The EPHF measurement exercise in 41 countries and territories of the Americas has generated results that reflect the need for institutional development and infrastructure strengthening to improve public health practice in the region.

The magnitude and complexity of this task requires conceptual and methodological developments that could benefit from joint efforts by countries and international cooperation institutions. This will allow for the sharing of successful experiences, the identification of spaces for joint action, and the creation of economies of scale to achieve sustainable progress.

This highlights the importance of building a program or “agenda” for joint cooperation. This agenda should bring together, among others, international actors from the health field (bilateral, multilateral, international funding institutions, and private foundations), sub-regional health actors, and different actors at the country level, especially the health authorities and academic institutions in public health.


Priority aspects that should guide international cooperation

1. Continuous improvement of the EPHF performance measurement instrument; adapting it to the changing realities, technological innovation, and to the institutional and organizational arrangements in the Region.

2. Adaptation of the EPHF performance measurement instrument for application at the sub-national level, both for unitary and federal states.

3. Development and improvement of methods and instruments to plan and implement infrastructure strengthening strategies.

4. Development of EPHF financing, spending, costing, and budgeting frameworks.

5. Institutional strengthening actions and creation of national, sub-regional, and regional capacity for developing the public health work force.

6. Creation of new spaces for conceptual debate, and methodological development as related to the articulation of the EPHF with other components of the health system.

Critical aspects in International Cooperation

1. Periodical implementation of the EPHF performance evaluation exercises.

2. Conceptual and methodological development to ensure coordination between EPHF performance measurement, elaboration of national plans to improve public health practice, work force development, and support for national, sub-regional, and regional health objectives.

3. Establishment of a clearinghouse to disseminate lessons learned related to public health.

4. Fostering and consolidation of institutional networks including agencies that support EPHF performance evaluation and the improvement of the practice of public health.

5. Sustained advocacy both in the countries and in the international community to confront the challenges.