Comparative health governance in Latin America: the case of national policy decisions during pandemic response in five countries

Context: Little is known about pandemic response in Latin America. The aim of this study was to compare key COVID-19 response measures taken by five Latin American countries to understand what elements of public governance are needed for more effective policy strategies, and to inform future pandemic preparedness. Methods: Using a qualitative, iterative approach guided by a governance framework, we analyzed the most salient characteristics of each country’s response (restriction, sanitary, and social protection measures). Findings: A focus on transparency and inclusion, together with attention to the primary level of care, appeared to be more prominent in countries with less Covid-19 incidence and mortality such as Argentina and Costa Rica. In contrast, Brazil, Chile, and Ecuador, with more fragmented and segmented health systems, coupled with less transparency and participatory decision making, were more severely impacted. Conclusions: Pandemic preparedness may benefit from emphasizing organizational, institutional, and informational elements of governance. Since data is essential to decision making in an evolving pandemic, the flow of information interacts with different elements of governance; therefore, more attention should be placed on the relation of the informational dimension with the organizational and institutional dimensions.