Dramatic economic, political and social improvements can largely be seen across the Americas over the last two decades. Amid the overall trend toward democratic consolidation and macroeconomic stability, however, one issue that receives less attention is the sweeping improvements that have been made in the quality and equality of the region’s health care systems.
Despite this progress, a number of underprivileged groups—including the urban and rural poor, indigenous populations, Afro-Latinos, and women—remain isolated from health care services. The reasons are complex but include lack of knowledge, geographic isolation, cultural barriers, and other factors. Combating systemic problems of social inclusion in the area of health care will improve the short and long-term health of these populations and contribute to social mobility and economic growth. After all, health care costs—whether the direct costs of services or the indirect costs of lost work due to illness—are some of the top impediments for excluded populations to move up the socioeconomic ladder.
That is why [Americas Society (AS)](http://www.as-coa.org/), with support from the [Ford Foundation](http://www.fordfoundation.org/) and leveraging its relationship with sister organization [Council of the Americas (COA)](http://coa.counciloftheamericas.org/), focused on improving access to quality health care services as one of the three pillars of its Social Inclusion Program. Our work involved forming a peer review committee (with two members from [Results for Development](http://www.resultsfordevelopment.org/)), collecting information from corporations, NGOs and foundations about existing initiatives, and presenting and discussing preliminary findings so that in-country researchers could then compare programs.
We specifically focused on what is being done in Mexico and Colombia.
These countries were chosen in part due to their ongoing national efforts to increase health care access. In Mexico, _[Seguro Popular](http://www.seguro-popular.gob.mx/)_, a program launched in 2003 to provide health financing for the uninsured, has increasingly bridged the gap in access to health care services, with nearly 50 percent of the Mexican population estimated to be affiliated by the first half of 2011. Similar efforts have been underway in Colombia with the enactment of _la Ley 100_ in 1993, which sought to enroll the population in one of two insurance regimes: a contributory regime for those able to pay and a subsidized regime for those that could not.
After nearly a year of research and meetings, we recently published [Addressing Systemic Challenges to Social Inclusion in Health Care: Initiatives of the Private Sector](http://www.as-coa.org/articles/3091/Addressing_Systemic_Challenges_to_So...), which found that new practices are increasingly allowing marginalized populations to access primary health care services. But challenges remain for effectively addressing systemic challenges of society-wide health care inclusion. Particularly relevant for countries like Mexico and Colombia—where health care models seek to broadly expand access or even achieve universal access—a void still exists for the private and nonprofit sectors to serve marginalized populations.
In addition, cross-sector collaboration can greatly increase an initiative’s scalability and sustainability. But collaboration must be ongoing and initiated at an early stage. Involvement of the public sector, hospitals and community leaders will lead to greater buy-in of the desired outcome and results. Here is where greater efforts need to be made. The first step to be taken is for the private and public sectors to view each other as potential partners—rather than as competitors for patients or clients—in order to use resources effectively.
But collaboration first requires dialogue. For that reason, we recommend that regular discussions be established between health ministries or local departments and the private sector in order to harmonize health care delivery efforts. Here, we point out that greater confidence in collaboration is seen at the local or state/department levels rather than at the national level. Regular dialogue would also help in the coordination of service delivery efforts so that stakeholders can focus on the most pressing health needs. In addition, greater utilization of information and communications technology, through eHealth and mHealth initiatives, can expand access to quality care, reduce inefficiencies and cut costs.
We also found that a regional clearinghouse of private-sector initiatives that serve marginalized populations can be an effective strategy for consolidating efforts. A region-wide platform—both online and through working level discussions—is crucial for exchanging best practices and lessons learned. Of course, the individual dynamics of each country and community require different approaches to improving health care access, but baseline knowledge of successful efforts is needed. The Center for Health Market Innovations is a good model for this.
What is clear is that access to health care is increasing across the region but those historically left out of society are once again being excluded. We cannot let this happen. Without health care access, excluded groups will remain on the periphery of society rather than woven into its fabric. And countries will lose out on the economic growth potential that a more robust middle class brings.