Health financing and access to medicines in the Caribbean
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Health financing and access to medicines in the Caribbean. (2024). [Publications]. PAHO. https://iris.paho.org/handle/10665.2/60341
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English; 28 pages
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2024
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978-92-75-12800-8 (PDF)
978-92-75-72800-0 (print version)
978-92-75-72800-0 (print version)
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For millions of people, including those in the Caribbean region, accessing affordable and high-quality medicines poses significant challenges. These include affordability issues, concerns over the quality and safety of medicines, and inadequate financing for health care, as well as the inappropriate use of essential medicines, weak or limited regulatory systems, and complex procurement and supply chain management processes. The Caribbean region also faces a unique set of challenges, including high levels of public debt and significant informal economies. These factors constrain the capacity of governments to invest in social programs and agendas, including the provision of universal health coverage. At present, public spending on health care in the region is only 3.9% of gross domestic product, well below the 6% target. Consequently, many people must rely on out-of-pocket payments for health care, including medicines. This financial burden creates barriers to accessing health care and can lead to the irrational use of prescription drugs and other medicines. This report offers an initial and concise evaluation of certain health financing aspects that are crucial for accessing medicines in the Caribbean. It also provides a preliminary set of recommendations to guide national and regional efforts to improve the region’s current organization, financing, and provision of medicines. These recommendations aim to tackle the significant challenges highlighted in the report, including those related to system financing, barriers to access, and the financial burden of out-of-pocket costs. Envisioned as an integral part of a broader series of initiatives, this study aims to promote equitable, affordable, and sustainable access to medicines and health technologies by strengthening regulatory frameworks and production capacities, as well as by promoting the rational use of medicines. The publication also aims to be a useful resource for policymakers, health professionals, and other stakeholders in the region and beyond, as they work toward ensuring that everyone in the Caribbean has access to the medicines they need to lead healthy and productive lives, and that the region can achieve sustainable and equitable health financing.
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Pan American Health Organization. Health financing and access to medicines in the Caribbean. Barbados: PAHO; 2024. Available from: https://doi.org/10.37774/9789275128008.
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Item Concerning “The HEARTS app: a clinical tool for cardiovascular risk and hypertension management in primary health care”(2022)Dear editor, We read with interest the article entitled “The HEARTS app: a clinical tool for cardiovascular risk and hypertension management in primary health care” by Ordunez and colleagues, published on March 28th, 2022 (1). This article describes a recently developed app to assess cardiovascular disease (CVD) risk, as well as its use, potential functionality, and validation process. Despite the central role of the HEARTS initiative in the Americas and in the vulnerable region of Latin America and the Caribbean (LAC), we believe that the interpretation of the findings of this study requires some caution. There are some methodological issues in this manuscript that could compromise the strong conclusion that “the HEARTS app is an essential step in the journey towards eliminating preventable CVD in the Americas.” First, the risk prediction models that inform this app are derived from 85 cohorts from high-income countries in the Emerging Risk Factors Collaboration study (2). Of these, we were only able to identify the Puerto Rico Heart Health Program study as directly representative of the LAC region. Therefore, the lack of representativeness of the models for risk-prediction should be made more explicit. At the same time, the important role of the STEPwise approach to surveillance to obtain population-level indicators and trends, as well as calibration of the risk-prediction models should be both considered as potential solutions to this issue. Second, the authors state that “the app is intended to be used in clinical practice, especially at the primary health care level” although it can also “be used by anyone in the general population.” If the use of the app is available to the general public, this could systematically exclude underrepresented groups by creating differential engagement and generating digital inequity (3). Hence, the “ideal” target population of the app in low- and middle-income countries should be specified. Third, the language of the article should reflect the uncertainty regarding the long-term success of this digital health application in the region, which will likely depend on how it is implemented and maintained over time, and the promptness of the initiation of effective pharmacological treatment after the obtention of a risk score. Several barriers to the implementation of CVD risk calculators in primary care have been described, including time constraints, lack of electronic health records integration, and patient fears (4). Low-resource contexts potentially require tailoring of the app to address some of these barriers and ensure sustainability. The burden of CVD in LAC, estimated at 3 497.14 disabilityadjusted life years per 100 000 (range, 3 226.2 – 3 790.1), appears to be highly influenced by the years lived with disability due to ischemic heart disease (5) and by the increasing impact of high systolic blood-pressure (≥110-115 mmHg according to the Global Burden of Disease definition) as the leading mortality risk factor in the region. This public health scenario presents both a tremendous challenge and an opportunity for improvement. The HEARTS app is a promising driver of change. However, its validity should be evaluated in view of some methodological caveats and its implementation capacity should stress the letter “A” of its acronym to advocate for equitable “access to essential medicines and technology” in places where the availability and affordability of generic drugs is still scarce. To read the complete letter, please download the manuscript using the link on the left.Item PAHO/WHO Multi-Country Cooperation Strategy 2026–2031 for Barbados and the Eastern Caribbean Countries(PAHO, 2025-09-26)The PAHO/WHO Multi-Country Cooperation Strategy (MCCS) 2026-2031 for Barbados and the Eastern Caribbean Countries sets out a medium-term vision for advancing health and development in Antigua and Barbuda, Barbados, Dominica, Grenada, Saint Kitts and Nevis, Saint Lucia, and Saint Vincent and the Grenadines. Developed in close consultation with these Membe States, partners, and civil society, this strategy outlines a shared path forward to strengthen health systems, confront emerging challenges, and ensure equitable, people-centred care for all. Barbados and the Eastern Caribbean Countries are at a pivotal juncture. They continue to confront the dual burden of high rates of noncommunicable diseaseas (NCDs) alongside persistent infectious threats, all while facing the increasing impacts of climate change and natural disasters. Despite high life expectancy, health inequities persist driven by social and economic factors such as income inequality, limited resources, and the vulnerabilities of marginalized populations. Health systems face structural pressures, including workforce shortages and financing constraints that lead to high out-of-pocket spending. In response, governments have prioritize reforms such as expanding primary health care, rolling out national health insurance schemes, and investing in climate-resilient infrastructure through PAHO's Smart Hospitals initiative. Political commitment is evident in progressive action on NCD prevention, antimicrobial resistance, and the integration of health information systems, while growing emphasis on mental health and life course approaches signals a shift toward more inclusive and responsive care. There are still vulnerabilities, economic dependencies, and climate risks that threaten progress, underscoring the urgent need for stronger health data, more equitable resource allocation, and sustainable financing mechanisms. To meet these challenges, the MCCS emphasizes solidarity and collaboration, leveraging regional integration through organizations such as the Organisation of Eastern Caribbean States and CARICOM. Grounded in equity and resilience, the strategy identifies 5 Strategic Priorities and 16 Strategic Deliverables, reflecting the outcomes of extensive consultations with ministries of health, nongovernmental organizations, civil society, and development partners. These priorities chart the course for building sustainability, climate-adaptive health systems that protect communities, close equity gaps, and leave no one behind. The MCCS is more that a technical road map; it is a commitment to collective action, solidarity, and the shared vision of healthier, stronger, and more resilient societies across Barbados and the Eastern Caribbean.Item Out-of-pocket expenditure: Reliable data to monitor universal health(PAHO, 2024-10-09)Out-of-pocket expenditures (OPE) are one of the most important categories of health expenditure, reflecting the burden of households with the highest financial risk. They are also the main source of inequity in access to health services and the most inefficient way of financing health systems. However, they are one of the most difficult categories to measure due to the insufficient coverage and standardization of records in different countries. OPE is, in practice, a source of financing, but it is the least desirable one because of its negative impact on access to health services and on equity, and in terms of efficiency in health spending. Above all, it reflects an absence of insurance coverage or financial protection with respect to a set of health goods and services for certain population groups. By measuring and analyzing OPE, it is possible to identify targeted policy interventions to protect households from financial risks when they have to use health services. The challenge is to understand the purpose of the measurement, extract the maximum benefit from existing data, and progressively improve OPE reporting. This document aims to support a move in this direction.Item Noncommunicable diseases: Advances, challenges and the path to multisectoral action(PAHO, 2025-10-06)Noncommunicable diseases (NCDs)—including cardiovascular diseases, cancer, diabetes, and chronic respiratory diseases—account for approximately 80% of all deaths in the Region of the Americas, many of them premature and preventable. Reducing this burden requires much more than interventions in the health sector: it requires a comprehensive approach that addresses the social, commercial, and environmental determinants of health through coordinated multisectoral action. This fact sheet, developed by the Pan American Health Organization/World Health Organization (PAHO/WHO), is aimed at national authorities and decision-makers who are leading the design of public policies, as well as the technical teams responsible for their implementation. The document provides a clear vision of the role of multisectoral action as an essential pathway to accelerating progress towards target 3.4 of the Sustainable Development Goals: to reduce by one third premature mortality from NCDs through prevention and treatment, and to promote mental health and well-being. The publication highlights that WHO-recommended cost-effective interventions, or ”best buys” (such as tobacco control, alcohol regulation, improving the food environment, promoting physical activity, and managing NCDs with a primary care approach using cost-effective technologies) require the joint effort of multiple sectors (including education, finance, transportation, urban planning, agriculture, the justice system, and the media) to achieve a significant impact at the population level. In addition to presenting the benefits of this approach, the main facilitators, barriers, and governance mechanisms necessary for its implementation are described, including specific examples of technical cooperation in the Region. The document also provides guidelines for institutionalizing multisectoral action in national health plans, regulatory frameworks, intersectoral coordination mechanisms, and monitoring systems. PAHO/WHO calls on Member States to strengthen high-level political commitment, allocate adequate resources, and consolidate governance structures to move toward more equitable, resilient, and people-centered health systems. Multisectoral action represents not only an opportunity, but also an indispensable condition for guaranteeing the right to health and accelerating compliance with regional and international commitments on NCDs. This publication is a key tool to guide decision-making and promote an articulated response to NCDs in the Americas. The time to act is now. PAHO/WHO is committed to supporting this process.Item Objetivos de Desarrollo Sostenible: impacto de la falta de protección financiera en salud en países de América Latina y el Caribe(2021)[RESUMEN]. Objetivo. Determinar el impacto del gasto de bolsillo en salud en los hogares, los niveles de protección financiera y su desigualdad según variables relevantes en países de la Región. Se indaga su evolución y relación con el uso de servicios del sistema de salud. Métodos. Se recopila información descriptiva comparada acerca del gasto de bolsillo, su incidencia en la población, y su peso y composición en el consumo de los hogares. Se presentan indicadores de protección financiera en el nivel nacional y su distribución por quintiles de consumo total de hogares y por género. Se contrastan con un indicador de cobertura de servicios. Resultados. Los indicadores de gasto de bolsillo y protección financiera son deficientes pero diferenciados entre los países. Se identifica la composición del gasto en salud para un subgrupo de ellos y existen gradientes significativos cuando se estudian las desigualdades. Para algunos casos, se muestran cambios en el tiempo y posibles asociaciones con los niveles de cobertura de servicios. Discusión. La desprotección financiera afecta a una gran parte de la población, se configuran grupos de países con dificultades mayores que otros, con preponderancia de gasto en medicamentos y exposición mayor de grupos en situaciones de vulnerabilidad, como los más pobres y las mujeres, lo que denota una gran inequidad. Se identifican políticas de algunos países que pueden asociarse con la evolución de la protección financiera. Para reemplazar el gasto de bolsillo, barrera para el acceso, los países necesitan aumentar el gasto público mediante el financiamiento de los sistemas de salud en transformación hacia la salud universal.