Challenges

In the Dominican Republic, efforts to mitigate the COVID-19 pandemic—while also maintaining the delivery of essential health services—encountered the following challenges:

In the Dominican Republic, decades of weak investment in the health sector resulted in systems unequipped to manage a large-scale emergency while delivering essential health services. Due to limited capacity at the primary health care level, the public health care network of the Dominican Republic is more reactive than preventive: it focuses primarily on delivering acute care rather than preventing disease. It was therefore unprepared for many aspects of the pandemic. The country’s COVID-19 case counts were among the region’s highest between March and August 2020, and mitigating interventions such as contact tracing were difficult to implement. In addition, the testing system became overwhelmed at the beginning of the pandemic, which affected infection control.

At the beginning of the COVID-19 pandemic, these weak systems left the Dominican Republic unprepared to respond to the pandemic emergency while maintaining the delivery of essential health services. This was exacerbated by the delay in their election process until July 2020. Some key services were more affected than others, such as directly observed treatment for tuberculosis and in-person treatment for HIV patients. Efforts to mitigate the pandemic’s spread— including mobility restrictions for patients, reduced working hours for providers, and shortages of key supplies and personal protective equipment—undermined the delivery of key maternal and neonatal health services. These disruptions also inequitably affect low-income populations, because higher-income citizens are more likely to use the private system instead.