"We are all in the same sea, but we are not in the same boat."
The phrase of Dr. Jafet Arrieta, director and improvement advisor for the Institute for Healthcare Improvement (IHI), during the seventh edition of the Latin American Forum on Quality and Safety in Health, held in the city of Sao Paulo, Brazil, from 12 to September 15, 2022, synthesizes one of the punctual imprints of today's Latin American health panorama.
Unequal conditions, socioeconomic inequity and an imbalance within public, social and health system policies permeate and negatively impact the population of each different community in the region.
"We have to give each person what they need to resolve their clinical condition, and this is not being done," said Marcelo Pellizzari, director of the Department of Quality and Patient Safety at Hospital Universitario Austral, in Buenos Aires.
“In Argentina, for example, there are cities where there is an excess of MRI and CT equipment, and places where there is no radiology equipment.
The challenge is very deep and very basic at the same time.
And it is a great responsibility for everyone”, Pellizzari added.
In the forum, organized between the Sociedade Beneficente Israelita Brasileira Albert Einstein and the IHI, various specialist voices searched through discussions, collaborative work tables and the union of different specializations around ESG policies (Environment, Social Health and Governance, by its acronym in Spanish but known in the world as ESG), responses and strategic solutions that can trigger real, urgent and replicable transformations, for the benefit of the region.
Representatives of health organizations from Chile, Colombia, Argentina and Brazil discuss the problems of the sector in the region.Fábio H. Mendes
“Today, a large part of health is determined by where we are born, where we grew up: in the countryside, in the city, on the outskirts, in a favela, in a privileged place;
where we work, where we educate ourselves, what we eat, how we get to a health service”, observed the specialist Bernd Oberpaur, medical director of the German Clinic, in Chile, during a table on the Future Paths of the Health System in Latin America, with participants from Argentina, Brazil, Chile and Colombia.
Faced with this reality, in which socioeconomic conditions determine the quality of individual health, health institutions in the region have "three tasks," according to Oberpaur: "we have ears, we have hands, and we have a voice."
“Ears to listen inside, to our collaborators, and outside: 'what do our communities need and expect from us?'
Hands, when we have to act, and, ultimately, include the voice of those who also participate in health: education, urban planning, environment, work, housing, authorities, laws, financing... We have the responsibility to lower barriers and raise our voice," he emphasized.
Henry Gallardo Lozano, general director of the Hospital Fundación Santa Fe de Bogotá, highlighted the responsibility that health organizations have not only with patients and their families, but also with the communities in which they are found.
"We have to get out of our four walls and worry massively, with the knowledge we have about taking care of the health risks that are out there."
From the experience of the pandemic in Colombia, Gallardo Lozano shared lessons that he took from those complex days, which can be applied to current and future scenarios, both locally and for the entire region.
First, the amplification of the importance of people-centered work, referring to health personnel (doctors, technicians, stretcher bearers, nurses, specialists, etc.).
The director was also emphatic about the need for a Latin American system that is much more flexible and willing to change, where its operating structures are not an obstacle, but rather an ecosystem with a high and efficient response to the next crises to come.
Young people from the community of Paraisópolis, in São Paulo, Brazil, present a dance number during the forum.Fábio H. Mendes
Faced with the real detection of a transregional problem to overcome in a timely, immediate and comprehensive manner, the voice of Pellizzari, from the Hospital Universitario Austral, in Argentina, was clear and critical, referring to problems of bureaucracy, inequity and even corruption, which unfortunately permeate the reality of poor and incomplete access for the region.
“Access to a quality health system is very uneven, and it is a point to aim at in the region in an important way.
If there is a priority, that is it.
There is an inequitable distribution, from the beginning, and that means that whoever applies the care does not have enough tools to solve it,” said the Argentine specialist.
Local Efficiency, Regional Opportunity
The debate on the efficiency of health systems in providing quality care to the population also implies a review of their main characteristics.
In the case of Brazil, the disparities are evident: the population that makes use of a private health system uses four times more resources than one in the public sector.
“There is an efficiency problem: in the public system there is a lack of investment and it is possible that in a private one there is waste.
Both cases tell us about inefficiency”, points out Dr. Eliezer Silva, director of the Einstein Health System in Brazil.
“A large part of the investments should go to health promotion, prevention and primary care in both the public and private sectors.
In the public sector, primary care is insufficient, and in the private sector, people go directly to specialists – more tests are done, more procedures are done, and it's not necessarily because people are sicker,” says Silva.
Part of the solution is to convey to the population the importance of prevention and health promotion, and to invest more in primary care and family doctors, adds Silva.
“People learn that the most important thing is not taking exams, often unnecessarily, but that they need comprehensive care.”