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This article describes 8 guiding principles for the digital transformation of the health sector and identifies their relationship with the COVID-19 pandemic, as well as highlights their importance to countries undergoing digital transformation processes. In the Region of the Americas, among other gaps, 30% of people do not have access to the Internet, which is why it is mandatory to develop policies and actions to deliver public health interventions equitably and sustainably to ensure that no one is left behind. The 8 principles focus on the 4 areas of a sustainable health system—human, social, economic, and environmental—and highlight the broader possibilities for using digital technology to have an impact on the sustainability of health systems. (Am J Public Health. 2022;112(S6):S621–S624. https://doi.org/10.2105/AJPH.2022.306749 )

The COVID-19 pandemic led to declines in in-person consultations and substantial increases in telemedicine use in many countries. This paper investigates whether this pattern occurred in Colombia using data for people with particular health conditions prior to the pandemic (rheumatoid arthritis, hemophilia, chronic kidney disease, HIV, and cancer). The study shows that healthcare utilization by people in Colombia with these conditions dropped significantly during the first months of the pandemic relative to the average of the previous two years. However, by the end of 2020, the rate of healthcare utilization had almost reached pre-pandemic levels. While the number of services fell for people in both the contributive and subsidized scheme, the share of people who had any contacts with healthcare providers each month declined substantially for those in the subsidized scheme and by a statistically insignificant amount for those in the contributive scheme. Declines in utilization and contacts for in-person consultations were partially offset by the increased use of telemedicine services which accounted for almost one-fifth of healthcare contacts by December 2020. Of the main explanations for healthcare disruptions, the diversion of healthcare resources to treat COVID-19 patients does not seem to have been as significant as changes in social mobility and government lockdown policies. These findings have a variety of implications for public policy, including: the need to address the causes of healthcare utilization declines among individuals in the subsidized scheme; the importance of incorporating better social communication and adjustments to lockdown policies when planning for future health emergencies; the value of expanding telemedicine, not only during emergencies but also during normal times; and the potential benefits from improving the quality and availability of administrative data so that future research can contribute more effectively to policies that promote greater equity and effectiveness in Colombian healthcare services.

Background: Implementation of international guidelines in Latin American settings requires additional considerations (i.e., values and preferences, resources, accessibility, feasibility, and impact on health equity). Objective: To provide evidence-based guidelines about diagnosis of VTE and management in children and during pregnancy. Methods: We used the GRADE ADOLOPMENT method to adapt recommendations from three American Society of Hematology, ASH, VTE guidelines (Diagnosis of VTE, VTE in Pregnancy and VTE in Pediatric population). ASH and 12 local hematology societies formed a guideline panel comprised of medical professionals from 10 countries in Latin America. Panelists prioritized 10 questions about VTE diagnosis and 18 about management in special populations that were relevant for the Latin American context. A knowledge synthesis team updated evidence reviews of health effects conducted for the original ASH guidelines and summarized information about factors specific to the Latin American context. Results: In comparison with the original guideline, there were significant changes in 2/10 diagnostic recommendations (changes in the diagnostic algorithms) and in 9/18 management recommendations (4 changed direction and 5 changed strength). Conclusions: This guideline ADOLOPMENT project highlighted the importance of contextualization of recommendations in other settings, based on differences in values, resources, feasibility and health equity impact.

El presente documento expone cómo ocurrió el desarrollo del Sistema Nacional de Información y Registro único de Beneficiarios del Estado (SINIRUBE) enfocándose en las decisiones clave, los retos y las lecciones aprendidas. Para su elaboración se entrevistaron a personas que fueron partícipes del proceso y se realizó una revisión documental de legislación e informes de rendición de cuenta de SINIRUBE, entre otros estudios.

Given the rates of transmission of COVID-19, relying only on manual contact tracing might be infeasible to control the epidemic without sustained costly lockdowns or rapid vaccination efforts. In the first study of its kind in Latin America, we find through a phone survey of a nationally representative sample of ten countries that an opt-out regime (automatic installation) increases self-reported intention to accept a contact tracing app with exposure notification by 22 percentage points compared to an opt-in regime (voluntary installation). This effect is triple the size and of opposite sign of the effect found in Europe and the United States, potentially due to lower concerns regarding privacy and lower levels of interpersonal trust. We see that an opt-out regime is more effective in increasing willingness to accept for those who do not trust the government or do not use their smartphones for financial transactions. The local severity of the pandemic does not affect our results, but feeling personally at risk increases intent to accept such apps in general. These results can shed light on the use of default options not only for contact tracing apps but in public health overall in the context of a pandemic in Latin America.

This study describes the perception, adoption, and acceptance factors involved in the deployment of digital technologies for public health in Latin America and considers the implications for future digital health interventions. We conducted a descriptive analysis using nationally representative data from a phone survey conducted in 2020 in 10 countries in Latin America. We found that early in the pandemic, in countries with existing applications, 74% of the population used a smartphone, 47% had knowledge of the government app to report symptoms, but only 2% reported using it. Those interviewed reported that they are willing to share their personal data during a pandemic (61%) 50 percentage points higher than in non-pandemic times, although understanding how their personal data was used by the government and private companies was extremely low. More than 70% reported that they would use an application to report symptoms and would use an app that accesses their location or that uses contact tracing technology to alert them about possible exposure. Also, at least half of the users agree with preventive measures against COVID-19 such as daily follow-up calls, tracking via GPS for quarantine enforcement, and daily visits. In all countries, adoption of digital technologies increases if individuals or their relatives report they are infected; it decreases when end-users do not trust the anonymity policies or are concerned about government surveillance. Yet, encouraging greater adoption of digital technologies strongly depends on who designed the technology. Results show that 73% of users would prefer an app designed by an international organization such as the WHO to an app designed by the local government (64%) or a telephone company (56%). The study concludes with a reflection on the promising results of digital technologies and discusses the importance of considering users perceptions, factors for acceptance, and trust when pursuing adoption of digital technologies.

The Social Protection and Health (SPH) Division of the Inter-American Development Bank (IDB) held its annual Regional Policy Dialogue (RPD) Digital Health for All: Latin America and the Caribbeans golden opportunity to improve the efficiency, quality and equity of sector on September 12-14th 2022 in Panama City, Panama. The RPD brought together over 120 participants, including leaders from over 20 countries, vice-ministers of health and directors of technology and communications, and regional and global experts in digital health. The meeting sought to provide a setting to discuss what the IDB and different countries have learned in the past four years of implementation of digital health, structural challenges to scale digital health, and the measures needed to ensure that decisions made today are both sustainable and transformational. The meetings objectives broadly included discussing three topics: 1) how to ensure that digital health adds value in terms of improved efficiency, quality, and equity;2) policy considerations for linking digital health to health outcomes; and3) the future state of our region in terms of digital transformation of the health sector.This report provides an overview of the meeting, its main findings, and the steps that lie ahead on this journey.

With millions of people in the world in situations of physical distancing because of COVID-19, information and communication technology (ICT) has become as one of the principal means of interaction and collaboration. The following advantages of ICT have been cited since the start of the new millennium: increased access to information and service delivery, educational strengthening, quality control of screening programs, and reduction of health care costs. In the case of telemedicine, however, a number of barriers-especially technological, human and social, psychosocial, anthropological, economic, and governance-related-have stood in the way of its adoption. The past 20 years have seen an increase in the availability of resources and technical capacity, improvements in digital education, empowerment of patients regarding their treatment, and increased public interest in this area. Successes have included the use of interdisciplinary teams, academic and professional networking, and virtual medical consultations. After reviewing the state of telemedicine in the Region of the Americas, the authors recommend the urgent adoption of measures aimed at implementing national telemedicine policies and programs, including a regulatory framework and adequate funding. Implementation of the measures should be integrated and interoperable and include the support of academic networks and the collaboration of specialized institutions. The policies should generate an enabling context that ensures sustainability of the progress achieved, bearing in mind the possible barriers mentioned.Com milhões de pessoas no mundo em situação de distanciamento físico devido à COVID-19, as tecnologias da informação e comunicação (TICs) se enquadraram como um dos meios principais de interação e colaboração. Já no início deste milênio, começaram a ser mencionadas as seguintes vantagens: maior acesso à informação e à prestação de serviços; fortalecimento da educação; controle de qualidade dos programas de detecção e redução dos custos na atenção à saúde. No entanto, entre as principais barreiras de adoção da telemedicina se encontram as de caráter: tecnológico; humano e social; psicossocial e antropológico; de governança e econômico. Nestes 20 anos, houve um aumento nos recursos e na capacidade técnica, uma melhora na educação digital, um empoderamento do paciente em seu tratamento e um maior interesse público nessa área. Em especial, são consideradas bem-sucedidas a constituição de equipes interdisciplinares e as redes acadêmicas e profissionais, e as consultas médicas virtuais. Após revisar o estado da telemedicina na Região das Américas, os autores recomendam a adoção de medidas urgentes para implementar políticas e programas nacionais de telemedicina, incluindo o marco normativo e o orçamento necessário. Essa implementação deve ser realizada de maneira integral e interoperável e sustentada por redes acadêmicas, de parceria e instituições especializadas. Tais políticas devem gerar um contexto favorável, dando sustentabilidade ao avanço obtido e considerando os aspectos mencionados nas possíveis barreiras.

La pandemia de COVID-19 demostró la centralidad de la salud de la población para las economías y el bienestar social, a la vez que evidenció serios problemas estructurales de larga data en los sistemas sanitarios. En América Latina y el Caribe (ALC), se destacaron serias deficiencias en dimensiones básicas como calidad, resultados, costos y equidad. Hoy, los países deben gestionar la complejidad cada vez mayor de sus sistemas sanitarios mientras hacen frente a una crisis económica sin precedentes. Este documento aborda cada aspecto del proceso de TD, comparte evidencia, prácticas y recomendaciones concretas, identifica el conjunto de actores que pueden y deben participar y delinea los elementos prácticos necesarios para que cada país pueda construir esta crucial trayectoria.

Most Salvadorans reach retirement age without a formal pension, resulting in increased financial vulnerability and poverty in old age. Moreover, fewer women qualify for a formal pension and the average amounts for women are smaller. In this paper, we study gender-disaggregated effects of the Universal Basic Pension (UBP), a non-contributory pension of $50 per month for individuals aged 70 years and over in extreme poverty. We analyze a purpose-specific sample of 2256 households with adults between 66 and 74 years of age in the 32 poorest municipalities in the country using an instrumental variables approach. We contribute to the literature on non-contributory pensions by exploring new outcomes and analyzing gender differentiated effects. Independent of the recipient’s gender, we find that the pension increases non-labor income by 53% on average, lowering the probability that a beneficiary household lives below the extreme poverty line by 17 percentage points for males and 8.1 percentage points for females. Increases in food consumption and medical attention, and reductions in remittances are qualitatively larger for male pensioners. Pensioners appear to have gender-specific preferences with regard to investments in children, with increases in school enrollment and attendance for boys aged 11 to 18 years in households with a male pensioner and of girls of the same age in households with a female pensioner.

This article describes eight guiding principles for the digital transformation of the health sector and identifies their relationship with the COVID-19 pandemic, as well as highlighting their importance to countries undergoing digital transformation processes. In the Region of the Americas, among other gaps, 30% of people do not have access to the Internet, which is why it is mandatory to develop policies and actions to deliver public health interventions equitably and sustainably to ensure that no one is left behind. The eight principles focus on the four areas of a sustainable health system - human, social, economic and environmental - and highlight the broader possibilities using digital technology to impact the sustainability of health systems.Este artigo descreve oito princípios norteadores para a transformação digital do setor da saúde e identifica sua relação com a pandemia de COVID-19, além de destacar sua importância para os países que estão em processo de transformação digital. Na Região das Américas, entre outras lacunas, 30% das pessoas não têm acesso à Internet; portanto, é imprescindível desenvolver políticas e ações para realizar intervenções de saúde pública de maneira equitativa e sustentável, para assegurar que ninguém seja deixado para trás. Os oito princípios enfocam as quatro áreas de um sistema de saúde sustentável – humana, social, econômica e ambiental – e destacam possibilidades mais amplas do uso da tecnologia digital para impactar a sustentabilidade dos sistemas de saúde.

Being able to follow the chain of contagion of COVID-19 is important to help save lives and control the epidemic without sustained costly lockdowns. This is especially relevant in Latin America, where economic contractions have already been the largest in the regions history. Given the high rates of transmission of COVID-19, relying only in manual contact tracing might be infeasible. Acceptability and uptake of contact tracing apps with exposure notifications is key for the implementation the “test, trace and treat” triad. In the first study of its kind in Latin America, we find that for a nationally representative sample of 10 countries, an opt-out regime with automatic installation significantly increases the probability of acceptance of such apps in almost 22 p.p. compared to an opt-in regime with voluntary installation. This triples the size and is of opposite sign of the effect found in Europe and the United States. We see that an opt-out regime is more effective in increasing acceptability in South America compared to Central America and Mexico; for those who claim not to trust the national government; and for those who do not use their smartphones for financial transactions. The severity of the pandemic at the place of residence does not seem to affect the effectiveness of the opt-out regime versus an opt-in one, but feeling personally at risk does increase the willingness to accept contact tracing apps with exposure notifications in general. These results can shed light on the use of default options in public health in the context of a pandemic in Latin America.

El rastreo de contactos es el proceso de detectar, evaluar y decidir qué hacer con las personas que se han visto expuestas a una determinada enfermedad contagiosa con el fin de evitar que la transmisión se extienda. La pandemia causada por la COVID-19 ha desbordado la capacidad de los equipos dedicados a esta tarea generando la necesidad de nuevas técnicas y herramientas para asistir en este proceso. El tiempo de respuesta de los gobiernos ante una emergencia como la actual es vital para la contención y protección de vidas, y las lecciones aprendidas durante el año 2020 son claves para comprender cómo las tecnologías pueden ayudar a combatir enfermedades infecciosas. Este documento conjunto del Banco Interamericano de Desarrollo (BID) y la Organización Panamericana de la Salud (OPS) pretende mostrar cómo las tecnologías pueden ayudar a los gobiernos a superar crisis de esta categoría. En él se recopilan y analizan las distintas soluciones puestas en marcha con el objetivo de ayudar a distintos tipos de organizaciones o gobiernos a planear sus estrategias de rastreo de contactos y se incluyen recomendaciones con base en las experiencias existentes.

grant nr. ANR-I7-EURE-0001 Numerous evaluations of conditional cash transfer (CCT) programs show positive short-term impacts, but there is only limited evidence on whether these benefits translate into sustained longer-term gains. This paper uses the municipal-level randomized assignment of a CCT program implemented for five years in Honduras to estimate long-term effects 13 years after the program began. We estimate intent-to-treat effects using individual-level data from the population census, which allows assignment of individuals to their municipality of birth, thereby circumventing migration selection concerns. For the non-indigenous, we find positive and robust impacts on educational outcomes for cohorts of a very wide age range. These include increases of more than 50 percent for secondary school completion rates and the probability of reaching university studies for those exposed at school-going ages. They also include substantive gains for grades attained and current enrollment for others exposed during early childhood, raising the possibility of further gains going forward. Educational gains are, however, more limited for the indigenous. Finally, exposure to the CCT increased the probability of international migration for young men, from 3 to 7 percentage points, also stronger for the non-indigenous. Both early childhood exposure to the nutrition and health components of the CCT as well as exposure during school-going ages to the educational components led to sustained increases in human capital. authorsversion published

The article's main objective is to propose a new definition for Information Systems for Health, which is characterized by the identification and involvement of all the parts of a complex and interconnected process for data collection and decision-making in public health in the information society. The development of the concept was through a seven-step process including document analysis, on-site and virtual sessions for experts, and an online survey of broader health professionals. This new definition seeks to provide a holistic view, process, and approach for managing interoperable applications and databases that ethically considers open and free access to structured and unstructured data from different sectors, strategic information, and information and communication technology (ICT) tools for decision-making for the benefit of public health. It also supports the monitoring of the Sustainable Development Goals and the implementation of universal access to health and universal health coverage as well as Health in All Policies as an approach to promote health-related policies across sectors. Information Systems for Health evolves from preconceptions of health information systems to an integrated and multistakeholder effort that ensures better care and better policy-making and decision-making.El objetivo principal de este artículo es proponer una nueva definición de los sistemas de información para la salud, que se caracterizan por la identificación y la participación de todas las partes involucradas en un complejo proceso interconectado de recopilación de datos y toma de decisiones en el ámbito de la salud pública en la sociedad de la información. El concepto se desarrolló en un proceso de siete pasos que incluyó el análisis de documentos, sesiones presenciales y virtuales con expertos y una encuesta en línea a profesionales de la salud en general. Esta nueva definición procura ofrecer un criterio holístico, un proceso y un enfoque para la gestión de bases de datos y aplicaciones interoperables que considere desde un punto de vista ético el acceso abierto y gratuito a datos estructurados y no estructurados de diferentes sectores, información estratégica y herramientas de tecnologías de la información y de la comunicación (TIC) para la toma de decisiones en beneficio de la salud pública. También brinda apoyo al seguimiento de los Objetivos de Desarrollo Sostenible y la ejecución del acceso universal a la salud y la cobertura universal de salud, así como la salud en todas las políticas como iniciativa para promover políticas relacionadas con la salud en todos los sectores. El concepto de sistemas de información para la salud implica una evolución desde lo que se consideraba anteriormente sistemas de información de salud hacia un esfuerzo integrado por parte de varios interesados directos que garantiza una mejora en la atención, la formulación de políticas y la toma de decisiones.O principal objetivo deste artigo é propor uma nova definição para Sistemas de Informação em Saúde, que são caracterizados pela identificação e participação de todas as partes de um processo complexo e interconectado para a coleta de dados e tomada de decisão em saúde pública na sociedade da informação. O conceito foi desenvolvido por um processo de sete passos incluindo análise de documentos, sessões presenciais e virtuais com especialistas e uma pesquisa on-line com profissionais de saúde generalistas. A nova definição busca oferecer uma visão, um processo e uma abordagem holística para gerenciar aplicativos e bases de dados interoperáveis que consideram eticamente o acesso aberto e gratuito a dados estruturados e não estruturados de diferentes setores, informações estratégicas e ferramentas de tecnologia da informação e comunicação (TIC) para tomadas de decisão em prol da saúde pública. Também sustenta o monitoramento dos Objetivos de Desenvolvimento Sustentável e a implementação do acesso universal à saúde e da cobertura universal de saúde, assim como a Saúde em Todas as Políticas como uma abordagem para promover políticas relacionadas à saúde em vários setores. Os Sistemas de Informação em Saúde evoluíram de pré-conceitos dos sistemas de informação de saúde para um esforço integrado e com muitas partes interessadas, assegurando melhor cuidado, formulação de políticas e tomada de decisão.

The opinions and experiences of the public regarding health services are valuable insights into identifying opportunities to improve healthcare systems. We analyzed the 2012-2013 Public Opinion Health Policy Survey carried out in Brazil (n = 1486), Colombia (n = 1485), El Salvador (n = 1460), Jamaica (n = 1480), México (n = 1492) and Panama (n = 1475). In these countries between 82 and 96% of participants perceived that their health systems needed fundamental changes. The most frequent barrier to access to healthcare was lack of the primary medical home, difficulties in obtaining medical care during the weekends and financial barriers. Type of health insurance and challenges in obtaining medical care during the weekends were associated with an increased opinion for the need for fundamental changes in healthcare systems, whereas having a primary medical home showed a protective effect. Focusing on tackling organizational and financial barriers and ensuring access to a primary medical home should be placed on the agenda of Latin American countries.

Targeted social policies are the main strategy for poverty alleviation across the developing world. These include targeted cash transfers (CTs), as well as targeted subsidies in health, education, housing, energy, childcare, and others. Due to the scale, diversity, and widespread relevance of targeted social policies like CTs, the algorithmic rules that decide who is eligible to benefit from them---and who is not---are among the most important algorithms operating in the world today. Here we report on a year-long engagement towards improving social targeting systems in a couple of developing countries. We demonstrate that a shift towards the use of AI methods in poverty-based targeting can substantially increase accuracy, extending the coverage of the poor by nearly a million people in two countries, without increasing expenditure. However, we also show that, absent explicit parity constraints, both status quo and AI-based systems induce disparities across population subgroups. Moreover, based on qualitative interviews with local social institutions, we find a lack of consensus on normative standards for prioritization and fairness criteria. Hence, we close by proposing a decision-support platform for distributed governance, which enables a diversity of institutions to customize the use of AI-based insights into their targeting decisions.

En la region de America Latina y Caribe (ALC), la mayoria de los paises buscan reformar sus sistemas de salud para lograr la cobertura universal y mejorar la eficiencia de sus gastos sanitarios, al tiempo que cumplen con las expectativas cada vez mayores de los ciudadanos acerca de la calidad de la atencion. El papel de la atencion primaria de salud (APS) destaca como clave para lograr esos objetivos de forma integrada. Por ello, el Banco Interamericano de Desarrollo llevo a cabo, entre 2012 y 2014, la Encuesta sobre Acceso, Experiencia y Coordinacion de la Atencion Primaria de Salud en America Latina y el Caribe, en poblaciones adultas de Colombia, Mexico, Brasil, El Salvador, Panama y Jamaica, buscando contribuir al diseno de politicas publicas de salud, y considerando especialmente el punto de vista de los pacientes. Los dos primeros capitulos del presente libro presentan el contexto y desafios de los sistemas de salud de la region y describen el marco conceptual y la metodologia del estudio. Los capitulos tres al ocho tratan, por separado, de cada uno de los seis paises estudiados, con resultados sobre las experiencias de los pacientes con la atencion primaria de salud y su integracion con los demas niveles de atencion. El capitulo nueve cierra el libro con un analisis comparativo entre los seis paises de ALC y extiende la comparacion a 11 paises de altos ingresos de la OCDE, donde se evidencian las brechas persistentes en los indicadores de acceso, experiencia y coordinacion en la APS entre los paises de ALC y los de la OCDE. Un analisis multivariado con los 17 paises demuestra que los principales atributos observados de la APS estan directamente vinculados a las percepciones de los pacientes acerca de la necesidad de cambios fundamentales en los sistemas de salud y de la calidad de los servicios utilizados.

Los programas de transferencias monetarias condicionadas cumplen veinte anos de implementacion en America Latina y el Caribe. Este libro aprovecha dicha ocasion para revisar criticamente las opciones de diseno y las soluciones operativas que han utilizado los paises de la region con el objetivo de sistematizar el conocimiento operativo acumulado e identificar buenas practicas y retos pendientes. Aborda los principales procesos del ciclo operativo: analiza la identificacion de los beneficiarios y el manejo del padron, la verificacion de condicionalidades y el pago de las transferencias. Ademas, discute temas transversales como la organizacion de los programas en el territorio, los sistemas de gestion de la informacion y la vinculacion de los beneficiarios a otros programas sociales. Este libro es una herramienta util y practica para las personas que buscan entender como funcionan los programas de transferencias y como pueden ser mejorados aprovechando las experiencias de otros paises.