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The need to build on recent progress

making. The ICP considered multiple forms

of HTA agencies, including those linked to the

ministries of health, as long as they exhibit

independence from the payers in the health

system. However, challenges remain, in Brazil

for example: “Currently the instruments to

evaluate and approve new technologies for

cancer (as well as other diseases) lack agility

and transparency, but the Ministry of Health

is discussing mechanisms to make these

instruments more agile, as well as creating an

independent agency for health technology

evaluation in the model of NICE [National

Institute for Health and Care Excellence] in

the UK,” says Mr Medici. In Argentina, Bolivia,

Ecuador and Mexico, there was an HTA

mechanism, but without enough influence in

decision-making. In Mr Merino’s view, “there

is a problem of inefficiency in spending. There

is not enough prioritisation, specificity and

technicity.” In Costa Rica, Panama, Paraguay

and Peru there was no HTA system, at all, or

with independence from payer or provider

agencies.

With growing needs and limited resources,

institutional developments such as HTA

agencies will be crucial for the sustainability

of healthcare systems in Latin America. With

a role in evaluating the social, economic,

organisational and ethical aspects of health

technologies, HTAs can help the countries by

informing policies that maximise efficiency and

effectiveness of interventions.^91

Infrastructure: A ubiquitous

challenge

Infrastructure was measured in the ICP

through the proxies of the density of surgeons

and skilled health professionals. Brazil and

Uruguay lead in this component, while Costa

Rica and Paraguay come last. Chile (0.41)

and Brazil (0.35) have the highest density of

surgeons per 1,000, and fare well compared

with other high-income or upper-middle-

income countries.^92 However, about half of

the countries underperform in global terms,

especially Argentina, Uruguay, Panama, Costa

Rica, Colombia and Paraguay, which have

densities below other upper-middle-income

countries, according to WHO data.^93

But the infrastructure challenges are seen

everywhere, especially considering the

imbalances between urban centres and rural

provinces, which lead to patients travelling

long distances to receive medical care. “It is

a very centralised system,” says Mr Merino.

“There are few patients that have access to

effective treatment. This results in little access

and late diagnosis.” In Panama, for example,

there are ten times more hospital beds per

head in Colón or Panamá City than in rural

areas.^94

The countries examined also underperform

when the density of skilled health professionals

more broadly is considered (physicians,

nurses and midwives). Uruguay and Brazil

(^91) WHO, Health Technology Assessment.
(^92) The Economist Intelligence Unit, “Cancer preparedness around the world: National readiness for a global epidemic”, 2019.
(^93) Data from Global Health Observatory data repository. International comparison based on The Economist Intelligence Unit, Cancer preparedness
around the world: National readiness for a global epidemic, 2019.
(^94) Oxford Business Group, “Panama improves access to health care system”, 2015.