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Download&Gid=20125 154th SESSION OF THE EXECUTIVE COMMITTEE Washington, D.C., USA, 16-20 June 2014 Provisional Agenda Item 4.1 CE154/10 17 April 2014 Original: English PRELIMINARY FINAL REPORT OF THE PAHO STRATEGIC PLAN 2008-2013 AND END-OF-BIENNIUM ASSESSMENT OF THE PROGRAM AND BUDGET 2012-2013 CE154/10 TABLE OF CONTENTS Page I. EXECUTIVE SUMMARY .........................................................................................3 II. INTRODUCTION........................................................................................................7 III. OVERVIEW OF THE PERFORMANCE MONITORING AND ASSESSMENT (PMA) PROCESS IN PAHO………………………………………… 8 Programmatic Assessment .......................................................................................9 Budgetary Assessment and Resource Analysis .......................................................9 IV. REGIONAL HEALTH OVERVIEW......................................................................11 A. Communicable Diseases .................................................................................11 B. NCDs and Risk Factors ..................................................................................14 C. Maternal, Child, Adolescent, and Elderly Health and Nutrition ....................17 D. Emergency and Disaster Preparedness ...........................................................18 E. Social, Economic, and Environmental Determinants of Health .....................20 F. Health Systems and Services ..........................................................................22 Main Achievements of the PASB Technical Cooperation ....................................25 Challenges for the PASB .......................................................................................32 V. PROGRAMMATIC PERFORMANCE ..................................................................33 Assessment of Strategic Objectives (SOs) .............................................................33 Assessment of Region-wide Expected Results (RERs) .........................................34 Status of the RER indicators ..................................................................................37 VI. BUDGET AND RESOURCE MOBILIZATION ...................................................39 Budget Overview: 2008-2013 ................................................................................39 Resource Mobilization ...........................................................................................42 Funding by Source, 2008-2013 ..............................................................................45 Funding by Strategic Objective, 2008-2013 ..........................................................46 Funding by National Voluntary Contributions (NVCs).........................................48 Analysis of Resource Allocation versus Prioritization of Strategic Objectives ....49 VII. CONCLUSIONS AND RECOMMENDATIONS .................................................51 VIII. ANNEXES 2 CE154/10 I. EXECUTIVE SUMMARY 1. The purpose of this report is to present to the Pan American Health Organization (PAHO) Governing Bodies the findings of the final assessment on implementation of the PAHO Strategic Plan 2008-2013. While the report focuses on the six-year period of the Plan, it also includes the results of the end-of-biennium assessment of the Program and Budget (PB) 2012-2013. 2. The report conforms with the Organization’s commitment to accountability and transparency in line with its results-based management (RBM) framework. It builds on the two interim progress reports previously presented to the PAHO Governing Bodies and incorporates the recommendations of Member States. 3. The report relies on information provided by the Performance Monitoring and Assessment (PMA) process conducted across the Pan American Sanitary Bureau (PASB). It consists of programmatic and budgetary implementation analyses by Strategic Objective (SO) and by each level of the Organization. Information is provided on PASB resource mobilization efforts to cover the funding gap for the three Program and Budgets approved for implementation of the Plan (2008-2009, 2010-2011, and 2012-2013). The report also provides an analysis of resource allocation by programmatic priorities. 4. The assessment shows that the Organization maintained a consistent implementation rate throughout the three biennia covered by the Plan. By 2013, seven of the 16 Strategic Objectives (SOs) were fully achieved (with 100% of targets met or exceeded) and nine partially achieved. Of the nine partially achieved, eight reached over 75% of their indicator targets; and only one (SO1–communicable diseases) attained less than 75% of its targets. Out of 90 Region-wide Expected Results (RERs), 75 (83%) were fully achieved and 15 were partially achieved. Of the 256 RER indicator targets for 2013, a total of 233 (91%) were reached. Not only were they reached, but 127 of them (54%) were exceeded. 5. In the past six years, the Region has made substantial progress towards achieving the public health impact-level targets specified in the Strategic Plan. For example: a) All but one country in the Region reduced infant mortality to lower than 32.1 deaths per 1,000 live births. Childhood deaths due to vaccine-preventable diseases alone saw an estimated 53% reduction during 2002-2012. b) The Region made significant progress towards meeting the elimination targets for neglected infectious diseases (NIDs). A total of 18 countries successfully eliminated leprosy at the national and subnational level. Seventeen countries eliminated human rabies transmitted by dogs. Another 17 countries interrupted 3 CE154/10 the vector-borne transmission of Chagas’ disease by lowering household infestation in the defined area to lower than 1%. c) Notably, Colombia was the first country in the world to eliminate onchocerciasis, as verified by WHO. d) There was a 49% reduction in the incidence of malaria in the Region during 2006- 2012. The case-fatality rate for dengue declined from 0.07% in 2010 to 0.05% in 2013. e) The incidence of HIV infections was reduced to 15% in 2012, down from 16.9% in 2006. Nineteen countries in the Region reduced mother-to-child transmission (MTCT) of HIV to under 5%. Furthermore, 75% of HIV/AIDS patients had access to antiretroviral treatment (ART) by 2012. In addition, 13 countries had met the congenital syphilis elimination target of less than 0.05 cases per 1,000 live births by 2012. f) The incidence of tuberculosis (TB) continued to decline, down to 29 cases per 100,000 in 2012 compared with 39 cases in 2005, with a similar decline in TB mortality. g) The trend analysis of premature mortality (in the population aged 30-69 years) for the four major groups of noncommunicable diseases (NCDs) showed that age-adjusted rates per 100,000 dropped from 379.9 in 2000 to 318.7 in 2010, reaching an overall decrease of 16.1%. By the end of 2013, eight countries had achieved a 10% reduction in the prevalence of tobacco use compared with only three countries in 2007. h) Daily mortality in populations affected by major emergencies was below 1 per 10,000 during the initial emergency response phase in all the emergencies assessed during 2008-2013. i) The Region met the Millennium Development Goal (MDG) 7 target for improved access to safe drinking water, achieving an overall coverage of 97%. 6. Other important achievements include: a) The percentage of population covered by any type of social protection scheme in the Region increased from 46% in 2003 to 60% in 2013. Public sector expenditure on health as a percentage of GDP grew from 3.1% in 2006 to 4.1% in 2010 but had a slight decrease to 3.8% in 2011. b) Nineteen countries of the Region have incorporated the principle of the right to the highest attainable standard of health in their constitution or in national health legislation. More than 30 countries have signed international treaties endorsing these same principles. In addition, 15 countries and territories have legislation aimed at increasing access to health and health care. Three countries have 4 CE154/10 upgraded their health legislation to incorporate the right to health and recognize the goal of universal health coverage. c) Thirty-one countries and territories have strengthened their primary health care-based health systems. Twelve countries have implemented insurance schemes and national health plans to increase health coverage through explicit health care warranties, while eight countries have adopted explicit policies and/or financial mechanisms intended to reduce or eliminate the financial risk associated with disease and accidents. d) The number of countries that achieved the recommended health workforce density, namely 25 per 10,000 inhabitants or greater, has more than doubled since 2006 from 12 to 25 by the end of 2013. e) Six States Parties met the International Health Regulations (IHR) criteria of core capacity for surveillance and response. 7. Despite significant progress and accomplishments, several challenges remain. For example, the reduction in the maternal mortality rate remains slow. There continues to be a need to expand and coordinate multisectoral action in the fight to prevent NCDs and their risk factors, and to address the social determinants of health. To ensure adequate detection, response, and management of public health emergencies of international concern, the countries must augment their national core capacities in line with the IHR requirements. Moreover, health systems and services must be better organized and managed
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