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.

Although most countries achieved the indicator because services are already in place, some are not very structured. Countries are currently in the process of strengthening capacities so that services for men’s health can be developed within the framework of primary care.

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.

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.

Countries in the region, including those at risk, are making structural changes regarding the procurement of medicines and validated blood pressure devices, as well as adopting standardized treatment protocols to help expand access to quality care from the primary health care setting and improve hypertension control rates. However, the adoption of systematic quality improvement methodologies to improve hypertension management is still incipient in the region and must be accompanied by monitoring and evaluation systems designed to enable primary health care teams to monitor and correct deviations in their own performance. Additionally, a lack of updated population-level data limits the ability to accurately gauge progress.

Important progress was made at country level, with 6 out of 8 target countries having already achieved the indicator. Chile and Colombia are on track to achieve it, with technical support from PASB on strategies to increase access to medicines. At the regional level, data was collected from 20 MS, including Chile and Colombia, through a survey on access to medicines and other health technologies, which allowed PASB to identify access gaps and needs for technical cooperation and prepare the final report for Resolution CD55.R12 on Access and Rational Use of Strategic and High-cost Medicines and other Health Technologies.

Although the current rating of this indicator is “No progress” due to a regression from the baseline, it should be noted that, of the total number of countries (14), 5 achieved the target and 7 are on track to achieve it; only 2 countries are at risk. Countries that are on track to achieve the indicator have progressed in expanding blood collection capacity and reducing blood loss or expiration as they improve their quality processes. Additional efforts are being made to support Caribbean countries through quality training so that better performance also improves the availability of blood for transfusion. Likewise, the promotion of voluntary blood donation was strengthened with the World Blood Donor Day campaign and through regional seminars. Greater support will be provided to the countries that are at risk to help them reach the target by 2025.

Access barriers were exacerbated during the COVID-19 pandemic, affecting both the supply and demand sides of health services. Achievement of this indicator is at risk in five countries due to lack of updated data to measure the indicator and little progress in the reduction of reported access barriers. There are, however, five other countries that have achieved or are on track to achieve this indicator, having made significant progress in overcoming service disruptions and reducing access barriers to health services overall. Understanding barriers to healthcare access and the resulting magnitude of unmet needs is key to monitoring progress toward universal access to health and universal health coverage, but measuring and implementing policy options to reduce and eliminate access barriers remains a challenge.

Substantial progress has been made on the evaluation of capacities and the development of action plans to strengthen the Essential Public Health Functions (EPHF). One country has already achieved this indicator, and 12 out of the 17 countries are on track to achieve it. Two countries are at risk, and two have not shown progress as a recent evaluation of the EPHF has not been completed. The countries that are on track have completed the baseline evaluation, with results showing that less than 60% of capacity is currently being met; however, they are moving forward with the implementation of action plans to improve capacity and could reach that threshold. Efforts toward strengthening leadership, governance, and institutional capacities, alongside intersectoral collaboration and technical cooperation, are contributing to the positive trajectory of this indicator.

No country has yet achieved this indicator, although 4 countries are reported to be on track to do so by 2025.

The financial protection indicators within the SDG framework (catastrophic and household-impoverishing expenditures) are constructed based on household surveys that record relevant data. These surveys are carried out by countries at various points in time, but almost always at 5- or 10-year intervals. Many countries have great difficulties in implementing these surveys, and this causes years of delay.

Only 4 countries in the region (Bolivia, Mexico, Peru, and United States of America) would be in a position to calculate such indicators, with 2 or more years (data points) in the period 2019-2025 (or relevant adjacent years) available to calculate variation. Four other countries (Colombia, Dominican Republic, El Salvador, and Panama) currently have one data point for the relevant or adjacent years and could eventually complete the measurement toward the end of the period in 2025. It is therefore recommended to eliminate their measurement or simply limit the indicator baselines and targets to countries for which sufficient data are available.

These indicators are monitored by PAHO in collaboration with WHO. Countries are encouraged and trained to use them so that they can carry out surveys and then analyze the results. More recently, PASB has begun to analyze the determinants that contribute to a lack of financial protection. This will allow countries to have more evidence to improve their policies.