Washington, DC, 30 September 2020 (PAHO/WHO)—Countries in the Region of the Americas have been making considerable progress in improving health systems’ resilience since 2016. Still, the COVID-19 pandemic has exposed structural deficiencies in health, social, and economic policies that need to be addressed to improve equity, political and social stability, and create the necessary conditions to support the development of robust, responsive, resilient, and people-centered health systems. These are some of the findings of the report on Resilient Health Systems published by the Pan American Health Organization (PAHO) during the 58th Directing Council.
The policy guidance document (CD55/9), adopted in 2016, provides a framework for reporting on advances in the development of resilient health systems in the Americas. Health systems in the Region have faced multiple and sustained challenges and crises stemming from public health events, natural disasters, and socio-political unrest, among other causes since the adoption of the document.
According to the Report, resilient health systems intrinsically contribute to individual and collective health, well-being, and improvements in equity through a whole-of-government and whole-of-society approach. The Report highlights that countries have taken significant steps to address the social determinants of health in order to achieve health and health equity. The 2030 Agenda for Sustainable Development, adopted by all United Nations (UN) Member States in 2015, is being translated into national and local policies and strategies.
The Report highlights the Region’s progress during the reporting period 2016 - 2019 in the adoption of action-oriented frameworks and strategies for disaster and risk reduction that contribute to the development of resilient health systems. As of February 2020, 33 Member States and six territories were monitoring the Plan of Action for Disaster Risk Reduction 2016-2021. Ten countries and territories have evaluated emergency and disaster risk in the health sector as a key element in strategic risk planning, and 18 countries and territories are updating their analysis of hazards, capacities, and vulnerabilities.
Furthermore, the Report states that countries of the Region have made considerable efforts to expand and strengthen their health systems, advancing towards the achievement of Universal Access to Health and Universal Health Coverage. During the reporting period 2016 to 2019, 34 countries and territories developed health strategies, plans, policies, and road maps to advance toward universal health. Of those, 26 countries included specific health financing policy options to address issues of equity, sustainability, and resilience.
The Region also reported an increase in public expenditure on health over the past five years, from an average of 3.8% to 4.2% of gross domestic product, contributing to improvements in access to health services, equity in health, and resilience in health systems. Investment in health systems is central to achieving resilience. Sustained investment in health systems preparedness is considerably more efficient than financing emergency responses when an event has happened. During the period, 35 countries updated their health expenditure estimates in the WHO Global Health Expenditure Database (GHED). Evidence from studies in 13 countries highlighted opportunities to create fiscal space for health but showed that economic growth alone is not sufficient to produce the resources needed to achieve health goals.
In addition, the Report highlights that countries continue to face critical challenges in transforming health systems and improve resilience. Segmentation and fragmentation of health systems persist, perpetuating inequities and barriers to access; out-of-pocket expenditures in health remain high, in particular for medicines and health technologies; coverage of health services remains low, in particular in rural and poorer peri-urban settings; and the health workforce continues to concentrate in urban centers and specialized health service delivery settings.
PAHO’s Report proposes eight actions to improve the resilience of health systems, taking into consideration the current context of the COVID-19 pandemic. It recommends that countries intensify the implementation of the International Health Regulations (IHR) core capacities integrated within a more systemic approach to strengthening the essential public health functions and risk reduction. Furthermore, the Report recommends assessing fiscal space for health and opportunities to improve efficiencies and promote the development of responsive and adaptive health systems and services, progressively eliminating out-of-pocket payments at the point of service, and increasing investment in health systems and public expenditure in health.