The cost of inaction to strengthen the resilience of primary health care in Latin America and the Caribbean: a modelling study
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.006 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.007 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".