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.

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.

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.

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.

Countries in the region are moving toward implementing standardized, evidence-based protocols to improve the quality of diabetes care. However, in parallel with these efforts, the prevalence of obesity, one of the main risk factors for diabetes, continues to increase. This challenge makes it difficult to stop the sustained increase in diabetes, reflecting the need to redouble efforts and move toward a joint, integrated, and comprehensive response to diabetes and other non-communicable diseases and risk factors. Additionally, the need for updated, standardized, and internationally comparable population data makes it difficult to evaluate the progress achieved with this indicator. Strengthening population surveillance systems for non-communicable diseases, including diabetes, would have a positive effect on the monitoring of this indicator.

Countries in the region, including those at risk, are making structural changes regarding the procurement of medicines and validated blood pressure devices, as well as adopting standardized treatment protocols to help expand access to quality care from the primary health care setting and improve hypertension control rates. However, the adoption of systematic quality improvement methodologies to improve hypertension management is still incipient in the region and must be accompanied by monitoring and evaluation systems designed to enable primary health care teams to monitor and correct deviations in their own performance. Additionally, a lack of updated population-level data limits the ability to accurately gauge progress.