Barrio adentro, Spanish for "Inside the Neighborhood," is a national welfare program launched by Venezuelan President Hugo Chavez back in 2003, with the promise to grant free health care to the most needy. The program comprises health care, dental care and even sports training coverage for the entire Venezuelan population, with special attention for the dwellers living in the poorest slums in the country.

After the government initially built small primary-care centers in Caracas's slum neighborhoods, these centers began popping up all over the country. The government then talked of rebuilding rehabilitation and diagnostic centers with the help of Cuban and Chinese technology, erecting new hospitals and refurbishing the existing ones in impoverished areas. Further, Cuban physicians helped to develop a National Training Program for Comprehensive Community Physicians to train young Venezuelan medical students. As a result, over 20,000 students were enrolled durinmg the three years that followed.

The ideological implications of this program were evident. Barrio adentro was saluted as the Bolivarian alternative to neo-liberalism in health care by progressive movements throughout the world; and certainly the program's early successes boosted Chavez's popularity at home and over the rest of South America. After eight years of running this experiment in social health care, however, the results appear to be far from what was expected.

In a report from Venezuela, Reuters explains how the program, rather than being Chavez's flagship, became a liability. Reuters tells the story of Osmar Herrera, a sick and impoverished Venezuelan, who started coughing up blood early in 2011. When he went, almost collapsing, to look for help in one of the barrio adentro health centers, instead of receiving care, was sent from one institution to another until eventually "ending up in the thoracic ward of a run-down public hospital three hours from his home." Herrera, said in the interview to be a supporter of Chavez, but "laments his [Chavez's] inability to provide hospitals in his area with the equipment they need to treat pneumonia." Jorge Diaz, a Venezuelan health policy researcher, goes further, saying to Reuters that the barrio adentro program "has been a rip-off… It started as electoral bait with some health benefits, but it turned into a fraud -- not only for health reasons, but a fraud of the national treasury." According to Diaz, maternal and child care indicators have also deteriorated, and health coverage has not improved, even though the state oil company, PDVSA, invested $6.36 billion from 2003-2010. It is also estimated that the overall budget for public health reached 9% of the GDP in 2004. "Where did all that money go during all these years?" asked Diaz.

When the barrio adentro program started, more than 14,000 in medical staff were sent from Cuba. Today most of this staff has gone back there, and many of the doctors who had been trained have left for either some post abroad or for the private sector at home. To make things worse, the heavy investments in the alternative system left the traditional hospitals penniless. The result is that at present in Venezuela, there are three different health systems, totally disjointed from each other: the traditional hospitals, the barrio adentro system and private clinics. Given the poor performance of the public sector, Venezuelans seem to turn more and more towards private clinics, despite their cost.

What affects the health system of the public sector is not lack of funds but, according to many observers, a dangerous combination of corruption and inefficiency. This is something that has been seen before -- in fact, a recurrent feature, it seems, of any system that adheres to the principles of socialism as in the case of the Bolivarian economy.. Utopia and great promises are matched only by chronic inefficiencies, poor management, lack of transparency and the creation of a system from which only a few profiteers take advantage. So the result is the exact opposite of what was intended.

As for Chavez, despite his praise for the Socialist health program, he seems to prefer to get medical treatment elsewhere and leave the barrio adentro clinics only to his fellow-citizens. The Venezuelan president, who is undergoing treatment for cancer, is not only receiving chemotherapy in Cuba, but being treated there by private doctors from Spain. In the meantime, while Chavez gets pampered by Cuban leader Fidel Castro, Reuters reports that frustration in Venezuela is mounting "over marathon waits at crumbling hospitals and shortages of basic medicines and supplies."

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