International Seminar "Inequalities in access to health: the centrality of Primary Health Care to move towards universal health"

Background

The COVID-19 pandemic has been a historic opportunity to highlight the centrality of people’s health for sustainable development, made up of the intersection of inclusive economic development, inclusive social development and an environmental sustainability dimension (United Nations, 1987). The crises triggered by the pandemic revealed the way in which health promotes inclusive economic and social development, since only healthy populations can reach the potential of their capacities in these spheres. In turn, the unequal impact of the pandemic reminded us that health is subject to the economic, social and environmental conditions that allow people to live a healthy life and exercise their right to health, once again suggesting that health is essential for sustainable development. Therefore, strengthening health systems and investing in the health of the population is also investing in sustainable development.

For people to exercise their right to health, it is necessary to advance in its universal access. However, the health systems of Latin America and the Caribbean suffer from a series of structural weaknesses that, together with insufficient articulation with the social protection systems, hinder said access. In this area, the chronic underfinancing of health systems stands out, hand in hand with marked segmentation in coverage and high levels of fragmentation in care (ECLAC, 2022; ECLAC/PAHO, 2021; ECLAC/PAHO, 2020). These weaknesses translate into problems of sufficiency in access, inefficiency, coordination difficulties, lack of solidarity and situations of inequality, hindering effective universal access to health.

Despite global advances in terms of health coverage in recent decades in the region, great barriers to access to health still remain, preventing the effective enjoyment of the entire population (WHO/World Bank, 2021). Regional deficiencies are reproduced between and within countries, with the most vulnerable populations being those with the greatest difficulty in accessing sufficient levels of well-being, conditioned by the structuring axes of the matrix of social inequality (ECLAC, 2022). The gaps both in terms of access to health systems and with respect to health indicators are directly related to the social determinants of health, which are also unequally distributed in society through the determining axes of the social inequality matrix. . These determinants refer to the conditions in which people live and carry out their daily activities, which have an effect on the health of the population, such as education, income, housing, access to water and sanitation, employment characteristics and environmental conditions. , among others. Understanding health from this dynamic allows us to understand it as a multidimensional issue, which requires intersectoral interventions and integrated into broader development strategies (ECLAC, 2006).

The Economic Commission for Latin America and the Caribbean (ECLAC) has raised the need to transform health systems to transition to universal access and coverage from a rights-based approach and through a Primary Health Care (PHC) strategy, which respond to the specific and differentiated needs of people, increasing spending on public health, consolidating its financial sustainability and prioritizing the allocation of resources to the first level of care (ECLAC, 2022). Similarly, PHC should consider active participation and social dialogue, addressing the social determinants of health, intersectoral and interinstitutional coordination, and adaptability to the environment. The World Health Organization (WHO) has positioned the PHC strategy as the most inclusive, equitable, cost-effective and effective approach to improve people’s physical and mental health, as well as their social well-being (WHO/UNICEF, 2018 ). Building these types of systems is the first step for countries to move towards universal health access and coverage while reducing the fragmentation of their services. In line with the efforts made in recent years in the area of ​​PHC, the United Nations High-Level Commission on Universal Health in the 21st Century: 40 years of Alma-Ata, held in 2019, established the commitment of the countries, through through PAHO’s 30-30-30 Pact for Universal Health, to reinforce the strategy, under the recommendation to consolidate public spending on health of at least 6% of the Gross Domestic Product, eliminate access barriers by 30 % and allocate 30% of public resources to the primary level of care. Expanding PHC interventions, strengthening the response capacity of the first level of care in line with the recommendations of the Pan American Health Organization (PAHO, 2019), particularly in low- and middle-income countries, could save 60 million lives and increase life expectancy 3.7 years by 2030 (WHO, 2021).

ECLAC highlights the importance of improving the capacity of the countries of the region to design, adapt and implement strategies and policies aimed at advancing towards universal, comprehensive, sustainable and resilient health systems, to comply with the 2030 Agenda and better face catastrophic events of a diverse growing nature. Likewise, take advantage of new technologies and digital transformation for the inclusion of innovative tools that allow these commitments to be achieved. Within the framework of the United Nations Development Account project “Resilient health systems with universal coverage in Latin America and the Caribbean”, this International Seminar aims to review the experiences of different countries regarding universal access and coverage of health. In this instance, it seeks to delve into the main obstacles and barriers that the population faces in access, as well as the PHC strategy as a tool to achieve universal health, generating the opportunity to reflect together with authorities and/or specialists from each country about the main challenges facing their health systems regarding universality and the lessons and lessons learned from systems with a consolidated strategy.