The bustling capital of Santo Domingo served as the backdrop for a pivotal moment in regional health policy this December. Dr. Jarbas Barbosa, the Director of the Pan American Health Organization, arrived in the Dominican Republic with a message of urgency and hope. His mission was clear as he addressed the Dominican Senate, aiming to rally legislators, national authorities, and public health experts around a common cause. According to PAHO official website.
The visit marked a significant step toward reshaping how nations in the Americas approach the well-being of their citizens. Dr. Barbosa emphasized that the path to a more equitable and resilient future relies heavily on two main pillars, which are the strengthening of health legislation and the reinforcement of primary health care systems.
During his keynote address, the Director presented a comprehensive overview of the current state of health across the region. He painted a vivid picture of the progress made over the last few decades while simultaneously highlighting the formidable obstacles that remain. The address was not merely a recitation of statistics but a call to action for lawmakers to use their power to effect tangible change. He argued that the laws passed within those parliamentary walls have profound real-world consequences for the everyday lives of citizens. “Health legislation does more than regulate policies; it shapes lives, determines futures, and strengthens a country’s ability to guarantee the right to health,” said the PAHO Director.
Navigating a Landscape of Complex Threats
The region is currently navigating a perfect storm of long-standing systemic issues and rapidly emerging threats. Dr. Barbosa detailed how these challenges are rigorously testing the resilience of health systems from North to South America. The disparities are stark, characterized by deep inequalities in access to essential services and a troubling uneven distribution of medical personnel. Too often, the quality of care a person receives depends on their geographic location or economic status.
Gaps in the continuity of care, persistent poverty, and social exclusion continue to leave millions behind. These structural weaknesses have been further exacerbated by external shocks that are becoming all too common. “These gaps have been worsened by economic crises, climate events, natural disasters, and rapid demographic transitions,” he emphasized.
One of the most pressing demographic shifts is the rapid aging of the population. There are now more than 190 million people over the age of 60 residing in the region. This demographic reality creates a growing urgency to overhaul primary care and significantly expand long-term care services. Social protection systems must adapt to support this aging populace, or they risk collapse. Simultaneously, the region is fighting a war on two fronts regarding infectious diseases.
Dr. Barbosa pointed to outbreaks of Oropouche and chikungunya, alongside the worrying re-emergence of preventable diseases like measles. Furthermore, he highlighted zoonotic risks such as avian influenza A(H5N1) and the silent pandemic of antimicrobial resistance, which is currently claiming over half a million lives annually across the Americas.
The Critical Necessity of Public Funding
A central theme of the Director’s message was the undeniable link between financial investment and health outcomes. Building a robust health system requires adequate and sustainable public financing. Dr. Barbosa analyzed the economic trends of recent decades, noting that countries in the Americas have managed to increase public health spending to an average of 4.5 percent of their Gross Domestic Product (GDP). This increased investment has yielded positive results, specifically in reducing the financial burden on individual families.
The reduction of out-of-pocket payments to 30 percent of total health expenditure is a significant milestone, yet it is not the finish line. “This increase has helped reduce out-of-pocket payments to 30% of total health expenditure, which is critical to prevent families from falling into poverty when seeking care. However, this level remains insufficient to ensure universal access and financial protection.”
To truly achieve universal health coverage where no one is left behind, PAHO is recommending a more aggressive financial target. The organization suggests that countries should increase public health spending to at least 6 percent of GDP. This additional funding should not be spent indiscriminately but rather prioritized for primary health care. By channeling resources directly into the community level and removing the access barriers that still affect millions, governments can create a safety net that protects their citizens from both illness and financial ruin.
The Technical Cooperation Framework Agreement between PAHO and the Dominican Senate was formally signed by Dr. Barbosa and Senate President Ricardo de los Santos.
source: www.paho.org
A Strategic Vision for Regional Transformation
In response to these multifaceted challenges, Dr. Barbosa outlined a comprehensive roadmap consisting of eight strategic priorities for regional cooperation. These priorities are designed to guide nations toward a healthier future through systemic reform and collaboration. The first priority focuses on health system reform anchored in stronger primary care. This involves integrating various health services with public health programs to ensure a seamless experience for patients while reducing barriers and promoting active community participation. The second priority emphasizes the strengthening of governance and essential public health functions. This ensures that stewardship, surveillance, and workforce competencies are maintained at high standards across all levels of government.
The third and fourth priorities address disease control directly. There is a renewed push for disease elimination, through rigorous vaccination campaigns, improved surveillance, and better access to diagnostics and treatment. This requires sustained investment and coordination across different sectors. Simultaneously, there must be improved care for noncommunicable diseases, involving promoting early detection strategies, managing risk factors in an integrated way, and ensuring that essential medicines are continuously available to those who need them.
Safeguarding the Vulnerable and Embracing Technology
The roadmap continues with a strong focus on maternal health, setting a bold goal of zero maternal deaths. Achieving this requires a commitment to comprehensive prenatal care, the strengthening of primary-level facilities, and the continuous training of the health workforce. Another key priority involves the use of Regional Revolving Funds. These financial mechanisms are essential for ensuring rapid and equitable access to vaccines, medicines, and high-quality health technologies, ensuring that lower-income nations are not left at the back of the queue.
The final priorities look toward the future and the unknown. Dr. Barbosa called for a digital transformation for universal health. This includes the development of national digital agendas, the expansion of telehealth services, and the implementation of interoperability, artificial intelligence, and strong cybersecurity measures. Finally, he stressed the importance of health emergency preparedness. Nations must build resilient infrastructure and improve interagency coordination to handle future crises, including securing access to safe water and maintaining strict epidemiological surveillance.
Historic Agreements Pave the Way Forward
The visit to the Dominican Republic was not just about speeches but also about solidifying partnerships. Accompanied by PAHO Representative Alba María Ropero, Dr. Barbosa signed a Technical Cooperation Framework Agreement with the Dominican Senate. This agreement is historic as it stands as the first of its kind in the entire region. Its goal is to bolster the legislative health agenda through the sharing of information, joint research initiatives, and specialized training.
This includes the participation of PAHO specialists in the Dominican Parliamentary Innovation Hub. “The laws you pass guarantee rights, organize systems, strengthen institutions, promote transparency, and ensure no one is excluded from the right to health. This is the first agreement of its kind in the region and will set a new standard for parliamentary health cooperation in the Americas,” said Dr. Barbosa.
Earlier in his itinerary, at the Ministry of Public Health, Dr. Barbosa joined the Minister of Public Health, Dr. Víctor Atallah, to sign another crucial document. This was the Country Cooperation Strategy (CCS) for the years 2026 through 2031. This strategy will serve as the guiding star for PAHO’s technical cooperation with the Dominican Republic for the next six years. It is carefully aligned with the National Health Strategic Plan 2030 and the National Development Strategy, ensuring a cohesive approach to national development.
The strategy is also set to receive endorsement from the Minister of the Presidency, José Ignacio Paliza Nouel, at a later date. Throughout his three-day visit, Dr. Barbosa continued his engagement by meeting with other senior national authorities and representatives of multilateral organizations, as well as visiting primary health care service networks to see the reality on the ground.