Many countries in the region are continuing their efforts to enhance the response capacity of primary care services. Countries such as Belize, Bolivia, Canada, Chile, and Honduras, among others, have formulated policies and strategies to improve access to primary care, support healthcare professionals, build capacities to address chronic diseases, enhance preventive and palliative care, and promote the integration of health networks, including the use of telehealth. Similarly, other countries such as Argentina, Costa Rica, Ecuador, and Guyana, have focused on strengthening governance, improving infrastructure, fostering intersectoral collaboration, and reinforcing maternal and child healthcare services. Despite these endeavors, much work remains to be done, particularly concerning the advancement of health service integration with a focus on equity. The sustained continuation of these efforts is crucial to achieving long-term impact on health outcomes.

Overall, although there was a regression from the baseline, countries achieved or are on track to achieve this outcome indicator to improve children's health and development. Some countries have a national strategy on maternal and newborn health under implementation, but improved monitoring and alignment of these strategies with the WHO/UNICEF Framework are needed. Strategies for moving forward include adoption and implementation of the WHO frameworks Parenting for Lifelong Health and Global Scale for Early Childhood Development in the region.

Overall, the countries are mostly on track with their development of actions to prevent care dependence. The Decade of Healthy Aging movement was seen as an important opportunity to advance this agenda, encouraging countries to implement actions that are conducive to integrated care and intersectoral actions, especially concerning enabling environments and the protection of older adults' rights.

Through implementation of the EMTCT Plus Initiative, PASB has been working with national health authorities to strengthen national responses to syphilis and congenital syphilis, toward the achievement of elimination targets. The coverage of syphilis treatment among infected pregnant women has been historically high in Latin America and the Caribbean, reaching 89% in 2023. Eleven countries have been validated for the dual EMTCT of HIV and syphilis, and additional countries have shown progress and may be ready to seek validation in the near future.

PASB will continue supporting at-risk countries in conducting follow-up campaigns to update the vaccination status of unvaccinated children under 5 years of age. This should improve MMR-1 and MMR-2 vaccination coverage by the end of 2023. Countries report 2023 data in the first quarter of 2024 via the PAHO-WHO/UNICEF electronic Joint Immunization Data Reporting Form (eJRF).

DPT vaccination coverage has been affected by the pandemic. Although efforts are being made to improve coverage and reduce dropout rates, the goal is to ensure that the under-vaccinated are reached.

The countries of the Region have made great efforts to incorporate the vaccine into their national vaccination schedules; as of December 31, 2023, only 4 countries had not introduced the HPV vaccine. 26 countries in the Region are vaccinating children and 12 countries have switched to a single-dose schedule.

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.

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.

In the area of substance use, PAHO implemented workshops to improve the quality of healthcare services for people with substance use problems. A total of 22 participants from the six Caribbean Dutch Islands (Aruba, Curaçao, Sint Maarten, BON, STA, and SAB) attended the workshop in Curaçao.

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.