Strategies for expanding childhood vaccination in the Americas following the COVID-19 pandemic.

Objective: To provide an overview of the status of the childhood vaccination schedule in the Americas, outline program structures, and identify updated implementation strategies to improve vaccination coverage following the COVID-19 pandemic. Methods: A group of experts in pediatrics, epidemiology, vaccines, and global and public health discussed the current status of the childhood vaccination schedule in the Americas, describing the program structure and identifying new implementation strategies that have the potential to improve vaccination coverage in the post-pandemic context, after the challenges COVID-19 presented for more than two years. Results: The Americas currently face a high risk of resurgence of diseases that were previously controlled or eliminated. Therefore, it is important to find new strategies to educate citizens on the risks associated with lower vaccination rates, especially in children. Conclusions: New strategies along with strong mobilization of the population and advocacy by citizens are necessary to prevent antivaccination groups from gaining a stronger presence in the region and jeopardizing the credibility of the Expanded Program on Immunization.

[Legal framework for electronic medical records in the Region of the Americas: definition of domains to legislate and situation analysisEnquadramento legal para os registros eletrônicos em saúde na Região das Américas: definição de domínios para regulamentação e análise da situação]. / Marco legal para registros médicos electrónicos en la Región de las Américas: definición de dominios a legislar y análisis de situación.

OBJECTIVES: Define a legal framework for electronic medical records (EMRs) and determine the degree to which the countries of the Region of the Americas are prepared in this regard. METHODS: The methodology consisted of two phases. In the first, a Delphi methodology was used to develop a questionnaire and define the framework and legal domains applicable to EMRs. In the second, the questionnaire was completed in each country. This included identifying national experts and the data collection process. RESULTS: Information was collected from a total of 21 countries regarding their situation with respect to legislation on EMRs in the following domains: 1) specific legislation on EMRs; 2) protection of patients' data and secondary use of the data; 3) legislation related to the actions of health professionals; 4) regulation on EMRs and the role of patients; and 5) health standards and EMR promotion programs. CONCLUSIONS: There has been progress in the Region with respect to new legislation covering the main areas related to EMRs (for example, protection of sensitive data and use of digital signatures). However, it is necessary to continue to address issues such as access to and updating of information in EMRs. This study contributes information on the essential components of legislation on EMRs, and reports on the situation in the Region of the Americas.

OBJETIVOS: Definir um enquadramento legal para os registros eletrônicos em saúde (RES) e identificar o grau de preparação dos países da Região das Américas neste sentido. MÉTODOS: A metodologia do estudo foi dividida em duas fases. Na primeira fase, foi usado o método Delphi para elaborar o questionário e definir o enquadramento e os domínios legais para RES. Na segunda fase, foi realizada a pesquisa por país, com a identificação de dados referentes nacionais e processo de coleta de dados. RESULTADOS: Ao todo, foram obtidos dados de 21 países sobre os aspectos legais e RES distribuídos nos seguintes domínios: 1) legislação específica para RES, 2) proteção dos dados dos pacientes e uso secundário da informação, 3) legislação relacionada à atuação dos profissionais da saúde, 4) regulamentação dos RES e papel dos pacientes e 5) padrões em saúde e programas de promoção dos RES. CONCLUSÕES: Houve progresso na Região quanto à promulgação de leis que abrangem os principais domínios dos RES (p. ex., proteção de dados sensíveis ou o uso de assinatura digital). Porém, alguns aspectos precisam ser reforçados, como o acesso e a atualização das informações nos registros. Este estudo contribui ao descrever os aspectos básicos da regulamentação e informar a situação dos RES na Região das Américas.

[Systems for surveillance of birth defects in Latin America and the Caribbean: present and futureSistemas de vigilância de anomalias congênitas na América Latina e Caribe: presente e futuro]. / Sistemas de vigilancia de anomalías congénitas en América Latina y el Caribe: presente y futuro.

OBJECTIVES: To determine the availability of national systems for surveillance of birth defects in Latin America and the Caribbean and describe their characteristics. METHODS: Cross-sectional study based on a semi-structured, self-administered online survey sent in 2017 by local representative offices of the Pan American Health Organization to authorities at the ministries of health of all countries in Latin America and the Caribbean. The survey obtained information on the availability and characteristics of national systems for surveillance of birth defects in each country. RESULTS: Eleven countries have a national system for surveillance of birth defects: Argentina, Colombia, Costa Rica, Cuba, Dominican Republic, Guatemala, Mexico, Panama, Paraguay, Uruguay, and Venezuela. These systems have heterogeneous features: six are hospital-based; 10 include both live births and stillbirths in their case definition. All the surveillance systems include cases with severe and minor defects, except in Argentina, Colombia, and Guatemala, where only severe birth defects are recorded. Only Argentina, Costa Rica, and Uruguay prepare periodic reports that consolidate and present the results of surveillance. The registries in Argentina and Costa Rica have operational manuals. CONCLUSIONS: The availability of national systems for surveillance of birth defects remains limited and highly heterogeneous in Latin America and the Caribbean. Priority should be given to continued expansion and strengthening of this type of surveillance in these countries.

OBJETIVOS: Conhecer a existência de sistemas nacionais de vigilância de anomalias congênitas na América Latina e Caribe e descrever as características destes sistemas. MÉTODOS: Estudo transversal realizado por meio de uma pesquisa online com uso de questionário semiestruturado e autoaplicado enviado no 2017 pelas representações locais da Organização Pan-Americana da Saúde (OPAS) às autoridades dos ministérios da Saúde em todos os países da América Latina e Caribe. Foram coletados dados sobre a existência de sistema nacional de vigilância de anomalias congênitas e as características destes sistemas. RESULTADOS: Onze países possuem um sistema nacional de vigilância de anomalias congênitas: Argentina, Colômbia, Costa Rica, Cuba, Guatemala, México, Panamá, Paraguai, República Dominicana, Uruguai e Venezuela. Os sistemas são de natureza heterogênea, seis são baseados em registros hospitalares e 10 incluem nascidos vivos e morte fetal na definição de caso. A maioria dos sistemas de vigilância abrange casos de anomalias congênitas maiores e menores, exceto na Argentina, Colômbia e Guatemala em que são registradas apenas as anomalias congênitas maiores. A Argentina, Costa Rica e Uruguai são os únicos países que apresentam relatórios periódicos reunindo os achados da vigilância e a Argentina e Costa Rica possuem manuais operacionais para o registro. CONCLUSÕES: Verificou-se que, na América Latina e no Caribe, os sistemas nacionais de vigilância de anomalias congênitas são ainda em um pequeno número e bastante heterogêneos. É uma prioridade expandir e reforçar esta forma de vigilância nos países da região.

Health promotion and the agenda for sustainable development, WHO Region of the Americas.

The approaches and tools of health promotion can be useful for civil society groups, local and national governments and multilateral organizations that are working to operationalize the 2030 agenda for sustainable development. Health promotion and sustainable development share several core priorities, such as equity, intersectoral approaches and sustainability, that help maximize their impact across traditional sectoral boundaries. In the Region of the Americas, each of these priorities has strong resonance because of prominent and long-standing health inequities that are proving resistant to interventions driven solely by the health sector. We describe several cases from the World Health Organization's (WHO) Region of the Americas in which the approaches and tools of health promotion, with a focus on cities, healthy settings and multisectoral collaboration, have been used to put the agenda into practice. We highlight areas where such approaches and tools can be applied effectively and provide evidence of the transformative potential of health promotion in efforts to achieve the sustainable development goals.

Les approches et outils de promotion de la santé peuvent être utiles aux groupes de la société civile, aux gouvernements locaux et nationaux et aux organismes multilatéraux qui s'efforcent de mettre en œuvre le Programme de développement durable à l'horizon 2030. La promotion de la santé et le développement durable ont plusieurs priorités centrales en commun, telles que l'équité, la collaboration intersectorielle et la durabilité, qui contribuent à optimiser leur impact au-delà des limites sectorielles habituelles. Chacune de ces priorités a une forte résonance dans la Région des Amériques, où les importantes inégalités en termes de santé durent depuis longtemps et semblent résister aux interventions menées à la seule initiative du secteur de la santé. Dans cet article, nous décrivons divers exemples provenant de la Région des Amériques de l'Organisation mondiale de la Santé (OMS), où plusieurs approches et outils de promotion de la santé (ciblant principalement les populations urbaines, la création d'environnements-santé et une collaboration multisectorielle) sont actuellement employés pour mettre en œuvre le Programme de développement durable. Nous mettons l'accent sur les domaines dans lesquels ces approches et outils peuvent être efficacement appliqués et nous proposons des données probantes sur le potentiel de transformation de la promotion de la santé dans les efforts menés pour atteindre les objectifs de développement durable.

Los enfoques y las herramientas para el fomento de la salud son útiles para los grupos de la sociedad civil, los gobiernos locales y nacionales y las organizaciones multilaterales que trabajan para poner en marcha el programa de desarrollo sostenible de 2030. El fomento de la salud y el desarrollo sostenible comparten varias prioridades básicas, como la equidad, los enfoques intersectoriales y la sostenibilidad, que ayudan a maximizar el impacto dentro de los límites sectoriales tradicionales. En la Región de las Américas, cada una de estas prioridades tiene una fuerte repercusión debido a las inequidades sanitarias prominentes y prolongadas que resisten a las intervenciones impulsadas únicamente por el sector de la salud. Se describen varios casos de la Región de las Américas de la Organización Mundial de la Salud (OMS) en los que los enfoques y las herramientas para el fomento de la salud, centrado en ciudades, entornos saludables y colaboración multisectorial, se han utilizado para poner en práctica el programa. Se destacan las áreas donde tales enfoques y herramientas se pueden aplicar de manera efectiva y ofrecer pruebas del potencial transformador del fomento de la salud en los esfuerzos por alcanzar los objetivos de desarrollo sostenible.

[Foundations for the development and implementation of a women's and perinatal health information model for management in Latin AmericaFundamentos do desenvolvimento e implementação de um modelo de informação em saúde da materna e perinatal orientado à gestão na América Latina]. / Bases para el desarrollo e implementación de un modelo de información en salud de la mujer y perinatal orientado a la gestión en Latinoamérica.

OBJECTIVE: The Perinatal Information System (SIP) represents a milestone in the use of systematized information in the Region of the Americas. What has been learned from the system has contributed to the development of a model based on a set of core indicators (SCI). The objective of the study was to describe the historical and methodological process involved in the development, implementation, and territorial scaling-up of an SCI to monitor and evaluate women's and perinatal health policies, programs, and services geared to management (SIP-GESTIÓN). METHODS: The study was conducted in two stages: 1) a four-phase validation of an SCI in a hospital network: a) construction of the theoretical indicator model, b) operations research, c) final selection of the indicators, and d) the definition of reference standards; and 2) territorial scaling-up. RESULTS: A total of 17 indicator models were identified. The initial model included 177 indicators divided into seven dimensions (context, habits, accessibility, use of services, quality of care, maternal and fetal impact, and maternal and neonatal impact), with 21 indicators remaining after three Delphi rounds. The final model (SIP-GESTIÓN), which included 40 indicators, was then used to study 240,021 (79.1%) of the 303,559 deliveries attended in 122 selected maternity facilities in 24 jurisdictions (100%) in Argentina. The information is presented in national terms and by health region, province, and hospital. CONCLUSIONS: This model has made it possible to achieve high levels of information coverage and quality and territorial scaling-up and is useful for management, research, and the reorientation of programs and policies.

OBJETIVO: O Sistema de Informação Perinatal (SIP) é um marco no uso de informação sistematizada na Região das Américas. A experiência obtida contribuiu para o desenvolvimento de um modelo baseado em um conjunto mínimo de indicadores (CMI). O objetivo do estudo foi descrever o processo histórico e metodológico do desenvolvimento, implementação e dimensionamento territorial do CMI para monitorar e avaliar políticas, programas e serviços de saúde materna e perinatal orientado à gestão (SIP-gestão). MÉTODOS: O estudo foi realizado em duas etapas. A primeira etapa consistiu da validação em quatro fases de um CMI em uma rede de hospitais: a) construção do modelo teórico de indicadores, b) implementação da pesquisa operacional, c) seleção final dos indicadores e d) definição dos padrões de referência. A segunda etapa consistiu da determinação da escala territorial. RESULTADOS: Foram identificados 17 modelos de indicadores. O modelo inicial incluiu 177 indicadores agrupados em sete dimensões (contexto, hábitos, acessibilidade, utilização de serviços, qualidade do atendimento, impacto materno-fetal e impacto materno-neonatal) que foram reduzidas a 21 após três rodadas de aplicação da técnica Delphi. O modelo final (SIP-gestão) inclui 40 indicadores. Foram analisados 240.021 partos (79,1%) de um número total de 303.559 casos atendidos nas 122 maternidades selecionadas em 24 jurisdições (100%) da Argentina. Os dados são apresentados ao nível nacional e desagregados por região de saúde, província e hospital. CONCLUSÕES: O modelo desenvolvido atingiu altos níveis de cobertura e qualidade da informação e determinação da escala territorial, e pode ser usado na gestão, pesquisa e reorientação de programas e políticas.

Maternal health research outputs and gaps in Latin America: reflections from the mapping study.

As part of the MASCOT/WOTRO multinational team conducting the maternal health literature mapping, four Latin American researchers were particularly interested in analysing information specific to their region. The mapping started with 45,959 papers uploaded from MEDLINE, CINAHL, Embase, LILACAS, PopLINE, PsycINFO and Web of Knowledge. From these, 4175 full texts were reviewed and 2295 papers were subsequently included. Latin America experienced an average maternal mortality decline of 40% between 1990 and 2013. Nevertheless, the region's performance was below the global average and short of the 75% reduction set in Millennium Development Goal 5 for 2015. The main outcomes show that research on maternal health in the countries where the most impoverished populations of the world are living is not always aligned with their compelling needs. From another perspective, the review made it possible to recognize that research funding as well as the amount of scientific literature produced concentrate on issues that are not necessarily among the main causes of maternal deaths. Even though research on maternal health in Latin America has grown from an average of 92.5 publications per year in 2000-2003 to 236.7 between 2008 and 2012, it's not satisfactorily keeping pace with other regions. In conclusion, it is critical to effectively orient research funding and production to respond to the health needs of the population. At the same time, there is a need for innovative mechanisms to strengthen the production and uptake of scientific evidence that can properly inform public health decision making.

Embedding research to improve program implementation in Latin America and the Caribbean.

In the last 10 years, implementation research has come to play a critical role in improving the implementation of already-proven health interventions by promoting the systematic uptake of research findings and other evidence-based strategies into routine practice. The Alliance for Health Policy and Systems Research and the Pan American Health Organization implemented a program of embedded implementation research to support health programs in Latin America and the Caribbean (LAC) in 2014-2015. A total of 234 applications were received from 28 countries in the Americas. The Improving Program Implementation through Embedded Research (iPIER) scheme supported 12 implementation research projects led by health program implementers from nine LAC countries: Argentina, Bolivia, Brazil, Chile, Colombia, Mexico, Panama, Peru, and Saint Lucia. Through this experience, we learned that the "insider" perspective, which implementers bring to the research proposal, is particularly important in identifying research questions that focus on the systems failures that often manifest in barriers to implementation. This paper documents the experience of and highlights key conclusions about the conduct of embedded implementation research. The iPIER experience has shown great promise for embedded research models that place implementers at the helm of implementation research initiatives.

International Health Regulations, Ebola, and Emerging Infectious Diseases in Latin America and the Caribbean.

The World Health Organization's determination of the Ebola virus disease outbreak as a public health event of international concern prompted nonaffected countries to implement measures to prevent, detect, and manage the introduction of the virus in their territories. The outbreak provided an opportunity to assess the operational implementation of the International Health Regulations' core capacities and health systems' preparedness to handle a potential or confirmed case of Ebola virus disease. A public health framework implemented in Latin America and Caribbean countries encompassing preparatory self-assessments, in-country visits, and follow-up suggests that the region should increase efforts to consolidate and sustain progress on core capacities and health system preparedness to face public health events with national or international repercussions.

Local and foreign authorship of maternal health interventional research in low- and middle-income countries: systematic mapping of publications 2000-2012.

BACKGROUND: Researchers in low- and middle-income countries (LMICs) are under-represented in scientific literature. Mapping of authorship of articles can provide an assessment of data ownership and research capacity in LMICs over time and identify variations between different settings. METHODS: Systematic mapping of maternal health interventional research in LMICs from 2000 to 2012, comparing country of study and of affiliation of first authors. Studies on health systems or promotion; community-based activities; and haemorrhage, hypertension, HIV/STIs and malaria were included. Following review of 35,078 titles and abstracts, 2292 full-text publications were included. Data ownership was measured by the proportion of articles with an LMIC lead author (author affiliated with an LMIC institution). RESULTS: The total number of papers led by an LMIC author rose from 45.0/year in 2000-2003 to 98.0/year in 2004-2007, but increased only slightly thereafter to 113.1/year in 2008-2012. In the same periods, the proportion of papers led by a local author was 58.4 %, 60.8 % and 60.1 %, respectively. Data ownership varies markedly between countries. A quarter of countries led more than 75 % of their research; while in 10 countries, under 25 % of publications had a local first author. Researchers at LMIC institutions led 56.6 % (1297) of all papers, but only 26.8 % of systematic reviews (65/243), 29.9 % of modelling studies (44/147), and 33.2 % of articles in journals with an Impact Factor ≥5 (61/184). Sub-Saharan Africa authors led 54.2 % (538/993) of studies in the region, while 73.4 % did in Latin America and the Caribbean (223/304). Authors affiliated with United States (561) and United Kingdom (207) institutions together account for a third of publications. Around two thirds of USAID and European Union funded studies had high-income country leads, twice as many as that of Wellcome Trust and Rockefeller Foundation. CONCLUSIONS: There are marked gaps in data ownership and these have not diminished over time. Increased locally-led publications, however, does suggest a growing capacity in LMIC institutions to analyse and articulate research findings. Differences in author attribution between funders might signal important variations in funders' expectations of authorship and discrepancies in how funders understand collaboration. More stringent authorship oversight and reconsideration of authorship guidelines could facilitate growth in LMIC leadership. Left unaddressed, deficiencies in research ownership will continue to hinder alignment between the research undertaken and knowledge needs of LMICs.

Perspectives on the methods of a large systematic mapping of maternal health interventions.

BACKGROUND: Mapping studies describe a broad body of literature, and differ from classical systematic reviews, which assess more narrowly-defined questions and evaluate the quality of the studies included in the review. While the steps involved in mapping studies have been described previously, a detailed qualitative account of the methodology could inform the design of future mapping studies. OBJECTIVES: Describe the perspectives of a large research team on the methods used and collaborative experiences in a study that mapped the literature published on maternal health interventions in low- and middle-income countries (2292 full text articles included, after screening 35,048 titles and abstracts in duplicate). METHODS: Fifteen members of the mapping team, drawn from eight countries, provided their experiences and perspectives of the study in response to a list of questions and probes. The responses were collated and analysed thematically following a grounded theory approach. RESULTS: The objectives of the mapping evolved over time, posing difficulties in ensuring a uniform understanding of the purpose of the mapping among the team members. Ambiguity of some study variables and modifications in data extraction codes were the main threats to the quality of data extraction. The desire for obtaining detailed information on a few topics needed to be weighed against the benefits of collecting more superficial data on a wider range of topics. Team members acquired skills in systematic review methodology and software, and a broad knowledge of maternal health literature. Participation in analysis and dissemination was lower than during the screening of articles for eligibility and data coding. Though all respondents believed the workload involved was high, study outputs were viewed as novel and important contributions to evidence. Overall, most believed there was a favourable balance between the amount of work done and the project's outputs. CONCLUSIONS: A large mapping of literature is feasible with a committed team aiming to build their research capacity, and with a limited, simplified set of data extraction codes. In the team's view, the balance between the time spent on the review, and the outputs and skills acquired was favourable. Assessments of the value of a mapping need, however, to take into account the limitations inherent in such exercises, especially the exclusion of grey literature and of assessments of the quality of the studies identified.

Mapping of research on maternal health interventions in low- and middle-income countries: a review of 2292 publications between 2000 and 2012.

BACKGROUND: Progress in achieving maternal health goals and the rates of reductions in deaths from individual conditions have varied over time and across countries. Assessing whether research priorities in maternal health align with the main causes of mortality, and those factors responsible for inequitable health outcomes, such as health system performance, may help direct future research. The study thus investigated whether the research done in low- and middle-income countries (LMICs) matched the principal causes of maternal deaths in these settings. METHODS: Systematic mapping was done of maternal health interventional research in LMICs from 2000 to 2012. Articles were included on health systems strengthening, health promotion; and on five tracer conditions (haemorrhage, hypertension, malaria, HIV and other sexually transmitted infections (STIs)). Following review of 35,078 titles and abstracts in duplicate, data were extracted from 2292 full-text publications. RESULTS: Over time, the number of publications rose several-fold, especially in 2004-2007, and the range of methods used broadened considerably. More than half the studies were done in sub-Saharan Africa (55.4 %), mostly addressing HIV and malaria. This region had low numbers of publications per hypertension and haemorrhage deaths, though South Asia had even fewer. The proportion of studies set in East Asia Pacific dropped steadily over the period, and in Latin America from 2008 to 2012. By 2008-2012, 39.1 % of articles included health systems components and 30.2 % health promotion. Only 5.4 % of studies assessed maternal STI interventions, diminishing with time. More than a third of haemorrhage research included health systems or health promotion components, double that of HIV research. CONCLUSION: Several mismatches were noted between research publications, and the burden and causes of maternal deaths. This is especially true for South Asia; haemorrhage and hypertension in sub-Saharan Africa; and for STIs worldwide. The large rise in research outputs and range of methods employed indicates a major expansion in the number of researchers and their skills. This bodes well for maternal health if variations in research priorities across settings and topics are corrected.

Clinicians' knowledge and practices regarding family planning and intrauterine devices in China, Kazakhstan, Laos and Mexico.

BACKGROUND: It is widely agreed that the practices of clinicians should be based on the best available research evidence, but too often this evidence is not reliably disseminated to people who can make use of it. This "know-do" gap leads to ineffective resource use and suboptimal provision of services, which is especially problematic in low- and middle-income countries (LMICs) which face greater resource limitations. Family planning, including intrauterine device (IUD) use, represents an important area to evaluate clinicians' knowledge and practices in order to make improvements. METHODS: A questionnaire was developed, tested and administered to 438 individuals in China (n = 115), Kazakhstan (n = 110), Laos (n = 105), and Mexico (n = 108). The participants responded to ten questions assessing knowledge and practices relating to contraception and IUDs, and a series of questions used to determine their individual characteristics and working context. Ordinal logistic regressions were conducted with knowledge and practices as dependent variables. RESULTS: Overall, a 96 % response rate was achieved (n = 438/458). Only 2.8 % of respondents were able to correctly answer all five knowledge-testing questions, and only 0.9 % self-reported "often" undertaking all four recommended clinical practices and "never" performing the one practice that was contrary to recommendation. Statistically significant factors associated with knowledge scores included: 1) having a masters or doctorate degree; and 2) often reading scientific journals from high-income countries. Significant factors associated with recommended practices included: 1) training in critically appraising systematic reviews; 2) training in the care of patients with IUDs; 3) believing that research performed in their own country is above average or excellent in quality; 4) being based in a facility operated by an NGO; and 5) having the view that higher quality available research is important to improving their work. CONCLUSIONS: This analysis supports previous work emphasizing the need for improved knowledge and practices among clinicians concerning the use of IUDs for family planning. It also identifies areas in which targeted interventions may prove effective. Assessing opportunities for increasing education and training programs for clinicians in research and IUD provision could prove to be particularly effective.

Role of PAHO/WHO in eHealth Capacity Building in the Americas: Analysis of the 2011-2015 period.

Political will and adoption of measures toward the use of eHealth have been steadily increasing, facilitating mobilization of resources necessary to adopt and implement digital services that will make it possible to improve access, expand coverage, and increase financial efficiency of health care systems. Adoption of the Strategy and Plan of Action on eHealth of the Pan American Health Organization (PAHO) in 2011 by all Member States in the Region of the Americas has led the Region to major progress in this regard, including the following: creation of knowledge networks and development of information sources, establishment of eHealth sustainability models, support for development of electronic health records, promotion of standards on health data and related technologies that ensure exchange of information, use of mobile devices to improve health, and improvement in quality of care through telemedicine. This article details the main actions carried out by PAHO with regard to eHealth, specifically by the office of Knowledge Management, Bioethics, and Research in the 2011-2015 period (first period of implementation of the PAHO eHealth strategy and plan of action), which include research and capacity-building activities, development of technical guidelines, and formation of knowledge networks.

La voluntad política y la adopción de medidas en relación con el uso de la eSalud han ido en aumento de forma constante, favoreciendo la movilización de los recursos necesarios a fin de adoptar y poner en marcha servicios digitales que permitan mejorar el acceso, ampliar la cobertura y aumentar la eficiencia financiera de los sistemas de atención de salud. Con la aprobación de la Estrategia y Plan de Acción de eSalud de la Organización Panamericana de la Salud (OPS) en 2011 por todos los Estados Miembros de la Región de las Américas, se han realizado importantes avances a este respecto en la Región, entre los que se destacan: la creación de redes de conocimiento y desarrollo de fuentes de información, el establecimiento de modelos de sostenibilidad en materia de eSalud, el apoyo al desarrollo de los registros electrónicos de salud, la promoción de normas sobre datos de salud y tecnologías conexas que garanticen el intercambio de información, la utilización de los dispositivos móviles para mejorar la salud y la mejora de la calidad asistencial por medio de la telemedicina. El presente artículo detalla las principales acciones ejecutadas por la OPS en eSalud, específicamente por la Oficina de Gestión del Conocimiento, Bioética e Investigación en el período comprendido entre 2011 y 2015 (primer período de implementación de la estrategia y plan de acción de eSalud de la OPS), entre las que se encuentran actividades de investigación y desarrollo de capacidad, la creación de lineamientos técnicos y la construcción de redes de conocimiento.

[International Health Regulations, Ebola, and emerging infectious diseases in Latin America and the Caribbean]. / El Reglamento Sanitario Internacional, la enfermedad por el virus del Ébola y las enfermedades infecciosas emergentes en América Latina y el Caribe.

The World Health Organization's determination of the Ebola virus disease outbreak as a public health event of international concern prompted non affected countries to implement measures to prevent, detect, and manage the introduction of the virus in their territories. The outbreak provided an opportunity to assess the operational implementation of the International Health Regulations' core capacities and health systems' preparedness to handle a potential or confirmed case of Ebola virus disease. A public health framework implemented in Latin America and Caribbean countries encompassing preparatory self-assessments, in-country visits, and follow-up suggests that the region should increase efforts to consolidate and sustain progress on core capacities and health system preparedness to face public health events with national or international repercussions.

The new United Nations approach to sustainable development post-2015: Findings from four overviews of systematic reviews on interventions for sustainable development and health.

Objective To identify reported interventions that facilitate sustainable development and have had a positive impact on health in four areas: sustainable food production; sustainable energy use; sustainable jobs ("decent work"); and prevention of toxic exposure to chemicals. Methods Systematic review methods were used to synthesize evidence from multiple systematic reviews and economic evaluations. A comprehensive search was conducted of at least 14 databases and 8 websites for each of the four overviews, using pre-defined protocols, including clear inclusion criteria. To qualify as "sustainable," interventions needed to aim (explicitly or implicitly) to positively impact at least two dimensions of the integrated framework for sustainable development and had to include measures of health impact. Results In total, 47 systematic reviews and 10 economic evaluations met the inclusion criteria. The most promising interventions, such as agricultural policies, were identified for each of the four topics. While the evidence for the interventions is not strong because of the limited number of studies, there is no evidence of a definite negative impact on health. The only possible exception is that of taxes and subsidies-though this intervention also has the potential to be pro-equity with higher relative impacts for lower income groups. Conclusions The evidence found for effective interventions is useful for guiding countries toward the best options for non-health sector interventions that can positively impact health. This overviews shows that intersectoral work benefits every sector involved.

National research for health systems in Latin America and the Caribbean: moving towards the right direction?

BACKGROUND: National Research for Health Systems (NRfHS) in Latin America and the Caribbean (LAC) have shown growth and consolidation in the last few years. A structured, organized system will facilitate the development and implementation of strategies for research for health to grow and contribute towards people's health and equity. METHODS: We conducted a survey with the health managers from LAC countries that form part of the Ibero-American Ministerial Network for Health Education and Research. RESULTS: From 13 of 18 questionnaires delivered, we obtained information on the NRfHS governance and management structures, the legal and political framework, the research priorities, existing financing schemes, and the main institutional actors. Data on investment in science and technology, scientific production, and on the socio-economic reality of countries were obtained through desk review focused on regional/global data sources to increase comparability. CONCLUSIONS: By comparing the data gathered with a review carried out in 2008, we were able to document the advances in research for health system development in the region, mostly in setting governance, coordination, policies, and regulations, key for better functionality of research for health systems. However, in spite of these advances, growth and consolidation of research for health systems in the region is still uneven.

[Priority research agendas: a strategic resource for health in Latin America]. / Agendas de investigación priorizadas: un recurso estratégico para la salud en América Latina.

OBJECTIVE: Understand and analyze procedures used to create national integrated research agendas from 2007 to 2011 in Argentina, Guatemala, Mexico, Panama, and Paraguay. METHODS: Descriptive, cross-sectional study using an online survey of agenda preparation processes; specifically, development, integration, implementation, and use and dissemination of the agenda. RESULTS: The 45 respondents reported following specific methodologies for agenda construction and had a good opinion of organizational aspects with regard to prior information provided and balance among disciplines and stakeholders. Some 60% considered the coordinators impartial, although 25% mentioned biases favoring some subject; 42% received technical support from consultants, reading matter, and methodological guidelines; 40% engaged in subject-matter priority-setting; and 55% confirmed dissemination and communication of the agenda. However, only 22% reported inclusion of agenda topics in national calls for research proposals. CONCLUSIONS: In the countries studied, development of the health research agenda was characterized by prior planning and appropriate organization to achieve - consensus-based outcomes. Nevertheless, the agendas were not used in national calls for research proposals, reflecting lack of coordination in national health research systems and lack of connection between funders and researchers. It is recommended that stakeholders strengthen integration and advocacy efforts to modify processes and structures of agenda-based calls for research proposals.

Tiered Pricing and Alternative Mechanisms for Equitative Access to Vaccines in Latin America: A Narrative Review of the Literature.

OBJECTIVES: To review and describe alternative strategies for the supply of vaccines in Latin America. METHODS: We conducted a narrative review to explore and describe alternatives for equitable vaccine access in Latin America. We searched and considered the main access strategies reported in the literature through PubMed, Science Direct, and Google Scholar. Additionally, we reviewed the web sites of key stakeholders. The search was conducted using the following keywords: ("access" or "availability" or "acquisition" or "affordability" or "tiered pricing") and ("vaccine"). Subsequently, documents that met the inclusion criteria were selected. Finally, findings were grouped by means of a thematic analysis and an interpretative synthesis. RESULTS: Twenty-four publications were included. We identified 5 main topics: current supply strategies, challenges for the acquisition of vaccines, vaccine prices equity, alternative supply strategies, and the advantages and impact of a tiered pricing strategy. CONCLUSIONS: Our review suggests that tiered pricing can be an tool for accelerating the process of introducing vaccines in low-income countries at affordable prices and for countries that do not adhere to the current procurement mechanisms or are not eligible for Vaccine Alliance because giving countries prices for vaccines that reflect their ability to pay can result in better programmatic and financial planning for the purchase of these vaccines, and in return, vaccine manufacturers can gain access to wider markets However, this model has not been z improve access to vaccines that are aimed only at developing countries, mainly because the market in these countries is not profitable for producers.

Setting research priorities for global pandemic preparedness: An international consensus and comparison with ChatGPT's output.

Background: In this priority-setting exercise, we sought to identify leading research priorities needed for strengthening future pandemic preparedness and response across countries. Methods: The International Society of Global Health (ISoGH) used the Child Health and Nutrition Research Initiative (CHNRI) method to identify research priorities for future pandemic preparedness. Eighty experts in global health, translational and clinical research identified 163 research ideas, of which 42 experts then scored based on five pre-defined criteria. We calculated intermediate criterion-specific scores and overall research priority scores from the mean of individual scores for each research idea. We used a bootstrap (n = 1000) to compute the 95% confidence intervals. Results: Key priorities included strengthening health systems, rapid vaccine and treatment production, improving international cooperation, and enhancing surveillance efficiency. Other priorities included learning from the coronavirus disease 2019 (COVID-19) pandemic, managing supply chains, identifying planning gaps, and promoting equitable interventions. We compared this CHNRI-based outcome with the 14 research priorities generated and ranked by ChatGPT, encountering both striking similarities and clear differences. Conclusions: Priority setting processes based on human crowdsourcing - such as the CHNRI method - and the output provided by ChatGPT are both valuable, as they complement and strengthen each other. The priorities identified by ChatGPT were more grounded in theory, while those identified by CHNRI were guided by recent practical experiences. Addressing these priorities, along with improvements in health planning, equitable community-based interventions, and the capacity of primary health care, is vital for better pandemic preparedness and response in many settings.

Comparison of national health research priority-setting methods and characteristics in Latin America and the Caribbean, 2002-2012.

OBJECTIVE: To compare health research priority-setting methods and characteristics among countries in Latin America and the Caribbean during 2002 - 2012. METHODS: This was a systematic review that identified national health research policies and priority agendas through a search of ministry and government databases related to health care institutions. PubMed, LILACS, the Health Research Web, and others were searched for the period from January 2002 - February 2012. The study excluded research organized by governmental institutions and specific national strategies on particular disease areas. Priority-setting methods were compared to the "nine common themes for good practice in health research priorities." National health research priorities were compared to those of the World Health Organization's Millennium Development Goals (MDG). RESULTS: Of the 18 Latin American countries assessed, 13 had documents that established national health research priorities; plus the Caribbean Health Research Council had a research agenda for its 19 constituents. These 14 total reports varied widely in terms of objectives, content, dissemination, and implementation; most provided a list of strategic areas, suggestions, and/or sub-priorities for each country; however, few proposed specific research topics and questions. CONCLUSIONS: Future reports could be improved by including more details on the comprehensive approach employed to identify priorities, on the information gathering process, and on practices to be undertaken after priorities are set. There is a need for improving the quality of the methodologies utilized and coordinating Regional efforts as countries strive to meet the MDG.