ILO highlights fragmentation and gaps in health in Latin America

Latin America's health systems are "highly fragmented" and maintain "significant gaps in coverage" between contributory social security affiliates and the rest of the population, the International Labour Organisation (ILO) said in a report presented on Tuesday.

The organisation, which has its regional headquarters in Lima, analysed the short-term health responses that Latin American countries have put in place to deal with the health emergency generated by the HIV/AIDS pandemic, as well as the "persistent challenges" facing the region.

He warned that achieving "universal and equitable access" to quality health services will require very careful management of fiscal policy in the context of the current economic crisis that is also hitting the continent.

"The gaps in coverage and quality of services between contributory social security affiliates and the rest of the population are still very large in these countries," said Pablo Casalí, a social protection specialist at the ILO's Andean Office, one of the authors of the report.

This is compounded by the low priority of public spending on health and efficiency problems, which generate "significant out-of-pocket expenses" to access health services or medicines.

Health systems in the region are also under-resourced in terms of human and physical resources, he added.

The report cited Brazil as "the most relevant case" in terms of systems without compulsory contributory health insurance, while Costa Rica is the "clearest and most traditional case of coordination between contributory and general revenue sources of financing for a homogeneous universal coverage system".

The ILO added that countries such as Uruguay and Colombia "had already advanced, before the pandemic, in important reforms" to eliminate fragmentation and gaps in coverage between contributory social security affiliates and the rest of the population.

In the case of Peru, Bolivia, Ecuador and Mexico, they had announced reforms in the same direction, but the organisation considered that "progress is not as significant as in the previous case".

The report mentioned that in the case of Chile, the reforms "tend to consolidate the gap or fragmentation between contributory and non-contributory insurance".

In Argentina, it added, coverage of the entire population was determined, but "the changes led to a greater degree of divergence and the system today has serious equity problems".

"The outbreak of the COVID-19 pandemic has made countries rethink the priority of health systems within each country," Casalí said.

The ILO stressed that the measures implemented during the health emergency have been "quite similar" in the region, and included the predominance of health policy in government agendas and public budgets, and the strengthening of the steering role of health ministries.

In addition, incentives for health personnel and centralised management of hospital infrastructure, accelerated incorporation of information and communication technologies (ICTs) into services, financial support for social security, in-kind transfers to vulnerable groups, and vaccine financing and procurement schemes.

Casalí said that "it is now time to think beyond the current crisis and define which long-term reform pathways will achieve universal and equitable access to quality health services", with "solidarity-based and sustainable" financing mechanisms.

The expert considered, in this sense, that when the health emergency passes, "some of these measures will gradually disappear", but said that "some of the elements (...) should remain and form the basis for more permanent changes".

Among these changes, the ILO mentioned the "revalorisation" of public policy, especially the stewardship of health ministries, and the incorporation of ICTs in health services.

"There is no ideal reform path. Each country must take the appropriate path, considering the fiscal space that the crisis allows and making the most efficient use of scarce resources, in order to move towards social protection policies that guarantee universal coverage and access to health services," the organisation concluded.