Can We Do Better than Normal for Health?

In the third year of the COVID-19 pandemic it is easy to both remain stunned by the pandemic’s impact and long for some kind of normalcy. That is certainly true for health systems in Latin America and the Caribbean, which were hit hard and are struggling to recover.

But what should recovery look like? While it is tempting to be nostalgic about pre-pandemic times, those were not “good” old days for the region. Instead, as our Health Sector Framework notes, health systems performed poorly, falling short in terms of quality of care, efficiency, equity, and health outcomes. Many also had structural deficiencies and low resilience to crises.  In short, the old normal was not good for countries and people.

Going Beyond Normal

The IDB’s new Health Flagship report examines how to avoid a return to this unsatisfactory “old normal” and instead ensure that health systems work better for everyone. That was an urgent task before the pandemic, but it is even more critical now. The report describes the situation before the pandemic and offers new analysis based on what has happened. At the end, it lays out the priorities and actionable steps needed to go beyond the old normal.

In the old normal, prior to the pandemic, the region displayed both progress and problems. In many countries, access to care and financial risk protection improved but there were unresolved issues related to the growing importance of non-communicable and chronic diseases, insufficient and inefficient spending, and low quality of care. There were also fundamental weaknesses in core health systems functions, from payment systems and human resources to procurement and disease surveillance.

Insights on Utilization, Health, and Spending

The pandemic hit hard in terms of infections, deaths, and disruption. Along with the accompanying technical note, the Health Flagship report has three broad take-aways regarding the impact on non-COVID-19 health care services, health outcomes and health spending:

1. The pandemic disrupted health care utilization across the board, but with larger declines in services that may be considered less critical or easier to postpone, such as vaccinations, cancer screenings and chronic disease care. There were fewer disruptions for care that cannot be delayed, such as delivering babies. The declines are mostly due to demand and supply factors, such as avoiding health care facilities or over-stretched health systems. The need for health care decreased only for a few conditions, such as respiratory infections and traffic accidents, which may have benefited from policy responses, such as lower mobility or mask-wearing. 

• The health effects of the pandemic are substantial and will have long-term repercussions. Mortality and morbidity due to COVID-19 are sizeable and unequally distributed. There are also many indirect effects, from increased acute malnutrition in children to more undetected cancers. And with Long Covid, the pandemic also brought about a new condition that countries and health systems will need to confront.

• Health spending will need to rise to address the backlog of care, reestablish services and improve pandemic response and surveillance. Recent work commissioned by the IADB estimates that, in normal times, per-capita health spending would grow between 2-3 percent per year to 2050. The pandemic may further raise spending.

Overall, the pandemic had a devastating impact with long-term consequences that are both due to and contributing to the health systems’ pre-existing problems and vulnerabilities.  It also exacerbated inequalities and brought about new challenges.

Old issues, new priorities

The pandemic has increased the urgency for addressing long-standing issues in the region’s health systems, such as improving quality, efficiency, and equity. It was also a stark reminder that population health is the foundation for almost every social and economic activity. This central role of health demonstrates the need for greater social and government investment in health systems, including in resilience and pandemic preparedness. Such investments are part and parcel of a broader strategy to align with the (still incomplete) agenda of universal health coverage. The synergies are clear: for example, a strong primary care system can also improve disease surveillance. 

The report also highlights three issues that have not received much attention. First, at least some of the disease burden in the region, such as respiratory infections and traffic accidents, was reduced during the pandemic –which suggests that it could be avoided, for example through mask-wearing and improved hygiene. Second, regional integration and collaboration can enhance the production and procurement of equipment, drugs, and vaccines. And third, there is a large untapped potential from digital technologies, including the kinds of remote consultation by phone or computer that some countries were able to use to offset some reductions in healthcare utilization. This is another case where an action that enhances preparedness can also improve health system performance more broadly.

Toward a better normal

The COVID-19 pandemic has bluntly exposed deficiencies in the region’s health systems and generated new challenges and pressures. It has also illustrated the value of resilient and high-performing health systems to contain impacts on health and economies. This has put health at the top of the policy agenda, creating an unusual opportunity for fundamental reforms to go beyond normal – to be better prepared for the next crisis and make health systems work better for everyone.