Sharing Lessons from the Americas on Universal Health Coverage

Dr. Jeanette Vega & Dr. Carissa Etienne

From the launch in 1952 of Chile's landmark Universal Health System to Mexico's recent success in the last decade enrolling more than 50 million previously uninsured citizens, Latin America has been a pioneer in moving towards universal health coverage for its people. Though Latin America is an economically, politically, and culturally diverse region, we have declared to the world that achieving universal health coverage is entirely possible, in rich and poor countries alike.

Latin American nations recognized early on that health is fundamental to economic development and social cohesion. In recent years, the international community has gradually come to the same conclusion.

Today, more than 500 organizations from more than 100 countries are coming together to celebrate the world's first Universal Health Coverage (UHC) day, marking the two-year anniversary of a United Nations resolution, unanimously passed on 12 December 2012, endorsing universal health coverage as a pillar of sustainable development and global security.

The first-ever Universal Health Coverage Day is a time to celebrate Latin America's leadership and consider how we can help other regions of the world achieve universal health coverage. Latin America's approach to universal access to health, built on the principles of the right to highest attainable standard in health, equity, solidarity and collective action, can provide helpful lessons for other nations. The commitment of countries from the Region of the Americas to this approach was evident when, in October of this year, all Member States of the Pan American Health Organization strongly endorsed a Regional Strategy for Universal Access to Health and Universal Health Coverage.

Among the most important lessons is the importance of political leadership. In many Latin American countries, health reform grew out of democratic social movements demanding access to healthcare and health coverage as a key part of citizens' rights. As a result, countries like Brazil, Cuba, Chile Colombia and Argentina enshrined the right to health within their constitutions, while other nations created legal entitlements that held governments accountable for providing certain health services. Visionary political leaders have also played important roles, for example in Costa Rica, pushing forward health reforms as tools to address inequality and social segregation.

These reforms have had far-reaching impacts. For example, before Brazil established its Unified Health System (Sistema Único de Saúde) in 1988, only 30 million Brazilians had access to health services. Today, coverage reaches 75 percent of the population and 94 percent of all municipalities. Increased access to primary and emergency care through in Brazil has been associated with a number of health improvements, including a 71 percent drop in the infant mortality rate and a 43 percent reduction in the maternal mortality ratio between 1990 and 2010, according to the World Bank.

For many Latin American countries, the journey toward universal access and universal health coverage began with prioritizing the poorest and most vulnerable. For example, Mexico achieved significant success in 2003 when it established the program "Seguro Popular," which focuses on those most likely to be left without other forms of insurance. When Costa Rica began working toward universal coverage in the 1990s, it began by targeting lower income groups, rural households, and workers in the informal sector. Even today, with a strong UHC policy in place, the Costa Rican government focuses expenditures on the poorest citizens in order to ensure equity.

We have also learned that the progressive elimination of out-of-pocket fees is as an important part of addressing inequities in access to healthcare. In recent years, countries like Brazil, Uruguay, and Costa Rica have sought to increase public spending on health, which has in turn reduced the out-of-pocket expenses that can prevent poorer communities from accessing services.

Perhaps one of biggest lessons from Latin America is that there are many roads to success. Chile's system focuses on guaranteeing certain types of health procedures, while other countries, like Costa Rica and Uruguay, have organized care around the life cycle.

Today, many countries around the world are following in Latin America's footsteps. Global institutions such as The Rockefeller Foundation and, more recently, The World Bank, have elevated the benefits of UHC globally, and to date more than 80 countries have asked the World Health Organization for assistance in implementing universal health coverage. Within the Region of the Americas, PAHO/WHO is now working with countries to support health reform processes, preparing roadmaps towards Universal Access to Health and Universal Health Coverage. As the world prepares to develop its global agenda for development after 2015, universal health coverage must be an integral part of the global discussion. In this critical time in history, Latin America continues to consolidate its leadership role as a regional and global champion for every citizen's right to health.

Dr. Jeanette Vega is Director of FONASA, Chile's National Health Fund. Dr. Carissa Etienne is Director of the Pan American Health Organization