This page compiles a selection of Good Practices in Public Health: Experiences and Lessons Learned from the Americas (BP) endorsed by the Pan American Health Organization (PAHO) within the framework of the Call for Good Practices for the Reduction of Maternal and Neonatal Mortality, October 2025. These initiatives reflect innovative and sustainable solutions implemented by governments. From this page, you can access each of the experiences available on the PAHO Good Practices Portal.
The purpose of this initiative is to recognize, document, and disseminate replicable experiences that contribute to accelerating the reduction of maternal and neonatal mortality in the Region, within the framework of the call to action “Zero Preventable Maternal Deaths in the Americas” and in alignment with the Sustainable Development Goals.
The experiences are classified into two strategic areas:
- Maternal Mortality
- Neonatal Mortality
In the case of experiences that contain elements corresponding to both categories, they have been classified under the predominant category, and the other is indicated with numbers at the end of the summary.
AREA 1: NEONATAL MORTALITY
This area focused on experiences from the first call that contribute to accelerating progress toward reducing neonatal mortality in the Region in alignment with the Sustainable Development Goals.
Neonatal Mortality
Córdoba faces significant increase in gestational and congenital syphilis: positivity rates increased from 5% in 2018 to 52.5 per 1,000 live births in 2022. Since 2021, the City of Córdoba implements a surveillance strategy based on Primary Health Care and telemedicine to detect gestational syphilis early and prevent vertical transmission to the fetus. The model adopts primary care as the coordinating axis that ensures longitudinal, person-centered care, guaranteeing that pregnant women transit through the system without interruptions in their treatment, enabling timely detection and effective treatment.
Ponta Grossa city in Paraná state, Brazil, with 375,000 inhabitants and 83% Primary Health Care coverage, faced concerning infant mortality: 11.47 deaths per thousand live births in 2024 and 9.28 in 2025, including preventable deaths. Facing this scenario, municipal management identified the need to strengthen preventive actions, particularly for preventable home-based causes such as airway obstruction and sudden infant death. The strategy qualified Community Health Agents as multipliers of educational practices, using epidemiological data for planning. It integrated surveillance, health promotion, and continuing education, strengthening the strategic role of community health agents in preventing avoidable infant deaths and improving the quality of longitudinal care in the community.
El Salvador transformed its maternal-perinatal care through a regulatory framework aligned with rights and international standards. In 2019, under political leadership, maternal-child health was prioritized, promoting the Crecer Juntos Policy. The Integral Maternal Perinatal Directorate was created and the Maternidades Nacer con Cariño model was implemented, based on Primary Health Care. The model structures five axes: organizational culture centered on family and safety, respect for rights, community participation, effective clinical practices, and articulation with other initiatives. Recovery strategies reversed the trend, reducing the Maternal Mortality Ratio (MMR) from 62.9 per 100,000 live births in 2021 to 34.5 in 2022 and to 26 maternal deaths in 2023 and 2024, the lowest level recorded, an MMR of 26.8. Likewise, neonatal mortality decreased from 5.5 per 1,000 live births in 2020 to 4.9 in 2024, incorporating five essential newborn screenings, strengthening a more humane and accessible health system.
Since 2012, Peru monitors fetal and neonatal mortality through mandatory epidemiological surveillance. With approximately 4,500 annual notifications, the neonatal mortality rate is 7.8 per 1,000 live births. The CDC Peru developed a national systematic analysis model that transforms routine data into standardized indicators to identify risks and guide decision-making. The model generates three products: coverage and quality modules, stratified analysis with sentinel indicators, and dissemination through public dashboards and epidemiological reports. Deaths concentrate in five departments, many preventable, related to prematurity, low birth weight, and home delivery in poverty contexts.
The Regional Hospital faces overcrowding in neonatology, operating at 120-130% capacity. A neonatology service with hospitalization was implemented at a Tupac Amaru Health Center I-4 to manage low-complexity pathologies (jaundice, dehydration, congenital syphilis, and weight-gaining premature infants), decongesting tertiary hospitals. The team includes pediatricians, family doctors, and trained nurses, with 8 cribs equipped with phototherapy and basic laboratory services. This decentralized initiative demonstrates that low-complexity health problems can be effectively resolved at the primary level, reducing conflicts between facilities and improving care quality through integrated work between first and third-level establishments.
In 2016, Trinidad and Tobago's Cabinet created the Directorate of Women's Health (DoWH) to identify and address deficiencies in maternal, perinatal, and neonatal health systems. Within the DoWH operates the National Breastfeeding Coordinating Unit (NBCU), which accredits health facilities as Baby Friendly through PAHO/WHO support. The NBCU implements nine key responsibilities of the Baby Friendly Hospital Initiative (BFHI), including establishing coordination bodies, integrating Ten Steps to Successful Breastfeeding into national policies, ensuring health professional competency, utilizing external assessment systems, developing compliance incentives, providing technical assistance, monitoring implementation, advocating for BFHI, and allocating sufficient resources for sustained funding.
AREA 2: MATERNAL MORTALITY
This area focused on experiences from the first call that contribute to accelerating progress toward reducing maternal mortality in the Region in alignment with the Sustainable Development Goals. Eligibility was limited to national government authorities and intergovernmental organizations.
Maternal mortality
The public maternity hospital in Tucumán implemented a unique, unambiguous, secure, and permanent identification system that includes minimum requirements to ensure filiation and filial linkage of the pregnant woman and her newborn, in compliance with current legislation, through biometric data registration and legal identity verification (National Identity Document - DNI) linkable with your digitized clinical records. This process enables secure and unambiguous identification of the pregnant woman upon admission to the institution and the newborn at the time of delivery, through filial data, biometric data registration, QR code on tamper-proof printed wristbands, and integration into the medical record. In this manner, the international right of the child to a name and nationality is respected and guaranteed, compliance is achieved with WHO's International Patient Safety Goal Nº 1 (IPSG) regarding correct patient identification, and filial linkage of the newborn with the mother is ensured, enhancing patient safety. Furthermore, patient traceability is guaranteed throughout the care process and the patient is linked to the medical record in real time, in compliance with national and international legislation, including National Law 23.849 (International Convention on the Rights of the Child), Law 24.540 (Newborn Identification), Law 26.413 (Civil Registry), and Provincial Law 6.689 (Newborn Identification).
The primary objective of the Intercultural Maternal Health program is to reduce maternal morbidity and mortality while improving access to quality health services in indigenous communities in Argentina. Implemented by UNICEF with MSD Argentina's support since 2021 in Misiones, Chaco, and Salta provinces, the program aims to strengthen health team capacities, improve care conditions, and promote community participation. Grounded in three strategic pillars—legal framework for indigenous rights, human rights approach, and intersectoral coordination—it seeks to culturally adapt health services for indigenous pregnant adolescents and women, addressing persistent maternal mortality inequities. The initiative generates concrete results in improved care practices, institutional strengthening, and local model adoption. From this base, the initiative generated concrete results in improving care practices, institutional strengthening and local ownership of the model.
The Consultório na Rua (CnR) [Street Clinic] in Santo André is a Primary Health Care service for homeless populations, operating since 2013 with a Harm Reduction approach. Between 2016 and 2025, it accompanied 33 pregnant women in street situations facing multiple vulnerabilities: substance use, food insecurity, violence, and system access barriers. In 2019, all homeless pregnant women were classified as high-risk, considering both clinical and social vulnerability criteria. The care line integrates Primary Care, specialized care, and intersectoral services, ensuring timely access to prenatal care, safe delivery, and postpartum care, reducing preventable maternal and neonatal mortality in contexts of extreme social vulnerability.
Preventable maternal mortality remains a major public health challenge linked to access inequalities. In Brazil, Primary Health Care nursing is crucial for sexual and reproductive care. To overcome barriers in providing long-acting reversible contraceptives (LARCs), the Regional Nursing Council of São Paulo (Coren-SP) implemented the "Programa Avança Mais". This initiative trained nurses in IUD insertion and bedside ultrasound use. In 2025, the program achieved over 3,000 consultations and 2,000 IUD insertions, training 90 reference professionals. This successfully expands access to reproductive planning, helps reduce maternal mortality, and strengthens the Unified Health System by promoting equity and evidence-based care.
Maternal mortality in the Brazilian Amazon is critical due to geographic barriers, social inequalities, and health service limitations. The TelePNAR Project emerges as an innovative solution, using clinical telemonitoring and structured telecoaching to qualify high-risk prenatal care in Primary Health Care. Initiated in December 2021 in 12 municipalities in Amazonas, it expanded to all 62 municipalities in the state, 7 Special Indigenous Health Districts, Acre, and Roraima. Recognized by the Ministry of Health, it strengthens local problem-solving capacity, reduces unnecessary referrals, and ensures continuity of care for vulnerable populations in the Amazon region.
Tocantins, a Brazilian state located in the Legal Amazon, has 85% of its municipalities considered small, characterized by limited infrastructure, low human development indicators, and fragile health networks. In 2023, it registered 60.48 maternal deaths per 100,000 live births, highlighting a scenario of social and economic vulnerability. To address this crisis, the State Health Secretariat implemented an educational program for managers, SUS (Brazilian Public Health System) workers, and health residents, aligned with Sustainable Development Goal 3 (SDG 3). The strategy aims to reduce maternal mortality by training health professionals to improve care during pregnancy, childbirth, and the postpartum period.
The Good Practices in Women, Child and Adolescent Health Portal is an initiative of the Fernandes Figueira Institute (IFF) of the Oswaldo Cruz Foundation, integrated by Brazilian research institutions. Its objective is to generate and disseminate scientific knowledge to implement evidence-based health policies. Directed at Unified Health System (SUS) services, managers, and health professionals, the portal promotes care qualification, reduces morbidity and mortality, and improves health practices. It prioritizes relevant topics, disseminates practices with solid scientific evidence, and maintains commitment to comprehensive care organized in networks. The initiative integrates multiple teaching and research institutions.
"TOGETHER FOR MOTHERHOOD" is a comprehensive strategy in Soledad municipality (Atlántico, Colombia) based on Primary Health Care to reduce maternal and perinatal mortality. It implemented a robust epidemiological surveillance system, institutional strengthening of 12 health insurance companies and 22 health service providers, and continuous training in obstetric emergencies. The initiative reactivated 46 community mothers who conducted 18,000 home visits for active identification of pregnant women without prenatal care. It incorporated differential approaches for ethnic and migrant populations.
The Integrated Health Services Network (RISS) Yaruquí strengthened its maternal-neonatal axis by implementing a care coordination model to ensure timely and continuous attention. Initial diagnosis revealed low early identification of pregnant women and weaknesses in referral and counter-referral processes. A model was structured with territorial organization by circuits, care pathways according to obstetric risk, liaison points for nominal follow-up of pregnant women and newborns, and an integrated digital platform. Risk stratification allows classification of pregnant women as low, medium, or high-risk. Results include increased prenatal care coverage, improved first-trimester identification, activation of prenatal ultrasound at primary level, and nominal follow-up of pregnant women and children under two years.
Hospital Gabriela Alvarado in Honduras implemented a comprehensive continuous improvement process to reduce maternal mortality. Initial assessment revealed compliance with only 12.8% of 47 obstetric safety criteria, with weaknesses in protocol standardization and case analysis. The obstetric process was systematically reorganized, institutionalizing management teams, standardizing six critical procedures, and implementing verification checklists. Innovatively, the hospital integrated dengue management in pregnancy within obstetric safety protocols. Through technical support, clinical simulation training, and monitoring of 20 strategic indicators, compliance increased to 51%, demonstrating significant transformation even with limited resources. This replicable model strengthens health systems and advances maternal mortality reduction in the Americas.
Territorial inequities in Paraguay's Western Chaco region perpetuate high rates of maternal and neonatal mortality. Geographic, cultural, and structural barriers limit access to maternal-neonatal health services in indigenous and dispersed rural communities. The Ministry of Health implemented a comprehensive intervention (2023-2025) that reorganized four health micronetworks, benefiting 93 indigenous communities from 13 ethnic groups. The strategy strengthened primary care capacity, improved referral systems, and integrated intercultural dialogue with community leaders. The intervention addressed three critical delays: decision to seek care, transportation to facilities, and system responsiveness. These changes reduced access barriers and improved continuity of maternal-neonatal care.
La Libertad Region achieved the highest reduction in maternal deaths nationally in 2025 through a comprehensive Primary Health Care strategy. It implemented active monitoring of pregnant women without prenatal care (SAG), organization of an intersectoral obstetric network, primary care equipment, improved referral systems, and the CODIGO MATER program for immediate response. It strengthened clinical competencies of health workers. The preventive approach includes early identification, timely prenatal care, humanized intercultural delivery, management of severe maternal morbidity as a sentinel event, intervention in social determinants, and adolescent pregnancy prevention. Good results are due to the coordinated work between the different levels of care.
Trinidad and Tobago's Ministry of Health, through the Directorate of Women's Health, established clinical guidelines in 2018 standardizing care for pregnant women with diabetes (DiP). This replaced selective screening with universal screening at first prenatal visit. In 2020, the National Screening and Management Project for Diabetes in Pregnancy was launched, funded by the IDB, aiming to reduce maternal and neonatal morbidity and mortality from DiP and prevent childhood obesity and diabetes. The initiative involved coordinated national leadership, building workforce capacity, establishing supply chains, and implementing digital systems. The aim of the project was to reduce the maternal and neonatal morbidity and mortality from DiP for pregnant women, as well as reduce childhood obesity and diabetes. It is estimated that 1 in 6 pregnancies in Trinidad and Tobago may be complicated by Diabetes Mellitus (Type 1, Type 2, and Gestational Diabetes). This pioneering effort was a coordinated effort that relied heavily on leadership and stakeholder involvement on a national level. This initiative was not only about rollout of the guidelines, but also about building the workforce capacity, supply chains, and digital systems necessary to operationalize universal screening in the public health care system.
Background
Within the framework of the Call to Action "Strategy to Accelerate the Reduction of Maternal Mortality in the Region of the Americas, Based on Primary Health Care" and the initiative "Access to Sexual and Reproductive Health Services in the Region of the Americas," both launched in 2024, as well as the 2025 World Health Day campaign "Healthy Beginnings, Hopeful Futures," which calls for intensifying efforts to eliminate preventable deaths of mothers and newborns and to prioritize the comprehensive health and well-being of women, the Pan American Health Organization presents the Call for Best Practices for the Reduction of Maternal and Neonatal Mortality Based on Primary Health Care.
This call aims to recognize, document, and disseminate best practices developed in Latin America and the Caribbean, with the purpose of fostering cooperation among countries, promoting the replication of successful experiences, and contributing to the strengthening of more equitable and resilient health systems, in accordance with the Sustainable Development Goals.
The concept of a good practice
The term "good practices" has various definitions. Essentially, it involves the exchange of knowledge through the documentation of methods, processes, and other aspects that could be beneficial to other institutions or countries.
The Pan American Health Organization defines good practices as those initiatives, interventions, solutions, methodologies, or procedures applied during the implementation of activities and projects at the local, subregional, or regional level that have produced results that could be adapted or replicated in different contexts and by different countries, territories, or organizations.
PAHO's intention is not to validate (or guarantee) the success of an experience, initiative, or lesson learned, but rather to ensure the systematic documentation of all practices using a validated methodology.
Call 2025
In 2025, the Pan American Health Organization launched the first call to identify and recognize Good Practices (GPs).
A total of 29 experiences were submitted from 11 Member States, of which 19 were selected that met the highest standards of quality, relevance, and potential for expansion. The evaluation process was carried out by a technical committee with support from regional experts, ensuring transparency and rigor.
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