Increasing interoperability of information systems for health: Countries improved their information systems for health, as shown in a comprehensive assessment of IS4H maturity. Seven countries (Bahamas, Brazil, Costa Rica, El Salvador, Guatemala, Honduras, and Panama) reinforced or established national committees for IS4H and health sector digital transformation to ensure integrated information systems, including at the first level of care. Brazil integrated its national network of health data as a hub for interoperability, and El Salvador, Guyana, Jamaica, Nicaragua, and Uruguay developed national electronic health records platforms. Argentina, Brazil, Chile, Guyana, and Panama updated their national legislation in line with this technological advance. Significant progress was made toward the adoption of ICD-11 in 14 Caribbean countries, which enhanced the quality of data under the IS4H initiative. Increased financial contributions came from partners such as Global Affairs Canada, GIZ, Spanish Agency for International Development Cooperation (AECID), USAID, US Centers for Disease Control and Prevention (CDC), Vital Strategies, Robert Wood Johnson Foundation, and Bloomberg Philanthropies, helping to catalyze action in this area.

Advancing digital transformation of the health sector: With technical cooperation from PASB, 15 countries are implementing an integrated package of interventions on telehealth for strengthening primary health care. The resources include the All-in-One Telehealth Platform, an innovative platform developed by PASB as a digital public good, as well as a virtual course on integration of telehealth in PHC. Over 30 000 participants in more than 70 countries worldwide have completed the course, which is available through PAHO’s Virtual Campus. PASB also developed a tool to measure the maturity of telehealth services, which has been applied to more than 4000 institutions in the Region. The measurement tool was also used in three Portuguese-speaking countries in the African Region (Cape Verde, Guinea-Bissau, and Mozambique).

Moving toward cross-border interoperability of data: Digital certification of COVID-19 vaccination is being implemented in 15 countries, with support from the US Government. A digital certificate of vaccination is being provided in accordance with WHO guidelines and international standards. Citizens who are fully vaccinated against COVID-19 can use the digital document in almost all WHO Member States. The remaining countries in the Region are moving toward adoption of the COVID-19 certificate, and PAHO is extending the technological infrastructure to certificates for other routine vaccines. In collaboration with the Inter-American Development Bank and other partners, PASB provided technical cooperation in developing digital certification infrastructure and revising and updating data management systems, including reengineering of immunization information systems to improve the efficiency of vaccination and continued care for patients. The initiative is fully aligned with the Global Digital Health Trust Network led by WHO.

Advancing the use of data science to better respond to health challenges: To bolster health surveillance and vaccination coverage data, PASB revamped the regional vaccination dashboard with an innovative automated system for efficiently tracking routine vaccine data. This analysis revealed an urgent need to escalate vaccination efforts, specifically targeting measles-containing vaccines, the third dose of polio vaccine, and the diphtheria-tetanus-pertussis vaccine. Micro-census activities began in the last quarter of 2023 in the Plurinational State of Bolivia, Panama, Paraguay, and Peru; these activities will continue moving forward and are crucial for the accuracy of health intelligence. PASB pioneered the use of geographic information systems (GIS) and artificial intelligence in Costa Rica to map waste dumpsites. This emerging methodology promises to shed light on the complex interplay between waste disposal, climate change, social equity, and health outcomes. Under the Geolocated Health Facilities Data initiative and in collaboration with the WHO GIS Centre for Health, PASB is leading the way toward significant advancement in the Region’s health data collection and analysis capabilities.

Strengthening capabilities to monitor and analyze health equity: Enhanced capacity to monitor health inequalities is critical for informing pro-equity policies, evaluating and strengthening national and subnational health information systems, and advancing accountability on the regional commitment to leave no one behind. PAHO provided technical guidance and training in 12 countries to strengthen their capacity to monitor health inequalities for SDG 3 indicators over time by using routine, administrative, and disaggregated data, including social and vital statistics. The PAHO Equity Explorer computational tool supports the estimation of health inequalities at national and subnational levels by incorporating users’ own data. Training on this tool was implemented in eight countries (Antigua and Barbuda, Plurinational State of Bolivia, Chile, Colombia, Ecuador, Guyana, Jamaica, and Trinidad and Tobago). This accessible and user-friendly analytical tool will help countries incorporate equity measurements and monitoring in health programs to identify gaps and strategically target areas and population groups for program improvement.

Moving toward open public health data to enhance data-driven decisions in public health: Significant advances were made through the implementation and continual refinement of information systems and technical data platforms. These developments enhanced the accessibility and analysis of disaggregated public health data, greatly improving access to health information for decision-making and policy formulation. In this context, PASB has made progress on four key digital platforms that are available for use by all countries and territories in the Region: 

a) Core Indicators portal: An interactive portal featuring over 140 health and health-related indicators from 1995 onward, with detailed data disaggregation. 

b) Health in the Americas portal: A comprehensive source for health conditions, determinants, and trends in the Region, offering interactive tools for data exploration and cross-country comparisons. 

c) SDG 3 portal: A one-stop shop focusing on Sustainable Development Goal 3, providing valuable data, analysis tools, and evidence to support informed decision-making for health and well-being. 

d) Immunization Data and Statistics portal: A tool that focuses on vaccination coverage, particularly for the diphtheria-tetanus-pertussis immunization. This portal aids in monitoring and adapting vaccination strategies at subnational level and offers extensive information on vaccine-preventable diseases.

Expanding access to key sources of information: Celebrating its 25th anniversary in 2023, the PAHO Virtual Health Library (VHL) provides access to 57 information sources with almost 37.3 million references to scientific and technical documents. The portal recorded over 15 million access sessions by 8.5 million users during the biennium, resulting in 28 million page views. Key sources of information available through the VHL include the LILACS literature database and DeCS/MeSH (Health Science Descriptors/Medical Subject Headings). The updated LILACS now contains 1.07 million document records, with 210 centers from 19 countries contributing to its database, and new indexed journals from seven countries. Additionally, the DeCS/MeSH 2023 version remains operational, with nearly 3.7 million access sessions and 10 million page views during the biennium. The DeCS/MeSH Finder service was accessed by 27 600 users across 90 countries, highlighting the portal’s global reach. Brazil, Colombia, Mexico, Peru and Spain were ranked among the top accessing countries.

Enhancing institutional capacities and integration of the science, research, and evidence systems: The Region made significant progress in solidifying research and development and evidence systems, facilitated by the adoption of PAHO’s Handbook for Adapting and Implementing Evidence-Informed Guidelines and its Guide for Evidence-Informed Decision-Making, Including in Health Emergencies. Joint work between the Evidence-Informed Policy Network of the Americas (EVIPNet) and RedETSA, with 22 countries participating, helped coordinate efforts. Fourteen countries have developed capacities in governance, priorities, standards, and evidence-informed products. The BIGG REC database, which efficiently organizes over 3500 current WHO and PAHO recommendations for easy access, was made available in the four official languages of the Organization. The PAHO Virtual Campus offered 34 courses on systematic reviews development (7000 participants), evidence based guidelines (10 900 participants), evidence-informed policies (4700 participants), and reporting guidelines to enhance the visibility and value of health research (6300 participants). In collaboration with the WHO global clinical platform, 13 countries participated in analyzing and publicly sharing anonymized data on COVID-19 (137 000 cases), post-COVID (long-term follow-up of more than 10 000 cases), and mpox (3800 cases). This analysis constituted a key development toward the establishment of a regional clinical intelligence network and the commitment to design data driven health improvements.

Expanding access to vital knowledge through global alliances: In collaboration with WHO, PASB worked to expand access to a vast store of knowledge, including the global literature related to COVID-19 (377 000 documents accessed by more than 5000 users) and Global Index Medicus (2.4 million references accessed by more than 278 000 users). PASB supported the African Index Medicus by hosting it on the Virtual Health Library platform, sparking cross-regional collaboration. At the global level, the Bureau supported the ProEthos platform, which was developed by PAHO to systematize the work of human research ethics committees. PASB also prepared information products and services for the First WHO Traditional Medicine Global Summit.

Strengthening research ethics systems and the integration of ethics in health: With technical support from PASB in developing a draft national policy, Paraguay revamped its research ethics system. Normative documents for ethical research (laws and clinical trials regulations) were also developed for the Plurinational State of Bolivia, Costa Rica, El Salvador, Guatemala, Peru, and Trinidad and Tobago. The regional research ethics landscape is also changing in response to the implementation of a PASB-developed tool for the accreditation of research ethics committees by health authorities. The Region improved its preparedness for emergencies by implementing the recommendations in PAHO’s publication Catalyzing Ethical Research in Emergencies, the only guidance of its kind available worldwide. Lessons learned from the COVID-19 pandemic, such as those regarding the ethical use of unproven interventions outside of research, were implemented as part of the mpox response, which further integrated ethics in surveillance and in the allocation of vaccines by the PAHO Revolving Fund. Published training material, notably the book Public Health Ethics: Cases Spanning the Globe, provided a better understanding of public health ethics. Courses were also developed on this topic, including three that served over 25 000 government workers in Puerto Rico.

Strengthening the social innovation ecosystem and national research policies: Eight countries implemented national policies on research for health by December 2023, and 13 reported research for health investment to the Global Observatory on Health Research and Development (SDG Indicator 9.5.1). PASB strengthened the innovation ecosystem through the Social Innovation in Health Initiative, WHO’s Health Innovation for Impact approach, and the WHO 2023 LEAD Innovation Challenge. The progressive integration of social innovation with the Bureau’s technical cooperation supported the co-creation of context-appropriate sustainable solutions to address health equity gaps. Regionally, the Bureau supported the Latin American and Caribbean Alliance on Social Innovation for Health (ALACISS), advanced tools and standards, and facilitated capacity development. A regional call identified 67 innovations, with standouts from Brazil, Costa Rica, Nicaragua, and Panama participating and exchanging insights. Innovators from the Amazon joined the alliance to train Amazonian Indigenous communicators and promote community health workers. These efforts were crucial in growing ALACISS, underlining PASB’s dedication to leveraging social innovations for improved health outcomes.

Advancing scientific production and information and knowledge management across the Region: In collaboration with Member States, PASB maintained the production of scientific and technical literature through the Pan American Journal of Public Health and the PAHO Institutional Repository for Information Sharing (IRIS), both of which have shown a marked increase in digital resources. In 2023, the Journal published original papers and other evidence addressing public health issues and achievements in the Americas, including more than 160 peer-reviewed scientific papers from a total of over 1000 manuscripts received. PAHO IRIS saw active engagement, with over 16 million visits and 1100 new documents. Webinars targeting 22 countries and territories highlighted the value of the Research4Life program, and technical support was provided to El Salvador and Guyana, the latter becoming the first country in the Region to participate in the Research4Life Country Connectors project. The Good Practices in Public Health initiative opened an avenue for knowledge exchange, aiming to enhance the replication and scaling up of successful practices among Member States. PASB’s technical cooperation was strengthened thanks to work with over 180 PAHO/WHO Collaborating Centers in the Americas, providing critical technical expertise and underscoring the importance of shared knowledge and collaborative efforts in advancing public health objectives.