Universalizing health systems, integrating people in a solidary society, and integrating countries within a solidarity region: the challenges of a better life for all.

20/07/2018 - Felix Rigoli

South America, despite being a region with wide inequalities, has managed to dream of giving access to health services for all.

Until two decades ago, having health problems was a misfortune that led  between 5 and 15% of South American families to poverty.  Of course, not all were equally affected by these misfortunes, partly because better-off social groups could avoid some causes of illness and mainly because they could pay for existing treatments in the country or abroad.

                                                                   Xu et al  Household catastrophic health expenditure: a multicountry analysis THE LANCET • Vol 362 • July 12, 2003


The decision of the governments of the region to extend and make accessible their health services to the entire population, with the lowest possible financial barriers, was an initiative framed in the extension of citizenship rights There were included in that extension of rights,  the recognition of ethnic, cultural communities , racial and with different identities, that needed not only the absence of financial barriers, but the adequacy of the services to their particular needs. As was expressed in Brazil at the time of the creation of the Unified Health System (SUS), and that could be applied to many of our countries, the extension of the health system for all is part of a civilizatory process, transforming all the population in citizens with rights to a life free of misfortunes.

In this still unfinished process, countries have used many strategies, from those that create a totally new health system, to those that have gradually adapted their existing structures using primary health care as the axis that organizes and concentrates the transformation efforts .

The results are clear, most countries have significantly reduced their out-of-pocket health expenditures, and therefore the risk that health contributes to poverty or increase poverty. The health system becomes a factor that frees people from a life risk, and thus helps to equalize the opportunities to live a better life.

                                                                  Source: data.worldbank.org


The distribution of resources, and especially of health professionals, has improved in regions that until the beginning of the 21st century had never had access to a doctor, a nurse or a dentist. This is especially true in remote regions and in indigenous communities that are difficult to access. South America has created cutting-edge programs in extending access to health for citizens who until recently did not feel integrated into their country.

The effects of this extension of rights and access are felt in the priorities of the governments and in the demands of the communities, allowing to consolidate these achievements. However, as indicated at the beginning of this text, these health systems are inserted into societies that maintain important differences in the distribution of resources and power.

ISAGS has promoted and promotes the monitoring of asymmetries in health systems, within countries and between countries, so that social actors can appropriate this knowledge and promote the reduction of these unfair and avoidable differences. To this end, ISAGS maintains different study activities, analysis of the situation, data platforms, dissemination of news and health monitoring tools using the perspective of a universal and egalitarian system, based on primary health care, as defined by the health authorities of the countries.

The influence of the integration processes on these advances can not be ignored. The constitution of a common citizenship, of an awareness of rights for all, which has permeated the action of UNASUR, also had a concrete expression in terms of health. The countries understood that it was important for their citizens to have similar rights and that the reduction of asymmetries that was imperative within each society was also a necessity among the different countries. At the same time, it is not only the comparison of countries that drives improvement. In a very important way, countries have learned from each other. The joint action of the countries sharing best practices, the ability to learn together, to create information systems and joint planning, is a source of ideas and techniques for each country to take advantage of, for its own benefit and to share with others.



Felix Rigoli

Specialist in Health Systems & Services