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

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

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).

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.

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.

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.

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

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

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

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.

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.

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.

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