Universal Health Coverage in Palliative Care: a long way to go in Latin America

This article was exclusively written for The European Sting by Mr. Sebastian Abanto-Urbano, a 5th year medical student at Universidad Nacional Federico Villarreal in Lima, Perú. He is affiliated with the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writers and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

One of the biggest problems in public health is the inequity of access to health services. There are big differences in Latin America between the urban area, which has a greater number of complex health facilities, compared to the rural area. This problem is not only limited to the complexity of hospitals, it is also related to the expenditure on medicines by patients or their families, number of specialists, time from home to health centre, among others, constitute a concrete block on the road to Universal Health Coverage (UHC).

According to the WHO, the goal of UHC is that everyone should have access to the health services they need without incurring harmful financial costs, but with sufficient quality to be effective [1].

Today, there is a growing concern about providing equitable care for patients in need of palliative care. Recognized as a right, palliative care seeks to improve the lives of family members and patients facing incurable and progressive illnesses. The most prevalent diseases requiring palliative care are cardiovascular disease, cancer, chronic respiratory disease, AIDS and diabetes. It is estimated that 40 million people require palliative care and 78% of these people live in low- and middle-income countries [2]. Access to palliative care in resource-poor settings is described as a ‘chasm’. Although it is an element of the CSU, several obstacles explain this neglect (opioid phobia, the focus on curing and extending life, non-medical substance use, neglect of disease, etc.) [3].

Dr Tania Pastrana mentions that “unequal access to palliative care and pain treatment represents the greatest inequity in the world today”. In Latin America, only 4% of patients in need of palliative care have access to medicines to relieve symptoms and pain. [4]

Latin American health systems reforms produced a different approach to the CSU. Insurance coverage for the uninsured had to be expanded. On the demand side, determinants of health were identified by alleviating poverty and access to the most vulnerable. However, not all countries have an earmarked tax for each health system and limited funds are available [5]. So, are we on the right track?

Without a doubt, each country’s health system must be committed to providing and enforcing universal health care by including palliative care in national laws and programmes. In Latin America, emphasis should be placed on access to medicines, equipment and further research in universities and hospitals, especially to further strengthen the health system to achieve universal health care.

The work belongs to all of us, we must fight to achieve “equity”.

References:

[1] WHO. Universal Health Coverage [Internet]. 2020 [cited 2020 Dec 21]. Available from: https://www.who.int/healthsystems/universal_health_coverage/en/

[2] WHO. Palliative Care [Internet]. 2020 [cited 2020 Dec 21]. Available from: https://www.who.int/news-room/fact-sheets/detail/palliative-care

[3] Knaul FM, Farmer PE, Krakauer EL, De Lima L, Bhadelia A, Jiang Kwete X, et al. Alleviating the access abyss in palliative care and pain relief—an imperative of universal health coverage: the Lancet Commission report. Lancet [Internet]. 2018 Apr 7;391(10128):1391–454.

[4] Infobae. Sólo el 4% de los pacientes que requieren cuidados paliativos acceden a ellos [Internet]. 2019 [cited 2020 Dec 21]. Available from: https://www.infobae.com/salud/2019/12/07/solo-el-4-de-los-pacientes-que-requieren-cuidados-paliativos-acceden-a-ellos/

[5] Atun R, De Andrade LOM, Almeida G, Cotlear D, Dmytraczenko T, Frenz P, et al. Health-system reform and universal health coverage in Latin America. Lancet. 2015 Mar 28;385(9974):1230–47.

About the author

Sebastian Abanto-Urbano is a 5th year medical student at Universidad Nacional Federico Villarreal in Lima, Perú. He is a member of IFMSA-Perú’s SCORE committee and currently LORE of the local association SOCEMVI. His major areas of interest are epidemiology, animal welfare and animal research.