Latin America Advisor

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How Has Covid-19 Forced Health Care to Restructure?

The Covid-19 pandemic has led to a restructuring of health services in Latin America and the Caribbean, according to a report by ECLAC and PAHO. The San Juan de Dios hospital in Santiago is pictured. // File Photo: Carlos Figueroa via Creative Commons. The Covid-19 pandemic has led to a restructuring of health services in Latin America and the Caribbean, according to a report by ECLAC and PAHO. The San Juan de Dios hospital in Santiago is pictured. // File Photo: Carlos Figueroa via Creative Commons.

The Covid-19 pandemic has led to a reorganization of health services across Latin America and the Caribbean. Among the most worrisome trends has been an increased disruption of essential primary health services, ECLAC and PAHO said in a joint report last month. This trend has harmed the well-being of individuals and communities, and is having serious repercussions for economic performance and social development in the region, the report added. What are the most important ways—negative or positive—that health systems and services in the region are being reorganized as a result of the pandemic? What types of investments in health services would lead to better economic and social conditions? What tools or best practices, such as diagnostics or data-sharing technologies, hold the most promise for the region’s recovery? How can these be used to address the Covid-19 Omicron variant, and what obstacles stand in the way of making the most of them?

Jarbas Barbosa, assistant director, and James Fitzgerald, director of health systems and services, both at the Pan American Health Organization: “The surge in health systems required to tackle Covid-19 in the Americas has resulted in a major reorganization of health services. Some countries in Latin America had to double capacity at the tertiary care level to address overwhelming needs in critical care, while struggling to ensure access to personal protective equipment, oxygen, essential medicines for intubation and, more recently, Covid-19 vaccines. The shift in focus and resource allocation including task shifting within the health work force, combined with implementation of public health measures, has significantly affected the delivery of non-Covid-19 essential health services. In the most recent PAHO survey, 46 percent of countries in the region continue to report significant disruption in health service delivery, affecting mother and child care, control and management of communicable disease, routine immunization and noncommunicable disease control and prevention. Although data is still limited, excess mortality and morbidity is rising. At the same time, innovation has occurred in the deployment of digital health technology at the primary care level, the organization of outreach services to the community, expansion of social protection mechanisms for health and the reorganization of service payment mechanisms. Pre-pandemic deficiencies in health systems need to be addressed, increasing public financing in health to reach 6 percent of public spending on health, allocating 30 percent to the primary health care level. Health systems’ transformation based on the primary health care strategy will increase capacity, access, equity and resiliency, addressing future health needs in Latin America and improving preparedness in the face of future pandemics and public health emergencies.”

Katherine E. Bliss, senior fellow at the CSIS Global Health Policy Center: “Even before the pandemic, many countries in the region struggled to prioritize primary health care and improve community-level access to quality, affordable health services. Average annual spending on public health was below the regional standard of 6 percent; there was a shortage of health care workers; and in many countries, a patchwork of private and public insurance schemes offered a fragmented set of inconsistent services. Regional coverage of the diphtheria-tetanus-pertussis vaccine (DTP3), an indicator of children’s access to the health system, had declined from 93 percent in 2012 to 80 percent in 2019. Covid-19 era disruptions have made reaching the goals of the region’s 2014 Universal Health Strategy even more elusive. During the pandemic, hospitals have diverted existing beds to accommodate Covid-19 patients or added new intensive care unit beds without investing in trained care providers. Broken supply chains and delays in the delivery of imported medicines have undermined access to care for chronic, noncommunicable diseases, a leading cause of death in the region. And in 2020, DTP3 coverage dropped to 77 percent, now placing a double burden on immunization providers, as they work to close the gap in routine coverage for children while delivering Covid-19 vaccines to adults. Committing to provide at least 30 percent of public health financing to primary health care, investing in training and retaining skilled health personnel and making better use of data to monitor for quality of care and equitable access to services can strengthen health systems and improve preparedness for future health emergencies.” 

Antonio Vergara, head of Diagnostics Latin America at Roche: “The Covid-19 pandemic has put health at the center of the discussion again. Most of the attention and resources of the sector have been focused, understandably, on immediate needs. However, this situation has triggered interruptions in care needed by patients with other diseases that also represent public health challenges. Therefore, this current situation should be taken as an opportunity not only to address unexpected events but also to protect people from long-standing diseases. In this sense, innovative diagnostics are essential as they have the potential not only to identify diseases at early stages but even in some cases to avoid them. We could also produce data that provides a better understanding of the conditions in order to predict risk factors for more people, assess the effectiveness of ongoing treatments, and/or adjust them accordingly, keeping in mind that diagnostics influence approximately 70 percent of clinical decisions. Despite this context, in Latin America, only 1 percent of the investment in the sector goes to this area. In a nutshell, diagnostics can contribute to creating more resilient health care systems with enhanced management of most public health challenges, ensuring a healthier society that is able to boost the development of Latin America and its recovery from the pandemic. To make this happen, collaborative work across sectors that articulates knowledge and resources into long-term plans oriented toward the sustainability of the health ecosystem is a must. We could leverage the power of data and innovation and comprehensive policies with a focus on better outcomes for patients.”

Ricardo Izurieta, professor at the College of Public Health at the University of South Florida: “The Covid-19 pandemic continues to upend the Latin American and world economy more than any other time in modern history. It forced international acceptance that economies depend on the health of our global and local communities. Hopefully, businesses have learned that health is not an expenditure but rather an investment. By investing in public health infrastructure and measures, the global economy will be reactivated, helping to curb the monetary effects of the current pandemic and others to come. Currently, SARS-CoV-2 found most countries’ health care systems unprepared to face such catastrophe. Economically driven politics created health systems with weak primary health care subsystems but expensive tertiary health care infrastructures. Due to a lack of investment in primary health care subsystems, the first line of defense during any pandemic, health care systems, failed. This caused an avalanche of complicated Covid-19 cases going into intensive care units of tertiary health care subsystems. Almost two years have passed since this pandemic began. But governments still fail to understand that like with a house, infectious disease control strategies cannot stand on one pillar for support (vaccines), but need at least four pillars to stand securely: 1.) vaccines; 2.) testing, tracking and isolation; 3.) repowering primary health care; and 4.) preventive measures, such as using masks and avoiding crowds. Furthermore, the brutal inequities globally, where resource-rich countries hoard vaccines, diagnostic tests and pharmacological therapeutics, prolong this pandemic. It is imperative for governmental, academic and industrial institutions to work together to decentralize the development (academia), manufacturing (industry) and procurement (government) of vaccines, rapid tests, variants sequencing, monoclonal antibodies and antivirals.”

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