What can COVID-19 teach us about building sustainable health systems in Latin America?

COVID-19 has shown us that, when it comes to the resiliency of health systems, it is never too early to plan. In Latin America, it is urgent that we look at the lessons the pandemic is teaching us and plan for the future, to build sustainable health systems that can meet the needs of its populations without compromising quality care in times of crises.

Having worked in the pharmaceutical industry for more than 25 years, most of them in Latin America, I understand the challenges are complex. Although there has been progress, the region has a history of not prioritizing health, creating deficiencies that challenge patients’ access to quality care. These include governance with a short-term vision, health system fragmentation that leads to work in silos, and a lack of investment in innovation that prevents optimal diagnosis and treatment and generates high out-of-pocket costs (see figure below).

The impact of the pandemic has proved that these challenges remain and shows us that, to meet the needs of the future, we need to advance on three key areas: optimizing health system infrastructure and efficiencies, investing in innovation and technology, and shifting from a model of disease management to health promotion.

The COVID-19 response has shown us that more effective and efficient health systems are possible when we can rely on multi-stakeholder collaboration and integral public health policies.

Increasingly, actors across industries and sectors recognize the health challenges that affect Latin America cannot be solved by one stakeholder alone. Innovative solutions that generate meaningful impact are enabled by the public and private sectors working together. When COVID-19 became a threat to public health, pharmaceutical companies, academics, health professionals, governments, NGOs and start-ups joined capacities and expertise to accelerate the development of diagnostic tests, treatments, vaccine candidates and other initiatives beyond the lab. When the speediness of response was critical to saving lives, coming together was crucial to delivering effective solutions.

At the same time, health systems needed public policies to facilitate the regulatory process and an accelerated delivery of these solutions. In Latin America, record-time approvals for COVID-19 diagnostic tests have allowed governments to understand the spread of the virus and make timely and informed decisions about responses such as social distancing measures and travel restrictions. This is an example of what is possible and an opportunity to rethink the approach to public policies.

The pandemic has shown that health is an essential part of social and economic development and has reinforced the need for more and better investment in health. It is a matter of both individual wellbeing and societal prosperity. We now have a clear reason for different government agencies – ministries of health, finance, education and others – to work together so that public policies can respond to the needs of the population in an integral way. The young political leaders of today will be a key driver of sustainability if they embrace this collaborative approach with a long-term vision.

When we think of innovation in health, the possibilities are endless. The pandemic has shown us that, as we prioritize efforts, we must invest in systems and technologies that support digital health solutions and data-based decision-making. One of the essential tools for the digitalization of healthcare systems is electronic health records (EHR); yet, while there has been progress, EHRs are still not widespread in Latin America.

Countries where EHRs are more established have benefitted from greater interoperability between health institutions, being able to seamlessly share and access a patient’s clinical history. This communication between systems supports quality care and more effective patient management. In the COVID-19 context, EHRs have facilitated telemedicine, allowing for remote monitoring of cases as well as continued care for patients with other conditions. Yet while EHRs are a way forward for increased access to health data, they are only one piece of the puzzle.

Health systems need complimentary digital health solutions across the healthcare spectrum to translate data into sustainable benefits for patients. In the face of a pandemic, access to timely and accurate data becomes exponentially more important, as it is essential for effective decision-making and coordinated actions. Uruguay and Costa Rica, for example, were able to quickly adapt existing digital technologies to track and register COVID-19 cases, assess risks and make data-driven decisions. As we look to the “new normal”, we must continue prioritizing the use of real-world evidence to better understand the impact and potential of medical solutions and to incorporate them into health systems effectively.

The success of digital tools and any other long-term solution depends on the transformation of health systems using a model that takes a patient-centric approach and which prioritizes health promotion.

Today, health systems are focused on disease management and are struggling to care for patients with existing conditions alongside COVID-19 patients, with services for noncommunicable diseases experiencing significant interruptions in Latin America. The Health in All Policies (HiAP) approach is one example of how we can prioritize health promotion by making health implications part of all policy decision-making, regardless of sector.

Nevertheless, health systems still need to be prepared for disease management, particularly in emergency situations. In low- and middle-income countries, responding to crises can be 36 times more costly than preparing for outbreaks. In addition to the economic hit, the lack of preparation also impacts quality care, as we are seeing with the limited capacity to respond to the increase in patients seeking care for COVID-19. Reinforcing health infrastructure with the right equipment and trained professionals supports a sustainable system that can effectively respond to health emergencies while continuing to care for existing patient populations.

We are in a pivotal moment for health systems and the actions taken today will determine the health systems we will leave behind for future generations. The pandemic is showing us the way forward. Now, we must come together to be successful on this journey.