As countries around the world strive to provide quality healthcare for their population, Chile emerges as an example of how an innovative approach has the potential to transform public health systems and improve healthcare service provision.
Over recent decades, Chile has been one of the fastest-growing economies in Latin America. This progress has led to reductions in poverty, improvements in average health outcomes, and increased life expectancy. Yet the country faces a pressing challenge: noncommunicable diseases (NCDs) and mental health disorders now account for over 85% of deaths, outpacing infectious diseases as the leading causes of mortality.
A timely World Bank report, supported by Access Accelerated, examines Chile’s healthcare landscape, and offers a roadmap for countries facing a host of interconnected crises. These challenges span the demands of an aging demographic, the surge in NCDs and mental health disorders and the complexities of multimorbidity. The report gains even greater relevance as global events such as pandemics and conflicts further strain national health budgets and undermine public health systems.
Bridging the healthcare gap: A chronic challenge
Healthcare access in Chile is marked by significant disparities. Of the estimated 11 million people living with an NCD, only about 4 million—approximately 36%—receive the treatment they need. Compounding this issue is a fragmented health system that results in inconsistent quality of care, redundant medication prescriptions, and often inefficient, unsafe treatment.
In answer to these challenges, Chile’s Minister of Health is leading a significant strategic shift. The strategy targets multimorbidity—the presence of two or more long-term health conditions[i]—through an innovative reorganization of care delivery, moving away from defragmented care to continuous, people-centered comprehensive care. Implemented since 2019, this approach reaches beyond the traditional healthcare model, seeking to empower people, and their families and caregivers as active participants in their health, ultimately improving both clinical outcomes and personal well-being.
Dr. Rialda Kovacevic, a World Bank Health Specialist co-authored the policy note that documents the Chile’s innovative response. “Chile’s story is a beautiful narrative where the health needs and wants of its people meet a long-term political commitment, coming in various forms, including financial.”
Strengthening primary healthcare
At the heart of Chile’s healthcare strategy is a strong, effective primary healthcare (PHC) system. Chile’s PHC provides health services to nearly 80% of Chile´s population, especially those in low-income settings.
Takanori Sato, Director, Global Public Affairs, Takeda and Vice-chair of Access Accelerated, emphasizes the importance of PHC strengthening. “Robust primary care enables better allocation of limited resources, fosters equitable access through community-driven health strategies, and enhances affordability by delivering care closer to patients’ homes.”
Prioritizing and decentralizing mental healthcare
Mental health is an increasingly critical public health issue in Chile, with nearly a third of the population over age 15 experiencing a psychiatric disorder in their lifetime. A significant 6% of the country’s health budget has been allocated to mental health initiatives, marking a change in both perspective and priority.
Over the last three decades, efforts have been underway to integrate mental health services into the national health network and to coordinate primary health care with specialized mental health teams.
“Mental health is an inextricable part of whole-person well-being, and the implications of addressing or ignoring it span outside of health, including social and economic ones,” notes Dr. Kovacevic. “The imaginary division between mental and physical health is a product of our human need to organize and simplify. This reductive approach to health costs humanity millions of lives lost, and economies trillions of dollars.”
Chile’s National Mental Health Plan (2017-2025) solidifies this more integrated approach, requiring that all mental health services to be embedded within the community care model and are made an essential part of Chile’s network of health services.
For Mr. Sato, this represents critical progress. “This move away from an institutional, hospital-centric model to a more community-based framework represents more than an administrative reorganization. It is an important shift that places the dignity and needs of individuals at the forefront.”
Gains, gaps, and the road ahead
Funding for mental health within Chile’s PHC has tripled between 2008 and 2017. The impact is evident: a 2014 WHO Report indicates that psychologists are present in 99.6% of Chile’s primary healthcare systems, representing almost one psychologist in every primary care center. However, disparities in access and quality of care persist. Despite 15 million people being covered under the Public Primary Health Care insurance, only six million people can access these services. Achieving universal access to care and universal health coverage remains a crucial goal for the government.
Chile’s concerted, ongoing efforts offer a rich source of insights and invaluable lessons that can inform other nations striving to strengthen their primary care and health system. Neighboring nations like Brazil, Colombia, and Uruguay have already begun to adopt some of Chile’s innovative approaches, highlighting the value and importance of knowledge sharing and collaboration between countries.
“Thanks to the collaboration across sectors, leadership, communities, and academia, innovation was nurtured, resulting in valuable lessons learned that enabled successful scale-up of effective interventions,” says Dr. Kovacevic.
[i] Skou, S.T., Mair, F.S., Fortin, M. et al. Multimorbidity. Nat Rev Dis Primers 8, 48 (2022). https://doi.org/10.1038/s41572-022-00376-4