ECLAC and PAHO call to prioritize investment in health to reduce inequality and achieve the SDGs in Latin America and the Caribbean

The Economic Commission for Latin America and the Caribbean (ECLAC) and the Pan American Health Organization (PAHO) today called on the countries of the region not to postpone health on the public agenda in the current post-pandemic period. Investment in this sector should be a priority, both due to the duty to guarantee the population’s right to health and due to its fundamental role in achieving inclusive social development in Latin America and the Caribbean, they indicated in a new joint report.

Six years after the deadline established to fulfill the 2030 Agenda for Sustainable Development, ECLAC and PAHO presented the policy document The urgency of investing in health systems in Latin America and the Caribbean to reduce inequality and achieve the Sustainable Development Goals (SDG), in which they point out that the coronavirus disease 2019 (COVID-19) pandemic, together with the development crisis in Latin America and the Caribbean, have created a situation that threatens the achievement of the SDGs in the region.

“The inequalities in access to health, the gaps in the quality of care received and the high out-of-pocket expenses incurred by the population not only reveal the urgency of increasing public spending on health, hand in hand with a efficient management of resources, but also reveal the need to advance the financial sustainability of investments to strengthen the resilience of health systems,” say ECLAC and PAHO. To achieve this, it is essential that countries can advance social agreements that are accompanied by solid fiscal pacts.

Although between 2000 and 2014 public spending on health in Latin America and the Caribbean increased by 25%, the average of said spending was 4.5% of GDP in 2021, a percentage still lower than the goal of at least 6 .0% of GDP proposed by PAHO/WHO.

In 2021, only 61% of the region’s total health spending corresponded to public spending, which reflects the importance that private spending still has in countries, with out-of-pocket spending being the main component. On average, the report says, households in the region had to cover more than 28% of total health spending with direct out-of-pocket payments in 2021, and 11 countries had out-of-pocket spending even higher than 35%. This figure is worrying, since out-of-pocket expenses reproduce inequalities in access and quality of care, and can translate into catastrophic or impoverishing expenses.

The document was presented by José Manuel Salazar-Xirinachs, Executive Secretary of ECLAC, and Jarbas Barbosa, Director of PAHO, with comments from Ximena Aguilera, Minister of Health of Chile.

“Today, Latin America and the Caribbean faces a development crisis, subject to three traps: low capacity to grow, high inequality and low mobility and social cohesion, and low institutional capacity and ineffective governance. In the health field, problems of chronic underfinancing, fragmentation and segmentation of health systems persist. Now more than ever, essential transformations are required in the region’s development models, with health being essential for the expansion of social protection and to move towards a more productive, inclusive and sustainable development,” said José Manuel Salazar-Xirinachs, Secretary ECLAC Executive.

For his part, Jarbas Barbosa, Director of PAHO, stressed that “overcoming the barriers to access to care, which today cause almost 3 out of every 10 people to have unmet health care needs in the region, is essential to meet the right to health and achieving universal health.” Furthermore, he emphasized that “countries must invest more and better, not only in hospitals and health centers, but in the appropriate combination of human resources, infrastructure, equipment, medicines and health technologies that guarantee quality care for all. The pandemic has taught us that we need stronger and more resilient health systems, and that we will only achieve this if we invest in it.”

The latest ECLAC projections indicate that only 22% of the SDG goals will be achieved in 2030, while 46% of them require greater speed to be met on time and 32% would not be achieved.

The setback in compliance with the SDGs due to the pandemic and cascading crises “is manifested in key health indicators, such as maternal mortality, immunization coverage and others associated with malnutrition and mental health,” the document specifies. set.

In the region, the high inequality resulting from the social determinants of health is reflected, for example, in the fact that the lowest income quintile has maternal mortality equivalent to more than seven times that of the highest income quintile. The same occurs with the mortality of girls and boys under 5 years of age: the most disadvantaged group in terms of income has around 4.5 times the risk of dying compared to the most economically advantaged group.

The above is repeated in the case of chronic non-communicable diseases: the most disadvantaged group has a 46% higher risk of dying between the ages of 30 and 69 from these diseases compared to the most advantaged group. Finally, data from 2019 indicate that the mortality rate attributed to unsafe water, poor sanitation and lack of hygiene is almost six times higher in the lowest income quintile, which reveals the effect of living conditions in the health of people.

Both ECLAC and PAHO highlight the relevance of the primary health care strategy, considering its three components—integrated services and essential public health functions, multisectoral action and social participation—as part of the transformation of health systems to reduce inequalities and address setbacks in the implementation of the 2030 Agenda. A comprehensive and intersectoral approach that coordinates health and the other components of social protection makes it possible to address the social determinants of health.

“It is essential to consolidate universal, comprehensive, sustainable and resilient health systems that guarantee universal access and coverage, provide timely and quality care to the entire population, regardless of their ability to pay, and have supportive and sustainable financing mechanisms. and capacity to adapt to changes and crises,” the document concludes.

The report presented today is the third publication prepared by both institutions, after the 2020 documents and 2021 dedicated to analyzing the impacts of the COVID-19 pandemic.