Universal Access to Health and Universal Health Coverage Strategy (Universal Health)

WHO/PAHO led the development and negotiation of a landmark strategy on Universal Access to Health and Universal Health Coverage in 2014, with the adoption of the corresponding Regional Strategy during the 53rd PAHO Directing Council. Subsequently, major efforts have been made to foster an institutional response to support the implementation of that Strategy in the Region.
Recognizing that there are many ways to achieve universal health and that each country will need to establish its own action plan, taking into account its social, economic, political, legal, historical and cultural context, as well as its priorities and current and future health challenges, PAHO is working with Member States and other partners to guide, as appropriate, the strengthening of their health systems with a view to achieving universal health.
Areas of focus for the PAHO’s work during 2016-2017 included the development of national roadmaps towards Universal Health that expand access to services through primary care within integrated health service delivery networks; the development of comprehensive financing strategies in countries; the realignment of policies on human resources for health that meet the existing needs of health systems and services; and access to safe, efficacious and quality medicines and health technologies, according to the health needs of the population.

Activities:
• In line with the technical cooperation provided by PAHO/WHO to assist countries in advancing their implementation of the Universal Health Strategy, three relevant documents were developed and presented to the 53rd PAHO Directing Council in September 2016 on important health policy and systems issues: Resilient Health Systems; Access and rational use to strategic and high cost medicines and other health technologies; and Health of Migrants. These documents were well received by Member States with the adoption of specific resolutions.

• Providing technical support to countries that are either initiating or in the process of major health systems transformations. Integrated missions were organized to Argentina, Guatemala, Guyana, Bolivia, Honduras, Panamá, Suriname, Jamaica, Chile, Ecuador, Dominican Republic, Cuba, El Salvador and Colombia in order to support implementation of strategies and support advocacy efforts toward Universal Health.

• Providing technical support to countries in the development of comprehensive financing strategies towards Universal Health, through the following activities:
o Health financing studies were finalized, (fiscal space in five countries; catastrophic and impoverishing health expenditures in the Region of the Americas; and public and private expenditures on pharmaceutical products in the LAC);
o Targeted technical cooperation was provided to Guatemala, Chile, Cuba, Ecuador, Jamaica, El Salvador, Honduras, Panama, Suriname and Colombia to increase awareness and discuss policy options/interventions to augment fiscal priority for health and improve the efficiency of health financing.
o The first OECD Health Systems Joint Network meeting for Latin America and the Caribbean was co-organized by PAHO, July 2016, including a high level dialogue between senior officials from health and finance ministries to increase awareness on the need to improve governance and co-ordination mechanisms in health financing and identify effective policy choices.

• Providing technical support to Trinidad and Tobago, Panama, Peru, Jamaica, and El Salvador, in preparing their health systems profiles and M&E of UH Strategy using PAHO guideline.

• Supporting countries’ efforts to update health-related laws and regulations, including the health code, which will facilitate achieving Universal Health. As a result, 11 countries (Bolivia, Brazil, Colombia, Ecuador, El Salvador, Honduras, Guatemala, Nicaragua, Peru, Suriname, and Uruguay) have developed regulatory frameworks for Universal Health.

• Providing technical support to Member States in the development of integrated networks for health care delivery continues to be intensified. A new tool for the assessment of progress towards the development of such networks was developed and tested in five countries. In addition, technical support was delivered to countries on health services organization development issues (policies, legislation, IHSDN, hospital management, strengthening of the first level of care) as part of the implementation of road maps for Universal Health in Guyana.

• In 2016 HSS supported the institutional response to the ZikaV outbreak. HSS reinforced the development of a network of neurologists to support diagnosis and management of congenital malformations, capacity building of HSS country advisors in health systems issues relating to the disease outbreak, the provision and management of IGG for the treatment of GBS patients, and country missions to support health systems preparedness (Bolivia, Guatemala, Colombia, Honduras, Paraguay, Haiti and Dominican Republic). In addition, an interagency tool has been developed jointly with the IDB and World Bank to assess health systems preparedness and align the response of the three institutions to the outbreak and its consequences.

• The Region continues to work intensively to strengthen the regulatory systems for medicines and other health technologies. The Caribbean Regulatory System (CRS) launched its pilot phase and have developed the procedures to register generic priority medicines.

• Proving technical assistance to 32 countries that participated in the external quality evaluation performance for blood services received positive results demonstrating a continuous improvement in blood service in the Americas.

• Since its creation in 2000, the Strategic Fund has contributed to the strengthening and sustainability of health systems, positioning itself as the regional mechanism for the procurement of priority public health medicines. The SF continues to grow with an expanded portfolio of medicines and medical products and the renewed focus on improving supply chain management capacities. These efforts resulted in more than a 15% increase in the volume of orders measured in USD, five new signatory’ Member States and ten Member States applying and accessing the capital account. Ecuador, Nicaragua, Honduras, El Salvador, Paraguay, through a special collaboration project with the Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM), worked on improving supply chain management for HIV medicines.

• A policy document draft on the Regional Strategy on Human Resources for Universal Health to be presented to the 29th Pan American Sanitary Conference was produced. The identification of future priorities for action to support health systems transformation towards Universal Health was also a product of three sub-regional meetings (Central-America, MERCOSUR and Andean Countries) with the participation of seventeen Member States.

• The document “The Situation of Nursing Education in the Latin America and Caribbean towards Universal Health” was completed. In this document twenty countries in the region and 246 Schools of Nursing have participated in the data collection.

• The Virtual Campus for Public Health (VCPH) reached 300,000 participants through the development of massive self-learning courses and progress with country nodes such as Ecuador and Venezuela.

• The Edmundo Granda Ugalde Leaders in International Health Program (LIHP) 2016 concluded with 46 participants from 21 countries.

Beneficiaries: Countries in Latin America and the Caribbean. Specific examples included under activities.

Partnerships and Financing: AECID, Australia, Bill and Melinda Gates Foundation, Brazil, Health Canada, The Kellogg Foundation, USAID and US FDA

Website: www.paho.org/hss

SDG Goals, are closely related as they fully fall under the scope of the application and implementation of the International Health Regulations.

Brief description of initiative:
PAHO’s programmatic work related to the implementation of the International Health Regulations (IHR) – aiming at preventing, protecting against, controlling and providing a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks, and which avoid unnecessary interference with international traffic and trade – revolve around the following areas:
i. Risk management related to events with potential or actual international public health implications - of biological, chemical, or radiation-related nature - including: early detection through official and unofficial sources; risk assessment, jointly conducted by the PAHO Secretariat and affected States Parties; control of the risk through information sharing, provision of technical advice to States Parties, deployment of response teams to affected States Parties;
ii. Capacity building to enhance the inter-sectoral preparedness of States Parties to respond to acute public health events, including at points of entry and in occasion of mass gatherings events, in the context of health systems strengthening;
iii. Compliance with IHR provisions of more administrative nature: submission of States Parties Annual Reports to the World Health Assembly and PAHO Governing Bodies; presentation of Reports to the PAHO Governing Bodies; update of requirements for the International Certificate of Vaccination or Prophylaxis as a condition for entry or exit; authorization of ports to issue the Ship Sanitation Certificate; etc.;
iv. Collaborations with other UN Technical Agencies to strengthen a collaborative intersectoral approach both, at national and international levels.
In the context of the reform of WHO work in health emergencies; in September 2016, PAHO established the PAHO Health Emergencies Department (PHE), aiming at ensuring a holistic approach to the management of health emergencies.

Activities:
v. Risk management: Annually, approximately 100 acute events with potential international public health implications are detected and jointly assessed by PAHO and States Parties. Over the past two years, efforts were focused on the management of vector borne diseases outbreaks, including with long term consequences, such as: Zika virus diseases, also determined to be a Public Health Emergency of International Concern (PHEIC) under the IHR; chikungunya; yellow fever. The management of ZIka virus disease and yellow fever required the activation of the Incident Management System as well as the coordination of the deployment of field response teams;
vi. Capacity building: PAHO is supporting preparedness efforts its Member States through country specific activities as well as sub-regional and regional activities. Technical areas tackled through those activities include: strengthening of the National IHR Focal Points; epidemiological surveillance (event-based and indicator-based); strengthening of preparedness at points of entry (airports, ports, and ground crossings); strengthening of laboratory capacity (diagnostic and quality management); preparedness for and delivery of mass gatherings events (Olympic and Paralympic Games, Rio de Janeiro, Brazil, 2016; APEC Summit, Peru, 2016; 35th America’s Cup, Bermuda, 2017);
vii. Compliance with IHR provisions: States Parties Annual Reports submitted to the World Health Assemblies between 2011 and 2016 showed steady improvements at the regional level in all core capacities. However, the status of the core capacities across the subregions continues to be heterogeneous, with the lowest scores consistently registered in the Caribbean subregion. When the States Parties Annual Reports in their current format were instituted for reporting to the Sixty-fourth World Health Assembly in 2011, the response rate was 51% (18 of 35 States Parties); in 2016, for the first time, the response rate was 100%, with all 35 States Parties in the Americas reporting to the Sixty-ninth World Health Assembly. Signaling an increased ownership of the IHR, in occasion of the 55th PAHO Directing Council in 2016, PAHO Member States adopted Decision CD55(D5) “Implementation of the International Health Regulations”, related to Document CD55/12, Rev. 1, that extensively addresses States Parties’ recommendations for the future application and implementation of the IHR in the Region. Approximately 500 ports have been authorized by States Parties in the Region to issue Ship Sanitation Certificates;
viii. PAHO is closely collaborating with the following UN Technical Agencies at national, sub-regional, and regional level, including through the organization of joint activities for in-country capacity building: International Civil Aviation Organization (ICAO), Food and Agriculture Organization (FAO) at the annual regional, International Atomic Energy Agency (IAEA), World Organization for Animal Health (OIE).

Beneficiaries: 35 States Parties to the International Health Regulations in the Region of the Americas, and overseas territories of France, The Netherlands, and the United Kingdom geographically located in the Americas.

Partnerships and Financing: Government of Brazil, Government of Canada, Centers for Disease Control and Prevention (CDC), United States.

Website: http://www2.paho.org/hq/; http://www.paho.org/disasters/index.php?option=com_content&view=frontpage&Itemid=1&lang=en; http://www2.paho.org/hq/index.php?option=com_content&view=article&id=1239&Itemid=2291; http://www2.paho.org/hq/index.php?option=com_content&view=article&id=11585&Itemid=41688&lang=en; http://www2.paho.org/hq/index.php?option=com_topics&view=article&id=343&Itemid=40931&lang=en; http://www2.paho.org/hq/index.php?option=com_topics&view=article&id=69&Itemid=40784&lang=en;

Implementation of UN strategic plans on nutrition: WHO comprehensive implementation plan on maternal, infant and young child nutrition, PAHO/WHO plan of action for the prevention of obesity in children and adolescents and the UN decade of action on nutrition (2016-2025).

PAHO has been providing technical support to implement countries to implement the WHO comprehensive implementation plan on maternal, infant and young child nutrition, PAHO/WHO plan of action for the prevention of obesity in children and adolescents and the UN decade of action on nutrition (2016-2025). All of them encourage multi sectorial action involving public and non-governmental sectors.

PAHO, in coordination with FAO, UNICEF, World Bank, INCAP, CARPHA, COMISCA, MERCOSUR, CARICOM, and IBFAN, is providing technical cooperation on programs and policies to prevent malnutrition in all its forms, including:
- breastfeeding protection, promotion and support,
- improvement of school food environment,
- implementation of fiscal policies, regulation of food marketing and front of package labeling,
- promotion of physical activity,
- reduction of salt consumption, and,
- promotion of family farming and locally sourced foods, and
- the development of guidelines to implement sustainable food systems to end all forms of malnutrition.
Furthermore, PAHO (NMH and LEG departments) is working with parliamentary networks in the Americas, such as "Frente Parlamentario contra el Hambre de América Latina y Caribe", and a parliamentary network on early child development (currently in the process of defining the structure and functioning) to include nutrition actions as part of early child development policies as well as to end hunger and food insecurity.

Beneficiaries: Member States in the region to address NCDs, policy-makers and legislators in the Region of the Americas.

Partnerships and Financing: FAO, UNICEF, World Bank, INCAP, CARPHA, COMISCA, MERCOSUR, CARICOM, IBFAN

Inter American Task Force on NCDs (IATF on NCDs)

: In recognition of the enormous social and economic burden posed by noncommunicable diseases,responsible for 80% of all deaths in the Americas and the political commitments declared for NCDs in the Declaration of Port of Spain during the Fifth Summit of the Americas, in 2009, the United Nations High Level Meeting on NCD Prevention and Control, in 2011, as well as the endorsement of a regional NCD Plan of Action by the ministers of health of the region in 2013 and call for the establishment of an Inter-American Task Force on Noncommunicable Diseases (NCDs) at the Seventh Summit of the Americas in April 2015, led by PAHO, that complements the United Nations Interagency Task Force on the Prevention and Control of NCDs, the Inter-American Task Force on NCDs was officially launched on 17 June 2015. Its aim is that of promoting intersectoral work and coordinating activities within the Inter-American system, and associated international institutions and agencies, towards the achievement of the PAHO Plan of Action for the Prevention and Control of Noncommunicable Diseases in the Americas 2013-2019. Through this alliance the Task Force will leverage expertise and resources within the Region to improve technical cooperation on NCDs and their risk factors. The global and regional goals and targets for NCDs can only be achieved through coordinated multisectoral action. The Inter-American Task Force on NCDs is a regional expression of collaboration across leading institutions of the Inter American System and will support countries in Latin America and the Caribbean with policy advice, technical assistance, resource mobilization and capacity building in order to reduce premature mortality from NCDs. The Task Force aims to stimulate a coordinated and harmonized response across the region to achieve the goals of the PAHO Regional Action Plan for NCDs. Efforts will also be made to coordinate and synergize the Task Force’s work with the regional UN agencies as it relates to the UN Inter-Agency Task Force on NCDs.
Specifically, the objectives of the Task Force for the period 2015-2019 are to:
1. Seek synergies among the participating agencies and the relevant activities and strategies to support Member States in implementing actions to prevent and control NCDs;
2. Enhance harmonization of interagency efforts to strengthen the national capacities for NCD policies and programs, within the mandates of the individual agencies of the Task Force, and support the integrated implementation of plans and actions to prevent and control NCDs in the Americas;
3. Facilitate the optimal deployment of resources, collaboration, networking and exchange of information among the organizations of the Inter-American system and associated international institutions and agencies to support Member States in the prevention and control of NCDs; and
4. Coordinate with the multi-sector NCD actions of related UN, WHO and PAHO initiatives, including the UN Interagency Task Force on NCDs, the WHO Global Action Plan on NCDs, and the achievement of the NCD-related Sustainable Development Goals (SDGs), to ensure complementarity of purpose and optimal use of resources.
The duration of this Task Force is aligned with the timeframe of the Plan of Action for the Prevention and Control of Noncommunicable Diseases in the Americas, which is until December 2019.

Activities:
• IATF on NCDs launched (June 17th 2015, OAS headquarters, Washington, D.C.). More info here
• IATF / Mapping exercise/inventory of agency multi-sector actions on NCDs and identification of potential areas of synergy, gaps, collaboration and potential country collaborations (finalized in June 2016)
• Side event organized at the OAS Ministerial meeting on social inclusion. “Social inclusion and health in all policies: a multisectoral approach”: (Paraguay, July 2016)
• 5 bilateral meetings PAHO - IATF members to exchange information, and coordinate activities and projects at the national level (April - May 2017)
• Meeting at PAHO with all IATF members (scheduled for May 2017) with regards NCD and RF mandates.
• Task force communication activities (website, joint messaging, sharing information platform) (to be developed in May- August 2017)

Beneficiaries: To support Member States in the region to address NCDs, through multi-sector approaches. Given the urgent need for a multi-sector response to the NCD burden, and to engage with relevant government sectors beyond health the work of this Task Force will benefit the efforts of Member States to reduce the burden of NCDs and Risf Factors related and strengthen multisectoral collaboration.

Participating agencies include: the Pan American Health Organization (PAHO) that serves as a Secretariat, the Organization of American States (OAS), the Inter-American Institute for Cooperation Agriculture (IICA), the Inter-American Development Bank (IDB), the Economic Commission for Latin America and the Caribbean (ECLAC), and the World Bank. Funding for the activities emerging from the work of the Task Force, including participation in meetings, are covered by the existing budget for health related programs within the organizations of the Inter-American system and associated international organizations and agencies.

1. Sub-regional integration mechanisms advanced with adolescent pregnancy strategies in Member States.

2. Eight Ministries of Health signed a high level political resolution committing to incorporate health inequality on Maternal, Child and Adolescent Health (MCAH) measurement and monitoring into existing national strategic information systems during 2017.
3. Interpretation and implementation of the Global Strategy for Women’s, Children’s and Adolescents’ Health in the context of the Americas in the context of the Americas.

Activities:
1. A joint review and planning meeting, based on COMISCA and ORAS/CONHU integration mechanisms, was organized with PAHO support. A joint framework to address adolescent pregnancy in Southern Cone countries was also developed.
2. A regional report on Maternal, Child and Adolescent Health (MCAH) inequalities in LAC was finalized and launched, and support was provided to eight countries in Central America and the Dominican Republic to finalize and present a set of national MCAH inequality profiles.
3. Attain regional and national analysis of the Global Strategy in the context of the Americas, a set of inter-sectorial recommendations for improving regional and national collaboration in women’s, children’s and adolescents’ health and regional and national commitment towards implementing of the Global Strategy in the context of the Americas.

Activities:
3. Implementation of three of sub-regional inter-sectorial consultations (May and June 2017).
High-Level Inter-Sectorial Summit in Chile, July 3, 2017.

Access to potable water and sanitation

In the Region of the Americas, access to quality sanitation and water services remains a critical situation. Data published by the Joint Monitoring Program for Water Supply and Sanitation (2015) show that, despite widely varying progress among countries, Latin America and the Caribbean surpassed the MDG targets for drinking water, but not for sanitation. The Region has expanded water services by 94.6% and sanitation by 83.1%. This progress, however, is insufficient. Six of our countries still have not achieved the MDG targets for drinking water and 10 countries have not reached the targets for sanitation. In addition, 34 million people in Latin American and the Caribbean still lack access to an improved water source, 21 million of them in rural areas. Regarding sanitation, the figures are even more staggering: 106 million people lack access to improved sanitation, 41 million of them in rural areas, including 18.5 million who continue to practice open defecation. This situation puts the population at risk of contracting diseases such as cholera, dysentery, typhoid fever, and polio.

Activities:
The main activities implemented in this area include the following:
1) Implementation of the cholera action plan in the Water, Sanitation and Hygiene (WASH) sector;
2) Strengthening of a regional team for rapid response to water-borne outbreaks and assessments of country capacities in WASH;
3) Development and application of the methodology for Water Security Plans (WSP) and Sanitation Security Plans (SSP) in the countries, with an emphasis on national norms and policies;
4) Implementation of a cross-sectoral approach to the social and environmental determinants of health at the local, national and regional levels;
5) Promotion of decision-making through the systemic approach on risk management through the WSPs and SSPs for reducing the burden of diseases related to water and sanitation.

Beneficiaries: Latin American countries

Partnerships and Financing: Government of Peru, Global Affairs Canada

Countries reported advances in accordance with the Strategy on Universal Access to Health and Universal Health Coverage Universal Health (Universal Health) adopted by the 53rd PAHO Directing Council in 2014. Twenty countries and territories in the Region (Bahamas, Brazil, Canada, Chile, Colombia, Cuba, Dominican Republic, Ecuador, El Salvador, Guyana, Honduras, Jamaica, Mexico, Monserrat, Peru, Saba, Trinidad and Tobago, United States of America, Uruguay, and Venezuela), developed comprehensive national health policies, strategies, and/or plans, including universal health. PAHO’S technical support was increased to support Member States in the development and/or the implementation of these plans of action, law reforms and/or roadmaps towards Universal Health in countries such as Bahamas, Chile, Colombia, El Salvador, Ecuador, Honduras, Jamaica, Panama, Paraguay, and Peru.
PAHO aims to promote access to and rational use of safe, effective, and quality medicines, medical products, and health technologies, as countries move towards Universal Access to Health and Universal Health Coverage. Member States have made tangible progress in the development, implementation, monitoring, and evaluation of national policies on access, quality, and use of medicines and other health technologies.

Fifteen countries namely, Bahamas, Brazil, Canada, Chile, Colombia, Costa Rica, Cuba, Dominican Republic, Ecuador, El Salvador, Mexico, Panama, Peru, Uruguay, and United States of America have developed and implemented financial frameworks for universal health. PAHO supported Country studies tackling different aspects of efficiency in health financing. In addition, PAHO commissioned a regional study on fiscal space for health comprising 14 countries of the Region and a specific country study for Peru. To date, 6 countries of the Region commit at least 6% of their Gross Domestic Product (GDP) to public expenditure in health, namely Aruba, Canada, Costa Rica, Cuba, Uruguay, and United States of America. The dialogue and advocacy interventions are to continue into 2016 with expected country actions to increase fiscal space for health and public health-financing.
27 countries signed an agreement to participate in the Strategic Fund, a technical cooperation mechanism that facilitates access of safe, quality-assured and effective medicines and other strategic health supplies. Last biennium, countries procured over 140 million dollars through the fund, received technical advice e on how to improve their supply chain and make more cost-effective choices for medicines and other health technologies. Moreover, PAHO provided political and technical support to MERCOSUR, leading price negotiations for high cost medicines in 2015. The mechanism whereby the outcomes of the negotiations are linked with the procurement capacity of the PAHO Strategic Fund resulted in significant reductions in the price of medicines for HIV/AIDS and Hepatitis C, and increased the awareness of Member States on the value of participating in the Strategic Fund.

PAHO has improved the sharing of knowledge and information available on emerging and reemerging infectious diseases, enhancing surveillance and response to epidemic diseases of potential international concern. During 2015, 24/7 epidemiologic monitoring and response actions were maintained to rapidly inform Member States about threats or public health risks, such as the Zika virus.
As a part of ongoing preparedness and response efforts to emerging infectious disease outbreaks, the Ebola Virus Disease (EVD) Preparedness Framework was developed and implemented with direct technical cooperation provided to more than 26 Member States and it provided an opportunity to assess the operational implementation of IHR core capacities and health systems’ preparedness to adequately respond to a potential EVD case or other emerging infectious disease such as Zika virus.
Clinical management tools and laboratory capacity have been developed to strengthen countries’ capacities for Chikungunya and comprehensive technical cooperation has been mobilized and coordinated to countries affected by the Zika Virus outbreak. These efforts have provided important lessons in regards to maintaining and achieving International Health Regulations (IHR) core capacities to build capacity in emerging infectious diseases in the Region.

As part of the development of International Health Regulation capacities, PAHO has provided technical support to update national plans in the context of the Ebola virus disease (EVD) Preparedness Framework focused on elements of preparedness and response for a country to manage a potential EVD case during the first 72-hours after its detection. A detailed progress report of the implementation of the International Health Regulations was presented to the 67th Session of the Regional Committee of WHO for the Americas in the 54th Directing Council during September 2015, showing the current status of core capacities of States Parties (including preparedness and response capacities.
In the wake of the Zika Virus Outbreak The Pan American Health Organization’s Latin American Center for Perinatology and Human Development (CLAP) organized an ad hoc expert group in maternal and perinatal health, genetics, epidemiology, surveillance and pediatric neurology. From consultation and technical reviews, the first guidelines for monitoring newborn with microcephaly and other associated conditions for the care of pregnant women exposed to Zika virus and newborn with microcephaly were developed. Likewise technical content related to the situation was developed with the communication team, and broadcasted across different media.

As a regional mechanism for multi-sector cooperation on NCDs, the Inter-American Task Force on NCDs was established as a mandate from the XII Summit of the Americas, held in Panama in 2015. This regional task force aims to promote and coordinate multi-sector activities with the agencies and associated international institutions within the Inter-American system, towards the achievement of the PAHO Regional Plan of Action for the Prevention and Control of Noncommunicable Diseases 2013-2019. It was launched in July 2015 with the participating agencies -- Pan American Health Organization (PAHO), the Organization of American States (OAS), the Inter-American Institute for Cooperation on Agriculture, the Inter- American Development Bank, the Economic Commission for Latin America and the Caribbean, and the World Bank. PAHO is leading the Inter-American Task Force on NCDs to promote the response to NCDs across all relevant sectors of government in the region. A mapping of each agency’s current investments and technical cooperation in NCDs and their risk factors has been conducted, and PAHO is currently analyzing the information to inform potential areas of synergy, gaps, and collaboration. A joint work plan is being developed, with a focus on the priority topics of tobacco control, obesity prevention in children and adolescents, and cardiovascular disease prevention and control. The elements of the work plan include advocacy and community mobilization, legislation, economic analysis, and capacity building for key interventions for a multi-sector response to NCDs, among others.

PAHO has strengthened the water and sanitation services through the implementation of Water Quality Surveillance Programs and Water Safety Plans in Latin America and the Caribbean (LAC) countries. An online free access platform course on Water Safety Plan (WSPs) was developed by PAHO in Spanish, aimed at those in the water sector with management, engineering, or operational responsibilities.
Moreover, due to different outbreaks in our Region, regional and country capacities were reinforced in the preparation of water safety plans with an emergency approach articulating actions from preparedness and response among health and water and sanitation sectors in priority countries. This initiative also included the establishment of a network to exchange experiences and knowledge.
Through these initiatives, PAHO has supported access to safe water and therefore, the promotion of human rights and the reduction of inequalities in LAC countries towards a sustainable integration of water resources management into national water strategies.

PAHO’s Project Zero Maternal Deaths by Hemorrhage mobilizes governments, civil society, and communities where obstetric hemorrhage is a leading cause of maternal deaths. This project also works toward empowering women so their rights and preferences are respected and they are encouraged to seek timely qualified medical care.
The quality of care in maternal health services in the Region has improved through human resource training using competency-based training models, strengthening midwifery, reducing unnecessary caesarean sections, improving respectful treatment in health services and handling major obstetric emergencies.
In response to the guidelines defined by the Strategy and Regional Plan on newborn health as well as the global plan “All Newborns”, it was decided in 2014 to begin a process to strengthen the register and monitoring of birth defects systems. Congenital malformations are the second leading cause of death in newborns and children under one year in the region. They also contribute substantially to the burden of disease. To this end, in coordination with key actors, experts in epidemiology and birth defects surveillance as well as CDC and WHO experts, a training program on surveillance of birth defects was developed and offered in 2015.

Initiative: Access to potable water and sanitation
In Latin America, 93% of the population have access to improved drinking water sources and 80% have access to improved sanitation. However, these statistics do not reflect the quality of water or the disparities in gender, income, and race which affect access to water sources and sanitation. In fact, a high proportion of the Region’s population still lives in conditions that do not meet the minimum standard necessary for fulfillment of the right to life and well-being. Current public policies have brought
progress, but there remain significant gaps between levels of access for different sectors of the population.

Activities: The main activities implemented in this area include the following:
1) Implementation of the cholera action plan in the Water, Sanitation and Hygiene (WASH) sector;
2) Strengthening of a regional team for rapid response to water-borne outbreaks and assessments of country capacities in WASH;
3) Development and application of the methodology for Water Security Plans (WSP) and Sanitation Security Plans (SSP) in the countries, with an emphasis on national norms and policies;
4) Implementation of a cross-sectoral approach to the social and environmental determinants of health at the local, national and regional levels;
5) Promotion of decision-making through the systemic approach on risk management through the WSPs and SSPs for reducing the burden of diseases related to water and sanitation.

Website: http://www.paho.org/hq/index.php?option=com_content&view=article&id=5172&Itemid=40085&lang=en

Beneficiaries: Latin American countries

Partnerships and Financing: Government of Peru, Government of Spain

Initiative: Preparedness and response capacities to confront emerging epidemic diseases
The sudden emergence of Ebola Virus Disease (EVD) in 2014 called attention to the severe and ongoing global threat of emerging infectious diseases and forced governments to re-assess their preparedness and response capacities. In the Americas, many countries remain vulnerable to the possible spread of infectious disease, such as Chikungunya and cholera, particularly those countries that have not fully achieved the core capacities defined by International Health Regulations (IHR). The Pan American Health Organization (PAHO) continues to lead Emergency Preparedness, Readiness and Response actions in Latin American and Caribbean countries.

Activities: “The Framework for Strengthening National Preparedness and Response for Ebola Virus Disease in the Americas” was finalized and disseminated among countries with the following objectives: 1) to characterize the capacity of the countries to respond to emerging or re-emerging infectious disease hazard; 2) to support countries in addressing and bridging gaps identified; and 3) to define a joint technical cooperation work plan to support national preparedness efforts for emerging and re-emerging infectious diseases.

Within the context of this Framework, the following activities have taken place to ensure an adequate level of preparedness and response capacity in the LAC as a step toward achieving and maintaining IHR core capacities.
1) Ongoing dialogue with Heads of States, Ministries of Health and other sectors of LAC countries to undertake all necessary actions to mitigate risks and prepare the region for the potential introduction of emerging infectious diseases.
2) Technical missions conducted to 27 LAC countries, in collaboration with experts from partner agencies, to generate recommendations for strengthening areas in need of improvement.
3) Development of technical guidelines and targeted multi-country training workshops for government designated officials and expert consultations on clinical management, infection prevention and control, laboratory diagnostic, rapid response and contact tracing, and risk communication were conducted.
4) Establishment of a regional Stockpile of Personal Protective Equipment, with access to other needed supplies.

Website: http://www.paho.org/hq/index.php?option=com_content&view=article&id=10137&Itemid=41116

Beneficiaries: Latin American and Caribbean countries (PAHO Member States)

Partnerships and Financing: PAHO Director, PAHO’s Pandemic Epidemic Emergency Fund, Government of Brazil

Initiative: What is PAHO doing to support the implementation of the Universal Access to Health and Universal Health Coverage Strategy?

The Strategy for Universal Access to Health and Universal Health Coverage was adopted by Member States of the Region in October 2014 (CD53.R14) which addresses inequities in access to health systems and services that prevent people from enjoying optimal health.

Universal access is the absence of geographical, economic, sociocultural, organizational, or gender barriers that prevent all people from having equitable use of comprehensive health services and healthy living to allow their development and well-being. Universal coverage means that there are organizational and financing mechanisms to cover the entire population.

Recognizing that there are many ways to achieve universal health and that each country will need to establish its own action plan, taking into account its social, economic, political, legal, historical and cultural context, as well as its priorities and current and future health challenges, PAHO is working with Member States and other partners to guide, as appropriate, the strengthening of their health systems with a view to achieving universal health.

Activities:
1. Providing technical support for the development and or implementation of national plans (road maps) to strengthen or transform the health systems toward universal health. PAHO missions and direct technical cooperation ongoing in Bahamas, Chile, Costa Rica, Curacao, Ecuador, El Salvador, Honduras, Jamaica, Panama, Peru since the approval of the Strategy in October 2014.

2. Carrying out advocacy with governments, and other sectors:
-Meeting of PAHO/WHO and World Bank in Chile (May 2015) to review new tool for countries to monitor and evaluate progress towards universal health. The tool is being piloted in Chile, Panama and Trinidad and Tobago.
- PAHO presence on discussions within the economic and financing sectors including IMF/World Bank Governors Meetings in Lima, Peru (October 2015).
- High level forum with Ministers of Finance and other financial institutions to take place in December 2015, Universal Health Day.
- Working with MERCOSUR, UNASUR and SICA around access to medicines in health systems and with CARICOM / CARPHA on the development of the Caribbean Regulatory Systems for Medicines and Health Technologies.

3. Reinforcing capacity building on management of health services, financing and health economics, governance and stewardship.

4. Ensuring linkages between the movements towards universal health and regional movement to strengthening non communicable diseases and health in all policies.

5. Building the evidence base for universal health:
- Launch of the Lancet Series on Universal Health Coverage in Latin America in English (October 2014) and Spanish, MEDICC edition (May 2015)
- A joint World Bank and PAHO publication "Toward Universal Health Coverage and Equity in Latin America and the Caribbean: Evidence from Selected Countries" (June 2015).
- 7 health financing efficiency studies from Bolivia, Chile, Honduras, and Peru (ongoing).
- 15 countries receiving support to produce health accounts.
- Situation analysis of health financing in OECS countries in collaboration with the University of West Indies.

6. Facilitating triangular cooperation and sharing knowledge and experiences on:
- Social security mechanisms (Costa Rica and Panama)
- Health financing service networks (Panama- Spain and Panama-Uruguay)

7. Improving availability, quality and affordability to medicines thru the Strategic Fund including the strengthening of regulatory systems at the national and sub- regional level, and support in the evaluation and incorporation of health technologies within health systems in Member States. Seven countries (Bermuda, Bolivia, Brazil, Chile, Colombia, Suriname and Uruguay) reported having laws that require some use of health technology assessment in decision processes. (CD54/INF/5-F)

8. Facilitating discussions to define the strategic orientations and content that will guide Human Resources for Health Post-2015 Agenda for the Region of the Americas within two contexts: (1) the WHO Global Strategy on Human Resources and (2) the Strategy of Universal Access and Universal Health Coverage approved (CD53.R14).

Beneficiaries: Countries in Latin America and the Caribbean. Specific examples included under activities.

Partnerships and Financing: PAHO, WHO, World Bank, IDB, Ministries of Health from LAC.

Initiative: Inter-American Task Force on Noncommunicable Diseases
The Inter-American Task Force on Noncommunicable Diseases (NCDs), was officially launched on 17 June 2015, with the aim of promoting intersectoral work and coordinating activities within the Inter-American system, and associated international institutions and agencies, towards the achievement of the PAHO Plan of Action for the Prevention and Control of Noncommunicable Diseases in the Americas 2013-2019. Through this alliance the Task Force will leverage expertise and resources within the Region to improve technical cooperation on NCDs and their risk factors.
The global and regional goals and targets for NCDs can only be achieved through coordinated multisectoral action. The Inter-American Task Force on NCDs is a regional expression of collaboration across leading institutions of the Inter American System and will support countries in Latin America and the Caribbean with policy advice, technical assistance, resource mobilization and capacity building in order to reduce premature mortality from NCDs. This working group aims to stimulate a coordinated and harmonized response across the region to achieve the goals of the PAHO Regional Action Plan for NCDs. Efforts will also be made to coordinate and synergize the Task Force’s work with the regional UN agencies as it relates to the UN Inter-Agency Task Force on NCDs.

Activities: Specifically, the objectives of the Task Force for the period 2015-2019 are to:

1. Seek synergies among the participating agencies and the relevant activities and strategies to support Member States in implementing actions to prevent and control NCDs;
2. Enhance harmonization of interagency efforts to strengthen the national capacities for NCD policies and programs, within the mandates of the individual agencies of the Task Force, and support the integrated implementation of plans and actions to prevent and control NCDs in the Americas;
3. Facilitate the optimal deployment of resources, collaboration, networking and exchange of information among the organizations of the Inter-American system and associated international institutions and agencies to support Member States in the prevention and control of NCDs; and
4. Coordinate with the multi-sector NCD actions of related UN, WHO and PAHO initiatives, including the UN Interagency Task Force on NCDs, the WHO Global Action Plan on NCDs, and the achievement of the NCD-related Sustainable Development Goals (SDGs), to ensure complementarity of purpose and optimal use of resources.

Since the official launch of the Task Force in June 2015, the participating agencies met and agreed to refine objectives and to develop the Task Force Work Plan (2015-2019) that specifies milestones, results and accountability frameworks to guide the work going forward.
The agreed priority areas are:
• Tobacco control (including taxation, warning labels, smoke free places, regulations for sponsorship, advertising and marketing);
• Prevention of childhood/adolescent obesity (including taxation, promotion of physical activity, regulatory actions, education, communication and health promotion, promotion of healthy food baskets); and
• Cardiovascular disease and hypertension prevention and control (including salt reduction, diet, physical activity, blood pressure medication).

Participating agencies also developed a list of activities to be accomplished in the first year (2015-2016). These activities will be ratified by participating agencies during a follow up meeting in November 2015. These include:
1) A mapping exercise/inventory of agency multi-sector actions on NCDs and identification of potential areas of synergy, gaps, collaboration and potential country collaborations;
2) Hosting of a regional meeting on multi-sector approaches for NCDs in 2016;
3) Integrating NCDs into the “Third Meeting of Ministers and High Authorities of Social Development of the OAS” in Paraguay in 2016;
4) Collecting and disseminating country data on health expenditure projections due to aging/NCDs;
5) Implementing Task Force communications activities (website, joint messaging, information sharing platform).

Website: http://www.paho.org/hq/index.php?option=com_content&view=article&id=11134&Itemid=41578&lang=en

Beneficiaries: To support Member States in the region to address NCDs, through multi-sector approaches.

Partnerships and Financing: Participating agencies include: the Pan American Health Organization (PAHO) that serves as a Secretariat, the Organization of American States (OAS), including the Inter-American Commission of Women (CIM) and the Inter-American Children's Institute (IIN), the Inter-American Institute for Cooperation Agriculture (IICA), the Inter American Development Bank (IDB), the Economic Commission for Latin America and the Caribbean (ECLAC), and the World Bank.

Initiative: PLAN OF ACTION ON WORKERS' HEALTH /SDE
The Plan of Action on Workers’ Health aims to address the current situation resulting from the changes caused by the world of work, and also responds to the WHO Global Plan of Action on Workers’ Health 2008-2017, endorsed by the WHA in 2008. The purpose is to reduce injuries, diseases and death at work; and, noncommunicable diseases in certain critical economic sectors.

To achieve this access to health and universal health coverage and the social determinants related to workers’ health is required, and actions have been taken to meet these goals.

Activities: 1- Training of PHC personnel in Member States with a basic curriculum on Occupational Health, Safety and Wellbeing, addressing basic activities and interventions for low income and informal workers.

2-Providing comprehensive health services and registration of health surveillance programs for populations aged 18 to 65 years, to detect occupational risks and NCD in early stages.

3- Contributions were made for building the WHO guidelines to protect HCW against Ebola in West Africa with two collaborating centers in OH (University of Maryland & University of British Columbia).

4- Initiative to protect health of health care workers by means of training, surveillance systems for blood-borne diseases (HBV,HIV), and occupational safety and health measures in health institutions.

5- Fund raising and mobilization

Website: http://www.paho.org/hq/index.php?option=com_content&view=article&id=10763&Itemid=41401&lang=en&limitstart=1

Beneficiaries: Working populations of Member States (Approximately 490 million workers)

Partnerships and Financing: WHO, ILO, OAS, PAHO and the network of Collaborating Centers in Occupational health

Initiative: Faces, Voices and Places: Achieving MDG’s at the Local Level
The Faces, Voices, and Places initiative, designed to work with the poorest municipalities and most vulnerable social groups, reflects the values of equity and Pan-Americanism. It stresses advocacy by the most vulnerable and strengthens citizenship building through a shared rights and responsibilities approach, with an inter-sectoral,inter-agency effort that unites actions and wills to achieve the MDGs in places where progress has stalled and national averages have made the reversals invisible. The initiative seeks to shine a spotlight on the social determinants of inequity in health. It also seeks to open new paths for coordinating the Primary Health Care and Health Promotion strategies from the local development perspective and at the same time aims to demonstrate that a shared commitment, born of the needs expressed by communities, with political will and technical and financial support can reduce poverty in these neglected municipalities. This initiative’s contribution to the Region is to shift from the analysis of MDG indicators to participatory, action-oriented research that fosters local empowerment and a government and interagency commitment to changing conditions in the community. Systematizing
and sharing experiences can further dissemination of the lessons learned and/or add to the dynamic in each country for comprehensive, integrated public policy-making that substantially improves health indicators as quickly as possible.
The initiative seeks to make all the instruments and experience of PAHO and other agencies available to communities in order to work locally with the most vulnerable groups and create a basket of methodologies, strategies, good practices, and policies consistent with local needs and community work in the most vulnerable communities from the perspective of the MDGs, health, and the social determinants of health.

Activities:
Community Selection & Initial Diagnosis:
Communities are selected by ministries of health in collaboration with PAHO/WHO representatives, among others. Participating communities are selected based on their levels of poverty and vulnerability in health. As part of this process, an initial diagnosis takes place and a baseline is developed.

ParticipatORY Diagnostics:
Based on the results of the situation analysis and the process of community organization, a community participatory diagnosis takes place using the Action Research Methodology, confirming the construction of the baseline.

Defining Key Interventions:
Commissions are created for each of the MDGs, in which community members, supported by experts, work to define, plan and implement key interventions.

Monitoring & Follow-up:
Monitoring instruments are created to evaluate progress and the impact of interventions and to support
follow-up.

Dissemination:
Throughout this process there will be periodic updates on the initiative’s progress and on opportunities and remaining challenges to achieving the MDGs at the local, national, subregional and regional levels.

Beneficiaries:
Vulnerable groups and population from the poorest communities in Latin America and the Caribbean
http://www.youtube.com/watch?v=xUs4o6KpnNI&feature=relmfu
http://www.youtube.com/watch?v=RC7VSeeDcqQ
http://www.youtube.com/watch?v=ANruk0QMR14&feature=relmfu

Partnership:
Ministries of Health in coordination with other ministries at the local level, local authorities, community’s organizations and local leaders. This initiative has received an important support from the Spanish Agency of Cooperation for Development (AECID)

Information available in Spanish

Information available in Spanish

Initiative: Safe Hospitals in the Americas

What are the objectives of a ‘safe hospitals’ Initiative?
To develop national policies and regulations on making hospitals safe from disasters.
To protect the lives of the occupants of a hospital or health facility.
To protect the economic investment as well as the functionality of both new facilities and those identified as priorities within the health services network.
To compile, organize and monitor the implementation of policies and national and international regulations on safe hospitals.

Activities:
What strategies guide a ‘safe hospitals’ program?

Lobby with decision makers to incorporate a ‘safe hospitals’ program in ministries of health and other institutions that contribute to this goal, as well as in subregional integration organizations (SICA, the Central American Integration System; CAN, the Andean Community; and CARICOM, the Caribbean Community).

Identify other sectors involved in safeguarding health facilities from disasters (drinking water, electric power, finance, disaster response committees, communications media, etc.) and involve them in joint technical and outreach activities.

Develop scientific and academic programs and activities on safe hospitals in universities, research centers, professional associations related to the construction and operation of hospitals.

Incorporate criteria for the protection of health facility into health investment projects so they serve as technical guidelines for incorporating risk mitigation in new health facilities. Include reference to these criteria the solicitation of bids on design, construction and operation of health facilities.

Establish and implement independent mechanisms for control and supervision of projects, with the intervention of skilled professionals that work in coordination with the team executing the project.

Mobilize the national and regional technical capacity in safe hospitals including WHO Collaborating Centers and the Disaster Mitigation Advisory Group (DiMAG).

Beneficiaries:
Latin America and the Caribbean Countries

Partnerships:
Ministries of Health, Civil Society Organizations, Universities.

UNISDR Latin America, World Bank, CIDA, USAID, AECID

The “Safe Motherhood Initiative in the Americas” is a part of the activities of the Regional Working Group for the Reduction of Maternal Mortality (GTR), the regional mechanism that brings together the efforts of the organs of the United Nations system, the bilateral international cooperation agencies, and networks of professionals and civil society organizations, to promote programs and policies for reducing maternal illness and mortality in Latin America and the Caribbean.

The “Strategy and Plan of Action for the Reduction of Chronic Malnutrition” was adopted during
PAHO’s 50th Directing Council with the goal of reducing, by five percentage points, chronic malnutrition among under-fives and the prevalence of nutritional anemia among pregnant women by 2015. The strategy emphasizes the generation and exchange of information and lessons learned, advocacy, and inter-sector and interagency coordination in capacity building for the provision of integrated services based on renewed primary treatment, on the incorporation of actions within families and communities, and on the mobilization of resources and strategic alliances.

PAHO developed the “Initiative for the Elimination of Mother-to-Child Transmission of HIV and the Reduction of Congenital Syphilis,” which aims to achieve the goals of eliminating 2% of cases of vertical transmission of HIV and of reducing the incidence of congenital syphilis to less than 0.5 cases per 1,000 live births by 2015. To this end, programs and interventions have been designed and launched for prevention, early detection, and timely treatment of pregnant women and newborns at the primary care level in all the countries, with an oversight and monitoring system. The initiative has an interagency coordination mechanism led by PAHO and UNICEF. The countries of the Caribbean are at the forefront of the elimination efforts, with the commitment of the highest political levels.