Religious Beliefs. The Catholic church and Catholic beliefs are nominally central to Dominican culture. It is estimated that 98 percent of Dominicans are Catholic, even if not all of these people attend church regularly. Catholicism was introduced to the Dominican Republic by Columbus and the Spanish missionaries and has remained a force in Dominican society ever since. Toward the end of the twentieth century, the dominance of the Catholic church diminished because of a decrease in funding, a shortage of new priests, and a lack of social programs for the people. As a result, Protestant evangelical movements, with their emphasis on personal responsibility and family rejuvenation, economic entrepreneurship, and biblical fundamentalism, have been gaining support among some Dominicans. An unknown number of Dominicans practice synchronistic religions combining Catholicism and Vodun. Santería is also found among Dominicans.
Medicine. The Dominican Republic, like many other countries in Latin America and the Caribbean, has three parallel public health-care delivery systems. The largest is the government-funded Secretaria de Estado de Salud Publica y Asistencia Social (SESPAS), which serves the general population. Because of structural and economic constraints, SESPAS is concentrated in urban areas, has a focus on curative rather than preventive care, often has inoperative medical equipment, and is known for high absenteeism among physicians. These factors severely limit access to health care for the majority of Dominicans in the rural areas. This system, which is inadequate for the needs of the majority of Dominicans, is a result of the Spanish-colonial tradition and the biomedical system put into place by the United States during its occupation from 1916 to 1924. The other health-care delivery systems in the Dominican Republic are the Instituto Dominicano de Sequros Sociales (IDSS), which is a social-security health system, and the Instituto de Seguridad Social de las Fuerzas Armadas (ISSFAPOL), which provides health care to members of the armed forces. Private health care is also available, primarily in the urban centers.