Public health services are directed by the Ministry of Health, whose programs include free health examinations and medical care for the needy, health education, sanitation inspection, hospital and clinic construction, and nutrition services. As of 1999, total health care expenditure was estimated at 7.3% of GDP.
In 1997, Panama had 4,434 physicians, 1,397 dentists, and 3,923 registered nurses (including nursing assistants). As of 1999, there were an estimated 1.7 physicians and 2.2 hospital beds per 1,000 people. In 2000 there were close to 2,000 beds in public hospitals at the national, regional, and municipal levels.
Proceeds from a national lottery support state hospitals, asylums, and public welfare. Assistance has been received from such organizations as the World Health Organization, the US Institute of Inter-American Affairs, the Pan American Sanitary Bureau, the Institute of Nutrition of Central America and Panama, and UNICEF.
During the first two decades of the 20th century, when the Panama Canal was being built, the major health threats were yellow fever, malaria, smallpox, typhoid, dysentery, and intestinal parasites. Through the efforts of Col. William Crawford Gorgas, a US military surgeon and sanitary officer, malaria was controlled and the yellow fever mosquito was virtually eliminated. Today, the principal causes of death are cancer, heart disease, cerebrovascular disease, pneumonia and bronchopneumonia, enteritis, and diarrhea.
Col. Gorgas pioneered in providing Panama City and Colón with water and sewer systems; in some areas of Panama, poor sanitation, inadequate housing, and malnutrition still constitute health hazards. In 2000, 87% of the population had access to safe drinking water and 94% had adequate sanitation. However, in the same year, 18% of children under five years old were considered malnourished. The government of Panama is currently increasing distribution of vitamin A capsules to populations with high risk of vitamin A deficiency, mostly the Indians in the western region of Panama. Immunization rates for children up to one year old in 1997 were: tuberculosis, 99%; diphtheria, pertussis, and tetanus, 95%; polio, 99%; and measles, 92%. Polio, measles, and neonatal tetanus were at extremely low numbers during 1994. Goiter was present in 13.2% of school-age children during 1996. There were 476 malaria cases in 1996.
As of 2002, the crude birth rate and overall mortality rate were estimated at, respectively, 18.6 and 5 per 1,000 people. The fertility rate was 2.5 children per woman surviving her childbearing years in 2000 and the infant mortality rate was 20 per 1,000 live births in 2000. Maternal mortality was 70 per 1,000 live births in 1998. Average life expectancy in 2000 was 75 years.
As of 1999, the number of people living with HIV/AIDS was estimated at 24,000 and deaths from AIDS that year were estimated at 1,200. HIV prevalence was 1.5 per 100 adults. By 1998, AIDS and pneumonia were the only communicable diseases among the ten leading causes of death in Panama.