Latin America and the Caribbean (LAC) face a convergence of vulnerabilities: pandemics, climate-related disasters, political and economic turbulence, and the persistent weight of inequality. When primary health care (PHC) systems falter in the face of such shocks, the social and economic toll is staggering, measured in destroyed lives, livelihoods, and eroded trust. The central challenge is how to build PHC systems that can withstand, adapt, and recover from shocks, while continuing to meet people's everyday needs.
The journal's new Commission on Resilience in Primary Health Care in Latin America and the Caribbean makes an urgent and compelling case: resilient PHC is essential in a region highly vulnerable to pandemics, climate disasters, and political and economic turbulence. The Commission's modelling starkly quantifies the costs of inaction, projecting US$ 7 billion to US$ 37 billion in societal economic costs and upwards of 160,000 deaths over a five-year term if PHC systems keep failing.1 Its call to centre resilience in PHC reforms is timely, evidence-based, and ambitious.
Yet if the promise of resilient PHC is to be realised, reforms must be pursued through a gender lens that recognises the central role of gender and intersecting inequities in health access, vulnerability, and resilience.
Resilience through a gender lens: what would be different?
Resilience in PHC is not gender neutral. Women comprise the majority of the health workforce, including in this region,2 provide unpaid and underpaid care,3,4 and face persistent unmet health needs within existing systems.5,6 At the same time, rigid gender norms, systemic inequities, and gender-based violence (GBV) continue to restrict women's access to care and participation in decision-making.7,8 Designing PHC resilience without addressing these realities risks entrenching inequalities rather than dismantling them. Applying a gender lens would ensure that resilience strategies account for care burdens, protect health workers, and address barriers to access that disproportionately affect women, girls, and gender-diverse individuals. Crucially, while PHC is already linked to intersectoral responses to GBV and other structural determinants of health, these connections are often fragmented and under-resourced. Strengthening them through a gender lens would position PHC not only as a site of service delivery but as an active platform for equity and protection.
The Commission is correct to highlight that strengthening PHC and building resilience are mutually reinforcing. A gender lens sharpens this argument. For example, empanelment, assigning populations to primary care teams, can improve continuity and equity of access, but only if teams are equipped to meet the needs of historically marginalised groups, including Indigenous, Afro-descendant, migrant, and LGBTQI + communities. Similarly, digital health holds promise for expanding PHC coverage,9 yet women and girls in LAC are disproportionately affected by digital divides in access, literacy, and affordability.10, 11, 12 Without targeted measures, digitalisation risks excluding the very populations PHC is meant to reach. Making gender equity explicit in the design of these reforms, both bolsters resilience and ensures inclusivity is realised in practice. A resilience framework that foregrounds intersectionality would recognise these compounded disadvantages and prioritise models of PHC that bridge divides between communities and health systems. As such, gender equity and PHC strengthening for resilience are synergistic goals.
Applying a gender lens also forces us to confront the politics of resilience. Gender is a structuring force in how systems are organised, resourced, and led. The discrimination faced by LGBTQI + populations,13 the undervaluing of women's labour in the health workforce,7 and the persistence of GBV in this region14, 15, 16 are not discrete problems but interconnected expressions of power that weaken PHC. Confronting these inequities is not only about fairness; it is essential to the effectiveness and resilience of PHC systems.
Gender across the pillars of resilient PHC
Building resilient PHC requires progress across several pillars: integrated health services and essential public health functions; community empowerment and participation; multisectoral action; and sustainable financing. Gender considerations sharpen and strengthen each pillar. Integrated services must include sexual and reproductive health, available and affordable to all, alongside sustained investment in women's health across the life course, generating positive health, social, and economic outcomes.17 Likewise, community empowerment requires the active participation of women's organisations, LGBTQI + groups, and youth. Multisectoral action must address deeply gendered determinants such as education, employment, and protection from violence. Financing must reduce reliance on out-of-pocket payments, which disproportionately affect women and the poor, while ensuring sustainable support for the predominantly female PHC workforce.
A gender-responsive agenda for PHC resilience
Reforms to PHC must be gender-responsive if they are to be resilient. This entails: (i) embedding responses to GBV and discrimination as core functions of PHC, (ii) ensuring digital health and empanelment strategies are explicitly designed to reduce gender gaps, (iii) valuing and protecting the PHC workforce by addressing inequities in pay, education, conditions, and leadership opportunities, (iv) institutionalising participation of women, LGBTQI + groups, and community organisations in governance, and (v) incorporating intersectional monitoring and evaluation to reveal and close equity gaps.
Conclusion
Applying a gender lens that foregrounds power, intersectionality, and economic value allows calls for PHC reforms to move beyond resilience as merely an argument for improved survival. Instead, resilience can also be understood as a lever for justice: systems that not only withstand shocks but transform to meet the needs of all communities they serve. The Commission shows that the costs of inaction are high, yet the returns on gender-responsive investment in PHC are potentially transformative.
Contributors
BME conceived of the Comment and developed the first draft. GJD and RCA critically edited and contributed to writing subsequent drafts. All authors approved the final manuscript.
Declaration of interests
The authors have no conflict of interests to declare.
Acknowledgements
Positionality Statement: BME and RCA are citizens of countries in the LAC region, though they currently reside outside of the region. Both maintain active research collaborations and partnerships with colleagues and institutions across LAC. Equity and gender equity are core themes that feature in the research programs of all authors.
Funding: No other funding to declare.
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