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, 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.

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.

Since 2020, a decrease in vaccination coverage with the third dose of PCV vaccine has been noted. In 2023, a very slight improvement was noted compared to 2022 (81% vs. 80%). This, together with improvement in coverage of other vaccines (e.g., pentavalent), could indicate that PCV3 vaccination coverage has started to recover. It is important to closely monitor the progress of member states.

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.

The mental health Gap Action Programme (mhGAP) continues to be broadly adopted across the Region to integrate evidence-based care in primary settings through non-specialist health workers.
107 MhGAP trainings were conducted in countries. 25 countries received training on the integration of MH into primary health care; 144,790 health personnel were trained. Among those countries that received training were Aruba, Saint Lucia, and Saint Vincent and the Grenadines. Increased integration of MH into primary health care can improve the continuum of care for mental health conditions. During the biennium, Belize showed an increase in mental health diagnosis at the outpatient level.
mhGAP implementation in Latin American countries showcases significant progress in key metrics, with 4,131 new trainers. For instance, Chile and Mexico have trained 5144 and 136,131 individuals respectively. Both countries have successfully integrated mhGAP into their national mental health policies. Paraguay, demonstrating notable advancement, has trained 103 individuals with 67 trainers, and successfully incorporated mhGAP into its national policy.

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.

In the area of substance use, PAHO implemented workshops to improve the quality of healthcare services for people with substance use problems. A total of 22 participants from the six Caribbean Dutch Islands (Aruba, Curaçao, Sint Maarten, BON, STA, and SAB) attended the workshop in Curaçao.

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.

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.

During the biennium, countries in the Region made progress toward improving their food control systems to prevent and mitigate risks to food safety. PASB has provided technical guidance to countries (Brazil, Chile, Costa Rica, Cuba, Guatemala, Ecuador, Honduras, Panama, Peru, Paraguay, URU) to improve their food control systems based on the principles of risk analysis (risk management, risk assessment and risk communication).

Country achievements include the development of national food safety policies and Codex Alimentarius programs for standard-setting and implementation from farm to fork – One Health (Guatemala, Guyana, Honduras, El Salvador). Additionally, Paraguay, Dominican Republic, Colombia and Haiti are improving the capacity of their traditional food markets to prevent emerging food safety risks under the One Health approach. In the Caribbean, a survey was conducted to assess the readiness of food control systems to mitigate risks related to climate change (Saint Lucia, Trinidad and Tobago, Barbados, Saint Kitts and Nevis, Guyana, Jamaica). Based on the findings of this survey, Trinidad and Tobago and Barbados developed climate-resilient national food safety plans. One of the main challenges in achieving the indicator at country level is the high turnover of government officials. As a lesson learned, it is important to facilitate collaboration across sectors and regularly monitor the implementation of developed policies, programs, and plans. PASB has mobilized resources to improve and harmonize the food safety risk analysis capacity of countries in Latin America.

The Report of the PAHO High-Level Commission on Mental Health and COVID-19 and the new Strategy for Improving Mental Health and Suicide Prevention provide the vision and the recommended actions for increased technical cooperation in MH in the Region. Several countries have started to take important actions to improve and reform their mental health systems. The recommendations of the Commission emphasize the importance of intersectoral work and integration of mental health into all areas of government to better face the long-term crisis of mental health in the Americas. In the area of suicide prevention, comprehensive strategies aligned with global best practices were developed with the support of PAHO, including the promotion of intersectoral collaboration and policy developments. For instance, PAHO helped Uruguay establish a multi-stakeholder network for suicide prevention across healthcare, education, social services, and civil society. Prioritized policy recommendations have also been formulated. Bolivia targeted action across societal, community, relationship, and individual levels based on the WHO LIVE LIFE framework.
Furthermore, 70 media professionals were trained on responsible reporting on suicide in Guyana (25), Barbados (22), and Grenada (23).