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Salvadoran health professionals prevent privatization of health care, 2002-2003

Summary

From September 17, 2002 to June 2003, 700 doctors of the Salvadoran Social Security system and the Citizen Alliance Against Privatization ran a seven-month strike backed by eight mass “Marchas Blancas” (white marches) that forced President Francisco Flores to abandon his privatization plan and accept a final agreement banning privatization. [source: nv-database] The campaign scored 10 of 10 on the source’s rubric — full marks on demand achievement, survival, and growth. [source: nv-database]

Tactics used

Background

In 2002, the IMF and World Bank were pressuring El Salvador to privatize its public healthcare system. The 1999 ISSS strike had already shown that mass public opposition to privatization could be mobilized; services had gradually improved in the years since. [source: nv-database] Despite this, President Flores actively championed a privatization bill and sent it to the National Assembly on October 16, 2002, the day after the strikers began organizing opposition. [source: nv-database]

What happened

Seven hundred ISSS doctors, together with the Citizen Alliance Against Privatization, opened the strike on September 17, 2002. The first “Marcha Blanca” — so named because protesters wore white for healthcare and peace — drew middle- and lower-class supporters who feared losing guaranteed health coverage. [source: nv-database]

On October 16, the Assembly received Flores’s privatization bill. Opposition parties blocked the bill, and the next day the Assembly passed a decree prohibiting the privatization of healthcare. The president responded by threatening a veto on constitutional grounds. [source: nv-database]

On October 23, between 50,000 and 80,000 people rallied in San Salvador in the second and largest Marcha Blanca. Faced with the size of the protest, Flores backed away from the veto but proposed substantive changes to the law instead, which the strikers rejected. The strike continued. [source: nv-database]

A rally on November 15 drew thousands of additional health workers. Police subsequently fired tear gas, water cannons, and rubber bullets at protesters, injuring at least 15. On December 19 the National Assembly overturned the October 17 anti-privatization bill, leaving the option of privatization legally available; the government did not move to use the option. [source: nv-database]

By the end of January 2003, the government had replaced as many of the strikers as possible and announced it would no longer negotiate. When roughly 550 remaining doctors voted to return to work, the government refused to reinstate them. As a last resort, seven of the strikers launched an 11-day hunger strike on April 1. On April 12 the Legislative Assembly officially reinstated all strikers and promised no penalties for their seven-month action. [source: nv-database]

On May 28, 2003, all parties — the National Assembly, the social security workers, the unions, and the government — began formal negotiations. In June 2003, they signed an agreement officially ending the strike and Flores’s privatization attempt. [source: nv-database]

Key people & organizations

  • SIMETRISS — reactivated from the 1999 wave [source: nv-database]
  • Citizen Alliance Against Privatization — the cross-sector coalition [source: nv-database]
  • Isaías Cordero del Cid and Ricardo Monge — strike leaders [source: nv-database]
  • The 700 striking ISSS doctors [source: nv-database]
  • The seven hunger strikers of April 2003 [source: nv-database]
  • President Francisco Flores — who eventually conceded [source: nv-database]

Outcome

Verdict: won.

Flores abandoned his privatization plan, the National Assembly reinstated all 700 striking doctors, and a June 2003 agreement formally ended the campaign. [source: nv-database] The source scores it 6 of 6 on demand achievement, 1 of 1 on survival, and 3 of 3 on growth, for a total of 10 of 10. [source: nv-database]

Lessons

  • A sector that has won a strike before (here, 1999) is well-placed to repeat; institutional memory shortens the time to a working coalition [source: nv-database]
  • When the state tries to break a strike by mass replacement, persistence plus a dramatic escalation (here, a hunger strike at the very end) can force a retroactive reinstatement.
  • Color symbolism (white for healthcare and peace) gave a multi-class coalition a single visual identity that transcended union membership [source: nv-database]

Sources

Disclaimer: Included as a teaching example of campaign craft, not as endorsement.

Sources & verification

  • nv-database — grounding: primary — license: link-only / all-rights-reserved (ND-style; content paraphrased, not quoted)
  • Verified: 2026-07-04 by human

Last verified: 2026-07-09