PAHO Director calls for strengthened health legislation and primary care during visit to the Dominican Republic – PAHO/WHO

Santo Domingo, Dominican Republic, December 1, 2025 (PAHO) – The Director of the Pan American Health Organization (PAHO/WHO), Dr. Jarbas Barbosa, today urged the countries of the region to strengthen health legislation and reinforce primary health care, key pillars for more equitable, resilient and sustainable health systems.

During his official visit to the Dominican Republic, Dr. Barbosa presented an overview of health advances and challenges in the Americas to legislators, national authorities and public health experts during a keynote speech in the Dominican Senate on the state of health in the region.

“Health legislation does more than regulate policies; it shapes lives, determines the future and strengthens a country’s capacity to guarantee the right to health,” said the PAHO Director.

Dr. Barbosa highlighted that the region faces emerging and long-standing challenges that test the resilience of health systems. These include inequalities in access to services, unequal distribution of health personnel, gaps in continuity of care, poverty, social exclusion, and geographic and economic barriers. “These gaps have been aggravated by economic crises, climate phenomena, natural disasters and rapid demographic transitions,” he emphasized.

With more than 190 million people over 60 years of age in the region, there is a growing urgency to strengthen primary care, expand long-term care services and adapt social protection systems. Among emerging health threats, Dr. Barbosa mentioned outbreaks of diseases such as Oropouche and chikungunya, the resurgence of preventable diseases such as measles, and zoonotic risks such as avian influenza A(H5N1). He also warned about the alarming rise in antimicrobial resistance, which is responsible for more than half a million deaths annually in the region.

Dr. Barbosa highlighted the importance of adequate and sustainable public financing. «In recent decades, countries in the Americas have increased public health spending to an average of 4.5% of GDP. This increase has helped reduce out-of-pocket payments to 30% of total health spending, which is critical to prevent families from falling into poverty when they seek care. However, this level remains insufficient to ensure universal access and financial protection.»

Therefore, PAHO recommends increasing public health spending to at least 6% of GDP, prioritizing the financing of primary health care, and eliminating access barriers that still affect millions of people.

Eight strategic regional priorities

The Director of PAHO described eight strategic priorities for regional cooperation:

1. Health system reform based on stronger primary careto integrate health services and public health programs, reduce access barriers and promote community participation.
2. Strengthening governance and essential public health functionsto ensure management, oversight and competencies of the workforce at all levels.
3. Elimination of diseasesthrough vaccination, surveillance, access to diagnoses and treatments, sustained investment and intersectoral coordination.
4. Better care for non-communicable diseasespromoting early detection, integrated risk factor management and continued availability of essential medicines.
5. Zero maternal deathsthrough prenatal care, strengthening the primary level and training health personnel.
6. Regional revolving fundsto ensure rapid and equitable access to high-quality vaccines, essential medicines and health technologies.
7. Digital transformation for universal healththrough national digital agendas, telehealth, interoperability, artificial intelligence and cybersecurity.
8. Preparedness for health emergenciesto strengthen resilient infrastructure, inter-institutional coordination, access to drinking water, vector control and epidemiological surveillance.

Signing of agreements

Accompanied by the PAHO/WHO Representative, Alba María Ropero, Dr. Barbosa signed a Technical Cooperation Framework Agreement between PAHO and the Dominican Senate. The agreement is the first of its kind in the region and aims to strengthen the health legislative agenda through the exchange of information, joint research and training, including the participation of PAHO specialists in the Dominican Parliamentary Innovation Center.

“The laws they approve guarantee rights, organize systems, strengthen institutions, promote transparency and guarantee that no one is excluded from the right to health,” said Dr. Barbosa. “This is the first agreement of its kind in the region and will set a new standard for parliamentary health cooperation in the Americas.”

Earlier, at the Ministry of Public Health, Dr. Barbosa and the Minister of Public Health, Dr. Víctor Atallah, signed the Country Cooperation Strategy (ECC) 2026-2031, which will guide PAHO’s technical cooperation with the Dominican Republic for the next six years, aligned with the National Strategic Health Plan 2030 and the National Development Strategy. The Minister of the Presidency, José Ignacio Paliza Nouel, will also support the strategy later.

During his three-day visit, from December 1 to 3, Dr. Barbosa will meet with other high national authorities and representatives of multilateral organizations, in addition to visiting networks of primary health care services.