Lives and economies at risk from weak primary health care in Latin America and the Caribbean: World Bank–PAHO Lancet Regional Health – Americas Commission report

New report outlines a five-point plan to build resilient, people-centered systems that protect health during, and after crises

Washington, D.C., 29 September 2025 (PAHO/World Bank) - A landmark report released today by the World Bank-Pan American Health Organization (PAHO) Lancet Regional Health Americas Commission warns that the failure to build resilience within primary health care (PHC) in Latin America and the Caribbean could lead to significant preventable losses in both lives and long term economic development.

The report, No Time to Wait: Resilience as the Cornerstone of Primary Health Care in Latin America and the Caribbean, was launched on the sidelines of PAHO's 62^nd Directing Council in Washington, D.C., before ministers of health and high-level delegates from across the region.

It outlines stark projections: if a health emergency-such as a pandemic or natural disaster-were to reduce primary health care delivery by 25-50% for one to five years, the region could face upto 165,000 preventable deaths and economic losses between US$7-37 billion.

These deaths could include as many as 11,300 maternal deaths, 10,000 child deaths, and more than 149,000 deaths from noncommunicable diseases (NCDs), along with up to 14 million unintended pregnancies.

"There is no trade-off between building strong primary health care and building resilience-they go hand in hand," said Dr. Jarbas Barbosa, Director of PAHO. "Without resilient PHC, the next crisis will again hit the poorest and most marginalized communities the hardest. With it, we can ensure essential services - prevention, treatment, and care - continue before, during, and after shocks. Resilience is not a luxury-it is the foundation of health security, social stability, and economic growth."

The report defines resilience as the ability of health systems to maintain essential services equitably before, during, and after shocks, including pandemics, hurricanes, heatwaves, floods, and vector-borne outbreaks. At the heart of resilience is strong, community-rooted PHC capable of reaching everyone, especially the most vulnerable.

A wake-up call for the region

The COVID-19 pandemic laid bare the region's vulnerabilities. Despite accounting for just 8.5% of the world's population, Latin America and the Caribbean reported 30% of all COVID-19 deaths. Essential services-such as maternal and newborn care, childhood immunization, and chronic disease treatment-fell by up to 50%, with gaps that in some countries persisted for two years or more.

The region is also one of the most disaster-prone in the world, facing a rising number of hurricanes, floods, and vector-borne outbreaks. Yet health systems remain heavily hospital-centered, fragmented, and underinvested in PHC.

"Strengthening primary health care is one of the greatest health challenges of Latin America and the Caribbean," said Jaime Saavedra, Director of Human Development for Latin America and the Caribbean at the World Bank. "The Commission's report is a roadmap that shows what works to move towards a resilient primary health care. But the hardest part isn't technical- governments need to place primary health care at the heart of their agendas, invest in it urgently and at scale, and ensure universal coverage so that protecting lives and the economies is not optional but a priority."

A five-point plan to build resilience

To prevent future losses, the Commission calls on governments and other stakeholders to implement a five-point action plan to build resilience within primary health care:

1. Expand equitable and comprehensive care models that deliver services for all, ensuring that every community has access to culturally sensitive, multi-professional health teams that can continue delivering essential services before, during and after crisis.
2. Embed essential public health functions within primary care, including surveillance, vaccination, and health promotion at the community level.
3. Place communities at the centerby involving them in decision-making, respecting cultural diversity, and building trust through accountability and clear communication.
4. Work across sectors, recognizing that health outcomes depend on education, housing, climate resilience, and social protection, with public-private collaboration.
5. Secure sustainable financing, prioritizing predominantly public investment in primary health care and establishing mechanisms to rapidly mobilize funds during emergencies.

The report's findings are a call to action for health leaders to make primary health care resilience a political and economic priority. By re-anchoring health systems in strong PHC, governments can close financing gaps, strengthen governance, invest in a well-trained and digitally supported health workforce, and advance reforms that promote quality, equity, and people-centered care.

About the Commission

The World Bank-PAHO Lancet Regional Health Americas Commission on Primary Health Care and Resilience brings together leading researchers, policymakers, and practitioners from across Latin America and the Caribbean, alongside global health experts. Drawing on expert reviews, country case studies, regional surveys, and extensive consultations, the Commission identifies evidence-based strategies to strengthen public health resilience and highlights the grave consequences of inaction.

This is the first Lancet Commission dedicated specifically to primary health care resilience in the Americas, building on decades of commitment to universal health in the region.