Despite notable scientific and medical advances, broader political, socioeconomic and behavioural factors continue to undercut the response to the COVID-19 pandemic1,2. Here we convened, as part of this Delphi study, a diverse, multidisciplinary panel of 386 academic, health, non-governmental organization, government and other experts in COVID-19 response from 112 countries and territories to recommend specific actions to end this persistent global threat to public health. The panel developed a set of 41 consensus statements and 57 recommendations to governments, health systems, industry and other key stakeholders across six domains: communication; health systems; vaccination; prevention; treatment and care; and inequities. In the wake of nearly three years of fragmented global and national responses, it is instructive to note that three of the highest-ranked recommendations call for the adoption of whole-of-society and whole-of-government approaches1, while maintaining proven prevention measures using a vaccines-plus approach2 that employs a range of public health and financial support measures to complement vaccination. Other recommendations with at least 99% combined agreement advise governments and other stakeholders to improve communication, rebuild public trust and engage communities3 in the management of pandemic responses. The findings of the study, which have been further endorsed by 184 organizations globally, include points of unanimous agreement, as well as six recommendations with >5% disagreement, that provide health and social policy actions to address inadequacies in the pandemic response and help to bring this public health threat to an end.

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INTRODUÇÃO O objetivo deste trabalho é detalhar algumas tendências já descritas por Nogueira 6 sobre a dinâmica do emprego em saú-de, na conjuntura da crise econômico-brasileira do qüinqüênio 1979-1984, bem como apontar alguns bloqueios, atualmente, existentes, no campo específico da política de recursos humanos em saúde, tendo em vista as bases para a Reforma Sanitá-ria que vem sendo discutida por amplos segmentos da sociedade brasileira, desde a realização da VIII Conferência Nacional de Saúde.Ao longo dos anos 70 ocorreu um forte crescimento do número de profissionais de saúde, bem como do quantitativo de empregos ligados ao setor. Este crescimento foi uma decorrência direta da reforma das instituições da Previdência Social, em 1967, onde, a partir da unificação e extensão da assistência médica previdenciária a todos, os trabalhadores formais 1 *, aumentou, sensivelmente, a demanda por serviços de saúde. Dado que esta demanda não poderia ser suprida pelo estoque de estabelecimentos prestadores de serviços até então existentes, no setor público, optou-se por uma política de contratação de prestadores privados. O aumento da demanda por serviços levou a um rápido crescimento da absorção de profissionais de saúde. Entre 1966 e 1974 o número de empregos, nas atividades hospitalares, passa de 150.123 para 303.098, destacando-se os postos de trabalho de nível médio e elementar e, em particular, os atendentes. Quanto aos profissionais de nível superior a demanda passou a ser suprida pela larga expansão do aparelho formador. "Entre 1935 e 1965 o número de Escolas Médicas aumentou de 12 para 27 e o nú-mero de formados em medicina, de 8.184 para 15.754. A partir de 1965 foram autorizadas a funcionar 33 novas escolas de medicina, sendo a maioria delas no setor educacional privado" 1 . Esta grande ampliação do aparelho formador não correspondeu, no entanto, a uma adequação dos profissionais, às reais necessidades da população no campo médico-assistên-cial. Como resultado, grande parte do corpo médico formada nos anos 70 tem, como referência, uma medicina especializada, tecnificada, privatizante e totalmente distante do quadro social de saúde no Brasil.Nas figuras do médico -este profissional especializado e tecnificado -e do atendente -mão-de-obra, sem especialização, capaz de aceitar os níveis salariais mais baixos ergueu-se a assistência médica privada dos anos 70. Financiada tanto ao nível do investimento quanto ao nível do custeio pelo setor

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Latin American and Caribbean (LAC) countries have experienced a long-term process of improvement in populational health conditions, shifting their health priorities from child–mother care and transmissible diseases to non-communicable diseases (NCDs). However, persistent socioeconomic inequalities create barriers to achieve universal health coverage (UHC). Despite a high level of governmental commitment to UHC, and rising coverage, approximately 25% of the population does not have access to healthcare, particularly in rural and outlying areas. Health system quality issues have been largely ignored, and inefficiency, from health financing to health delivery, is not on the policy agenda. The use of incentives to improve performance are rare in LAC health systems and there are political barriers to introduce reforms in payment systems in the public sector, though the private sector has opportunity to adapt change. Fragmentation in the financing of healthcare is a common theme in the region. Most systems retain social health insurance (SHI) schemes, mostly for the formal sector, and in some cases have more than one; and parallel National Health System (NHS)-type arrangements for the poor and those in the informal labor market. The cost and inefficiency in delivery and financing is considerable. Regional health economics literature stresses inadequate funding—despite the fact that the region has the highest inequality in access and spends the most on healthcare across the regions—and analyzes multiple aspects of health equity. The agenda needs to move from these debates to designing and leveraging delivery and payment systems that target performance and efficiency. The absence of research on payment arrangements and performance is a symptom of a health management culture based on processes rather than results. Indeed, health services in the region remain rooted in a culture of fee-for-service and supply-driven models, where expenditures are independent of outcomes. Health policy reforms in LAC need to address efficiency rather than equity, integrate healthcare delivery, and tackle provider payment reforms. The integration of medical records, adherence to protocols and clinical pathways, establishment of health networks built around primary healthcare, along with harmonized incentives and payment systems, offer a direction for reforms that allow adapting to existing circumstances and institutions. This offers the best path for sustainable UHC in the region.