The huge health crisis in Venezuela has no comparison.

The international indicators reflect a regression in the health situation in Venezuela. On average, the country retreated some 25-30 years. Elaborating scenarios for 2018 is complicated by the lack of regular information. Added to this is the fact that the Yearbook of Mortality and Morbidity, which contains the most important indicators, has not been published since 2013. In addition, the objective situation characterized by the difficulty to obtain medicines, the crisis of the hospitals at national level and the resurgence of diseases due to lack of compliance with preventive strategies, frames 2017, as the worst year in health performance in the Republican history from Venezuela. At least since 1940, when it began to keep records of diseases in a systematic way.

Problems such as access to basic foods, malnutrition, de-schooling, insecurity and the lack of basic public services such as water, electricity and mobility, have a substantial influence on the production of diseases, their complications and the capacity to prevent them.

Having this as a basis, it is unlikely that despite resolving the specific aspects - such as medication and hospital situation if other aspects of civic life are not improved, the impact of the improvement on health could be minimal.

Health indicators are more vulnerable to deterioration than to improvement. For example, the progress made in maternal and child health from the 1950s to the end of the 1980s was lost in just 10 years. Sign of a recovery would be access to commonly used medicines, or basic basket of medicines, which should include the most frequent diseases. In this sense the governmental signs around the decisions and the general approach on this specific point have been ominous.

The shortage of raw materials and the difficult access to foreign currency makes it practically impossible to improve a realistic distribution of medicines in the short term. For this reason, only external assistance-whatever name you want-for importing finished products could have a quick impact on this issue. At the same time, it is necessary to strengthen the national productive apparatus so that after a first phase of external assistance the drug industry can be reactivated, which had the capacity to supply the national market.

The malignant equation that we suffer has as a determinant the difficulty of access to nutrients and medicines, the deterioration of purchasing power and hyperinflation, which results in conditions that according to international definitions are those of a "complex humanitarian emergency". This lays the basis for requesting help from international organizations or friendly countries. The how, when and what is the subject of deep discussions that have been worked with technical teams and patient organizations, with the focus on these and their needs.

Getting and distributing medicines in sufficient quantity and quality is just one step in the chain. The effort is ephemeral if there is no articulation that guarantees the suitability of programs that allow us to return to levels of attention according to our level of development. A clear example of this is diseases preventable by vaccines. Currently in the country, diphtheria and measles have extensive activity in the national territory. A central question on this aspect is: what is the reason why they stopped vaccinating millions of Venezuelans in recent years if there was no shortage of vaccines?

The answer points to complex causes: from the lack of commitment of the makers and executors of public health policies, to the lack of managerial capacity of those who direct these programs, ending with the country's own difficulties -as shortage of fuel and spare parts, the battered access roads, the electricity problems, etc-.

Without a doubt, the first sign of changes would be the acceptance or implementation of aid in the field of medicines, followed by an integrated policy of actions in the health sector that tries to avoid the debacle by which we are moving at an accelerated pace.