PAHO: Reform Needs Equity Focus

Health sector reform in Latin America and the Caribbean has increased efficiency and productivity in many countries but has not been as successful in increasing equity in health services provision, according to Daniel López-Acuña, director of program management for the Pan American Health Organization (PAHO).

"Greater equity in health status and access to health services was one of the guiding principles of health sector reform," López-Acuña said at a workshop in Washington, D.C., in March. "But only a few health sector reforms seem to be contributing to reducing the gaps in coverage of basic services and programs." As a result, the region today needs "a new generation of health sector reforms centered in people's health, not only on increasing the efficiency of services."

The event was part of a Technical Seminar Series on Health Systems Strengthening, sponsored by PAHO, Management Sciences for Health, the World Bank, USAID and the Global Health Council.

Health sector reforms first launched in the 1990s tended to emphasize economic factors, "relegating equity and public health concerns to a secondary level," said López-Acuña. As a result, "there are some 200 million people in Latin America and the Caribbean with no form of health insurance."

López-Acuña said the next generation of reforms should aim at:

• Insuring universal access to health services, regardless of patients' ability to pay.
• Reorienting health systems and services using health-promotion criteria.
• Improving the quality of care.
• Ensuring efficiency and inclusiveness in health financing and the allocation of resources.
• Promoting social participation.
• Training health personnel, to ensure that these changes are sustainable.
• Strengthening the steering role of public health authorities.

Ilona Kickbusch, PAHO senior advisor on the Millennium Development Goals (MDGs), noted that the MDGs should provide impetus for such reforms, by placing equity more squarely at the center of the development agenda.

"The MDGs point toward a new type of health policy process based on targeted development with specific goals and indicators." She added that the MDGs provide new opportunities for forming partnerships, mobilizing resources and identifying and overcoming bottlenecks in the region's health systems.

"The MDGs are not just about rich countries pumping more money into poorer countries. They're an ideal focus for addressing the determinants of health, creating synergies for health and addressing the contributions of health to countries' development," she said.