Washington, D.C., 20 June 2025 (PAHO) — The Pan American Health Organization (PAHO) participated in the International Seminar on Governance and Health Care Networks in Federated and Decentralized Countries, held from May 27 to 30, 2025, in Salvador de Bahia, Brazil. The event, organized by the Bahia State Secretariat of Health, the Collective Health Institute of the Federal University of Bahia, and PAHO, brought together health authorities, academics, and experts from across the globe.
The initiative created a space to exchange experiences and lessons learned on the challenges and opportunities of multilevel governance in health, with an emphasis on the articulation of integrated health service networks in federated and decentralized contexts. The agenda included technical presentations, regional debates, and collaborative working sessions, with delegations from Bolivia, Canada, Chile, Colombia, Mexico, Peru, the United States, and Venezuela from the Region of the Americas, as well as others from outside the Region, including Germany, Spain, and Italy.
In this context, Ernesto Báscolo, Chief of PAHO’s Primary Health Care and Integrated Service Delivery Unit, presented the new conceptual framework on Integrated and Comprehensive Health Service Networks (RISS) and coordinated a collaborative workshop in which the four key domains of the framework were analyzed, with contributions from technical representatives of ministries of health, subnational managers, and academics from the Region.
Báscolo emphasized that “building integrated health service networks requires not only solid technical frameworks, but also multilevel governance that articulates capacities, responsibilities, and decision-making from the local to the national level,” and noted that the seminar was “a key step forward in that direction, grounded in the realities of federated health systems in the Region.”
In another session, titled “Current challenges of health systems in global policy: mission-oriented for health for all,” Báscolo presented PAHO’s health systems governance framework, highlighting the role of the Essential Public Health Functions (EPHFs). His presentation served as a foundation for a plenary discussion and group work focused on national and subnational coordination, service integration, and territorial planning.
PAHO reaffirms its commitment to the countries of the Region to advance toward more equitable, integrated, and resilient health systems by strengthening governance, community participation, and effective articulation across levels of government.
