Central America and the Dominican Republic at Crossroads: The Importance of Regional Cooperation and Health Economic Research to Address Current Health Challenges.

We discuss key health challenges currently faced by countries in the Central America and Dominican Republic region after the COVID-19 pandemic. We highlight the influence of socioeconomic determinants for the challenging public health dynamics observed and the crucial roles that regional cooperation and health economic research can have for tackling such challenges. We present a descriptive overview of the current situation of public finances and its effect on government capacity to improve social expenditure. We also discuss the impact of the COVID-19 pandemic crisis on social dynamics and living conditions in the region. Our analysis suggests that the interplay between all these factors is likely to have important consequences for health systems and population health in the post-pandemic period. Previous examples of successful cross-country cooperation in the region indicate the great potential that these initiatives have for supporting health system resilience against current challenges. Technical cooperation must be informed by (currently unavailable) research evidence that can guide decision making, especially health economic research to support national health resource allocation policies. Areas identified as priorities for applied health economic research include both macro and microeconomic analyses. Central America and the Dominican Republic face significant health challenges post-pandemic. Our article emphasizes the great potential that regional technical cooperation, informed by further health economic research, has to improve public policies and health governance in the region. • Central America and the Dominican Republic were particularly vulnerable to the effects of the COVID-19 pandemic, which further aggravated the region's structural problems and exposed the weaknesses and gaps within health and social protections systems. • We show the detrimental impacts of the pandemic on public finances and on government capacity to increase social expenditure in the Central America and Dominican Republic region. We also illustrate how the interplay of factors including constrained domestic fiscal space for health, rising inflation and food insecurity, aggravated poverty and inequalities, and increased migration flows poses substantial risks for health systems and population health in the post-pandemic period. • Previous examples of successful cross-country cooperation in the region illustrate the great potential that these initiatives have for supporting health system resilience against current challenges. Such cooperation must be informed by research evidence that can robustly guide decision making in particular health economic research to support national health resource allocation policies, including both macro (eg, health expenditure productivity) and microeconomic (eg, health technology assessment) analyses. [ABSTRACT FROM AUTHOR]