By: OLGA LUCIA LOPEZ MUÑOZ, Journalist
In 2016 the reduction in public investment in Medellin impacted social investment and public health.
Among the major cities and metropolitan areas in Colombia, Medellin was the city that reduced extreme poverty the most last year, lowering rates from 3.3% in 2015 to 2.9% in 2016. It also reduced poverty rates between 2015 and 2016 by 1.6%, placing it in 14.1% (although this meant, in absolute terms, an increase in 13,150 more people in this condition between the two years).
This was one of the main conclusions of the report "Medellín Cómo Vamos" 2016, which also stressed that income inequality rates in Medellin and its metropolitan area kept going down. This seems to be associated with the increased participation of employees with technological/technical training in the labor market, which went from 19.2% in 2014 to 21.9% in 2016.
Between 2010-2016 we saw a downward trend in the gaps between communes in the Multidimensional Index of Living Conditions, and a reduction in the gap between rural and urban areas. Unemployment grew by only 0.1 percentage points, while informality had a slight increase, reaching 42.3%.
A 4% reduction in municipal revenues (compared to 2015), coupled with greater commitments in debt repayments, reduced the municipal public investment. Most sectors were affected by cuts, especially in equipment, public safety, attention to vulnerable population, and healthcare.
In 2016, Medellin remained the city with the largest percentage of investment in vulnerable population, with 9.5% of total investment resources, but in 2015 the percentage investment fell 0.3% to $ 53,700 million, due to lower total investment resources for the municipality. This impacted negatively the investment in early childhood care and extreme poverty, while investment in care for the elderly (over $ 24,000 million) increased .
Among the most important demographic changes in 2016, we count the decrease of reported displacement. Yet, concerns remains about the aging of the local population, which demands greater public resources to guarantee the rights of the elderly who lack social security and family support networks.
In public services, despite the historical records of high coverage in the city, 53,000 households still lack of sewage and 38.000, water supply. The Mayor’s Office and Empresas Publicas de Medellin are working on a plan to bring these services to 40,200 homes to 2019: in 2016 they reached more than 10% (4,813).
Air quality worsened in Medellin.
Indicators measuring water, air, and noise conditions did not show major changes. But in the case of air, comparing to 2015, the situation of the particles that affect health, PM2.5, worsened: in the first half of 2016, an environmental contingency occurred in the city when the limits established by the regional authority for air quality were surpassed. The city is working on a decontamination plan with support from the Clean Air Institute, based on the knowledge acquired over several decades by the Network of Air Quality Monitoring. Decontamination goals were proposed for 2030, with commitments for all involved. It is imperative that everyone assumes their responsibilities, and that the authorities follow strict controls. With this we expect to raise environmental awareness.
In the case of noise, the biggest challenge is the effective implementation of environmental and urban protocols included in the POT (Land Use Plan), with the aim of enabling the presence of residential uses in areas of high mixture. And measurements for water quality for the first half of 2016 show the need to expedite the process of the Recovery and Sewage Management Plan, and to strengthen the cleaning of the streams that cross the Aburra Valley, especially in northern Medellin, and southern and central Bello.
Pedestrian and motorcyclists deaths increased.
Despite the decreasing number of deaths on the roads, that reduced mortality in traffic accidents 10.8% per 100,000 inhabitants, road safety remains a concern at the level of pedestrians and motorcyclists deaths: the latter rose from 81 dead in 2015 to 100 deaths in 2016. The city needs to review and adopt a plan —Vision Zero style—, seeking to reduce speed limits to exercise proper control.
Increased "express" kidnappings
In 2016, there were 24 cases of kidnappings, a growth of more than 100% compared to 2015. The director of "Medellín Cómo Vamos", Piedad Patricia Restrepo, explained that this is due to the form of express kidnapping: robberies where victims are retained for a few hours: "This is a very negative result for the city." The Mayor of Medellin, Federico Gutiérrez, insisted that these cases were not like those experienced by city in previous decades. He also reported that the extortion reports increased from 1.9% to 2.6% between 2015 and 2016, a figure that falls short of reality, since many do not report being extorted. The mayor also reiterated that safety is and will remain a priority in his administration.
Medellin should improve access and satisfaction with health services.
The results of the Survey on Public Perception "Medellín Cómo Vamos 2016” highlight healthcare as a critical element for the people. It stands out as the most important element to their quality of life, but unequal conditions and discrimination in access prevail.
Nearly 4 in 10 Medellineans stated that it took them more than 6 days to receive outpatient care, when the regulation specifies that the allocation of these can not exceed 3 working days.
This affected satisfaction with health services in 2016, when it was among the lowest compared to other public goods. Besides the increased dissatisfaction with the service, dissatisfaction may be influencing the decision of users to access healthcare. In 2016, there was a greater proportion of Medellineans that, despite needing health services, decided not to use them: 14% did not have access to services.
Medellin continues to present challenges in effective access to health services, evidenced by a high proportion of access via ER, and in the fact that there is a high rate of users who, needing health services, decide not make use of them. These two factors, in an environment of decreasing satisfaction with the service, could indicate self-exclusion decisions on access.
In addition to ongoing discussions in the country and the region about the sustainability of the health system —specifically in Medellin and Antioquia, the viability of Savia Salud EPS’s 1,700,000 users-, it is necessary to stress the urgency of change of focus, strengthening primary health care and increased investment in disease prevention and promotion of healthy lifestyles.
This because in Medellin the prevalence of two risk factors for developing more serious diseases —obesity and overweight— continues to increase. As in previous years, chronic non-communicable diseases remain the major source of mortality and loss of potential years of life, and of outpatient consultations,.
In 2016, investment in health by the Municipality of Medellin fell by just over $ 50,000 million. Unfortunately, with the health budget reduction, investment in public health was reduced from 12% in 2015 to 8% in 2016.
Furthermore, although there were decreases in the proportion of teenage pregnancy and fertility of the age group between 10 and 19, a territorial concentration phenomenon was evidenced, specifically for teenage pregnancies in ages 15 to 19, in districts of precarious socio-economic situation like Popular, Manrique and Villa Hermosa.
Dissatisfaction and the likely decision of self-exclusion from health services are strong signals of the fact that, for Medellineands, there are urgent tasks in service quality and timely access. All actions taken to improve both will result in an improved assessment of local governance, and most important, in a significant increase in wellbeing.
Recommendations for mayor of Medellin.
Based on the results of the report, "Medellín Cómo Vamos" gave four main recommendations to improve key indicators, starting from a change in the model of public management.
1. More active management of municipal resources: The city has room to improve the collection of taxes such as property and ICA, and to reduce dependence on transfers from EPM.
2. We need to complete public policy cycles of with technical evaluation on the impact of major municipal projects and with a review of investments: This should lead to the escalation of pilot programs with a high degree of innovation, and to a constant on-site dialogue with citizens.
3. Greater knowledge of the territory is required: We should increase that knowledge and manage the challenges in a more decentralized way, together with an engaged community that is co-responsible for its own development.
4. Greater interagency coordination in the Metropolitan Area: Command and control functions of the Metropolitan Area of ??the Aburrá Valley, in charge of road mobility and environmental issues, need to increase. With this, Medellin will ensure compliance with planning guidelines for the metropolitan territory, and with the development of management tools that guarantee the fulfillment of what has been planned.