The pandemic set back progress and revealed that health systems remain fragile and susceptible. It also confirmed the need to transform them to respond effectively to a crisis without disrupting essential health services.
December 2022
Health service coverage in the Americas region improved, albeit slowly, during the 20 years prior to the COVID-19 pandemic. In 2019, 77% of the population had health coverage compared to 65% in 2000. The availability of health workers increased and government investment in health grew by 1.1 percentage points. In almost two decades, average life expectancy at birth rose from 73.7 years in 2000 to 77 years in 2019.
But in the world's most unequal region, these gains were not for all, with a third of people continuing to face barriers to accessing care. The health workforce remained understaffed to meet demand, and difficulties persisted in accessing medicines and other technologies, despite improvements in state regulation and surveillance.
"These and other inequities were highlighted by the pandemic, which underscored the difficulty countries face in maintaining continuity of essential health services during a crisis," said James Fitzgerald, Director of Health Systems and Services at the Pan American Health Organization (PAHO).
Essential health services were disrupted and those receiving COVID-19 patients were overwhelmed by high demand. In many cases health care workers became infected with the virus or suffered mental health consequences. The pandemic claimed more than 2.8 million lives in the Americas.
But this challenge put the transformation of health systems back on the agenda of the region's governments. In September 2022, during PAHO's last Pan American Sanitary Conference, the Ministers of Health of the Americas agreed on a policy to transform health services toward integrated, non-fragmented care, ensuring seamless, quality, person-centered care.
"Universal health, based on primary care, is the pillar of a resilient health system," said Fitzgerald. "We are facing an opportunity to move forward in transforming our health systems so that all people have health coverage and access to health by 2030. We need to accelerate recovery from the pandemic," he emphasized.
Primary health care (PHC) is a strategy that allows healthcare providers to address people’s health problems throughout their lives, understanding their needs through a close link with the community and the continuous and integrated delivery of health services. Strong primary care is also key to better responding to the next pandemic.
PAHO has been working to strengthen primary health care since before the 1978 Alma-Ata International Conference on Primary Health Care in Kazakhstan. PAHO’s technical cooperation has made it possible to increase life expectancy, create immunization programs that have protected the lives and health of children and the entire family, and eliminate dangerous diseases such as smallpox, polio and rubella from the region.
Today, moving toward universal health requires greater investment. Most countries in Latin America and the Caribbean invest less than the minimum 6% of Gross Domestic Product (GDP) in health and allocate less than 30% of the health budget to the first level of care as recommended by PAHO.
"Many people believe that only large hospitals should be built and that they alone can solve their health problems, but that belief is false," said Ernesto Bascolo, PAHO Regional Advisor on Health Governance, Policy and Planning. "However, we must invest more in health services based on a strong first level of care, with the capacity to resolve problems and which coordinates and works in a network with centers and hospitals of greater complexity," he added.
Beyond financing, greater investment in human resources is required. It is estimated that 600,000 health professionals are still needed in the region, including doctors, nurses and midwives, dentists and pharmacists.
The pandemic magnified the importance of having health personnel to keep the system functioning, highlighting not only their quantity, but also their availability, distribution, physical and mental well-being, as well as their diverse expertise, access to supplies and equipment.
Shortages and inequity in access to essential drugs and other technologies limited or jeopardized the delivery of health services during the pandemic. This situation exposed the dependence of Latin America and the Caribbean on imports of medicines, medical supplies and technologies, and the urgency of deploying regional productive and technological capabilities.
In this regard, PAHO launched a platform that seeks to strengthen local systems to produce vaccines and other health technologies.
"The time to make up for the gains and get back on track to health for all is now and the path to achieve this is made up of resilient health systems and universal social protection," Fitzgerald concluded.
