Five high-yield investments to finance resilient health systems

The toll of the COVID-19 pandemic on health has been high in Latin America and the Caribbean (LAC): life expectancy has decreased by almost three years between 2019 and 2021 with a sharp reduction in population growth; mental health conditions have become much more prevalent, especially for the youth ; and the disruption of essential health services will have a long lasting effect on the health of populations. These impacts are documented in a recent World Bank report entitled Building Resilient Health Systems in Latin America and the Caribbean: Lessons Learned from the COVID-19 Pandemic.

To enhance the resilience of health systems and reduce the negative impact of future health crises, more resources are needed. A recent report from the OECD recommends an annual targeted investment of 1.4% of Gross Domestic Product (GDP) across OECD countries relative to their expenditure in 2019, with a focus on health workforce, prevention and key infrastructure. Yet, with shrinking health budgets following the COVID-19 crisis response, countries in LAC need to set priorities for high-yield resilience spending.

What is next for investments in health systems in Latin America and the Caribbean

Resilient health systems are aware of threats and of what drives risks, agile in responding to the evolving health needs of populations, absorptive to cushion health shocks including the consequences of climate change, adaptive to minimize disruptions to essential health services, and able to transform based on lessons learned. Enhancing the resilience of health systems is a condition to achieve effective universal health coverage for all. 

Building on the unprecedented level of innovations unleashed by the pandemic, the World Bank Report Building Resilient Health Systems in Latin America and the Caribbean: Lessons Learned from the COVID-19 Pandemic proposes five priority investments for governments to consider :

1. Achieve effective Universal Health Coverage through high-performing primary health care meeting the needs of the most vulnerable, better prevention and health promotion, empowered health workers, and enabling digital systems. For instance, authorizations for telemedicine services in Colombia grew by over 5-fold during the pandemic.
2. Ensure that health systems are emergency ready by investing in smart surveillance systems and coordination networks, building a multisectoral prevention and response system, investing in surge capacities including public health professionals, and leveraging primary health care for better surveillance and response. For example, during the pandemic, Peru achieved interoperability between the national health epidemiology system and the national laboratory system of the National Institute of Health, improving surveillance and coordination for better response.
3. Ensure adequate financing for health sector resiliency including the availability of surge financing, boosting health taxes in fiscal reforms, and investing in smart interventions for efficiency, disease prevention and better population health outcomes. For example, taxes on sugar-sweetened beverages have recently been implemented in Colombia and Chile, providing new sources of tax revenue, and reducing risk factors by influencing consumers behaviors.
4. Take a life course approach to investments in better human capital outcomes, commit to health and nutrition in the first 1,000 days of life; re-commit to vaccination for all, including adults; invest to reduce teen pregnancy and tackle risky behaviors; and invest in key multisectoral interventions promoting healthy longevity. For example, Uruguay has dramatically decreased adolescent fertility rates over the last decades through progressive policies, strong multisectoral responses, and active monitoring by civil society.
5. Build climate-resilient, climate-smart health systems by integrating public health, population health, and climate change surveillance systems; investing in adaptation efforts to provide essential services during future health crises and in efforts to reduce the health sector’s carbon footprint. For example, Costa Rica’s national plan addresses the links between climate change and health, and adaptation considerations for healthcare systems are referred to in detail in its Nationally Determined Contribution Climate Action Plan.

This set of priority investments is offered as a tool to help governments guide the prioritization of health sector investments—a process that will also require strong local and national leadership; dedicated and adequate health care infrastructure (including data infrastructure, models of care, and other interventions, all tailored to local contexts); and international collaboration to invest in regional and global public goods.

With its deep engagement in financing, analytics and technical assistance for health reforms in the region, including 18 active lending operations related to health systems resilience and a growing portfolio, the World Bank will continue to work with governments to contribute to the ability of health systems to effectively respond to various health shocks. 

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