- In a context of limited resources, planning health investments is key to improving services and reducing access gaps.
- Health Investment Master Plans allow for the organization, prioritization, and guidance of investment decisions based on evidence and the needs of the population.
- The experiences of Guatemala and El Salvador show that strategic planning, accompanied by realistic and sustainable implementation, can transform investment into concrete improvements for health systems.
Modernizing health infrastructure and closing equipment gaps in Latin America and the Caribbean requires more than $170 billion, equivalent to 70% of annual public health spending before the pandemic. And while diagnoses abound, turning investment plans from paper into reality is no easy task. The region faces an urgent challenge: transforming needs into strategic decisions that improve services, especially for the most vulnerable populations.
In a context of limited resources and growing needs, efficiency in health systems is not optional: it is essential. That is why tools such as Master Plans for Investment in Health (MPIH) are critical for countries to carry out methodical planning of their investments.
They are studies of the supply and demand for services and resources, which are reflected in a prioritized investment portfolio to respond to the demand for services from the most vulnerable populations.
During the webinar Master Plans for Investment in Health: What to Invest In and How to Do It?, we shared some key insights (in Spanish) on the implementation of these plans in Guatemala and El Salvador, two countries that have begun to move toward more strategic health investments. In this blog article, we highlight lessons and challenges.
Planning begins by understanding the magnitude of the challenge. In Guatemala, for example, a technical analysis revealed that 83% of health facilities required some type of intervention, and that more than 1,000 new health posts were needed nationwide. Faced with this reality, technical dialogue with the government and the teams from the Ministry of Public Health and Social Assistance (MSPAS) made it possible to prioritize short-, medium-, and long-term investments.
The use of objective criteria — such as the main causes of mortality, the distribution of the population, and existing infrastructure — helped guide informed decisions. Community participation was also key, ensuring local commitment to each project.
Currently, the Ministry is implementing a network methodology expected to ensure that each intervention is integrated into existing health service networks. With this effort, the aim is to promote improvements in the efficiency and functioning of health facilities.
Designing a plan is only the first step. Execution faces concrete obstacles that must be anticipated from the outset, and experiences like these allow us to identify the factors that can make the difference.
For example, approval times may be longer than expected, especially when legislative validation is required. The preparation of technical documents — such as the development of technical files or the drafting of specifications for project design — also demands time and technical capacity: each file can take between six months and one year. On top of that, the region faces common challenges such as frequent turnover of authorities, lack of availability of legalized land, and the steady increase in construction and equipment costs.
All this calls for realistic expectations and the design of a flexible but well-founded roadmap. It is also essential to look beyond infrastructure: ensuring the availability of trained personnel, strengthening operational management, and anticipating the resources needed for the continuous operation and maintenance of new facilities.
The experience in Guatemala, which led to the formulation of an investment program that prioritizes the departments with the greatest needs, and in El Salvador, which made it possible to build a new type of facility dedicated to specialty outpatient care, shows that well-planned and well-executed health investments can have a deep and lasting impact. But achieving this requires more than political will: it takes vision, coordination across levels of government, ongoing dialogue with communities, and the capacity to adapt to contextual challenges.
According to Bank estimates, a hospital bed can cost between $200,000 and $500,000, depending on the level of complexity and the country. Every poorly sized decision represents a missed opportunity and a potential long-term cost for the system. That is why having tools such as Master Plans for Investment in Health allows for strategic, evidence-based decisions with a realistic projection of sustainability.
For technical teams seeking to move in this direction, the IDB offers training resources and technical support that strengthen countries’ capacity to organize, prioritize, and execute impactful investments. Because investing in health, when done well, can change the present and future of millions of people.