There was no consensus on the assessment results for 1 target country (PAN). In addition, 2 baseline country (BRA, URY) and 2 target countries (CUW, DOM) did not complete the assessment. These 5 countries were not counted towards the overall indicator assessment.
PASB Comments
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.
Three target countries (BRA, CUW, DOM) did not complete the assessment. These 3 countries were not counted towards the overall indicator assessment.
PASB Comments
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.
Two baseline countries (BRA, DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
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.
One baseline country (BRA) did not complete the assessment. This country was not counted towards the overall indicator assessment.
PASB Comments
Although most countries achieved the indicator because services are already in place, some are not very structured. Countries are currently in the process of strengthening capacities so that services for men’s health can be developed within the framework of primary care.
Through implementation of the EMTCT Plus Initiative, PASB has been working with national health authorities to strengthen national responses to syphilis and congenital syphilis, toward the achievement of elimination targets. The coverage of syphilis treatment among infected pregnant women has been historically high in Latin America and the Caribbean, reaching 89% in 2023. Eleven countries have been validated for the dual EMTCT of HIV and syphilis, and additional countries have shown progress and may be ready to seek validation in the near future.
PASB will continue supporting at-risk countries in conducting follow-up campaigns to update the vaccination status of unvaccinated children under 5 years of age. This should improve MMR-1 and MMR-2 vaccination coverage by the end of 2023. Countries report 2023 data in the first quarter of 2024 via the PAHO-WHO/UNICEF electronic Joint Immunization Data Reporting Form (eJRF).
There was no consensus on the assessment results for 3 baseline countries (BMU, NIC, KNA) and 1 target country (CRI). In addition, 1 baseline country (CUW) and 1 target country (DOM) did not complete the assessment. These 6 countries were not counted towards the overall indicator assessment.
PASB Comments
DPT vaccination coverage has been affected by the pandemic. Although efforts are being made to improve coverage and reduce dropout rates, the goal is to ensure that the under-vaccinated are reached.
One baseline country (BRA) did not complete the assessment. This country was not counted towards the overall indicator assessment.
PASB Comments
Since 2020, a decrease in vaccination coverage with the third dose of PCV vaccine has been noted. In 2023, a very slight improvement was noted compared to 2022 (81% vs. 80%). This, together with improvement in coverage of other vaccines (e.g., pentavalent), could indicate that PCV3 vaccination coverage has started to recover. It is important to closely monitor the progress of member states.
Three baseline countries (BRA, DOM, GLP) did not complete the assessment. These 3 countries were not counted towards the overall indicator assessment.
PASB Comments
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.
There was no consensus on the assessment results for 1 target country (JAM). In addition, 2 baseline countries (BRA, DOM) did not complete the assessment. These 3 countries were not counted towards the overall indicator assessment.
One baseline country (BRA) and 1 target country (DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
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.
One target country (CUW) did not complete the assessment. This country was not counted towards the overall indicator assessment.
PASB Comments
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.
There was no consensus on the assessment results for 1 target country (CYM). In addition, 1 baseline country (DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
As part of the deinstitutionalization process, a mental health crisis management course was delivered to first responders in Saint Kitts and Nevis and the Bahamas. Deinstitutionalization processes were accelerated across several countries to shift toward community-based services. For instance, Paraguay made progress transitioning patients from a national psychiatric hospital into integrated community-based mental healthcare, supporting 156 patients through new municipal-level centers last year. Mobile crisis response gained more prominence as an alternative to hospitalizations. Another example is the Bahamas emergency response service, which has prevented avoidable hospital admissions. Similar assistance programs now run across 3 Argentine provinces.
Two target countries (BRA, DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
Sexual violence is a particularly severe challenge in the Americas, requiring timely intervention by the health system to mitigate the consequences for survivors’ health and well-being. The need for comprehensive post-sexual assault (post-rape) care services in emergency health services is reiterated in the Strategy and Plan of Action on Strengthening the Health System to Address Violence against Women, which defines post-rape care to include:
a) First-line support and psychological first aid;
b) Emergency contraception to women who seek care within 5 days;
c) Referral to safe abortion if a woman is pregnant as a result of rape, where such services are permitted by national law;
d) Sexually transmitted infection and/or HIV post-exposure prophylaxis, per applicable protocols; and
e) Hepatitis B vaccination.
PASB has supported Member States in strengthening the health system response to sexual violence, including through improved health system protocols and health workforce training. A recent analysis of health system protocols found that text references to these essential post-rape care services remain limited. For example, 54% of Member States refer to first-line support in their protocols, while hepatitis B vaccination is mentioned by 43%, demonstrating significant gaps. While a text reference to these criteria does not necessarily mean corresponding services are readily available and accessible, it is an important starting point for them to be specifically mentioned in protocols that outline the health system’s response to violence. Importantly, one barrier in this area is the lack of health service evaluation tools to assess specific progress on post-rape care in line with established indicators. In response, PASB has collaborated with selected Member States in the development and piloting of a rapid service evaluation tool for post-sexual assault care. This tool has the potential to improve monitoring of this indicator beyond the pilot countries (Argentina, Colombia, Honduras, Peru), thereby helping to strengthen quality improvement of post-sexual assault care.
There was no consensus on the assessment results for 1 target country (JAM). In addition, 1 baseline country (BRA) and 1 target country (DOM) did not complete the assessment. These 3 countries were not counted towards the overall indicator assessment.
PASB Comments
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.
One target country (DOM) did not complete the assessment. This country was not counted towards the overall indicator assessment.
PASB Comments
Access barriers were exacerbated during the COVID-19 pandemic, affecting both the supply and demand sides of health services. Achievement of this indicator is at risk in five countries due to lack of updated data to measure the indicator and little progress in the reduction of reported access barriers. There are, however, five other countries that have achieved or are on track to achieve this indicator, having made significant progress in overcoming service disruptions and reducing access barriers to health services overall. Understanding barriers to healthcare access and the resulting magnitude of unmet needs is key to monitoring progress toward universal access to health and universal health coverage, but measuring and implementing policy options to reduce and eliminate access barriers remains a challenge.
There was no consensus on the assessment results for 1 baseline country (MEX). In addition, 1 baseline country (BRA) and 1 target country (GUF) did not complete the assessment. These 3 countries were not counted towards the overall indicator assessment.
PASB Comments
Existing post-pandemic conditions continue to negatively impact the ability of countries to effectively implement field interventions to address this problem. Better achievements are expected in the next biennium (2024-2025).
Two baseline countries (BRA, DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
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.
Two target countries (CUW, DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
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.
Two target countries (BRA, DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
Most target Member States have demonstrated political commitment to the elimination of industrially produced trans fatty acids from their food supply. Continued PASB efforts to support them in securing the adoption of PAHO/WHO best practices to achieve such elimination suggest the indicator is on track, provided that Member States' commitments translate into policy action in 2024.
Two baseline countries did not complete the assessment (BRA, DOM). These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
An advisory committee or lead agency in road safety is crucial for coordinating efforts across various sectors such as transportation, health, education, and law enforcement, ensuring a unified and strategic approach. Additionally, it is responsible for developing and implementing evidence-based policies and regulations, such as seatbelt laws, speed limits, and measures to prevent drunk driving. A lead agency also plays a vital role in the collection and analysis of data on road traffic injuries, allowing for the identification of trends and the evaluation of intervention effectiveness. Proper resource allocation and international cooperation are other areas where such an agency can have a significant impact, adopting global best practices to enhance road safety and reduce road traffic deaths and injuries.
PAHO has provided technical support to various road safety advisory committees or lead agencies in the Region, as requested, to support their efforts in road safety management. One key area of focus is the strengthening of road safety data systems. In line with this, WHO/PAHO produced the Fifth Global Road Safety Status Report to help countries identify gaps and priorities to accelerate implementation of the recommendations of the Global Plan for the Second Decade of Action for Road Safety 2021-2030. These initiatives aim to achieve the ambitious but reachable target of reducing global road mortality and serious injuries by 50%.
Two target countries (BRA, DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
Given the high prevalence of violence in the Americas, it is crucial that Member States place a strong emphasis on prevention. Preventing violence relies on the collaboration of many government sectors and non-government stakeholders. While no single institution or actor can prevent violence, it is essential that the health sector collaborate with other partners in the prevention of violence. National or multisectoral policies and plans play an essential role in defining a country’s vision, goals, policy directions, and strategies, as well as coordination mechanisms for preventing and responding to violence. The importance of a national or multisectoral plan addressing violence that includes the health system is reiterated by the Strategy and Plan of Action on Strengthening the Health System to Address Violence against Women, as well as by the multi-agency frameworks INSPIRE and RESPECT. PASB has been supporting countries in building capacity on evidence-based strategies and interventions in the Region of the Americas so as to inform the policy-making process. While many Member States report the existence of such a national or multisectoral plan, it is important to note that several of these plans are soon to expire, stressing the urgency of advancing action in this area and sustaining the progress achieved in the last decade. Partnerships with UN Women, UNICEF, and the World Bank to strengthen implementation tools and policy dialogue on INSPIRE and RESPECT in countries, as well as preparations for the forthcoming Global Ministerial Conference on Violence against Children, set the tone for this important work, which has the potential to be scaled up in the future.
One baseline country (DOM) and one target country (BRA) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
The Report of the PAHO High-Level Commission on Mental Health and COVID-19 and the new Strategy for Improving Mental Health and Suicide Prevention provide the vision and the recommended actions for increased technical cooperation in MH in the Region. Several countries have started to take important actions to improve and reform their mental health systems. The recommendations of the Commission emphasize the importance of intersectoral work and integration of mental health into all areas of government to better face the long-term crisis of mental health in the Americas. In the area of suicide prevention, comprehensive strategies aligned with global best practices were developed with the support of PAHO, including the promotion of intersectoral collaboration and policy developments. For instance, PAHO helped Uruguay establish a multi-stakeholder network for suicide prevention across healthcare, education, social services, and civil society. Prioritized policy recommendations have also been formulated. Bolivia targeted action across societal, community, relationship, and individual levels based on the WHO LIVE LIFE framework.
Furthermore, 70 media professionals were trained on responsible reporting on suicide in Guyana (25), Barbados (22), and Grenada (23).
One baseline country (BRA) and 1 target country (DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
As of 2022, 85% of people with HIV in Latin America are diagnosed; of those, 85% are on antiretroviral therapy (ART); and of those, 92% have suppressed viral loads. In the Caribbean, 83% of people with HIV are diagnosed; of those, 81% are on ART; and of those, 84% have suppressed viral loads. ART coverage for people living with HIV in Latin America and the Caribbean increased 2.2-fold from 2010 (32%) to 2022 (71%). As part of efforts to optimize HIV treatment, PASB has been actively supporting countries in updating their national strategic plans and HIV treatment guidelines. This includes targeted assistance in several countries across the Region, including support for the optimal selection and forecasting of antiretroviral (ARV) drugs. Additionally, PASB has been supporting countries on HIV and aging, pediatric treatment, resistance, elimination, and cure. Furthermore, a newly designed WHO Collaborating Center on HIV resistance, CIENI/INER, is expected to reinforce technical cooperation.
Regarding advanced HIV disease, PASB provides technical assistance for the introduction of new tests and treatments for opportunistic infections and supports implementation research, including mortality analysis, in selected countries.
Three baseline countries (DOM, GLP, MTQ) did not complete the assessment. These 3 countries were not counted towards the overall indicator assessment.
PASB Comments
During the biennium, countries in the Region made progress in eliminating malaria or interrupting its transmission both at the national and subnational levels, as well as preventing re-establishment in malaria-free countries and receptive territories. Case investigation is being incorporated by endemic and non-endemic countries, including improvements in guidelines, instruments, and surveillance processes. These actions should integrate the efforts made so far by vertical programs with more cross-cutting epidemiologic surveillance processes and actors. Important challenges remain in this aspect of integration and in the quality of investigations. Pending improvements include the adoption of investigation in endemic territories where the small number of cases already justifies this action to accelerate elimination, as well as improvements in response. The technical cooperation that PAHO has developed in this area has been replicated with partner implementation actions, such as the RMEI initiative in Central America.
There was no consensus on the assessment results for 2 baseline countries (KNA, URY). In addition, 1 baseline country (BRA) and 1 target country (DOM) did not complete the assessment. These 4 countries were not counted towards the overall indicator assessment.
PASB Comments
During the REDIPRA meeting held in Colombia in late 2023, significant progress was noted toward the interruption of dog-mediated human rabies transmission, following the elimination validation criteria. PAHO support – through provision of standards, generation of data, and technical cooperation – has been pivotal. Achievements include successful mass dog vaccination campaigns, enhanced public awareness, and improved surveillance systems. Many countries have reported zero human cases for multiple years; however, four countries have reported cases in the past years. Challenges remain in some countries, such as maintaining high vaccination coverage, addressing surveillance gaps, and ensuring access to post-exposure prophylaxis. Continued commitment is essential to overcome these hurdles and sustain the progress made toward eliminating canine rabies.
Two target countries (BRA, DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
Costa Rica, Suriname, and Trinidad and Tobago were removed from the list of LF endemic countries by WHO (upon PAHO's request) in 2011. In Guyana, the Transmission Assessment Survey (TAS) has been completed, with results suggesting a potential need for another round of Mass Drug Administration (MDA) in certain areas.
One baseline country (BRA) and 1 target country (DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
Following the technical specification of the indicator, PASB recognizes that 28 countries have established capacity and effective processes to eliminate dog-mediated human rabies, showcasing significant progress in the region. PAHO contributions, including provision of standards, generation of data, and technical cooperation, have been instrumental in these achievements. Successful strategies include comprehensive dog vaccination campaigns, public awareness initiatives, and robust surveillance systems. However, several countries continue to report canine rabies, with some also reporting human cases. Lessons learned highlight the importance of sustained vaccination efforts, enhanced surveillance, and accessible post-exposure prophylaxis. Continued support and commitment are essential to address these challenges and achieve the complete elimination of dog-mediated human rabies across the region.
There was no consensus on the assessment results for 1 target country (JAM). In addition, 1 baseline country (BRA) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
Progress has been observed in the implementation of different WHA resolutions through legislation, national action plans, capacity-building activities, and programs addressing prioritized chemicals. However, the challenges observed in some countries highlight the need for further attention in a multisectoral environment.
Two baseline countries (BRA, DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
The health sectors of several countries have strengthened capacities to engage with other sectors, ensuring that health is included in climate change discussions at the local, regional, and international levels. This achievement is facilitated by the appointment of designated climate change and health focal points who advocate for health inclusion in climate change inter-ministerial committees.
One baseline country (BRA) did not complete the assessment. This country was not counted towards the overall indicator assessment.
PASB Comments
Progress has been observed in the context of the special initiative on SDH and health reform in some countries; e.g., in Chile, intersectoral action, social participation, and social prescription were integrated as part of the universalization of PHC. Reviews of the evidence regarding social prescription and experiences of health promotion in PHC have also been undertaken. Future technical cooperation will focus on implementing health promotion and the social determinants in primary health care.
There was no consensus on the assessment results for 1 target country (BHS). In addition, 1 baseline country (BRA) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
Progress has been observed regarding implementation of the Health Promoting Schools (HPS) approach. PASB has developed Regional Guidance for the Development of Health Promoting Schools that will contribute to strengthening the actions of schools in the region, incorporating the HPS approach; and has developed a course on Health Promoting Schools to strengthen the capacities of school personnel. Furthermore, lessons learned from the piloting of WHO Global Standards for Health Promoting Schools in Paraguay will be systematized and disseminated throughout the region.
There was no consensus on the assessment results for 3 target countries (BMU, BON, KNA). In addition, 1 baseline country (BRA) and 5 target country (DOM, GUF, MTQ, GLP, CUW) did not complete the assessment. These 9 countries were not counted towards the overall indicator assessment.
PASB Comments
The number of countries that have generated and produced analytical health reports which include disaggregated data on a regular basis has increased from 5 to 17. Additionally, countries are increasingly making these reports and other health data and information more accessible both internally and externally. Improved national health information systems and advances in digital transformation have led to increased data demand and utilization. Such data increasingly include the social determinants of health and allow countries to monitor progress and gaps. PASB provided technical cooperation through ongoing capacity-building efforts in health analysis, particularly for monitoring SDG3 indicators among interdisciplinary country teams at national and subnational levels. This has been crucial to the progress achieved for OCM 21.b. An additional 13 countries are on track to achieve this indicator.
No agreement was reached for three countries and territories. PASB assessed that the criteria as detailed on the technical note for the indicator were not met, and no documentation was submitted or otherwise available at the time of the assessment.
One baseline country (BRA) and one target country (DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
Progress has been observed in the Americas regarding the generation, circulation, and utilization of scientific and technical information, as well as the promulgation of knowledge-sharing initiatives among Members States, PASB, and stakeholders.
Overall, the impact factor of the scientific output and the number of journals increased across all Member States during the period 2022-2023, with special emphasis on medicine, public health, and related topics. The increase in implementation of open-access platforms and policies helped ensure more equitable and accessible access to scientific production in public health-related fields.
The contribution from documentation centers to regional databases such as LILACS, MedCarib, and other open-access platforms worldwide has also increased. A total of 22 countries and territories are eligible to access the Research4Life (R4L) program, and there has been an increase in the number of registered institutions, which have helped to meet the need for more equitable access to scientific and technical information and to reduce the digital divide across the Region. El Salvador became the first Member State to participate in the R4L Country Connector initiative.
Despite a slight decrease in the number of new designations and re-designations, PAHO/WHO Collaborating Centers (CC) have proven to be an important mechanism of technical cooperation. PAHO/WHO CCs support the Organization in fulfilling the mandates and priorities of the Region and globally, by developing research models and evidence-based literature and providing health analysis and methodologies. By December 2023, there were 179 CCs in the Region, distributed across 15 Member States.
Despite these advancements, persistent efforts to strengthen research systems, enhance knowledge sharing, and promote evidence-informed policies are needed. Institutionalizing knowledge, evidence, and science at the national level is essential, as is fostering integrated policies for information use and knowledge dissemination. Furthermore, capacity building and a continued focus on digital literacy are necessary to ensure that public health workers, decision-makers, researchers, and communities have access to the best scientific and technical information.
One baseline country (BRA) did not complete the assessment. This country was not counted towards the overall indicator assessment.
PASB Comments
PASB supported Member States in the development and revision of national standards governing the ethics of research, such as laws, regulations, and national policies, with the goal of ensuring that they adhere to international ethical standards for research with human participants. The COVID-19 pandemic brought increased attention to the importance of adhering to international standards to expedite the conduct of high-impact clinical trials. Furthermore, international standards for research now include specific provisions for research in emergencies (as described in PAHO’s Catalyzing Ethical Research in Emergencies: Ethics guidance, lessons learned from the COVID-19 pandemic and pending agenda), and PASB supported countries in including these provisions in national standards, thus improving ethics preparedness to conduct research in future emergencies. Measuring progress in this indicator has often entailed distinguishing the ethical from the strictly regulatory oversight of research with human participants.
Seven baseline countries (BON, BRA, CUW, DOM, GLP, GUF, MTQ) did not complete the assessment. These 7 countries were not counted towards the overall indicator assessment.
PASB Comments
In the 2022-23 biennium, progress was made toward strengthening country capacity for all-hazards health emergency and disaster risk management. As of the latest assessment, 22 countries fully meet or exceed minimum capacities to manage public health risk associated with emergencies, with another 15 on track to do so. PASB's technical support, including the development of assessment tools and coordinator meetings, remains essential for achieving the 2025 target of 37 countries. Continuous monitoring and emphasis on gender-sensitive disaster preparedness, supported by tools such as the Preparedness Index for Health Emergencies and Disasters and the monitoring survey for the Plan of Action on Disaster Risk Reduction, are critical for maintaining and building on the progress made.
There was no consensus on the assessment results for 3 target countries (BRB, CRI, MEX). In addition, 2 target countries (BRA, DOM) did not complete the assessment. These 5 countries were not counted towards the overall indicator assessment.
PASB Comments
To achieve this indicator, a State Party must have improved its scores or maintained them (where the score is higher than 0%), for at least 12 of the 15 core capacities, as compared to the previous year. Three countries did not comply with the State Party Self-Assessment Reporting Tool in 2021, precluding comparison with results for the past biennium. PASB is working closely with the countries to strengthen and maintain their core capacities under the IHR, which contribute directly to global health security.
Two target countries (BRA, DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
Twelve countries achieved the indicator by the end of 2023, and another 21 were on track to do so by 2025. This indicator aims to measure and track the capacity of countries and territories to respond to major epidemics and pandemics and to ensure a rapid exchange of information about impending public health threats and, as a result, to increase confidence and trust among all parties.
PASB provided technical cooperation to improve disease surveillance systems and train health workers to strengthen preparedness for epidemics and pandemics, notably by strengthening national and regional surveillance networks and implementing the Strategy on Regional Genomic Surveillance for Epidemic and Pandemic Preparedness and Response.
Two countries achieved the indicator by the end of 2023, and another 3 were on track to do so by 2025. This indicator tracks progress toward reducing the risk of urban yellow fever. With ≥80% vaccine coverage, the risk of urban yellow fever (large outbreaks with transmission of yellow fever virus from person to person via Aedes vector species) in endemic areas is minimized.
Eight target countries (BRA, CAN, CUW, DOM, GLP, GUF, MTQ, PRI) did not complete the assessment. These 8 countries were not counted towards the overall indicator assessment.
PASB Comments
The majority of countries and territories express satisfaction with PAHO/WHO's leading role on global and regional health issues, indicating that the Organization’s efforts and initiatives are generally perceived positively across the region. This widespread satisfaction underscores PAHO/WHO's role as a leading public health authority, engaging countries and territories in the regional and global public health agenda at the highest level – politically, strategically, and technically. Efforts will continue to ensure alignment between biennial work plans and the priorities indicated by national health authorities. This commitment involves ongoing coordination and collaboration with national health authorities to tailor PAHO/WHO's biennial work plans to address the specific health challenges and priorities identified by each country.
There was no consensus on the assessment results for 1 baseline country (BHS). In addition, 1 baseline country (DOM) and 5 target countries (BRA, CUW, GLP, GUF, MTQ) did not complete the assessment. These 7 countries were not counted towards the overall indicator assessment.
In addition, 2 baseline countries (BRA, DOM) and 1 target country (CUW) did not complete the assessment. These 3 countries were not counted towards the overall indicator assessment.
PASB Comments
Although countries continuously work to implement the IHSDN framework, some have approved policies or regulations that reinforce IHSDNs, but require time to be implemented to achieve their objectives. Technical cooperation during the next period needs to support countries in these implementation processes.
Two baseline countries (BRA, DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
Despite a regression from baseline, all sixteen countries (achieved and partially achieved) have made progress in implementing strategies to increase access to quality health services for adolescents, even though this will remain an ongoing area of work. PASB’s technical cooperation includes capacity building for a standard-driven approach to adolescent health services and training of health workers through virtual and face-to-face modalities.
One baseline country (BRA) and one target country (DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
This is a composite indicator based on the inclusion of HIV pre-exposure prophylaxis (PrEP) policies, the incorporation of short oral treatment for tuberculosis (bedaquiline) into national guidelines, and the use of direct-acting antivirals (DAA) for treatment of hepatitis C. While countries have made great strides in incorporating these commodities in their national policies and guidelines, it is vital to scale up access and increase the number of people receiving PrEP, bedaquiline, and DAAs, all of which can be procured through the Strategic Fund. The technical team has been promoting the scale-up of these interventions.
One baseline country (DOM) and one target country (BRA) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
Six countries have fully achieved the indicator, while 2 have partially met the criteria outlined in the technical specifications. For instance, in Haiti, challenges such as political instability, civil unrest, and natural disasters have hindered the implementation of interventions like mass drug administration for lymphatic filariasis and soil-transmitted helminthiasis. Guatemala conducted a serosurvey of multiple diseases using multiplex methodology and is currently analyzing its results to inform integrated actions. The delay in analysis was due to a change in government, which impacted the project's continuity.
Two baseline countries (BRA, DOM) and one target country (GUF) did not complete the assessment. These 3 countries were not counted towards the overall indicator assessment.
PASB Comments
By the end of the biennium, endemic countries had adopted policies promoted by PAHO/WHO to reduce malaria transmission and achieve elimination. Significant progress was noted in several countries, especially in Central America, through the introduction of the DTI-R strategy and the adoption of reactive and responsive interventions to accelerate elimination. Strategic partnerships with organizations such as the IDB and the Global Fund have supported the implementation of these policies, while collaboration with USAID continues to contribute to PAHO's technical cooperation.
However, significant challenges in improving coverage and implementing policies remain in all 17 endemic countries, with emphasis on addressing the barriers that persist for the affected population to access diagnosis and treatment. Challenges also persist in updating national strategic plans, improving regulations and guidelines on aspects related to the role of community health workers, and political decisions to maximize the use of RDTs. Despite these challenges, the implementation of key interventions recommended by PAHO/WHO has significantly reduced malaria cases in Venezuela, helping reverse the trend of increasing cases in the Region up to 2019.
One baseline country (BRA) and one target country (DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
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.
One target country (DOM) did not complete the assessment. This country was not counted towards the overall indicator assessment.
PASB Comments
Several countries are initiating or expanding information and monitoring systems. For instance, Chile developed a database which tracks diagnosed cases and service referrals to analyze gaps. Similar surveillance efforts are underway in countries like Argentina.
There was no consensus on the assessment results for 1 target country (VEN). In addition, 1 baseline country (BRA) and 1 target country (DOM) did not complete the assessment. These 3 countries were not counted towards the overall indicator assessment.
PASB Comments
Countries have shown significant progress in the development and implementation of national human resources for health (HRH) policies. The first objective of the Plan of Action on Human Resources for Universal Access to Health and Universal Health Coverage 2018-2023 calls for promoting the formulation and implementation of a national policy on human resources for health at the highest level and agreed through intersectoral engagement. Some countries have already developed a national HRH policy, while others have been doing so with technical support from PAHO. Additionally, the Policy on the Health Workforce 2030: Strengthening Human Resources for Health to Achieve Resilient Health Systems recommends among its priority actions the strengthening of governance and promotion of national policies and plans for HRH, which should reinforce the work of countries that are on the path to achieving this objective.
One baseline country (BRA) and one target country (DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
Although countries are making progress in the development of interprofessional teams at the first level of care, the indicator suffered a regression from the baseline. Greater effort is required to develop standards that define their capabilities and scope. Some of the countries that are on the path to achieving the indicator have prepared technical proposals aligned with their national health reforms and are working on ways to define the capabilities and scope of practice of interprofessional teams at the first level of care. The formation of interprofessional teams at the first level of care was one of the objectives defined in the Plan of Action on Human Resources for Universal Access to Health and Universal Health Coverage 2018-2023, which helped guide countries to achieve this challenge. Additionally, the Policy on the Health Workforce 2030: Strengthening Human Resources for Health to Achieve Resilient Health Systems recommends among its priority actions strengthening the formation and integration of interprofessional teams in integrated health services networks based on primary health care, which should reinforce the work of countries that are on the path to achieving this objective.
Two baseline countries (BRA, DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.Dos países de línea de base (BRA, DOM) no completaron la evaluación. Estos 2 países no se tuvieron en cuenta en la evaluación general del indicador.
PASB Comments
Out of 13 countries, 12 achieved this indicator and Mexico reported having partially achieved it. PASB is currently supporting Mexico in the development of a national pharmaceutical policy. At the regional level, data was collected from 20 Member States through a survey on access to medicines and other health technologies, which allowed PASB to identify access gaps and needs for technical cooperation, as well as to prepare the final report for Resolution CD55.R12 on Access and Rational Use of Strategic and High-cost Medicines and other Health Technologies.
There was no consensus on the assessment results for 1 target country (COL). In addition, 1 baseline country (BRA) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
PASB continues to collaborate 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 indicator is expected to be achieved in the next biennium.
Two baseline countries (BRA, CUW) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
Countries made progress toward achieving the indicator. Guidelines on quality, a course on good manufacturing practices, and several seminars on improving blood services have been developed.
One target country (DOM) did not complete the assessment. This country was not counted towards the overall indicator assessment.
PASB Comments
Seven countries achieved or partially achieved this indicator. These countries have developed roadmaps based on the results of assessments of the essential public health functions (EPHF), which have informed strategic planning instruments such as national health plans, national development plans, and investment programs. The three countries that achieved the indicator developed a specific action plan to improve the EPHF at a national level. PASB continues to support countries in the implementation of the EPHF evaluation to make progress toward achievement of this indicator.
There was no consensus on the assessment results for 1 baseline country (JAM). In addition, 1 baseline country (DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
While monitoring and evaluation remains a challenge for health systems, there has been significant progress, supported by PASB. For example, a dashboard on primary health care indicators has directly contributed to progress on this output. Five countries have achieved this indicator and five others have partially achieved it, highlighting considerable progress in the development of mechanisms for monitoring and evaluation. Countries that achieved this target applied the monitoring framework for universal health, and those that have partially achieved it continue with strategies to develop the necessary mechanisms to do so. Relevant obstacles preventing the expansion of monitoring and evaluation of progress toward universal health include issues related to data availability and technical capacity at the national level.
One baseline country (DOM) did not complete the assessment. This country was not counted towards the overall indicator assessment.
PASB Comments
PASB provided direct technical cooperation for the formulation, implementation, and review of legal and regulatory frameworks to ensure universal access to health and universal health coverage within a health promotion, health determinants, and risk reduction perspective and a comprehensive primary health approach, and considering equity, gender, human rights, and cultural diversity. This also includes enhanced engagement with legislative bodies in the region.
The challenge has been the absence of an integrative, overarching review of the legal and regulatory frameworks at national level, as most of the countries have segmented legislation that is not reviewed for consistency, applicability, and impact or periodically reviewed on a systematic basis. This kind of analysis could lead countries to a better balance on the ratio between legislation and regulations, thus allowing room for improvement and consistency in regulatory measures by allowing these two branches of government to interact better.
Best practices in legislative and regulatory techniques worldwide require that legislation, regulations, rules, and standards be reviewed and updated at least every 5 years. Therefore, some target countries will need more time to achieve this indicator. Several tools to support member states on these matters are being developed, including model legislation to be adapted according to needs and requirements.
One baseline country (BRA) did not complete the assessment. This country was not counted towards the overall indicator assessment.
PASB Comments
There has been progress in developing and increasing countries’ capacity to produce health accounts (HA). Countries like Bolivia, Guatemala, and Peru have been making efforts to institutionalize this by producing new HA studies and new classifications. Peru had stopped producing official estimates in 2020 but has resumed the process and is now reporting to the WHO Global Health Expenditure Database (GHED). In terms of data collection, the WHO survey on the institutionalization of HA 2024 will provide new attributes to assess the capacity of countries to produce HA.
Two baseline countries (BRA, DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
During the biennium, countries strengthened their Infection Prevention and Control (IPC) programs, including their capacity to respond to multidrug-resistant organism outbreaks in healthcare facilities. PASB directed efforts toward supporting countries to consolidate their IPC and antimicrobial stewardship programs to enhance the effectiveness of local interventions. Countries also strengthened the coordination between National Reference Labs and national IPC programs for rapid detection and response to emerging resistant mechanisms.
One baseline country (BRA) did not complete the assessment. This country was not counted towards the overall indicator assessment.
PASB Comments
Throughout the biennium, countries continued the formalization of multisectoral AMR committees to ensure that AMR National Action Plans receive proper funding for sustainability of key AMR activities. As per TrACCS 2023, 90% of countries in the region have formalized AMR multisectoral committees for the implementation of their AMR National Action Plans.
Two baseline countries (BRA, DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
Throughout the biennium, countries across the region started shifting from reporting AMR aggregated surveillance data to isolate-level data, which allows for a more in-depth assessment of social determinants of AMR and development of more targeted equitable interventions. ReLAVRA+ provided technical guidance and support for countries to strengthen and harmonize their capacities in phenotypic and genotypic characterization and implementation of new technologies for characterization of carbapenemases. Within the ReLAVRA+ framework, the network has implemented the protocol for Candida surveillance, to which 18 countries have adhered; of these, 8 have provided data: Argentina, Colombia, Costa Rica, Guatemala, Panama, Peru, Paraguay, and Uruguay.
Substantial progress has been made to improve the capacities for food control in countries in the Region. Honduras, Guatemala, El Salvador, and Guyana have developed their Codex Alimentarius programs to set and implement food safety standards from farm to fork within the One Health approach, and Argentina, Bolivia, Brazil, Colombia, Cuba, Chile, Guyana, Paraguay, Peru, and URU have improved their integrated AMR surveillance plans to include the food value chain. Suriname’s IHR Capacity 13 for Food Safety was assessed, and some areas of improvement have been detected. Countries’ food monitoring capacities have been improved through the technical support provided by the Inter-American Network of Food Analysis Laboratories (INFAL). PASB has provided technical guidance in risk analysis and foodborne disease surveillance regularly and on an ad-hoc basis to countries in Latin America.
One baseline country (BRA) and one target country (DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
PASB continuous efforts to support Member States has been successful in advancing labeling provisions to reduce the demand for and offer of products excessive in saturated fats and trans fats. However, the support for adoption of PAHO/WHO best practices to eliminate industrially produced trans fats needs to be intensified particularly in the Caribbean and in Central America.
One baseline country (BRA) did not complete the assessment. This country was not counted towards the overall indicator assessment
PASB Comments
PASB continued to provide technical assistance to Member States in the Region of the Americas toward progressing the tobacco control agenda, including the implementation at the highest level of the four major demand-reduction measures in the WHO Framework Convention on Tobacco Control (FCTC):
1) tobacco taxes representing more than 75% of the final retail price, or the country has increased taxes in the reviewed period and has moved to the next category according to the WHO Report on the Global Tobacco Epidemic (measure R),
2) all enclosed public places, workplaces and public transportation totally smoke-free (measure P),
3) large graphic health warning covering an average of at least 50% of the front and the back of the packaging of tobacco products (measure W) and pictorial warnings covering at least 50% of the principal display areas of the outside packaging and labeling of all tobacco products, plus a ban on misleading descriptors (measure W), and
4) a total ban on all tobacco advertisement, promotion, and sponsorship (measure E).
Peru dropped out of the baseline as it did not increase taxes sufficiently during the reviewed period to move to the next category according to the WHO Report on the Global Tobacco Epidemic.
Colombia, Jamaica, and El Salvador partially achieved the indicator. However, there were significant efforts toward this in Colombia and Jamaica. In Colombia, Bill No. 274/2022 to increase tobacco taxes, including taxation of emerging nicotine and tobacco products, was filed in November 2022. At regional and country levels, PASB collaborated with international and national partners to provide technical assistance in support of the bill and to organize strategic meetings to present evidence supporting this bill, convening advisors to the bill authors and representatives of the Ministry of Finance. Tobacco industry interference has been active during the legislative process discussions and debates. While the bill was approved for further discussion at a second debate at the Plenary of the House of Representatives in 2022, it was killed in June 2024 when the legislature came to an end. It is expected to be filed again and continue its discussion and approval processes at the upcoming legislative session.
In Jamaica, PASB provided technical assistance to national at regional and country levels and presented before the Joint Select Committee, by request, in previous years since the Tobacco Control Bill was filed in 2020. In 2022, the Joint Select Committee conducted a clause-by-clause analysis of the bill, considering submissions from national stakeholders. In addition to technical assistance provided to the Ministry of Health, PASB supported communications activities by the health authority at regional and country levels, such as creating and pushing existing materials through joint media interviews (Smile Jamaica, Beyond the Headlines, Cliff Hughes on Nationwide), TV adverts, social media, and newspapers. The deliberations of the Joint Select Committee concluded in October 2022, and it was expected that the bill would be presented for voting by the end of 2022. However, the sittings planned for November and December 2022 were postponed and deliberations expected to resume in 2023 did not take place.
PASB recognized Brazil’s leadership in the Region of the Americas and worldwide as it has demonstrated the viability of implementing the four major WHO FCTC demand-reduction measures at the highest level of achievement, as well as other tobacco control policies.
In addition, other PAHO Member States, such as Bolivia and Costa Rica, are devoting efforts to tobacco control, with the latter having a bill on tobacco taxes and the former working toward the drafting and filing of a similar one, following national evidence generated on the topic. Also, through a CCHD, Bolivia, Cuba, and Panama are moving forward on tobacco control.
There was no consensus on the assessment results for 2 baseline countries (COL, MEX). In addition, 2 baseline countries (BRA, DOM) did not complete the assessment. These 4 countries were not counted towards the overall indicator assessment.
PASB Comments
PASB supports countries in the development of policies and implementation of measures supportive of maternal, infant, and young child nutrition, including breastfeeding policies and infant and young child policies. These are guided by the Global Strategy for Infant and Young Child Feeding, the Comprehensive Implementation Plan on Maternal, Infant, and Young Child Nutrition, and other relevant guidance documents. PASB also supports initiatives such as the Baby-friendly Hospital Initiative (BFHI) and the implementation of food-based dietary guidelines.
Two baseline countries (BRA, DOM) and 1 target country (GUF) did not complete the assessment. These 3 countries were not counted towards the overall indicator assessment.
PASB Comments
PASB supports Member States in the development and implementation of national policies and plans to achieve the global nutrition targets, including the reduction of stunting. PASB has developed a roadmap to guide member states in responding to all forms of malnutrition using a food and nutrition systems approach. PAHO is also part of the UN High-Level Regional Task Force to follow up on the UN Food Systems Summit of September 2021, and PAHO supports the transformation of food systems, putting health at the center.
Two baseline countries (BRA, DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
In the Americas, violence intersects with complex trends – such as social, economic and gender inequality, migration, social and intergenerational change, organized crime, and others – which cannot be addressed in isolation. Integrated responses that actively engage different sectors and stakeholders are fundamental to ensuring the sustainability of investments. However, the involvement of diverse actors and perspectives can increase the risk of duplication and misalignment of activities. As a result, multisectoral coordination mechanisms play a key role in setting joint priorities and aligning agendas, coordinating actors, mobilizing human and financial resources, and uniting all stakeholders around the common goal of ending violence. PASB has worked with partners to strengthen the capacity for multisectoral dialogue and collaboration in countries in line with INSPIRE and RESPECT, including through multisectoral training workshops. While a substantial number of countries report having a national multisectoral coalition/task force in place to prevent and respond to violence, these mechanisms are not always set up to cover all forms of violence, thus potentially reducing their impact. Moreover, countries report challenges to keeping these mechanisms operational, which underscores the importance of strengthening access to technical support, capacity building, and other resources in future.
Two baseline countries (BRA, DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
Mental Health plans and policies have advanced in the Region, with Saint Marteen and Guyana developing new plans. The Ministry of Health in Honduras delivered the National Mental Health Policy to the National Secretariat of Strategic Planning. Several countries strengthened legal frameworks and oversight mechanisms to uphold the rights of people with MH conditions. Paraguay now requires judicial review before involuntary hospitalization. Saint Lucia implemented care consent policies and Grenada mandated appeal processes for treatment decisions. Antigua and Barbuda, Barbados, Grenada, Jamaica, and Saint Vincent and the Grenadines continue to advance in the review of their mental health legislation as a key step toward reforming mental health services. Of note, Grenada designated 2023 as the year of mental health and, for the first time, the country has appointed a national MH Coordinator and allocated funding specifically to MH.
Two baseline countries (BRA, DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
Comprehensive suicide prevention strategies aligned with global best practices were developed with the support of PAHO, including the promotion of intersectoral collaboration and policy developments. For instance, PAHO supported Uruguay in establishing a multi-stakeholder network for suicide prevention across healthcare, education, social services, and civil society. Prioritized policy recommendations were also formulated. Bolivia targeted action across societal, community, relationship, and individual levels based on the WHO LIVE LIFE framework.
70 media professionals were trained on responsible reporting on suicide in Guyana (25), Barbados (22), and Grenada (23).
Strategies to improve surveillance and response systems for suicide prevention were created with the support of PAHO. PAHO supported the development of suicide surveillance centers in Argentina as part of the national registry and monitoring system for suicidality, while Paraguay expanded telehealth to enable urgent access to support.
Capacity building for frontline providers was another pillar, with training in identification, counseling, and treatment implemented with the support of PAHO. Paraguay implemented suicide risk monitoring, counseling, and crisis management for healthcare workers. Gatekeeper networks were also expanded from the community to clinical levels, as Paraguay increased community gatekeepers to direct at-risk individuals into care.
Two baseline countries (BRA, DOM) and 1 target country (GUF) did not complete the assessment. These 3 countries were not counted towards the overall indicator assessment.
PASB Comments
Despite significant progress in implementing changes toward malaria elimination in the E2025 countries, major implementation challenges persist in these areas, especially in the countries with the highest disease burden and dispersion. In addition to the structural weaknesses of the health systems in endemic areas, financial challenges, and the aftermath of COVID-19, social factors such as gold mining, migration, and social conflicts have limited the implementation of changes by the countries; nevertheless, significant progress was made. PASB support included developing guidelines and technical tools, as well as promoting changes that were replicated by strategic partners such as the RMEI initiative. Focal pockets of transmission in a limited number of territories continue to be a factor in favor of elimination, insufficiently leveraged by decision-makers to implement high-impact interventions with the necessary structural improvements in specific locations, which would have a major impact on the national situation. Preventing the re-establishment of transmission at the subnational level is another strategy facing significant implementation challenges in the coming years.
Given that these target countries were selected before the pandemic and considering the evolving public health conditions in various countries, a detailed assessment will be necessary to determine which countries should be included as targets for future biennia.
Two baseline countries (BRA, DOM) and 1 target country (CUW) did not complete the assessment. These 3 countries were not counted towards the overall indicator assessment.
PASB Comments
As of 31 December 2023, 27 baseline countries achieved this output indicator and two partially achieved it. This assessment was conducted based on the information entered by the countries through eJRF.
One baseline country (BRA) did not complete the assessment. This country was not counted towards the overall indicator assessment.
PASB Comments
Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Peru, Paraguay, Suriname, and Uruguay have maintained their FMD-free status, while Guyana has achieved such status. Information on countries’ FMD-free status is available on the World Organization for Animal Health website (https://www.woah.org/en/disease/foot-and-mouth-disease/#ui-id-2). It is also important to highlight that the most recent FMD outbreak recorded in the Americas was in Colombia in 2018, and the current PHEFA action plan covers the period from 2021 to 2025.
There was no consensus on the assessment results for 1 target country (DMA). This country was not counted towards the overall indicator assessment.
PASB Comments
Two South American countries that are targeted for 2023 have achieved this output. Caribbean countries are all at risk due to failure in achieving the reporting rate of at least 2 suspected cases by 100,000 population and at least 3 of 5 surveillance indicators.
One baseline country (BRA) and 1 target country (DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
Twenty-five countries have successfully implemented plans of action for the prevention, prophylaxis, surveillance, control, and elimination of dog-mediated human rabies. PAHO has made significant contributions by providing standards, data, and technical cooperation. Achievements include comprehensive vaccination campaigns, improved surveillance systems, and effective public awareness programs. However, several countries still need to enhance their national capacities, as canine rabies cases persist, posing a continued risk for human rabies transmission. Lessons learned highlight the importance of sustained efforts in vaccination, surveillance, and access to post-exposure prophylaxis. Ongoing support is essential to strengthen these capacities and achieve the complete elimination of dog-mediated rabies.
One baseline country (BRA) did not complete the assessment. This country was not counted towards the overall indicator assessment.
PASB Comments
Overall, countries have been working on different aspects of chemicals management, including participation in capacity-building activities, using appropriate guidance documents, and reflecting global chemicals policies in national planning, especially regarding regulations and programs, although competing interests within and outside the health sector remain a challenge.
One baseline country (BRA) did not complete the assessment. This country was not counted towards the overall indicator assessment.
PASB Comments
Countries have developed Health National Adaptation Plans (HNAPs), which provide an assessment of the status of the health sector and outline a plan for implementing actions aimed at strengthening climate-resilient health systems. The target was not achieved in 2 countries due to delays in starting the process (Guyana) and slow progress (Jamaica) on HNAP development, but both are expected to be completed in 2024. Engagement with Dominica has started, assessments have been done, and background documents prepared for the process to continue to have the HNAP completed. Nevertheless, significant progress has been made, as the indicator was achieved for 4 countries that were not on the list of baseline or target countries (Grenada, St Lucia, Bahamas, and Barbados) during this period.
The region has made significant progress in providing access to clean household energy for cooking, thereby reducing exposure to harmful air pollutants. According to WHO, during 2019 and 2021, more than 1.9 million people in the region secured access to clean energies and technologies for cooking. PASB technical cooperation has been pivotal in achieving this progress. PASB has implemented innovative tools from WHO, such as the Household Energy Assessment Rapid Tool (HEART), in Panama, Peru, and Paraguay. Additionally, PASB has piloted the newly developed BAR-HAP tool to estimate health benefits from these energy transitions in Panama and initiated working groups in Peru, El Salvador, and Nicaragua for similar efforts. The Organization has delivered expert training sessions on air quality, household energy and health, and use of assessment tools. The Bureau has also conducted outreach and awareness activities to build capacities within the health workforce to understand the connections between health, household energy, and air pollution. This work is integrated into the PAHO Elimination Initiative.
One baseline country (BRA) did not complete the assessment. This country was not counted towards the overall indicator assessment.
PASB Comments
Progress has been made in the Region, with most of the countries achieving the indicator. The Strategy and Plan of Action on Health Promotion within the context of the Sustainable Development Goals 2019-2030, adopted by Member States in 2019, has served as an example for developing and updating national health promotion policies and programs.
One baseline country (BRA) and one target country (DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
From 2019 to 2023, initiatives for improving information systems for health (IS4H) have driven significant advances toward set targets. These efforts have focused on improving governance mechanisms, maturity assessments, regulatory frameworks, and health information architecture, and they have achieved substantial progress in enhancing data-driven health strategies regionally. The establishment of monitoring and evaluation frameworks, interinstitutional committees, and national policies for electronic health records with open data has been crucial. Significant advances include the adoption of governance mechanisms by several countries and territories, exceeding the target; use of the PASB model for maturity assessment with financial and technical support from the Inter-American Development Bank and the World Bank; and the establishment of regulatory frameworks and health information architecture by numerous countries and territories. Initiatives in data management and information technologies include the adoption of Fast Healthcare Interoperability Resources (FHIR) and ICD-11 standards by 17 countries and territories, as well as progress in electronic health records implementation, moving toward a more unified and efficient health data management model. Additionally, engagement with academic and professional communities and networks has strengthened health analysis and knowledge management, while innovations such as the PASB telehealth platform indicate a shift toward a more integrated approach for the co-creation of health-focused digital public goods. These advances reflect broad progress toward robust, data-informed public health strategies and policies, demonstrating an important commitment to improving health outcomes and operational efficiencies within all Member States.
Two baseline countries (BRA, DOM) and four target countries (CUW, GLP, GUF, MTQ) did not complete the assessment. These 6 countries were not counted towards the overall indicator assessment.
PASB Comments
A comprehensive maturity assessment of IS4H was conducted by PASB of progress made between 2016 and 2023. Using over 240 standardized indicators, the evaluation assessed national health information systems with respect to governance, strategy, laws, financial sustainability, human resources, data management, and quality, including vital statistics, analysis capabilities, information flows, project management, and information technology (IT) infrastructure. Information for the assessment was gathered through country visits, expert consultations, database and gap analyses, and reviews of policies, procedures, and technical documentation. Site visits allowed for direct observation of information platform use and interoperability, especially in primary care, and for data collection and interviews with frontline administrative and clinical staff.
A comprehensive report on the regional IS4H maturity assessment will be published in late 2024; however, the assessment found that 42.8% of the countries are still at level 1, “building awareness.” These countries are characterized by early adoption of health information systems, with mostly analogue data and a growing recognition of the need for digitalization. With very limited capacity to generate data and assure its quality, including on health indicators whose data source relies on civil registration and vital statistics, they depend largely on international organizations in this regard. Investments in digital health have often not expanded infrastructure as expected due to gaps in access to electricity and connectivity, as well as a lack of long-term planning and sustainable financing.
A third of the countries, 34.7%, have reached level 2, “implementing best practices.” They are developing their health information systems with data from various sources and managing health information effectively. However, they face challenges such as incomplete development of indicators, insufficient data exchange, and limited implementation of data standards and public health communication strategies. Another 18.4% have reached level 3, “standardization and continuous improvement,” reflecting advances in IS4H policies and strategies and the use of high-quality data for decision-making. Only 4.1% of countries are at level 4, “integration and alignment,” marked by highly integrated information systems that are aligned with national and international standards.
No country in the Region has reached level 5, the maximum maturity level in IS4H, which entails complete deployment of all components of the model and a constant search for innovation.
Two baseline countries (BRA, DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
Progress has been observed in the Americas regarding the generation, circulation, and utilization of scientific and technical information, as well as the promulgation of knowledge-sharing initiatives among Members States, PASB, and stakeholders.
Overall, the impact factor of the scientific output and the number of scientific journals increased across all Member States during the period 2022-2023, with special emphasis on medicine, public health, and related topics. The publication of an average of 904 titles of scientific journals in medicine and related fields across 19 Member States demonstrates that there has been strong implementation of open-access platforms and policies, helping ensure more equitable and accessible access to scientific production in public health-related fields.
The contribution from documentation centers to LILACS reached 45 291 new documents and a total of 657 indexed scientific journals. The MedCarib database, which focuses on scientific and technical production in the Caribbean, also showed an increase in new contributions during the period. A total of 22 countries and territories are eligible to access the Research4Life (R4L) program, with 1,414 institutions registered. El Salvador became the first Member State to participate in the R4L Country Connector initiative.
By December 2023, there were 179 PAHO/WHO Collaborating Centers (CCs) distributed across 15 Member States in the Region. Two CCs (in Cuba and Brazil) are focused on knowledge management and scientific communication. PAHO/WHO CCs support the Organization in fulfilling the mandates and priorities of the Region and globally, by developing research models and evidence-based literature and providing health analysis and methodologies, among other roles.
Despite these advancements, persistent efforts to strengthen research systems, enhance knowledge sharing, and promote evidence-informed policies are needed. Institutionalizing knowledge, evidence, and science at the national level is essential, as is fostering integrated policies for information use and knowledge dissemination. Furthermore, capacity building and a continued focus on digital literacy are necessary to ensure that public health workers, decision-makers, researchers, and communities have access to the best scientific and technical information.
Two baseline countries (BRA, DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
As per the IHR (2005), all 35 State Parties are mandated to report annually on the status of their core capacities through the State Party Self-Assessment Reporting Tool (SPAR). Compliance with this requirement demonstrates transparency and accountability among Member States and the Secretariat. PASB has supported multisectoral discussions to comply with the SPAR by developing guidance documents for the 15 core capacities, as well as country profiles using the SPAR indicators for the period 2010-2022.
Two baseline countries (BRA, DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
In the 2022-2023 biennium, significant strides were made in health sector risk management, with 23 countries conducting national and/or subnational risk assessments to update their response plans. PASB supported this by implementing the "Emergency Risk Management in Health and Disasters" virtual course. This course trained 1,466 healthcare professionals, including 17 facilitators, on risk assessments, preparedness evaluation, and multi-threat response planning using methodologies like STAR, EDHPI, and the Multi-Threat Response Framework.
Two baseline countries (BRA, DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
Significant progress was made in the 2022-2023 biennium; 37 countries have full-time personnel dedicated to health emergencies. Training played a crucial role, with 5,682 health professionals certified in Health Facility Assessment, totaling 14 767 certified individuals. Additionally, the “Emergency Risk Management in Health and Disasters” virtual course trained 1,466 health professionals, including 17 facilitator trainers.
Two baseline countries (BRA, DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
This indicator reports on Member States’ institutionalization to evaluate capacities during real and non-actual events once plans, mechanisms, and standard operating procedures are in place by scoring 100% in at least one of the four State Party Self-Assessment Reporting Tool indicators that reflect the country’s emergency response. PASB facilitated an IHR meeting among Small Island Developing States in Jamaica (May 2023), in which delegates concluded that most of the SPAR indicators could reach the highest level in the context of SIDS, which includes the four indicators measured under this overall output indicator.
One baseline country (DOM) and one target country (BRA) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
In the 2022-2023 biennium, progress was made in enhancing the resilience and safety of healthcare facilities across the Caribbean and South America through the Resilient Hospitals Initiative. This initiative focused on the strengthening of SMART Hospitals to fortify health facilities against health emergencies and disasters, which 24 countries have launched, promoting safety, sustainability, inclusivity, and adaptability within health facilities. Technical support was instrumental in helping Caribbean countries integrate SMART standards, with notable achievements such as the evaluation of 10 facilities for A70 standards in Barbados and the modernization of eight health centers in Belize. Continuous efforts in monitoring, resource allocation, and addressing data gaps remain essential if the 2025 targets for safe and resilient healthcare infrastructure are to be met.
Three additional countries achieved this indicator during the biennium. The indicator measures country progress toward mainstreaming disaster risk reduction and climate change adaptation/mitigation in the health sector.
In the 2022-1023 biennium, 17 countries included the criteria for disaster mitigation and climate change adaptation under the SMART H initiative, ensuring the operation of health services during and in the aftermath of disasters. As part of this group of countries, three additional countries achieved this indicator during the biennium. Two countries have had delays in implementation of interventions after the assessment, but both are working to achieve the indicator.
There was no consensus on the assessment results for 1 baseline country (BHS). In addition, 2 baseline countries (BRA, DOM) did not complete the assessment. These 3 countries were not counted towards the overall indicator assessment.
PASB Comments
Surveillance and early detection systems continue to be strengthened in the region. Training activities, lab quality assessments, and reviews of lessons learned have allowed improvement of this indicator’s performance in countries.
One baseline country (BRA) and one target country (DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
The Public Health Emergency of International Concern associated with COVID-19 demonstrated the solidarity expressed by Member States in responding to health emergencies. All national public health laboratories received training, technology transfer, and essential supplies in a timely manner. In parallel, laboratory guidelines were shared with countries, and re-certification of the laboratory personnel on the regulations for the transport of infectious substances and associated materials was reactivated in the Region.
The cholera epidemic in Hispaniola still poses a threat to the Region. Training of laboratory personnel in early detection, case confirmation, and molecular characterization of pandemic V. cholerae O:1 strains was provided.
The new strategy for genomic surveillance of epidemic- and pandemic-prone pathogens has started to be implemented at the regional level. This instrument represents added value for decision makers during outbreak investigations. Challenges remain to harmonize knowledge, technologies, and Standard Operating Procedures within public health laboratory networks.
There was no consensus on the assessment results for 1 baseline country (JAM). In addition, 2 baseline countries (BRA, DOM) did not complete the assessment. These 3 countries were not counted towards the overall indicator assessment.
PASB Comments
Infection prevention and control (IPC) continues to be strengthened across the region through preparedness activities, such as the implementation of respiratory protection programs and virtual IPC trainings as part of implementation of the World Health Organization Core Components of Infection Prevention and Control Programs (WHO-IPC CC) at the national level.
There was no consensus on the assessment results for 2 target countries (BHS, JAM). In addition, 2 target countries (BRA, DOM) did not complete the assessment. These 4 countries were not counted towards the overall indicator assessment.
PASB Comments
Progress has been made in most countries. However, target countries continue to show either no progress or partial achievement. PASB will redouble its efforts to examine the health equity approach in key strategic programs, policies, and plans, with particular emphasis on those countries which did not complete the assessment.
Two target countries (BRA, DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
Progress has been made in many countries; however, some continue to show either no progress or partial achievement. PASB will continue to provide support to integration of gender approaches in key strategic programs, policies, and plans, with an emphasis on countries that did not complete the assessment.
One baseline country (BRA) did not complete the assessment. This country was not counted towards the overall indicator assessment.
PASB Comments
Major advances have been made in the region in line with the implementation of the Strategy and Plan of Action on Ethnicity and Health 2019-2025; however, challenges remain. PASB will intensify its efforts to ensure culturally adequate approaches are taken when addressing the health needs of the diverse ethnic groups in the region.
There was no consensus on the assessment results for 2 target countries (BRB, VEN). In addition, 1 baseline country (DOM) did not complete the assessment. These 3 countries were not counted towards the overall indicator assessment.
PASB Comments
PASB has provided technical support and promoted the right to health and other health-related rights, supporting legislative processes at national levels, including capacity building with relevant stakeholders on a variety of issues, including healthy nutrition (front-of-package nutrition labeling, trans fats and sodium, breast milk substitutes), mental health, violence (police and armed forces), LGBT+, persons with disabilities (review of a course for NGOs prepared in PAN), and elimination of diseases among persons deprived of liberty, as well as inter-programmatic work, mapping and analysis of legislation, regulations, and policies across the 33 Member States of the Region, including systematization and analysis of relevant judicial decisions, national/international human rights standards, and intellectual property discussions. Regarding lessons learned and challenges, data collection is generally a challenge, especially when it requires coordination with other authorities and branches of government (legislative and judiciary). Even if the human rights approach is sometimes politically present, inclusion of human rights norms/principles/standards in national legislation, policies, plans, programs, and mechanisms is not always reflected in operational and preventive terms. Therefore, capacities on health-related human rights perspectives and approaches should be strengthened systematically and continuously at the national level.
There was no consensus on the assessment results for 1 baseline country (ECU). In addition, 1 target country (BRA) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
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.