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.

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.

At the regional level, the indicator showed progress for the target countries, for which the average public expenditure on health as a share of Gross Domestic Product (GDP) rose from 4.3% to 5.3% between 2019 and 2021. Nine countries (Argentina, Aruba, Bermudas, Canada, Colombia, Cuba, El Salvador, Montserrat, and Uruguay) have achieved this indicator, investing more than 6% of GDP in the health sector using public sources of funding. Of the 7 target countries, two (Chile and Honduras) are working to achieve the indicator, but progress is at risk. In Chile, public expenditure on health rose from 4.8% in 2019 to 5.5% in 2020 but subsequently decreased to 5.2%. On other hand, Honduras increased public expenditure on health from 2.9% to 3.4% in 2020, remaining stagnant. In terms of data collection, new data from the WHO Health Expenditure Database in 2024 will allow assessment of the progress of countries that have not fully achieved this indicator.

Most target Member States have demonstrated political commitment to the elimination of industrially produced trans fatty acids from their food supply. Continued PASB efforts to support them in securing the adoption of PAHO/WHO best practices to achieve such elimination suggest the indicator is on track, provided that Member States' commitments translate into policy action in 2024.

An advisory committee or lead agency in road safety is crucial for coordinating efforts across various sectors such as transportation, health, education, and law enforcement, ensuring a unified and strategic approach. Additionally, it is responsible for developing and implementing evidence-based policies and regulations, such as seatbelt laws, speed limits, and measures to prevent drunk driving. A lead agency also plays a vital role in the collection and analysis of data on road traffic injuries, allowing for the identification of trends and the evaluation of intervention effectiveness. Proper resource allocation and international cooperation are other areas where such an agency can have a significant impact, adopting global best practices to enhance road safety and reduce road traffic deaths and injuries.
PAHO has provided technical support to various road safety advisory committees or lead agencies in the Region, as requested, to support their efforts in road safety management. One key area of focus is the strengthening of road safety data systems. In line with this, WHO/PAHO produced the Fifth Global Road Safety Status Report to help countries identify gaps and priorities to accelerate implementation of the recommendations of the Global Plan for the Second Decade of Action for Road Safety 2021-2030. These initiatives aim to achieve the ambitious but reachable target of reducing global road mortality and serious injuries by 50%.

During the biennium, countries in the Region made progress in eliminating malaria or interrupting its transmission both at the national and subnational levels, as well as preventing re-establishment in malaria-free countries and receptive territories. Case investigation is being incorporated by endemic and non-endemic countries, including improvements in guidelines, instruments, and surveillance processes. These actions should integrate the efforts made so far by vertical programs with more cross-cutting epidemiologic surveillance processes and actors. Important challenges remain in this aspect of integration and in the quality of investigations. Pending improvements include the adoption of investigation in endemic territories where the small number of cases already justifies this action to accelerate elimination, as well as improvements in response. The technical cooperation that PAHO has developed in this area has been replicated with partner implementation actions, such as the RMEI initiative in Central America.