The region requires major investments to meet basic needs in health and education, expand access to services, improve quality and modernize or replace aging infrastructure.
One of the most basic problems in the health system is that the physical infrastructure is aging and poorly maintained. The IDB estimates the need for investment in this area at around $100 billion—both to replace old hospitals, clinics and medical equipment and to upgrade infrastructure to meet today’s energy efficiency standards.
Access to health care has improved in the region, though it still falls short when compared with more developed countries. A 2017 report by the Pan American Health Organization (PAHO) found that Latin America and the Caribbean had made important strides in recent years on indicators related to infant and maternal mortality, reproductive health, infectious diseases and malnutrition. Prenatal care—measured as the percentage of pregnant women who had at least four prenatal checkups—rose from 72.6 percent in 2005 to 85.7 percent in 2016. However, that still leaves a big gap, and there are deep inequalities in health coverage within and between countries.
Education is another area where progress in the region is mixed. On the positive side, primary schooling has become almost universal, and secondary enrollment has risen from 69 to 77 percent in the last two decades, according to the IDB.
But students in the region are falling behind their peers in more developed regions. In the 2015 version of the PISA test—the Programme for International Student Assessment, administered by the Organisation for Economic Co-operation and Development (OECD)—most of the countries from Latin America and the Caribbean ranked in the lower third of the distribution. Of the nine Latin American and Caribbean countries that participated, Chile registered the best performance in all three categories (science, reading and math) but still ranked in the lower half among the 70 participating countries, an IDB analysis found. The test is administered every three years to 15-year-old students around the world.
As with health care, the educational infrastructure in Latin America and the Caribbean needs to be updated and improved. Learning spaces in schools tend to be inadequate and distributed unequally, with the poorest students and those who attend rural schools at the greatest disadvantage. Only around 65 percent of students in the region have adequately equipped classrooms or attend schools that have at least one academic space in addition to classrooms, according to IDB data.
In short, when it comes to these basic social needs, much of the region is underserved. While health and education services are primarily provided by the public sector, the scale of the needs and today’s fiscal challenges mean governments cannot always go it alone.