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.

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.

The reduction in time to diagnose and treat malaria cases is an essential indicator for actions against malaria and is one of the main focuses of PAHO's technical framework for cooperation. Early access to treatment has been the cornerstone of the regional strategy, with actions ranging from maintaining diagnostic capacity and promoting the use of rapid tests to managing antimalarials, promoting microplanning, and implementing the DTI-R strategy.

Thanks to nominal information systems, all endemic countries monitor the timing of diagnosis and treatment. While a significant number of countries reported compliance with the indicator, partial compliance by two baseline countries may affect the overall performance of the indicator. All endemic countries continue to face challenges in shortening the time between the onset of symptoms and treatment and should prioritize actions to address the barriers the population faces in accessing treatment.

However, as noted in the technical specifications, this indicator is variable and difficult to achieve in settings of low transmission, penalizing those countries that achieve significant reductions in the number of cases. As transmission is reduced, cases take longer to be detected. Therefore, it is expected that baseline countries that are reducing malaria transmission, as well as other countries achieving significant reductions in case volume, will experience difficulties in achieving the indicator by 2025, despite making progress toward elimination.

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).

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 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.

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.

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.

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).