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Disjointed practices, limited access to health care, process failures, technological gaps and general quality issues are holding back progress in Latin American healthcare services and systems. That changes need to be made to improve integrated care is not in question. But the difficulty lies in pinpointing where to start and how to obtain the best results given budget restraints facing healthcare systems in the region, and beyond.
“There is scant evidence on best practices in healthcare coordination in Latin America,” according to the team behind the Equity-LA II project, a collaboration between health services, policy-makers and researchers in the EU and Latin America. This international team is evaluating different ways to improve the quality of care through better coordinated, more integrated health service networks.
This work builds on the previous Equity-LA (FP7-SICA) project by expanding the scope of the research in Colombia and Brazil and adding new countries offering different perspectives and respective contributions to the overall results. In the follow-up project, two European (Spain and Belgium) and six Latin American (Argentina, Brazil, Chile, Colombia, Mexico and Uruguay) countries are on-board.
“With around 16 000 people directly involved and potentially 3 million indirect beneficiaries, it is a very challenging project that develops parallel research interventions in six countries,” says María-Luisa Vázquez, Equity-LA II’s principal investigator at the Consortium for Health Care and Social Services of Catalonia (CSC). For this, the team carried out quasi-experimental research with a controlled before-and-after design for evaluating complex interventions and adopted a “participatory action research” approach.
Mutual trust boosts coordination across levels of care
Each of the Latin American partners is working together with a public healthcare services network using the participatory action research approach to design and implement ways to improve clinical coordination across levels of care. This fosters collaboration, knowledge-sharing and mutual trust between the primary- and secondary healthcare providers.
“We are in the final analysis phase right now, but we can already see very promising results, particularly in some of the participating countries, such as Chile, where the intervention has expanded progressively to other primary care centres and hospitals,” explains Vázquez. Chile’s Ministry of Health regards the intervention as a ‘best practice’ in programming healthcare networks and has already introduced the lessons learned in the 2018 national health policy, and it will be included again in 2019 policy.
“What’s more, performing a transnational comparative analysis under Equity-LA II means that we should be able to identify the contextual factors that may explain different processes and results across countries,” notes Vázquez.
“This kind of extended international research collaboration really wouldn’t have been possible without the EU support, and the networks and relationships that formed out of it will be enduring and fruitful,” adds Ingrid Vargas, the project’s co-principal investigator at CSC. “We are planning to apply for a scaling-up project of Equity-LA’s many best practices, and hope to secure further EU support for that.”
New ways to foster clinical agreements
Another example of Equity-LA’s achievements is the analysis of trajectories of patients with chronic conditions in Argentina to improve its clinical management across levels. The research steering committee firstly identified the core problems in the primary and secondary health care delivered to patients with hypertension and diabetes. A second phase focused on developing a locally-adapted clinical agreement for patients’ care across levels of care. The international scientific collaboration has delivered the Argentinian team a number of benefits.
“Apart from boosting working relations with health services, it has further developed our capacity in different research methods,” says Delia Inés Amarilla, Equity LA II research coordinator of the Universidad Nacional de Rosario in Argentina. “The simultaneous work process and continuous exchange of experiences between partner countries has strengthened and broadened local efforts.”
The net effect of the work has significantly strengthened research capacity and the exchange of knowledge among all actors (health services and universities) involved and has put in place processes that have the potential to greatly improve information flow and heathcare systems management for better integrated services, according to the team.
“Perhaps a more hidden, but equally important, initial outcome of the project is its contribution to confidence-building and skill-development, especially on the health services side. On many levels, it really provided a motivation ‘booster shot’ to the healthcare workforce in Latin America,” stresses Vázquez.
The key to success in projects like this, Vargas concludes, is to pursue a long-term vision, secure high-level endorsement and backing, and to engage all relevant professionals, stakeholders and networks in a proactive and participatory programme aimed at tangible improvements in Latin American heath systems.