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.

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.

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

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

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.

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.

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

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

In the area of substance use, PAHO implemented workshops to improve the quality of healthcare services for people with substance use problems. A total of 22 participants from the six Caribbean Dutch Islands (Aruba, Curaçao, Sint Maarten, BON, STA, and SAB) attended the workshop in Curaçao.

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.

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