The hospitalization rate for ambulatory care-sensitive conditions serves as a valuable indicator for evaluating progress in strengthening the first level of care, including its economic implications for the overall healthcare system. During this reporting period, only two countries have made notable advances in this indicator: Mexico has integrated it into their National Sectoral Health Program 2022-2024 monitoring system, and El Salvador is currently in the process of collecting data for this indicator.
Measurement of this indicator has posed challenges for many countries in the region. While PASB has provided technical cooperation, tools, and support for this purpose, there is a need to enhance the commitment of countries further and improve countries’ capacities to utilize these resources effectively.

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, although there was a regression from the baseline, countries achieved or are on track to achieve this outcome indicator to improve children's health and development. Some countries have a national strategy on maternal and newborn health under implementation, but improved monitoring and alignment of these strategies with the WHO/UNICEF Framework are needed. Strategies for moving forward include adoption and implementation of the WHO frameworks Parenting for Lifelong Health and Global Scale for Early Childhood Development in the region.

Work is ongoing to strengthen countries’ arboviral disease surveillance capacities, facilitating the monitoring of the largest dengue epidemic ever recorded in the Americas. Significant progress has been made via operationalization of collaborative surveillance through the implementation of Virtual Collaboration Spaces. In addition, a new Integrated Surveillance Manual for Arboviral Diseases has been completed following two consultation meetings with country experts.

Rehabilitation services are a key component of a health system and PAHO has been working with Member States to conduct needs assessments (STARS analysis) and develop strategic plans to strengthen availability and access to rehabilitation services in the region. ASHA, an NGO in official relations with PAHO, has trained health providers in speech and language therapy to build capacity in this area. However, numerous challenges persist within overall health system strengthening that pertain to rehabilitation, such as limited capacity, sufficient human resources, and insufficient funding.

The mental health Gap Action Programme (mhGAP) continues to be broadly adopted across the Region to integrate evidence-based care in primary settings through non-specialist health workers.
107 MhGAP trainings were conducted in countries. 25 countries received training on the integration of MH into primary health care; 144,790 health personnel were trained. Among those countries that received training were Aruba, Saint Lucia, and Saint Vincent and the Grenadines. Increased integration of MH into primary health care can improve the continuum of care for mental health conditions. During the biennium, Belize showed an increase in mental health diagnosis at the outpatient level.
mhGAP implementation in Latin American countries showcases significant progress in key metrics, with 4,131 new trainers. For instance, Chile and Mexico have trained 5144 and 136,131 individuals respectively. Both countries have successfully integrated mhGAP into their national mental health policies. Paraguay, demonstrating notable advancement, has trained 103 individuals with 67 trainers, and successfully incorporated mhGAP into its national policy.

This indicator is on track to be achieved by the target date. However, countries with historical issues of shortages and migration of health workers will probably face challenges in achieving the indicator, and therefore will require additional support from PASB.

Despite a regression from baseline, some countries are progressing toward the target. One country is classified as “at risk” as it has reported progress in increasing the capacity of interprofessional teams at the first level of care, but has not yet reached the level its model of care requires. Examples of progress in countries that are on track include PASB support in preparing technical proposals aligned with the national health reform, joint work between PASB and academia to define the composition and organization of interprofessional teams, and passing resolutions on primary health care that enable the development of interprofessional teams within countries.

The Plan of Action on Human Resources for Universal Access to Health and Universal Health Coverage 2018-2023 included the formation of interprofessional teams at the first level of care as one of its objectives, guiding countries toward achieving this goal. Additionally, the Policy on the Health Workforce 2030: Strengthening Human Resources for Health to Achieve Resilient Health Systems outlines measures to strengthen the formation of interprofessional teams and incorporate them into integrated health services networks based on primary health care as a strategic line, which will support the efforts of countries on track to meet this goal.

Important progress was made at country level, with 6 out of 8 target countries having already achieved the indicator. Chile and Colombia are on track to achieve it, with technical support from PASB on strategies to increase access to medicines. At the regional level, data was collected from 20 MS, including Chile and Colombia, through a survey on access to medicines and other health technologies, which allowed PASB to identify access gaps and needs for technical cooperation and prepare the final report for Resolution CD55.R12 on Access and Rational Use of Strategic and High-cost Medicines and other Health Technologies.

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.

Although the current rating of this indicator is “No progress” due to a regression from the baseline, it should be noted that, of the total number of countries (14), 5 achieved the target and 7 are on track to achieve it; only 2 countries are at risk. Countries that are on track to achieve the indicator have progressed in expanding blood collection capacity and reducing blood loss or expiration as they improve their quality processes. Additional efforts are being made to support Caribbean countries through quality training so that better performance also improves the availability of blood for transfusion. Likewise, the promotion of voluntary blood donation was strengthened with the World Blood Donor Day campaign and through regional seminars. Greater support will be provided to the countries that are at risk to help them reach the target by 2025.

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.

Substantial progress has been made on the evaluation of capacities and the development of action plans to strengthen the Essential Public Health Functions (EPHF). One country has already achieved this indicator, and 12 out of the 17 countries are on track to achieve it. Two countries are at risk, and two have not shown progress as a recent evaluation of the EPHF has not been completed. The countries that are on track have completed the baseline evaluation, with results showing that less than 60% of capacity is currently being met; however, they are moving forward with the implementation of action plans to improve capacity and could reach that threshold. Efforts toward strengthening leadership, governance, and institutional capacities, alongside intersectoral collaboration and technical cooperation, are contributing to the positive trajectory of this indicator.