When people seek medical care, they expect the health system to work as one. They expect their medical information to follow them, different providers to communicate with one another, and follow-up care to be available when they need it.
But that is not always the case.
— July 2026 —
Across much of Latin America and the Caribbean, patients often navigate fragmented systems. They repeat their medical histories, move between disconnected facilities, and can lose access to follow-up care along the way. The result is lower-quality care and less efficient use of limited health resources.
A common example highlights the challenge. A person living with hypertension arrives at a hospital emergency department during a health crisis, receives immediate treatment, and returns home. Yet the primary care clinic responsible for that person's long-term follow-up may never know the visit occurred. The services exist, but the system does not always connect them.
Addressing these gaps is one of the priorities behind ongoing health reforms in the Dominican Republic, where authorities are working to build a more integrated health system rooted in primary health care.
“The Dominican Republic's health system remains more hospital-centered than preventive,” said Ilka Adelina González, Director of Planning at the National Health Service. “One of our main challenges is a long-standing culture that tends to react to illness rather than prevent it. There are also limitations in communication between different levels of care, while many people continue to place greater trust in hospital services.”
To help address these challenges, the Dominican Republic became one of the first countries to join the Alliance for Primary Health Care in the Americas, a regional initiative launched in December 2023 by the Pan American Health Organization (PAHO), the Inter-American Development Bank (IDB), and the World Bank.
The Alliance seeks to strengthen health systems across the region through investment, innovation, and technical cooperation. Its goal is to improve coordination across services so that people receive seamless care throughout their lives, with primary health care serving as the foundation of transformation.
Primary health care includes the clinics, health centers, and community health teams that often serve as people's first point of contact with the health system. According to PAHO and the World Health Organization (WHO), strong primary care networks can address most common health needs throughout a person's life, often more than 80 percent of them, while bringing services closer to communities, emphasizing prevention, and reducing reliance on hospitals.
In practical terms, this means families can receive timely care closer to home, with greater continuity and a more person-centered approach, rather than navigating a fragmented system.
To date, the Alliance has helped align investment plans among PAHO, the World Bank, and the IDB, mobilizing more than US$1 billion to strengthen primary health care across the region. Eleven countries are now actively participating.
