Bureaucracy After the Dictatorship: PRAIS Is Buckling Under a «Lack of Political Will» and Chronic Underfunding

The program—vital for survivors of state violence—serves only a small share of its registered users, while the Ministry of Health (MINSAL) ignores calls for more professionals and resources.

Inaction by the Ministry of Health (MINSAL) and successive governments has condemned survivors of the dictatorship to a state of «painful resignation,» critics say, by refusing to provide the staff and funding the Comprehensive Health Care and Reparation Program (PRAIS) needs. The result is a system in collapse and the effective denial of the reparations the Chilean state promised. Fifty-two years after the coup, administrative bureaucracy has become a new penalty layered atop the lasting trauma of torture and exile.

Edmundo Jiles Fuenzalida, director of PRAIS Metropolitan South, is blunt: the program’s current inoperability stems from a «lack of political will» to secure a budget commensurate with the demand for care. Under Technical Standard No. 88, there are roughly 800,000 PRAIS users nationwide, yet on average the program reaches only 4% of them. The figure lays bare the state’s failure to meet its commitment to victims of human rights violations, whose comprehensive, no-cost care was formally recognized.

Delays in psychiatry and psychology—the core of reparation for those carrying extreme trauma—are among the most criticized failures. Waiting lists stretch six months to a year, turning a promise of care into daily anguish. According to Jiles, PRAIS cannot respond effectively because the country’s 29 teams are incomplete and lack the funding to hire enough clinicians and the new roles required by regulation—such as network managers, receptionists, and occupational therapists—to operate properly.

Demand for care is compounded by a surge in reports needed to request financial reparations and by judicial requests under the Plan for the Search of Disappeared Detainees. These requirements add to the paperwork and management burden on PRAIS teams, which are already underfunded by MINSAL, operating at the limit—and in some services covering just 2% of users. «The current budget does not cover the number of professionals required by the program’s technical standard,» the director says, placing responsibility squarely on budget instability and ministerial indifference.

The criticism points to a «historic debt» left unpaid over 35 years of democracy: there is still no «comprehensive reparation policy,» only fragmented measures that fail to coordinate with each other. At its core, reparation is a human rights obligation that should not be subject to budget cycles or the lack of interest of the government of the day.

The director of PRAIS Metropolitan South reflects: «In Chile there is no comprehensive reparation policy. The different reparation measures adopted do not respond to an integrated vision.»