There was no consensus on the assessment results for 1 target country (PAN). In addition, 2 baseline country (BRA, URY) and 2 target countries (CUW, DOM) did not complete the assessment. These 5 countries were not counted towards the overall indicator assessment.
PASB Comments
The hospitalization rate for ambulatory care-sensitive conditions serves as a valuable indicator for evaluating progress in strengthening the first level of care, including its economic implications for the overall healthcare system. During this reporting period, only two countries have made notable advances in this indicator: Mexico has integrated it into their National Sectoral Health Program 2022-2024 monitoring system, and El Salvador is currently in the process of collecting data for this indicator.
Measurement of this indicator has posed challenges for many countries in the region. While PASB has provided technical cooperation, tools, and support for this purpose, there is a need to enhance the commitment of countries further and improve countries’ capacities to utilize these resources effectively.
Three target countries (BRA, CUW, DOM) did not complete the assessment. These 3 countries were not counted towards the overall indicator assessment.
PASB Comments
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.
Two baseline countries (BRA, DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
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.
One baseline country (BRA) did not complete the assessment. This country was not counted towards the overall indicator assessment.
PASB Comments
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.
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).
There was no consensus on the assessment results for 3 baseline countries (BMU, NIC, KNA) and 1 target country (CRI). In addition, 1 baseline country (CUW) and 1 target country (DOM) did not complete the assessment. These 6 countries were not counted towards the overall indicator assessment.
PASB Comments
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.
One baseline country (BRA) did not complete the assessment. This country was not counted towards the overall indicator assessment.
PASB Comments
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.
Three baseline countries (BRA, DOM, GLP) did not complete the assessment. These 3 countries were not counted towards the overall indicator assessment.
PASB Comments
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.
One baseline country (BRA) did not complete the assessment. This country was not counted towards the overall indicator assessment.
PASB Comments
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.
There was no consensus on the assessment results for 1 target country (MEX). In addition, 1 target country (BRA) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
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.
One baseline country (BRA) did not complete the assessment. This country was not counted towards the overall indicator assessment.
PASB Comments
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.
There was no consensus on the assessment results for 1 target country (JAM). In addition, 2 baseline countries (BRA, DOM) did not complete the assessment. These 3 countries were not counted towards the overall indicator assessment.
One baseline country (BRA) and 1 target country (DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
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.
One target country (CUW) did not complete the assessment. This country was not counted towards the overall indicator assessment.
PASB Comments
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.
There was no consensus on the assessment results for 1 target country (CYM). In addition, 1 baseline country (DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
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.
Two target countries (BRA, DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
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.
One baseline country (CUW) and 1 target country (BRA) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
Although the current rating of this indicator is “No progress” due to a regression from the baseline, it should be noted that, of the total number of countries (14), 5 achieved the target and 7 are on track to achieve it; only 2 countries are at risk. Countries that are on track to achieve the indicator have progressed in expanding blood collection capacity and reducing blood loss or expiration as they improve their quality processes. Additional efforts are being made to support Caribbean countries through quality training so that better performance also improves the availability of blood for transfusion. Likewise, the promotion of voluntary blood donation was strengthened with the World Blood Donor Day campaign and through regional seminars. Greater support will be provided to the countries that are at risk to help them reach the target by 2025.
There was no consensus on the assessment results for 1 target country (GUY). In addition, 1 target country (DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
Substantial progress has been made on the evaluation of capacities and the development of action plans to strengthen the Essential Public Health Functions (EPHF). One country has already achieved this indicator, and 12 out of the 17 countries are on track to achieve it. Two countries are at risk, and two have not shown progress as a recent evaluation of the EPHF has not been completed. The countries that are on track have completed the baseline evaluation, with results showing that less than 60% of capacity is currently being met; however, they are moving forward with the implementation of action plans to improve capacity and could reach that threshold. Efforts toward strengthening leadership, governance, and institutional capacities, alongside intersectoral collaboration and technical cooperation, are contributing to the positive trajectory of this indicator.
Two baseline countries (BRA, DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
Although the current rating of this indicator is “No progress”, countries have been able to address risk factors for communicable diseases through intersectoral action with the technical support provided by PASB. From the integrated public health perspective embedded in the One Health approach, countries are experiencing tangible improvements in public health outcomes. Notable advances include the implementation of national action plans for antimicrobial resistance, the development and strengthening of national food safety systems based on Codex Alimentarius, and improved access to lifesaving antivenoms through production by public health laboratories and their inclusion in the PAHO revolving funds.
Two target countries (CUW, DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
During the biennium, countries in the Region made progress toward improving their food control systems to prevent and mitigate risks to food safety. PASB has provided technical guidance to countries (Brazil, Chile, Costa Rica, Cuba, Guatemala, Ecuador, Honduras, Panama, Peru, Paraguay, URU) to improve their food control systems based on the principles of risk analysis (risk management, risk assessment and risk communication).
Country achievements include the development of national food safety policies and Codex Alimentarius programs for standard-setting and implementation from farm to fork – One Health (Guatemala, Guyana, Honduras, El Salvador). Additionally, Paraguay, Dominican Republic, Colombia and Haiti are improving the capacity of their traditional food markets to prevent emerging food safety risks under the One Health approach. In the Caribbean, a survey was conducted to assess the readiness of food control systems to mitigate risks related to climate change (Saint Lucia, Trinidad and Tobago, Barbados, Saint Kitts and Nevis, Guyana, Jamaica). Based on the findings of this survey, Trinidad and Tobago and Barbados developed climate-resilient national food safety plans. One of the main challenges in achieving the indicator at country level is the high turnover of government officials. As a lesson learned, it is important to facilitate collaboration across sectors and regularly monitor the implementation of developed policies, programs, and plans. PASB has mobilized resources to improve and harmonize the food safety risk analysis capacity of countries in Latin America.
Two target countries (BRA, DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
Most target Member States have demonstrated political commitment to the elimination of industrially produced trans fatty acids from their food supply. Continued PASB efforts to support them in securing the adoption of PAHO/WHO best practices to achieve such elimination suggest the indicator is on track, provided that Member States' commitments translate into policy action in 2024.
Two baseline countries did not complete the assessment (BRA, DOM). These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
An advisory committee or lead agency in road safety is crucial for coordinating efforts across various sectors such as transportation, health, education, and law enforcement, ensuring a unified and strategic approach. Additionally, it is responsible for developing and implementing evidence-based policies and regulations, such as seatbelt laws, speed limits, and measures to prevent drunk driving. A lead agency also plays a vital role in the collection and analysis of data on road traffic injuries, allowing for the identification of trends and the evaluation of intervention effectiveness. Proper resource allocation and international cooperation are other areas where such an agency can have a significant impact, adopting global best practices to enhance road safety and reduce road traffic deaths and injuries.
PAHO has provided technical support to various road safety advisory committees or lead agencies in the Region, as requested, to support their efforts in road safety management. One key area of focus is the strengthening of road safety data systems. In line with this, WHO/PAHO produced the Fifth Global Road Safety Status Report to help countries identify gaps and priorities to accelerate implementation of the recommendations of the Global Plan for the Second Decade of Action for Road Safety 2021-2030. These initiatives aim to achieve the ambitious but reachable target of reducing global road mortality and serious injuries by 50%.
Two target countries (BRA, DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
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.
One baseline country (DOM) and one target country (BRA) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
The Report of the PAHO High-Level Commission on Mental Health and COVID-19 and the new Strategy for Improving Mental Health and Suicide Prevention provide the vision and the recommended actions for increased technical cooperation in MH in the Region. Several countries have started to take important actions to improve and reform their mental health systems. The recommendations of the Commission emphasize the importance of intersectoral work and integration of mental health into all areas of government to better face the long-term crisis of mental health in the Americas. In the area of suicide prevention, comprehensive strategies aligned with global best practices were developed with the support of PAHO, including the promotion of intersectoral collaboration and policy developments. For instance, PAHO helped Uruguay establish a multi-stakeholder network for suicide prevention across healthcare, education, social services, and civil society. Prioritized policy recommendations have also been formulated. Bolivia targeted action across societal, community, relationship, and individual levels based on the WHO LIVE LIFE framework.
Furthermore, 70 media professionals were trained on responsible reporting on suicide in Guyana (25), Barbados (22), and Grenada (23).
One baseline country (BRA) and 1 target country (DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
As of 2022, 85% of people with HIV in Latin America are diagnosed; of those, 85% are on antiretroviral therapy (ART); and of those, 92% have suppressed viral loads. In the Caribbean, 83% of people with HIV are diagnosed; of those, 81% are on ART; and of those, 84% have suppressed viral loads. ART coverage for people living with HIV in Latin America and the Caribbean increased 2.2-fold from 2010 (32%) to 2022 (71%). As part of efforts to optimize HIV treatment, PASB has been actively supporting countries in updating their national strategic plans and HIV treatment guidelines. This includes targeted assistance in several countries across the Region, including support for the optimal selection and forecasting of antiretroviral (ARV) drugs. Additionally, PASB has been supporting countries on HIV and aging, pediatric treatment, resistance, elimination, and cure. Furthermore, a newly designed WHO Collaborating Center on HIV resistance, CIENI/INER, is expected to reinforce technical cooperation.
Regarding advanced HIV disease, PASB provides technical assistance for the introduction of new tests and treatments for opportunistic infections and supports implementation research, including mortality analysis, in selected countries.
Three baseline countries (DOM, GLP, MTQ) did not complete the assessment. These 3 countries were not counted towards the overall indicator assessment.
PASB Comments
During the biennium, countries in the Region made progress in eliminating malaria or interrupting its transmission both at the national and subnational levels, as well as preventing re-establishment in malaria-free countries and receptive territories. Case investigation is being incorporated by endemic and non-endemic countries, including improvements in guidelines, instruments, and surveillance processes. These actions should integrate the efforts made so far by vertical programs with more cross-cutting epidemiologic surveillance processes and actors. Important challenges remain in this aspect of integration and in the quality of investigations. Pending improvements include the adoption of investigation in endemic territories where the small number of cases already justifies this action to accelerate elimination, as well as improvements in response. The technical cooperation that PAHO has developed in this area has been replicated with partner implementation actions, such as the RMEI initiative in Central America.
There was no consensus on the assessment results for 2 baseline countries (KNA, URY). In addition, 1 baseline country (BRA) and 1 target country (DOM) did not complete the assessment. These 4 countries were not counted towards the overall indicator assessment.
PASB Comments
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.
Two target countries (BRA, DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
Costa Rica, Suriname, and Trinidad and Tobago were removed from the list of LF endemic countries by WHO (upon PAHO's request) in 2011. In Guyana, the Transmission Assessment Survey (TAS) has been completed, with results suggesting a potential need for another round of Mass Drug Administration (MDA) in certain areas.
One baseline country (BRA) and 1 target country (DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
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.
There was no consensus on the assessment results for 1 target country (JAM). In addition, 1 baseline country (BRA) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
Progress has been observed in the implementation of different WHA resolutions through legislation, national action plans, capacity-building activities, and programs addressing prioritized chemicals. However, the challenges observed in some countries highlight the need for further attention in a multisectoral environment.
Two baseline countries (BRA, DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
The health sectors of several countries have strengthened capacities to engage with other sectors, ensuring that health is included in climate change discussions at the local, regional, and international levels. This achievement is facilitated by the appointment of designated climate change and health focal points who advocate for health inclusion in climate change inter-ministerial committees.
There was no consensus on the assessment results for 1 baseline country (COL). In addition, 1 baseline country (BRA) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
Progress has been made in promoting health and wellbeing and reducing health inequities by implementing the Health in All Policies (HiAP) framework. In 2022, Member States adopted Resolution CE170.R12 on the Policy for Recovering Progress toward the Sustainable Development Goals with Equity through Action on the Social Determinants of Health and Intersectoral Work, which has among its strategic lines of action “promote intersectoral action to address the indivisible goals of the 2030 Agenda, integrating equity as a cross-cutting value”. The first regional meeting on intersectoral action and HiAP for health equity was held in 2023, with the participation of over 20 countries of the Americas, resulting in the creation of the Network on Intersectoral Work and Social Participation for Health Equity in the Americas (TIPSESA). Additionally, the PASB will launch 3 virtual courses to strengthen capacities for development of intersectoral action and HiAP, aimed at both the health sector and other sectors, and for different levels of government. A proposal of indicators to monitor Intersectoral Action will also be developed.
One baseline country (BRA) and one target country (DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
Moving toward robust institutional capacity of the science, evidence, and applied knowledge ecosystems, evidence-informed policy and practice programs are being implemented in 15 countries, in alignment with regional initiatives and other key priorities: Argentina, Brazil, Chile, Colombia, Costa Rica, Dominican Republic, Ecuador, El Salvador, Jamaica, Mexico, Panama, Paraguay, Peru, Trinidad and Tobago, and Venezuela. There has also been progress as evidenced by 20 countries participating in the PAHO/WHO regional joint meeting of the Evidence-Informed Policy Network (EVIPNET) and Health Technology Assessment Network of the Americas (REDETSA), which took place in Jamaica in October 2023. The BIGG-REC database efficiently organizes over 3,500 current WHO and PAHO recommendations for easy access in four languages. Through 3 courses on the Virtual Campus, decision-makers and healthcare professionals in 28 countries received training in development of systematic reviews, evidence-based guidelines, and evidence-informed policies, engaging more than 20 000 participants. A PAHO Handbook for Adapting and Implementing Evidence-Informed Guidelines Second Edition was developed with the participation of 15 Member States and has been disseminated and used for guideline adaptation by national guideline programs.
There was no consensus on the assessment results for 3 target countries (BMU, BON, KNA). In addition, 1 baseline country (BRA) and 5 target country (DOM, GUF, MTQ, GLP, CUW) did not complete the assessment. These 9 countries were not counted towards the overall indicator assessment.
PASB Comments
The number of countries that have generated and produced analytical health reports which include disaggregated data on a regular basis has increased from 5 to 17. Additionally, countries are increasingly making these reports and other health data and information more accessible both internally and externally. Improved national health information systems and advances in digital transformation have led to increased data demand and utilization. Such data increasingly include the social determinants of health and allow countries to monitor progress and gaps. PASB provided technical cooperation through ongoing capacity-building efforts in health analysis, particularly for monitoring SDG3 indicators among interdisciplinary country teams at national and subnational levels. This has been crucial to the progress achieved for OCM 21.b. An additional 13 countries are on track to achieve this indicator.
No agreement was reached for three countries and territories. PASB assessed that the criteria as detailed on the technical note for the indicator were not met, and no documentation was submitted or otherwise available at the time of the assessment.
One baseline country (BRA) and one target country (DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
Progress has been observed in the Americas regarding the generation, circulation, and utilization of scientific and technical information, as well as the promulgation of knowledge-sharing initiatives among Members States, PASB, and stakeholders.
Overall, the impact factor of the scientific output and the number of journals increased across all Member States during the period 2022-2023, with special emphasis on medicine, public health, and related topics. The increase in implementation of open-access platforms and policies helped ensure more equitable and accessible access to scientific production in public health-related fields.
The contribution from documentation centers to regional databases such as LILACS, MedCarib, and other open-access platforms worldwide has also increased. A total of 22 countries and territories are eligible to access the Research4Life (R4L) program, and there has been an increase in the number of registered institutions, which have helped to meet the need for more equitable access to scientific and technical information and to reduce the digital divide across the Region. El Salvador became the first Member State to participate in the R4L Country Connector initiative.
Despite a slight decrease in the number of new designations and re-designations, PAHO/WHO Collaborating Centers (CC) have proven to be an important mechanism of technical cooperation. PAHO/WHO CCs support the Organization in fulfilling the mandates and priorities of the Region and globally, by developing research models and evidence-based literature and providing health analysis and methodologies. By December 2023, there were 179 CCs in the Region, distributed across 15 Member States.
Despite these advancements, persistent efforts to strengthen research systems, enhance knowledge sharing, and promote evidence-informed policies are needed. Institutionalizing knowledge, evidence, and science at the national level is essential, as is fostering integrated policies for information use and knowledge dissemination. Furthermore, capacity building and a continued focus on digital literacy are necessary to ensure that public health workers, decision-makers, researchers, and communities have access to the best scientific and technical information.
One baseline country (BRA) did not complete the assessment. This country was not counted towards the overall indicator assessment.
PASB Comments
PASB supported Member States in the development and revision of national standards governing the ethics of research, such as laws, regulations, and national policies, with the goal of ensuring that they adhere to international ethical standards for research with human participants. The COVID-19 pandemic brought increased attention to the importance of adhering to international standards to expedite the conduct of high-impact clinical trials. Furthermore, international standards for research now include specific provisions for research in emergencies (as described in PAHO’s Catalyzing Ethical Research in Emergencies: Ethics guidance, lessons learned from the COVID-19 pandemic and pending agenda), and PASB supported countries in including these provisions in national standards, thus improving ethics preparedness to conduct research in future emergencies. Measuring progress in this indicator has often entailed distinguishing the ethical from the strictly regulatory oversight of research with human participants.
Seven baseline countries (BON, BRA, CUW, DOM, GLP, GUF, MTQ) did not complete the assessment. These 7 countries were not counted towards the overall indicator assessment.
PASB Comments
In the 2022-23 biennium, progress was made toward strengthening country capacity for all-hazards health emergency and disaster risk management. As of the latest assessment, 22 countries fully meet or exceed minimum capacities to manage public health risk associated with emergencies, with another 15 on track to do so. PASB's technical support, including the development of assessment tools and coordinator meetings, remains essential for achieving the 2025 target of 37 countries. Continuous monitoring and emphasis on gender-sensitive disaster preparedness, supported by tools such as the Preparedness Index for Health Emergencies and Disasters and the monitoring survey for the Plan of Action on Disaster Risk Reduction, are critical for maintaining and building on the progress made.
There was no consensus on the assessment results for 3 target countries (BRB, CRI, MEX). In addition, 2 target countries (BRA, DOM) did not complete the assessment. These 5 countries were not counted towards the overall indicator assessment.
PASB Comments
To achieve this indicator, a State Party must have improved its scores or maintained them (where the score is higher than 0%), for at least 12 of the 15 core capacities, as compared to the previous year. Three countries did not comply with the State Party Self-Assessment Reporting Tool in 2021, precluding comparison with results for the past biennium. PASB is working closely with the countries to strengthen and maintain their core capacities under the IHR, which contribute directly to global health security.
Two target countries (BRA, DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
Twelve countries achieved the indicator by the end of 2023, and another 21 were on track to do so by 2025. This indicator aims to measure and track the capacity of countries and territories to respond to major epidemics and pandemics and to ensure a rapid exchange of information about impending public health threats and, as a result, to increase confidence and trust among all parties.
PASB provided technical cooperation to improve disease surveillance systems and train health workers to strengthen preparedness for epidemics and pandemics, notably by strengthening national and regional surveillance networks and implementing the Strategy on Regional Genomic Surveillance for Epidemic and Pandemic Preparedness and Response.
One target country (BRA) did not complete the assessment. This country was not counted towards the overall indicator assessment.
PASB Comments
Progress has been observed in advancing health equity, gender and ethnic equality in health, and human rights in the region. The continued commitment of Member States to issues of ethnicity and human rights was demonstrated by the approval of two progress reports presented at the 60th Directing Council, held 25-29 September 2023: Health and Human Rights (Resolution CD50.R8) [1] and the Strategy and Plan of Action on Ethnicity and Health 2019-2025 (CD57/13) [2]. In addition, DHE/EG collaborated with the WHO Department of Gender Equity and Rights on the resolution on Indigenous Health tabled by the Government of Brazil and approved by the 67th World Health Assembly in May 2023. Furthermore, Member States requested an update to PAHO Resolution CD52.R6, Addressing the Causes of Disparities in Health Services Access and Utilization for Lesbian, Gay, Bisexual and Trans (LGBT) persons.
[1] https://www.paho.org/en/documents/cd50r8-health-and-human-rights
[2] https://www.paho.org/en/documents/cd5713-strategy-and-plan-action-ethnicity-and-health-2019-2025
Eight target countries (BRA, CAN, CUW, DOM, GLP, GUF, MTQ, PRI) did not complete the assessment. These 8 countries were not counted towards the overall indicator assessment.
PASB Comments
The majority of countries and territories express satisfaction with PAHO/WHO's leading role on global and regional health issues, indicating that the Organization’s efforts and initiatives are generally perceived positively across the region. This widespread satisfaction underscores PAHO/WHO's role as a leading public health authority, engaging countries and territories in the regional and global public health agenda at the highest level – politically, strategically, and technically. Efforts will continue to ensure alignment between biennial work plans and the priorities indicated by national health authorities. This commitment involves ongoing coordination and collaboration with national health authorities to tailor PAHO/WHO's biennial work plans to address the specific health challenges and priorities identified by each country.
There was no consensus on the assessment results for 1 baseline country (BHS). In addition, 1 baseline country (DOM) and 5 target countries (BRA, CUW, GLP, GUF, MTQ) did not complete the assessment. These 7 countries were not counted towards the overall indicator assessment.
In addition, 2 baseline countries (BRA, DOM) and 1 target country (CUW) did not complete the assessment. These 3 countries were not counted towards the overall indicator assessment.
PASB Comments
Although countries continuously work to implement the IHSDN framework, some have approved policies or regulations that reinforce IHSDNs, but require time to be implemented to achieve their objectives. Technical cooperation during the next period needs to support countries in these implementation processes.
All countries linked to this indicator undertake many of the activities outlined in the Plan of Action; however, these activities are not consistently implemented across all lines of action. While this target could be achieved during the next biennium, achieving it will require strengthening actions through PASB technical cooperation for implementation of the Plan of Action.
One baseline country (BRA) and one target country (DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
National data from almost all countries of the Americas exceed the threshold of four antenatal care (ANC) visits. However, few countries regularly collect and publish such data disaggregated by different aspects (age, educational level, ethnicity, rural-urban residence, among others), as required by this indicator. For this reason, the indicator is showing a lack of progress, with a regression from the baseline. It is well known that national averages mask the problems experienced by women living in the most vulnerable conditions. Therefore, to reduce maternal mortality, Member States must carry out epidemiological analyses to identify these groups and implement actions focused on them.
One baseline country (BRA) and one target country (DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
This is a composite indicator based on the inclusion of HIV pre-exposure prophylaxis (PrEP) policies, the incorporation of short oral treatment for tuberculosis (bedaquiline) into national guidelines, and the use of direct-acting antivirals (DAA) for treatment of hepatitis C. While countries have made great strides in incorporating these commodities in their national policies and guidelines, it is vital to scale up access and increase the number of people receiving PrEP, bedaquiline, and DAAs, all of which can be procured through the Strategic Fund. The technical team has been promoting the scale-up of these interventions.
Two baseline countries (BRA, DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
Major gains have been made in clinical management of arboviral diseases, especially dengue. Despite the most severe epidemic in recorded history, the case fatality rate remained under the target threshold of 0.05%. This improvement in clinical management notwithstanding, some countries have measured the achievement of this indicator as partially completed because they have not concluded a national adaptation of the Regional Guidance. As can be assessed by the low case fatality rate, the updated clinical guidance is being implemented throughout the Region. Four countries indicate that activities to update guidelines were halted during the epidemic but will resume in these countries during the 2024-2025 biennium.
Two target countries (BRA, DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
DPT vaccination coverage has been affected by the COVID-19 pandemic. PASB is working to improve coverage and reduce dropout rates to ensure that under-vaccinated individuals receive the necessary immunizations.
One baseline country (BRA) and one target country (DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
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.
One target country (DOM) did not complete the assessment. This country was not counted towards the overall indicator assessment.
PASB Comments
Several countries are initiating or expanding information and monitoring systems. For instance, Chile developed a database which tracks diagnosed cases and service referrals to analyze gaps. Similar surveillance efforts are underway in countries like Argentina.
One baseline country (BRA) did not complete the assessment. This country was not counted towards the overall indicator assessment
PASB Comments
The establishment of a single emergency care access number is crucial to streamline communication, improve response times, and enhance coordination among emergency responders. This supports Target 12 of the voluntary Global Road Safety Performance targets, which aims at ensuring that road traffic victims receive timely and effective pre-hospital care, thus improving survival rates and recovery outcomes.
The importance of having a free-to-call, single, easily recognizable, and universal (i.e., with countrywide coverage) emergency care access number cannot be overstated. This significantly enhances the effectiveness and efficiency of emergency medical services. It simplifies the process for victims and bystanders, ensuring they can quickly and easily reach the necessary emergency services without confusion or delay. This streamlined communication is essential in crisis situations, where every second counts. Furthermore, it facilitates better coordination among emergency responders, enabling them to provide timely and effective care.
Rapid access to emergency medical services is a critical component of reducing road traffic fatalities and injuries, as outlined in the Global Road Safety Performance Targets. The Pan American Health Organization (PAHO) has supported this initiative by promoting the standardization of emergency numbers across the Americas in different technical publications and by providing/incentivizing interprogrammatic technical cooperation to different countries. One example of this technical cooperation is the Emergency and Critical Care Systems Assessment (ECCSA) conducted in different countries of the Region, which has translated into the development of roadmaps to implement action priorities. ECCSA is also underway in other countries. These efforts are integral to achieving the global targets and, ultimately, saving lives.
Two baseline countries (BRA, DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment
PASB Comments
A milestone for a strong health-system response to violence is the existence of at least one health sector protocol which provides information on services and care to be provided to survivors of violence. These protocols are critical tools to guide high-quality health service delivery. They provide standardized guidance that ensures consistency across people and settings and over time. Protocols can also be useful to guide training and professional development of health workers, as these documents often set the expectation for the health-system response to survivors of violence. Countries may have one national sector-wide violence protocol or several ones focusing on specific forms of violence, specific settings, or specific groups of survivors. PASB has developed substantial guidance for Member States with evidence-based recommendations of what should be included in such protocols. The Organization has continued to provide support to Member States in the development, review, and updating of national guidelines on violence. While a large majority of Member States now have at least one health-sector protocol on violence, which is a considerable achievement for the Region, a recent analysis by PASB stressed that more work was needed to improve the quality of these documents. The more detailed the guidance included, the easier it is for health managers to implement and for health workers to understand exactly what is required of them, improving the quality of care for survivors in all their diversity. Moreover, while the existence of a protocol and its alignment with the evidence base and related indicators is a critical milestone, it is important that these documents be implemented and supplemented by clinical handbooks, job aids, and similar reference tools, as well as by training for health workers to support them in their day-to-day interactions with survivors.
There was no consensus on the assessment results for 1 target country (VEN). In addition, 1 baseline country (BRA) and 1 target country (DOM) did not complete the assessment. These 3 countries were not counted towards the overall indicator assessment.
PASB Comments
Countries have shown significant progress in the development and implementation of national human resources for health (HRH) policies. The first objective of the Plan of Action on Human Resources for Universal Access to Health and Universal Health Coverage 2018-2023 calls for promoting the formulation and implementation of a national policy on human resources for health at the highest level and agreed through intersectoral engagement. Some countries have already developed a national HRH policy, while others have been doing so with technical support from PAHO. Additionally, the Policy on the Health Workforce 2030: Strengthening Human Resources for Health to Achieve Resilient Health Systems recommends among its priority actions the strengthening of governance and promotion of national policies and plans for HRH, which should reinforce the work of countries that are on the path to achieving this objective.
There was no consensus on the assessment results for 1 target country (COL). In addition, 1 baseline country (BRA) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
PASB continues to collaborate with Member States in the development, adoption, and implementation of national radiation safety plans in accordance with the International Basic Safety Standards (BSS). While most Member States are using the BSS when establishing or updating national rules or regulations and have employed operational criteria in the field of radiation safety, it will take time for them to make the necessary changes to existing national radiation protection systems in order to fully comply with BSS requirements. The indicator is expected to be achieved in the next biennium.
One target country (DOM) did not complete the assessment. This country was not counted towards the overall indicator assessment.
PASB Comments
Seven countries achieved or partially achieved this indicator. These countries have developed roadmaps based on the results of assessments of the essential public health functions (EPHF), which have informed strategic planning instruments such as national health plans, national development plans, and investment programs. The three countries that achieved the indicator developed a specific action plan to improve the EPHF at a national level. PASB continues to support countries in the implementation of the EPHF evaluation to make progress toward achievement of this indicator.
PASB supported Member States addressing ethical issues in public health through the publication of training material, the development of courses, the development of ethics guidance for emergency situations (such as the emergency use of unproven interventions outside of research, known as the MEURI framework, and the ethical conduct of mpox surveillance), and direct support for their implementation. Support was also provided to address issues that became prominent as a result of the COVID-19 pandemic, e.g., the ethical acceptability of vaccination mandates. Because of the pervasive nature of ethical challenges in public health, ethics support to Member States was embedded in the technical cooperation provided in other areas, e.g. immunization, surveillance, and emergency response.
There was no consensus on the assessment results for 1 baseline country (JAM). In addition, 1 baseline country (DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
While monitoring and evaluation remains a challenge for health systems, there has been significant progress, supported by PASB. For example, a dashboard on primary health care indicators has directly contributed to progress on this output. Five countries have achieved this indicator and five others have partially achieved it, highlighting considerable progress in the development of mechanisms for monitoring and evaluation. Countries that achieved this target applied the monitoring framework for universal health, and those that have partially achieved it continue with strategies to develop the necessary mechanisms to do so. Relevant obstacles preventing the expansion of monitoring and evaluation of progress toward universal health include issues related to data availability and technical capacity at the national level.
Two baseline countries (BRA, DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
During the biennium, countries strengthened their Infection Prevention and Control (IPC) programs, including their capacity to respond to multidrug-resistant organism outbreaks in healthcare facilities. PASB directed efforts toward supporting countries to consolidate their IPC and antimicrobial stewardship programs to enhance the effectiveness of local interventions. Countries also strengthened the coordination between National Reference Labs and national IPC programs for rapid detection and response to emerging resistant mechanisms.
Substantial progress has been made to improve the capacities for food control in countries in the Region. Honduras, Guatemala, El Salvador, and Guyana have developed their Codex Alimentarius programs to set and implement food safety standards from farm to fork within the One Health approach, and Argentina, Bolivia, Brazil, Colombia, Cuba, Chile, Guyana, Paraguay, Peru, and URU have improved their integrated AMR surveillance plans to include the food value chain. Suriname’s IHR Capacity 13 for Food Safety was assessed, and some areas of improvement have been detected. Countries’ food monitoring capacities have been improved through the technical support provided by the Inter-American Network of Food Analysis Laboratories (INFAL). PASB has provided technical guidance in risk analysis and foodborne disease surveillance regularly and on an ad-hoc basis to countries in Latin America.
There was no consensus on the assessment results for 5 target countries (BHS, BRB, DMA, GUY, VEN). In addition, 1 baseline country (BRA) and 1 target country (DOM) did not complete the assessment. These 7 countries were not counted towards the overall indicator assessment.
PASB Comments
Significant progress has been made in enabling countries to implement interventions against zoonotic diseases using a One Health approach. Many countries have achieved this indicator through enhanced intersectoral coordination, effective surveillance, prevention, and control measures. PAHO has been crucial in providing standards, producing data, and offering technical cooperation. Achievements include the establishment of national policies and integrated strategies. However, several countries still need to improve intersectoral coordination and fully implement One Health policies. Continued efforts are necessary to strengthen these areas, ensuring comprehensive and effective responses to zoonotic disease threats and preventing transmission from animals to humans.
There was no consensus on the assessment results for 1 target country (CRI). In addition, 1 baseline country (BRA) and 1 target country (DOM) did not complete the assessment. These 3 countries were not counted towards the overall indicator assessment.
PASB Comments
PASB’s continued efforts to support Member States have been successful in advancing policy processes from an agenda-setting stage to policy discussion, formulation, adoption, and/or implementation. The work needs to be further intensified in the Caribbean and in Central America, while sustaining the achievements of those countries that have already adopted and/or started implementing fiscal and regulatory policies to curb the obesity and NCDs epidemics.
One baseline country (BRA) and one target country (DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
Through a series of policy dialogues held in 2020 and 2021, PASB is collaborating with the OAS on school-based interventions under the framework of the Inter-American Education Agenda.
In October 2022, PASB and OAS launched the Inter-American Plan on healthy food and physical activity policies in school environments, with the participation of high-level officials appointed by the Ministries of Education and Health of approximately 26 countries. The objectives of the Inter-American Plan include sharing experiences to advance the framework of action and public policies in the countries; promote South-South cooperation, technical assistance, and capacity building; and develop lessons learned and regional guidance on school environments for healthy eating, nutrition, and physical activity.
One baseline country (BRA) and one target country (DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
PASB continuous efforts to support Member States has been successful in advancing labeling provisions to reduce the demand for and offer of products excessive in saturated fats and trans fats. However, the support for adoption of PAHO/WHO best practices to eliminate industrially produced trans fats needs to be intensified particularly in the Caribbean and in Central America.
There was no consensus on the assessment results for 2 baseline countries (COL, MEX). In addition, 2 baseline countries (BRA, DOM) did not complete the assessment. These 4 countries were not counted towards the overall indicator assessment.
PASB Comments
PASB supports countries in the development of policies and implementation of measures supportive of maternal, infant, and young child nutrition, including breastfeeding policies and infant and young child policies. These are guided by the Global Strategy for Infant and Young Child Feeding, the Comprehensive Implementation Plan on Maternal, Infant, and Young Child Nutrition, and other relevant guidance documents. PASB also supports initiatives such as the Baby-friendly Hospital Initiative (BFHI) and the implementation of food-based dietary guidelines.
Two baseline countries (BRA, DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
In the Americas, violence intersects with complex trends – such as social, economic and gender inequality, migration, social and intergenerational change, organized crime, and others – which cannot be addressed in isolation. Integrated responses that actively engage different sectors and stakeholders are fundamental to ensuring the sustainability of investments. However, the involvement of diverse actors and perspectives can increase the risk of duplication and misalignment of activities. As a result, multisectoral coordination mechanisms play a key role in setting joint priorities and aligning agendas, coordinating actors, mobilizing human and financial resources, and uniting all stakeholders around the common goal of ending violence. PASB has worked with partners to strengthen the capacity for multisectoral dialogue and collaboration in countries in line with INSPIRE and RESPECT, including through multisectoral training workshops. While a substantial number of countries report having a national multisectoral coalition/task force in place to prevent and respond to violence, these mechanisms are not always set up to cover all forms of violence, thus potentially reducing their impact. Moreover, countries report challenges to keeping these mechanisms operational, which underscores the importance of strengthening access to technical support, capacity building, and other resources in future.
Two baseline countries (BRA, DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
Mental Health plans and policies have advanced in the Region, with Saint Marteen and Guyana developing new plans. The Ministry of Health in Honduras delivered the National Mental Health Policy to the National Secretariat of Strategic Planning. Several countries strengthened legal frameworks and oversight mechanisms to uphold the rights of people with MH conditions. Paraguay now requires judicial review before involuntary hospitalization. Saint Lucia implemented care consent policies and Grenada mandated appeal processes for treatment decisions. Antigua and Barbuda, Barbados, Grenada, Jamaica, and Saint Vincent and the Grenadines continue to advance in the review of their mental health legislation as a key step toward reforming mental health services. Of note, Grenada designated 2023 as the year of mental health and, for the first time, the country has appointed a national MH Coordinator and allocated funding specifically to MH.
Two baseline countries (BRA, DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
Comprehensive suicide prevention strategies aligned with global best practices were developed with the support of PAHO, including the promotion of intersectoral collaboration and policy developments. For instance, PAHO supported Uruguay in establishing a multi-stakeholder network for suicide prevention across healthcare, education, social services, and civil society. Prioritized policy recommendations were also formulated. Bolivia targeted action across societal, community, relationship, and individual levels based on the WHO LIVE LIFE framework.
70 media professionals were trained on responsible reporting on suicide in Guyana (25), Barbados (22), and Grenada (23).
Strategies to improve surveillance and response systems for suicide prevention were created with the support of PAHO. PAHO supported the development of suicide surveillance centers in Argentina as part of the national registry and monitoring system for suicidality, while Paraguay expanded telehealth to enable urgent access to support.
Capacity building for frontline providers was another pillar, with training in identification, counseling, and treatment implemented with the support of PAHO. Paraguay implemented suicide risk monitoring, counseling, and crisis management for healthcare workers. Gatekeeper networks were also expanded from the community to clinical levels, as Paraguay increased community gatekeepers to direct at-risk individuals into care.
Two baseline countries (BRA, DOM) and 1 target country (GUF) did not complete the assessment. These 3 countries were not counted towards the overall indicator assessment.
PASB Comments
Despite significant progress in implementing changes toward malaria elimination in the E2025 countries, major implementation challenges persist in these areas, especially in the countries with the highest disease burden and dispersion. In addition to the structural weaknesses of the health systems in endemic areas, financial challenges, and the aftermath of COVID-19, social factors such as gold mining, migration, and social conflicts have limited the implementation of changes by the countries; nevertheless, significant progress was made. PASB support included developing guidelines and technical tools, as well as promoting changes that were replicated by strategic partners such as the RMEI initiative. Focal pockets of transmission in a limited number of territories continue to be a factor in favor of elimination, insufficiently leveraged by decision-makers to implement high-impact interventions with the necessary structural improvements in specific locations, which would have a major impact on the national situation. Preventing the re-establishment of transmission at the subnational level is another strategy facing significant implementation challenges in the coming years.
There was no consensus on the assessment results for 1 target country (DMA). This country was not counted towards the overall indicator assessment.
PASB Comments
Two South American countries that are targeted for 2023 have achieved this output. Caribbean countries are all at risk due to failure in achieving the reporting rate of at least 2 suspected cases by 100,000 population and at least 3 of 5 surveillance indicators.
One baseline country (BRA) and 1 target country (DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
Twenty-five countries have successfully implemented plans of action for the prevention, prophylaxis, surveillance, control, and elimination of dog-mediated human rabies. PAHO has made significant contributions by providing standards, data, and technical cooperation. Achievements include comprehensive vaccination campaigns, improved surveillance systems, and effective public awareness programs. However, several countries still need to enhance their national capacities, as canine rabies cases persist, posing a continued risk for human rabies transmission. Lessons learned highlight the importance of sustained efforts in vaccination, surveillance, and access to post-exposure prophylaxis. Ongoing support is essential to strengthen these capacities and achieve the complete elimination of dog-mediated rabies.
One target country (BRA) did not complete the assessment. This country was not counted towards the overall indicator assessment.
PASB Comments
PASB has significantly contributed to advancing actions aimed at reducing the health impacts of air pollution in the region. Following the launch of the 2021 WHO Air Quality Guidelines (AQG), PASB focused its efforts on assisting Member States in developing and maintaining air quality regulations based on these guidelines. PASB actions during the biennium included: conducting capacity-building activities on regulatory development, health impact assessments, and risk communication; preparing and implementing projects to develop integrated roadmaps on air quality, climate change, and health in Trinidad and Tobago and Central American countries; and facilitating capacity-building and use of WHO Health Impact Assessment tools related to air quality in countries such as Argentina, Chile, Colombia, Ecuador, Mexico, Peru, and Central American countries. These initiatives have been carried out in collaboration with UNEP, fostering well-articulated efforts between ministries of health and the environment. Progress has been made; the indicator was achieved for Uruguay, which was not in the list of baseline or target countries during this period. Uruguay issued updated regulations on air quality and health. Chile and Brazil initiated the process in 2021-2023 and issued updated regulations during the first half of 2024 as well.
One baseline country (BRA) did not complete the assessment. This country was not counted towards the overall indicator assessment.
PASB Comments
Overall, countries have been working on different aspects of chemicals management, including participation in capacity-building activities, using appropriate guidance documents, and reflecting global chemicals policies in national planning, especially regarding regulations and programs, although competing interests within and outside the health sector remain a challenge.
Two baseline countries (BRA, DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
Countries have been working toward strengthening healthy settings. Annual reporting on progress in schools, housing, markets, workplaces, or universities has been limited. Nevertheless, advances shown in policy documents, progress reports on health promotion, and publications have been taken into account for this indicator. PASB supports the achievement of this indicator by developing documents such as the Health Promoting Schools guidance, conducting webinars on housing, and participating in and disseminating the Health Promoting Universities Network.
One baseline country (BRA) did not complete the assessment. This country was not counted towards the overall indicator assessment.
PASB Comments
Progress has been made in the Region, with most of the countries achieving the indicator. The Strategy and Plan of Action on Health Promotion within the context of the Sustainable Development Goals 2019-2030, adopted by Member States in 2019, has served as an example for developing and updating national health promotion policies and programs.
There was no consensus on the assessment results for 1 baseline country (GTM). In addition, 1 baseline country (BRA) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
Progress has been made toward the establishment of mechanisms for community participation, with all countries achieving the indicator. The PASB has been strengthening mechanisms for community participation, for example by supporting the Network on Vulnerable Populations (EPSI.V) and the Latin American and Caribbean Confederation of Women Domestic Workers (CONLACTRAHO). PASB support includes knowledge dissemination and systematization, as well as gathering information to adapt health policies or strategies based on the needs of specific populations.
One baseline country (BRA) and one target country (DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
From 2019 to 2023, initiatives for improving information systems for health (IS4H) have driven significant advances toward set targets. These efforts have focused on improving governance mechanisms, maturity assessments, regulatory frameworks, and health information architecture, and they have achieved substantial progress in enhancing data-driven health strategies regionally. The establishment of monitoring and evaluation frameworks, interinstitutional committees, and national policies for electronic health records with open data has been crucial. Significant advances include the adoption of governance mechanisms by several countries and territories, exceeding the target; use of the PASB model for maturity assessment with financial and technical support from the Inter-American Development Bank and the World Bank; and the establishment of regulatory frameworks and health information architecture by numerous countries and territories. Initiatives in data management and information technologies include the adoption of Fast Healthcare Interoperability Resources (FHIR) and ICD-11 standards by 17 countries and territories, as well as progress in electronic health records implementation, moving toward a more unified and efficient health data management model. Additionally, engagement with academic and professional communities and networks has strengthened health analysis and knowledge management, while innovations such as the PASB telehealth platform indicate a shift toward a more integrated approach for the co-creation of health-focused digital public goods. These advances reflect broad progress toward robust, data-informed public health strategies and policies, demonstrating an important commitment to improving health outcomes and operational efficiencies within all Member States.
Two baseline countries (BRA, DOM) and four target countries (CUW, GLP, GUF, MTQ) did not complete the assessment. These 6 countries were not counted towards the overall indicator assessment.
PASB Comments
A comprehensive maturity assessment of IS4H was conducted by PASB of progress made between 2016 and 2023. Using over 240 standardized indicators, the evaluation assessed national health information systems with respect to governance, strategy, laws, financial sustainability, human resources, data management, and quality, including vital statistics, analysis capabilities, information flows, project management, and information technology (IT) infrastructure. Information for the assessment was gathered through country visits, expert consultations, database and gap analyses, and reviews of policies, procedures, and technical documentation. Site visits allowed for direct observation of information platform use and interoperability, especially in primary care, and for data collection and interviews with frontline administrative and clinical staff.
A comprehensive report on the regional IS4H maturity assessment will be published in late 2024; however, the assessment found that 42.8% of the countries are still at level 1, “building awareness.” These countries are characterized by early adoption of health information systems, with mostly analogue data and a growing recognition of the need for digitalization. With very limited capacity to generate data and assure its quality, including on health indicators whose data source relies on civil registration and vital statistics, they depend largely on international organizations in this regard. Investments in digital health have often not expanded infrastructure as expected due to gaps in access to electricity and connectivity, as well as a lack of long-term planning and sustainable financing.
A third of the countries, 34.7%, have reached level 2, “implementing best practices.” They are developing their health information systems with data from various sources and managing health information effectively. However, they face challenges such as incomplete development of indicators, insufficient data exchange, and limited implementation of data standards and public health communication strategies. Another 18.4% have reached level 3, “standardization and continuous improvement,” reflecting advances in IS4H policies and strategies and the use of high-quality data for decision-making. Only 4.1% of countries are at level 4, “integration and alignment,” marked by highly integrated information systems that are aligned with national and international standards.
No country in the Region has reached level 5, the maximum maturity level in IS4H, which entails complete deployment of all components of the model and a constant search for innovation.
There was no consensus on the assessment results for 1 baseline country (JAM). In addition, 1 baseline country (BRA) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
Member States have made notable progress in implementing national strategies and plans for digital transformation, as well as the roadmap for the digital transformation of the health sector in the Region, which is fully aligned with the Global Strategy on Digital Health. A network of countries was established to promote the adoption of digital health solutions and information systems, resulting in new models and digital public goods that facilitate this transformation. Additionally, the health sector’s active participation in e-government initiatives reflects a broader commitment to optimizing technology infrastructure and converging current initiatives for a more efficient and integrated approach to health information management. Highlights of this strategic line of action include adoption of emerging technologies for personalized patient care, partnerships with financial, technical, and academic institutions for increased use of technology, and piloting of innovative digital health solutions like the PASB telehealth platform and digital COVID-19 vaccine certificates.
Progress has been made in the following areas:
a. Universal connectivity: Twelve countries have strengthened information systems and digital health strategies to enhance connectivity and bandwidth. Most of these initiatives mainly target rural areas to bridge the digital divide and expand telehealth services at the first level of care. Actions have included investing in information technology infrastructure to ensure reliable internet access and bandwidth for ensuring teleconsultations. Additionally, Member States have focused on training health care workers in these areas to efficiently use digital tools, enhancing the quality of telehealth services and patient engagement.
b. Digital public goods: In response to the COVID-19 pandemic, 17 countries have made significant progress in digitalizing vaccination certification processes. Digitalization includes creating secure, accessible digital platforms for issuing and verifying COVID-19 vaccination certificates. This not only streamlines the process but also helps combat the production of fraudulent vaccination certificates. Seven countries are implementing the PASB All-in-ONE Telehealth Platform at the first level of care.
c. Inclusive digital health: Thirty-three countries and territories engaged in discussions on the importance of data for equity and committed to reinforcing data governance mechanisms across the health sector, aiming to achieve the highest and smartest possible level of data disaggregation. Additionally, Member States reached consensus on the importance of maintaining high-quality data to reduce or eliminate biases in artificial intelligence algorithms, ensuring that these technologies serve all segments of the population fairly and effectively.
d. Interoperability: Ten countries have established national committees on health information systems for standardization; 18 countries are transitioning from ICD-10 to ICD-11. Fourteen of them are from the Caribbean and are making significant progress not only in the adoption of the ICD-11, but also its integration with electronic health record platforms. Twelve countries are adopting the Systematized Nomenclature of Medicine Clinical Terms (SNOMED) for semantic interoperability, an important factor for ensuring convergence and coordination between SNOMED and ICD-11. Seventeen countries are actively participating in the development of technological infrastructure for cross-border data exchange and interoperability.
e. Artificial intelligence: Thirteen countries have actively engaged in discussions on the role of artificial intelligence (AI) in public health. These discussions sought to assess the impact of the COVID-19 pandemic on integrating AI into the digitalization of health care services and examining current advances in this field, share knowledge and identify needs concerning governance and ethical aspects of AI, understand the crucial elements of effectively applying AI and other subfields of AI such as machine learning and natural-language processing (including the use of generative AI solutions in public health), and present the PAHO and WHO action framework for AI application in public health. These ongoing efforts are fully integrated with current actions related to the digital transformation of the health sector in the Region.
There was no consensus on the assessment results for 1 baseline country (JAM). In addition, 2 baseline countries (BRA, DOM) did not complete the assessment. These 3 countries were not counted towards the overall indicator assessment.
PASB Comments
To enhance the capacity of science and evidence ecosystems, evidence-informed policy programs are being implemented in 15 countries in alignment with regional initiatives. This progress is highlighted by the participation of 20 countries in the PAHO/WHO joint meeting of the Evidence-Informed Policy Network (EVIPNET) and Health Technology Assessment Network of the Americas (REDETSA), which took place in Jamaica in October 2023. The BIGG-REC database organizes over 3,500 WHO and PAHO recommendations in four languages. Through the Virtual Campus, over 20 000 decision-makers and healthcare professionals from 28 countries received training in systematic reviews, evidence-based guidelines, and policies. The PAHO Handbook for Adapting and Implementing Evidence-Informed Guidelines (Second Edition) was developed with input from 15 Member States and is in use by national guideline programs.
Two baseline countries (BRA, DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
Progress has been observed in the Americas regarding the generation, circulation, and utilization of scientific and technical information, as well as the promulgation of knowledge-sharing initiatives among Members States, PASB, and stakeholders.
Overall, the impact factor of the scientific output and the number of scientific journals increased across all Member States during the period 2022-2023, with special emphasis on medicine, public health, and related topics. The publication of an average of 904 titles of scientific journals in medicine and related fields across 19 Member States demonstrates that there has been strong implementation of open-access platforms and policies, helping ensure more equitable and accessible access to scientific production in public health-related fields.
The contribution from documentation centers to LILACS reached 45 291 new documents and a total of 657 indexed scientific journals. The MedCarib database, which focuses on scientific and technical production in the Caribbean, also showed an increase in new contributions during the period. A total of 22 countries and territories are eligible to access the Research4Life (R4L) program, with 1,414 institutions registered. El Salvador became the first Member State to participate in the R4L Country Connector initiative.
By December 2023, there were 179 PAHO/WHO Collaborating Centers (CCs) distributed across 15 Member States in the Region. Two CCs (in Cuba and Brazil) are focused on knowledge management and scientific communication. PAHO/WHO CCs support the Organization in fulfilling the mandates and priorities of the Region and globally, by developing research models and evidence-based literature and providing health analysis and methodologies, among other roles.
Despite these advancements, persistent efforts to strengthen research systems, enhance knowledge sharing, and promote evidence-informed policies are needed. Institutionalizing knowledge, evidence, and science at the national level is essential, as is fostering integrated policies for information use and knowledge dissemination. Furthermore, capacity building and a continued focus on digital literacy are necessary to ensure that public health workers, decision-makers, researchers, and communities have access to the best scientific and technical information.
One baseline country (BRA) did not complete the assessment. This country was not counted towards the overall indicator assessment.
PASB Comments
PASB supported health authorities in addressing research ethics through the development of ethical standards for research in emergencies and improving the ethical oversight of research (e.g., Catalyzing Ethical Research in Emergencies: Ethics guidance, lessons learned from the COVID-19 pandemic and pending agenda); the development of normative documents establishing the ethics oversight of research in accordance with international ethical standards; capacity-building (e.g., through monthly training sessions based on a plan agreed upon with health authorities); and the development of tools to facilitate national health authority oversight of research ethics committees (e.g., Tool for the accreditation of research ethics committees). The pandemic has led the region to place renewed value on health research, and Member States have thus invested efforts in revamping their research ethics systems. Accordingly, the research ethics landscape described in 2022 using PAHO-developed indicators is rapidly changing.
There was no consensus on the assessment results for 1 target country (GTM). This country was not counted towards the overall indicator assessment.
PASB Comments
Reporting financial flows for research is a cumbersome task that requires intersectoral collaboration and coordination, especially in countries where funding and priorities are set by different sectors and entities. PAHO has worked closely with WHO’s Global Observatory on Research for Health and Development and its Governing Bodies to reduce the burden of reporting financial flows for research, a meaningful SDG indicator that is measured with support from UNESCO, OECD, RICyT, and other partners.
PASB has coordinated with these counterparts and countries to incentivize reporting and updating of these indicators at least every 10 years, sending reminders to countries. PAHO and WHO are exploring dynamics and capacity building to improve intersectoral collaboration, aiming to implement training in the next biennium to facilitate reporting and intersectoral dialogue.
Thirteen countries have updated reports in WHO’s Global Observatory, according to PAHO and the Global Observatory’s SDG Indicator 9.5.1.
Two baseline countries (BRA, DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
As per the IHR (2005), all 35 State Parties are mandated to report annually on the status of their core capacities through the State Party Self-Assessment Reporting Tool (SPAR). Compliance with this requirement demonstrates transparency and accountability among Member States and the Secretariat. PASB has supported multisectoral discussions to comply with the SPAR by developing guidance documents for the 15 core capacities, as well as country profiles using the SPAR indicators for the period 2010-2022.
Two baseline countries (BRA, DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
In the 2022-2023 biennium, significant strides were made in health sector risk management, with 23 countries conducting national and/or subnational risk assessments to update their response plans. PASB supported this by implementing the "Emergency Risk Management in Health and Disasters" virtual course. This course trained 1,466 healthcare professionals, including 17 facilitators, on risk assessments, preparedness evaluation, and multi-threat response planning using methodologies like STAR, EDHPI, and the Multi-Threat Response Framework.
One baseline country (BRA) and one target country (DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
This indicator measures the degree of institutionalization and sustainability of essential public health functions that are relevant for application, implementation, and compliance with the IHR. Therefore, this result reflects the challenges most countries face in sustaining the level of financial investment needed to maintain surveillance and response capacities.
Two baseline countries (BRA, DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
Significant progress was made in the 2022-2023 biennium; 37 countries have full-time personnel dedicated to health emergencies. Training played a crucial role, with 5,682 health professionals certified in Health Facility Assessment, totaling 14 767 certified individuals. Additionally, the “Emergency Risk Management in Health and Disasters” virtual course trained 1,466 health professionals, including 17 facilitator trainers.
Two baseline countries (BRA, DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
This indicator reports on Member States’ institutionalization to evaluate capacities during real and non-actual events once plans, mechanisms, and standard operating procedures are in place by scoring 100% in at least one of the four State Party Self-Assessment Reporting Tool indicators that reflect the country’s emergency response. PASB facilitated an IHR meeting among Small Island Developing States in Jamaica (May 2023), in which delegates concluded that most of the SPAR indicators could reach the highest level in the context of SIDS, which includes the four indicators measured under this overall output indicator.
One baseline country (DOM) and one target country (BRA) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
In the 2022-2023 biennium, progress was made in enhancing the resilience and safety of healthcare facilities across the Caribbean and South America through the Resilient Hospitals Initiative. This initiative focused on the strengthening of SMART Hospitals to fortify health facilities against health emergencies and disasters, which 24 countries have launched, promoting safety, sustainability, inclusivity, and adaptability within health facilities. Technical support was instrumental in helping Caribbean countries integrate SMART standards, with notable achievements such as the evaluation of 10 facilities for A70 standards in Barbados and the modernization of eight health centers in Belize. Continuous efforts in monitoring, resource allocation, and addressing data gaps remain essential if the 2025 targets for safe and resilient healthcare infrastructure are to be met.
Three additional countries achieved this indicator during the biennium. The indicator measures country progress toward mainstreaming disaster risk reduction and climate change adaptation/mitigation in the health sector.
In the 2022-1023 biennium, 17 countries included the criteria for disaster mitigation and climate change adaptation under the SMART H initiative, ensuring the operation of health services during and in the aftermath of disasters. As part of this group of countries, three additional countries achieved this indicator during the biennium. Two countries have had delays in implementation of interventions after the assessment, but both are working to achieve the indicator.
One baseline country (BRA) and one target country (DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
The Public Health Emergency of International Concern associated with COVID-19 demonstrated the solidarity expressed by Member States in responding to health emergencies. All national public health laboratories received training, technology transfer, and essential supplies in a timely manner. In parallel, laboratory guidelines were shared with countries, and re-certification of the laboratory personnel on the regulations for the transport of infectious substances and associated materials was reactivated in the Region.
The cholera epidemic in Hispaniola still poses a threat to the Region. Training of laboratory personnel in early detection, case confirmation, and molecular characterization of pandemic V. cholerae O:1 strains was provided.
The new strategy for genomic surveillance of epidemic- and pandemic-prone pathogens has started to be implemented at the regional level. This instrument represents added value for decision makers during outbreak investigations. Challenges remain to harmonize knowledge, technologies, and Standard Operating Procedures within public health laboratory networks.
Four baseline countries (BRA, DOM, GLP, MTQ) did not complete the assessment. These 4 countries were not counted towards the overall indicator assessment.
PASB Comments
The surveillance system for influenza and other respiratory viruses is highly robust. This system was strengthened during the COVID-19 pandemic and laid the foundation for the integration of COVID-19 surveillance in the region in 87% of countries. Within the countries that partially achieved the indicator, work continues to improve the frequency of epidemiological reporting.
There was no consensus on the assessment results for 2 target countries (BHS, JAM). In addition, 2 target countries (BRA, DOM) did not complete the assessment. These 4 countries were not counted towards the overall indicator assessment.
PASB Comments
Progress has been made in most countries. However, target countries continue to show either no progress or partial achievement. PASB will redouble its efforts to examine the health equity approach in key strategic programs, policies, and plans, with particular emphasis on those countries which did not complete the assessment.
Two target countries (BRA, DOM) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
PASB Comments
Progress has been made in many countries; however, some continue to show either no progress or partial achievement. PASB will continue to provide support to integration of gender approaches in key strategic programs, policies, and plans, with an emphasis on countries that did not complete the assessment.
There was no consensus on the assessment results for 1 baseline country (ECU). In addition, 1 target country (BRA) did not complete the assessment. These 2 countries were not counted towards the overall indicator assessment.
Measurement of this indicator has posed challenges for many countries in the region. While PASB has provided technical cooperation, tools, and support for this purpose, there is a need to enhance the commitment of countries further and improve countries’ capacities to utilize these resources effectively.