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.

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.

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.

No country has yet achieved this indicator, although 4 countries are reported to be on track to do so by 2025.

The financial protection indicators within the SDG framework (catastrophic and household-impoverishing expenditures) are constructed based on household surveys that record relevant data. These surveys are carried out by countries at various points in time, but almost always at 5- or 10-year intervals. Many countries have great difficulties in implementing these surveys, and this causes years of delay.

Only 4 countries in the region (Bolivia, Mexico, Peru, and United States of America) would be in a position to calculate such indicators, with 2 or more years (data points) in the period 2019-2025 (or relevant adjacent years) available to calculate variation. Four other countries (Colombia, Dominican Republic, El Salvador, and Panama) currently have one data point for the relevant or adjacent years and could eventually complete the measurement toward the end of the period in 2025. It is therefore recommended to eliminate their measurement or simply limit the indicator baselines and targets to countries for which sufficient data are available.

These indicators are monitored by PAHO in collaboration with WHO. Countries are encouraged and trained to use them so that they can carry out surveys and then analyze the results. More recently, PASB has begun to analyze the determinants that contribute to a lack of financial protection. This will allow countries to have more evidence to improve their policies.

Only 1 country has achieved this indicator, although 3 more are reported to be on track to do so by 2025.
The financial protection indicators within the SDG framework (catastrophic and household-impoverishing expenditures) are constructed based on household surveys that record relevant data. These surveys are carried out by countries at various points in time, but almost always at 5- or 10-year intervals. Many countries have great difficulties in implementing these surveys, and this causes years of delay.
Only 4 countries in the region (Bolivia, Mexico, Peru, and United States of America) would be in a position to calculate such indicators, with 2 or more years (data points) in the period 2019-2025 (or relevant adjacent years) available to calculate variation. Four other countries (Colombia, Dominican Republic, El Salvador, and Panama) currently have one data point for the relevant or adjacent years and could eventually complete the measurement toward the end of the period in 2025. It is therefore recommended to eliminate their measurement or simply limit the indicator baselines and targets to countries for which sufficient data are available.
These indicators are monitored by PAHO in collaboration with WHO. Countries are encouraged and trained to use them so that they can carry out surveys and then analyze the results. More recently, PASB has begun to analyze the determinants that contribute to a lack of financial protection. This will allow countries to have more evidence to improve their policies.

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

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

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

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.

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.

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.

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.