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.
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.
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.
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.
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.
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.
Two 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
As of 31 December 2023, 27 baseline countries achieved this output indicator and two partially achieved it. This assessment was conducted based on the information entered by the countries through eJRF.
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.
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.
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.
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
Infection prevention and control (IPC) continues to be strengthened across the region through preparedness activities, such as the implementation of respiratory protection programs and virtual IPC trainings as part of implementation of the World Health Organization Core Components of Infection Prevention and Control Programs (WHO-IPC CC) at the national level.
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.