The criminal neglect of public health care systems across the Caribbean

By A.T. Freeman

One critical area of life in the Caribbean that the Covid 19 crisis has shed light on has been the criminal neglect of public health care systems across the region. Government after government in country after country have so neglected the public health care systems that these are not fit for purpose in the best of times and are totally incapable of responding to the challenges posed by any public health emergency.

This reality is laid bare by a recent publication of the United Nations Economic Commission for Latin America and the Caribbean (ECLAC). The report, entitled, “Latin America and the Caribbean and the COVID-19 pandemic: Economic and social effects” states the following about health care provision in the region.

Extracts from the report

  • The impacts on the health sector will be profound owing to shortages of skilled labour and medical supplies, and to escalating costs. Most countries have underinvested in health. Central government spending on the sector, which in 2018 stood at 2.2% of regional GDP (ECLAC, 2019; United Nations, 2020), is far from the 6% of GDP recommended by the Pan American Health Organization (PAHO) to reduce inequities and increase financial protection within the framework of universal access to health and universal health coverage. Additional resources would help to strengthen the first level of care, with an emphasis on disease prevention (PAHO, 2019).
  • Most countries of the region have weak and fragmented health systems, which do not guarantee the universal access needed to address the COVID-19 health crisis.
  • In general, health systems are organized through public sector services for people with low incomes, social security services for formal workers and private services for those who can afford them. As a result, health systems remain segregated and patently unequal, providing different services of varying quality to different population groups. Although reforms have been undertaken to reduce fragmentation and expand access, health system are still inadequate.
  • Moreover, health systems tend to be geographically centralized, with specialized services and physicians concentrated in a few urban centres.
  • The facilities are insufficient for the level of expected demand and are heavily dependent on imports of equipment and inputs. This is a major problem because, as at 11 March 2020, 24 countries around the world had already restricted exports of medical equipment, medicines or their ingredients (The Economist, 2020). In 2018, only seven countries of the region had significantly more hospital beds per 1,000 people than the world average.
  • There are wide gaps in access to health systems. Participation in health insurance plans for employed people aged 15 years and older was only 57.3% in 2016, and coverage was only 34.2% among the population in the lowest income decile. In addition, difficulties in accessing health facilities are acute in rural and remote areas.
  • The health systems in several countries of the region were already under pressure from the dengue epidemic: there were more than 3 million cases of dengue in 2019 (the highest number ever recorded in the region to date), with 1,538 deaths attributed to the disease. Brazil had the highest number of cases: 2.2 million people (PAHO, 2020).
  • The population covered by private health insurance could face high co-payments for access to coronavirus tests, which would be an obstacle to early detection. In 2016, out-of-pocket health expenditure by households as a proportion of total current health expenditure in Latin America and the Caribbean (37.6%) was more than double that of the European Union (15.7%) (WHO, 2017).
  • As the demographic structure of the region is quite young, the overall impact may be less than in developed countries. On average, only 10% of the population of Latin America and the Caribbean (almost 58 million people) is aged 65 years or older. The health systems of countries with a population distribution more skewed towards older adults, such as Barbados, Cuba, Uruguay, Aruba and Chile, could be put under greater pressure.

As working people, we must demand that sufficient funds are invested into public health care systems in the region so that these are fit for purpose in the 21st century. They need to provide all who live here with access to modern health care on a day to day basis and have the capacity to respond to public health emergencies like Covid 19.

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