This function exhibited intermediate performance, with a median of 0.56 for the Region. As the graph below demonstrates, most countries performed at this intermediate level, with only one country exhibiting optimal results:
The indicators with the lowest performance were the definition of national health objectives (indicator 1), and NHA support to sub-national levels (indicator 5). The indicators with the highest performance were the development of public health policies (indicator 2), and the capacity to manage international cooperation efforts (indicator 4). The development of institutional capacity for public health management revealed an intermediate performance (indicator 3).
The weaknesses revealed in the indicator for public health management should encourage health authorities to formulate policies that address the current and future challenges in this area. Furthermore, efforts should be made to identify measures that strengthen institutional capacities for the improvement of public health.
Among the highest performing indicators, the low variability shown by indicator 2 (development, monitoring, and evaluation of public health policies) supports the conclusion that this is a strong area within the LAC Region.
The same performance was not seen in indicator 4 (management of international cooperation in public health), which showed the greatest variability among countries in the Region. Although this indicator exhibited an adequate performance overall, it remains a weak area for some countries.
With respect to the indicators that exhibited low and intermediate performance (definition of public health objectives, public health management, and support for sub-national levels), some countries exhibited optimal performance while others performed poorly.
The primary factors determining this function’s performance are:
• In most countries, the NHA defines its health objectives based on the health priorities of each country. However, the countries recognized weaknesses in updating health priorities, and 43% of the countries stated that health goals and social policy objectives were directly related. Important participants in the formulation of these objectives, such as members of civil society, were not always included. Fifty-one percent of the countries stated that the defined health goals can be measure by specific indicators chosen to assess their performance.
• In general, the countries’ health policy plans are sanctioned by the executive branch, and to a lesser extent (68% of countries) by the legislative branch. Most countries convert their policies into legal instruments and legislation necessary for successful implementation.
• Less than half of the countries consult current and potential partners to assess the support for developing, implementing, and evaluating national health policy processes. Similarly, the private sector and civil society are often not included in this consultation process.
• The countries have personnel trained in policy development, elaboration of legal instruments, and prioritization of public health policies. Most countries also have qualified personnel and resources to manage international cooperation projects and programs.
• With respect to institutional management capacity, strengths were observed in strategic planning and leadership in health. While the majority of countries have skilled personnel in strategic planning, 64% asserted that they have carried out at least one planning exercise during the last year, and that their greatest weakness in this area is in the evaluation and monitoring of these processes. With respect to leadership, most countries acknowledged that they have the capacity to generate consensus and promote inter-agency cooperation in health, and 65% have used this experience to channel resources to the health sector. The most important weaknesses observed were in the areas of conflict-resolution and communication.
• The countries indicated that adequate financing mechanisms to help achieve health objectives are not available.
• In addition, weaknesses were identified in the definition of performance indicators for measuring the attainment of health objectives. Only 51% of the countries have indicators and 38% developed evaluation strategies through participatory processes. Most countries do not engage the private sector in evaluation efforts.
• The NHA experienced difficulties in establishing partnerships to implement health policies. In general, private health services providers, insurers, social security institutes, and consumers are not included in the process.
• The principal weaknesses in institutional capacity for public health management were in the decision-making process. Forty-three percent of the countries indicated that they did not have a clear organizational vision to guide their actions. Only 32% of the countries learned from changes, and 27% evaluated institutional performance.
• With respect to support for the sub-national entities, the weaker areas coincided with those of the NHA. Most countries acknowledged difficulties in defining the necessary actions to support management at the sub-national level, and inability to respond in a timely fashion.