The cost of inaction to strengthen the resilience of primary health care in Latin America and the Caribbean: a modelling study.

Background: The Latin America and the Caribbean (LAC) region will face future public health emergencies due to pandemics, natural disasters, migration, economic crisis or other unforeseen events. These events disrupt healthcare service coverage with consequences for morbidity, mortality and economic productivity. This study aimed to estimate the health and economic cost of potential future health system shocks, as a proxy for the cost of inaction to strengthen the resilience of primary health care. Methods: For 33 countries in LAC, primary health care shock scenarios were modelled as short-term reductions to the coverage of antenatal care and child health interventions using the Lives Saved Tool, and to family planning services and non-communicable disease management using custom models. Primary health care shocks starting in 2026 and leading to 25-50% relative coverage reductions (50% being a COVID-19-like disruption) with recovery periods of one to five years were compared to a strengthened primary health care scenario with intervention coverage maintained. Excess deaths and unintended pregnancies were estimated for 2026-2030 and converted to lifetime societal economic costs with 3% per annum discounting based on years of life lost (deaths) and reduced workforce productivity (unintended pregnancies). Findings: Depending on the magnitude and recovery time, the modelled primary health care shocks resulted in an additional 600-3100 stillbirths, 300-1400 neonatal deaths, 2000-10,000 child deaths, 2200-11,300 maternal deaths, 29,000-149,000 non-communicable disease deaths, and 2.7-14.1 million unintended pregnancies over 2026-2030. This translates to US$7-37 billion in societal economic costs per primary health care shock. Interpretation: Substantive investment in primary health care resilience would be warranted to limit the potential impact of health system shocks on service coverage. Funding: The World Bank.