Foreword

Seven Latin American countries, Argentina, Brazil, Chile, Colombia, Costa Rica, Mexico and Peru (LAC-7) have made great efforts to strengthen their primary health care systems over the past decades. This contributed to some important health outcomes. Life expectancy at birth has increased in LAC-7 countries, reaching 78.5 years on average in 2019 (a gain of 3 years since 2000 compared to 3.6 years across other OECD countries). Infant mortality has been halved over the past two decades, going from 21 deaths per 1 000 live births in 2000 to 10.8 in 2020.

However, the COVID-19 pandemic inflected a large blow as shown by high rates of excess mortality in LAC-7 countries, that is, many more people died in the 2020 and 2021 in comparison with the average number of deaths in the five years before the pandemic. In Peru and Mexico, excess mortality were higher than in any other country in the world, twice to three times higher than the OECD average. The pandemic brought additional stress to health systems that already experienced important structural challenges, including a growing burden of chronic diseases, population ageing, high levels of social health inequality, under-investment and strong budgetary restrictions, and systemic inefficiencies.

Primary health care for resilient health systems in Latin America discusses how doubling down on primary health care is a cost-effective strategy to strengthening health systems, both to increase preparedness to future pandemics and to address the structural challenges in the region. A conceptual framework is used to analyse the performance of primary health care across LAC-7 and identify weaknesses along three core functions: health promotion and immunisation; providing regular exams and screening to identify diseases; and delivering routine care for underlying health conditions. For each of the three core functions, the report examines policies and actions that were implemented to absorb the impact of the COVID-19 pandemic, and to recover from it.

The COVID-19 pandemic revealed challenges in these LAC-7 health systems in maintaining routine care. Disruptions in routine vaccination, cancer screening and treatment show how primary health care systems were not resilient enough during the COVID-19 pandemic. Across LAC-7, for example, coverage of three doses of childhood vaccination for diphtheria, tetanus toxoid and pertussis (DTP3) at age one fell by 8% in 2020 compared to 2015-19. In Peru, a 50% drop in registered cancer cases was observed in 2020 when compared with the previous 4-year average, while in Chile treatment for cervical cancer was reduced by more than half between 2019 and 2020. These care disruptions are likely to impose high human and financial costs, including possible exacerbation of health complications and a worsening of the population health conditions which could reverse much of the gains in well-being and health achieved during the last two decades. To get ready for the future, LAC-7 countries will need to continue to expand primary health care and invest in the health workforce and the health information infrastructure. This is key for primary health care to be a strong first point of contact with the health system for everyone, and capable of delivering a wide range of critical health services.