By Kimberly Ramkhalawan
December 13, 2022
Coming out of the COVID 19 pandemic, the inequalities in access to health care was apparent and wide to the Caribbean and Latin America. From access to vaccines from international manufacturers to medicines needed to help combat the virus, all countries in the region faced some degree of struggle before attaining the much-needed inoculations for fighting the dread COVID 19 virus.
But to outgoing Director of PAHO Caribbean, Dr. Carissa Etienne, emerging from this period means, trying to come back by regaining strides made pre-pandemic. Speaking at a regional health conference to mark Universal health day on December 12th, under this year theme, “Build the world we want: a healthy future for all”, Dr Etienne in hosting observances remotely, and welcoming health ministers from across the region, described the day as “representing an opportunity for the region to reflect on the main challenges and the opportunities that the region of the Americas face to introduce the transformation changes necessary in health systems, based on the foundational health strategies of primary health care and underpinned by the values of equity, solidarity and mostly the right for health for all”.
She says “this year’s celebration comes at a time when countries are rebuilding from the impact of the COVID pandemic, at the same time confronting many other crises, including natural disasters and conflict, and a wave of foregone care and unmet health care needs generated by the disruption of the essential health care services over the past three years. Faced with this, countries are moving with urgency to implement policies and strategies to buffer and build social protection systems, while expanding the capacity of health systems and services that respond in a timely manner to health needs of the population, now and into the future”.
However, she urged health ministers to learn from what has passed, taking note of “the context of health and health systems prior to the pandemic and understand how that context impacted the capacity to respond during the pandemic”.
Dr Etienne remarked that prior to the COVID 19 Pandemic the region was making steady progress nearing the “achievement of universal access to health care and universal health coverage”. She noted that “systemic deficiencies and inequalities persisted, and gains were slow”, statistics that were recorded by the United Nations when it came to the region and its achievement of the SDG 3.8 on service coverage. This was seen to be improving as shown by the UN Service coverage index which increased from an average of 65,000 to 77,000, reaching the third highest average value across all WHO regions. Between 2017, the Americas was the only WHO region that experienced reductions in the incidents of catastrophic and impoverishing health spending.
But despite this progress, Dr Etienne said “inequalities in service coverage persisted and about a third of the population faced multiple barriers to access health services, a situation that was more prevalent among the most vulnerable populations throughout the region”.
PAHO has played a key role in supporting member states in responding to the COVID 19 Pandemic in the region of the Americas, and is working intensely with its countries right now on building sustainable and long term strategies for the post pandemic period with resiliency, inclusion and equity as drivers for health system transformations, Director Etienne says the “window for action is small”. She warns that while it is not known “when and where the next international public health emergency will hit”, PAHO says it aware that they have an obligation to act now, to strengthen preparedness, response and capacity, and to expand universal coverage for all. And while she notes that public spending slowly improved, it remained still insufficient and low priority was given to investments at the first level of care. This she says is “relevant because prioritizing the first level of care is a necessary condition to improve resolving capacity at access to health services for people and health communities”.
She says more needs to be done to stop the dependence of the region on the importation of health medicines and technologies from outside the region. The vulnerability of global supply chains in emergencies and the high degree of heterogeneity in the Americas in terms of COVID 19 vaccines research, development and production capacity. If we are to build the world that we want and ensure health for all, this region needs to urgently act if it to reverse the socio- economic and health losses caused by the pandemic and they also need to address the growing burden of foregone care and recover the loss from public health gains.
She says that PAHO is fully convinced that health sector reform with a view to achieving universal access to health and coverage based on a primary health care approach constitutes the foundation for building resilient health systems. This has since been able to prepare the health capacity to respond effectively to health crises to maintain core functions when a crisis hits and reorganize and transform if conditions are required.
In 2021, Dr Etienne says PAHO member states adopted the strategies of building resilient health systems and post COVID pandemic recovery to sustain and provide public health gains. This strategy is guiding its actions for the recovery of health systems and a recouperation of lost health funds and health gains. She added that “critical lines of actions have been identified via all countries and call for transforming health systems from the point of primary health care, strengthening leadership, stewardship and governance through its renewed focus on the essential public health functions, strengthening capacity of delivery health networks and increasing public health financing and social protection”.
Moving forward, she says member states are now “looking at leveraging the power of digital health to accelerate transformation, working across sectors so that everyone can benefit from digital health technology platforms”.
Countries have called for renewed efforts for research and innovations for vaccines medicines and other health technologies, inventory regulatory systems and promoting greater integration regional solidarity in these efforts.
She says this call has been heard, through the regional platform the for production of medicines and vaccines, launched with its partners last year, PAHO says it is supporting countries and projects to ensure that they have the necessary vaccines and medical products to respond to its health needs in pandemic times and beyond.
This overall framework provides with a path moving forward, with its approach the first to be launched by any WHO regional office and constituted the foundation for the action plan on health and resilience that was adopted by heads of state at the ninth summit of the Americas in June of last year.
And while it’s her last observance as Director of PAHO, Dr Etienne says she “leaves with great confidence and hope that countries can achieve when there is the will, as having witnessed the capacity of this organization to respond to its member states in times of the greatest public health emergency of their lifetime and she knows that they can act collectively in the interest of all people in the Americas, to truly build a better world and Americas for all, one that is health and one that is the right to truly become a reality”.
This year, the World Health Organisation, WHO, calls on the people, communities, and organizations of the world to take action to Forge the world we want: a healthy future for all. PAHO makes a call to resume the path towards universal health, in the recovery from the COVID-19 pandemic to build Resilient Health Systems, increasing their capacities to move decisively towards the SDGs and the 2030 agenda, move forward with a base on strong social protection and welfare states, preparing for eventual new public health emergencies. All this while maintaining essential health services based on integrated care that is centered on individuals, families, and communities.