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An important component of the support that PAHO/WHO provides to this movement is developing and strengthening regional networking activities and encouraging sharing of knowledge and experiences between municipalities and countries. Collaboration among countries has been a key aspect in the success of the movement.

In the last year the movement has dramatically increased. All of the countries are involved in implementing the healthy municipalities movement, including the island nations of the Caribbean.

In Boca del Río the countries signed two milestone agreements: 1) to create a Latin American Network of Healthy Municipalities and Communities, and 2) to continue building and strengthening their national networks.

The movement faces many challenges as it presents many opportunities to continue strengthening health promotion approaches in the region. Without exception there is a need to continue strengthening community participation, both in the planning and evaluation phases. The networks and projects need to continue to build consensus and alliances with the many institutions and organizations within the health sector and with other sectors.

It is important to continue to be aware of the risks of political party manipulation, and to develop negotiation skills to deal with conflicts that may arise over ideological issues. The movements in all of the countries strongly defend the need to accept local government representatives from all political parties. The movement also needs to continue to be aware of the risks of excessive control from the health sector. Health promotion requires the leadership and full participation of all sectors, many strategies and activities go beyond the capacity of the health sector. The health sector needs to continue embracing health promotion approaches, and needs to build its capacity to implement health promotion activities.

The need to mobilize internal and external resources continues to present many limitations to implementing the plan of action in most countries and to deliver technical cooperation at the regional level. The reorientation of health services is an important challenge and a fundamental opportunity to be pursued in the context of this movement. As local government and community leaders understand the concept of healthy municipalities and health promotion goals and approaches, it is plausible that more resources will be allocated to the major challenges facing public health today.

Without a doubt this movement presents a fundamental opportunity to establish healthy public policies at the regional, national and local levels. The movement is supportive of the decentralization processes, it requires decentralization of decision making processes and strengthens local capacity to make decisions and control the use of resources. The healthy municipalities movement requires strong and determined community participation and action and it provides a concrete opportunity to continue strengthening and consolidating democratic processes in the region. It also contributes to build people's capacity to participate in "reinventing government" and provides opportunities for people to participate in public choices and in decisions concerning them, their family and their community.