The Healthcare Sector Plays a Crucial Role in Times of Crisis

In recent decades, the world has experienced a series of extreme events. From economic periods of recession to political instability causing social conflicts, terrorism and wars. From health crises such as pandemics or plagues to natural disasters such as earthquakes, floods, hurricanes, droughts and heat waves.

Regarding the latter, the frequency of extreme natural phenomena is increasing and much of this is attributed to climate change. Latin America and the Caribbean (LAC), due to its geography and socioeconomic conditions, is considered to be at high risk from this kind of event. In LAC countries, more than 50% of the impoverished population lives in areas of high climate vulnerability; in Guatemala, Bolivia and Honduras this figure exceeds 80%.

What is the role of the health sector in the face of this type of crisis, and how can resilient health systems be achieved? These questions guided the last IDB Regional Policy Dialogue, where policy and decision-makers from the region gathered to review and discuss best practices and challenges for building adaptive social protection systems.

Shocks Have a Dual Impact on the Healthcare Sector: They Increase Demand While Reducing Supply Capacity

The demand increases due to serious injuries and intoxication, as well as the impact on mental health, to name but a few consequences. The population that flees to escape such events faces hypothermia, cardiovascular conditions, and complications during pregnancy and childbirth. Children under 5 years of age are among the most vulnerable due to contexts of resource constraints, limited access to goods and services, and stressful situations that compromise their future development (Tome and Bagolle 2023). Food scarcity, new infectious outbreaks, the spread of viral diseases and even an increase in the prevalence of chronic conditions exacerbate the situation, even more so in an adverse economic context.

The healthcare supply is affected by the direct effects of a shock. For example, in Peru, in the 2007 earthquake, 11 facilities were completely destroyed; in Mexico, in 2017, 129 structures were reported affected. The collapse of these affected the availability of beds, equipment, medicines and suitable facilities for medical care. Furthermore, healthcare personnel suffered injuries, in addition to facing restrictions on traveling to medical centers.

A New Approach: the Adaptive Comprehensive Strategy

In order to address and face future crises, we must work from a comprehensive strategy focused on proactivity instead of reactivity. As advocated by Adaptive Social Protection (ASP), this is a comprehensive strategy aiming to integrate Disaster Risk Management (DRM) and Climate Change Adaptation (CCA) policies into social protection actions. It promotes an anticipatory, rapid, and effective response before, during, and after events; in addition to an overall transition towards a more sustainable lifestyle. This requires ensuring adequate financing and establishing institutional frameworks to support these interventions: ten LAC countries have already published a financial strategy for disaster management, including Ecuador, Honduras, Panama and Peru.

Building a resilient system requires a cumulative process considering six fronts: i) leadership and governance of those responsible for designing and implementing policies, ii) the medical workforce, iii) health information systems, iv) infrastructure and medical supplies for care, v) service delivery programs and vi) financing).

Operational Framework for the Development of Resilient Healthcare Systems and their Role

The Vision: A Resilient Healthcare System

In order to protect the population against any contingency, it is necessary to establish the foundations for a resilient healthcare system. This entails great challenges and investment, but it is imperative to make the political decision to start building it. Some countries, such as Mexico, Chile and Brazil, have made this decision in the face of emergencies caused by natural disasters or health crises, as in the case of the pandemic. For example, in Mexico, after the 2017 earthquake, the government activated previously designed response plans and protocols. Each health center prepared for the mass reception of those affected: whenever possible, scheduled surgeries were postponed, patients who could continue their care from home were discharged, and patients in intensive care were transferred to general hospital wards. The objective was to free up space to quickly and safely accommodate emergency cases (Ahued-Ortega 2018).

In Rio de Janeiro, Brazil, during the COVID-19 pandemic, the Emergency Operations Center (COE) was activated in order to make evidence-based, timely and strategic decisions. They created and strengthened synergies among stakeholders and institutions that fostered the constant exchange of information on the population, diseases, external conditions of the area, and more. This allowed them to design robust contingency plans and mitigate risks related to extreme events even to the present day (Oliveira e Cruz et al. 2022.)

How can healthcare systems be strengthened to ensure adequate and timely care in the event of shocks? Lessons learned from multiple crises in different parts of the world point the way forward:

• Early warning systems: identifying and documenting high-risk areas and populations; defining internal and external monitoring variables;
• Decentralization of the healthcare system: ensuring a nationwide healthcare network with accessible health centers in all regions of the country and a strengthened primary care level, focusing on PHC;
• Resilient infrastructure: designing, constructing, and reinforcing healthcare facilities to sustain operational continuity, fully equipped and staffed with trained healthcare personnel before, during, and after events;
• Response and contingency plans: designing and deploying comprehensive contingency plans related to preparing temporary healthcare centers in different areas to continue healthcare provision; identifying alternative suppliers in case of shortage or failure of any; identifying and documenting safe zones where the population can relocate in the event of a disaster or risk event;
• Technological tools: i identifying and acquiring technologies that ensure healthcare delivery despite road disruptions and facility impacts (expansion of telehealth); and improving interoperable information systems aimed at trend analysis for timely decision-making.
• Communication and awareness strategies: designing stratified and personalized communication campaigns for different population groups, incorporating local culture; and
• Crisis financing schemes: designing a robust financing structure to support necessary actions during crises, ensuring a coordinated and comprehensive response.

In conclusion, the health system plays a critical role in times of crisis: it has the power to mitigate risks, restore and protect the overall health of the population. While there are challenges that must be analyzed in each context, there is a great opportunity to transform the current healthcare structure care in the region. Building a healthcare system based on a vision focused on primary care, strengthening leadership and governance of institutions, creating policies and institutional frameworks supporting an integrated system with highly trained personnel, and supported by a robust financing scheme, will be essential to achieve a resilient and sustainable healthcare system.

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