In recent years, agencies that provide technical cooperation in health have increased their contractual relationships with private consulting entities. This has made it possible to respond in a timely manner to the support needs that countries have, to develop skills at the national level, and to reduce the operating costs for the cooperation agencies. However, these relationships risk moving the cooperation agencies away from generating ideas and new knowledge, which, until recently, was considered one of their essential roles. Contracting with private enterprises will almost certainly increase in the coming years. This makes it worth reviewing the tasks that correspond to the cooperation agencies in this scenario as well as mechanisms to see that these relationships result in the greatest benefit for deprived groups. Actions that can be undertaken immediately include organizing the "structural capital" (such as programs, databases, strategies, and organizational "culture," structure, systems, and procedures) of the technical cooperation agencies, precisely identifying tasks that cannot be delegated, and adequately designing and controlling terms of reference.

The nationalistic tendencies observed in the world today, rooted in ethnic and ancestral cultural values that do not necessarily coincide with the physical boundaries of countries, have an enormous influence on societal organization, the distribution of wealth, and the processes of decentralization being carried out by governments. At the same time, the economic liberalization policies which are in fashion accentuate social divisions and favor models of health care that are fragmented according to the economic means of the user. This document explores the consequences of these trends for equity in the health and medical insurance systems of Latin America, as well as the role of the State and the private sector in the provision of services.