Boji Eliassen is Director of Health at the Copenhagen Institute for Future Studies. This blog post was written jointly by Rolf Hoinger, Area President at Roche Pharma in Latin America, and Rifaat Aton, Professor of Global Health Systems at Harvard University.
Movimiento Salud 2030 is a bold initiative launched in 2020 in nine countries simultaneously. Its goal is to improve health systems in Latin America to deliver better and more equitable health outcomes.
Movimiento Salud 2030 promotes broad collaboration across sectors and across countries in a coordinated top-down and bottom-up approach by embedding local national ecosystems with leaders in related fields. Movimiento Salud 2030 supports concrete solutions launched to solve the challenges identified by local stakeholders in order to transform Latin America’s health systems to become better and more sustainable by 2030.
The COVID-19 pandemic has exposed vulnerabilities of the Latin American health system and presented challenges to build Movimiento Salud 2030 due to travel restrictions and time requirements for crisis management for many participants in countries.
However, as the COVID-19 pandemic demonstrated the need, the drive to create better health systems was also evident to stakeholders and we were able to overcome the barriers of COVID-19. We had a full year of online activities in 2020, and so successful that the Movimiento Salud 2030 concept will soon be rolled out globally with the aspiration to become the world’s leading healthcare innovation network.
The first step in this initiative was to establish a comprehensive literature review and to conduct more public research, conduct interviews, and facilitate expert round tables with the aim of creating an overview not only of the biggest challenges, but also of the opportunities and ways to enable them. In identifying challenges, the aim was to identify the true bottlenecks of transformational change as well as to assess how to work with them.
This resulted in the selection of four focus areas, linked to a fifth – interoperability. In the process, we also learned that low budget execution is one – if not the greatest – of barriers to change.
The four focus areas will be built simultaneously in the ecosystem of the countries concerned as well as across borders in the region.
The fifth element, not visible in the above model, is the interoperability required to deliver integrated care supported by digital capabilities that allow the system to collect, analyze and share relevant patient-related data.
Towards a Peruvian pilot
One of the main findings from research, interviews and roundtables in Latin America was that budget implementation is an enormous challenge in many countries. Most Latin American countries have low public spending on health, and on top of that many of them face challenges in implementing their budgets. Thus, a large part of scarce resources is not actually spent exacerbating deficiencies in health services.
To solve these challenges, Movimiento Salud 2030 has identified an opportunity to develop solutions with an emphasis on doing the right things right, that is, spending allocated budgets on the right things without causing unnecessary waste.
When former Peruvian President Martin Vizcarra promised in his annual address to the nation on July 28, 2020, a major increase in the health budget, the Movimiento Salud 2030 Consortium reacted swiftly by setting up a task force in Peru. In addition, we have entered into a dialogue with key opinion leaders, including former health ministers, on how to improve the health system in Peru.
We are focusing on how to solve the challenges of low budget implementation while also improving the quality of health services, especially now that more funding may be allocated substantially to the health system considering that the implementation of the health budget is approximate. 65-70% for many regions of Peru.
Interviewees felt that an integrated and comprehensive solution could best be achieved through a regional experience supported by a real-time digital data management system, where the challenges identified by the respondents could be met in a comprehensive, integrated and comprehensive manner.
The Peruvian health system is complex and one of the biggest challenges is the lack of data and analytics systems to link plans, budgets and goals, visualize business process flows, and assess budget delays. This is urgently needed so that both payers (Ministry of Health and Ministry of Finance) as well as the service provider can obtain a continuous overview of the intelligence information needed to inform the decision-making process in real time as well as follow up on resource use.
Although there are many challenges, we have chosen to focus the Peruvian experience on better budget execution as it allows for further development in other areas. We deal with budget execution at four levels: legislative, institutional, operational and efficiency. The legislation includes solutions such as reviewing legislation, creating a unified pool of financing, and reducing fragmentation.
The corporate level is characterized by the creation of a needs assessment unit, a review of budget management, establishment of digital data systems, and the creation of a multidisciplinary “delivery unit”. On an operational level, we focus on creating a demonstration project and a digital course on budget planning. Finally, at the instrument level, a three- to five-year transition plan, establishment of Standard Operating Procedures (SOPs), and quarterly budget reviews.
To summarize, the Peruvian experience addresses the challenges of digital infrastructure related to the digital architecture and it addresses the challenges in the following incremental way to create a better and more sustainable digital architecture for the health system, which builds the backbone of the necessary information infrastructure with traceability, transparency and accountability.
The Peruvian pilot will be presented on March 4 by the Peruvian Ministry of Health, the regional government of Cuzco and the Team Movimento Salud 2030 at 11:00 Lima. Come join the discussion!
HIMSS Latam and El Movimiento Salud 2030 will collaborate on developing the digital health ecosystem in Latin America. Find out more on Movimiento Salud 2030 Homepage.