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The Latin America and Caribbean has the highest life expectancy at birth among developing regions. Between 1990 and 2007 (latest data available), the under-five mortality rate was more than halved from 55 to 24 per 1,000 individuals. The region also ranks high in the area of reproductive health as reflected in the 95 percent of pregnant women receiving prenatal care and 89 percent of births being attended by skilled health staff.
Although significant progress has been made in the health sector in the Latin America and Caribbean region, challenges do persist. These challenges are heightened as the region faces two contrasting realities, high inequality on the one hand and sophisticated clients on a path of economic growth on the other. Of particular note is the region’s inequality which is the highest among all regions resulting with nearly 35 percent of the region’s population living in poverty. This inequality is only heightened when you add the elements of racial, gender, and sexual discrimination which have resulted in around 22 percent of the population not having access to health services. This inequality is also reflected in the polarized epidemiological transition the region is undergoing where a subset of the population is facing health issues reflective of a modernized and developed society, such as chronic and degenerative diseases and accidents and injuries, whereas another sub-set continues to struggle in the areas of child and maternal mortality. Even though the maternal mortality ratio in Latin America is the second lowest among developing regions, this only serves to emphasize the contrasting realities of the region where significant advances and progress in the health sector are being achieved on the one hand, whereas, a basic and critical area such as maternal mortality is not at pace with these advances and continues to be a challenge for sub-sectors of the region’s population.
Issues contributing to the inequitable coverage and quality of health care services in the region, include:
- Health expenditures. Total health expenditures in the region account for 7 percent of GDP which makes it the highest-expending region in the world after the countries in the Organisation for Economic Co-operation and Development (OECD). Public expenditures in health are low in most LAC countries and private health expenditures correspondingly high with most private health spending coming directly from out-of-pocket which forces individuals to cut their budget for other basic needs and fall further below the poverty line. Adverse health events or normal life-cycle events (such as old age) will not only bear on the health of individuals, but can also impoverish their households. In addition to treatment costs, households will bear the cost of productive time lost from work, as well as the opportunity costs due to days spent taking care of ill family members. This combination can force individuals and households to cut on nonmedical consumption, a situation that disproportionately affects the already poor population the most.
- Segmentation of the Health Systems. When compared to the rest of the world, spending on health services in Latin America is high relative to per capita income, but health outcomes are not commensurate with the spending. The most common explanation is that the development of separate systems of provision for the rich, the working classes, and the poor has created an inefficient physical network of redundant and poorly utilized facilities that reinforce inequalities in access to health services.
- Public Sector Coordination. Health Ministries need to become more effective at assessing the health status of the population, developing policies to address the needs identified, and ensuring these policies are carried out. The Ministries of Health in the Latin America and Caribbean region share a main emphasis on acting as providers of health services in their countries. These efforts could be re-directed to ensuring their stewardship role for the essential public health functions in their countries which include overseeing the improvement and efficient allocation of resources for priority public health programs and expanding coverage, improving quality, and assuring the universal delivery of a package of priority public health programs. Within this context, the Ministries of Health can take on a knowledge management role where they can improve the good base of vital statistics, epidemiological surveillance, and other available indicators in the region and use it for decision-making and strategic planning of health policy.
- Rapid Demographic Change. The aging of the population and epidemiological changes have altered the health care landscape in the region. Countries must develop policies to respond to these changes, including providing home care for the chronically ill and bolstering efforts to prevent non-communicable diseases, such as diabetes, cardiovascular disease, and cancer, and injuries.
- Chronic Malnutrition. Malnutrition is not usually thought of as a Latin American problem, but in much of Central America - notably El Salvador, Guatemala, Honduras, and Nicaragua – chronic child malnutrition is as prevalent as it is in Africa or South Asia. In Guatemala, half of all children under five years are chronically malnourished. In El Salvador, Honduras and Nicaragua, one out of every three children under five years is affected. The region’s nutritional situation is extremely diverse, with a great deal of disparities both between and within countries with the highest prevalence reaching from 70-75 percent among poor, indigenous, and rural populations. These differences are expressed in terms of both the intensity with which they manifest themselves, as well as in the different stages of the demographic and epidemiological transitions that the countries are undergoing. In Peru, one quarter (25.4 percent) of children under age 5 suffer from growth retardation, or stunting due to malnutrition.
WORLD BANK ASSISTANCE TO HEALTH IN THE REGION
Access to quality health care, along with education, food security, water and sanitation, is fundamental to economic development. Over the 1970 to 2009 Fiscal Year period, the Bank has channeled US$8,863 million, to support health and critical social services in Latin American and Caribbean (LAC) countries which is the highest from among all the regions.
World Bank-financed health projects support LAC countries' policies to improve health, nutrition, and population outcomes of poor people and protect people from the impoverishing effects of illness, malnutrition, and high fertility.
The strategic objectives being pursued by the Bank in the health sector are:
1. Improve the level and distribution of key Health, Nutrition, and Population (HNP) outcomes (e.g., Millennium Development Goals), outputs, and system performance at country and global levels in order to improve living conditions, particularly for the poor and the vulnerable.
2. Prevent poverty due to illness (by improving financial protection)
3. Improve financial sustainability in the HNP sector and its contribution to sound macroeconomic and fiscal policy and to country competitveness.
4. Improve governance, accountability, and transparency in the health sector.
HEALTH, NUTRITION, AND POPULATION AND THE MILLENNIUM DEVELOPMENT GOALS
As part of its mission to eliminate poverty and achieve sustainable development, the World Bank is committed to helping countries achieve the Millennium Development Goals by 2015, which include:
• Halving the proportion of people who suffer from hunger;
• Reducing by two-thirds the under-five mortality rate;
• Reducing by three-quarters the maternal mortality rate; and
• Halting and start reversing the spread and incidence of HIV/AIDS, malaria and other major diseases.