Households in developing economies face frequent and uninsured shocks that generate income volatility and persistent vulnerability. Using harmonized longitudinal data from household surveys in Colombia, El Salvador, Mexico, and Peru covering 20022023, this paper presents new evidence on the incidence and persistence of self-reported shocks related to weather, health, and employment, as well as on the welfare changes and coping strategies that follow. We document five main findings. First, exposure is widespread and persistent: roughly one in four households experiences at least one adverse event in a given year, with a shock in one period raising the probability of being hit again in the next by eleven to twenty-two percentage points depending on the type of shock. Second, incidence varies sharply across households. Rural and poorer families are more likely to experience weather and health shocks, while employment shocks are more common among urban, less deprived households. Third, changes in welfare differ markedly across shock types and time horizons. Employment shocks are followed by the steepest short-term declines in income and consumption, while weather shocks are associated with smaller but more persistent and compounding losses. Health shocks, in contrast, raise expenditures as households increase spending to cope with medical needs. Fourth, shocks trigger costly coping responses. Households rely on borrowing, public transfers, and labor reallocation to smooth losses, with the mix of strategies varying across shock types. Fifth, long-run recovery is markedly unequal: after an initial downturn, households with higher baseline consumption manage to largely recover from weather shocks, while poorer households do not. Households enrolled in government programs before shock occurrence experience substantially lower income losses from both weather and employment shocks, suggesting these programs act as insurance against a broad range of adverse events.

América Latina y el Caribe (ALC) enfrentan un nuevo panorama de riesgos sistémicos como desastres de origen natural, cambio climático, crisis económicas, sanitarias y migratorias que se suman a los tradicionales del ciclo de vida. La región es la segunda más afectada del mundo por desastres, con más de 1.300 eventos entre 2000 y 2022 que impactaron a 190 millones de personas. Sequías, inundaciones y huracanes han generado pérdidas económicas, daños a la infraestructura y un aumento de la inseguridad alimentaria. Estas crisis, junto con la desigualdad estructural y la alta informalidad, afectan con mayor severidad a los hogares pobres y vulnerables. En este contexto, fortalecer y adaptar los sistemas de protección social es esencial para responder de forma efectiva a los choques múltiples y mejorar la resiliencia de las poblaciones más vulnerables. El Modelo de Madurez evalúa la capacidad de los sistemas de protección social para responder a choques y fortalecer la resiliencia y adaptación de los hogares frente al cambio climático y otros eventos adversos. Los resultados del análisis muestran que los países de la región alcanzan, en promedio, un 54% de madurez en Protección Social Adaptativa (PSA), con los mayores niveles observados en Brasil (71%), Chile (70%), República Dominicana (64%) y Perú (63%). Si bien estos resultados reflejan avances importantes, ningún país supera el 80%, lo que evidencia que aún queda un largo camino por recorrer. Las dimensiones con mayores progresos son las de capacidad de gestión y coordinación interinstitucional (65%) y gobernanza y financiamiento (62%), impulsadas por la experiencia acumulada en la implementación de programas de transferencias monetarias y por la reciente creación de marcos normativos y estrategias nacionales en PSA. En contraste, las dimensiones con menores avances son protección social informada (42%) y cobertura y adaptación (44%), donde persisten importantes brechas en el uso de datos, integración con sistemas de alerta temprana y extensión de la cobertura de programas regulares, especialmente de seguros de desempleo y servicios de cuidado. El estudio confirma que una mayor madurez en PSA se traduce en respuestas más rápidas y eficaces ante choques y desastres, como se observó durante la pandemia de COVID-19, cuando los países más avanzados (Brasil, Chile, Perú, República Dominicana) lograron desplegar apoyos en menor tiempo. También revela una alta correlación entre el gasto social y la madurez en PSA, reforzando el vínculo estrecho entre la solidez de los sistemas regulares de protección social y su capacidad adaptativa. Mirando hacia el futuro, es esencial que los países sigan invirtiendo en cada uno de los siete componentes analizados. Esto permitirá consolidar sistemas de protección social verdaderamente adaptativos, capaces de proteger a la población más vulnerable y reforzar su resiliencia frente a los riesgos crecientes del siglo XXI.

En las últimas dos décadas, el Sistema Único de Beneficiarios (SIUBEN) ha experimentado un profunda transformación. Fue creado en 2004 como respuesta a una severa crisis económica y social, con el mandato inicial de construir una base de datos que permitiera focalizar de forma más justa y eficiente los programas sociales. Desde entonces, ha pasado de ser una herramienta orientada exclusivamente a la asignación de transferencias monetarias a convertirse en una plataforma clave para la identificación y caracterización de hogares en situación de vulnerabilidad, evolucionando hacia un sistema de información social más dinámico, transversal y estratégico. Esta transformación profunda se alinea con una nueva visión de protección social en el país, orientada a ser universal, resiliente y adaptativa, con el fin de contar con sistemas capaces de prevenir, prepararse y responder de forma coordinada a choques económicos, ambientales y sanitarios, protegiendo los ingresos, activos y la seguridad alimentaria de los hogares, especialmente en un contexto de creciente vulnerabilidad climática. Este estudio de caso, documenta la evolución institucional, operativa y tecnológica del SIUBEN. A partir de una revisión documental y entrevistas a actores clave se analizan los factores que han facilitado su consolidación, los principales desafíos enfrentados durante su implementación, las respuestas institucionales adoptadas para superarlos, y las lecciones aprendidas que pueden contribuir a una política social más cohesionada, adaptativa e inclusiva en el futuro.

The objective of this study was to summarize the evidence in relation to telemedicine systems as regards their effectiveness, costs and satisfaction in the last decade. A summary of main findings is presented. According to results telemedicine proved to be a feasible and effective tool to provide health care as a replacement or complement to usual care, especially when applied to chronic diseases.

The Republic of Korea's management of the COVID-19 pandemic showcases an exemplary model through its robust and comprehensive approach, underscored by decisive leadership and a unified governmental strategy using ICT tools. Central to its success was the deployment of the 3T strategy (Testing, Tracing, Treatment) and a four-pillar policy response centered on Openness, Transparency, Civic Engagement, and Innovativeness. The establishment of the Korean Center for Disease Control and Prevention (KCDC) in 2004 and the Infectious Disease Control and Prevention Act paved the way for the pan-governmental COVID-19 response. The use of sophisticated ICT tools played a significant role in the success of Korea's response. The study argues that South Korea's approach, particularly its innovative use of ICT tools, offers valuable lessons for enhancing global emergency preparedness and response systems.

This document describes the foundations of cybersecurity practices in the Republic of Korea, specifically laws, regulations, governance, and foundational infrastructure, which comprise the core components of its cybersecurity practices. It also highlights a number of important lessons for improving cybersecurity practices in the country. The first lesson is that laws and regulations are essential for the deployment of effective responses to future cyber threats. Korea has enacted many national laws related to cybersecurity, these laws have been revised to reflect current realities in Korea. These laws form the basis of national policy and governance for effective cybersecurity responses. Second, the Korean government has implemented a pan-government national cybersecurity plan, which delineates the development of a national pan-government information protection system encompassing the public, private, national defense, and financial sectors. Under the National Security Council, Korea's top administrative entity for dealing with national cybersecurity, several agencies work closely to protect the country against cyber threats. The Inter-American Development Bank member states should promote and nurture special cybersecurity-related institutions.

The Social Protection and Health (SPH) Division of the IDB hosted its annual Regional Policy Dialogue (RPD) on Adaptive Social Protection Systems from June 17th to 19th, 2024, in Lima, Peru. This event aimed to address the increasing vulnerability of households to natural disasters, economic disruptions, and health crises, many of which are exacerbated by climate change. With over 78 million people living in high-risk areas in Latin America and the Caribbean (LAC), the dialogue was crucial for fostering resilient social protection systems. The RPD brought together over 120 participants from 31 countries, including high-level representatives from the Ministries of Finance, Social Protection, and Health, including 10 ministers, vice-ministers, and many worldwide experts. The RPD focused on the need to bring together experts and practitioners involved in Adaptive Social Protection (ASP) systems in the region and other continents to promote the exchange of knowledge and lessons learned, as well as to explore new methods, financial tools, best practices, and innovative activities that can contribute to furthering the discussion on the challenges faced by the region on this matter.

Adaptive social protection refers to the utilization of social protection systems and programs to enhance the ability of impoverished and vulnerable households to withstand and recover from various shocks, such as those associated with climate change.The maturity model is an assessment tool that seeks to measure the capacity of social protection systems to fulfill these new functions. This model is organized into 7 dimensions and consists of 50 indicators. It assesses the level of maturity of the system across 5 different levels. The interconnectedness and reciprocal influence across these dimensions ensure a holistic examination, preventing fragmented approaches and offering a comprehensive perspective of the system.

This case study underscores the significance of digitalization in healthcare, exemplified by Korea's successful integration of electronic health record (EHR) systems, which has markedly enhanced clinical services quality and efficiency. Focusing on the Seoul National University Bundang Hospital (SNUBH), a leading national multispecialty academic medical center in Korea, the case study details the hospital's journey towards digitalization through the implementation of its interoperable EHR system, BESTCare. Through focus group interviews with field-deployed staff, the study reveals the critical factors for successful digital transformation in hospital management, including leadership investment decisions and the engagement of end-users from the outset. The gradual yet significant benefits of digital transformation, such as cost efficiency and clinical quality improvements, are highlighted, along with the adaptability of digital tools in crisis situations like the COVID-19 pandemic. The study concludes with the documented impacts of BESTCare and other digital tools on care quality and efficiency, suggesting that similar digital transformation efforts in Latin America and the Caribbean could lead to significant health outcomes improvements while maintaining current healthcare spending levels.

The Digital Health Procurement Guide is a comprehensive resource developed by the Inter-American Development Bank (IDB) to assist its clients in procuring digital health tools. It provides an overview of the procurement process, including key stages and responsibilities, and offers practical tools and templates to facilitate a successful procurement. The guide emphasizes the importance of strategic planning, understanding needs, executing a structured procurement process, and negotiating effective contracts. Collaboration among stakeholders is also highlighted as crucial for successful digital health procurement. The guide does not replace the IDB's procurement policies but serves as a valuable reference for clients seeking support in this area. This guide will: Help Purchasers understand the process for procuring digital health tools from defining its need to contract negotiation; Discuss the difference between defining what a Purchaser needs (i.e., its requirements) and how it asks (i.e., goes to market) for solutions to meet those needs; Provide an overview of a procurement process following a multi-stage bidding process; Provide tools and templates that can help a Purchaser execute a digital health procurement based on good practice.

Given the rates of transmission of COVID-19, relying only on manual contact tracing might be infeasible to control the epidemic without sustained costly lockdowns or rapid vaccination efforts. In the first study of its kind in Latin America, we find through a phone survey of a nationally representative sample of ten countries that an opt-out regime (automatic installation) increases self-reported intention to accept a contact tracing app with exposure notification by 22 percentage points compared to an opt-in regime (voluntary installation). This effect is triple the size and of opposite sign of the effect found in Europe and the United States, potentially due to lower concerns regarding privacy and lower levels of interpersonal trust. We see that an opt-out regime is more effective in increasing willingness to accept for those who do not trust the government or do not use their smartphones for financial transactions. The local severity of the pandemic does not affect our results, but feeling personally at risk increases intent to accept such apps in general. These results can shed light on the use of default options not only for contact tracing apps but in public health overall in the context of a pandemic in Latin America.

En este artículo se describen ocho principios rectores para la transformación digital del sector de la salud, se establece su relación con la pandemia de COVID-19 y se destaca su importancia para los países que se encuentran en un proceso de transformación digital. En la Región de las Américas, 30% de las personas no tiene acceso a Internet, entre otras brechas, por lo que es imperativo adoptar políticas y medidas para que la implementación de las intervenciones de salud pública sea equitativa y sostenible, de manera de garantizar que nadie se quede atrás. Los ocho principios se centran en las cuatro esferas de un sistema de salud sostenible (humana, social, económica y ambiental) y ponen de relieve las posibilidades más amplias de utilizar las tecnologías digitales para incidir en la sostenibilidad de los sistemas de salud.

The Social Protection and Health (SPH) Division of the Inter-American Development Bank (IDB) held its annual Regional Policy Dialogue (RPD) Digital Health for All: Latin America and the Caribbeans golden opportunity to improve the efficiency, quality and equity of sector on September 12-14th 2022 in Panama City, Panama. The RPD brought together over 120 participants, including leaders from over 20 countries, vice-ministers of health and directors of technology and communications, and regional and global experts in digital health. The meeting sought to provide a setting to discuss what the IDB and different countries have learned in the past four years of implementation of digital health, structural challenges to scale digital health, and the measures needed to ensure that decisions made today are both sustainable and transformational. The meetings objectives broadly included discussing three topics: 1) how to ensure that digital health adds value in terms of improved efficiency, quality, and equity;2) policy considerations for linking digital health to health outcomes; and3) the future state of our region in terms of digital transformation of the health sector.This report provides an overview of the meeting, its main findings, and the steps that lie ahead on this journey.

This article describes 8 guiding principles for the digital transformation of the health sector and identifies their relationship with the COVID-19 pandemic, as well as highlights their importance to countries undergoing digital transformation processes. In the Region of the Americas, among other gaps, 30% of people do not have access to the Internet, which is why it is mandatory to develop policies and actions to deliver public health interventions equitably and sustainably to ensure that no one is left behind. The 8 principles focus on the 4 areas of a sustainable health system-human, social, economic, and environmental-and highlight the broader possibilities for using digital technology to have an impact on the sustainability of health systems. (Am J Public Health. 2022;112(S6):S621-S624. https://doi.org/10.2105/AJPH.2022.306749).

This study describes the perception, adoption, and acceptance factors involved in the deployment of digital technologies for public health in Latin America and considers the implications for future digital health interventions. We conducted a descriptive analysis using nationally representative data from a phone survey conducted in 2020 in 10 countries in Latin America. We found that early in the pandemic, in countries with existing applications, 74% of the population used a smartphone, 47% had knowledge of the government app to report symptoms, but only 2% reported using it. Those interviewed reported that they are willing to share their personal data during a pandemic (61%) 50 percentage points higher than in non-pandemic times, although understanding how their personal data was used by the government and private companies was extremely low. More than 70% reported that they would use an application to report symptoms and would use an app that accesses their location or that uses contact tracing technology to alert them about possible exposure. Also, at least half of the users agree with preventive measures against COVID-19 such as daily follow-up calls, tracking via GPS for quarantine enforcement, and daily visits. In all countries, adoption of digital technologies increases if individuals or their relatives report they are infected; it decreases when end-users do not trust the anonymity policies or are concerned about government surveillance. Yet, encouraging greater adoption of digital technologies strongly depends on who designed the technology. Results show that 73% of users would prefer an app designed by an international organization such as the WHO to an app designed by the local government (64%) or a telephone company (56%). The study concludes with a reflection on the promising results of digital technologies and discusses the importance of considering users perceptions, factors for acceptance, and trust when pursuing adoption of digital technologies.

La pandemia de COVID-19 demostró la centralidad de la salud de la población para las economías y el bienestar social, a la vez que evidenció serios problemas estructurales de larga data en los sistemas sanitarios. En América Latina y el Caribe (ALC), se destacaron serias deficiencias en dimensiones básicas como calidad, resultados, costos y equidad. Hoy, los países deben gestionar la complejidad cada vez mayor de sus sistemas sanitarios mientras hacen frente a una crisis económica sin precedentes. Este documento aborda cada aspecto del proceso de TD, comparte evidencia, prácticas y recomendaciones concretas, identifica el conjunto de actores que pueden y deben participar y delinea los elementos prácticos necesarios para que cada país pueda construir esta crucial trayectoria.

Machine learning methods are being increasingly applied in sensitive societal contexts, where decisions impact human lives. Hence it has become necessary to build capabilities for providing easily-interpretable explanations of models' predictions. Recently in academic literature, a vast number of explanations methods have been proposed. Unfortunately, to our knowledge, little has been documented about the challenges machine learning practitioners most often face when applying them in real-world scenarios. For example, a typical procedure such as feature engineering can make some methodologies no longer applicable. The present case study has two main objectives. First, to expose these challenges and how they affect the use of relevant and novel explanations methods. And second, to present a set of strategies that mitigate such challenges, as faced when implementing explanation methods in a relevant application domain -- poverty estimation and its use for prioritizing access to social policies.

With millions of people in the world in situations of physical distancing because of COVID-19, information and communication technology (ICT) has become as one of the principal means of interaction and collaboration. The following advantages of ICT have been cited since the start of the new millennium: increased access to information and service delivery, educational strengthening, quality control of screening programs, and reduction of health care costs. In the case of telemedicine, however, a number of barriers-especially technological, human and social, psychosocial, anthropological, economic, and governance-related-have stood in the way of its adoption. The past 20 years have seen an increase in the availability of resources and technical capacity, improvements in digital education, empowerment of patients regarding their treatment, and increased public interest in this area. Successes have included the use of interdisciplinary teams, academic and professional networking, and virtual medical consultations. After reviewing the state of telemedicine in the Region of the Americas, the authors recommend the urgent adoption of measures aimed at implementing national telemedicine policies and programs, including a regulatory framework and adequate funding. Implementation of the measures should be integrated and interoperable and include the support of academic networks and the collaboration of specialized institutions. The policies should generate an enabling context that ensures sustainability of the progress achieved, bearing in mind the possible barriers mentioned.

The article's main objective is to propose a new definition for Information Systems for Health, which is characterized by the identification and involvement of all the parts of a complex and interconnected process for data collection and decision-making in public health in the information society. The development of the concept was through a seven-step process including document analysis, on-site and virtual sessions for experts, and an online survey of broader health professionals. This new definition seeks to provide a holistic view, process, and approach for managing interoperable applications and databases that ethically considers open and free access to structured and unstructured data from different sectors, strategic information, and information and communication technology (ICT) tools for decision-making for the benefit of public health. It also supports the monitoring of the Sustainable Development Goals and the implementation of universal access to health and universal health coverage as well as Health in All Policies as an approach to promote health-related policies across sectors. Information Systems for Health evolves from preconceptions of health information systems to an integrated and multistakeholder effort that ensures better care and better policy-making and decision-making.