The commemoration this year of the 40th anniversary of the Alma-Ata Declaration provides an opportunity for accountability. Over these 40 years, much progress has been made. It is important to learn the lessons of Alma-Ata as we seek to confront the challenges of attaining the SDGs, especially SDG 3: “Ensure healthy lives and promote wellbeing for all at all ages.” Some of these key lessons are that barriers to access must be systematically identified and removed; fragmentation and segmentation of health systems and services is a recipe for failure; social participation at the grassroots level is a prerequisite for success; national governments must lead and own the process towards universal health, in coordination with partners; “universal” means universal, with no excuses or half measures in providing all necessary health services to all people; and universal health cannot be attained without multisectoral policies, programs, and actions that address the social determinants of health.
In order to advance to the highest attainable standard of physical, mental, and social well-being, we must maintain the long-standing commitment that PAHO’s Member States and PASB have to the values and principles of PHC; the promotion of rights-based approaches to health; equitable national health development; and the concepts of participation and inclusion.
Though the priority public health issues for the Region of the Americas may appear to be constant—including health systems strengthening, prevention and control of communicable and noncommunicable diseases, and public health emergencies—they are evolving. As the years pass and the technical cooperation environment changes, informed by new developments and knowledge, so must there be evolution in the strategies, mechanisms, methodologies, and techniques used by PAHO’s Member States and the PASB to maintain and improve the health of the peoples of the Americas.
Given the changing political landscapes in the countries and the subregions of the Americas, greater advocacy for UH and primary health care is needed to maintain the health gains achieved in the Region, manage emerging and reemerging issues, and advance the 2030 Sustainable Development Agenda, while maintaining PASB’s country focus and catalyzing exchanges among the Member States themselves.
The pursuit of equity in health demands strengthened social participation and community engagement. The involvement of civil society to enable a people-centered approach to health systems strengthening and implementation of the PHC approach, where people are partners in managing their own health and that of their community, is a critical component of progress to UH. In working toward health for all, especially for those in conditions of exclusion and vulnerability, PAHO’s partnerships must continue to include civil society organizations and other non-State actors, working within FENSA as mandated by the PAHO Member States.
The Governments of PAHO Member States remain responsible for the health and development of their people, countries, and territories. Government leadership and political will to strengthen the PHC approach and advance to UH are fundamental factors in the processes that aim to strengthen and transform health systems in the Region. The exercise of the stewardship function of the health authorities requires strengthening of their technical capacity to formulate and implement health policies, as well as to advocate for, and contribute to, the formulation and implementation of all public policies that promote and underpin UH. This technical capacity entails determination of the feasibility, viability, and legitimacy of the changes needed; analysis of health needs and social determinants of health; and identification of relevant interventions. To persuade and support Governments to embrace multisectoral and whole-of-society actions towards UH and equity, the PASB’s efforts must include advocacy and provision of evidence to enable sound decision-making; sharing of knowledge and lessons learned; and promotion of cooperation among countries.
Mechanisms, spaces, and accountability for social participation are essential tools in ensuring that the design and implementation of health policies is aligned with the people’s expectations and needs. The development of a people- and community-centered model of care enables the integration of people and civil society as key stakeholders in this process. This is an opportune time for innovative and creative strategies to enhance community and social participation, and to enable people to make optimal choices for their own health.
A key tenet of the PHC approach is the provision of comprehensive health services as close as possible to where people live and work. Effective service coverage and health outcomes can be greatly improved by strengthening the first level of care within an integrated health services delivery network that brings together health promotion, disease prevention, and a set of progressive health services; takes into consideration the specific social and health conditions of the population; and uses an intersectoral approach. Strategic investments in health financing that target the development of human resources for UH and improvement in health infrastructure are critical. So is the establishment of social insurance and social protection programs that allow people to access PHC and integrated health services when needed. Improved financial accessibility of PHC services is an essential component of progress to UH and reduction of health inequities.
The Region of the Americas has consistently participated and demonstrated leadership in global processes to define, renew, and strengthen the PHC approach. The Region will continue to do so at the Global Conference on PHC in October 2018 and beyond, by advocating for UH as a concept that includes both coverage of and access to quality, comprehensive, integrated health services and by sharing successful experiences that can contribute to the renewal of national, subregional, regional, and global commitments for PHC as a key strategy to achieve UH and the SDGs. PASB is dedicated to the values and principles of PHC as a strategy to transform health systems towards universal health. PASB’s regional leadership in the renewal of the commitment to PHC has made possible stronger alliances with Member States; with technical teams in the ministries of health, health services, and other sectors related to health; with academia; and with both organized and nonorganized civil society.
As concepts, strategies, mechanisms, and tools for attaining the desired state of universal health evolve, PAHO Member States and PASB, in alignment with WHO and other UN agencies, and in close collaboration with development partners, civil society, and the private sector—as appropriate—will continue to plan, implement, monitor, and evaluate strategies for countries to enhance primary health care, develop resilient health systems, and progress to universal health, thus advancing health and well-being and leaving no one behind.
List of acronyms and abbreviations
AECID: Spanish Agency for International Development Cooperation
AMR: antimicrobial resistance
CARPHA: Caribbean Public Health Agency
CARICOM: Caribbean Community
CCHD: cooperation among countries for health development
CCS: Country Cooperation Strategy
CICOM: Medical Information and Coordination Cell
COHSOD: Council for Human and Social Development (CARICOM)
COMISCA: Council of Ministers of Health of Central America
CRS: Caribbean Regulatory System
DFID: Department for International Development (United Kingdom)
EMTs: emergency medical teams
EOC: Emergency Operations Center
EWEC-LAC: Every Woman, Every Child – Latin America and the Caribbean
FAO: Food and Agriculture Organization of the United Nations
FCTC: Framework Convention on Tobacco Control
FENSA: Framework of Engagement with Non-State Actors
GAC: Global Affairs Canada
GDP: gross domestic product
GPW 13: Thirteenth General Program of Work (World Health Organization)
HCC: Healthy Caribbean Coalition
HiAP: Health in All Policies
HIV: human immunodeficiency virus
HRUH: human resources for universal health
IAEA: International Atomic Energy Agency
IDB: Inter-American Development Bank
IDRC: International Development Research Center (Canada)
IHR: International Health Regulations (2005)
IHSDN: integrated health services delivery network
IHSLAC: Integrated Health Systems in Latin America and the Caribbean
IMCI: Integrated Management of Childhood Illnesses
IMF: International Monetary Fund
IMS: Incident Management System
IS4H: information systems for health
LGBT: lesbian, gay, bisexual, and trans
mhGAP: Mental Health Gap Action Program (World Health Organization)
NCDs: noncommunicable diseases
NSAs: non-State actors
OFID: OPEC Fund for International Development
PAHO: Pan American Health Organization
PASB: Pan American Sanitary Bureau
PASC: Pan American Sanitary Conference
PERC: Production, Efficiency, Resources and Costs
PHAC: Public Health Agency of Canada
PHC: primary health care
PMMHS: Productive Management Methodology for Health Services
SDG: Sustainable Development Goal
SHAA2030 Sustainable Health Agenda for the Americas 2018-2030
SICA: Central American Integration System
SIDS: small island developing states
STIs: sexually transmitted infections
SUS: Unified Health System (Brazil)
TCIM: traditional, complementary, and integrative medicine
UH: universal health
UHC: universal health coverage
UNAIDS: Joint United Nations Program on HIV/AIDS
UNDP: United Nations Development Program
UNICEF: United Nations Children’s Fund
UNFPA: United Nations Population Fund
UNGA: United Nations General Assembly
UN Women: United Nations Entity for Gender Equality and the Empowerment of Women
U.S. CDC: United States Centers for Disease Control and Prevention
VCPH: Virtual Campus for Public Health
WB: World Bank
Acknowledgments of support
The Pan American Sanitary Bureau is grateful for the support of its Member States through their quota contributions, and for the generous voluntary contributions of governments, agencies, and institutions, including:
Alliance for Health Policy and Systems Research
Amazon Cooperation Treaty Organization
Americares
Andalusian Agency for International Development Cooperation
Andean Health Organization [ORAS-CONHU]
Anton de Kom University of Suriname
Autism Speaks
Axon Medical Technologies
Bernard van Leer Foundation
Bill & Melinda Gates Foundation
Binational Development Plan for the Peru-Ecuador Border Region, Peru chapter
Caribbean Community
Caribbean Community Climate Change Center
Caribbean Development Bank
Caribbean Law Institute Center
Caribbean Public Health Agency
CARICOM Regional Organization for Standards and Quality
Cayetano Heredia Peruvian University
CDC Foundation
Center for State Control of Drugs and Medical Devices (Cuba)
Central National Institute of Ablation and Implants (Argentina)
City of Buenos Aires
Climate and Clean Air Coalition
Costa Rican Social Security Fund
Council for International Organizations of Medical Sciences
Dalhousie University
Department of Foreign Affairs and Trade (Australia)
Department of Foreign Affairs, Trade and Development (Canada)
Direct Relief
District Health Fund – Bogota District Health Department
Durham University
Emory University
European Civil Protection and Humanitarian Aid Operations
European Commission
European Union
Federal University of Rio Grande do Sul
Federal University of Santa Catarina
Food and Agriculture Organization of the United Nations
Garrahan Foundation
Gavi, the Vaccine Alliance
Global Affairs Canada
Global Fund to Fight AIDS, Tuberculosis and Malaria
Good Neighbors Guatemala
Government of Australia
Government of Brazil
Government of Canada
Government of Chile
Government of Cuba
Government of Ecuador
Government of Haiti
Government of Luxembourg
Government of Nicaragua
Government of Norway
Government of Peru
Government of Spain
Government of Sweden
Government of the Republic of Korea
Government of Trinidad and Tobago
Healthy Caribbean Coalition
Hemispheric Program for the Eradication of Foot-and-Mouth Disease
Humber River Hospital
India, Brazil and South Africa Fund
Inter-American Development Bank
InterAmerican Heart Foundation
Inter-American Institute for Cooperation on Agriculture
Inter-American Network of Food Analysis Laboratories
Inter-American Society of Cardiology
International Agency for the Prevention of Blindness
International Agency for Research on Cancer
International Atomic Energy Agency
International Bank for Reconstruction and Development
International Business Machines Corporation
International Development Research Center
International Medical Corps
International Monetary Fund
International Organization for Migration
International Regional Organization for Plant and Animal Health
Italian Hospital of Buenos Aires
Japan International Cooperation Agency
Johns Hopkins University School of Nursing
Joint United Nations Program on HIV/AIDS
Korea International Cooperation Agency
Latin American Association of Pharmaceutical Industries
Latin American Federation of the Pharmaceutical Industry
Latin American Society of Hypertension
Luxembourg Ministry of Development Cooperation and Humanitarian Affairs
MacArthur Foundation
Ministry of Agriculture, Livestock, and Food Supply (Brazil)
Ministry of Agriculture, Livestock, Aquaculture, and Fisheries (Ecuador)
Ministry of Foreign Affairs and International Cooperation Office of Development Cooperation (Italy)
Ministry of Foreign Relations and Trade of New Zealand
Ministry of Foreign Relations of Chile
Ministry of Health and Sports of Bolivia
Ministry of Health, Labour and Welfare of Japan
Ministry of Health of Argentina
Ministry of Health of Brazil
Ministry of Health of Chile
Ministry of Health of Costa Rica
Ministry of Health of the Province of Entre Ríos (Argentina)
Ministry of Health of the Province of Mendoza (Argentina)
Ministry of Health of the Province of Santa Fe (Argentina)
Ministry of Health of the Province of Santiago del Estero (Argentina)
Ministry of Health of the Republic of Panama
Ministry of Health of the Republic of Peru
Ministry of Health of Trinidad and Tobago
Ministry of Public Health of Guyana
Ministry of Public Health and Social Assistance of Guatemala
Ministry of Public Health and Social Assistance of the Dominican Republic
Municipal Secretariat of Health of the City of São Paulo (Brazil)
National Autonomous University of Nicaragua
National Cancer Institute of Argentina
National Cancer Institute of Colombia
National Council of State Health Secretaries (Brazil)
National Drug Board (Uruguay)
National Health Agency (Brazil)
National Health Foundation (Brazil)
National Health Regulation, Control and Surveillance Agency (Ecuador)
National Health Surveillance Agency (Brazil)
National Institute of Food and Drug Surveillance (Colombia)
National Institute of Health of Colombia
National Institute of Health of El Salvador
National Institute of Public Health of Mexico
National Institute of Social Services for Retirees and Pensioners (Argentina)
National School of Public Health (Cuba)
National Service for Animal Health and Quality (Paraguay)
Netherlands Ministry of Foreign Affairs
Network of National Cancer Institutes of the Union of South American Nations
NextGenU
Norwegian Agency for Development Cooperation
Office of United States Foreign Disaster Assistance
OPEC Fund for International Development
Orbis International
Organization of Eastern Caribbean States
Organization of American States
OPEC Fund for International Development
Pan Caribbean Partnership against HIV/AIDS
Permanent Mission of Brazil to the OAS
Plan International
Population Services International
Program for Appropriate Technology in Health
Public Health Agency of Canada
Rosarino Center for Perinatal Studies
Royal Netherlands Army
Royal Netherlands Navy
RTI Health Solutions
Sabin Vaccine Institute
Secretariat of Health of Cundinamarca (Colombia)
Secretariat of Health of Honduras
Secretariat of Health of Mexico
Secretariat of Health of the State of Bahia (Brazil)
Secretariat of Health of the State of Maranhão (Brazil)
Secretariat of Health of the State of Pará (Brazil)
Secretariat of Health of the State of Pernambuco (Brazil)
Secretariat of Health of the State of Rio Grande do Sul (Brazil)
Secretariat of Health of the State of São Paulo (Brazil)
Secretariat of Health of the State of Tocantins (Brazil)
South American Council on Health
Spanish Agency for International Development Cooperation
Special Program for Research and Training in Tropical Diseases
Standards and Trade Development Facility
Sustainable Sciences Institute
Task Force for Global Health
Therapeutic Goods Administration (Department of Health of Australia)
Tobacco-Free Kids
Together for Girls
United Kingdom Department for International Development
United Kingdom Department of Health and Social Care
United Nations Central Emergency Response Fund
United Nations Children's Fund
United Nations Development Program
United Nations Entity for Gender Equality and the Empowerment of Women
United Nations Environment Program
United Nations Foundation
United Nations Fund for International Partnerships
United Nations Secretariat for the International Strategy for Disaster Reduction
United Nations Joint Global Program on Cervical Cancer Prevention and Control
United Nations Multi-Partner Trust Fund
United Nations Partnership to Promote the Rights of Persons with Disabilities
United Nations Population Fund
United Nations Trust Fund for Human Security
United States Agency for International Development
United States Department of Health and Human Services
United States Food and Drug Administration
United States-Mexico Border Health Commission
United States National Council on Urban Indian Health
University of Belize
University of Brasilia
University of Chile
University of Guyana
University of Illinois
University of the West Indies
U.S. Centers for Disease Control and Prevention
Vaccine Ambassadors
Vital Strategies
Wellcome Genome Campus
World Bank
World Diabetes Foundation
World Hypertension League
World Organization for Animal Health