Latin American Health Systems Research Articles

¿Sistemas de salud resilientes para países ya resilientes? Los discursos de la pandemia en la era post COVID-19

Abstract This study aimed to reconstruct and analyze the discourses of the pandemic in the post-COVID-19 era. The methodology was based on a critical review of the scientific literature on the pandemic, selecting 80 non-biomedical, clinical, or pharmacological articles published in journals indexed in Scopus or Web of Science from a sample of the 500 most cited scientific articles on the pandemic in Google Scholar. The theoretical approach was based on the debates on predictability, unpredictability, determination, and indeterminacy in the health and social sciences. As a result, six theses on the pandemic were identified and analyzed: a) the thesis of the unpredictability of pandemics; b) the thesis of pandemic denial; c) the thesis of the pandemic as a failure in predictability systems; d) the thesis of the prevention of catastrophic events with timely interventions; e) the thesis of the structural postponement of predictive care by non-developed countries; and f) the environmentalist-health thesis, of foreseeing a critical phase for the planet and humanity. We concluded on the limits of resilience as the center in preparing Latin American health systems in the post-pandemic.

COVID-19 in Latin America: inequalities and response capacity of health systems to health emergenciesCOVID-19 en América Latina: desigualdades y capacidad de respuesta de los sistemas de salud ante emergencias de salud

To identify correlations between COVID-19, demographic and socioeconomic characteristics, and the capacity of Latin American health systems to respond to health emergencies. An ecological study was performed using secondary data from 20 Latin American countries regarding incidence, mortality, testing and vaccination coverage for covid-19 from 2020 to 2021 as well as demographic and socioeconomic indicators. The preparedness of countries to respond to health emergencies was explored based on the 2019 State Party Self-Assessment Annual Report on the implementation of the International Health Regulations (IHR). Statistical analyses were performed using the Spearman correlation test (rho). A high positive correlation was noted between gross domestic product per capita and the human development index with the incidence of COVID-19, testing, and vaccination coverage; and between the proportion of elderly population and vaccination coverage. No correlations were identified between the covid-19 indicators and previous IHR implementation capacities. The lack of correlation between indicators related to COVID-19 and the ability to implement the IHR may reflect limitations of the indicators used or of the IHR monitoring tool as an instrument that induces the preparedness of countries to face health emergencies. The results suggest the importance of structural conditioning factors and the need for longitudinal, comparative, and qualitative studies to understand the factors that influenced the response of countries to COVID-19.

Trends in scientific output on artificial intelligence and health in Latin America in Scopus

Introduction: technological developments in artificial intelligence and health are necessary for Latin American health systems. Objective: to describe the trends in scientific production on artificial intelligence and health in Latin America in Scopus. Method: This is a retrospective bibliometric study of Latin American authors' scientific production on artificial intelligence and health in Scopus between 2012 and 2021. Production, visibility and impact indicators were used. VOSviewer and SciVal were used for data analysis. Results: 2871 articles were published, with a variation between 2012 and 2021 of 94.98%. 2,397 articles were original, and 2,741 were written in English. 58.3% were published in first-quartile journals, the most productive being Sensors (Ndoc=79) and Plos One (Ndoc=66). 64,128 citations were received (mean of 22.3 citations per article). Brazil was the most productive country (Ndoc=1420), and the institution was the University of São Paulo (Ndoc=288). 498 thematic groups were identified, and 1376 themes. 54% of the articles had international collaboration and 3.3% with academic-corporation collaboration. Conclusions: there is a growing scientific production on artificial intelligence and health in Latin America, written mainly in English, medical, engineering and computer science research areas, disseminated in specialized magazines in the first quartiles. Brazil and its institutions were the top producers. The main topics were predictive models and the application of artificial intelligence for classifying, diagnosing and treating diseases.

Measuring the performance of health systems in Latin America

Abstract Background Efficiency has been identified as a key intermediate policy objective for Universal Health Coverage. Despite that, it was estimated that 20 to 40% of health sector resource utilization is wasteful globally. An efficient use of existing resources in healthcare is critical and a priority policy in sustaining positive health outcomes for the population. This study aimed to perform a longitudinal efficiency analysis was found concerning health systems specific to all the Latin America region over the last 13 years. Methods Health Adjusted Life Expectancy (HALE), Diphtheria Pertussis Tetanus (DPT)Immunization and Survivability Rate of under-5 were chosen as outputs, while Pooled Health Expenditure, Gross Domestic Product (GDP) per Capita and Population over 65 were selected as inputs. Cross sectional Data Envelopment Analysis using five-year averages and a longitudinal Data Envelopment Analysis (DEA) were performed creating several model iterations with our selected indicators. All the models had an output orientation, adjusted for variable returns to scale and incorporating a five-year time lag between inputs and outputs. Results Our cross-sectional DEA Analysis found that the best performing country ended up being Nicaragua, followed by Cuba, Honduras, Costa Rica and Chile, while the countries performing the worst were Suriname, Venezuela and Guatemala. When observing efficiency scores behaviors longitudinally, all our model iterations result in the region decreasing efficiency in their health systems by 2.5% to 6.9% from 2000 to 2013, depending on the model chosen. Conclusions The study reveals that all countries in Latin American can improve their health systems efficiency performance to different extents. Latin America reduced total health system productivity between 2000 and 2013. Further studies are required to uncover the extent and causes of this regression. A similar analysis in Europe may be warranted and could aid policy making. Key messages • Overall efficiency in Latin American health systems has decreased by 3% to 7% over the last thirteen years. • Nicaragua, Cuba, Honduras and Costa Rica seem to have the most efficient health systems in the region, whereas Venezuela and Guatemala are the least efficient.

Embedded implementation research determinants in Latin American health systems.

ABSTRACTOBJECTIVE:To assess the determinants of embedded implementation research (EIR) conduct in seven Latin American and Caribbean countries.METHODS:This qualitative interpretative study conducted and analyzed 14 semi-structured interviews based on a grounded theory approach using Atlas-ti© 7.5.7. We grouped the conditions appointed by interviewees as determinants of EIR conduct into six domains.RESULTS:The participation of high-level engaged decision makers as research co-producers is an important EIR determinant that fosters research use. Nevertheless, EIR faces challenges such as dealing with key personnel changes and fluctuating political contexts.CONCLUSIONS:Despite its limitations, EIR is effective in creating a sense of ownership of research results among implementers, which helps bridge the gap between research and decision-making in health systems.

Peruvian health system: Proposal for a new model

ABSTRACTThis present study is carried out with the general objective of Proposing a New Health System Model based on the Praxeology of the actors that participate in the Health System Model of Peru, and as specific objectives (i) Analyze the Peruvian health system model from the subjectivities of its actors; (ii) Contrast jointly with the actors the models of Latin American health systems with the Peruvian health system model; (iii) Design the health system model for Peru from the perspective of the actors; (iv) Validate the proposed health system model for Peru; with reference to the bases of pragmatic paradigms, of complementarity, systemic, humanist and complexity. A mixed Derivative Sequential Exploratory study was conducted, contemplating the scope of transdisciplinary, projective research and multiple triangulation was applied. The study was presented in two successive phases, in the first, the theory based on the research method was chosen, 40 key participants were interviewed using the semi-structured in-depth interview; in the second, the exploratory research method, applying a questionnaire to 1308 participants nationwide. The results on the analysis, a negative rating was determined: degree of user satisfaction of 10.7%, and it was determined that 89.3% agree with what a reform to the current model. Regarding the comparison with other models, it is was found that 89.3% believe that reforms applied in other countries must be implemented in our country. About the design of the model, it was found that 89.3% of the participants prefer a combination between public and private; the 91.6% that should be emphasized the implementation of health determinants; the 37.2%, of the models presented, prefer the Bismarck Model. Accordingly, a praxeological model for the Peruvian health system is proposed, that relegates the dilemma of preferences between public and private, that considers a comprehensive approach to health determinants; and progressively towards a Bismarck model.

Paediatric cardiomyopathies: echocardiographic diagnosis, clinical profile, and demographic characteristics: the experience of a tertiary referral centre for Latin American paediatric cardiology.

Although multiple studies have been conducted in the adult population, there is a vast knowledge gap regarding the epidemiologic characteristics of cardiomyopathies in the paediatric population. This issue is even more crucial when the precarious situation of medical research in Latin America is considered. Given the potential impact that these disorders could have on Latin American health systems, a comprehensive epidemiologic study regarding the clinical profile and sociodemographic characteristics of these patients will influence the way we approach paediatric cardiomyopathies. An observational retrospective study was conducted at a tertiary referral centre for Colombian and Latin American paediatric cardiology. We analysed all cases of primary cardiomyopathies in children younger than 18 years of age who presented at our institution between 2010 and 2016. Cases of cardiomyopathies were classified according to World Health Organization guidelines. From a total of 29,533 children who attended our institution during the study period, 89 new cases of primary cardiomyopathies were identified. The median age at diagnosis was 11 years (interquartile range 4-9). Dilated cardiomyopathy accounted for 57.3% (n = 51) of cases; hypertrophic cardiomyopathy, 12.3% (n = 11); restrictive cardiomyopathy, 8.9% (n = 8); non-compacted cardiomyopathy, 7.8% (n = 7); arrhythmogenic ventricular cardiomyopathy, 6.7% (n = 6); and unspecified cardiomyopathy, 6.7% (n = 6). Heart failure was observed in 53.93% of the patients. The overall mortality was 12.36% (n = 11), which included two of eight patients who underwent cardiac transplantation.

Caracterización epidemiológica de familias con niños en condición de vulnerabilidad y riesgo de adquirir infección respiratoria Aguda (IRA)

Acute Respiratory Infections are one of the main causes of morbidity and mortality in children under 5 years of age and a warning sign for the Latin American Health Systems. This research has as general objective; Sociodemographic and epidemiological characterization in vulnerable families with children under 5 years of age at risk of acquiring Acute respiratory infection in two areas of Colombian geography identified by their social problems. A cross-sectional study was carried out with a mixed approach. The data collection instrument was the survey applied to the caregiver, arriving at the following conclusion: In the Zamorano neighborhood, belonging to Palmira commune 1, the percentage of Acute respiratory infection in children under 5 years of age is greater, with 40%, than in the commune 20 of Cali where the percentage was 32%, definitely influences the socioeconomic level to which they belong.

Comparing the performance of the public social security and private health sub-system in Rosario (Argentina) / Comparacion del desempeño de la seguridad social pública y del sub-sistema de salud privado en Rosario (Argentina)

Introduction: Latin American health systems are generally described as comprising three health sub-systems that segregate the population in separate segments. The private sub-system (PrS) is usually described as serving the rich population with high quality standards; the public sub-system (PubS) as serving the poor population with low quality standards; and the social security (SS) falling some place in between. We argue that this is an oversimplified picture that persists because of the lack and fragmentation of data and the failure to recognize changes occurred in the private health market during the last decades. This work compares the performance of the PubS, SS and PrS health services in Rosario city. The findings are intended to contribute to the reflection and the current efforts to move forward to integrated and PHC-based health systems and to achieve universal health access and coverage in Latin America. Theory/Methods: This cross-sectional study compares the performance of the PubS, SS and PrS through a household survey to a representative sample of 822 inhabitants of Rosario Municipality, stratified by age with a confidence interval of 95% and 3.5% precision. The questionnaire included questions on population health status and insurance, demographic and socio-economic conditions, health services use and perception for core dimensions and sub-dimensions of PHC performance. The individuals were assigned to a health sub-system based on their affiliation of the self-reported usual provider to one of the health sub-systems. We did not consider health insurance as a stratified variable because of the high percentage of people with more than one type of insurance, as well as insured individuals that use public services. Sub-systems were compared to look for significant differences in PHC performance and in demographic socio-economic and health status) using Chi Square analysis for categorical variables and one-way ANOVA test for numerical variables. We use a categorical nonlinear

Universal health coverage in Latin American countries: how to improve solidarity-based schemes

In this Health Policy we examine the association between the financing structure of health systems and universal health coverage. Latin American health systems encompass a wide range of financial sources, which translate into different solidarity-based schemes that combine contributory (payroll taxes) and non-contributory (general taxes) sources of financing. To move towards universal health coverage, solidarity-based schemes must heavily rely on countries' capacity to increase public expenditure in health. Improvement of solidarity-based schemes will need the expansion of mandatory universal insurance systems and strengthening of the public sector including increased fiscal expenditure. These actions demand a new model to integrate different sources of health-sector financing, including general tax revenue, social security contributions, and private expenditure. The extent of integration achieved among these sources will be the main determinant of solidarity and universal health coverage. The basic challenges for improvement of universal health coverage are not only to spend more on health, but also to reduce the proportion of out-of-pocket spending, which will need increased fiscal resources.

Late-life depression in Peru, Mexico and Venezuela: the 10/66 population-based study

The proportion of the global population aged 60 and over is increasing, more so in Latin America than any other region. Depression is common among elderly people and an important cause of disability worldwide. To estimate the prevalence and correlates of late-life depression, associated disability and access to treatment in five locations in Latin America. A one-phase cross-sectional survey of 5886 people aged 65 and over from urban and rural locations in Peru and Mexico and an urban site in Venezuela. Depression was identified according to DSM-IV and ICD-10 criteria, Geriatric Mental State-Automated Geriatric Examination for Computer Assisted Taxonomy (GMS-AGECAT) algorithm and EURO-D cut-off point. Poisson regression was used to estimate the independent associations of sociodemographic characteristics, economic circumstances and health status with ICD-10 depression. For DSM-IV major depression overall prevalence varied between 1.3% and 2.8% by site, for ICD-10 depressive episode between 4.5% and 5.1%, for GMS-AGECAT depression between 30.0% and 35.9% and for EURO-D depression between 26.1% and 31.2%; therefore, there was a considerable prevalence of clinically significant depression beyond that identified by ICD-10 and DSM-IV diagnostic criteria. Most older people with depression had never received treatment. Limiting physical impairments and a past history of depression were the two most consistent correlates of the ICD-10 depressive episode. The treatment gap poses a significant challenge for Latin American health systems, with their relatively weak primary care services and reliance on private specialists; local treatment trials could establish the cost-effectiveness of mental health investment in the government sector.

Lessons from local engagement in Latin American health systems

To examine the management of recent policies for stronger patient and public involvement in Latin American health systems, identifying common features and describing local practice examples of relevance to the UK. Participation is a core principle of many contemporary policies for health system reform. In Latin America, as in the UK, it is frequently associated with innovations in primary care services and their organizational developments. This shared interest in alternative models of local engagement offers new opportunities for collaborative research and policy development. Commissioned by UK policy makers, a 4-year research programme was designed to promote exchanges with international counterparts focusing on how modern reform policies are being implemented. The selected countries possessed comparable principles and timeframes for their reforms. A series of individual country case studies were undertaken. Data were drawn from literature and documentary reviews; semi-structured interviews with national policy makers and expert advisers; and with management representatives at local exemplar sites. The aggregate data were subjected to thematic analysis applying a model for sustainable development. Six common factors were identified in Latin American policies for stronger patient and public involvement. From these the most significant transferable learning for the UK relates to the position and status of professions and non-governmental agencies. Illustrative case exemplars were located in each of the eight countries studied.

Challenges to Latin-American health systems: what can be learned from the European experience?

This article compares the challenges of health systems in Latin America and the experience in Europe. The framework is the analysis of four functions: a) to generate resources; b) to produce activities; c) to finance, and d) to exercise stewardship. It is at this level where actors can influence health system responsiveness. Five challenges are identified in Latin America: a) to extend (prepayment and solidarity) financial protection; b) to stabilise that protection for crisis times; c) to equilibrate resources in accordance to capacity for financing services; d) to increase efficiency (technical and of placement) to produce services, and e) to improve the stewardship function in public and private sectors (the most important and difficult challenge Latin-American systems have nowadays). The experience of reform in Europe is analysed, showing: a) experiences about financial protection in Beveridge and Bismarck systems; b) stability in crisis times, recently confirm (West) and with important obstacles (East); c) efforts to equilibrate hospital beds and health care professionals, combining regulation and incentives; d) increase of efficiency in services production, with more express prioritisation, empowering patients, decentralising management and with market incentives, and e) improvement of stewardship with better (not less, sometimes even more) regulation. Three areas of European experience stand out: a) to combine solidarity with financial sustainability; b) to introduce market incentives in a measured way, but maintaining a clear stewardship role for the state, and c) to adopt innovations in organising and producing services. In spite of methodological difficulties, convergence of challenges and adopted solutions justify this analysis, but learning must be seen in each national context. A future article will analyse lessons offered by reform in Latin-American systems for European reforms.

Latin American health policy and additive reform: the case of Guatemala.

Until the mid-1960s, the market-based, dependent-development-conditioned structure of Latin American health systems reflected the skewed distribution of wealth in the region: most (including government) health resources were found in curative care medicine and were concentrated in the capital cities, where they primarily served the needs of the elite. But for many countries of the area, the 1964 PAHO-led efforts to introduce health planning, intended as a first step in rationalizing the health sector, marked a fundamental turning point in the structural development of their delivery systems. Since then, this commitment has been reaffirmed in the Latin American Ministers of Health's 1973 adoption of the primary care approach as the cornerstone of their national health plans, and their ongoing endorsement and pursuit of "Health For All by 2000." Guatemala, however, was and remains an exception. Guatemalan technocrats have proven unable to plan effectively. But, far more fundamentally, the Guatemalan oligarchy has proven unwilling to appropriate the resources necessary to effect change. The reforms that have been made have been the products of bilateral and multilateral agencies, which have conceptualized, promoted, designed, built, and underwritten them. Those changes have not altered the fundamental structure of the system, but instead have been tacked onto it, and exemplify what may be termed "additive reform." Evidence suggests that without the continued sponsorship, support, and guidance of the bilateral and multilateral agencies, even these "reforms" will prove evanescent.