PAHO, World Bank, and IDB launch technical consensus to strengthen Integrated Health Service Delivery Networks in the Americas

Washington, D.C., 27 October 2025 (PAHO) - The Pan American Health Organization (PAHO), the World Bank, and the Inter-American Development Bank (IDB) today launched the technical consensus "Updating the conceptual and operational framework for integrated health service delivery networks (IHSDNs) in the Americas," a landmark document that redefines strategies to strengthen the organization and management of health services in the Region.

The consensus-developed through a collaborative process under the Alliance for Primary Health Care in the Americas-brings together, for the first time, the strategic and programmatic perspectives of the three institutions, with the shared objective of accelerating the transformation of health systems toward integrated, equitable, and sustainable models capable of addressing structural health system challenges and the diverse barriers to access the health services, especially among population in vulnerable conditions.

"This technical consensus demonstrates that interinstitutional collaboration is not only possible but also the strategy our Region needs to tackle public health challenges," said Dr. Jarbas Barbosa, PAHO Director, during the virtual launch event. "IHSDNs are primary health care in action-adapting principles to each territory's conditions and reorganizing services to ensure access, continuity, and quality of care for all," he added.

Cristina Lustemberg, Minister of Health of Uruguay, and Carlos Alvarenga, Vice Minister for Health Management and Development of El Salvador, highlighted the relevance of the document in guiding reforms based on primary health care.

"We warmly welcome this updated document, which results from a collaborative effort within the framework of the Alliance for Primary Health Care," said Cristina Lustemberg, during her presentation. "It will serve as a clear point of reference for our commitment to overcome inequalities in access, as well as the fragmentation and segmentation that still compromise the quality of care and equity in our health system, and to deepen the PHC strategy."

When presenting El Salvador's experience, Carlos Alvarenga mentioned that "for El Salvador, it is a privilege to participate in this launch and to share our experience in advancing the maturity of our integrated health networks. El Salvador adopts the updated conceptual and operational framework for Integrated Health Service Networks (IHSDNs), aligning every strategy and project with the axes of integration and its key attributes. We have strengthened governance, the legal and regulatory framework, and ensured strategic planning and coordination across the three levels of care."

The document presents an updated conceptual and operational framework, building on PAHO's original 2010 proposal and more than a decade of regional evidence. It introduces key innovations, including:

• Strengthened governance as a process guiding institutional transformation.
• People-, family-, and community-centered models of care, with a life-course approach.
• Territorial and social participatory approaches to adapt networks to community needs and enhance intersectoral action.
• Adoption of innovative organizational and operational practices that foster a results-oriented culture and collective action, driving transformations that improve access and population health.
• Digital transformation, encompassing telehealth, interoperability, and the ethical use of data to support evidence-based decision-making, as both a platform and an integrated component of care networks.
• Flexible organizational structures that replace the traditional hierarchical model of care levels with a more integrated and adaptable organization, promoting continuity of care, coordination among services, and coherent, effective, people-centered operations.
• Progressive network implementation and development, aimed at strengthening equity, efficiency, and quality of care.

IHSDNs are essential to ensure that priority public health programs-such as maternal and child health, communicable and noncommunicable disease prevention and control, immunization, and health emergency preparedness-achieve more integrated and effective results for populations. IHSDNs seek to improve equitable access to health services, strengthen continuity and people-centered care, increase efficiency in the use of resources, and address the social determinants of health.

"This document is an important step because it provides highly relevant guidelines to address the main challenges facing health systems in the Region. It highlights the importance of governance, change management, intersectoral coordination, and digital transformation as key elements to advance toward more resilient systems," said Javier Guzmán, Head of the Health, Nutrition, and Population Division of the IDB, during his virtual intervention.

"This first technical consensus comes as we approach the two-year anniversary of the Alliance, updating the understanding of a key topic such as IHSDNs and reaffirming the commitment of the three international agencies to collaboration as the cornerstone of multilateral action in LAC. The next step will be to work with countries to implement the new IHSDN model, to deliver services with the quality and efficiency that their citizens need and deserve," said Cristian A. Herrera, Senior Health Specialist for Latin America and the Caribbean, Health, Nutrition, and Population Global Practice, World Bank.

The new publication recognizes that there is no single path to integration and proposes a flexible, adaptable framework that respects the institutional and territorial realities of each country. This technical consensus serves as a call to action and a guide to accelerate the transformation of health systems from the local to the national level.

The technical consensus on IHSDNs reaffirms the shared commitment of PAHO, the World Bank, and the IDB to advance a joint agenda that supports countries in reorganizing their health services and strengthening primary health care throughout the Region.