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What is the future of health systems in Latin America?

. Aug 16, 2020
What is the future of health systems in Latin America? Public hospital in Villaguay, Entre Ríos, Argentina. Photo: Raota/Shutterstock

Health systems all across Latin America have been put under extreme stress tests during the Covid-19 pandemic. The lasting effects of the crisis are likely to persist for the region’s economy and society, but healthcare is also likely to suffer. “The Americas are at risk of losing years of health gains in a matter of months”, said Pan American Health Organization (PAHO) director Clarisse Etienne, during the organization’s weekly press briefing.

Experts point out that the economic and social consequences of the Covid-19 crisis will severely affect the region’s health systems in the long and short term. Among the immediate impacts on the health sector will be the return to regular routines in hospitals and health clinics.

</p> <p>“One big issue regards when society returns to normal and when people feel confident in going back to surgeries, and when hospitals will be ready and safe for these patients,” explains Zoe Dauth, senior manager at the Americas Society/Council of the Americas (AS/COA).</p> <p>The interruption and suspension of treatments for chronic or contagious diseases — such as diabetes, tuberculosis, and HIV — will also have an impact on regional healthcare. “Eleven countries in the Americas have less than three months&#8217; supply of antiretrovirals for HIV, and others are running short of tuberculosis medication,” said Ms. Etienne.</p> <p>In Brazil, there was a 40 percent reduction in tuberculosis diagnostic tests during the pandemic period, according to pulmonologist and research professor at Oswaldo Cruz Foundation (FioCruz) Margareth Dalcomo. “This will leave a deep legacy, with an impact on the incidence of these diseases,” she explains.</p> <h2>Deepening inequalities in Latin American health</h2> <p>The pandemic laid bare the inequalities in access and deficiencies in the region’s health systems, caused by decades of underfunding. Latin America invests about 3.7 percent of its GDP on health, half what is recommended by the Organization for Cooperation and Development (OECD).</p> <p>The Economic Commission for Latin America and the Caribbean (ECLAC) has predicted that the region’s GDP will contract by 9.1 percent this year, saying 83 million people could fall into extreme poverty. While this will pose a series of problems, experts say it is essential for Latin America to invest heavily in healthcare even in the face of this crisis.</p> <p>“Health systems need to be a priority from now on”, declared the Social Affairs Officer of ECLAC’s Social Development Division, Heidi Ullmann. According to the Economist Intelligence Unit (<a href="https://www.eiu.com/public/topical_report.aspx?campaignid=healthcarespending2020">EIU</a>), however, the world’s top 60 economies will <a href="https://brazilian.report/coronavirus-brazil-live-blog/2020/05/29/despite-pandemic-latin-america-to-spend-less-on-healthcare-this-year/">reduce healthcare spending</a> by 1.1 percent in 2020 (in U.S. Dollars). That trend is even worse in Latin America — the region is expected to decrease healthcare investment by 13.4 percent in 2020.</p> <p>EIU expects a recovery in late 2020, which will be carried over to 2021, when spending is predicted to go up by 11.2 percent. Plummeting healthcare investment in Latin America can be explained in part by the <a href="https://brazilian.report/latin-america/2020/05/06/more-imf-loans-in-latin-america-dig-up-troubled-memories/">devaluation of local currencies</a> in comparison to the U.S. Dollar, which has caused a “spending slump in dollar terms.”</p> <div class="flourish-embed flourish-chart" data-src="visualisation/2627871"><script src="https://public.flourish.studio/resources/embed.js"></script></div> <h2>Cooperation is the key</h2> <p>One strategy to address bottlenecks in the post-pandemic period is to galvanize cooperation between Latin American nations, which has fallen out of favor in recent years. “There needs to be regional strengthening, mainly for the development of technologies and to promote long-term economic recovery,” explained Ms. Ullmann.</p> <p>According to Zoe Dauth, one important lesson of the pandemic is countries&#8217; need to reduce their foreign dependence on medical and pharmaceutical supplies. “It is a great opportunity for countries to strengthen their domestic industries and diversify their trading partners so as not to depend only on China. Regional cooperation can be instrumental in this supply chain.”</p> <p>AS/COA represents the private sector and provides government officials with information to better understand key issues. In a recent report, the organization laid out a series of strategies for countries to build innovative and <a href="https://brazilian.report/power/2020/07/01/exclusive-health-spending-in-brazil-states-as-small-as-usd-20-cents-a-day/">sustainable health systems</a>.</p> <div class="flourish-embed flourish-chart" data-src="visualisation/3040215"><script src="https://public.flourish.studio/resources/embed.js"></script></div> <p>The first suggestion is for countries to shift their healthcare models from disease management to health promotion. Ms. Dauth writes “that the promotion of health is beneficial for the population and for governments because it helps to reduce the costs of treating diseases.”</p> <p>AS/COA also encourages investment in telemedicine and digital interventions, which have become all the more prominent during the Covid-19 pandemic. Ms. Dauth states that the time is right to further telemedicine, as it can &#8220;create more efficiency and a better allocation of funds in places where you have outlying regions, such as in Brazil.”</p> <p>Beyond this, the report calls for a transition to a care model centered on patients and the strengthening of regulatory capabilities to further public-private partnerships in health. Many Latin American countries have &#8216;mixed&#8217; health systems, with the public and private sector offering concurrent services. While this functions well in some countries, in others it has proved difficult to promote cooperation.</p> <p>“With the region facing a deep economic crisis, private capital will be very important. Countries such as Mexico, Brazil, Chile, and Colombia are very open to private investment,” wrote AS/COA&#8217;s senior manager.</p> <p>She also argues that “the public and private sectors need to align their incentives, so the expertise, management, and capital from the private sector can be sustainable.”</p> <p>However, ECLAC warns that such a partnership must be carried out carefully. Ms. Ulmann says that mixed health systems can contribute to social erosion. &#8220;There is a very strong perception of the difference between the service and the resources available in the public and private systems. This dramatic fragmentation contributes to health inequity in the country.” </p> <p>Such a situation can be seen in Brazil, which has a huge public health service that is dismissed by the middle class as slow and of poor quality, leading anyone with money to rely solely on private healthcare.

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Natália Scarabotto

Natália Scarabotto is a freelance journalist who covered the 2018 Venezuelan humanitarian crisis. She is a postgraduate student of Politics and International Affairs at the São Paulo Sociology and Politics Foundation (FESP-SP).

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