Addressing Health System Fragmentation By Improving Coordination

The COVID-19 pandemic has exposed the vulnerabilities within the health systems of G20 nations, revealing issues such as care fragmentation, limited information sharing, and poorly integrated systems. Striking the optimal balance between decentralizing health services and upholding national standards, a challenge in normal circumstances, proved even harder during the pandemic. Improved coordination among providers, both public and private, as well as various health stakeholders and institutional actors, holds the potential to enhance quality and reduce costs, ultimately leading to better outcomes. Brazil is an illustrative case for both the challenge and potential of improved health coordination. SUS, its universal public health system, is the largest of its kind and is by design dependent on continuous negotiation between the Union, states, and municipalities, all of which share responsibility for health. Regionalisation, an organisational principle of SUS, aims to organise care regionally by leveraging the coordinating power of states vis-a-vis municipalities, which often lack the scale and capacity to deliver care. However, implementation has been unequal and compounded by political and technical challenges, an experience that provides lessons for Brazil and other nations. This brief will: 1) describe the challenges of coordination considering the continuum between decentralisation and centralisation; ii) connect these challenges to the pandemic experience; and iii) suggest the creation of mechanisms to share experiences and improve coordination on the domestic level, based on the experiences of Brazil and other G20 nations. The primary recommendation is to reduce system fragmentation and move towards integrated health services, with a priority on coordination and experience sharing forums, strengthening social participation and connection to other care services, and digital health.