The hospitalization rate for ambulatory care-sensitive conditions serves as a valuable indicator for evaluating progress in strengthening the first level of care, including its economic implications for the overall healthcare system. During this reporting period, only two countries have made notable advances in this indicator: Mexico has integrated it into their National Sectoral Health Program 2022-2024 monitoring system, and El Salvador is currently in the process of collecting data for this indicator.
Measurement of this indicator has posed challenges for many countries in the region. While PASB has provided technical cooperation, tools, and support for this purpose, there is a need to enhance the commitment of countries further and improve countries’ capacities to utilize these resources effectively.

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.

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.

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.

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.

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.

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.