PAN AMERICAN HEALTH ORGANIZATION WORLD HEALTH ORGANIZATION
52nd DIRECTING COUNCIL 65th SESSION OF THE REGIONAL COMMITTEE
Washington, D.C., USA, 30 September-4 October 2013
Provisional Agenda Item 4.1 Off. Doc. 345 (Eng.) 1 September 2013 ORIGINAL: ENGLISH
STRATEGIC PLAN OF THE PAN AMERICAN HEALTH ORGANIZATION 2014-2019*
* Note: This final version contains editorial changes and adjustments to the baselines as well as to the targets of the program area indicators. This note will be removed from the document at the time of its approval during the 52nd Directing Council.
STRATEGIC PLAN OF THE PAN AMERICAN HEALTH ORGANIZATION 2014-2019
“Championing Health: Sustainable Development and Equity”
Introductory Note for the Directing Council
1. In accordance with the road map for developing the Strategic Plan (SP) 2014-2019 and Program and Budget (PB) 2014-2015 of the Pan American Health Organization (PAHO), as approved by the 151st Session of the Executive Committee of PAHO in September 2012, the SP 2014-2019 has been developed in three phases aligned with PAHO’s Governing Bodies cycle for 2013, as follows:
(a) Phase 1: An outline was presented to the Seventh Session of the Subcommittee on Program, Budget, and Administration (SPBA7) in March 2013, taking into consideration the decisions made by the Executive Board of the World Health Organization (WHO) in January 2013 regarding WHO’s draft 12th General Programme of Work (GPW) 2014-2019. (b) Phase 2: A draft of the SP 2014-2019 was submitted for consideration by the 152nd Session of the Executive Committee of PAHO in June 2013, with input from the final version of the WHO 12th GPW as well as WHO’s PB 2014-2015, as approved by the World Health Assembly in May 2013. (c) Phase 3: The final version of the SP 2014-2019 is being presented for approval by PAHO’s 52nd Directing Council in September 2013.
2. To ensure the involvement of PAHO Member States and their ownership of the development of PAHO’s SP 2014-2019, in addition to the mechanisms established by its Governing Bodies, PAHO’s Executive Committee appointed a Member States Countries Consultative Group. This Group was assigned responsibility for providing strategic and technical input into the crafting of the SP 2014-2019 and its first PB 2014-2015. In addition, the Pan American Sanitary Bureau (PASB) facilitated national consultations to obtain input from all countries and territories in the Region. PASB staff at all levels also participated in the development of this Plan.
3. The PASB is pleased to present the complete SP 2014-2019 to the 52nd Directing Council for its consideration and approval.
STRATEGIC PLAN OF THE PAN AMERICAN HEALTH ORGANIZATION 2014-2019
“Championing Health: Sustainable Development and Equity”
Pan American Health Organization Regional Office of the World Health Organization
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CONTENTS
Page
I. Foreword by the Director ...... 9
II. Executive Summary ...... 11
III. Introduction ...... 16
IV. The Context ...... 21 Political, Economic, Social, and Environmental Context ...... 21 Social Determinants of Health ...... 22 Demographic Trends ...... 24 Health and Environment ...... 25 Regional Health ...... 27 The Health System Response ...... 29 Status of the PAHO Strategic Plan 2008-2013 ...... 31 V. Strategic Agenda ...... 34 Strategic Overview ...... 34 Impact Goals and Strategic Focus ...... 38 Organization of the Plan ...... 42 Priority Setting ...... 44 VI. Categories, Program Areas, and Outcomes ...... 47
Category 1 - Communicable Diseases ...... 47 Scope ...... 47 Context ...... 47 Key Stakeholders’ Analysis ...... 53 Strategies for Technical Cooperation ...... 54 Cross-Cutting Themes and Strategic Approaches in Health ...... 55 Assumptions and Risks ...... 57 Category 1. Communicable Diseases: Program Areas and Outcomes ...... 59 1.1 HIV/AIDS and STIs ...... 59 OD345 (Eng.) Page 6
1.2 Tuberculosis ...... 59 1.4 Neglected, Tropical, and Zoonotic Diseases...... 61 1.5 Vaccine-Preventable Diseases ...... 62 Category 2 - Noncommunicable Diseases and Risk Factors ...... 63 Scope ...... 63 Context ...... 63 Key Stakeholders’ Analysis ...... 67 Strategies for Technical Cooperation ...... 68 Cross-Cutting Themes and Strategic Approaches in Health ...... 69 Assumptions and Risks ...... 69 Category 2. Noncommunicable Diseases and Risk Factors: Program Areas and Outcomes ...... 71 2.1 Noncommunicable Diseases and Risk Factors ...... 71 2.2 Mental Health and Psychoactive Substance Use Disorders ...... 72 2.3 Violence and Injuries ...... 72 2.4 Disabilities and Rehabilitation ...... 73 2.5 Nutrition ...... 73 Category 3 - Determinants of Health and Promoting Health
throughout the Life Course ...... 74 Scope ...... 74 Context ...... 74 Key Stakeholders’ Analysis ...... 81 Strategies for Technical Cooperation ...... 82 Cross-Cutting Themes and Strategic Approaches in Health ...... 83 Assumptions and Risks ...... 84 Category 3. Determinants of Health and promoting Health throughout the Life Course: Program Areas and Outcomes ...... 86 3.1 Women, Maternal, Newborn, Child, Adolescent, and Adult Health, and Sexual and Reproductive Health ...... 86 3.3 Gender, Equity, Human Rights, and Ethnicity ...... 87 3.4 Social Determinants of Health ...... 87 3.5 Health and the Environment ...... 88
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Category 4 - Health Systems ...... 89 Scope ...... 89 Context ...... 89 Key Stakeholders’ Analysis ...... 93 Strategies for Technical Cooperation ...... 94 Cross-Cutting Themes and Strategic Approaches in Health ...... 96 Assumptions and Risks ...... 96 Category 4. Health Systems: Program Areas and Outcomes ...... 98 4.1 Health Governance and Financing; National Health Policies, Strategies, and Plans ...... 98 4.2 People-Centered, Integrated, Quality Health Services ...... 99 4.3 Access to Medical Products and Strengthening of Regulatory Capacity ..99 4.4 Health Systems Information and Evidence ...... 100 4.5 Human Resources for Health ...... 100 Category 5 - Preparedness, Surveillance, and Response ...... 101 Scope ...... 101 Context ...... 101 Key Stakeholders’ Analysis ...... 104 Strategies for Technical Cooperation ...... 105 Cross-Cutting Themes and Strategic Approaches in Health ...... 106 Assumptions and Risks ...... 108 Category 5. Preparedness, Surveillance, and Response: Program Areas and Outcomes ...... 109 5.1 Alert and Response Capacities (for IHR) ...... 109 5.3 Emergency Risk and Crisis Management ...... 110 5.4 Food Safety ...... 110 5.5 Outbreak and Crisis Response ...... 111 Category 6 - Corporate Services/Enabling Functions ...... 112 Scope ...... 112 Context ...... 112 Key Stakeholders’ Analysis ...... 118 Strategies for Delivering Corporate Services/Enabling Functions ...... 119 Cross-Cutting Themes ...... 120 Assumptions and Risks ...... 121
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Category 6. Corporate Services/Enabling Functions: Program Areas and Outcomes ...... 122 6.1 Leadership and Governance ...... 122 6.2 Transparency, Accountability, and Risk Management ...... 123 6.4 Management and Administration ...... 123 6.5 Strategic Communication...... 123 Acronyms and Abbreviations ...... 128
Annexes ...... 133 Annex I. Key Lessons Learned from Previous Plans...... 133 Annex II. Programmatic Priority Stratification Framework ...... 137 Annex III. List of Countries and Territories with their Acronyms ...... 141 Annex IV. PAHO Mandates, Resolutions, Strategies, and Plans of Action ...... 142
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PAHO STRATEGIC PLAN 2014-2019
I. Foreword by the Director
1. As the Pan American Health Organization (PAHO) renews its commitment to improving the health of the peoples of the Region of the Americas, it builds upon important past achievements, the strengths of its Member States, and the competence of the Pan American Sanitary Bureau (PASB). With many complex challenges at hand and much work to be done, it is my great pleasure to present the Organization’s Strategic Plan for the period 2014-2019, entitled “Championing Health: Sustainable Development and Equity.” This ambitious Plan is the product of intensive consultation and collaboration with Member States and staff across the Organization. While ensuring a country focus, it provides a clear direction for the coming years, allowing the Organization to remain in the forefront of efforts to improve the health and quality of life of the Region’s peoples.
2. In developing this Plan, the Organization continues to be responsive to Member States and to the Region’s public health priorities while ensuring programmatic alignment with the World Health Organization’s global health objectives. Furthermore, the Plan defines the accelerated actions required for the final push to achieve the Millennium Development Goals by 2015 and the new strategic interventions required for improving health in the post-2015 development agenda.
3. The Region of the Americas has made sustained progress in addressing the determinants of health and improving the health of its population. Human development indicators are improving, employment income is rising, there is notable progress on reducing poverty and inequality, and significant advances have been made toward achieving universal primary education. All of these factors have a positive impact on health. Together with these social advances, the Region has seen positive trends in health indicators, including declines in infant and maternal mortality, a reduction in HIV morbidity and mortality, falling rates of tuberculosis, and a reduced burden of malaria in countries where that disease is endemic. The elimination from the Region of several neglected infectious diseases is within reach, an achievement that will benefit future generations.
4. While we celebrate these important milestones, we all recognize that much remains to be accomplished. This Plan details how the Organization, together with its Member States, will build upon our collective successes and address the remaining gaps in an equitable and sustainable manner. For example, an important challenge facing the Region over the next six years is to halt and reverse the epidemic of chronic noncommunicable diseases. Our Member States have shown considerable leadership on this issue, which has dramatic social and economic impacts on individuals, families, OD345 (Eng.) Page 10
communities, and health services, and demands an integrated, multisectoral response. The rights-based approach is fundamental to ensure fairness and equity in these efforts. Attaining universal health coverage is therefore a key commitment embedded in the Strategic Plan.
5. The leadership, involvement, and ownership of the Member States will be critical for the success of this Strategic Plan. Accordingly, the Plan establishes the joint responsibility and commitment of Member States and PASB to support the range of interventions needed to sustain progress and meet new challenges. The Plan also details targets and indicators by which the performance of the Organization (both Secretariat and Member States) will be assessed. In this way, the Plan reflects PAHO’s ongoing commitment to a results-based approach, leading to improved efficiency, effectiveness, accountability, and transparency.
6. Through ongoing collaboration and dialogue with the range of stakeholders, we will build upon and implement this Plan together. Our commitment to sustainable development and health equity depends upon the Organization’s leadership and its ability to build a broad coalition with engaged partners across sectors. The Strategic Plan 2014-2019 recommits PAHO to improve the health of the peoples of the Americas in the years to come.
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II. Executive Summary
7. Under the theme “Championing Health: Sustainable Development and Equity,” the Pan American Health Organization (PAHO) Strategic Plan (“the Plan”) sets out the Organization’s strategic direction, based on the collective prioriti