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Virginia Rodríguez Bartolomé
Policy Advicacy Coordinator, ISGlobal
Clara Del Olmo Suárez
Analysis Officer, ISGlobal
July 2026
Latin America and the Caribbean possess their own multilateral health system, built over more than a century, which combines technical agencies, financial institutions, and political consensus-building spaces. This mapping systematically explores the key actors within this ecosystem to explain what each organization does, the instruments they use to operate, and their most recent priorities. Through this overview, it becomes clear how these diverse institutions perform deeply complementary roles, shaping a collective effort that we will address here specifically from the perspective of their role, scope, and impact in the field of health.
Pan American Health Organization (PAHO)
Founded in 1902, the Pan American Health Organization (PAHO) is the world's oldest international public health agency. Since 1948, it has also served as the Regional Office for the Americas of the World Health Organization (WHO). This dual mandate allows it to coordinate WHO’s global guidelines with the specific needs of its 35 Member States, supported by a structure that includes an operational presence in 27 countries and eight specialized centers in France, the Netherlands, the United Kingdom, Spain, and Portugal.
While epidemiological surveillance of infectious diseases (such as dengue, malaria, tuberculosis, and HIV) remains a priority, PAHO has expanded its scope of action. On one hand, it defines the technical standards for diagnosis, treatment, and prevention adopted by the region's governments. On the other hand, it drives agendas to combat non-communicable chronic diseases (such as diabetes, hypertension, and kidney failure) that severely impact populations living in poverty.
The organization emphasizes that social determinants (housing, safe water, education, employment, and food security) shape health more powerfully than isolated medical care. Under this approach, it also develops frameworks to mitigate health risks stemming from climate change, such as floods, droughts, and extreme temperatures.
Its current roadmap is defined in its Strategic Plan 2026-2031, titled "Together for a healthier region of the Americas for all" which is organized into five objectives:
- Population health: Addressing social determinants, environmental challenges, and modifiable risk factors.
- Resilient systems: Promoting primary healthcare-based systems to ensure universal coverage without access causing catastrophic spending for individuals.
- Prevention and elimination: Accelerating the eradication of preventable communicable diseases and improving the management of chronic conditions and mental health.
- Health emergencies: Strengthening preparedness, early detection, and coordinated crisis response.
- Governance: Robustly strengthening PAHO's own technical, financial, and administrative capacities.
To execute this plan, PAHO generates scientific evidence, trains human resources, provides direct technical assistance to ministries of health, facilitates technology transfer, and coordinates health emergency responses in the region.
The Revolving Fund for VaccinesThe PAHO Revolving Fund is a solidarity-based cooperation mechanism created in 1977. Its primary feature is that it pools the demand of Member States to make joint purchases of high-quality vaccines, syringes, and related supplies. How it operates It functions through a pooled capital fund that enables the purchase of supplies at low, uniform prices through economies of scale and transparent bidding processes. Additionally, it offers countries a 60-day credit window and provides technical guidance in demand planning, logistics, and cold chain management. Achievements
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Intergovernmental Organizations
Organization of American States (OAS)
The Organization of American States, founded in 1948 and comprising 35 Member States, is built on the pillars of peace, security, democracy, and human rights. Although health is not an explicit institutional mandate, the organization addresses it transversally as a key component of social development.
This influence is channeled through the Inter-American Commission on Human Rights (IACHR), an autonomous body that monitors regional standards and defines health as a fundamental right. The IACHR does not possess direct enforcement powers to legally sanction governments, but its public investigations and recommendations generate high political pressure. Ignoring them exposes states to international scrutiny, pressure from bilateral donors, and diplomatic isolation.
Recently, the IACHR has issued recommendations on health in contexts of forced migration, mental health in prisons, reproductive rights, and access to medicines for rare diseases. These actions have prompted legislative and public policy reforms in several countries across the region, with results that vary depending on the local political context.
Ultimately, the OAS does not fund health programs, execute technical activities, or set clinical standards. Its role consists of exercising strong normative pressure through an accumulated body of jurisprudence that calls upon states to guarantee minimum conditions of coverage, equity, and access to healthcare.
Economic Commission for Latin America and the Caribbean (ECLAC)
The Economic Commission for Latin America and the Caribbean, established in 1948 and headquartered in Santiago, Chile, has 46 Member States (33 from the region and 13 from Europe, Asia, and North America) alongside subregional headquarters and offices in Argentina, Brazil, Colombia, Mexico, Uruguay, and Trinidad and Tobago. Although its original focus was on industrialization and trade, it now fully integrates the social dimension into its analyses.
ECLAC’s contribution to health governance stems from a central premise: economic inequality inevitably breeds health inequality. For the commission, fragmented, chronically underfunded health systems that are conditioned on the ability to pay represent a structural obstacle to sustainable development. Under this vision, investing in universal health is not an expense but a productive investment, as a healthy population studies better, works more, and generates greater economic value.
Through its reports, ECLAC correlates macroeconomic indicators with health outcomes. Its analyses address:
- How regressive tax structures and the burden of external debt limit public spending on health.
- The coverage gaps of fragmented social protection systems.
- The impact of rapid demographic aging on the rise of chronic and costly diseases.
- The effects of the COVID-19 pandemic in widening access gaps, particularly between vulnerable rural and urban populations.
Although it lacks executive powers, ECLAC's analyses inform the decisions of operational organizations such as PAHO and the IDB. Furthermore, it provides fiscal sustainability diagnostics to ministries of health upon request, offering the necessary technical groundwork to support their budget negotiations and substantiate political decision-making.
Community of Latin American and Caribbean States (CELAC)
The Community of Latin American and Caribbean States, created in 2011, is a political consensus-building mechanism that brings together 33 sovereign states from the region, explicitly excluding the United States and Canada. Its presidency, which rotates annually, promotes regional identity, participatory governance, and South-South solidarity.
Unlike the technical approach of PAHO or the economic analysis of ECLAC, CELAC focuses its efforts on political cooperation and consolidating a joint stance in global forums. In the field of health, it promotes two key regional sovereignty initiatives:
- Regional Health Self-Sufficiency Plan: It seeks to reduce dependence on imports of medicines and medical technologies by strengthening local pharmaceutical industries and sharing manufacturing capacities. This priority gained momentum following the severe restrictions on access to vaccines and supplies suffered during the COVID-19 pandemic, when developed countries' markets were prioritized.
- Equitable access to health technologies: It promotes technology transfer as a matter of sovereignty and global equity, rather than a purely commercial or intellectual property issue. This is vital for acquiring high-cost medicines in decentralized systems.
CELAC does not manage direct operational technical cooperation like PAHO; instead, it acts as a catalyst for bilateral and subregional agreements. An example was facilitating the regional trade of medicines produced by Cuba and Venezuela to treat COVID-19 symptoms in countries lacking them (an exchange that would have been highly complex without this political framework).
Finally, CELAC is the platform through which the region engages in bi-regional dialogue with the European Union. During periodic EU-CELAC summits, the bloc presents a common position on global health issues, including technology transfer, tropical disease research, pandemic coordination, and equity in access to medicines.
Ibero-American Summits and SEGIB
The Ibero-American Summits bring together Heads of State and Government from Latin America, the Caribbean, Spain, and Portugal. Unlike CELAC, its European dimension builds a triangular bridge toward the European Union. In preparation for these meetings, thematic ministerial gatherings are organized, including those focused on health.
The Ibero-American General Secretariat (SEGIB) acts as the permanent technical secretariat that coordinates and follows up on these summits. With a stable executive structure and a rotating presidency, SEGIB includes health as a key area of work to promote cooperation in maternal health, communicable diseases of regional relevance, and the strengthening of health systems in vulnerable contexts.
SEGIB’s value lies in providing continuity to the summits' debates, translating high-level declarations into operational actions among governments. This work is especially effective along the Spain–Latin America axis, where cultural, linguistic, and historical proximity facilitates a much more fluid technical cooperation than in other multilateral arenas.
Multilateral Financial Institutions
Inter-American Development Bank (IDB)
Founded in 1959, the Inter-American Development Bank is the main source of multilateral financing for development in Latin America and the Caribbean. It has 26 borrowing countries in the region and 18 non-borrowing shareholder partners in Europe, Asia, and Oceania. Its outstanding loan portfolio exceeds $100 billion, with health representing between 5% and 10% of annual approvals. Although its Board of Executive Directors represents all members, the presidency of the bank is traditionally held by a U.S. citizen.
The IDB’s Social Protection and Health Division designs sector loans based on a logic of complementarity with PAHO: while the latter provides technical guidelines and clinical standards, the IDB provides the capital. Thus, when a ministry of health adopts PAHO’s recommendations on care networks, it turns to the IDB to finance their execution. These loans carry performance, effectiveness, and fiscal sustainability conditions, funding everything from regulatory reforms and hospital infrastructure to equipment, rural network expansion, and technical assistance (training and digitalization).
The IDB's 2024–2030 institutional strategy prioritizes three health areas:
- Integrated primary care networks: Strengthening accessible health centers that act as the entry point to diagnose chronic conditions, resolve acute issues, and refer complex cases.
- Digital transformation: Implementing electronic health records, epidemiological information systems, and telemedicine for remote areas.
- Anticipatory epidemiological surveillance: Developing capacities to detect and respond early to outbreaks of emerging infectious diseases.
Additionally, since 2020, the bank has accelerated financing for pandemic preparedness, supporting the strategic stockpiling of medical supplies, the modernization of national laboratories, and emergency training for healthcare personnel.
All of its operations align with SDG 3 (Good Health and Well-being) and the Sustainable Health Agenda for the Americas 2018–2030. However, while its projects are designed with execution periods of 5 to 10 years to achieve deep structural changes, this timeframe often creates tension with the shorter political and electoral cycles of governments, which can compromise the continuity of reforms.
CAF - Development Bank of Latin America
CAF - Development Bank of Latin America, founded in 1970 and headquartered in Caracas, comprises 21 shareholder countries (16 from the region, plus Spain, Portugal, and Trinidad and Tobago) alongside private investors. With a loan portfolio of nearly $70 billion (smaller than that of the IDB and concentrated primarily in the Andean region and the Southern Cone), the institution finances both the public and private sectors.
Although its mandate covers infrastructure, education, and productivity, health has established itself as a strategic pillar. Its portfolio prioritizes physical infrastructure (highly complex hospitals, primary care centers, and basic water and sanitation systems) and comprehensive social protection (child nutrition, health insurance for vulnerable populations, and job training). In response to climate change, CAF promotes green infrastructure and resilient water systems, aiming for 50% of its approvals by 2030 to be green financing. This focus addresses how phenomena like droughts, floods, and extreme temperatures directly amplify health risks for the poorest populations.
Compared to the IDB, CAF stands out for its specialization in the unique challenges of the Andean region, such as the impact of altitude on drug metabolism, the complex mountainous geography that restricts access to services, and care for Indigenous communities with traditional medicine systems that require culturally sensitive approaches.
Both banks act in a complementary rather than competitive manner: while the IDB leads institutional reforms in health systems, CAF finances the physical infrastructure and social protection programs that sustain those reforms. Indeed, it is common for governments to simultaneously utilize financing from both entities to structure and execute their national health policies.
Regional Coordination in the Face of Global Debate: The Potential of the Latin American and Caribbean Health Ecosystem
Latin America and the Caribbean have consolidated a health architecture characterized by a remarkable complementarity among its technical, financial, and political consensus-building components. This structure, built over more than a century, offers an internal governance model capable of linking public policy design with financing and sector-specific diplomacy. However, a visible gap remains between the maturity of this regional ecosystem and its level of influence in discussions on reforming the global health and financial architecture, where the specific priorities of middle-income countries are often sidelined from major multilateral decisions.
In this context, the region's main challenge lies in leveraging the coordination of its own institutions to build a unified and strategic platform for dialogue. Operational alignment among technical organizations such as PAHO, political dialogue platforms, and development banks (IDB and CAF) not only strengthens internal health resilience against challenges like climate change, but also provides the bloc with a solid foundation to negotiate more equitable financing and governance conditions. Consolidating this collective voice is key to ensuring that future global health mechanisms recognize and draw upon the capacities and accumulated experience of the region.
