Organization of American States Summits of the Americas
Follow-up and Implementation: Mandates

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  1. Promote and encourage the use of digital technologies in the health sector to improve, inter alia, patient accessibility, process efficiency, and service delivery, while accommodating those who do not have digital access. (Regional Agenda for Digital Transformation, IX Summit of the Americas, Los Angeles, 2022).

  1. To decrease the amount of greenhouse gas emissions released into the atmosphere from agricultural, forestry, mining, and other land-use sectors, we commit to:

    • a. Promote policies to reduce greenhouse gas emissions, strengthen the adaptation and resilience of the agricultural sector to climate change, and enhance food security, as well as the development of sustainable agricultural practices that prioritize the health and wellbeing of local communities and stakeholders;

    • c. Pursue policies and develop mechanisms to improve the sustainable use and management of chemicals and technological practices, to promote the development of sustainable agriculture practices that maintain productivity and food security, and avoid negative impacts on local communities, rural producers, and consumers, and that support healthy terrestrial ecosystems, water systems, and the health of human populations and of fauna and flora in general; (Our Sustainable Green Future, IX Summit of the Americas, Los Angeles, 2022).

  1. Address, with solidarity and equity, the effects of the COVID-19 pandemic, in all its stages, through the aforementioned Action Plan, in accordance with national contexts, needs, and priorities with the aim of assessing and strengthening the capacity and resilience of health systems and health value chains at the national and regional levels, placing individuals at the core of health and resilience policies, the integration of the delivery of health services, including physical and mental health services, accounting for the amplified impact on and unique needs of members of groups that have been historically marginalized, discriminated against, and/or in vulnerable situations, as well as all women and girls, taking into account their diverse conditions and situations, in a manner consistent with national legislation and international law, promoting the implementation of universal health coverage for all, without discrimination, to further the wellbeing of current and future generations. (Action Plan on Health and Resilience in the Americas, IX Summit of the Americas, Los Angeles, 2022).

  1. Address the wider economic, social, and environmental dimensions of resilience, including challenges resulting from COVID-19 and constraints to sustainable post-pandemic recovery, including limited fiscal space; unsustainable debt-burdens, where applicable; lack of access to financing; challenges to food and nutrition security; and limited capacity to mitigate and adapt to the challenges of the climate crisis. (Action Plan on Health and Resilience in the Americas, IX Summit of the Americas, Los Angeles, 2022).

  1. Strengthen the resilience of our health and education systems, our economies, and our communities, bearing in mind that the Americas share many challenges, made evident or exacerbated by the COVID-19 pandemic, and that we need comprehensive and genderresponsive approaches. Likewise, work together to rebuild our economies and institutions in a resilient, inclusive, and equitable manner and with the full and equitable participation of all women in order to achieve growth. To this end, we note the importance of facilitating investments increasing the availability of critical and accessible infrastructure, strengthening supply chains and public procurement, strengthening international markets, and increasing commercial integration, which lay the foundation for long-term equitable growth and prosperity. (Action Plan on Health and Resilience in the Americas, IX Summit of the Americas, Los Angeles, 2022).

  1. Develop an evidence-based Action Plan that takes into account the sociocultural, economic, and structural challenges facing the Americas region and includes, among others, identifying measures for national and international coordination and cooperation, taking into account the global commitments assumed by the states with respect to health and resilience, with a view to:

    • a. Expanding equitable access to comprehensive people-and-community-centered health services of quality and strengthening primary care to move toward universal access to health services. To that end, promote the sharing of experiences and best practices regarding policies, regulations, and standards; strengthen intersectoral coordination in order to address the social determinants of health; and strengthen institutional structures, including building capacities for the regulation and evaluation of health systems to ensure health services and medicines are safe, effective, and of high quality; with due attention to building capacities to perform essential public health functions and implement the International Health Regulations (2005);

    • b. Strengthening educational programs in the fields of medicine, public health, nutrition, and biomedical science research, as well as recruitment and skills development of all professionals engaged in the field of health, through continuing education and training, promoting an increase in the number of people working in these specialties, with a comprehensive bio-psycho-social approach to meet the health needs of our populations; as well as retaining health personnel in developing countries, especially in the least developed countries and small-island and low-lying coastal developing states of the Caribbean and Central America;

    • c. Examining financing mechanisms that guide the involvement of national and international financial institutions and the public and private sectors in strengthening health systems in the management of new financing models aimed at improving efficiency, effectiveness, transparency, sustainability, and equity in financing, increasing and improving public financing, and making progress towards eliminating out-of-pocket expenses, when applicable, as well as pandemic prevention, preparedness, and response, encouraging international financial institutions to grant financing to the developing countries;

    • d. Strengthening regional and global health security and public health emergency preparedness for the future in keeping with previously established commitments, and increase health research and development funding, promoting regional actions to build and strengthen national and regional development and sustainable production capacities for raw materials, pharmaceuticals, and medicines, including safe and effective vaccines, medical supplies, and other essential health technologies; improving affordability and access; and responding to regional health needs, as appropriate, particularly during health emergencies;

    • e. Encouraging regional activities to increase investment and foster industry, including voluntary technology transfer on mutually-agreed terms;

    • f. Using public procurement to simultaneously promote affordability, sustainability, expertise, and development of existing health budgets in an effective, efficient, and inclusive manner; promoting ethical conduct to prevent corruption in both the public and the private sectors; and taking into account commitments adopted regionally and subregionally;

    • g. Leveraging digital tools and strengthen cooperation and the exchange of best practices for the development and application of these technologies, including the use of artificial intelligence; and safeguarding privacy in the handling of personal data, in order to facilitate access to actions for promotion of preventive and curative care, including treatment to bolster national and regional capacities;

    • h. Strengthening the capacities of health authorities and infrastructure and national epidemiological surveillance systems, as appropriate, to prevent, prepare for, detect, and respond to infectious disease outbreaks and events with epidemic characteristics, through the fulfillment of the commitments under the International Health Regulations and other international instruments, and through international cooperation and technical assistance from international organizations such as the Pan American Health Organization;

    • i. Redoubling efforts to accelerate achievement of the 2030 Agenda for Sustainable Development, including target 3.4 – to reduce by one-third premature mortality from noncommunicable diseases (NCDs) through prevention and treatment and promote mental health and wellbeing by 2030 – noting with concern that the leading cause of premature mortality in the Region of the Americas is NCDs, which disproportionately affect countries in the region, including small-island and low-lying coastal developing states in the Caribbean sub-region, accounting for the highest probability of death between the ages of 30 and 70 from any of the four major NCDs;

    • j. Scaling up commitments to mobilize and allocate adequate, predictable, and sustained resources, through domestic, bilateral, regional, and multilateral channels, including international cooperation and official development assistance; and continue exploring voluntary innovative financing mechanisms and partnerships to effectively prevent, control, and treat NCDs, taking into account the major funding gap in addressing prevention and control of NCDs, and its impact on health and resilience in the Americas;

    • k. Working to close the gaps in basic capacities among and within the countries of the region, considering in particular, impacts on access to health-related products, and the unique challenges of less developed countries especially land-locked and small-island and lowlying coastal developing states in the Caribbean and Central America. (Action Plan on Health and Resilience in the Americas, IX Summit of the Americas, Los Angeles, 2022).

  1. Emphasize, without exclusions, the mainstreaming of human rights, equity, equality, and the interconnection of multiple and compounding forms of discrimination, exclusion, and inequality, and the social determinants of health, with particular attention to the needs and challenges faced by members of groups that have been historically marginalized, discriminated against and/or in vulnerable situations, as well as all women and girls, taking into account their diverse conditions and situations, in a manner consistent with national legislation and international law, in all aspects of the Action Plan. (Action Plan on Health and Resilience in the Americas, IX Summit of the Americas, Los Angeles, 2022).

  1. Place persons and communities at the center of the Action Plan, addressing inequalities and inequities, promoting gender equality, to ensure universal access to sexual and reproductive health and reproductive rights, as agreed in accordance with the Programme of Action of the International Conference on Population and Development and the Beijing Platform for Action and the outcome documents of their review conferences, as expressed in Target 5.6 of the 2030 Agenda for Sustainable Development. (Action Plan on Health and Resilience in the Americas, IX Summit of the Americas, Los Angeles, 2022).

  1. The responsible authorities commit to evaluate gaps and develop an evidence-based action plan, rooted, inter alia, in a One Health approach to prevent, rapidly detect, and respond to infectious disease outbreaks, especially those resulting from threats to health between human beings, animals, plants and the environment and vector-borne transmission, and recognizing the threat posed by antimicrobial resistance (AMR) to human, animal, plant and environmental health, food safety, and global food security, encourage the integration of measures to improve awareness and understanding of AMR through communication, education, and training and to strengthen the evidence and knowledge base through surveillance and research. (Action Plan on Health and Resilience in the Americas, IX Summit of the Americas, Los Angeles, 2022).

  1. The responsible authorities commit to develop an Action Plan in consultation with diverse stakeholders, including civil society and other social actors and the private sector, as appropriate. (Action Plan on Health and Resilience in the Americas, IX Summit of the Americas, Los Angeles, 2022).

  1. The responsible authorities develop and implement the Action Plan with the support of the Pan American Health Organization, the Inter-American Development Bank, the Organization of American States, and other members of the Joint Summit Working Group, as appropriate and consistent with other regional initiatives underway. (Action Plan on Health and Resilience in the Americas, IX Summit of the Americas, Los Angeles, 2022).

  1. Foster multi-stakeholder forums for dialogue among the public sector, the private sector, and civil society, including women’s and youth organizations and social actors, to strengthen democratic practices, respect for human rights and fundamental freedoms, anticorruption, and open government efforts, including:

    • b. Community development planning processes, taking into account, in particular, the existence of inclusive processes, with a gender perspective, particularly with regard to post-COVID recovery and resilience to climate change that are inclusive of groups in vulnerable situations and/or historically discriminated against, and provide community members agency and oversight in the use of development resources; (Inter-American Action Plan on Democratic Governance, IX Summit of the Americas, Los Angeles, 2022).

  1. Increase efforts to ensure inclusion and diversity in all aspects of governance, through the following actions:

    • a. Increasing the use of tools that incorporate gender perspective in assessing and drafting legislation so that laws and policies are responsive to differential impacts on men, women, boys, and girls, including in efforts to address climate change, the digital economy, and healthcare, among others;

    • b. Ensuring that pandemic prevention, preparedness, and response are inclusive processes, including but not limited to the equitable and fair distribution of the provision of care, physical safety, equal digital access, and access to decent employment and wage equity and other economic opportunities; (Inter-American Action Plan on Democratic Governance, IX Summit of the Americas, Los Angeles, 2022).


  1. To continue moving toward the attainment of universal access to health and universal, quality, comprehensive, timely health coverage without discrimination, taking into consideration gender differences in health and including the availability of safe, affordable, effective, quality essential medications, as essential elements in achieving equity and social inclusion. To that end, we reaffirm our support for the Strategy for Universal Access to Health and Universal Health Coverage adopted by the member states of the Pan American Health Organization (PAHO) in 2014, and we request the collaboration of PAHO and other institutions engaged in this area to support national efforts for its implementation, consistent with international obligations, and its ongoing monitoring over time. (Health, Initiatives VII Summit of the Americas, Panama City, 2015).

  1. To continue working towards comprehensive health coverage being available to everyone at every stage of life, while ensuring that the use of health services does not expose people to financial hardship, particularly groups in a vulnerable situation. (Health, Initiatives VII Summit of the Americas, Panama City, 2015).

  1. To strengthen the ability of national health systems to prevent, detect, and respond to outbreaks of emerging infectious diseases and other public health emergencies, particularly those with the potential for cross-border effects and impacts in realms beyond health, including social, economic, security, and political risks. (Health, Initiatives VII Summit of the Americas, Panama City, 2015).

  1. We encourage efforts to strengthen preparedness and response capacities to handle outbreaks of emerging epidemic diseases, in particular through the International Health Regulations, and note the work done by PAHO to develop a regional mechanism to support those efforts. (Health, Initiatives VII Summit of the Americas, Panama City, 2015).

  1. To recall the Declaration of Commitment of Port of Spain of the Fifth Summit of the Americas, held in 2009, and the Regional Plan of Action on Non Communicable Diseases (NCDs), adopted by the member states of the Pan American Health Organization (PAHO) in 2013, which highlighted the need for the prevention and control of NCDs; also bearing in mind the global and regional target to achieve a 25 percent relative reduction in premature mortality from NCDs by 2025, and underscoring the need to intensify the multisectoral responses to the growing health, social, economic, and adverse development impacts of NCDs, through public policies and cost-effective measures within and outside the health sector. We call for the establishment of an Inter-American Task Force on NCDs, led by PAHO, that complements the United Nations Interagency Task Force on the Prevention and Control of NCDs. (Health, Initiatives VII Summit of the Americas, Panama City, 2015).

  1. To work to ensure secure and sustainable access to potable water and sanitation services for the population as a whole. We recognize that basic sanitation and hygiene are essential for health, integral and sustainable development, and environmental management and constitute a fundamental condition for the well-being and decent life of the population. (Health, Initiatives VII Summit of the Americas, Panama City, 2015).

  1. To encourage the joint efforts of the public and private sectors, civil society, and other social stakeholders to strengthen strategies for food and nutrition, specifically child nutrition, as an integral element of health in fighting poverty, hunger, and inequality. (Health, Initiatives VII Summit of the Americas, Panama City, 2015).

  1. To accelerate efforts to improve maternal and child health, in particular reducing maternal and child mortality, including neonatal mortality, and continue working to ensure effective access by all women to comprehensive healthcare, in particular during pregnancy, partum and post-partum periods. To request the collaboration of PAHO in continuing to support the countries in this endeavor. We commit to supporting the renewal of the United Nations Global Strategy for Women’s and Children’s Health. (Health, Initiatives VII Summit of the Americas, Panama City, 2015).

  1. To promote and encourage comprehensive, timely, and quality public policies on:

    1. Early childhood care, education, and development.
    2. Protecting children from economic exploitation and from any tasks that may interfere with their education and integral development, according to the principle of the effective abolition of child labor, which is contained in the ILO Declaration on Fundamental Principles and Rights at Work (1998); as well as preventing and eradicating the worst forms of child labor according to Convention 182 of the ILO (1999)
    3. Raising awareness about the adverse effects of adolescent pregnancies on the integral development of the adolescent and their offspring, as well as fostering their health and well-being.(Poverty, Inequality, and Inequity, Cartagena, 2012).

  1. To combat poverty, extreme poverty, hunger, inequality, inequity, and social exclusion through public policies that promote decent, dignified, and productive work; sustained economic growth; income growth; and access to comprehensive and quality education, health care, and housing, in order to achieve sustainable development with social justice in the Americas. (Poverty, Inequality, and Inequity, Cartagena, 2012).

  1. To promote the gradual formalization of the informal economy, recognizing its heterogeneous and multidimensional nature, through policies such as registration and information systems to facilitate formalization and access to credit, social protection mechanisms, improvement of occupational health and safety, strengthening of labor inspection, and effective enforcement of labor laws.* (Poverty, Inequality, and Inequity, Cartagena, 2012).
    *In St. Vincent and the Grenadines, the definition of “informal economy” is broad enough to encompass certain activities that are illegal but which, nevertheless, have an impact on the local economy. Taking into account their domestic circumstance, St. Vincent and the Grenadines joins consensus on this paragraph with the understanding that “informal economy” refers wholly and solely to activities that are legally sanctioned.

  1. To take action on the conditions that negatively impact the health of our people taking into account the 2011 World Conference on the Social Determinants of Health. (Poverty, Inequality, and Inequity, Cartagena, 2012).

  1. To give priority to nutrition, particularly child nutrition, in the fight against poverty, hunger, and inequality and, in this context, we underscore the importance of joint efforts by the public and private sectors, civil society, and other social actors. (Poverty, Inequality, and Inequity, Cartagena, 2012).

  1. To foster participation and collaboration between the public and private sectors, social actors and communities to promote initiatives, in accordance with corresponding domestic legal frameworks, which enable our educational centers and health facilities, including in remote and rural areas, to enjoy equitable and affordable access to, and use of, expanded broadband, information and communication technologies (ICTs), and computers. (Access to and use of Information and Communication Technologies, Cartagena, 2012).

  1. To promote the more intensive application of ICTs in health, with a view to improving the efficiency of our countries’ health information systems, including accurate record keeping, and of subregional and regional alert systems for public health events of international concern; the expansion of continuing education programs for health workers and the population; and access to information on health services in those centers and communities that need it the most. (Access to and use of Information and Communication Technologies, Cartagena, 2012).

  1. We recognise that the problem of inequality of access to comprehensive health care and health services persists, especially among vulnerable groups. We therefore commit to redoubling our efforts to promote social protection and to identify and implement strategies to advance towards universal access to quality comprehensive health care, taking into account labour, environment, gender-sensitive and social security policies, as well as the Health Agenda for the Americas 2008–2017, and will seek to provide necessary resources in order to improve our health indicators (Declaration of Port of Spain, 2009).

  1. While the region has made significant progress in reducing both maternal mortality and mortality in infants and children under 5 years, neonatal mortality has not decreased at the same rate. We call on the Pan American Health Organisation (PAHO) to continue to assist countries in addressing this problem through the implementation of the Regional Strategy and Plan of Action for Neonatal Health within the Continuum of Maternal, Newborn, and Child Care. We recognise the importance of cooperation in sharing experiences within the framework of the global Partnership for Maternal, Newborn and Child Health (Declaration of Port of Spain, 2009).

  1. We are convinced that we can reduce the burden of non-communicable diseases (NCDs) through the promotion of comprehensive and integrated preventive and control strategies at the individual, family, community, national and regional levels and through collaborative programmes, partnerships and policies supported by governments, the private sector, the media, civil society organisations, communities and relevant regional and international partners. We therefore reiterate our support for the PAHO Regional Strategy and Plan of Action on an Integrated Approach to the Prevention and Control of Chronic Diseases Including Diet, Physical Activity, and Health. We also commit to measures to reduce tobacco consumption, including, where applicable, within the World Health Organisation (WHO) Framework Convention on Tobacco Control (Declaration of Port of Spain, 2009).

  1. We instruct our Ministers of Health, with the support of PAHO, to incorporate the surveillance of NCDs and their risk factors into existing national health information reporting systems by 2015. We encourage national planning and coordination of comprehensive prevention and control strategies for NCDs and the establishment of National Commissions where appropriate (Declaration of Port of Spain, 2009).

  1. We commit to strengthening actions aimed at reducing drug abuse and illicit drug use, with particular regard to prevention, education, treatment, rehabilitation and reincorporation into society, with public awareness campaigns to assist in reducing the demand for illicit drugs (Declaration of Port of Spain, 2009).

  1. We commit to improving the health of our people through the renewal of primary health care and access by the population to comprehensive health care and health services, as well as to essential medicines. We therefore commit to take the necessary actions, in accordance with the laws, needs and capabilities of each of our countries, bearing in mind the Health Agenda for the Americas 2008-2017, the 2005 Declaration of Montevideo on the New Orientations for Primary Health Care, and the 30-15 Buenos Aires Declaration of 2007, as appropriate (Declaration of Port of Spain, 2009).

  1. We commit to improving the nutritional status of all the people of the Americas by 2015 and to the full implementation of the PAHO Regional Strategy on Nutrition in Health and Development 2006-2015. We will continue to promote the integration of nutrition into social and economic policies and plans and to reduce nutritional deficiencies through prevention and treatment strategies, including those targeted at the control of obesity and nutrition-related diseases. We also commit to increase awareness and educate our populations about the importance of diet and physical activity (Declaration of Port of Spain, 2009).

  1. We recognise that nutrition is important in combating poverty, hunger and chronic malnutrition for children, especially those under age five, and vulnerable groups. We consider it a high priority to address the issue of nutrition through the joint efforts of the public and private sectors, civil society and communities. We call upon international organisations where appropriate to continue to support national efforts to confront malnutrition and promote healthy diets (Declaration of Port of Spain, 2009).

  1. We reaffirm our commitment to the implementation of the International Health Regulations (IHR) (2005) to prevent the international spread of diseases such as pandemic influenza, yellow fever, dengue, malaria and others, and we commit to establish in our countries the basic capacities needed for surveillance and for responding to events that could constitute public health emergencies of international concern. We request that PAHO work with and support the countries, in accordance with the functions entrusted to it in the IHR (2005), in the areas of public health emergency prevention, control and response, particularly with respect to epidemics (Declaration of Port of Spain, 2009).

  1. We are committed to meeting the Millennium Declaration objective of halting and beginning to reverse the spread of HIV/AIDS by 2015 through, inter alia, identification and implementation of strategies to scale up towards the goal of universal access to comprehensive prevention programmes, treatment, care and support. We will promote scientific research and social awareness geared towards producing safe and high quality medicines and supplies with the aim of increasing access to treatment. We will implement the Regional HIV/STI Plan for the Health Sector 2006-2015, in coordination with PAHO, UNAIDS and other relevant institutions. We commit to strengthening public policies aimed at reducing the incidence of mother-to-child transmission of HIV to less than 5% by 2015. We reiterate our commitment to participating in and strengthening the Global Fund to fight AIDS, Tuberculosis and Malaria, including through resource mobilisation (Declaration of Port of Spain, 2009).

  1. We will promote integrated frameworks of public environmental, employment, health, and social security policies to protect the health and safety of all workers and foster a culture of prevention and control of occupational hazards in the Hemisphere (Declaration of Mar del Plata, 2005).

  1. We will strengthen cooperation and exchanges of information in the struggle against chronic diseases as well as emerging and re-emerging diseases such as HIV/AIDS, SARS, malaria, tuberculosis, avian flu, and other health risks. We commit to fighting the stigma, misinformation, and discrimination against people living with HIV/AIDS in the workplace and favor their full access to employment with dignity. We propose to develop crosscutting strategies and cooperation mechanisms, principally within the framework of the World Health Organization (WHO) and the Pan American Health Organization (PAHO), to combat these diseases, including the strengthening and adequate financing of the Global Fund to Combat AIDS, Tuberculosis, and Malaria as well as the development of national preparedness plans to fight potential pandemics, such as avian flu. We urge all countries to accelerate the process of ratification of the new international health regulations and seek to enhance the cooperation mechanisms that would facilitate access to pertinent measures of prevention, diagnosis, and treatment of the population at risk (Declaration of Mar del Plata, 2005).

  1. To promote occupational health and safety conditions and facilitate healthy work environments for all workers, and, to that end, ensure effective labor inspection systems. For this purpose, it is essential to foster strategic alliances between the labor, health, environment and education sectors Plan of Action Mar del Plata, 2005)

  1. To implement – with the support of the PanAmerican Health Organization (PAHO) – the “Three Ones Initiative: one HIV/AIDS action framework, one national AIDS coordinating authority, and one country-level surveillance and evaluation system” developing primary prevention of HIV/AIDS and strengthening health services for young people and other vulnerable groups, with special attention to the problem of stigma and discrimination in the labor environment, taking into account the ILO Code of Conduct on HIV/AIDS in the workplace. To promote efforts to provide integral prevention, treatment, and care to HIV/AIDS carriers with the aim of providing as close as possible universal access to treatment for all those who need it as soon as possible (Plan of Action Mar del Plata, 2005)

  1. To initiate immediately, with the support of PAHO, and finalize by June 2006, national plans on the preparation of influenza and avian flu pandemics in countries that do not have plans. In countries that already have plans, these should be implemented immediately according to the January 2005 decision of the Executive Committee of the World Health Organization (WHO) (Plan of Action Mar del Plata, 2005)

  1. To strengthen at the national level the strategy of supervised treatment of tuberculosis, with all of its components, and extend the coverage of the population at risk; in the same manner, coordinate efforts to reduce malaria in endemic countries and strengthen the fight against classic and hemorrhagic dengue (Plan of Action Mar del Plata, 2005)

  1. To strengthen, within national health systems , primary health care actions as a step to prevent diseases and their consequences and reduce morbidity with the purpose of ensuring equal access to health services for all people in the hemisphere (Plan of Action Mar del Plata, 2005)

  1. We recognize the positive results of the Global Fund for HIV/AIDS, tuberculosis, and malaria (GFATM) and we reaffirm our support to their activities and goals. We recommend the continued important participation of civil society in the fulfillment of these goals, and we urge the Global Fund Board to evaluate the eligibility criteria with the intent of addressing middle income countries in the hemisphere Plan of Action Mar del Plata, 2005)

  1. We emphasize that one of the pillars of human development and national progress is social protection for health and, accordingly, we will continue to broaden our prevention, care, and promotion strategies as well as investment in this field in an effort to provide quality health care for all and to improve, to the extent possible, social protection for all people, with a particular focus on the most vulnerable segments of society (Declaration of Nuevo León, 2004).

  1. We are particularly concerned with the toll that HIV/AIDS is taking on our respective societies, the proliferation of the disease, and the threat that it poses to the security of our peoples. We recognize that in order to combat the HIV/AIDS pandemic we must intensify our prevention, care, and treatment efforts within the Hemisphere. Our political leadership is essential to confront the stigma, discrimination, and fear, which deter people from being tested and from accessing treatment and care. We recognize that to confront the challenge posed by the HIV/AIDS pandemic, it is necessary to continue increasing global cooperation efforts (Declaration of Nuevo León, 2004).

  1. Pursuant to the relevant resolutions of the United Nations and its specialized agencies, the relevant decisions of the World Trade Organization and the World Health Organization’s 3x5 Initiative, we commit to facilitate affordable treatment for HIV/AIDS, with the goal of providing antiretroviral therapy to all who need it as soon as possible and to at least 600,000 individuals needing treatment by the year 2005 (Declaration of Nuevo León, 2004).

  1. We also urge the Global Fund to fight AIDS, Tuberculosis and Malaria to identify criteria to enable the countries of Latin America and the Caribbean to have greater access to its resources (Declaration of Nuevo León, 2004).

  1. We are also concerned about emerging diseases and reemerging diseases, such as malaria, dengue, yellow fever, tuberculosis, leprosy, Chagas, and others, bearing in mind the current economic, social, and environmental health contexts, the impact of recurrent natural disasters, and health problems associated with the unplanned growth of densely populated areas (Declaration of Nuevo León, 2004).

  1. We are therefore committed to reinforcing promotion, prevention, control, and treatment programs, continuing to develop and strengthen technical cooperation strategies among the countries of the region, and to deepening technical cooperation with Pan-American Health Organization, the Inter-American Development Bank, and other inter-American agencies and key actors, with a view to implementing integral public health activities for the control and eradication of these diseases (Declaration of Nuevo León, 2004).

  1. We believe that ensuring environmental health for our people is an investment for long-term well-being and prosperity. We are encouraged by the new alliance between our Ministers of Health and Environment in the Americas and we instruct them to develop a cooperation agenda to prevent and minimize the negative impacts to the environment and human health (Declaration of Nuevo León, 2004).

  1. We acknowledge that another major threat to the security of our people is HIV/AIDS. We are united in our resolve to adopt multi-sectoral strategies and to develop our cooperation to combat this disease and its consequences (Declaration of Québec, 2001).

  1. We emphasize that good health and equal access to medical attention, health services and affordable medicine are critical to human development and the achievement of our political, economic and social objectives (Declaration of Québec, 2001).

  1. Recognizing - further to the commitments made at the Miami and Santiago Summits and in accordance with agreed-upon international development goals in the areas of maternal, infant, child and reproductive health - that good physical and mental health is essential for a productive and fulfilling life, and that equitable access to quality health services is a critical element in the development of democratic societies, and for the stability and prosperity of nations; that the enjoyment of the highest standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition, as set forth in the Constitution of the World Health Organization; that gender equality and concern for indigenous peoples, children, the elderly and under-served groups must be of paramount concern in the development of health policy; that health outcomes are affected by physical, social, economic and political factors and that the technical cooperation of the Pan American Health Organization (PAHO) and other relevant international organizations should continue to support health actions in the Hemisphere, in a manner consistent with the Shared Agenda for Health in the Americas signed by PAHO, the IDB, and the World Bank: (Plan of Action Québec, 2001).

  1. Reaffirm their commitment to an equity-oriented health sector reform process, emphasizing their concerns for essential public health functions, quality of care, equal access to health services and health coverage, especially in the fields of disease prevention and health promotion, and improving the use of resources and administration of health services; promote the continued use of scientifically validated, agreed-upon, common indicators for assessing effectiveness, equity and efficiency of health systems;(Plan of Action Québec, 2001).

  1. Strengthen and promote development of domestic standards of practice, accreditation and licensing procedures, codes of ethics, and education and training programs for health personnel; improve the mix of health personnel in the provision of health services to better respond to national health priorities;(Plan of Action Québec, 2001).

  1. Intensify efforts and share and promote best practices to:

    • reduce maternal and infant morbidity and mortality;
    • provide quality reproductive health care and services for women, men and adolescents; and
    • carry out commitments made at the Cairo International Conference on Population and Development and its five-year follow-up in New York ;(Plan of Action Québec, 2001).

  1. Develop processes to evaluate the efficacy of alternative health practices and medicinal products to ensure public safety and share this experience and knowledge with other countries in the Americas; ( Plan of Action Québec, 2001).

  1. Commit, at the highest level, to combat HIV/AIDS and its consequences, recognizing that this disease is a major threat to the security of our people; in particular seek to increase resources for prevention, education and access to care and treatment as well as research; adopt a multi sectoral and gender sensitive approach to education, to prevention and to controlling the spread of HIV/AIDS and Sexually Transmitted Diseases (STDs) by developing participatory programs especially with high risk populations, and by fostering partnerships with civil society including the mass media, the business sector and voluntary organizations; promote the use of ongoing horizontal mechanisms of cooperation to secure the safety of blood; increase national access to treatment of HIV/AIDS related illnesses through measures striving to ensure the provision and affordability of drugs, including reliable distribution and delivery systems and appropriate financing mechanisms consistent with national laws and international agreements acceded to; continue dialogue with the pharmaceutical industry and the private sector in general to encourage the availability of affordable antiretrovirals and other drugs for HIV/AIDS treatment, and promote strategies to facilitate the sharing of drug pricing information including, where appropriate, that available in national data banks; promote and protect the human rights of all persons living with HIV/AIDS, without gender or age discrimination; utilize the June 2001 UN General Assembly Special Session on AIDS as a platform to generate support for hemispheric and national HIV/AIDS programs;(Plan of Action Québec, 2001).

  1. Enhance programs at the hemispheric, national and local levels to prevent, control and treat communicable diseases such as tuberculosis, dengue, malaria and Chagas ;( Plan of Action Québec, 2001).

  1. Promote healthy childhood development through: prenatal care, expanded immunization programs, control of respiratory and diarrheal diseases by conducting programs such as the Integrated Management of Childhood Illnesses, health education, physical fitness, access to safe and nutritious foods, and the promotion of breast feeding;(Plan of Action Québec, 2001).

  1. Implement community based health care, prevention and promotion programs to reduce health risks and non communicable diseases such as cardiovascular disease and including hypertension, cancer, diabetes, mental illness as well as the impact of violence and accidents on health;(Plan of Action Québec, 2001).

  1. Participate actively in the negotiation of a proposed Framework Convention on Tobacco Control; develop and adopt policies and programs to reduce the consumption of tobacco products, especially as it affects children; share best practices and lessons learned in the development of programs designed to raise public awareness, particularly for adolescents, about the health risks associated with tobacco, alcohol and drugs;(Plan of Action Québec, 2001).

  1. Provide sound, scientific and technical information to health workers and the public, utilizing innovations such as the Virtual Health Library of the Americas; encourage the use of tele-health as a means to connect remote populations and to provide health services and information to under served groups, as a complement to the provision of existing health care services;(Plan of Action Québec, 2001).

  1. Seek, through public and private efforts, or partnerships between them, to enhance the availability, access to, and quality of drugs and vaccines, especially for the most needy, by promoting efforts to safeguard the quality, rational selection and use, safety and efficacy of pharmaceutical products, with special emphasis on vital and essential drugs; and by supporting regional initiatives that by the year 2002 will facilitate research, development, production and utilization of vaccines, which will reduce the incidence of diseases, such as pneumonia, meningitis, measles, rubella and mumps. (Plan of Action Santiago, 1998).

  1. Strengthen and improve existing national and regional networks of health information and surveillance systems, so that stakeholders have access to data to address critical health issues in the Region, in order to make appropriate clinical and managerial decisions. They will address the development, implementation and evaluation of needs-based health information systems and technology, including telecommunications, to support epidemiological surveillance, the operation and management of health services and programs, health education and promotion, telemedicine, computer networks and investment in new health technologies.(Plan of Action Santiago, 1998).

  1. Develop initiatives designed to reduce deficits in access to and quality of drinking water, basic sanitation and solid waste management, with special emphasis in rural and poor urban areas, by applying existing technologies or developing new, appropriate and effective low-cost technologies.(Plan of Action Santiago, 1998).

  1. Make every effort to ensure that the necessary resources are allocated for the development of the lines of action of this Plan, with the technical support of the Pan American Health Organization (PAHO). They also will promote bilateral and multilateral collaboration, and will request the Inter-American Development Bank (IDB), the World Bank, and other financial and technical cooperation institutions to support the programs and activities included in this initiative, according to their own specific priorities and fields of action. (Plan of Action Santiago, 1998).

  1. Develop mechanisms for evaluating the relevance, cost and efficacy of the technologies introduced to deal with these and other priority health problems.(Plan of Action Santiago, 1998).

  1. Promote policies designed to improve women's health conditions and the quality of health services at every stage of their lives.(Plan of Action Santiago, 1998).

  1. Give the highest priority to reducing infant malnutrition, concentrating efforts on health, nutrition and education programs for the nutrition of infants, particularly those less than three, as those are the years of greatest vulnerability. To that end, emphasis shall be given to adequate nutrition and the correction of specific nutritional deficiencies, specifically with vitamin and mineral supplements combined with greater use of vaccinations and immunizations and monitoring during the growth of the child. (Plan of Action Santiago, 1998).

  1. Give high priority to the nutritional and caloric needs of women before and during pregnancy and while they are breast-feeding. Governments therefore will promote breast-feeding as an important source of nutrition for babies. The nutritional needs of other high risk groups such as the elderly and the disabled will also be addressed. (Plan of Action Santiago, 1998).

  1. Continue, as far as possible, with the dialogue begun at the Inter-American Conference on Hunger, held in Buenos Aires in October 1996, and they will explore the application, in their respective jurisdictions of the measures suggested there, in particular the creation of alliances with the private sector to fight hunger and malnutrition, the creation of food bank networks with volunteer participation and the creation of an Honorary Council dedicated to fostering activities to reach Summit objectives in this area.(Plan of Action Santiago, 1998).

  • Initiative 1. Strengthen programs to increase access to safe drinking water, control and improve air quality, and upgrade health conditions with a view to reducing mortality and morbidity among children and mothers, and establish environmental quality standards with the participation of civil society. (Plan of Action Santa Cruz de la Sierra, 1996).

  • Initiative 2. Strengthen national programs, and those of the Pan American Health Organization (PAHO), for the control of emerging and recrudescent infectious-contagious diseases and for immunization against diseases of public health importance, for example, those diseases related to environmental deterioration.(Plan of Action Santa Cruz de la Sierra, 1996).

  • Initiative 3. Promote mechanisms of hemispheric cooperation for the exchange of information and experiences on national policies and measures to reduce the effects of environmental problems on child health.(Plan of Action Santa Cruz de la Sierra, 1996).

  • Initiative 4. Improve the coverage and quality of the health services available to the population, for example, services related to diseases arising from environmental pollution, with emphasis on primary care for the most vulnerable groups, giving priority to preventive and promotional aspects and to access to family planning information and services, with the participation of the various sectors concerned.(Plan of Action Santa Cruz de la Sierra, 1996).

  • Initiative 6. Promote the inclusion of disease outbreak response and disaster planning, preparedness, and mitigation in national development plans; seek to establish, as appropriate, regional emergency response teams and regularly test contingency plans; and promote the establishment of appropriate building construction codes that include regulatory and enforcement mechanisms through the sharing of technical information and expertise. (Plan of Action Santa Cruz de la Sierra, 1996).

  • Initiative 47. Seek to establish, strengthen, and implement, where appropriate, specific programs, laws, and policies to protect public health by ensuring that drinking water is free from microorganisms, heavy metals, and chemical contaminants harmful to human health.(Plan of Action Santa Cruz de la Sierra, 1996)

  • 17.1 Despite impressive gains in the Hemisphere, limitations on health services access and quality have resulted in persistently high child and maternal mortality, particularly among the rural poor and indigenous groups. (Plan of Action Miami, 1994).

  • 17.2 Endorse the maternal and child health objectives of the 1990 World Summit for Children, the 1994 Nariño Accord and the 1994 International Conference on Population and Development, and reaffirm their commitment to reduce child mortality by one-third and maternal mortality by one-half from 1990 levels by the year 2000.(Plan of Action Miami, 1994).

  • 17.3 Endorse a basic package of clinical, preventive and public health services consistent with World Health Organization, Pan American Health Organization (PAHO) and World Bank recommendations and with the Program of Action agreed to at the 1994 International Conference on Population and Development. The package will address child, maternal and reproductive health interventions, including prenatal, delivery and postnatal care, family planning information and services, and HIV/AIDS prevention, as well as immunizations and programs combating the other major causes of infant mortality. The plans and programs will be developed according to a mechanism to be decided upon by each country. (Plan of Action Miami, 1994).

  • 17.4 Develop or update country action plans or programs for reforms to achieve child, maternal and reproductive health goals and ensure universal, non-discriminatory access to basic services, including health education and preventive health care programs. The plans and programs will be developed according to a mechanism to be decided upon by each country. Reforms would encompass essential community-based services for the poor, the disabled, and indigenous groups; stronger public health infrastructure; alternative means of financing, managing and providing services; quality assurance; and greater use of non-governmental actors and organizations. (Plan of Action Miami, 1994).

  • 17.5 Strengthen the existing Inter-American Network on Health Economics and Financing, which serves as an international forum for sharing technical expertise, information and experience, to focus on health reform efforts. The network gathers government officials, representatives of the private sector, non-governmental institutions and actors, donors and scholars for policy discussions, analysis, training and other activities to advance reform; strengthens national capabilities in this critical area; and fosters Hemisphere-wide cooperation.
    Convene a special meeting of hemispheric governments with interested donors and international technical agencies to be hosted by the IDB, the World Bank and PAHO to establish the framework for health reform mechanisms, to define PAHO's role in monitoring the regional implementation of country plans and programs, and to plan strengthening of the network, including the cosponsors' contributions to it.(Plan of Action Miami, 1994).

  • 17.6 Take the opportunity of the annual PAHO Directing Council Meeting of Western Hemisphere Ministers of Health, with participation of the IDB and donors, to develop a program to combat endemic and communicable diseases as well as a program to prevent the spread of HIV/AIDS, and to identify sources of funding. (Plan of Action Miami, 1994).

  • 17.7 Urge the March 1995 World Summit for Social Development and the September 1995 Fourth World Conference on Women to address the issue of access to health services. (Plan of Action Miami, 1994).



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