Based on evaluations conducted between 2021 and 2023 in 14 countries of the Americas, the report underscores the critical role of the essential public health functions (EPHF) as a strategic framework for improving health systems. These functions span 11 key areas, including population health surveillance and assessment, development of health policies and plans, and equitable access to care. Implementation of the EPHF seeks to strengthen health governance, reduce inequalities, and increase resilience in the face of crises such as the COVID-19 pandemic.
“By prioritizing the EPHF, countries can significantly improve the capacities of their health systems to respond to the needs of populations and achieve more equitable and effective outcomes,” said Dr Jarbas Barbosa, director of PAHO. “This not only strengthens the capacity to respond to emergencies, but also ensures a solid foundation for addressing long-term health challenges,” he added.
Evaluation of capacities: Progress and pending challenges
There has been significant but uneven progress in the region. Ten of the 14 countries evaluated have used the EPHF evaluations to identify priorities and develop strategic action plans. In general, the evaluated countries have moderate capacity to implement the EPHF, ranging from 40 to 59 percent of the established standards.
However, there are differences between subregions: Caribbean countries show more limited capacity, while Latin American countries achieve moderate levels. The average compliance rate for the region as a whole remains below 60 percent, reflecting persistent challenges such as fragmented health systems, lack of financial and human resources, and the absence of integrated information systems. These limitations hinder countries’ ability to monitor health, plan actions, and coordinate responses among different sectors.
The COVID-19 pandemic highlighted the importance of the EPHF. Countries that have made greater progress in implementation showed better preparedness and response during the pandemic, indicating the need to integrate these functions into a robust primary health care model.
Recommendations for action
PAHO urges its member states and partners to prioritize the following measures:
- Sustained investment:Increase funding for the EPHF, with emphasis on the development of human resources and information technologies.
- Robust data systems:Establish integrated platforms for the collection, analysis, and use of health data.
- Intersectoral cooperation:Strengthen coordination mechanisms between the public and private sectors and civil society.
- Health governance:Improve leadership and stewardship in public health to ensure inclusive and effective policies.
In September 2024, the countries of the Americas approved the Strategy for Strengthening the Essential Public Health Functions to Accelerate Health Systems Transformation 2024–2034, a regional framework that combines the EPHF with primary health care to transform health systems. This strategy helps countries develop national policies and train local teams, fostering a comprehensive approach that addresses diseases as well as their social determinants.
A call for regional collaboration
PAHO reiterates its commitment to provide technical and strategic assistance to the countries of the region as they assess and strengthen their public health capacities. “The EPHF provide a clear roadmap for moving toward resilient systems that protect the populations of today and tomorrow,” Dr Barbosa said.
As part of this effort, a regional network on governance and the EPHF is being created. This collaborative space seeks to promote more resilient and equitable health systems in the Americas, facilitating the exchange of experiences and solutions to overcome common challenges.
The full report is available on the PAHO website, along with additional resources that support the implementation of its recommendations. The Organization invites governments, health institutions, and international partners to join efforts to strengthen public health throughout the region.
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