[Health service coverage in Latin America and the Caribbean]

Since the 1970s the Member States of the World Health Organization have pledged themselves to the goal of "health for all" and to broadening the coverage, quality, and efficiency of the health care services they provide. In spite of that commitment, there has been little progress in the conceptual understanding and development of indicators to help evaluate the characteristics of the populations with and without coverage, as well as in knowing the relationship between coverage and the characteristics of health care services. Most of the countries of Latin America and the Caribbean are in the process of reforming their health care sectors, and they could benefit from new insight in these areas. To help build that knowledge, this study looked at the population without health care services in the countries of Latin America and the Caribbean, using four indicators: vaccination for poliomyelitis, tuberculosis (BCG) vaccination, prenatal care for pregnant women, and childbirths attended by a health professional. In 1995, out of a total population of 474 million in Latin America and the Caribbean, the number without coverage was a minimum of 40 million, calculated using the indicator of BCG vaccination coverage. Using the indicator for prenatal care, the number of persons without health care coverage was 137 million. By analyzing these four indicators in each country, it is possible to develop health services profiles that would suggest different health sector reform policies. The study also analyzed some characteristics of the structure and coverage of the health systems in 46 countries and territories and their correlation with indicators of result or impact. Five indicators of health care resources were used, along with ten indicators of coverage and seven indicators of result or level of health achieved. A statistically significant association (P = 0.05) was found between the coverage of prenatal care and professionally attended childbirths and the results as measured by rates of infant mortality and maternal mortality.