The results of this function were fairly homogenous, with most countries performing at the lower-intermediate level, and with a median of 0.46.
With the exception of indicator 1 (development of public health regulatory framework), which exhibited the highest performance, all other indicators performed at a lower level, especially with respect to enforcing norms (indicator 2).
Health legislation is regarded as an instrument for implementing health policies within the framework of state functions and its relationship with civil society. Therefore, countries’ efforts to reformulate existing legal frameworks and to regulate health rights and obligations present a challenge to the NHA in balancing the state’s duties and guaranteeing the effective exercise of citizen’s rights and responsibilities.
The variability among results obtained for each country shows a lower dispersion for the enforcement of laws and regulations (indicator 2) and for the development of a regulatory framework (indicator 1). The highest variation was observed in the support for sub-national entities. These results suggest that most countries have weak enforcement of regulations. Although institutional competencies and support for decentralization are strengths for some countries, they still remain critical areas for others.
The primary factors determining this function’s performance are:
• Most countries have competent staff who are knowledgeable about legislative procedures and public health regulations. They also have sufficient advisory personnel from international organizations and sufficient institutional capacity to draft health regulations.
• The countries review existing regulations to develop and modify draft legislations. However, only 11% of the countries indicated that they perform such reviews in a timely manner and 24% perform them periodically. Instead, there is a tendency to respond to pressures coming from outside the NHA, such as from the government and other institutions.
• The NHA leads the process of modifying the regulatory framework by providing technical assistance to legislators and advocating legal modifications to important decision makers.
• Although most countries have personnel responsible for enforcement, only 30% indicated that they supervise enforcement procedures, and a lower percentage reported following up on the timelines and efficacy of enforcement efforts. Eighty percent of countries do not supervise the abuse or misuse of authority by enforcement agencies, and countries generally do not have incentive programs to promote the proper use of authority by personnel.
• Fifty-one percent of the countries have mechanisms to educate the public on the importance of complying with existing laws, and only 11% offer incentives to encourage public compliance with these norms.
• Another critical area was the promotion of plans and actions to prevent corruption. Although anti-corruption measures were adopted in some countries, they were not evaluated and strategies to prevent the influence of powerful interest groups were not implemented.
• Forty-six percent of the countries have established systems to warn and punish illegal practices, and the public were aware of such systems in 35% of the countries.
• In general, countries did not have sufficient personnel or resources necessary to implement enforcement actions, making this the main critical area for the Region.
• Although new personnel are offered training courses on enforcement issues, only 24% of the countries ensure continuous training in this area. Forty percent of the countries evaluate their training programs.
• In most countries, sub-national entities receive support for the implementation of enforcement procedures and operations. However, the technical assistance provided is not evaluated periodically and support is lacking regarding informing the sub-national entities of developments in local regulation.