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.

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.

The reduction in time to diagnose and treat malaria cases is an essential indicator for actions against malaria and is one of the main focuses of PAHO's technical framework for cooperation. Early access to treatment has been the cornerstone of the regional strategy, with actions ranging from maintaining diagnostic capacity and promoting the use of rapid tests to managing antimalarials, promoting microplanning, and implementing the DTI-R strategy.

Thanks to nominal information systems, all endemic countries monitor the timing of diagnosis and treatment. While a significant number of countries reported compliance with the indicator, partial compliance by two baseline countries may affect the overall performance of the indicator. All endemic countries continue to face challenges in shortening the time between the onset of symptoms and treatment and should prioritize actions to address the barriers the population faces in accessing treatment.

However, as noted in the technical specifications, this indicator is variable and difficult to achieve in settings of low transmission, penalizing those countries that achieve significant reductions in the number of cases. As transmission is reduced, cases take longer to be detected. Therefore, it is expected that baseline countries that are reducing malaria transmission, as well as other countries achieving significant reductions in case volume, will experience difficulties in achieving the indicator by 2025, despite making progress toward elimination.

Work is ongoing to strengthen countries’ arboviral disease surveillance capacities, facilitating the monitoring of the largest dengue epidemic ever recorded in the Americas. Significant progress has been made via operationalization of collaborative surveillance through the implementation of Virtual Collaboration Spaces. In addition, a new Integrated Surveillance Manual for Arboviral Diseases has been completed following two consultation meetings with country experts.

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.

As part of the deinstitutionalization process, a mental health crisis management course was delivered to first responders in Saint Kitts and Nevis and the Bahamas. Deinstitutionalization processes were accelerated across several countries to shift toward community-based services. For instance, Paraguay made progress transitioning patients from a national psychiatric hospital into integrated community-based mental healthcare, supporting 156 patients through new municipal-level centers last year. Mobile crisis response gained more prominence as an alternative to hospitalizations. Another example is the Bahamas emergency response service, which has prevented avoidable hospital admissions. Similar assistance programs now run across 3 Argentine provinces.

This indicator is on track to be achieved by the target date. However, countries with historical issues of shortages and migration of health workers will probably face challenges in achieving the indicator, and therefore will require additional support from PASB.

Despite a regression from baseline, some countries are progressing toward the target. One country is classified as “at risk” as it has reported progress in increasing the capacity of interprofessional teams at the first level of care, but has not yet reached the level its model of care requires. Examples of progress in countries that are on track include PASB support in preparing technical proposals aligned with the national health reform, joint work between PASB and academia to define the composition and organization of interprofessional teams, and passing resolutions on primary health care that enable the development of interprofessional teams within countries.

The Plan of Action on Human Resources for Universal Access to Health and Universal Health Coverage 2018-2023 included the formation of interprofessional teams at the first level of care as one of its objectives, guiding countries toward achieving this goal. Additionally, the Policy on the Health Workforce 2030: Strengthening Human Resources for Health to Achieve Resilient Health Systems outlines measures to strengthen the formation of interprofessional teams and incorporate them into integrated health services networks based on primary health care as a strategic line, which will support the efforts of countries on track to meet this goal.

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.