Two years of the COVID-19 pandemic in Latin America and the Caribbean: Reflections to move towards universal, comprehensive, sustainable and resilient health and social protection systems

The analysis of the evolution of the pandemic makes it clear that the health crisis has not been overcome and that uncertainty remains. This prolonged crisis has exposed not only the weaknesses of the region’s health and social protection systems, but also the centrality of health for social and economic development.

After March 11, 2020 the World Health Organization declared the coronavirus disease (COVID-19) pandemic, the deep health and social crisis unleashed by it has generated a great deterioration in the living conditions of the population. Still in force in the third year of the pandemic, the economic crisis that showed signs of recovery in 2021 projects a slowdown in 2022.

The structural inequalities in Latin America and the Caribbean position the region in a place of greater vulnerability to the pandemic, both in number of cases and deaths from COVID-19. “Two years of the COVID-19 pandemic in Latin America and the Caribbean” provides evidence regarding how the impact of the pandemic has been uneven between and within countries. Observing, for example, that excess mortality was higher in those countries with higher levels of poverty, extreme poverty (graph 1) and labor informality. In this sense, it shows how the structuring axes of the social inequality matrix are closely related to the unequal impact of the pandemic through the uneven distribution of the social determinants of health, and emphasizes the urgency of moving towards higher levels of articulation between the health and social protection systems.

Latin America (17 countries): excess mortality, according to extreme poverty, 2020-2021
(In deaths per 100,000 inhabitants and percentages)
Source: Prepared by the authors, based on the Institute for Health Metrics and Evaluation (IHME). COVID-19 Excess Mortality Estimates [base de datos en línea] https://ghdx.healthdata.org/record/ihme-data/covid_19_excess_mortality2020-2021 and CEPALSTAT [base de datos en línea] https://statistics.cepal.org/portal/cepalstat/index.html.
a Countries included: Argentina, Plurinational State of Bolivia, Brazil, Chile, Colombia, Costa Rica, Cuba, Dominican Republic, Ecuador, El Salvador, Guatemala, Mexico, Nicaragua, Panama, Paraguay, Peru, and Uruguay.

Towards comprehensive, sustainable and resilient health systems

The impacts of the pandemic on socioeconomic dimensions, such as the increase in poverty and the effect on household income and the labor market, are expected to worsen the unequal distribution of the social determinants of health, deepening inequalities in region. This situation is more worrying considering the profound impact that the pandemic has had on health systems. This emphasizes the need to move towards universal health systems that guarantee access and ensure the satisfaction of people’s basic needs, regardless of their employment status.

Along with recognizing the consequences of the crisis in the health system (displacement effect, accumulation of demand for non-COVID-19 pathologies, and duplicate demand), the countries highlight the need to continue addressing the pandemic through the primary care system, public health measures and the deployment of vaccination. The document presents how, during the first year of the pandemic, health financing policy reacted in the right direction, but with insufficient intensity and sustainability and with great variability between countries. Despite the increase in public spending and a reorganization of services, the problems of access and low financial protection could not be avoided and resulted, among others, in important impacts on health measured in excess of deaths. Increasing public spending on health is key to facing the structural changes required to be more resilient in the face of new crises.

Seven learnings from the pandemic

Initially, the measures to contain the spread of the virus in the region consisted exclusively of periods of confinement, social distancing, and the use of personal protective equipment, together with monetary support to comply with these measures. During the second year of the pandemic, vaccination against COVID-19 was added, this being the main health control tool. The slow and uneven progress that has characterized the vaccination process in the region suggests the need to strengthen regional cooperation and coordination mechanisms.

Seven lessons are learned from the analysis of the evolution of the pandemic and the vulnerabilities and strengths of health systems and their determinants in the region:

1. Health is central to inclusive social, economic and sustainable development.
2. There is a deep interdependence between the social, economic and environmental dimensions and, therefore, comprehensive health policies are required.
3. The inequality that has marked the vaccination processes highlights the importance of regional cooperation and coordination and international collaboration.
4. It is urgent to restructure the health systems in the region towards universality.
5. Health systems must advance in financial sustainability and increase public spending based on a new fiscal pact.
6. The reorganization of health services in integrated networks and primary care should be the main recipient of the new resources.
7. It is necessary to strengthen the resilience of health systems and accentuate efforts to have services close to the population and with the capacity to reach out to the community.