It was one of the less conventional ways of delivering health care. In just 23 days, business leaders, medical experts and government officials came together to transform a giant convention center on the outskirts of Mexico City into a world-class 424-bed coronavirus field hospital. Together, they gave the Mexican capital a crucial additional weapon to fight the pandemic at its peak.
In 14 months of operation from April 2020, the Covid-19 Temporary Unit at the Citibanamex conference center has treated more than 9,000 patients with severe coronavirus, including nearly 2,600 in critical condition. All but 342 survived – a success rate that was the envy of many established Mexican hospitals.
Patients were given access to the latest drugs and treatments to fight the coronavirus, such as high-flow oxygen therapy and sophisticated diagnostics – the hospital had its own testing laboratory. No one paid for their stay: the cost of $ 76 million for setting up, equipping and running the hospital was covered by a private sector consortium. Two-thirds came from foundations created by Latin America’s richest man, Carlos Slim. The Mexico City authorities provided medical personnel.
What was most remarkable was the close teamwork between the public and private sectors in a region where health care is often sharply divided between underfunded public services of uneven quality and expensive treatments of high quality. quality offered to those with the money.
“The private sector has something of efficiency and autonomy in decision-making,” explains Rafael Valdez, who headed the medical team at the Mexico City hospital. “The public health sector can learn from the experience and innovative capacity of the private sector. For the private sector, it was an opportunity to get closer to the city government with something of common benefit.
The coronavirus has hit Latin America particularly hard. With just 8 percent of the world’s population, the region has suffered almost a third of all deaths. The reasons are complex, including high levels of urban poverty and work informality. But part of the explanation lies in the weakness of the region’s health systems.
“Most of the region’s health systems are grossly underfunded,” says Panos Kanavos, associate professor of health policy at the London School of Economics and co-author of a Latin American health care study. “Most claim to have universal health insurance. . . but services are fragmented or people cannot access them. The only relatively well funded countries are Costa Rica and Uruguay.
Health spending was only $ 1,025 per person in Latin America and the Caribbean in 2017, a quarter of the average for OECD countries after adjusting for purchasing power, according to a OECD Report 2020. Exacerbating the gap between rich and poor, only 59% of health spending in Latin America came from governments and compulsory health insurance; the rest was covered by private insurance or direct payments.
Jeremy Veillard, senior health specialist for Latin America at the World Bank, says that in addition to uneven coverage and limited access to health care, quality is an important issue. “The quality gaps are so important that we are going to need the mobilization of all actors – public and private sector – to close these gaps. ”
The way health care providers are paid in Latin America compounds the problem, as payment models are typically based on fees for the services provided. “There are very few incentives to adjust the payment for better clinical outcomes,” adds Veillard.
Nonetheless, he believes that private sector healthcare companies have an important role to play. “There is room for the private and public sectors to find complementary roles in a way that is inclusive and does not transform the private sector by providing services only to the rich,” he says.
The Inter-American Development Bank (IDB) estimates that more than $ 150 billion must be invested in hospitals, health centers and medical equipment in Latin America to bring them up to international standards. “We are convinced that the private sector is essential to finance these challenges,” said Cristina Simón, head of social infrastructure in the private sector arm of the IDB.
The IDB encourages public-private partnerships to help build hospitals and clinics: the private sector builds the facilities and manages them under a long-term contract, supervised and funded by the public sector.
“According to a study in Chile, installations cost 22% less. . . and are completed 35% faster, ”explains Simon.
However, not everyone is convinced. Maria José Romero, Policy and Advocacy Officer at the European Network on Debt and Development, co-wrote a document criticize PPPs in Latin America.
“Universal access to health care cannot be guaranteed by market forces and dynamics,” she says. “Even in cases where the private sector provides high quality services, someone will have to pay for it and there is a high risk of excluding those who cannot pay.
Simón, of IDB Invest, says the key to the success of PPPs lies in the proper preparation of contracts by the public sector and points out that they are now in use, or about to be, in Chile, Brazil, in Peru, Mexico and Colombia.
Another way the private sector has helped during the pandemic is to innovate and spread telemedicine, using online consultations and diagnostics to benefit low-income people or remote communities. “This has come to stay. . . it’s huge, ”she said.
Valdez has now returned to the private sector after running the field hospital and working for Pfizer. One of the Mexico City project’s most important legacies, he says, was a set of step-by-step instructions on how to set up a short-term field hospital.
“In the future, if there is a major earthquake or a pandemic, you can easily convert spaces like this,” he says. “It is a complete operating manual, open to all”.
Of the pioneering facility that mobilized private and public resources to save lives at a critical time, Valdez simply says: “This has been the most important experience of my professional life.