Ana Luíza Barezani Gomes
Gabriel Henrique Alves
Assistant Directors of UNODC 2017
In spite of the generalized structural weakness, there has been a shift in the realm of the healthcare discussion, especially in regards to accessibility and universal coverage. Although each country has chosen its own approach when dealing with health issues, it is safe to say that there has been a widespread attempt to provide health coverage to the whole population, particularly for those in the poorest regions (THE WORLD BANK, 2017).
Starting in the 1990s, reforms aimed at strengthening health systems to reduce inequalities in health access and outcomes focused on expansion of universal health coverage, especially for poor citizens. In Latin America, health-system reforms have produced a distinct approach to universal health coverage, underpinned by the principles of equity, solidarity, and collective action to overcome social inequalities (ATUN et al, 2014).
For the most part, high-quality healthcare is accessible to only the wealthier population. Health services, to a certain extent, start to be viewed more as a commodity, and less as a basic good, making them more expensive and restricted to a certain part of the population. Tackling this issue is also a way of contributing to the fight against the discrepancy between different social groups, which is a substantial problem in one of the most unequal regions in the world (IS GLOBAL, 2016).
Latin America has faced some challenges when approaching this issue. The demographic changes and the economic instability inherent to many countries appear to be a burden to the health system in the Latin American countries. With a falling birth rate and a growing life expectancy, the dynamics and treatment demands undergo some alterations, further straining the budget (IS GLOBAL, 2016). Moreover, the economic situation imposes a problem largely because of its impact on the funding of public programs. Debt and crisis are a handicap for the government, complicating their ability to allocate money for the health sector. Another consequence of the economic instability is unemployment rates, which in times of recession, can cause an overburden on the public health system because more people start to rely on it (ATUN et al, 2014).
Figure 1: Per-person income, total health expenditure, and health expenditure from public sources
Source: ATUN et al, 2014.
Countries such as Argentina, Brazil, Chile, Colombia, Uruguay, Cuba, Costa Rica, Mexico, Peru and Venezuela have undergone a shift in their approach to health care in an attempt to “strengthen their health systems and progress towards universal health coverage.” (ATUN et al, 2014). Furthermore, we discuss the specific situation of Colombia and Brazil.
The Health Care system in Brazil and Colombia: an inter-regional framework for comparison
The Brazilian Government is responsible for providing healthcare services in the country, and all legal citizens (including foreign residents) are entitled to free healthcare treatments at any public hospitals (ANGLOINFO, 2017). The Ministry of Health is responsible for all public health services being “in charge of organizing and outlining public plans and policies oriented to promote, prevent and assist the Brazilians’ health.” (PORTAL DA SAÚDE, 2017). One of its major responsibilities is the Unified Health System (Sistema Único de Saúde), commonly known as SUS, a publicly funded health system that provides basic services, which helps the majority of the Brazilian population, due to the fact that most of the population does not have condition to pay for private health care. It is considered that around 70% of the nation uses the SUS’s services, and the other part opted for private health plans because of its better quality (ANGLOINFO, 2017). As the country has one of the largest populations in the world and poverty is a big issue, the health system in Brazil is insufficient to account for the demand required by population. UN Brazil published in February of 2017 that the poverty level in Brazil increased in 2014, and it was also estimated 8,7% of population are living with poverty and 3,4% Brazilians are in extreme poverty (ONUBR, 2017).
Nevertheless, the UNBR[i] reported that with the crisis in Brazil and the falling employment rate, there is a large chance of these numbers increasing. Considering this, many people in Brazil won’t get a private plan of health care and most of them will depend on the public services, possibly leading to a collapse of system, on account of the contingent of Brazilians which would rely on this system and the lack of government resources (ONUBR, 2017).
As long as that, the country fights against the smuggling of drugs. In 2017, the office of UNODC Brazil, the Pan American Health Organization (PAHO) and the World Health Organization (WHO), reported on the imminence of compulsorily admitting, massively, people who use drugs in São Paulo, in view of the extreme condition of users of illicit drugs. In the report, the organizations urged for the consideration of the resolution of 2016 (ONUBR, 2017), in commitment to effectively addressing and countering the world drug problem, which recommends:
(1) the approach should be multilateral, with an integrated, balanced, comprehensive and evidence-based approach, through appropriate attention to people and communities for health protection; (2) in the field of health, it is decisive that any action is done voluntarily and consented by the people who need it, in order to prevent stigmatization and social exclusion; (3) respect, protect and promote all human rights, fundamental freedoms and the inherent dignity of all persons. (ONUBR, 2017; Resolution adopted by the General Assembly on 19 April 2016 – “Our joint commitment to effectively addressing and countering the world drug problem” (Our translation).
The recommendations made by the organization has as its purpose giving support to the countries in Latin America and strengthening the health care system, as can be seen in Brazil, which is a consequence of the bad infrastructure and politics to assist the population. Likewise in Brazil, the health care system in Colombia is not sufficient to attend the population, mainly because 97% of all health institutions is financed by the private sector and along with that, it was registered that an amount of 2,7 million Colombians don’t have access to health system (WHO, 2016).
In 2014, the country began to have troubles with the emergence of the chikunguya[ii], which attacked in 2015, around 359 725 people, and, in October of the same year, it was reported 80 793 cases of infection by the Zika Virus, those of which 14 365 were in pregnant women (WHO, 2016). The disease rises with 35 241 cases of malaria, registering 20 deaths in 2015. Therefore, the health care system in the country continues to not assist remote areas, such as indigenous populations or persons that came from Africa. The World Health Organization reported in 2016 that the “modern sanitation system coverage in urban areas is 92% while in rural areas it is 15%”. These numbers increase with the forced displacement, caused by the impact of armed conflict inside the country (WHO, 2016).
The WHO also reported in 2016, between 2010 and 2013, 2.7 million people were introduced to the health system reducing the infant mortality rate, and with this the Millennium Development Goal (MDG) was acquired until the time stipulated (17.47 per 1000 births in 2015).
Colombia adopted in 2012 a new integrated healthcare model (MIAS), which has the goal to improve the primary health care, helping families and community health care focus. The country has been receiving support from organizations such as the United Nations Development Assistance Framework (UNDAF), International Organization for Migration (IOM), United Nation Population Fund (UNFPA), Food and Agriculture Organization of United Nations (FAO), United Nations Children’s Fund (UNICEF), United Nations Development Programme (UNDP), United Nations Office on Drugs and Crime (UNODC), the International Atomic Energy Agency, as well as some international financial institutions such IMF, the Inter- American Development Bank and the World Bank and some donations from countries, like Spain, Germany, the United States of America, Switzerland, the Republic of Korea, the European Union, Israel, Japan, Canada, Finland, Norway and Ireland, to support the health system in Colombia with 4 goals (WHO, 2016):
(i) promoting access to affordable and equitably-priced quality medication; (ii) reshaping global drugs policies and giving a public health focus to national drugs policies;(iii) health promotion and public health management of chronic noncommunicable diseases; and(iv) capacity-building in the context of the International Health Regulations (IHR), by contributing its experience to development of the regional and global health agenda (WHO, 2016).
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[i] United Nations Brazil, or, in Portuguese, ONUBR.
[ii] Chikungunya is an illness caused by a virus that spreads through mosquito bites. The most common symptoms of chikungunya are fever and joint pain. Other symptoms may include headache, muscle pain, joint swelling, or rash.