​​Transforming Health: The World Bank's Shift from Crisis Response to Building Health System Resilience in Latin America and the Caribbean​

Synopsis

​​​Transitioning from immediate response to the COVID-19 pandemic, the World Bank is spearheading a resilience-focused health systems transformation in Latin America and the Caribbean, emphasizing investments in quality primary health care and climate-smart, climate-resilient infrastructure.​​

Challenge

​​The COVID-19 pandemic exposed significant vulnerabilities in pandemic preparedness and response, healthcare infrastructure, and care provision across Latin America and the Caribbean (LAC). LAC's GDP contraction in 2020 hit 7 percent-the largest in the last 100 years and the worst worldwide. As of July 2022, LAC accounted for 13 percent of global cases and 1.5 million deaths, despite representing only 8.5 percent of the world's population. LAC spends an average of $1,155 per capita on health, less than one third of the Organisation for Economic Co-operation and Development (OECD) average of $3,999. The region has only 2.1 hospital beds per capita, much lower than the OECD average of 4.3. These underlying vulnerabilities are exacerbated by the region's exposure to climate-related disasters, underscoring the need for a comprehensive strategy to enhance the resilience of health systems and preparedness for future health emergencies.​

Approach

The World Bank's approach to building resilient health systems in Latin America and the Caribbean is informed by recommendations from Building Resilient Health Systems in Latin America and the Caribbean: Lessons Learned from the COVID-19 Pandemic and Walking the Talk: Reimagining Primary Health Care after COVID-19. These priorities-outlined in a ministerial statement signed by LAC health ministers in early 2023-call on finance ministers to further invest in cost-efficient interventions to strengthen the resilience of health systems and mental health outcomes by:

• Strengthening emergency prevention, preparedness and response: The World Bank is investing in better health emergency prevention, preparedness, and response, and ensuring effective collaboration in the face of public health and climate-related threats. These investments include, for example, procuring vaccines and essential medicines or equipment; constructing climate-resilient health infrastructure; enhancing laboratory services and surveillance systems; developing emergency preparedness and disaster plans; and providing trainings for health care workers on infection controls and prevention. Analytical services and technical advice have also been provided to conduct resilience and preparedness assessments, offer tailored policy recommendations, and help countries improve their public health data collection and analysis.

• Promoting resilient health financing: The World Bank is supporting the implementation of health financing reforms that drive better population health outcomes and financial protection, reduce waste and inefficiencies, and ensure the financial sustainability of health systems. This includes, for example, advocating for health taxes to boost government revenues and improve health outcomes, alongside increasing health spending to achieve effective Universal Health Coverage and transforming payment and purchasing mechanisms to bolster public health systems against future crises. For example, the World Bank has been supporting results-based financing operations to strengthen health systems and expand access in Argentina for nearly 20 years, from the original Plan Nacer project and its successors (including to the SUMAR Program, the recently approved Program for Results operation and the new Digital Health investment project in the Province of Buenos Aires.. This sustained approach has been a central element in Argentina's strategy to improve its public health system, serving as a strategic tool for organizational transformation, the strengthening of institutional capacities within the country's health system at the national and subnational level, and expanding access to healthcare particularly preventive care, for previously uninsured people and other vulnerable populations.

• Fostering human capital through high-quality primary health care (PHC): Enhancing PHC as the cornerstone of resilient health systems, supported by investments in telehealth and telemedicine to improve service delivery and system adaptability. For example, in the Dominican Republic, a $190 million International Bank for Reconstruction and Development (IBRD) loan is expected to help at least 250 PHC public healthcare facilities meet the criteria to obtain their accreditation. Similarly, the recently approved $200 million Program for Universal Primary Healthcare Coverage and Resilience operation in Chile and the $304.5 million Program for Improved Access to Effective Health Services for the Vulnerable and Enhanced Health System Resilience operation in Colombia exemplify the World Bank's strategic shift towards integrating resilience into health care planning and implementation, ensuring that health systems are robust enough to withstand and adapt to the growing challenges of global health threats and climate change. This approach is further evidenced by the World Bank's support to telemedicine efforts in countries such as Panama and Argentina, where digital health infrastructure can help bridge the gap in healthcare access during emergencies, but also improve everyday health service delivery. The recently formed World Bank/Pan-American Health Organization (PAHO) Lancet Commission on PHC and Resilience in Latin America and the Caribbean is supporting this agenda by collectively generating actionable knowledge to improve PHC resilience, ensuring that health systems are resilient to health shocks.

Dr. Lisa de León provides remote assistance from the contact center located in Panama City, Panama. Fotograph: Javier Conte for the World Bank

Results

​​Between March 2020 and June 2024, World Bank investments have contributed to important results in strengthening public health preparedness and in facilitating resilience in both health infrastructure and health financing.

​Strengthened preparedness and response for public health emergencies

​From March 2020 to February 2022, the World Bank approved more than $1.1 billion under 12 dedicated COVID-19 operations in LAC and reallocated an additional $300 million in existing resources to support an immediate response to the COVID-19 pandemic and to strengthen preparedness for future health emergencies. These resources supported 22 LAC countries in combatting the pandemic through a range of measures, including: construction of temporary facilities in Guatemala and El Salvador to increase care capacity during the pandemic; enhancement of laboratory services and surveillance systems, including through wastewater epidemiology, in Belize, Colombia, Haiti, Honduras, Mexico, St. Lucia, Dominica, Grenada, St. Vincent and the Grenadines, and Peru; and procurement of vital medical supplies and extensive vaccination campaigns to control the spread of the virus, including the delivery of more than 133 million COVID-19 vaccine doses in Argentina with 82.5 percent of the population fully vaccinated. Faced with high infection and mortality rates, particularly in the country's largest city, Guayaquil, the government of Ecuador set an ambitious goal to vaccinate 9 million people, over half the country's population, in just 100 days. This effort was supported by the World Bank, which provided crucial resources for the emergency response and vaccination process. The government's strategic use of these resources, along with its collaboration with international and local partners, facilitated the rapid immunization of the population while supporting the most vulnerable groups and promoting economic recovery.

​Resilient Infrastructure Development

​In response to the increasing impacts of climate change, the World Bank has funded activities aimed at making health infrastructure more adaptive to climate events and other disasters, while also mitigating health sector emissions. For example, the Sint Maarten Hospital Resiliency and Preparedness Project financed essential repairs to the island's only hospital following structural damage caused by Hurricane Irma. Upgrades included roof reinforcement and the installation of generators to ensure continuity of care during emergencies. The project also financed the installation of 108 seismic base isolators, a technology that will allow the building to withstand earthquakes up to a magnitude of six on the Richter scale. In 2023, the World Bank financed the installation of renewable energy systems in Haiti's five major health facilities and main laboratories in Les Cayes and Cap-Haitien. These systems have led to a 50 to 100 percent decrease in fuel consumption (depending on hospital size), freeing up an average of $1,200 per hospital per month, and enabling uninterrupted service during (increasingly frequent) power outages. Analytical work has also enhanced these efforts; for example, from August 2022 to September 2023, the World Bank used modeling and GIS techniques in Colombia to estimate the vulnerability of health facilities to primary climate change risks, informing the government's capital infrastructure investment plan for the health sector.

​Promote resilient health financing

​The World Bank has continued to emphasize the importance of maintaining and prioritizing health spending during economic recoveries to bolster public health systems for future crises. The 2023 paper "Health Financing in a Time of Global Shocks" analyzed government health spending in developing countries during the COVID-19 pandemic and emphasized the importance of resilient health financing amid global shocks. This includes advocating for taxes on alcohol, tobacco, sugary beverages, and ultra-processed foods in countries including Brazil, Colombia, Mexico, and Chile, as a means to enhance government revenue and reduce the prevalence of non-communicable diseases such as cancer, diabetes, and cardio-vascular diseases, reducing health inequalities and benefiting the poorest. In Colombia, for example, the World Bank provided technical assistance and financing for the preparation of a fiscal reform that included a new tax on sugar-sweetened beverages.

​In many LAC countries, purchasing arrangements for health services present opportunities for improvement, both through the prioritization of the most cost-effective services and the strengthening of provider incentives. In Argentina, for example, the Plan Nacer and SUMAR programs have, over 20 years, laid the foundation for a national policy that provides incentives to provincial governments and public health care providers and finances a prioritized benefit package of around 700 interventions that provides basic health coverage and quasi-insurance to the otherwise uninsured population. As a result, the number of people with effective health coverage reached 6 million by mid-2022.

​Foster human capital, including through high-performing PHC

​To build long-term resilience, the World Bank continues to focus on primary healthcare (PHC) as the backbone of the region's health systems, supporting significant improvements in the accessibility and quality of primary health care services. For example, the Costa Rica Program for Results operation supported the successful scale-up of the single digital health record (known as EDUS), from 50 percent of the country's PHC facilities in 2016 to 90.1 percent in 2023, increasing access to quality medical services by reducing equity gaps and promoting the interoperability of information across health platforms. The Panama Telemedicine Program, supported by the World Bank and the Japan International Cooperation Agency, served over 60,000 people with chronic diseases. The program significantly reduced travel time, waiting hours, and time off from work for medical appointments in 12 of Panama's 16 health regions. It also alleviated hospital congestion and improved access to healthcare services, particularly during the COVID-19 pandemic.​

(Data highlights as of September 2024)

One World Bank in Action

​​Engaging the private sector through the International Finance Corporation (IFC), the World Bank Group seeks to foster public-private partnerships, enhance regulatory frameworks, and drive innovation in healthcare provision. This work is exemplified in Colombia, where the World Bank and IFC supported the development of a national vaccine production multi-sectorial strategy that was endorsed by the government of Colombia on July 25, 2022. The World Bank plans to continue working closely with IFC to pursue investment opportunities to promote sub-regional alliances and integrated vaccine production systems in the region, focusing on vaccines of particular relevance for LAC countries (e.g., neglected tropical diseases). This will require combining a regional strategy with country-specific support and investments, while establishing a regulatory framework, enhancing local capacity for stewardship, boosting research and development capacity, improving cold chain logistics, and identifying vaccine demand and types.​

World Bank Group Contribution

​​Since the COVID-19 pandemic, the World Bank has doubled its financial support to the health sector in LAC. The World Bank's current Health, Nutrition, and Population portfolio in LAC totals $3.9 billion in commitments (comprising 28 projects), of which $2.3 billion (18 projects) are specifically aimed at strengthening the resilience of health systems in the region. In the 2024 fiscal year, the World Bank approved $790 million in new IBRD loans in Argentina, Brazil, Chile, Colombia, and the Dominican Republic, financing investments in PHC, telemedicine, and health information and surveillance systems, which are expected to contribute to the ability of health systems to effectively respond to future shocks, including those related to climate change. ​

Partnerships

​​The World Bank's strategic collaborations to bolster resilience in health systems across Latin America and the Caribbean involve a wide array of partnerships and initiatives.

• ​Concerted efforts with global entities such as COVAX, AVAT, and the PAHO Revolving Fund to ensure broad access to vaccines, including for one million migrants in Colombia through the Migration Development Policy Loan during the COVID-19 pandemic. Close coordination between the World Bank and other multilateral development banks, including the Inter-American Development Bank (IDB) and the Central American Bank for Economic Integration (CABEI), has enhanced these efforts, ensuring a unified approach to health emergencies.

• ​Concessional resources from the GAVI, Korea-World Bank Partnership (KWPF), Global Fund and the Global Concessional Financing Facility (GCFF) have reduced the cost of borrowing for World Bank clients and provided grants to governments to support project-financed activities. For example, in Colombia, the GCFF provided $37.6 million under the Improving Quality of Health Services operation to help provide better access to care for Venezuelan migrants. Engagements in wastewater epidemiology and the establishment of comprehensive health monitoring systems with private sector partners, including leaders like Biobot and Mathematica and supported by the KWPF and Global Water Security & Sanitation Partnership, have also been vital for early warning and response.

• ​The recently formed World Bank-PAHO Lancet Commission for the Americas aims to forge resilient PHC systems that are well-equipped to handle challenges like climate change and public health emergencies. Similarly, the Alliance for Primary Health Care (A4PHC), involving key stakeholders like PAHO and the IDB, focuses on enhancing PHC as the cornerstone of resilient health systems.​

Looking Ahead

The World Bank's strategic directions in the health sector in LAC primarily focus on enhancing health system resilience, integrating digital transformation for improved access and efficiency, and adopting a One Health approach encompassing human, animal, and environmental health. Building on successful long-term support through results-based financing operations in Argentina, the World Bank recently approved a Program for Results (PforR) for Argentina. This PforR will be pivotal in institutionalizing the SUMAR and Plan Nacer Programs, transitioning them from program-based initiatives to a national policy. This institutionalization process includes the adoption of effective instruments and good practices, ensuring the sustainability of these programs. On digitalization, the World Bank is supporting the government of Colombia-in close coordination with the IDB-to prepare a new lending operation on digital transformation that aims to enhance public health surveillance with a One Health focus and develop integrated early warning systems at sub-national level. In El Salvador, the World Bank is supporting the preparation of a new lending operation that aims to strengthen primary care and would incorporate advanced technologies, including AI tools (e.g., for data and medical imaging and management data analytics) to enhance emergency preparedness and resilience. Through the Guyana COVID-19 Emergency Response Project (with support of the Health Emergency Preparedness and Response Umbrella Program), the World Bank has collaborated with the Government of Guyana and technical partners to promote PPR strengthening through a One Health approach, generating momentum for preparation and endorsement of a National Action Plan for Health Security. In partnership with PAHO/WHO, the World Bank is also leading the preparation of the PROTECT Project (Pandemic Response Optimization Through Engaged Communities and Territories in South America), funded by the Pandemic Fund. The overarching goal of the PROTECT project is to enhance the capacity, preparedness, and commitment of the participating countries for early detection and response to future pandemics through inter-sectoral and multi-level stakeholder coordination and cooperation in the Amazon Basin. In particular, the analytical work that will be conducted by the World Bank intends to support the identification and prioritization of investments and policy reforms to enhance One Health approaches in select LAC countries.

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