Latin America
Closing the gap with a Digital bridge (Part II)
How Latin America can close its healthcare access gap with digital health — and why the creation of startups alone is not enough.
As we said in Part I, Latin America has plummeted in terms of economy, social parity and healthcare access. The situation continues to deepen as the region tries to roll out its vaccine strategies against the inertia of a global pandemic that has now seen the discovery of new variants of the virus — the Brazilian strain in the countries of South America, the UK strain in the USA and the rest of North America, the South African strain, the Indian strains, and so on.
Apart from the general disruption that the different quarantine strategies per country in the Americas have generated, there has been an overall increase in the number of startups in healthcare, and an important shift in the market landscape towards new technologies oriented to healthcare, diagnostics, therapeutics and hospital management tools. These startups are driven by the decrease in the supply of medical attention and the increase in the volume of patients — not only COVID-19 patients, but also patients with chronic diseases who, due to the quarantine and the saturation of services, have not been able to attend to these conditions and now require emergency or urgent care.
Countries like Chile, Uruguay, Colombia and Panama are starting to invest heavily in these new companies that offer a new way of inclusivity and healthcare access for everyone. Governmental support budgets have been created to back the companies entering the innovation landscape across Latin America. But how can countries where vast pieces of land separate rural from urban, and where basic services like water or electricity are not covered, renew their healthcare access services? Is the creation of these startups enough?
Collaboration is the key for success in Latin America
Is the creation of these startups enough? Most certainly not.
There is a broad panorama of needs and requirements in order to generate the cadence for the development of healthcare access with these new tools. For the sake of this article, we will name a few of them and explain them subsequently:
- Mobile connectivity.
- Public and private commitment to development in digital healthcare (and digital services).
- Adoption of Digital Health tools by providers.
- Clear regulation and financing for Digital Health (explained in Part III).
Mobile connectivity
In the last five years, we have seen rapid development of these services, even in the most rural areas of countries such as Peru or Brazil. In Peru, 12.9 million people are already mobile-connected, 40.5% of the country's population. Until 2020, a further 3% of the population of Peru was acquiring mobile technologies yearly and entering these adoption groups. This expansion cannot stop, as it will help the country tremendously in closing the healthcare access gap. The COVID-19 pandemic poses a grave risk to this expansion, and it is a key factor that has to be taken into consideration in matters of healthcare parity and access.
The reality of the countries in Latin America in terms of connectivity and internet access is very varied. There are countries where connectivity services are accessible, and it is precisely in those countries that we see the growth of digital health services has increased significantly. And to have digital health services, connectivity alone is not enough — the quality of the connection matters too. Countries with high-speed mobile networks or fibre-optic services accessible to most of the population can provide telemedicine and remote monitoring services that allow continuity of care. Coincidentally, the countries that invest the most in health startups are also those with the highest quality and speed of connection in the region.
An important point regarding the implementation of 5G, on which there are many expectations for the use cases it will facilitate for digital health, is that it will probably continue to generate a gap between rural regions and urban areas, and accentuate inequality in access by social status, especially at the beginning of network deployment.
Public and private commitment to development in digital healthcare
Great initiatives like Health Panama or the Chilean collaboration of companies in health tech are being created to leverage public and private interventions in digital health. Private companies like Entel, in Chile, have been assertive in driving the creation of a tech hub in Santiago, and they run competitions and post-acceleration programmes for interesting startups.
The public sector, however, is very far behind. Overwhelmed by the COVID-19 situation and unable to create a strategic plan, public organisations at country level are collapsing and unable to plan for future healthcare initiatives. That would require a generational, professional and managerial change that, unfortunately, is not possible right now. The state of the pandemic in Latin America will continue to decrease efficiency and efficacy at public levels, so the private sector has the responsibility to steer development in the years to come.
As the pandemic continues, governments are developing new budget strategies to palliate the burden COVID-19 has imposed on their economies. Most budgets have been reallocated from R&D to social initiatives such as financial aid and tax relief for the poorest populations. While the necessity of these initiatives is clear, measures of this kind will have an impact in the short term, but defunding R&D and technology investment will have an impact in the middle and long term — the motor of the new economies will start working slower and slower, and a true economic recovery might take many more years to become a reality.
Adoption of Digital Health tools by providers
As difficult to understand as it sounds, the adoption of new technologies is not a strong characteristic of Latin American health institutions or healthcare providers. With the notorious exceptions of some high-end hospitals — Clínica Las Condes in Santiago, Albert Einstein Hospital in São Paulo, Fundación CardioInfantil in Bogotá, Hospital Clínica Bíblica in Costa Rica, and others from the América Economía list — the largest group of medical institutions and professionals is falling behind in digital health literacy and user knowledge.
A scaled, massive educational programme needs to be assessed to deliver medical and digital knowledge to thousands of medical professionals in Latin America — from digital radiology to the use of telehealth, AI, wearables and the implementation of these technologies in clinical practice. It is important that providers not only accept the existence of the technology, but that they learn to use it, rely on it, and advocate for it at an institutional level. This process should also involve the technology vendors, so they can help address the concerns of medical staff and provide a clear vision to institutions on how the use of this technology can help them achieve their strategic goals while providing better and more efficient healthcare services.
What comes next
There are more challenges we will face as technological development begins to surface in Latin America: patient digital health literacy, trust and willingness to use; guideline implementation of digital health solutions across medical specialties; and national programmes built on these new tools. All of these topics will be covered in Part III of this series.