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.

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.

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.

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.

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.

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.