{"id":14860,"date":"2024-10-31T13:12:39","date_gmt":"2024-10-31T12:12:39","guid":{"rendered":"https:\/\/saludporderecho.org\/?p=14860"},"modified":"2024-10-31T13:19:21","modified_gmt":"2024-10-31T12:19:21","slug":"strengthened-primary-care-is-the-foundation-of-a-resilient-health-system-that-guarantees-the-right-to-health","status":"publish","type":"post","link":"https:\/\/saludporderecho.org\/en\/strengthened-primary-care-is-the-foundation-of-a-resilient-health-system-that-guarantees-the-right-to-health\/","title":{"rendered":"“Strengthened primary care is the foundation of a resilient health system that guarantees the right to health”"},"content":{"rendered":"

A few days ago, we organized an event in Madrid in partnership with Fundaci\u00f3n Anesvad, Doctors Without Borders, and DNDi to discuss Neglected Tropical Diseases (NTDs), a group of 20 diseases affecting over one billion people worldwide, disproportionately impacting resource-poor populations in the most impoverished countries. They are termed “neglected” because they are overlooked by pharmaceutical R&D, as profit expectations are low, and are often excluded from national health programs and international funding.<\/span>\u00a0<\/span><\/p>\n

Throughout the various sessions, we recognized that, despite the efforts of recent years by the World Health Organization, governments of the most affected countries, and various philanthropic initiatives, funding to combat NTDs remains highly inadequate. The urgent need for increased R&D investment was also emphasized, promoting innovation models that prioritize access, technology transfer, and knowledge-sharing, along with the importance of integrating prevention, diagnosis, and treatment programs into health systems.<\/span>\u00a0<\/span><\/p>\n

The event featured interventions by Ant\u00f3n Leis, General Director of AECID; Dr. Jose Antonio Ruiz, a physician with the WHO\u2019s NTD program; and Dr. Jarbas Barbosa, Director of the Pan American Health Organization (PAHO), the WHO’s office for the Americas, with whom we discussed current health challenges ranging from NTDs to major pandemics, climate change, and access to new healthcare technologies.<\/span>\u00a0<\/span><\/p>\n

How is the situation, and how is the fight against the most neglected diseases on the planet unfolding in one of the regions most affected by them?<\/strong><\/p>\n

In Latin America and the Caribbean, we still face a significant burden of Neglected Tropical Diseases because, in reality, they are diseases affecting neglected people and groups. These diseases are closely linked to poverty, creating a vicious cycle: the poorest people are the most vulnerable to these diseases, and when they get sick, they become even poorer. It\u2019s a health issue but also a matter of equity.<\/span>\u00a0<\/span><\/p>\n

We have made significant progress with these diseases in the Americas, partly due to an elimination initiative approved by the region\u2019s countries in 2019, although everything was delayed by the pandemic. Last year, it was relaunched as one of the priorities under my leadership as PAHO director.<\/span>\u00a0<\/span><\/p>\n

There are several recent examples demonstrating these advancements: in the last five years, four countries have eliminated malaria. The latest was Belize last year, which also received, along with Saint Kitts and Nevis and Jamaica, a certification for eliminating mother-to-child transmission of HIV and syphilis. Or take Brazil, which recently received certification for eliminating Lymphatic Filariasis. Progress is being made, but challenges remain, such as identifying and overcoming barriers to ensure access to available treatments and diagnostic or preventive technologies.<\/span>\u00a0<\/span><\/p>\n

A challenge that, according to PAHO, involves strengthening health systems and primary care.\u00a0<\/strong><\/p>\n

We focus on avoiding vertical and isolated problem-solving, as was done in the past. The approach of single-disease detection and treatment campaigns must change. We need to pursue person-centered care that considers not just one aspect or disease but aims to provide comprehensive, sustainable care. These diseases, with their high prevalence, must be integrated into a wide range of health services that originate from primary care. Ultimately, we have the tools to combat these diseases; what\u2019s crucial is creating strategies to make these tools accessible to everyone in need.<\/span>\u00a0<\/span><\/p>\n

HIV, tuberculosis, and malaria may be less neglected among neglected diseases. Even so, we seem far from achieving the global goals for 2030. What are the main challenges in fighting these three major pandemics in the region?<\/strong><\/p>\n

These diseases have distinct profiles. Regarding malaria, we are making excellent progress with a strong elimination initiative in Central America. Many countries are close to elimination; even Suriname, in the Amazon basin, has gone three years without a local malaria case. There is significant progress in reducing cases, new strategies for treating asymptomatic individuals, and concerted efforts in vector control, along with faster access to diagnosis and treatment.<\/span>\u00a0<\/span><\/p>\n

We face various challenges, primarily climate change, which impacts all vector-borne diseases. Other challenges are different, like illegal mining in the Amazon, which forces many people to work without access to healthcare, turning treatments and diagnostics into commodities for buying and selling.<\/span>\u00a0<\/span><\/p>\n

For HIV, infections have risen by 4% since 2012, which may indicate strengthened diagnostic capacity. Mortality has decreased by over 34%, but challenges remain, and we need to implement new strategies more swiftly. For instance, self-tests for quick access to diagnosis or engaging vulnerable and marginalized communities, such as sex workers and transgender individuals, who face significant barriers to traditional healthcare services, often feeling unwelcome in conventional health units. We face additional cultural and legal challenges in some Caribbean countries where LGBTQ+ activities face laws that foster discrimination and stigma. We must ensure people\u2019s rights and that health systems have a greater willingness to introduce already available innovations.<\/span>\u00a0<\/span><\/p>\n

We also need to expand access to PrEP. We currently have around 160,000 people receiving treatment, but our goal is to reach nearly two million across the Americas to achieve better results in vulnerable groups, such as young men who have sex with men. We are working to procure PrEP at more accessible prices through PAHO\u2019s Strategic Fund, a joint purchasing mechanism for the region.<\/span>\u00a0<\/span><\/p>\n

And for tuberculosis?<\/strong><\/p>\n

I believe the main challenge is identifying innovative strategies for groups now concentrated in large cities like Lima or Rio de Janeiro, as well as in Latin American prisons, where inmates lack guaranteed access to healthcare. Some prisons hold 15,000 to 20,000 people without access to diagnosis or treatment.<\/span>\u00a0<\/span><\/p>\n

We need to find where the most tuberculosis-prone groups, mainly youth, are located. The previous strategy suggested, “if you have a cough lasting over three weeks, go to a health unit.” However, in Latin American countries, where many young people work informally, few will skip a day of work to visit a health unit for a cough alone. Thus, they worsen and spread the disease over time.<\/span>\u00a0<\/span><\/p>\n

For this reason, we are supporting countries with new interventions, like portable X-ray equipment that can be taken to prisons, construction sites, football fields, or other youth gathering spots with high prevalence rates. We need to overcome barriers and develop strategies to reach people, rather than waiting for them to visit health centers.<\/span>\u00a0<\/span><\/p>\n

Earlier, you mentioned climate change, which, according to the WHO, is the greatest environmental and health challenge we face. We\u2019re seeing an increase in vector-borne diseases, poor air quality, extreme weather events, and food insecurity\u2026 How is PAHO addressing this major threat?<\/strong><\/p>\n

Yes, it\u2019s a significant issue. During the first week of October, countries in the region approved a resolution to promote equity and respond to the impact of climate change on health. We are working on various approaches with countries. First, strengthening surveillance: many countries don\u2019t know the number of deaths due to poor air quality, so we\u2019re integrating and reinforcing surveillance systems, covering vector-borne diseases, environmental, air, and water quality issues. We\u2019re also working on resilience and preparedness. For instance, with Caribbean countries, we have a project called “Smart Hospitals” to increase resilience to hurricanes, now implemented in over 50 facilities.<\/span>\u00a0<\/span><\/p>\n

We\u2019re addressing the multiple dimensions brought on by climate change: prolonged droughts, direct impacts on food insecurity, immigration, and vector-borne diseases. Last year, we had a significant dengue outbreak with over six and a half million cases. This year, there are already 11 million cases, and the year isn\u2019t over. There\u2019s a major issue in Latin American cities: many lack necessary infrastructure. In poor areas, many people lack water access, resorting to various storage methods, which, combined with poor waste management, creates a favorable environment for Aedes aegypti, the mosquito that transmits dengue, Zika, and Chikungunya. We\u2019re therefore seeking a broader view of vector population reduction while strengthening health services to prevent dengue fatalities in the region.<\/span>\u00a0<\/span><\/p>\n

Climate change is critical, and we have high expectations for the COP30 meeting, set for 2025 in the Amazonian city of Bel\u00e9m do Par\u00e1, Brazil, a country with a strong commitment to placing health at the center of climate change action, seeking multi-sector solutions to this challenge.<\/span>\u00a0<\/span><\/p>\n

Given the rise in these diseases in the region\u2026 how is PAHO supporting access to advanced therapies in the Americas?<\/strong><\/p>\n

All countries in the region face significant challenges in accessing high-cost medications, such as CAR-T therapies, monoclonal antibodies, and other drugs. We\u2019ve agreed that a resolution on this issue will be passed next year, and we are helping countries develop policies, strengthen regulatory capacity, and enhance their own ability to evaluate the incorporation of new technologies. This is crucial because resources are limited, so we must seek the best options.<\/span>\u00a0<\/span><\/p>\n

At the request of countries in Mercosur, Central America, and the Caribbean, we are working on joint purchases through the region\u2019s strategic fund, focusing on seven high-cost diseases identified for joint procurement. This is important because Latin America and the Caribbean are undergoing a rapid demographic transition, with an aging population and a rise in non-communicable diseases like cancer. And with new technologies, careful assessment is necessary to incorporate them and ensure access while preventing increased inequality.<\/span>\u00a0<\/span><\/p>\n

In many cases, we see patients resorting to legal action to request treatments unavailable in the region. When a judge rules in their favor, the Ministry often ends up purchasing the medication from the U.S. market, where prices are typically the highest globally. This creates inequity. That\u2019s why we believe that, by strengthening regulation, improving the evaluation process for adopting new technologies, and using the joint purchasing mechanism, we can make real progress on access to new technologies.<\/span>\u00a0<\/span><\/p>\n

Finally\u2026 Could you tell us how PAHO approaches universal health coverage, given the challenges we’ve discussed?<\/span><\/b>\u00a0<\/span><\/p>\n

For PAHO, universal health coverage is essential. Often, people theoretically have the right to health, but this right isn\u2019t realized due to the many existing barriers.<\/span>\u00a0<\/span><\/p>\n

For example, there\u2019s the out-of-pocket expense barrier: if a person has to pay to access care. In Haiti, we see pregnant women traveling to the Dominican Republic under very difficult circumstances just to access prenatal or birthing care. The economic barrier is significant. There\u2019s also the socio-cultural barrier. If an Indigenous person in Guatemala or Honduras visits a health unit and cannot understand healthcare providers or is not understood, they\u2019re unlikely to return.<\/span>\u00a0<\/span><\/p>\n

We are pleased that many countries in the region have already enshrined health as a right in their constitutions or laws and are ensuring universal access. Last year, for example, Belize ended the need for copayments. In Chile, a project is underway to universalize primary care, regardless of migrant status or health insurance.<\/span>\u00a0<\/span><\/p>\n

There have been important advances. What we seek is for countries, beyond guaranteeing coverage, to identify and eliminate access barriers so people can truly benefit from healthcare services. During the pandemic, health funding increased, and we are fostering dialogue between finance and health ministers. We need to sustain this progress and ensure all countries reach a minimum of 6% of GDP in public health investment, with 30% of that funding directed to primary care \u2014 renewed, strengthened, with trained teams, connectivity, telemedicine, and bringing healthcare closer to communities. This last point is critical because it\u2019s useless to have great free healthcare services if people must lose two days of work, take three buses to get there, and three more to return. We need to be closer to communities. Not only does it improve access, but it also helps organize demand so that there\u2019s better integration with secondary and tertiary levels of care. We believe that strengthened primary care is the foundation of a resilient health system that guarantees people\u2019s right to health.<\/span>\u00a0<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

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