Nearly two thousand health workers were abruptly laid off on the eve of Christmas 2025 from Hospital Nacional Rosales, El Salvador’s main public and specialized hospital. Physicians, nurses, cleaning staff, security personnel, and technical workers report that they were informed of their termination verbally, without written administrative resolutions, without clear procedures, and without severance pay.

According to the official version, the layoffs are part of a transition of Hospital Rosales toward a model of administrative autonomy within a National Hospital Network. However, records from the National Coordinator for the Defense of Health (CONADESA) indicate that throughout 2025 a total of 7,772 dismissals were recorded across the Ministry of Health, the Salvadoran Social Security Institute (ISSS), the Solidarity Fund for Health (FOSALUD), and national hospitals, pointing to a restructuring process of a different nature.

Currently, 80% of the Salvadoran population relies on the public health system as their primary means of access to healthcare, in accordance with the constitutional mandate that recognizes health as a public good. Likewise, the Health Reform promoted by the FMLN beginning in 2009 consolidated the principle of free access by eliminating “voluntary fees” and all forms of user charges within the public system, laying the foundations for its financing through general taxation and oriented toward guaranteeing the right to health.

Contrary to this spirit, the layoffs have been promoted in parallel with a budget cut of more than 90 million dollars to the health sector, despite rising demand for services, leading to the closure of more than 50 Community Family Health Teams, primarily in rural areas, leaving thousands of people without nearby access to vaccinations, prenatal care, and medications for chronic illnesses, while the country experienced an increase in dengue outbreaks, respiratory diseases, and rising maternal and infant mortality.

All of this has taken place within the framework of an agreement with the International Monetary Fund (IMF), in force since 2025, which allows the Executive to access 1.4 billion dollars in financing, conditioned on fiscal adjustment measures that include reductions in public spending on wages.

Iván Solano Leiva, president of the Medical Association, warned that this scenario could be used to justify, in the medium term, the concession of health services to private companies. According to Leiva, hospital modernization under “administrative autonomy” schemes could facilitate the introduction of models based on private providers and mandatory health insurance, similar to those implemented in other countries in the region. In the early 2000s, ARENA governments attempted to impose a similar neoliberal logic, triggering the massive “white marches,” one of the largest social mobilizations of the postwar period, in rejection of structural adjustment policies aimed at privatizing public healthcare.

Although El Salvador has had, since 2013, a Special Law on Public-Private Partnerships regulating the concession of public services through defined requirements and procedures, reforms to the health system are advancing outside of that framework. The Law Creating the National Hospital Network enables direct concessions by the Executive without being subject to the mechanisms established in existing legislation, which has been questioned and described as a form of privatization without legally mandated oversight.

Recently, the government announced the implementation of the Doctor SV program, a digital platform that uses artificial intelligence to provide diagnoses and medical consultations via video calls. Health care sector unions have denounced that under this program, private pharmacies and laboratories have begun to be subcontracted for the delivery of medications and the performance of clinical tests. During the Bukele administration, journalistic investigations have revealed the awarding of health service contracts to companies linked to officials from the Nuevas Ideas party.

As part of this strategy, the Executive has announced an investment of 106.8 million dollars in telemedicine. The service, initially financed through a 77-million-dollar loan from the Development Bank of Latin America and the Caribbean (CAF), has been outsourced through companies such as Manpower Group, which, according to labor organizations, hire physicians without job stability to provide phone consultations under precarious wage conditions. At the same time, the government has hired foreign doctors, offering them better salary conditions than national specialists, along with housing support and tax exemptions.

The expansion of telemedicine began to take shape publicly in September 2023, when the Executive announced a “strategic alliance” with the U.S. company Google, accompanied by the approval of a law obligating the State to contract at least 500 million dollars in services from the company over a seven-year period.

In this regard, CONADESA argues that the Doctor SV application does not guarantee comprehensive medical care, as it fails to ensure immediate or specialized in-person attention in emergency situations and does not replace the face-to-face medical evaluation required for proper diagnosis and treatment. The coalition, which brings together unions and health sector organizations, further warned that replacing in-person hospital care with digital platforms undermines the effective exercise of the constitutional right to health, particularly for critical patients, people with chronic illnesses, older adults, and populations in vulnerable situations.

The president of the Medical Association also reported delays and interruptions in medical treatments following the layoffs. He indicated that patients with chronic kidney disease received incomplete or suspended hemodialysis sessions due to shortages of water, supplies, and staff. In some cases, he stated, patients were disconnected during treatment, forcing their families to cover the cost of continued care at private facilities.

In 2025, in response to the health crisis, social organizations and unions that make up CONADESA presented a National Multisectoral Health Plan developed from communities across the country to strengthen primary care, improve the tracking of epidemiological information, dignify health workers, and address the social determinants of health, such as access to water, food, and a healthy environment. However, instead of reinforcing public health, during just the first two years of bitcoin implementation the government allocated more than 180 million dollars to its rollout, an amount that exceeds the annual budget of Hospital Rosales, estimated at 70 million dollars.

At the same time, the Executive has taken actions aimed at progressively closing spaces for organization and denunciation within the health sector, ranging from dismissals linked to participation in peaceful protests to the imposition, in 2019, of a board of directors of the ISSS Workers’ Union (STISSS) that was not elected by its members.

For Rafael Aguirre, Secretary General of SIMETRISS, “the internal sabotage of the health system reflects a clear intention to privatize it. Experience in other countries shows that these processes end up segmenting the population into A, B, and C classes, where only those who can afford private insurance gain access to adequate care.”

Therefore, Aguirre maintains that it is “essential to defend and strengthen the specialized human resources of the ISSS,” since “defending them is defending the right to health, patient well-being, and the future of a system that, despite its difficulties, remains one of El Salvador’s greatest social achievements.”

This call seeks to draw attention to the dangers posed by advancing attempts to privatize healthcare, particularly in the run-up to the 2027 elections, in which Nayib Bukele seeks an unconstitutional second reelection, which would allow him to further deepen reforms of this kind that conceive health as a service subject to market logic rather than as a right.