It is time to transform health systems in Latin America and the Caribbean and advance in universality, comprehensiveness, sustainability and resilience

The COVID-19 pandemic has opened a window of opportunity to transform the health systems of Latin America and the Caribbean and advance in universality, comprehensiveness and financial sustainability, stated Chilean authorities and international specialists gathered at a seminar held this Wednesday, March 10. August at the headquarters of the Economic Commission for Latin America and the Caribbean (ECLAC) in Santiago, Chile.

The International Seminar: International learning and lessons to move towards universal, comprehensive and sustainable health systems featured opening remarks by Mario Cimoli, Acting Executive Secretary of ECLAC; María Begoña Yarza, Minister of Health of Chile; and Carissa F. Etienne, Director of the Pan American Health Organization (PAHO), moderated by Alberto Arenas de Mesa, Director of the Social Development Division of ECLAC.

During his speech, Mario Cimoli thanked the Chilean Ministry of Health for the trust placed in ECLAC by requesting technical assistance to support the process of reforming the national health system and emphasized that having universal access to health systems is crucial to advance towards development with equality in the region.

“You cannot grow with high productivity, global competitiveness and social inclusion if the population cannot access quality health care. That is what we mean when we talk about the inefficiency of inequality”, he remarked, adding that the ability of States to raise enough resources to finance universal, comprehensive, sustainable and resilient systems is key to carrying out the necessary reforms in the region, one of whose pillars should be the strengthening of primary health care.

The Chilean Minister of Health, María Begoña Yarza, thanked the various agencies of the United Nations System that support the reform process in Chile, including ECLAC and PAHO, for their work. “We came to this house, to ECLAC, to ask them to collaborate with the greatest challenge, after the 1952 reform, that Chile has in the field of health. And what we got was a generous reception from this organization, where development issues are discussed, because you can’t talk about development if you don’t talk about health,” she said.

In Chile, assured the Minister, health depends on people’s ability to pay, so one of the first challenges of the reform in process is to end the existing structural inequity and move towards a universal health system, she said.

For her part, Carissa F. Etienne, from PAHO, pointed out that “the data is clear: the region of the Americas reports the highest number of cases of COVID-19 and the highest number of deaths. Our public health infrastructure was not prepared and our health systems were fragmented, segmented and underfunded”.

The senior official stated that “the time has come to substantially transform our health systems, a transformation that must be guided by an exhaustive analysis of the performance of these systems during the pandemic and be based on the principle that everyone in this region has the right to Health”.

According to ECLAC data, public spending on health in Latin America and the Caribbean corresponds to 3.8% of GDP, far from the recommendation of 6% of GDP by the World Health Organization (WHO).

Along the same lines, 32.2% of total health spending in the region corresponds to household out-of-pocket spending (compared to 21% in OECD countries), with a third of Latin American and Caribbean countries with a share of out-of-pocket spending greater than 40% of total spending, which exposes the population to critical situations of financial vulnerability, particularly in the face of the sum of the crises that the region is experiencing (economic, health and social).

Health and social protection systems must be at the center of sustainable development strategies, ECLAC has stated, for which it is essential to consolidate a social pact focused on rights and equality, linked to a progressive fiscal pact that guarantees sustainability of health systems and progress towards a welfare state.

The event was organized by ECLAC in collaboration with the Chilean Ministry of Health, the Chilean National Health Fund (FONASA) and PAHO, within the framework of the technical assistance that ECLAC is providing to the Chilean Government in matters of health system reform.

The meeting aimed to learn about the experience of different regions and countries -such as Canada and Spain- that have more robust health systems and that are characterized by their universality, comprehensiveness and financial sustainability, as well as the main lessons and learning from those countries that They have recently implemented reforms.