The Healthcare System of El Salvador: How to Get Care as a French National

The Salvadoran healthcare system rests on three pillars: the public network, under the authority of the Ministry of Health; the Salvadoran Social Security Institute (ISSS), which covers registered workers and their dependants; and a paid private sector. The official sources consulted, including the PAHO health profile (not accessible during this verification) and the ministry websites (access denied), do not make it possible to give figures here on the number of facilities, the population covered or health expenditure: ask the ministry and the ISSS for them.

The World Bank describes a small dollarised economy, where care is paid for in US dollars, and stresses that access to quality jobs, that is, registered and affiliated ones, remains a challenge. For a foreigner, access to the ISSS in principle requires a registered employment contract, to be confirmed with the institute; otherwise, the private sector, international insurance or the CFE (the French expatriates’ health fund) are the options.

France Diplomatie cites no hospital or clinic on its El Salvador health page and indicates only that medical repatriation cover is required: it describes no evacuation procedure. The names of private clinics are not repeated here: the insurer or assistance provider communicates its network, and direct payment avoids paying up front when the facility is a partner. Ask for a written quote for a scheduled procedure, check the conditions of prior agreement and that medical evacuation and medical repatriation are in the contract.

France Diplomatie gives 911 for the police and 913 for the fire brigade, notably after a road accident. The health page publishes no ambulance number or list of hospitals: note the local medical numbers on arrival and confirm them with your insurer. The French contacts are the embassy in San Salvador (+503 2550 4444), which has no consular section, and the embassy in Guatemala (+502 23 57 24 06; emergencies outside office hours +502 52 02 20 22). First-line care is a public health centre or a private town doctor.

• Keep a list of the facilities accessible from where you live, especially outside the capital.
• Check with your insurer how long-term treatments are handled and the prior agreement required for scheduled procedures.
• Keep an identity document with you, as France Diplomatie recommends, including when going to the emergency department.

• Dengue: transmitted by the Aedes aegypti mosquito, present throughout the country; the mosquito proliferates in the rainy season; no curative treatment; anti-inflammatory drugs should be avoided.
• Chikungunya and zika: zika poses a risk in pregnancy; a woman who is pregnant or planning a pregnancy sees a doctor before travelling.
• Malaria: the WHO certified the country free in 2021, but cases are sometimes reported, notably in tourist areas; protect yourself from bites, especially at dusk and at night, and seek medical advice in the event of fever during or after the trip.
• Water, food, rabies, tuberculosis: typhoid through contaminated water or food; rabies to be prevented by avoiding contact with animals; airborne tuberculosis, with BCG vaccination and early screening.
• Vaccines: French schedule up to date; yellow fever required of travellers coming from endemic areas; hepatitis A and B, typhoid, rabies, tuberculosis for children under 15 on frequent or long stays, chikungunya and dengue depending on the situation.

See a doctor or an international vaccination centre well before departure.

In daily life, France Diplomatie recommends long, covering clothing, a skin repellent, impregnated mosquito nets or electric diffusers, and the removal of standing water where mosquitoes breed. On food, wash your hands often, eat well-cooked food, wash or peel fruit and vegetables and drink only safe water. Any fever occurring during the stay or in the weeks after returning calls for a quick consultation, mentioning the trip.

No social security agreement exists between France and El Salvador (CLEISS): the carte Vitale cannot be used. The options, depending on status, are the seconded employee’s retained scheme, the CFE and international health insurance. The detail is in the page on healthcare reimbursement in El Salvador, the guide to healthcare systems around the world and the El Salvador country page.

France Diplomatie describes dangerous driving, frequent accidents and night driving strongly advised against because of the lack of lighting. After an accident, do not move the vehicle before the insurer and the police arrive (911 for the police, 913 for the fire brigade); in the event of an accident causing injury, the driver must stay in the country until the courts decide and may be detained for 72 hours if no amicable agreement is reached. Helmets are compulsory for motorbikes, and reflective vests are required at night or in poor visibility.

On the Pacific coast, currents are dangerous: follow the flags and the lifeguards’ instructions and avoid swimming where few people are in the water. Climbing volcanoes without a local guide is advised against, even forbidden. These are the situations where evacuation and direct payment at a private hospital make the difference.

Zika poses a risk in pregnancy: see a doctor before travelling if you are pregnant or planning to be, and have any fever occurring during or in the weeks after the stay checked. Airborne tuberculosis calls for BCG vaccination and early screening, notably for children under 15 on frequent or long stays; rabies justifies vaccination of young children and of stays in rural or isolated areas.

For long-term treatment, plan for the medicines in their original packaging, with a prescription under the international non-proprietary name, and check that they are authorised in the country; care is paid for in US dollars, which should be reflected in the ceilings of your contract.

• Take out insurance covering care, hospitalisation, repatriation and evacuation; also check that you have sufficient funds to advance costs.
• Review the vaccination schedule and yellow fever, required of travellers coming from endemic areas.
• Protect yourself against mosquitoes (dengue present throughout the country) and against malaria, with cases sometimes reported.
• Note the numbers 911 and 913 and the contacts of the French embassy in San Salvador (+503 2550 4444) and in Guatemala (+502 23 57 24 06).
• Carry an identity document and keep copies of travel documents and the insurance contract.