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.

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.

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.

The number of countries that are reporting stigma data in health services has increased, but this has yet to become a systematic action to support stigma reduction and improve MSM access to health services.

Existing post-pandemic conditions continue to negatively impact the ability of countries to effectively implement field interventions to address this problem. Better achievements are expected in the next biennium (2024-2025).

Despite the complexity of the Chagas disease scenario, a marked reduction in the incidence and prevalence of this parasitosis has been observed in recent decades. This decline has been sustained above all by improvements in the quality of life of affected populations, the progress achieved by national control programs, the intensification of screening and infection detection actions in blood banks, and the actions of healthcare services aimed at managing morbidity and mortality in some countries. However, the unexpected emergence of the SARS-CoV-2 virus at the end of 2019, and the subsequent measures aimed at containing it, represented a turning point for the normal functioning both of plans and programs for the prevention and control of Chagas disease and of its evaluation mechanisms, with severe knock-on effects on this set of approaches, which relies on territorial deployments of diverse configuration and purpose. The most noticeable consequences of this contingency have been:

 The efforts of governments to mitigate the spread of COVID-19 meant that medical care was strictly limited for several months to urgent conditions and emergencies. This conspired against programs to diagnose, monitor, and treat Chagas disease, as evinced by the reduction of care actions for affected people, screening of pregnant women or women of reproductive age, and diagnostic confirmation, treatment, and follow-up of children born to infected mothers; all of these circumstances have partially invisible implications for health systems. The modification of health-seeking behavior by the vulnerable population (driven by fear of contagion and recommendations to stay home) was another determining factor in this regard.
 Programmatic vector surveillance and control schemes were postponed due to the reassignment of health personnel to pandemic response activities and the impossibility of traveling from operating bases to the rural areas of intervention.
 The financial crisis caused by the unexpected expenses required to implement COVID-19 prevention and control measures affected the regular funding of routine Chagas prevention and control programs, which are already highly expensive in relative terms.
 The continuity of many international cooperation activities was compromised due to the impossibility of (or limitations on) conducting face-to-face activities.
At the end of the biennium, the activities of national Chagas programs have not managed to recover to pre-pandemic levels. All of the above means there has not been any substantial gain from baseline.

During the REDIPRA meeting held in Colombia in late 2023, significant progress was noted toward the interruption of dog-mediated human rabies transmission, following the elimination validation criteria. PAHO support – through provision of standards, generation of data, and technical cooperation – has been pivotal. Achievements include successful mass dog vaccination campaigns, enhanced public awareness, and improved surveillance systems. Many countries have reported zero human cases for multiple years; however, four countries have reported cases in the past years. Challenges remain in some countries, such as maintaining high vaccination coverage, addressing surveillance gaps, and ensuring access to post-exposure prophylaxis. Continued commitment is essential to overcome these hurdles and sustain the progress made toward eliminating canine rabies.

Colombia, Ecuador, Guatemala, and Mexico were verified by WHO as having eliminated onchocerciasis transmission in 2013, 2014, 2016, and 2015, respectively. Venezuela faces significant challenges in reaching mass treatment coverage in the Yanomami Area, including geographical and cultural access difficulties. Achieving the indicator by 2025 is considered unlikely.

Following the technical specification of the indicator, PASB recognizes that 28 countries have established capacity and effective processes to eliminate dog-mediated human rabies, showcasing significant progress in the region. PAHO contributions, including provision of standards, generation of data, and technical cooperation, have been instrumental in these achievements. Successful strategies include comprehensive dog vaccination campaigns, public awareness initiatives, and robust surveillance systems. However, several countries continue to report canine rabies, with some also reporting human cases. Lessons learned highlight the importance of sustained vaccination efforts, enhanced surveillance, and accessible post-exposure prophylaxis. Continued support and commitment are essential to address these challenges and achieve the complete elimination of dog-mediated human rabies across the region.

Of the countries that reported endemic measles transmission in 2019, 1 was reverified as free of endemic transmission in 2023. The other country has gone for more than 2 years without endemic measles transmission. Rubella remains an eliminated disease in the region.