Background

The COVID-19 pandemic has been a historic opportunity to highlight the centrality of people's health for sustainable development, which consists of the intersection of inclusive economic development, inclusive social development, and environmental sustainability (United Nations, 1987). The crises triggered by the pandemic have demonstrated how health promotes inclusive economic and social development, as only healthy populations can achieve their potential in these areas. At the same time, the unequal impact of the pandemic has reminded us that health is subject to the economic, social, and environmental conditions that enable people to live a healthy life and exercise their right to health, once again revealing that health is essential for sustainable development. Therefore, strengthening healthcare systems and investing in population health is also an investment in sustainable development.

In order for people to exercise their right to health, progress in achieving universal access is necessary. However, health systems in Latin America and the Caribbean suffer from a series of structural weaknesses that, along with insufficient coordination with social protection systems, hinder such access. In this regard, chronic underfunding of healthcare systems stands out, accompanied by marked segmentation in coverage and high levels of fragmentation in care (ECLAC, 2022; ECLAC/PAHO, 2021; ECLAC/PAHO, 2020). These weaknesses result in problems of the adequacy of access, inefficiency, coordination difficulties, lack of solidarity, and situations of inequality, hindering effective universal health access.

Despite global advances in terms of health coverage in the region during recent decades, significant barriers to accessing health persist, preventing the entire population from effectively enjoying them (WHO/World Bank, 2021). Regional shortcomings are reproduced among countries and within them, with the most vulnerable populations facing the greatest difficulty in accessing sufficient levels of well-being, conditioned by the structural axes of the social inequality matrix (ECLAC, 2022). Gaps in both access to health systems and health indicators are directly related to the social determinants of health, which are also unequally distributed in society through the structural axes of the social inequality matrix. These determinants refer to the conditions in which people live and carry out their daily activities, which have an effect on the population's health, such as education, income, housing, access to water and sanitation, employment characteristics, and environmental conditions, among others. Understanding health from this perspective allows us to see it as a multidimensional issue that requires intersectoral and integrated interventions in broader development strategies (ECLAC, 2006).

The Economic Commission for Latin America and the Caribbean (ECLAC) has emphasized the need to transform healthcare systems in order to move towards universal access and coverage from a rights-based approach and through a Primary Health Care (PHC) strategy that responds to specific and differentiated needs of individuals, increasing public health spending, consolidating its financial sustainability, and prioritizing resource allocation at the primary care level (ECLAC, 2022). Likewise, PHC should consider active participation and social dialogue, addressing the social determinants of health, intersectoral and interinstitutional coordination, and adaptability to the environment. The World Health Organization (WHO) has positioned the PHC strategy as the most inclusive, equitable, cost-effective, and effective approach to improving the physical and mental health of individuals, as well as their social well-being (WHO/UNICEF, 2018). Building such systems is the first step for countries to advance towards universal health access and coverage while reducing the fragmentation of their services. In line with efforts made in recent years regarding PHC, the United Nations High-Level Commission on Universal Health in the 21st Century: 40 Years of Alma-Ata, held in 2019, established the commitment of countries, through the 30-30-30 Pact for Universal Health of the PAHO, to strengthen the strategy, with the recommendation to consolidate public health spending to at least 6% of the Gross Domestic Product, eliminate access barriers by 30%, and allocate 30% of public resources to primary care. Expanding interventions in PHC, strengthening the resolution capacity of the primary care level in line with the recommendations of the Pan American Health Organization (PAHO, 2019), particularly in low- and middle-income countries, could save 60 million lives and increase life expectancy by 3.7 years by 2030 (WHO, 2021).

ECLAC highlights the importance of improving the capacity of countries in the region to design, adapt, and implement strategies and policies aimed at advancing towards universal, comprehensive, sustainable, and resilient health systems, to meet the goals of the 2030 Agenda and better address growing catastrophic events of various nature. Additionally, it is important to take advantage of new technologies and digital transformation to include innovative tools that can help achieve these commitments. Within the framework of the United Nations Development Account project "Resilient Health Systems with Universal Coverage in Latin America and the Caribbean", this International Seminar aims to review the experiences of different countries regarding access and universal health coverage. In this instance, the objective is to delve into the main obstacles and barriers that the population faces in access, as well as the PHC strategy as a tool to achieve universal health, providing an opportunity to reflect with authorities and/or specialists from each country on the main challenges their health systems face in terms of universality and the lessons learned from systems with a consolidated strategy.