Paraguay

The Health in the Americas+¹ country profiles are based on the interagency indicators available as of the dates referenced. The sources are referenced in this table. In some cases, the values of the indicators may differ from the most recent data available in the country.

Environmental and social determinants of health

In 2000 the total population of Paraguay was 5 123 819 inhabitants; by 2023 this figure had risen to 6 861 524, representing a 33.9% increase. Regarding the country’s demographic profile, in 2023 people over 65 years of age accounted for 6.4% of the total population, an increase of 2.1 percentage points compared to the year 2000. In 2023, there were 99.4 women per 100 men and 22.2 older people (65 years or older) per 100 children under 15 years of age, as can be seen in the country’s population pyramids, distributed by age group and sex (Figure 1). Considering the population between 15 and 64 years of age to be potentially active (i.e., potential participants in the labor force), this group represented 64.9% of the total population of the country in 2023 (4 456 271 people). When we add these figures to the potentially passive population (1 968 544 under 15 years of age and 436 709 over 65 years of age), the result is a dependency ratio of 54.0 potentially passive people per 100 potentially active people. This ratio was 75.8 in 2000.

Life expectancy at birth in 2023 was 74.1 years, lower than the average for the Region of the Americas and 4.4 years higher that in 2000.

Figure 1. Population pyramids of Paraguay, years 2000 and 2023

Between 2003 and 2020, the average number of years of schooling in Paraguay increased by 26.7%, reaching an average of 8.9 years in the latest year for which information is available. The unemployment rate in 2022 was 6.9%. Disaggregated by sex, the rate was 8.5% for women and 5.7% for men. The literacy rate was 98.6% in 2020. In men, this figure was 98.7%; in women, 98.6%. In addition, 26.9% of the population were below the national poverty line in 2020, a decrease from 36.8% in 2001. In 2020, 0.8% of the population was living in poverty, defined as the percentage of the population with an income of less than US$ 1.90 per day; this is below the regional average of 3%.

During the period 2000-2021, the country improved its score on the Human Development Index, with an increase of 10.5% (from a score of 0.649 to a score of 0.717); during the same period, the index rose 13.5% internationally and 9.4% in Latin America (Figure 2).

Figure 2. Human Development Index in the Region of the Americas, 2021

In 2020, public expenditure on health accounted for 4.12% of gross domestic product (GDP) (Figure 3) and 15.94% of total public expenditure, while out-of-pocket spending on health accounted for 38.37% of total health expenditure.

Figure 3. Domestic general government health expenditure as percentage of gross domestic product, 2020

Digital coverage

In 2021, 77.0% of the population had an internet connection, representing a considerable increase from 2000, when .7% of the population had an internet connection.

Health situation

Maternal and child health

Between 2000 and 2020, infant mortality in Paraguay decreased from 20.2 to 12.2 deaths per 1000 live births, a decrease of 39.6% (Figure 4). The percentage of low-weight births (less than 2500 g) increased from 5.7% to 6.1% between 2000 and 2020, while exclusive breastfeeding in the child population up to 6 months of age was 21.9% in 2004 and 29.6% in 2016 (latest available data).

Regarding the immunization strategy, measles vaccination coverage was 42% in 2022, a decrease of 50 percentage points from 2000.

The maternal mortality ratio for 2020 was estimated at 71.1 deaths per 100 000 live births, a reduction of 52.1% from the estimated value for 2000 (Figure 5). In relation to fertility, it is estimated that in 2023 women had an average of 2.4 children throughout their reproductive lives. In the specific case of adolescent fertility, there was a 13.6% decrease, from 80.6 live births per 1000 women aged 15 to 19 years in 2000 to 69.6 in 2023. In 2020, 91.2% of births were attended by skilled birth personnel. Between 2009 and 2019 the percentage of pregnant people who had four or more consultations for antenatal care increased from 67.8% to 82.3%.

Figure 4. Infant mortality per 1000 live births, 1995–2020

Figure 5. Maternal mortality per 100 000 live births, 2000–2020

Communicable diseases

In 2021, there were 41 new cases of tuberculosis per 100 000 population in Paraguay. In 2019, the overall tuberculosis mortality rate (age-adjusted and per 100 000 population) was 4.5 (2.4 in women and 6.7 in men).

In 2020, the estimated human immunodeficiency virus (HIV) infection incidence rate (new diagnoses) was 18.1 per 100 000 population. The age-adjusted mortality rate for HIV was 7 per 100 000 population in 2019. It should be noted that during the 2000-2019 period this indicator decreased by 26.4%.

There were no reported cases of human rabies in the country in 2020.

Noncommunicable diseases and risk factors

In Paraguay in 2023, the prevalence of tobacco use among people aged 15 and older was 10.1%. In the same age group, the prevalence of overweight and obesity was 53.5% in 2016.

Also in 2016, 37.4% of the population reported insufficient physical activity. 

In 2015, the reported prevalence of arterial hypertension (high blood pressure) among people aged 18 years or older was 24.6, a decrease of 3.5 percentage points compared to 2000 (28.1%). The prevalence of diabetes mellitus, which stood at 6.1% in 2000, increased to 8.1% in 2014.

Mortality

In 2019, the adjusted rate of potentially preventable premature mortality in Paraguay was 263.44 deaths per 100 000 population, a decrease of 11% compared to the rate of 295.8 in 2000. This meant that, in 2019, the rate in the country was 16.2% higher than the average rate reported for the Region of the Americas as a whole. Among potentially preventable premature deaths, the rate for preventable causes was 140.1 per 100 000 population in 2019, which is 2.2% higher than the regional average rate; and the rate for treatable causes was 123.4 per 100 000 population, above the regional average of 89.6.

The overall age-adjusted mortality rate was 5.8 per 100 000 population in 2019, a decrease of 3.3% from 2000 (six deaths per 1000 population).

When deaths are categorized into three main groups, it is observed that, in 2019, the age-adjusted mortality rate from communicable diseases was 73.7 per 100 000 population (86.0 per 100 000 in men and 61.7 per 100 000 in women), while the age-adjusted mortality rate from noncommunicable diseases was 445.7 per 100 000 population (525.7 per 100 000 in men and 370.3 per 100 000 in women). The rate of age-adjusted mortality from external causes was 56.7 per 100 000 population (87.5 per 100 000 in men and 25 per 100 000 in women), including road traffic accidents (22.6 per 100 000 population), homicides (8 per 100 000 population) and suicides (6.2 per 100 000 population). In 2000, the percentage distribution of causes was 61.1% for noncommunicable diseases, 26.1% for communicable diseases, and 12.8% for external causes; in 2019, the percentages were 74.9%, 14%, and 11.1%, respectively (Figure 6).

Figure 6. Proportional mortality in Paraguay, 2000 and 2019

Cancer mortality

Regarding cancer mortality from tumors, in 2019, the adjusted mortality rate from prostate cancer was 21.2 per 100 000 men; lung cancer, 21.9 per 100 000; and colorectal cancer, 10.8 per 100 000. In women, these values were 16.5 deaths per 100 000 for breast cancer; 4.8 per 100 000 for lung cancer; and 8.4 per 100 000 for colorectal cancer.

The health situation and the COVID-19 pandemic

In 2020, Paraguay ranked 20th in the Region of the Americas in terms of the number of deaths from COVID-19, and second in 2021, with a cumulative 2481 deaths per million population over the two years (Figure 7). 

According to estimates by the World Health Organization, there was a total of 2411 excess deaths in 2020, or 36.4 per 100 000 population. A total of 17 406 deaths were estimated in 2021, for an excess mortality rate of 259.6 per 100 000.

As of 31 December 2021, at least one dose of COVID-19 vaccine had been given to 54.5% of the country's population. As of 20 April 2022 (latest available data), 47% of the population had completed the vaccination schedule. The vaccination campaign began on 20 February 2021, and eight types of COVID-19 vaccine have been used to date.

Figure 7. Cumulative COVID-19 deaths in the Region of the Americas, to July 29th, 2023

Prospects

Measures to achieve universal health coverage

In recent years, in an attempt to deal with noncommunicable diseases, Paraguay has implemented new community-based care systems, such as the Chronic Care Model for hypertension, diabetes mellitus, chronic kidney disease, and obesity, along with modifications to and reform of the mental health care system.
 
Implementation of free health care in the country has greatly facilitated people's access to these services. In addition to the provision of free services, medicines, and many other inputs since creation of the various national programs—such as those related to leprosy, tuberculosis, malaria, HIV/AIDS, Chagas disease, and leishmaniasis—people have also been given greater access to other, more complex types of health services. 

The support of the Pan American Health Organization has facilitated access to free treatment of these diseases, in addition to providing manuals, guides, and other technical items.

Challenges related to population health

One particularly important challenge facing the country in the short term is to restart activities that were suspended or cut back due to the COVID-19 pandemic, especially in relation to health promotion, monitoring, and supervision.

COVID-19 pandemic response

In terms of the diseases that are unrelated to COVID-19, care remained generally unaffected during the most acute stage of the pandemic, due mainly to the decentralization of national-program services and the use of remote monitoring. In efforts to strengthen response capacity, active work and training continues with regional managers and heads of both public and private health services, in order to ensure that people have unrestricted access to these services. One important aspect of these efforts involves forming infection prevention and control teams within health facilities, and the training of health personnel, along with strengthening surveillance of healthcare-associated infections (HAIs) in hospitals throughout the country.

Measures to reduce inequalities in health

Among other national public policies is the National Strategy for the Prevention and Control of Obesity 2015–2025, an initiative that promotes multisectoral integration. Its objectives are the prevention of overweight and obesity and the strengthening of comprehensive care throughout the life course, with the participation of public and private health systems, as well as civil society.

Historically, the stigmatization of diseases such as leprosy, tuberculosis, and HIV/AIDS has been the main barrier to timely diagnosis, but this has diminished significantly in recent years, thanks to increased promotional activities and campaigns and active case-finding, two tasks that were taken up with renewed impetus during this period. 

The sources of the interagency indicators used in this profile can be found in this table.

For the latest data on health indicators for the Region of the Americas, be sure to visit the PAHO Core Indicators portal.