistics and training to start the vaccinations on time and complete the project by the end of this year.

Duque explained that “These weeks prior to February 20 will be the weeks where we will be sending effective communication, where we will be doing pedagogy, where we will be doing campaigns, where we will have all the logistics arranged with local health networks, where we will also work with the EPS (Colombia’s basic health insurers), with the IPS (clinics), with all the actors, as foreseen in the National Vaccination Plan.”

“This gives us clarity not only to start, but to start in a sustained way. We have seen countries in the world that have made the decision, and we respect it, to start vaccination cycles without having guaranteed continuity with certain schedules. We made the decision, as provided in the National Vaccination Plan, that the important thing is to start with sustainability over time and guarantee the schedule.”

Sanaty is an “Institucion Prestadors de Servicios de Salud” (IPS) (a health providing institution) as designated by the Colombian Ministry of Health which allows Sanaty to provide medical consultation and diagnostic services in Colombia. Sanaty’s medical team is comprised of physicians, surgeons, psychologists, nurses and medical technicians. The primaryclinic and headquarters are in Cucuta, Santander, Colombia, Colombia’s largest border city with Venezuela.

Sanaty is authorized by the Colombian Ministry of Health to provide its services via telemedicine, allowing for long-distance patient and clinician contact, care, advice, reminders, education, intervention, monitoring and remote admissions. During the COVID-19 pandemic and due to the strict Colombian quarantine, Sanaty has been seeing patients virtually and prescribing both real-time reverse transcription polymerase chain reaction (rRT-PCR) and antibody tests for COVID-19.

Sanaty’s telemedicine business is growing quickly as the only entities authorized in Colombia to prescribe and administer diagnostic tests for COVID-19 are clinical laboratories and IPS (hospitals and clinics) and people are avoiding visiting hospitals and clinics and are using telemedicine more every day. Further, the economic impacts of COVID-19 have caused many Colombians to reallocate their healthcare expenditures from private insurance/hospitals to private medical clinics like Sanaty, that provide personalized, prompt care.

Sanaty is creating a COVID-19 program that would be the only voluntary and prepaid annual diagnostic program in Colombia, that includes taking one antibody test and 24 viral tests every 15 days, for one year. According to QuestCap, no private prepaid health plan in Colombia currently offers anything similar. Sanaty also plans to expand to other major cities in Colombia, including opening up four additional clinics in the next 12 months to reach additional patients.

QuestCap will acquire the indirect equity interest in Sanaty through the purchase of a 40% interest in Latin-Canada Pharma Inc. (Barbados) (“LCP Barbados”), Sanaty’s 70% shareholder, from Latin-Canada Pharma Inc. (Canada). For the acquisition of the 40% equity interest in LCP Barbados, QuestCap will issue to the shareholders of Latin-Canada Pharma Inc. (Canada) an aggregate of 12 million QuestCap common shares with an ascribed value of C$0.175 per common share. In addition, QuestCap will issue two million additional QuestCap common shares to the shareholders of Latin-Canada Pharma Inc. if Sanaty’s EBITDA is greater than US$9 million for the 2021 year-end as evidenced by financial statements audited under IFRS standards; and an additional two million QuestCap common shares to the shareholders of Latin-Canada Pharma if Sanaty’s EBITDA is greater than US$18 million for the 2022 year-end as evidenced by financial statements audited under IFRS standards.

The company will also have an option to acquire an additional 10% equity interest in LCP Barbados from Latin-Canada Pharma within 60 days following the closing of the transaction by paying USD$600,000 to the shareholders of Latin-Canada Pharma Inc. No finder fees are payable pursuant to the equity acquisition.

“No one can force us to commit suicide.”—Dr. Sergio Isaza

These charges are made by Dr. Sergio Isaza, head of the Colombian Medical Federation, the group representing the interests of Colombian doctors in the country. The doctors oppose Article 9 of Decree 538 of 2020 issued by the Colombian presidency, that seeks to obligate doctors to attend to the Coronavirus COVID-19 Pandemic irrespective of circumstances.

Dr. Sergio Isaza, head of the Colombian Medical Federation (Photo courtesy of the Colombian Medical Federation)

“We are not obligated by a decree, but by the oath we took when we graduated; not under any threat of sanction so the minister must remove that article,” said Dr. Isaza to W Radio in Colombia. Representatives of the federation, accompanied by the Colombian Association of Scientific Societies, The Colombian Medical College, and the Federation of Medical Unions walked out of negotiations with the government when they refused to amend Article 9. That led to a breakdown in relations between the four groups and the newly appointed health minister, Dr. Fernando Ruíz (above right).

21 doctors in Cartagena have already resigned from hospital Clinica San José de Torices. The doctors claim that they have repeatedly and formally asked for basic protective equipment but were ignored

“Doctors must be equipped according to the complexity of the patients they serve: gloves, gowns, masks, hospital clothes; guaranteeing the dressing rooms and that the staff should not go out with the same clothes that they use in the clinic for their home,” said Dr. Isaza. “It is not just that they give us gloves, masks, robes and dresses, because it is something to be expected. That is why the National Government must sanction the EPS (health plan providers) and IPS (clinics and hospitals), and punish those who fail to comply. This must be monitored by the National Health Superintendence, which has done nothing, in addition to the Office of the Attorney General and the Comptroller,“

Endemic Corruption

Colombia has a mixed public/private health care system that ranges from world-class to 3^rd-world depending upon geography, funding model and management. Hospitals may be public (government owned) or private. Along with specialty clinics, larger doctor’s offices and urgent care facilities, these are classified as IPS (Independent Health Provider) and may charge patients directly or receive payment by the various EPS (Health Provider Entity) programs. EPS are similar to health insurance plans or cooperatives and are generally paid for by employers or the government. In the case of independent  workers, they are paid directly by the policyholder. Low income residents have their EPS premiums subsidized or paid for by the government. Some EPSs are well run, others are mismanaged, then others still are flat out corrupt. Hospitals complain that EPS plans generally run several months behind in payments. Employees, rather than employers choose their EPS, then the employers contribute a fixed amount to the EPS coverage, irrespective of which the employee chooses.

Two Colombian doctors, Dr. Carlos Nieto and William Gutiérrez have already died due to the COVID-19 virus.

Optionally, Colombians and foreigners alike may purchase “medicina prepagada,” or private health insurance that works “on top” of EPS plans. These deluxe plans provide an additional level of care with separate facilities and doctors, and benefits such as doctor’s house calls, sports medicine, and coverage abroad for traveling policyholders.  Some companies, like SURA operate EPS plans, private insurance, and their own hospitals and clinics.

Doctors, clinics and hospitals may also charge patients “cash” directly, and some choose to completely opt out of government or private insurance arrangements.

On the other hand, many hospitals are government run and EPS plans serving low income patients are built around payments from SYSBEN, Colombia’s welfare plan (similar to Medicaid in the US). This creates tremendous opportunities for corruption. The Colombian government is already embroiled in “Coronavirus Corruption” with the government depositing COVID-19 Pandemic relief funds into thousands of ghost accounts, and procurement irregularities.

Many government hospitals have begun construction over the years but were never finished, with politicians and contractors bagging the funds allocated by local, departmental and the national government agencies.

The new mayor, William Dau, who ran on an anti-corruption platform in the historically corrupt coastal city of Cartagena let loose an expletive-laced tirade that put entrenched members of city-council such as Cesar Pión on the defensive. The citizens of Cartagena broke out in a spontaneous “cacerolazo” in support of their new mayor after his emotional diatribe. A “cacerolazo” is a type of protest in Latin America where people noisily bang on pots and pans outside of their windows.

A esto nos ha llevado la Clase política de Cartagena.
Se robaron toda la red hospitalaria, sumieron a la ciudad en pobreza, estancamiento, desigualdad.

No me preocupan la expresiónes del Alcalde, me preocupa mas ciudad.

Apoyó a @daulaw pic.twitter.com/TBG4V4vIpn

— Wilman De Los Reyes Franco (@Wilman_1998) April 13, 2020

Mayor Dau (pictured in above tweet) pointed out  more than a dozen unfinished hospitals in Cartagena; monuments to the city’s corruption and the avarice of its traditional political families.

On the defensive, Colombian Government Responds

Friday, the presidency announced that it was going to allocate $175 million USD immediately to purchase the receivables of hospitals, medical practices and IPS that are owed money by EPS plans. This is in addition to the $91 million already allocated to the EPS system, money that may or may not matriculate through to hospitals, IPS and doctors.

“Today I signed Resolution 619, which opens the portfolio purchase in ADRES (Administrator of the Resources of the General System of Social Security in Health) for $ 700,000 million COP,” said Minister of Health Fernando Ruiz (top photo, right), who stressed that the purchase is direct and not through the financial system.

“Right now we are working very intensively so that, from June and hopefully from before, from May, we can start turning over all of these resources, the $ 5.2 billion we have there and that would give immediate liquidity to the system,” said the minister.

Colombia’s president Ivan Duque (top photo, left) has announced that this week the government will disclose health measures that will remain in place when the 24-hour national pandemic is expected to be lifted on April 27^th.

The illegal sales of painkillers and antibiotics could soar in Latin America due to the coronavirus pandemic

In March, two shipments were seized in the municipalities of Maicao and Riohacha, police officials said in a news report. The pharmaceuticals were valued at eight billion pesos (about $2 million) and destined for La Guajira and neighboring Venezuela.

This article generously shared by Insight Crime. The original can be read here.

That same month, Colombian customs authorities made a series of seizures of US-sourced contraband medicine in the northern Cesar department, which also borders Venezuela. Antibiotics and over-the-counter anti-inflammatories were seized, including the pain reliever acetaminophen, known internationally as paracetamol, which has been recommended to reduce fevers associated with the coronavirus.

SEE ALSO: Colombia Busts Fake Medicine Ring Worth Millions

According to Colombia’s El Tiempo newspaper, failures in Colombia’s healthcare system make it easy to cover up the illegal sales of medicine as it is highly difficult to track such shipments.

“[Prosecutors] have detected a significant amount of these medications being imported by pharmacies located in border cities or ports,” Raúl González Flechas, a prosecutor from the Attorney General’s Office in Medellín, told El Tiempo.

The smuggling of medicine into Colombia is common. In August 2019, Colombian prosecutors dismantled a medicine contraband ring in the cities of Medellín, Cartagena and Santa Marta, which allegedly brought in expired medicine from Venezuela and Ecuador, El Comercio reported.

In February 2019, General Juan Carlos Buitrago, then-director of Colombia’s Tax and Customs Police (Policía Fiscal y Aduanera — Polfa), told Blu Radio that Venezuelan officials were likely involved in this type of contraband.

“We have seen contraband gangs that have connections like with other types of products … there are gangs which involve high-ranking authorities of the Venezuelan government, that distribute these products … in Colombia,” said Buitrago.

InSight Crime Analysis

Given the omnipresence and diversity of contraband in Colombia, medicine smuggling has received less attention. But the black market trade in pharmaceuticals — facilitated by corrupt government officials, health workers and criminal gangs — is primed to increase amid the coronavirus pandemic.

According to a September 2019 report published by Caracol Radio, medicine is siphoned off by Colombian healthcare providers (Instituciones Prestadoras de Salud — IPS) who write prescriptions for greater amounts of drugs than needed and then hold on to the excess. These medicines are then illegally sold on to private doctors and clinics.

SEE ALSO: What Does Coronavirus Mean for Criminal Governance in Latin America?

Another method involves corruption within pharmaceutical laboratories, where the medicine is diverted to criminal gangs.

The Colombian police has reported having carried out 1,393 operations against the illegal sale of medicine since the start of President Iván Duque’s term in August 2018.

Colombia also maintains 16 checkpoints dedicated to combating contraband and smuggling along its borders with Ecuador and Venezuela.

Such a general approach to combating smuggling is unlikely to be enough, given the many remote trails through which drugs, migrants and other contraband is consistently moved.

Instead, Interpol has called for specific actions to crack down on the medicine trade, warning that the coronavirus pandemic risks seeing a global rise in healthcare-related crimes.

This article was generously shared by Insight Crime with Finance Colombia under a Creative Commons license. The original can be read here.

Headline image by Ann San from Pixabay – box image from InsightCrime

The Colombian government is offering the free “CoronApp Colombia” for download on Android devices, and toll free information lines (within Colombia): 01-800 095-5590 or for Bogotá: 330 5041. International callers may dial +57 1 330-5041

The 34 year old man from Buga and the 50 year old woman from Medellín presented symptoms and sought health attention, where they were tested positive for the infection. Both patients are said to be in stable condition and epidemiological protocols have been established to contact and test those who may have come into contact with the patients.

Virus arrival coincides with new health minister appointment

The day before the health ministry confirmed the virus in Colombia, President Ivan Duque (above, left) swore in a new health minister after the previous official resigned in December. The new health minister, Dr. Fernando Ruíz Gomez (above, right) is a medical doctor and also holds a masters degree in economics, and one in public health, as well as a doctorate in public health.

Dr. Ruíz was vice minister of public health and social protection in Colombia from 2013 to 2016 during the Santos administration, and also served as regional health director for Bogotá.

Authorities urge that one of the most effective means of prevention is to wash hands thoroughly and frequently.

The young woman arrived without symptoms but after a coed in Mexico showed signs of infection, she went to give samples for analysis which eventually turned up positive for the virus. Though 3 Colombians have been confirmed to be infected in Brazil and Japan, and there have been several suspected cases on Colombian territory that tested negative, this is the first case confirmed as positive. Several other Colombian travelers are being held in quarantine in Bogotá until their status can be confirmed.

Out of 105,828 global cases of Coronavirus, there is only 1 confirmed case in Colombia as of publication. (Infographic courtesy of Colombian Ministry of Health)

Meanwhile air travel, meetings, and street traffic continues as normal throughout Colombia, albeit with a small but noticeable minority of people wearing respiratory masks.

Last Friday, the Colombian Minister of Health and Social Protection Fernando Ruiz Gómez met with regional secretaries of health, EPS (employee health plan providers), IPS (health services providers such as clinics), insurers, and medical associations to establish and coordinate a response plan to Coronavirus, and activate contingency plans developed over the past 8 weeks.

Colombia is now one of 96 countries that have confirmed Coronavirus cases, including China, Romania, Italy, the US, México, Ecuador, Brazil, Chile, Peru & Canada.

Medical experts say that Coronavirus is most frequently propagated from human to human through cough droplets and respiratory tract excretions and may also be transmitted by close human contact or fecal contamination. The virus is believed to have propagated from animals to human, and there have been cases reported of dogs catching the virus from humans.