Experts from PAHO/WHO, ECLAC and Rockefeller Foundation say Latin American experiences strengthen the evidence base for action going forward
Washington, D.C., 16 October 2014 (PAHO/WHO) — Representatives of the U.N. Economic Commission for Latin America and the Caribbean (ECLAC), the Rockefeller Foundation, the World Bank, The Lancet, and the Pan American Health Organization/World Health Organization (PAHO/WHO) said a new Lancet series on universal health coverage in Latin America, published today, provides evidence and lessons that can guide efforts toward achieving universal health coverage throughout the Americas and worldwide.
"Two and a half weeks ago, our member states unanimously approved an ambitious but doable strategy to advance the right of everyone to the highest attainable standard of physical and mental health," said PAHO Director Carissa F. Etienne, referring to the regional Strategy for Universal Access to Health and Universal Health Coverage, approved by ministers of health from throughout the Americas during PAHO's Directing Council meeting in early October. "Our region has had a unique path toward reaching universal health coverage, with different approaches and at different stages. This Lancet series comes at a fortunate time because it helps us to chronicle some of the challenges we have overcome over many years and helps us chart the way forward."
"We are moving from an era of health system strengthening to an era of universal health coverage, creating resilience in our societies," said Lancet Editor-in-Chief Richard Horton. Achieving universal health coverage, he said, is central to "ending preventable mortality."
The new Lancet series includes commentary and analysis of experiences in Latin American countries that have expanded access to health care for their populations historically and particularly in the past decade. The articles analyze different countries' experiences and lessons they provide on how to advance toward universal health coverage progressively and sustainably.
Jeanette Vega, Director of Chile's National Health Fund (FONASA) and coordinator of the special Lancet series, said that one of the lessons that can be drawn from Latin America's experience is that traditional social insurance schemes have failed to provide protection for the poor and workers in the informal sector. To finance systems that provide universal coverage, countries have had to move beyond traditional contributory schemes toward significant government subsidies. In addition, said Vega, advancing toward sustainable universal health coverage requires efforts to strengthen health systems to ensure equitable access to effective health services and also to enhance efficiency. Equally important is action beyond the health sector to address risks and social conditions that impact health.
Vega said the Latin American experience suggests the following actions that countries should take to advance further toward universal health coverage:
- Avoid separate coverage schemes for different population groups
- Progressively reduce out-of-pocket payments for heath care
- Increase financing for health and the proportion of financing that comes from government revenues
- Ensure "upstream" policies and programs that address the social conditions that impact health as well as "downstream" initiatives to reduce the burden of disease.
- Improve the training, availability, and distribution of human resources for health
- Strengthen key functions of the health system and government's role in guiding that system
- Invest in information systems, health systems research, and rigorous assessment
- Stimulate transparency, accountability, and social participation in the design, implementation and monitoring of efforts to advance toward universal health coverage.
Tim Evans, Senior Director for Health, Nutrition and Population Global Practice at the World Bank, said the new Lancet series shows that "there is no one-size-fits-all approach to universal health coverage. But when you look across countries, you see many common patterns emerging in their reforms. Learning from that is important within this region, but also beyond."
"The issue is not whether but how," said Michael Myers, Managing Director of the Rockefeller Foundation. "The fact that the rest of the world is working to catch up to Latin America should come as no surprise. The world is watching and learning from all that you do to advance universal health coverage."
