Many countries in the region are continuing their efforts to enhance the response capacity of primary care services. Countries such as Belize, Bolivia, Canada, Chile, and Honduras, among others, have formulated policies and strategies to improve access to primary care, support healthcare professionals, build capacities to address chronic diseases, enhance preventive and palliative care, and promote the integration of health networks, including the use of telehealth. Similarly, other countries such as Argentina, Costa Rica, Ecuador, and Guyana, have focused on strengthening governance, improving infrastructure, fostering intersectoral collaboration, and reinforcing maternal and child healthcare services. Despite these endeavors, much work remains to be done, particularly concerning the advancement of health service integration with a focus on equity. The sustained continuation of these efforts is crucial to achieving long-term impact on health outcomes.

Overall, the countries are mostly on track with their development of actions to prevent care dependence. The Decade of Healthy Aging movement was seen as an important opportunity to advance this agenda, encouraging countries to implement actions that are conducive to integrated care and intersectoral actions, especially concerning enabling environments and the protection of older adults' rights.

The countries of the Region have made great efforts to incorporate the vaccine into their national vaccination schedules; as of December 31, 2023, only 4 countries had not introduced the HPV vaccine. 26 countries in the Region are vaccinating children and 12 countries have switched to a single-dose schedule.

Countries in the region are moving toward implementing standardized, evidence-based protocols to improve the quality of diabetes care. However, in parallel with these efforts, the prevalence of obesity, one of the main risk factors for diabetes, continues to increase. This challenge makes it difficult to stop the sustained increase in diabetes, reflecting the need to redouble efforts and move toward a joint, integrated, and comprehensive response to diabetes and other non-communicable diseases and risk factors. Additionally, the need for updated, standardized, and internationally comparable population data makes it difficult to evaluate the progress achieved with this indicator. Strengthening population surveillance systems for non-communicable diseases, including diabetes, would have a positive effect on the monitoring of this indicator.

Countries in the region, including those at risk, are making structural changes regarding the procurement of medicines and validated blood pressure devices, as well as adopting standardized treatment protocols to help expand access to quality care from the primary health care setting and improve hypertension control rates. However, the adoption of systematic quality improvement methodologies to improve hypertension management is still incipient in the region and must be accompanied by monitoring and evaluation systems designed to enable primary health care teams to monitor and correct deviations in their own performance. Additionally, a lack of updated population-level data limits the ability to accurately gauge progress.

The year 2022 was primarily dedicated to recovering from the negative impact of the COVID-19 pandemic, with a particular emphasis on reinstating interrupted screening procedures. The Pan American Health Organization (PAHO) has been working toward facilitating the implementation of HPV testing as the primary screening procedure, and concurrently developing comprehensive national strategies aimed at eradicating cervical cancer through HPV vaccination.

In the period spanning 2022-2023, PAHO, in collaboration with the International Agency for Research on Cancer (IARC), worked on the CanScreen5 project, designed to comprehend the obstacles impeding the achievement of screening targets. Furthermore, they sought to devise methods to monitor progress through the utilization of standardized indicators. Subsequently, PAHO compiled and published a regional report that provides an overview of the current status of cervical cancer control within the region, utilizing all available data.

Palliative care services are an essential service as part of universal health coverage, and this indicator is a measure of access to palliative care. In 2022-2023, the PASB provided technical assistance in palliative care to all countries in the Region, through mentorship and discussion of cases through the ECHO program, as well as trained 31 young leaders from 13 countries to build HRH capacity for palliative care services in the region. Lastly, through the PAHO Strategic Fund, morphine and other pain relief medications are made available to all countries, though uptake continues to be a challenge.

Although the current rating of this indicator is “No progress” due to a regression from the baseline, regulatory systems in most countries are advancing toward maturity level 3. Examples of progress in countries that are on track to achieve the indicator include:
1) increased capacity to implement the Global Benchmarking Tool for assessing regulatory capacities,
2) increased participation in a roster of experts to assess regulatory capacities,
3) better identification of gaps, and
4) definition of institutional development plans with a view to increasing their maturity level, as per defined criteria.
Additional efforts are in place to guide and support the National Regulatory Authorities of Regional Reference from Latin America (Argentina, Brazil, Chile, Colombia, Cuba, and Mexico) in their transition to become WHO-listed Authorities through a streamlined procedure that may not require full assessment of regulatory capacities, but only demonstration of their performance.

PASB continues to cooperate with Member States in the development, adoption, and implementation of national radiation safety plans in accordance with the International Basic Safety Standards (BSS). While most Member States are using the BSS when establishing or updating national rules or regulations and have employed operational criteria in the field of radiation safety, it will take time for them to make the necessary changes to existing national radiation protection systems in order to fully comply with BSS requirements. The target is expected to be achieved by the end of 2025.

PASB continues to provide technical cooperation to countries (including some not included as targets for 2025) in developing mechanisms and official systems to monitor the quality of pharmaceutical services, as part of Integrated Health Services Delivery Networks. Brazil and El Salvador are both making progress in developing mechanisms to monitor the quality of pharmacies. While there was no agreement for two target countries on the specific rating of the indicator, advances were recognized in both cases.

Important advances have been made in the Region toward the institutionalization of health technology assessments (HTA) as a tool to inform decision-making related to the incorporation of health technologies into health systems. Five countries have already achieved the indicator, and 3 are on track to achieve it (Chile, Costa Rica, and El Salvador). PASB has been supporting Member States through technical cooperation to develop institutional frameworks, public policies, methodological documents, and capacity building. As the Secretariat of the Regional HTA Network (RedETSA), PASB has been promoting collaboration and information exchange among the 21 participating countries. Only one country is at risk, but PASB is working with the national health authorities to help them achieve the indicator by 2025.

At the regional level, the indicator showed progress for the target countries, for which the average public expenditure on health as a share of Gross Domestic Product (GDP) rose from 4.3% to 5.3% between 2019 and 2021. Nine countries (Argentina, Aruba, Bermudas, Canada, Colombia, Cuba, El Salvador, Montserrat, and Uruguay) have achieved this indicator, investing more than 6% of GDP in the health sector using public sources of funding. Of the 7 target countries, two (Chile and Honduras) are working to achieve the indicator, but progress is at risk. In Chile, public expenditure on health rose from 4.8% in 2019 to 5.5% in 2020 but subsequently decreased to 5.2%. On other hand, Honduras increased public expenditure on health from 2.9% to 3.4% in 2020, remaining stagnant. In terms of data collection, new data from the WHO Health Expenditure Database in 2024 will allow assessment of the progress of countries that have not fully achieved this indicator.

Although the current rating of this indicator is “No progress”, countries have been able to address risk factors for communicable diseases through intersectoral action with the technical support provided by PASB. From the integrated public health perspective embedded in the One Health approach, countries are experiencing tangible improvements in public health outcomes. Notable advances include the implementation of national action plans for antimicrobial resistance, the development and strengthening of national food safety systems based on Codex Alimentarius, and improved access to lifesaving antivenoms through production by public health laboratories and their inclusion in the PAHO revolving funds.

During the biennium, countries in the Region made progress toward improving their food control systems to prevent and mitigate risks to food safety. PASB has provided technical guidance to countries (Brazil, Chile, Costa Rica, Cuba, Guatemala, Ecuador, Honduras, Panama, Peru, Paraguay, URU) to improve their food control systems based on the principles of risk analysis (risk management, risk assessment and risk communication).

Country achievements include the development of national food safety policies and Codex Alimentarius programs for standard-setting and implementation from farm to fork – One Health (Guatemala, Guyana, Honduras, El Salvador). Additionally, Paraguay, Dominican Republic, Colombia and Haiti are improving the capacity of their traditional food markets to prevent emerging food safety risks under the One Health approach. In the Caribbean, a survey was conducted to assess the readiness of food control systems to mitigate risks related to climate change (Saint Lucia, Trinidad and Tobago, Barbados, Saint Kitts and Nevis, Guyana, Jamaica). Based on the findings of this survey, Trinidad and Tobago and Barbados developed climate-resilient national food safety plans. One of the main challenges in achieving the indicator at country level is the high turnover of government officials. As a lesson learned, it is important to facilitate collaboration across sectors and regularly monitor the implementation of developed policies, programs, and plans. PASB has mobilized resources to improve and harmonize the food safety risk analysis capacity of countries in Latin America.