Artículos en Inglés
Herbert Betancourt – ONU SIDA El Salvador
By: Gumercindo Ventura
Translated by: Vivian Melara
Who is Herbert Betancourt?
Since I was seven years old I knew I wanted to be a doctor; I studied in the United States in the University of North Carolina. I received a Masters in Science of Public Health and when I returned I was in different scenarios: from academic scenarios such as teaching in the University of El Salvador, to working with government agencies, working with United Nations agencies and other International Cooperation entities, including the Italian Cooperation.
How did you begin working within the topic of HIV?
I started working with the topic of HIV since 1998 with an organization called PASCA. Being there, I was called by the government where I started as Vice Minister first and then Health Minister during the last year.
Finishing that, I returned to the United Nations and focused my work on the topic of preventing and controlling HIV in El Salvador. So from 2005 until now, I have been involved with this. First as a focal point and now as an officer in the United Nations’ SIDA’s program. This is the United Nation’s program for HIV’s prevention.
How did you enter the Ministry of Health?
Joining the ministry was almost accidental; during the government’s transition they requested public health professionals that could help this process of transitioning from one government to another—the transition from former president Calderon Sol and the newly elected President Flores.
Then, in the middle of the debate of how I would focus all the campaign, in this process of accepting all proposals, I met Doctor Francisco Lopez Beltran. Eventually, he invited me to form part of his team as Vice Minister. He (Lopez Beltran) was minister for four years, then he went out and I stayed as Minister and Vice Minister, because there was no Vice Minister position to fill when I was appointed as Minister.
In those five years, which would you consider your most challenging moment?
There are two aspects here: first there are political situations, right? Social Security, which of course affected us as a Ministry, had an impressive amount of strikes. From the second day there was a strike already. But to this, the Ministry joined in with their own and there was a clear strategy to maintain the Health Ministry in a convulsive environment. The second was, precisely about these sanitary conditions, epidemics. In the year 2000, we had, previous to the earthquakes, a sequence of events.
We have seen many problems between the Health Minister and the Social Security’s unionists. From your experience how do you qualify the public health care system that we have in the country, and, do you consider that the unionists’ claims and behavior are justified and adequate?
The officer in the Health Ministry has an enormous workload. I believe that his wage claims are fair. I believe that it is important to fill these expectations, these needs. But I consider that there should be a Law of Public Administration or Law of Civil Service. The issue is how in actuality a public officer is in the system and who has been evaluated according to their profile or terms of reference, according to their performance, to their results. Their compensation should be in terms of that..
It is also important that this public officer has possibilities to imporve their qualities, his/her proficiencies, abilities to develop their career on the basis of merits and the quality of their performance. And I believe that each government should remove political party influence in areas such as healthcare and education and look for the best conditions for the officers in charge.
In the future, would you like to return to the Health Ministry?
I think that my contribution to the country could be in another measure, in other things. I think that there are talented and committed people who can assume that responsibility. The old people, like me, should in turn, give them, when they ask for it or when they request it, support, advice or accompaniment; whatever they need, but in a different role.
I believe that this is the task that requires integral time, it requires other skills, say, overall regarding political management, skills I believe I don’t have anymore.
Changing the topic, how did you become ONU SIDA’s national officer?
I was transitioning from working with an NGO and I wanted to return to the International Cooperation and it took off from there. I was an independent consultant. This international agency, PASCA, looked for me. This is financed by USAID. And this is where I initiated this HIV job, as a linking official between the civil society’s organizations and all else.
Was this before entering the ministry?
Yes, before entering the Ministry. The year prior to entering the Ministry. Then I already had, in good measure, large awareness that there are many people with AIDS. And, obviously, I knew the tremendous drama that came with the diagnosis; that he or she could not do anything to ameliorate their disease. It was basically waiting for someone to have a problem, an opportunistic infection, and then see what could be done to help them. But the mortality rate in those years was very high. A life expectancy diagnose was painfully between one to five years.
And for our readers, who don’t know much about ONU SIDA, can you tell briefly what is ONU SIDA and what is the aim of this program?
The United Nations program for HIV is an interagency effort. At world level there are eleven agencies in the United Nations System that are associated in ONU SIDA. In the case of El Salvador there is PNUD, the Population Fund, UNICEF, the World Food Program, the OPS, and in my case the secretary representative of ONU SIDA.
In this case there are six agencies in this interagency program. The fundamental mission is to support, give technical assistance, over financial support, to the countries that can meet with the identified objectives. In this case we are speaking of reducing sexually transmitted diseases; eliminating the vertical transmission, support the human rights’ base for affected people, helping countries develop their proposals and implement policies. In essence, these are the program’s aims.
A big part of the job done also includes sexual education and in this topic the church has always been a factor that in a certain way, opposes some measures. Does this have negative consequences, and, how much weight does the church’s opinion have over this topic or these programs?
Obviously this is a controversial topic, right? What we do is help the countries work on the bases of this program taking into account their type of government and all else, boosting the most efficient measures regarding prevention. Obviously inside these measures is sexual education. There is a compromise between the Ministries of Health and Education to boost sexual education in the school system over the base of methodological guides developed by pedagogues, specialists that evaluate the psychological maturity of girls and boys, according to their age, as it is logical. These materials have been developed just so they can have that progression. Meaning, in the measure that there is more psychological maturity, there is more maturity to the content of these programs. But sexual education is fundamental. This country has adopted this policy.
The church is not that dogmatic at all. I feel that other groups close to the church insist on these topics more than the actual church. The Vatican has commanded studies to evaluate the effectiveness of the condom. If they deemed this as bad, they wouldn’t bother to study it, in fact.
In terms of incidence, how does El Salvador measure against other Latin American countries?
Latin America in general has concentrated epidemics. At the Central American level, Belize is the country with the greatest number of people with problems, although it has improved substantially. It is followed by Honduras, El Salvador and Guatemala, which are more or less the same—although I consider that El Salvador is improving more so than Guatemala. Then there is Nicaragua, Costa Rica, and Panama. Out of these I think the better one is Costa Rica. This has to do with the same topic we are talking about: greater education, better sanitary culture, more culture of prevention through the use of the condom. This is in direct relationship to these.
In regards to the number of cases, what does this represent in annual terms?
El Salvador has had a prevailing diminution. In 2008, it was calculated that 30 people out of 100,000 inhabitants had this. In 2012, we are five points below: 25 people out of 100,000 inhabitants. Within this topic it is a declining trend, but still an insufficient one. We have been assessing more than two thousand cases per year, and then we stabilize between 800,000 and 700,000. We closed 2012 with 500,000. This gives a certain tendency towards decline. Our mortality rate has also decreased. It means that treatments are becoming increasingly effective.
What are the short-term and medium-term plans in ONU Sida?
El Salvador is basing their answers over a set of a strategic national multi-sector plan, which has participated in all the events it wants, in an orderly, systematic manner. With this knowledge it has prepared records for each population sector. We had correctional facilities, how many inmates had HIV in there? How many are in treatment? –meaning, real knowledge of prisons. Prison authorities and some representatives arrived to define which activities they should undertake to cater more effectively to the prison’s problems.
In the same manner, records of the people, of sex workers, their prevalence, the areas and the topics and problems specific to them were discussed.
A Quick Glance:
Herbert Betancourt: Aspiring farmer
Health Ministry: Needs more money
ONU SIDA: A well respected interagency program in the country
El Salvador: My country
Discrimination: The barrier which prevents the national response to HIV from advancing more
Favorite Book: Still the Quixote
The youth: Hope and enormous responsibility
Message to the youth of the country:
The emphasis is within your education. We have to educate ourselves to know our reality, to be able to influence reality. And in this, trying to do so without a flag, in the function of what the country wants and needs.