Panama - Country Profile

By PAHO/OPS, 13 September, 2022

The Health in the Americas+ 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 Panama was 3 010 369 inhabitants; by 2024 this figure had risen to 4 515 577, representing a 50.0% increase. Regarding the country’s demographic profile, in 2024 people over 65 years of age accounted for 9.4% of the total population, an increase of 4.4 percentage points compared to the year 2000. In 2024, there were 100. women per 100 men and 37.6 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 65.8% of the total population of the country in 2024 (2 969 081 people). When we add these figures to the potentially passive population (1 124 150 under 15 years of age and 422 347 over 65 years of age), the result is a dependency ratio of 52.1 potentially passive people per 100 potentially active people. This ratio was 59.5 in 2000.

Life expectancy at birth in 2024 was 79.8 years, higher than the average for the Region of the Americas and 6.4 years higher that in 2000 (73.4).

Figure 1. Population pyramids of Panama, years 2000 and 2024

Between 2000 and 2019, the average number of years of schooling in Panama increased by 33.8%, reaching an average of 10.5 years in the latest year for which information is available. The unemployment rate in 2023 was 7.6%. Disaggregated by sex, the rate was 9.3% for women and 6.5% for men. The literacy rate was 99.3% in 2022. In men, this figure was 99.3%; in women, 99.4%. In addition, 21.8% of the population were below the national poverty line in 2021, a decrease from 37.9% in 2000. In 2023, 1.3% of the population was living in poverty, defined as the percentage of the population with an income of less than US$ 2.15 per day; this is below the regional average of 2.6%.

During the period 2000-2022, the country improved its score on the Human Development Index, with an increase of 13.6% (from a score of 0.722 to a score of 0.82); during the same period, the index rose 14.6% internationally and 11.2% in Latin America (Figure 2).

Figure 2. Human Development Index in the Region of the Americas, 2022

In 2021, public expenditure on health accounted for 5.38% of gross domestic product (GDP) (Figure 3) and 21.66% of total public expenditure, while out-of-pocket spending on health accounted for 37.33% of total health expenditure.

Figure 3. Domestic general government health expenditure as percentage of gross domestic product, 2021

Digital coverage

In 2021, 67.5% of the population had an internet connection, representing a considerable increase from 2000, when 6.6% of the population had an internet connection.

Health situation

Maternal and child health

Between 2000 and 2021, infant mortality in Panama decreased from 16.7 to 12.16 deaths per 1000 live births, a decrease of 27.2% (Figure 4). The percentage of low-weight births (less than 2500 g) decreased from 8.2% to 8.1% between 2000 and 2021.

Regarding the immunization strategy, measles vaccination coverage was 92.0% in 2021, a decrease of five percentage points from 2000.

Figure 4. Infant mortality per 1000 live births, 1995–2021

The maternal mortality ratio in 2020 was estimated at 49.5 deaths per 100 000 live births, representing a 24.4% reduction compared to the estimated value in 2000 (Figure 5). In relation to fertility, it is estimated that in 2024 women had an average of 2.1 children throughout their reproductive lives. In the specific case of adolescent fertility, there was a 39.2% decrease, from 91.9 live births per 1000 women aged 15 to 19 years in 2000 to 55.9 in 2024. In 2021, 91.7% of births were attended by skilled birth personnel. Between 2010 and 2013 the percentage of pregnant people who had four or more consultations for antenatal care decreased from 94.1% to 87.9%.

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

Communicable diseases

In 2022, there were 37 new cases of tuberculosis per 100 000 population in Panama. In 2019, the overall tuberculosis mortality rate (age-adjusted and per 100 000 population) was 5.2 (3.3 in women and 7.2 in men).

In 2021, the estimated human immunodeficiency virus (HIV) infection incidence rate (new diagnoses) was 31.4 per 100 000 population. The age-adjusted mortality rate for HIV was 15.4 per 100 000 population in 2019. It should be noted that during the 2000-2019 period this indicator decreased by 22.5%. There were no reported cases of human rabies in the country in 2022.

Noncommunicable diseases and risk factors

In Panama in 2023, the prevalence of tobacco use among people aged 15 and older was 4.4%. In the same age group, the prevalence of overweight and obesity was 71.6% in 2022.

In 2015, the reported prevalence of arterial hypertension (high blood pressure) among people aged 18 years or older was 19.9%, a decrease of 2.9 percentage points compared to 2000 (22.8%). The prevalence of diabetes mellitus, which stood at 7.3% in 2000, increased to 9.3% in 2014.

Mortality

In 2019, the adjusted rate of potentially avoidable premature mortality in Panama was 195.7 deaths per 100 000 population, a decrease of 16% compared to the rate of 232.9 in 2000. This meant that, in 2019, the rate in the country was 13.7% lower 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 108.4 per 100 000 population in 2019, which is 20.9% lower than the regional average rate; and the rate for treatable causes was 87.3 per 100 000 population, below the regional average of 89.6.

The overall age-adjusted mortality rate was 4.4 per 1000 population in 2019, a decrease of 13.6% compared to 2000 (5 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 59.7 per 100 000 population (71.9 per 100 000 in men and 48.3 per 100 000 in women), while the age-adjusted mortality rate from noncommunicable diseases was 334.7 per 100 000 population (394 per 100 000 in men and 282.2 per 100 000 in women). The rate of age-adjusted mortality from external causes was 41.9 per 100 000 population (72.3 per 100 000 in men and 11.9 per 100 000 in women), including road traffic accidents (14 per 100 000 population), homicides (17.5 per 100 000 population) and suicides (2.9 per 100 000 population). In 2000, the percentage distribution of causes was 69.2% for noncommunicable diseases, 18.8% for communicable diseases, and 12.0% for external causes; in 2019, the percentages were 77.9%, 13.4%, and 8.8%, respectively (Figure 6).

Figure 6. Proportional mortality in Panama, 2000 and 2019

Cancer mortality

Regarding cancer mortality from tumors, in 2019, the adjusted mortality rate from prostate cancer was 18.1 per 100 000 men; lung cancer, 9.0 per 100 000; and colorectal cancer, 9.2 per 100 000. In women, these values were 12.1 deaths per 100 000 for breast cancer; 5.2 per 100 000 for lung cancer; and 6.8 per 100 000 for colorectal cancer.

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.

Country COVID-19 Perspective

The health situation and the COVID-19 pandemic

In Panama in 2020, there were a total of 242 744 cases of COVID-19, representing 55 785 per million population. In 2021, there were 250 963 identified cases, equivalent to 57 674 per million population. In 2022, 486 194 cases were reported. In the Region of the Americas, Panama ranked fifth in terms of the number of deaths from COVID-19 in 2020, with a rate of 914 deaths per million population, 32nd in 2021, with a rate of 793 deaths per million, and a rate of 242 deaths per million population in 2022, with a cumulative 1950 deaths per million population over the three years (Figure 7).

According to estimates by the World Health Organization, there was a total of 2997 excess deaths in 2020, or 69.8 per 100 000 population. A total of 4645 deaths were estimated in 2021, for an excess mortality rate of 106.8 per 100 000.

As of 31 December 2021, at least one dose of COVID-19 vaccine had been given to 80.1% of the country's population. As of 20 April 2022 (latest available data), 71% of the population had completed the vaccination schedule. The vaccination campaign began on 20 January 2021, and two 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

To achieve universal health coverage, the following actions are being proposed:

Implement a unified care model within the public health system that meets user demand and management needs with respect to the provision of health services, based on the Integrated Health Services Networks (RISS), in order for people to exercise their right to better health in the areas where they live.
Develop cost-effective interventions to combat the negative impact of social determinants on health and give primary attention to the needs and risks of vulnerable populations, considering differences of age, gender, and culture throughout the life course.
Manage the information system in a way that meets the criteria of timeliness, quality, and accessibility, based on integral health management to optimize decision-making.
In health facilities, monitor inventory control to ensure a timely and continuous supply of the inputs required by health care programs and clinical guidelines, to address the most prevalent morbidities in health facilities.

Challenges related to population health

The main health challenges in Panama include implementing the primary care-based approach at all levels of care; strengthening the leadership of the Ministry of Health (MINSA); and establishing effective and sustainable coordination between MINSA and the Social Security Fund (CSS). These efforts are aimed at strengthening the public system and providing the population with equitable, timely, quality health services, in welcoming and safe conditions, with proven effectiveness and broad social acceptance, while ensuring the financial sustainability of the services.

The government's proposed response is to unify the country's health services through implementation of the RISS, so that health facilities, human resources, and inputs can be used effectively and efficiently, to provide care for the entire population.

Executive Decree No. 290, of 9 July 2019, provided for effective and sustainable coordination of integral health services between MINSA and the CSS. The purpose of the decree was to implement and regulate all that is necessary for coordination within the framework of a national policy, with the support of the National Consultation on Development, the High-level Commission, and other key stakeholders in the health sector.

Lastly, it has been proposed that the necessary resources be provided so that MINSA can fully exercise its stewardship function.

COVID-19 pandemic response

Panama continues to work to strengthen the capacity of first-level care. Efforts have been intensified to implement a comprehensive approach to the COVID-19 pandemic, by expanding capacities to solve the demand generated by the pandemic. Furthermore, and with a view to 2025, efforts to provide comprehensive care for other health problems at the primary care level will continue. Rapid response teams have been formed to control and track cases of COVID-19. In addition, financial resources have been provided to cover a variety of needs, including strengthening the foundation of primary care. Lastly, there has been progress in modifying the care model, to prioritize promotion, prevention, and quality of services, while reducing access barriers.

Measures to reduce inequalities in health

To address inequalities in this field, the following policies of the National Health Promotion Plan 2016–2025 have been prioritized:

Policy 3: Achieve universal access to health and universal health coverage, with equity, efficiency, and quality.
Policy 4: Ensure health promotion through education, social marketing, and social participation, incorporating human rights, the gender perspective, and an intercultural approach.

Panama also has mechanisms and regulations in place, including Law No. 17 that protects traditional indigenous medicine; a proposed intercultural care model; and a project giving domestic workers membership in the social security system.

Lastly, the country is developing a process to mainstream the intercultural approach in health care, directed particularly at the indigenous and Afro-descendant population.

National strategy to address inequalities in health

Panama's road map for achieving universal access to health and universal health coverage delineates the measures needed, through collective and participatory actions, to formulate inclusive policies and accountability mechanisms; implement actions to strengthen governance and stewardship of the health sector; and define national goals and objectives, along with action plans for achieving universal access to health and universal health coverage. This roadmap consists of four strategic lines:

Expand equitable access to comprehensive, quality, person- and community-centered health services.
Strengthen health system oversight stewardship and governance.
Increase and improve health-related financing, equitably and efficiently, and working to eliminate direct payments that are a barrier to access at the point of service.
Strengthen intersectoral coordination to address social determinants of health.