Effective integration of health care at the territorial level is a significant challenge in strengthening health systems: Disparities in the implementation of policies and strategies across different countries and at the subnational level led to uneven health outcomes. Scaling up innovative health service delivery initiatives and integrating them into existing systems requires clear pathways, adequate resource allocation, and a culture of innovation. Strategic investments must focus on long‑term sustainability and impactful outcomes. 

Enhanced coordination is needed with multilateral organizations and national authorities: Though PAHO has always had good relationships with the international financial institutions, the far‑reaching negative impacts of the COVID-19 pandemic on national economies and health revealed an even greater need for enhanced coordination with these agencies to ensure an effective response. Consequently, PAHO took action to promote deeper engagement with the international financial institutions with a view to ensuring that their policies and programs prioritize equity, efficiency, and sustainability. At country level, much more needs to be done to engage with ministries of finance and economy. Absent meaningful rapport with these national authorities, PASB is less able to influence budgetary management practices, especially those that may be required to protect public health gains. The Economic and Health Dialogue of the Americas provides a promising opportunity to strengthen this connection.

The COVID-19 pandemic exacerbated barriers to access on both the supply and demand sides: The Region continues to grapple with economic disruptions that pose threats to increased public health funding in the post-COVID-19 context. As countries strive to stabilize their finances and prioritize sectors, prompt action is crucial to safeguard health funding, bolster financial security, and improve financial protection. Operational issues such as extended waiting lists for consultations, diagnostics, and surgical interventions, exacerbated by the pandemic, remain a pressing concern. This requires short-term actions to scale up service capacities and strengthen the health workforce while developing long-term strategies for enhancing health services. The COVID-19 pandemic exacerbated already existing shortages in HRH, and countries have not yet rebuilt their health workforce, despite the availability of options for virtual training on priority topics. 

Countries are lagging in applying a life-course perspective to comprehensive and mutually complementary health services and interventions in families, schools, and communities. Maternal and neonatal mortality, adolescent pregnancy, and access to sexual and reproductive health services are not being adequately prioritized. Insufficient attention has been paid to regaining maternal health services, while shifting political opinions undermine recent advances in sexual and reproductive rights. 

Countries still overpay for some essential health technologies: For example, the purchase of three high-priced vaccines—the pneumococcal conjugate, human papilloma virus, and rotavirus vaccines, which remain under patent monopoly—still absorbs up to 80% of national immunization budgets. There is limited inclusion of the Region’s countries and stakeholders in global strategies related to innovation and access, since these usually focus on least-developed or low-income countries. Finally, limited visibility of demand from Member States participating in the PAHO Strategic Fund also makes it difficult to negotiate the best terms on price and timeliness of supply.