Access to healthcare in rural areas of the Dominican Republic remains alarmingly inequitable, with stark disparities in the Province of Puerto Plata. Here, approximately 20,000 people face barriers to medical care, with only 8.8 physicians available per 10,000 residents, reflecting a broader national shortage where just 20 physicians serve every 10,000 people on average. The country has just over 1,700 primary healthcare centers to serve a population of 11 million, which falls far short of what is needed. Systemic issues, including inadequate citizen participation, insufficient development and training for healthcare professionals, and gaps in quality assurance of both personal and population-based health services, further complicate access to care.
Our work focuses on underserved Dominican residents and undocumented Haitian immigrants in the communities of Severet, Pancho Mateo, Negro Melo, and Arroyo de Leche, near Montellano. These areas are marked by widespread poverty, with nearly 40% of the Puerto Plata population living below the poverty line (defined as living on less than $6.85/day). This echoes broader national income inequality, where the poorest 10% receive less than 1.9% of GDP, while the wealthiest 10% receive nearly 40%. The deep-rooted poverty highlights the need for improved access to healthcare, public health initiatives, education, and economic opportunities.
Montellano was once centered around a sugarcane refinery, a major source of employment for cane cutters, refinery workers, managers, and others. However, the refinery’s closure in the early 2000s led to a surge in unemployment, further entrenching poverty and increasing the community’s vulnerability. Today, many residents suffer from untreated chronic illnesses, yet they are unable to afford transportation to overburdened healthcare providers. The high cost of medication only adds to the strain, driven by the soaring unemployment that has destabilized these communities.
Man working in a sugarcane field © Fran Alonso
Inadequate access to clean water results in frequent intestinal parasite infections, and infectious diseases that could be mitigated through public health interventions remain prevalent. Furthermore, barriers such as poor nutrition, limited access to safe spaces for exercise, and a lack of investment in health education hinder the pursuit of healthy lifestyles. Addressing the social determinants of health, including access to care, education, equitable immigration policies, and overcoming structural racism and discrimination, is crucial to improving the well-being of these communities.