Executive Summary
The healthcare industry’s medical devices and equipment sector has consistently provided good prospects for U.S. exporters in Honduras. The market is highly dependent on imports, and U.S. medical products enjoy a high receptivity among local healthcare providers due to brand recognition and a perception of high quality. Among the top country suppliers are also the European Union (particularly Germany) and Japan. Although Honduras remains a key market for U.S. exporters in Central America, there is significant margin for improvement in its healthcare system and regulatory frameworks are still being consolidated. Due to a weaker economic outlook for 2019, the general import market is anticipated to experience a slowdown in the next two years.
Market Entry
U.S. medical equipment and devices have high receptivity in Honduras. Success in the Honduran market requires appointing a qualified agent or local distributor or establishing a local subsidiary for providing strategic commercial infrastructure. In general, experienced distributors for medical products should be able to cover the entire country. As in the United States, performing due diligence on potential partners is very important.
When entering the Honduran market, U.S. firms should also be prepared to meet some additional criteria to ensure product marketability, such as translating product information and instruction manuals into Spanish, as well as providing reliable after sales support. U.S. suppliers should also maintain close contact with local distributors to stay informed about market developments or new regulations and laws concerning their products or areas of interest.
The Ministry of Health (MOH) governs the sector, coordinates all health-related activities, sets health priorities, and charts the course of development efforts in the public and private subsectors. Product registration is handled through the newly established Sanitary Regulation Agency (ARSA). As part of the U.S.-Central America-Dominican Republic Free Trade Agreement (CAFTA-DR), most medical equipment, devices and pharmaceuticals enter Honduras duty-free, provided a U.S. certificate of origin is presented to Honduran customs. Most products are subject to a 15 percent sales tax. Product registration is conducted through ARSA and is required for all pharmaceuticals. Registered importers may fulfill the registration process as representatives of the U.S. company. Requirements for obtaining sanitary licenses for medical devices vary in accordance to product classification and risk categories.
Current Market Trends
Imports of medical equipment and devices have been steadily increasing, amounting to an estimated $36 million in 2018. In 2018, imports of pharmaceutical products totaled an estimated $505 million, up 4 percent from imports in 2017. Honduras has the fourth largest pharmaceutical market in Central America. Honduras’ economic performance continues to be moderately favorable, with an estimated 3.4 percent growth rate in 2019, though this has lowered compared to 3.7 percent during the previous year.
The market is price sensitive, especially in the public sector where limited funds cover a large segment of the population. The private sector is also price sensitive; however, it is far more likely for private sector buyers to consider recognized brands that have good quality and after-sales reputation. Public sector entities conduct most of their purchases through competitive bidding processes, and do not purchase used medical equipment. Many Honduran physicians have foreign post-graduate degrees and maintain regular contact with important international healthcare institutions, including those located in the United States.
Honduras’ public spending on health is approximately 4 percent of its GDP. International technical and financial cooperation plays a pivotal role in the Honduran economy and in the success of efforts to promote economic and social development within the framework of the Poverty Reduction Strategy and the Millennium Development Goals (MDGs). External financing, including external grants and loans, accounts for approximately 17 percent of the total budget. Some of the largest health non-reimbursable project funds have come from multilateral organizations such as the World Food Program, EU, United Nations Development Program (UNDP), and U.S., Japanese, and Swedish cooperation agencies. Reimbursable project funding has been sourced by the IADB, Spanish International Cooperation Agency (AECI), and the World Bank.
Honduras has a population of 9.5 million inhabitants, of which 50.7 percent are women, and 49.3 percent are men. There is a trend towards urbanization, with an estimated 46 percent of the population living in rural areas. Indigenous ethnic groups represent approximately 7 percent of the population. Life expectancy at birth is estimated at 71.1 years. Almost 38 percent of health services are provided to those between 20 and 49 years of age. Honduras’ young population (57 percent are under the age of 25) significantly influences the demand for products, although products serving the aging population are also likely to experience growth.
Hondurans increasingly suffer from diabetes, vascular disease, malignant neoplasm (uterine, breast, skin, stomach, ovarian cancer), influenza and pneumonia, hypertension, chronic renal insufficiency, chronic lower respiratory diseases, intestinal infectious diseases, and metabolic/nutritional diseases, among others. Vector-borne diseases (such as dengue and malaria) are still prevalent. Opportunities exist for technologies that avert or reduce incidences of these types of diseases, which also have a significant impact on healthcare expenditures.
Honduras’ epidemiologic profile is characterized by an increase in transmissible diseases, as well as prevalence of infectious diseases. Conditions related to the respiratory and digestive systems coexist with chronic degenerative conditions such as cancer and cardiovascular disease. In recent years, externally caused injuries (ECIs) have risen and are one of the country’s most pressing public health problems and a leading cause of years of life lost due to premature deaths, followed by chronic diseases and complications during childbirth and neonatal deaths. Strategies geared toward preventing and controlling major health problems include reduction of infant and maternal mortality and malnutrition rates, measles eradication, rubella elimination, ensuring the continued eradication of polio, control of transmission of diseases, increased emphasis on comprehensive children’s healthcare and expansion of the Integrated Management of Childhood Illness (IMCI) component within child health services, participation in the Roll Back Malaria and Stop TB initiatives spearheaded by the Pan American Health Organization/World Health Organization (PAHO/WHO), and control of sexually transmitted infections and Chagas’ disease. Major ongoing health programs by the Ministry of Public Health include the HIV/AIDS Prevention Program, Tuberculosis Control Program, Cervical Cancer Control Program, National Oral Health Program, and the Expanded Program on Immunization (PAI).
Best Prospects
A growing demand for Externally Caused Injury (ECI) care is currently exceeding the installed capacity of the public health services network, resulting in high investment costs at health facilities and hospitals that treat emergencies. The prevalence of transmissible and infectious diseases also has an impact on public health spending.
Among some of the best prospects for medical equipment and devices include: patient monitoring systems; orthopedic and fracture appliances; anesthetic instruments and appliances; surgical instruments and appliances; oxygen and fracture appliances; syringes; electro-diagnostic apparatus; basal metabolism and blood pressure apparatus; parts and accessories for electrocardiographs.
Market Size
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Healthcare spending (including investment)
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3.95%
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… as percent of GDP
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… of which spent on inpatient services (including long-term care)
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… of which spent on pharmaceuticals/consumables
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… of which spent on investments
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… of which spent on outpatient services
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Hospitals, Procedures, Healthcare Professionals UN:
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Number of hospitals
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2,371
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…Public
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29 hospitals (plus outpatient facilities)
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…Private
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1,130 (including medical centers, clinics, labs)
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Number of hospital beds
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7,000
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… available beds per capita
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0.8 per 1,000 population
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…of which in general hospitals
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…of which in specialized clinics and rehabilitation centers
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Number of surgical procedures
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Physicians
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10 physicians and 3.8 nurses/10,000 population
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…of which surgeons
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…of which internists
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…of which pediatricians
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Dentists
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2,141
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Demographics
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Population
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9,587,522
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Life expectancy men/women
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Total population: 71.3 years
Male: 69.6 years
Female: 73 years
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Infant mortality
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24 per 1,000 live births.
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Percent of population older than 65
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7%
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…projection, 2030
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Annual deaths
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5.3deaths/1,000 population
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…caused by [highest disease burden]
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Infectious/Chronic Diseases
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…caused by [second highest]
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Complications during childbirth and neonatal
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Prevalence of [fastest growing disease burden]
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Externally Caused Injuries (ECIs)
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Main Competitors
The Honduran market for medical equipment and devices is highly dependent on imports and major foreign suppliers are the United States (which accounts for over 40% of the market), Germany, and Japan. In the pharmaceutical sector, top suppliers include the United States, Mexico, and Guatemala. The distribution market in Honduras is moderately fragmented, with approximately 65 companies distributing medical products and devices, as well as over 30 pharmaceutical firms. The majority are small or medium-sized companies.
Current Demand
The health system in Honduras is comprised of a public and private sector. The public sector includes the Ministry of Public Health (MOH) and the Honduran Social Security Institute (IHSS). Approximately 37.1% of the working population is covered by the IHSS public health insurance system. It also encompasses other public institutions administering special regimes (such as the Military Hospital and the Honduran Childhood and Family Institute). The MOH has the country’s largest health facilities network, with 29 hospitals and 1,241 outpatient or maternal and child healthcare facilities. It is organized through 18 Departmental Health Regions and 2 Metropolitan Health Regions (one in the Central District-Tegucigalpa, and another one in San Pedro Sula). The only specialized public facilities are the Thorax Hospital and the Santa Rosita Psychiatric Hospital.
In addition to the two specialty hospitals located in the country’s largest cities, the IHSS has 10 outpatient facilities, with plans for further expansion. It delivers health care through in-house and outsourced services on three different levels: the primary level, providing family and community health services to enrolled social security beneficiaries; the secondary level, providing outpatient and hospital care by referral; and the tertiary level, consisting of the Tegucigalpa and San Pedro Sula specialty hospitals, treating patients referred by lower levels.
The private sector is dominated by a set of providers offering services paid mostly out-of-pocket. It is comprised of approximately 1,130 outlets, including medical centers, clinics, laboratories, and pharmacies. NGOs and other agencies and organizations operate 108 hospitals and 820 outpatient facilities. The country has high-tech laboratory and diagnostic imaging services located mainly in private facilities in large cities. Institutions providing prehospital emergency care in Honduras include the Honduran Red Cross, the Emergency Preparedness Committee (COPECO), and the Honduran Fire Department.
The health sector is highly segmented and faces shortages in the number of beds and personnel. According to a recent survey, approximately 47% of the population visits a health facility when feeling ill; of this group, 58% seek care at a Ministry of Health facility, 7% goes to an IHSS facility, 30% go to a private health facility, and the remainder consults community health workers and pharmacies. Honduras has over 7,000 hospital beds (an estimated 0.8 beds per 1,000 population). Of these, over 4,600 are located at the MOH facilities, 330 in IHSS facilities, 1,700 in the private for-profit subsector; and over 100 in facilities run by NGOs and other agencies. On average, there are 10 physicians and 14.3 nurses per 10,000 population.
Registration Process
The registration process for medical products is an essential first step for exporting companies. Product registration in Honduras is currently undergoing various reforms aimed at simplifying procedures and facilitating trade. It is conducted through a relatively new regulatory agency, ARSA, established in May 2017. Among the requirements for information to be submitted by exporting companies are: company address, product classification details, commercial and/or generic name, manufacturer, type of product, country of origin, packaging details, compliance with current labeling/technical norms, and free sale certificate for imported products. The complexity of the approval process depends on the risk classification of the imported product. Information is available at the Sanitary Regulation Agency (ARSA): www.arsa.gob.hn.
Reimbursement
Overall, almost 70% of health expenditures in Honduras are public spending and 30% are private expenditures. Health is financed by out-of-pocket spending, the National Treasury, international cooperation and, to a lesser extent, by companies who offer their employees private health insurance, while adhering to the requirement to contribute to the Honduran Social Security Institute (IHSS). It is estimated that approximately 3% of the entire population has private medical insurance coverage.
Barriers
A persistent obstacle is the country’s healthcare model which has an emphasis on recuperative care, and only a very limited preventive health component. Currently, major inequities in healthcare exist, and large segments of the population are excluded from accessing the benefits of healthcare or appropriate health technologies at an affordable cost. There is not enough coverage or quality of services delivered to the country’s scattered rural and urban population, and difficult socioeconomic conditions pose challenges to the national health system. A high poverty rate affects over 58% of Honduran households, and over 60% of the total population.
The population without health care is estimated at 30 percent, and over 80 percent of the population does not have health insurance. The weakness of the health information system in capturing epidemiological surveillance, health services, and vital statistics data is also a serious problem in Honduras. Improvements are also needed in capacity building for public health regulation and enforcement, as well as in human resources development and training in the Public Health system.
Procurement and Tenders
Government tenders in Honduras’ procurement system are listed through the National Procurement Information System: https://www.honducompras.gob.hn.
The United Nations Office for Project Services (UNOPS) supports the implementation of various procurement processes in Honduras’ healthcare sector, specifically for medicines and surgical devices. Additional information is available at https://www.unops.org and https://hn.one.un.org/.
Trade Events
At present, there are no medical trade shows being planned in Honduras. However, several importers/distributors regularly attend U.S.-based events such as FIME (https://www.fimeshow.com) in Miami, Medtrade (https://www.medtrade.com) in Atlanta, and Clinical Lab Expo (https://meeting.aacc.org/clinical-lab-expo).
U.S. Commercial Service Contact Information
Name: Rossana Lobo
Position: Senior Commercial Specialist
Email: Rossana.Lobo@trade.gov
Phone: +(504) 2236-9320
