Expanding the HEARTS technical package in the Region: HEARTS promotes the adoption of global best practices in the prevention and control of cardiovascular diseases. It improves the performance of the health services through better control of high blood pressure and the promotion of secondary prevention, with an emphasis on primary health care. During the biennium, implementation of the HEARTS initiative expanded to include 13 new countries and territories (Anguilla, Antigua and Barbuda, Belize, Bermuda, Grenada, Guatemala, Montserrat, Saint Kitts and Nevis, Saint Vincent and the Grenadines, Suriname, Turks and Caicos, Uruguay, and the Bolivarian Republic of Venezuela). This brought to 33 the total number of countries and territories in the Region implementing the initiative. PAHO continued to promote the HEARTS initiative by developing technical resources such as clinical tools for PHC teams and by advocating for systematic implementation, which is the core of the HEARTS quality improvement program. Argentina, Cuba, Dominican Republic, and Mexico also developed clinical care pathways for diabetes management, aligned with HEARTS.

Scaling up cervical cancer screening and human papillomavirus (HPV) vaccination: With technical support from PASB, Antigua and Barbuda, Belize, and Brazil introduced HPV testing, including training of primary care providers. In addition, all but three countries incorporated the HPV vaccine into their routine immunization schedules. Eleven countries and territories (Argentina, Anguilla, Barbados, the Plurinational State of Bolivia, Guatemala, Guyana, Jamaica, Mexico, Montserrat, Peru, and Turks and Caicos) successfully transitioned to a one-dose schedule, thus making important progress toward the achievable goal of cervical cancer elimination.

Developing policies to increase treatment access and coverage for children and adolescents with cancer: Through 31 CureAll Americas active projects (28 national and three regional), over 110 000 health professionals benefited from PAHO’s virtual training courses on childhood cancer. Additionally, new technical documents and communication campaigns were developed to raise awareness of childhood cancer and of signs for early detection. The regional experiences and country impacts of CureAll Americas were presented in a special supplement to the Pan American Journal of Public Health, with 17 scientific publications, including an editorial from the Director of PASB. In addition, through the CCHD mechanism, political, social, clinical, and technological strategies for early identification of cancer during childhood and adolescence were developed in the Plurinational State of Bolivia, Colombia, Chile, Ecuador, Peru, and the Bolivarian Republic of Venezuela. 

Rolling out the inter-programmatic initiative Better Care for NCDs 2023–2030: Launched by the Director in September 2023, the initiative is designed to harness the collective strengths of different areas within PASB. Its purpose is to scale up and accelerate the integration of comprehensive NCD services into primary health care as one of the actions required to promote recovery in the post-pandemic era.

Enhancing data collection and analysis on NCD and risk factors through the STEPS survey: PASB continued to provide technical expertise and support to countries for the implementation of the STEPS survey as a means of understanding NCDs and their risk factors, promoting health equity, and shaping effective interventions. As a result, 11 countries and territories improved their NCD data collection efforts, incorporating over 14 NCD and risk factor thematic areas to inform decision making. Three of these 11 countries and territories (Aruba, Cayman Islands, and Cuba) completed data collection and are now in the data analysis and report-writing phase. Paraguay completed a data analysis workshop to organize and present the data collected from the surveys, while Antigua and Barbuda and Sint Maarten conducted fieldwork after the completion of their training. Five countries and territories (Barbados, Bermuda, Guatemala, Honduras, and Trinidad and Tobago) developed implementation plans and are preparing for fieldwork training.

Increasing taxes on tobacco to reduce consumption: In 2023, a partnership between PAHO and the Universidad Adolfo Ibáñez (a Bloomberg Initiative partner in Chile) successfully positioned tobacco taxes on the public policy agenda in Costa Rica and garnered political support from relevant government agencies able to influence the approval of tax policy changes. The support led to development of a tobacco tax bill in line with the WHO Framework Convention on Tobacco Control (FCTC), and the bill was submitted to the Legislative Assembly to be discussed in 2024. Argentina, the Plurinational State of Bolivia, Canada, and the Bolivarian Republic of Venezuela approved policies on tobacco control during the biennium.

Implementing measures to ban novel and emerging nicotine and tobacco products: The Bolivarian Republic of Venezuela approved a sales ban on these products, including e-cigarettes and heated tobacco products. The ban aligns with FCTC measures to protect the health of populations from novel tobacco products. As a result, 21 countries in the Americas currently have policies regulating electronic nicotine delivery systems, such as e-cigarettes. Eight countries (Argentina, Brazil, Mexico, Nicaragua, Panama, Suriname, Uruguay, and the Bolivarian Republic of Venezuela) prohibit the sale of these products altogether, and the other 13 have partially or totally adopted one or more regulatory measures, such as banning their use in public places or their advertisement and promotion. It is a significant step forward in preventing the uptake of these products, which are addictive, harmful, and aggressively marketed to youth.

Leading and inspiring global efforts to improve diets and protect public health with regulatory policies: Robust and consistent progress has been achieved on the regulation of ultra-processed and processed products with excessive nutrients and ingredients of public health concern. This has been done through the application of front-of-package warning labels, marketing restrictions, bans on availability in schools, and/or taxation. The Dominican Republic and Honduras have drafted healthy eating laws, Paraguay has adopted a healthy eating law, and Argentina and Colombia have begun implementing such laws. The US Food and Drug Administration has initiated a regulatory process for adoption of a front-of-package labeling system. Products with excessive nutrients and ingredients of public health concern now feature black octagonal warning labels in Argentina and Colombia. In Argentina these products can no longer be advertised, sold, or distributed in schools. Colombia has increased the taxation of these products, which makes them less affordable. The Plurinational State of Bolivia, Ecuador, and Peru have formulated amendments to their existing legislation to meet PAHO best practices and have issued the draft amendments for public comment.

Eliminating industrially produced trans-fatty acids (IP-TFA): In line with PAHO’s Plan of Action for the Elimination of Industrially Produced Trans-Fatty Acids 2020–2025 (Document CD57/8), nine countries have adopted PAHO/WHO best practices for IP-TFA. By the end of the biennium, 84.9% of the Region’s population was protected by best-practice policies for the elimination of these products. Colombia and Paraguay have also made progress in implementing interventions for sodium reduction, including warning labels for sodium, and Colombia has set sodium targets for processed foods. Panama approved an action plan for sodium reduction and IP-TFA elimination, and Suriname approved a strategic action plan for salt reduction.

Cooperating among agencies to implement proven approaches to promote nutrition: As part of the UN Inter-Agency Working Group on Food Systems for Latin America and the Caribbean, PAHO supported countries in the development of road maps to respond to all forms of malnutrition and promote healthy and sustainable diets, using a food and nutrition systems approach. Belize improved the design of its road map to place nutrition at the center of food systems transformation. Belize also improved the school food environment by eliminating sugary drinks, in partnership with PAHO and the OAS. Ecuador implemented a strategy to reduce the prevalence of chronic malnutrition by three percentage points and to prioritize the nutritional status of pregnant women and children between 2019 and 2023. Nine countries (Argentina, Brazil, Barbados, Chile, Mexico, Panama, Peru, Trinidad and Tobago, and Uruguay) are in various stages of completing road maps in line with the recommendations of the WHO Acceleration Plan to Stop Obesity. In the Caribbean, the number of hospitals accredited under the Baby-friendly Hospital Initiative has increased with the addition of new institutions in Jamaica (3), Trinidad and Tobago (2), Antigua and Barbuda (1), and Saint Kitts and Nevis (1), allowing these facilities to promote breastfeeding to ensure that infants receive this vital form of nutrition.

Strengthening rehabilitation services: Through the implementation of the WHO Systematic Assessment of Rehabilitation Situation (STARS) methodology, PASB worked with the Bahamas, Colombia, and Trinidad and Tobago to strengthen rehabilitation services. This effort helped expand access and contributes to the global Rehabilitation 2030 initiative.

Enabling countries to strengthen emergency and critical care and better respond to road traffic injuries: Belize, Costa Rica, Jamaica, and Paraguay completed assessments of the capacity of emergency and critical care systems to carry out essential functions in addressing road traffic injuries. Additionally, PAHO, in collaboration with the International Committee of the Red Cross and the International Federation for Emergency Medicine, developed the Basic Emergency Care course for first responders to road traffic accidents. The course has been institutionalized by local authorities in Costa Rica and Paraguay. An important milestone was Jamaica’s approval of road traffic regulations in 2022, with implementation in 2023. These regulations aim to reduce the country’s rate of road traffic deaths (18 deaths per 100 000 population per year in 2021), which is almost 30% higher than the regional average.

Evaluating quality of care in response to sexual violence: PASB worked with Member States to develop and test a rapid evaluation tool to assess the quality of care provided by the health system in response to sexual violence. Pilots were completed in Argentina, Colombia, and Honduras in 2023, offering comprehensive data on this topic for the first time. This tool has the potential to be used and adapted by ministries of health throughout the Region to improve care for survivors of sexual violence. Health services for women migrants and refugees from the Bolivarian Republic of Venezuela were strengthened in Argentina, Brazil, Colombia, and Peru. This included working in collaboration with local partners to offer training for health workers and other frontline actors, strengthening multisectoral dialogue, and improving attention to women migrants in policy.

Addressing intimate partner and sexual violence through policy guidelines and training: In collaboration with PAHO and the UN Spotlight Initiative, Trinidad and Tobago developed and launched its first-ever National Clinical and Policy Guidelines on Intimate Partner Violence and Sexual Violence. These guidelines help health care providers respond holistically to the physical, mental, and social needs of survivors to ensure appropriate follow-up care. They represent a milestone in strengthening health care for survivors of violence in line with PAHO’s regional strategy and plan of action on violence. PASB provided technical expertise for the development of similar guidelines in Honduras, Jamaica, and Peru, offering opportunities to strengthen learning and exchange. Health professionals were trained by PASB to respond to violence in Argentina, Belize, Plurinational State of Bolivia, Honduras, and Trinidad and Tobago.

Adopting measures in line with RESPECT and INSPIRE: In 2023, in collaboration with UN Women, the World Bank, and the United Kingdom Government, PAHO organized a high-level event to mark the annual international campaign known as 16 Days of Activism Against Gender-based Violence. During this event, PAHO and UN Women launched a report in Spanish on adaptation of the global RESPECT framework in Latin America and the Caribbean, describing strategies and programs for the prevention of violence against women and girls. Also in 2023, PAHO supported multisectoral trainings on RESPECT in the Plurinational State of Bolivia and Chile in partnership with the World Bank and UN Women. In collaboration with UNICEF and the Global Partnership to End Violence Against Children, PAHO expanded the INSPIRE workshop series to include the Caribbean, with two additional sessions targeting 100 representatives from 10 Caribbean countries. Given the high rates of violence against children, adolescents, and youth in Caribbean countries, the workshops provided an opportunity to build capacity for the INSPIRE interventions and highlight examples of good practices from Belize, Guyana, and Jamaica.

Better integrating mental health in primary health care: The PAHO High-Level Commission on Mental Health and COVID-19 launched its report in June 2023, calling for a new agenda for mental health in the Americas. The Strategy for Improving Mental Health and Suicide Prevention in the Region of the Americas (Document CD60/9) provided the pathway for establishment of a multi-stakeholder, multisectoral network for suicide prevention. Mental health plans and policies advanced, with Barbados and Guyana developing new action plans. Honduras moved ahead with its national mental health policy, and Antigua and Barbuda, Barbados, Grenada, Jamaica, and Saint Vincent and the Grenadines continue to advance their review of legislation as an important step toward reforming mental health services. Grenada dedicated 2023 as the year of mental health, and for the first time that country has a national coordinator and funding allocated specifically to mental health. PASB trained over 140 000 health workers from 25 countries on the integration of mental health into PHC and continued to advise countries on the deinstitutionalization of mental health patients. Paraguay has made progress in transitioning patients from a national psychiatric hospital into integrated community-based care, supporting 156 patients through municipal-level centers in 2023.

Providing mental health and psychosocial support (MHPSS) in response to emergencies: Sixteen countries in the Region have intersectoral working groups to coordinate national MHPSS response in emergencies. PASB continued to provide capacity-building for MHPSS in humanitarian emergencies and disasters through the PAHO Virtual Campus for Public Health. In December 2023, 10 virtual courses on mental health under the self-learning modality reached over 279 000 certified professionals. Nine tutored courses were delivered in different areas of mental health. Additionally, courses such as suicide prevention continued to be widely utilized, with over 256 000 persons registered during the biennium.