Objective:To describe the epidemiological and health care situation of advanced chronic kidney disease (CKD) and end-stage renal disease (ESRD) in Latin America; identify strengths and gaps in early detection, referral, and access to and coverage of renal replacement therapies (RRTs); contextualize these findings in light of the recent WHO Resolution WHA78.6 on kidney health and propose recommendations. Methods:A special report was prepared using a structured narrative approach based on a descriptive and comparative analysis of regional and global secondary data sources published over the past six years. Information was organized into four categories: 1) timely detection and referral; 2) access to and cost of RRTs;3) mortality and structural inequalities; and 4) availability and quality of national registries. Results:Latin America has a high prevalence of CKD and CKD-associated mortality that exceeds the global average, accompanied by marked disparities, deficiencies in timely referral to nephrology services, and a high proportion of unplanned dialysis initiations. Hemodialysis is far more common than peritoneal dialysis and kidney transplantation, even though the latter is the most cost-effective option and yields the best outcomes in terms of survival and quality of life. There are limitations in financial coverage and in the availability of comprehensive national registries. Conclusions:These findings highlight persistent structural shortcomings in kidney care across Latin America while also providing a basis for the development of specific, prioritized recommendations. The evidence reviewed underscores the need to strengthen kidney health governance, improve early detection and timely referral, ensure equitable and sustainable access to RRTs, strategically prioritize kidney transplantation, and consolidate interoperable information systems as a foundation for reducing mortality and inequality across the Region.
Background:Childhood cancer survival exceeds 80% in high-income countries but remains below 50% across much of Latin America. In Ecuador, limited access to diagnosis and essential medicines, and fragmented governance have hindered progress. In 2025, Ecuador became the first country in the Region of the Americas to implement the Global Platform for Access to Childhood Cancer Medicines, an initiative led by the World Health Organization (WHO) and St. Jude Children's Research Hospital to ensure equitable access to quality medicines while strengthening health systems. Methods:Between 2023 and 2025, Ecuador's Ministry of Public Health, the Pan American Health Organization (PAHO), WHO and St. Jude codesigned a participatory implementation plan. A national situational analysis guided the 2024-2026 roadmap and focused on governance, regulatory alignment, supply-chain optimization and workforce capacity. Key operational tools included medicine forecasting and quantification methodologies, developing standardized treatment protocols, and coordinating with the immunization program's cold-chain infrastructure. Results:The initiative catalyzed the creation of the National Commission for Childhood and Adolescent Cancer, integration of all prioritized oncology medicines into the national formulary, and consensus in national treatment protocols. Strengthened logistics reduced delivery times for medicines to less than 96 hours, and chemotherapy management training established a foundation for continuing education. Ecuador became the first country in the Region to receive medicines for childhood cancer procured through the Global Platform. Conclusions:Implementation of the Global Platform in Ecuador has strengthened pediatric oncology and positioned it as a national health priority. By coupling medicine access with systemic reform, Ecuador has demonstrated that collaborative governance, intersectoral coordination and political commitment can build sustainable capacity to deliver equitable childhood cancer care.
Objective:To assess mortality and disability due to injuries in the Americas, with a focus on subregional and gender disparities, and changes over time. Methods:Data from the 2021 World Health Organization Global Health Estimates were analyzed, covering all injury causes (ICD-10: V01-Y89) across 35 countries in the Americas from 2000 to 2021. Age-standardized mortality and disability-adjusted life year (DALY) rates were calculated by sex, cause, and subregion. Inequalities were quantified using absolute differences, relative ratios, and the index of disparity (IDisp). Results:In 2021, injuries caused over 662 000 deaths and 40.6 million DALYs in the Americas, with men accounting for nearly three-quarters of the burden. While age-standardized injury rates declined in most subregions, marked inequalities persisted. Interpersonal violence was the leading cause of injury-related mortality and disability, followed by road injuries, especially among men and boys aged 15-39 years. Self-harm increased substantially in both sexes, and falls rose in association with population aging. Interpersonal violence and drowning showed the highest between-country disparities, with IDisp values of 85.3 and 88.9, respectively, in 2021. Conclusions:Although some progress has been made in reducing injury burden in parts of the Americas, substantial challenges, including in some cases widening inequalities, remain. A renewed commitment to violence and injury prevention - rooted in equity, intersectoral action, and regional collaboration - is essential to reducing avoidable harms across the life course.
Objective:Noncommunicable diseases (NCDs) account for approximately 80% of annual mortality in Saint Lucia, with the results of national World Health Organization (WHO) STEPwise approach to NCD risk factor surveillance surveys in 2012 and 2020 indicating increasing prevalences of hypertension, obesity and physical inactivity. In response, the Ministry of Health, Wellness and Nutrition launched the St. Lucia Moves Initiative in 2022, aligned with the Caribbean Moves framework and WHO's Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013-2030. This study aimed to evaluate the implementation, reach, and early outcomes of the Initiative. Methods:A mixed-methods approach was used to assess program implementation and engagement. This approach combined quantitative and qualitative methods to provide a comprehensive understanding of the Initiative's reach, visibility and multisectoral integration. The study was guided by the socioecological model of health promotion, which informed both the analytical framework and the interpretation of findings across all levels. Results:Key achievements included increased public awareness of physical activity and wellness, broad cross-sectoral participation, and widespread engagement in fitness walks, media campaigns, school-based activities, and integration of the St. Lucia Moves Initiative into national cultural events. Although at the beginning, awareness of the Initiative was limited, it evolved into a recognized national movement within 2 years, supported by collaboration among government, civil society and community groups. Conclusions:Implementation of the St. Lucia Moves Initiative demonstrates the potential of evidence-based, multisectoral strategies to address the growing burden of NCDs. The program highlights the importance of strong leadership, phased implementation and youth engagement in promoting behavior change. The Initiative provides a promising model for small island developing states seeking to implement coordinated, data-driven approaches to reduce NCD risk factors and improve population health.
Objetivo. Describir la situación epidemiológica y asistencial de la enfermedad renal crónica avanzada (ERCA) y terminal (ERCT) en América Latina, identificar fortalezas y brechas en la detección temprana, la derivación, el acceso y la cobertura de las terapias de reemplazo renal (TRR), contextualizar los hallazgos ante la reciente resolución WHA78.6 aprobada por la Asamblea Mundial de la Salud sobre salud renal y proponer recomendaciones. Método. Se elaboró un informe especial con un enfoque narrativo estructurado, basado en un análisis descriptivo y comparativo de fuentes secundarias regionales y globales de los últimos seis años. La información se organizó en cuatro ejes: 1) detección y derivación oportunas, 2) acceso y costos de las TRR, 3) mortalidad e inequidades estructurales, y 4) disponibilidad y calidad de los registros nacionales. Resultados. América Latina presenta una elevada prevalencia de ERC y una mortalidad asociada a ERCA superior al promedio global, con marcadas inequidades, deficiencias en la derivación oportuna a nefrología y una alta proporción de inicios no planificados de diálisis. La hemodiálisis predomina ampliamente sobre la diálisis peritoneal y el trasplante renal, pese a que este último es la modalidad más costoefectiva y con mejores resultados en sobrevida y calidad de vida. Existen limitaciones en la cobertura financiera y en la disponibilidad de registros nacionales integrales. Conclusiones. Los hallazgos evidencian fallas estructurales persistentes en la atención renal en América Latina y, en paralelo, permiten establecer recomendaciones concretas y priorizadas. La evidencia analizada fundamenta la necesidad de fortalecer la gobernanza en salud renal, mejorar la detección y la referencia oportunas, garantizar un acceso equitativo y sostenible a las TRR, priorizar estratégicamente el trasplante renal y consolidar sistemas de información interoperables, como base para reducir la mortalidad e inequidades en la región.
Objective:To estimate the economic impact of standard pharmacological treatment for hypertension on a typical household in Argentina using a new indicator relating treatment costs to household income. Methods:A longitudinal study was conducted from December 2019 to December 2024. The standard Argentine antihypertensive treatment (amlodipine 5 mg and losartan 50 mg) was selected. Retail prices of these drugs, both as single-drug combinations and fixed-dose combinations, were obtained from the publicly available Kairos database. The Standard Treatment Economic Impact Index was developed to express monthly out-of-pocket expenditure as a proportion of the total basic basket published by Argentina's National Institute of Statistics and Censuses. Analyses were stratified by household health coverage status - with or without formal coverage. Results:Marked differences were seen in household costs by coverage status. Among households with health coverage, antihypertensive treatment costs represented 2.04%-3.39% of the total basic basket, placing expenditure below catastrophic health expenditure thresholds throughout the study. For households without health coverage, the index ranged from 6.81% to 11.31% of the total basic basket, which was above at least one of the catastrophic health expenditure thresholds used, and sometimes above both. Throughout the study, single-drug combinations were more expensive than fixed-dose combinations. Conclusions:These findings indicate a substantial financial burden for families without formal health coverage when accessing essential antihypertensive therapy. By focusing on treatment affordability rather than total household expenditure, the index may help anticipate and prevent future catastrophic health spending, particularly among uninsured populations.
Objective:To describe how Grenada leveraged the HEARTS in the Americas standardized clinical pathway to strengthen procurement of a single-pill fixed-dose antihypertensive and align prescribing and procurement across public and private sectors. Methods:Grenada adopted a national hypertension clinical pathway specifying a single-pill fixed-dose combination of telmisartan/amlodipine with chlorthalidone as preferred therapy. Implementation strategies included integration of pathway medicines into the essential medicines list and procurement systems; engagement of clinical and procurement leadership; dissemination to private providers; and engagement with private pharmacies. A descriptive analysis was conducted using predefined indicators aligned with adoption, feasibility, acceptability, and public-private alignment using survey data, program documents, procurement records, and routine reports. Results:Integration of the standardized regimen into procurement processes supported availability of telmisartan/amlodipine and chlorthalidone in public primary care facilities, although supply gaps persisted. Adoption of a single national pathway supported standardized prescribing, forecasting, and centralized procurement. Dissemination to private clinicians and pharmacies contributed to uptake in the private sector, with pharmacies independently procuring pathway medicines, supporting continuity of care across sectors, although alignment remained incomplete. Facilitators included early stakeholder engagement, alignment between clinical and procurement leadership, and regimen simplification. Limitations included data system gaps and supply chain constraints. Conclusions:A standardized clinical pathway can strengthen procurement and promote public-private alignment in hypertension care. Addressing supply chain constraints remains essential for sustained access and continuity of treatment, with lessons applicable to other small island developing states implementing HEARTS.
Objective:This analysis aimed to identify the underlying causes of gaps in routine immunization coverage observed during the COVID-19 pandemic recovery phase by applying the open-source Vaccination Coverage Quality Indicators package in R (vcqiR), addressing limitations in Multiple Indicator Cluster Surveys (MICS) that often omit quality metrics based on detailed vaccination date analysis. Methods:This secondary analysis examined vaccination doses and dates from the Jamaica 2022 MICS (MICS4), for 570 children ages 12-23 months and 24-35 months. Specific indicators included coverage, timeliness, dropouts, and missed opportunities for simultaneous vaccinations (MOSVs). Results:Vaccination coverage for first-year-of-life (1YL) doses exceeded 83% for both age cohorts. Coverage for MMR1 showed substantial catch-up from 12-23 months to 24-35 months, achieving the 95% target. However, MMR2 coverage lagged substantially (37.2% for 12-23 months and 61.9% for 24-35 months), indicating significant attrition in the second year of life. In the 12-23 month cohort, crude coverage of Penta3 was 89%, but only 70% had three valid doses. Most 1YL doses were administered in a timely manner (within 28 days), but premature administration was observed. MOSVs were negligible for 1YL doses but were frequent and mostly uncorrected for 18-month boosters, especially MMR2. Conclusions:The findings complement the MICS4 report and confirm robust early infant immunization delivery but identify programmatic gaps in second year-of-life retention plus the need to strengthen adherence to minimum age interval rules. These results provide detailed evidence necessary to inform targeted interventions and guide the design of future coverage surveys.
Objective: To synthesize the existing literature on the etiologic mechanisms of anemia, challenges in anemia measurement, and diagnostic criteria among children in Peru Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews was followed. PubMed, Web of Science, Scopus, Embase, and the Latin American and Caribbean Health Sciences Literature databases were searched for relevant studies published from 1990 to 2024. Two reviewers independently screened and extracted data from included publications. Etiologic proportions were pooled from heterogeneous studies. Data were analyzed from February 3 to August 1, 2025. Results: The scoping review included 55 studies comprising data on 4 688 221 children. Twenty studies focused on high-altitude populations and 35 on causal mechanisms of anemia, with some studies addressing both; 45 were cross-sectional (82%). Sample sizes ranged from small community studies (9 children) to large nationally representative studies (2 087 768 children). Eight studies did not report sample size. Five studies used existing databanks for spatial analyses or clustering methods to estimate anemia prevalence. Reported causes of anemia according to the findings of individual regional studies were: parasitic infections (53.0%), iron deficiency (14.0%), vitamin B-12 deficiency (13.0%), inflammation (8.0%), folate deficiency (0.2%), and unknown causes (36.0%), although estimates were not directly comparable across studies. Measurement approaches varied, with HemoCue portable hemoglobinometers used in 56.0% of studies. Use of altitude correction formulas was associated with an average increase of more than 30 percentage points in reported anemia prevalence. Conclusions: This scoping review found that anemia in Peruvian children is multifactorial, with regional studies identifying diverse etiologic mechanisms, most commonly parasitic infections and iron deficiency; nationally representative data are lacking. Variability in diagnostic methods, particularly in altitude adjustment, and limited comparability may complicate prevalence estimates. Standardized and validated approaches to anemia assessment are urgently needed to support context-specific interventions and effectively address the childhood anemia burden in Peru.
The World Health Organization (WHO) and Pan American Health Organization (PAHO) make statistical software scripts freely available to conduct standardized analysis of vaccination coverage surveys. The software and accompanying documentation are named the Vaccination Coverage Quality Indicators (VCQI). The software examines data from child vaccination records and caregiver recall to calculate indicators of vaccination access, coverage, continuity, and quality. VCQI produces output tables and figures that may be copied directly into reports and presentations, as well as survey response data sets augmented with child-level outcome indicator variables calculated according to WHO guidance. It can analyze data from routine immunization surveys, post-campaign coverage surveys, and maternal tetanus coverage surveys. VCQI may be used for either the primary analysis of data from new surveys or secondary analysis of earlier surveys. It can analyze data from USAID Demographic and Health Surveys, UNICEF Multiple-Indicator Cluster Surveys, or WHO Expanded Programme on Immunization surveys. Future versions of VCQI may be extended to analyze data from electronic immunization registries. VCQI has been available as a set of Stata scripts since 2015, and as of 2025, the core routine immunization indicators are also available as a new R package named vcqiR. To publicize VCQI’s features and capabilities and to celebrate the milestone of R package availability, the authors share this special report to describe the VCQI vision and design, discuss analyses and insights available from it, and map our vision of what the future may hold for flexible standardized analysis of vaccination coverage data.
Objective:To identify demographic, occupational, exposure, clinical, and laboratory factors independently associated with diagnostic confirmation of hantavirus infection by RT-PCR or IgM among patients with suspected hantavirus pulmonary syndrome evaluated in Río Negro and Neuquén, Argentina. Methods:A retrospective case-control study using emergency department records and epidemiological notification forms from public hospitals in Río Negro and Neuquén, Argentina, during 1996-2025. Cases were patients with suspected hantavirus pulmonary syndrome confirmed by RT-PCR detection of hantavirus RNA and/or hantavirus-specific IgM ELISA through a standardized laboratory confirmation pathway verified by the reference laboratory. Controls were suspected cases in whom hantavirus infection was ruled out through the same pathway. Demographic, occupational, exposure, clinical, laboratory, and chest radiography variables were analyzed. Logistic regression models were adjusted for age and sex; symptoms were mutually adjusted in the clinical block. Results:We included 325 suspected cases: 113 confirmed and 212 ruled out. Compared with no evident risk, the activity-based exposure scale showed strong associations for high-risk activity (aOR 156; 95% CI [10, 2 448]) and moderate-risk activity (aOR 33; 95% CI [2.4, 456]). Confirmed cases more often had elevated hematocrit (aOR 7.40; 95% CI [3.96, 13.8]), elevated lactate dehydrogenase (aOR 10.67; 95% CI [4.85, 23.3]), thrombocytopenia (aOR 11.08; 95% CI [5.59, 21.9]), and elevated creatinine (aOR 2.91; 95% CI [1.59, 5.34]). Severe respiratory failure/criteria for mechanical ventilation (aOR 5.58; 95% CI [3.16, 9.85]) and neurological symptoms (aOR 5.17; 95% CI [1.16, 28.0]) were independently associated with confirmation. Conclusions:Among patients with suspected hantavirus pulmonary syndrome evaluated in southern Argentina, structured exposure assessment and selected laboratory abnormalities were associated with laboratory confirmation. Given the study limitations, these hypothesis-generating findings may inform future development and prospective validation of clinical prediction tools.
Objective: To estimate the prevalence of human immunodeficiency virus (HIV) in men who have sex with men (MSM) in Belize and identify behavioral and structural factors associated with infection. Methods: This mixed-methods study was a secondary analysis of data from the 2024 Integrated Biological and Behavioral Surveillance Survey. A total of 490 MSM were recruited using respondent-driven sampling. Data were collected using a structured behavioral questionnaire administered via computer-assisted self-interview. Qualitative data were collected through key informant interviews and focus group discussions. Results: HIV prevalence was 11.0%. Condom use was inconsistent: 70.4% reported consistent use, while 16.1% never used condoms. Transactional sex was common (18.8% received payment and 22.0% paid for sex). Condom use was higher in respondents who paid for sex (84.3%) than in those who were paid (64.1%). HIV testing was moderate: 74.5% had ever tested, but only 42.0% were tested in the past year and 6.5% had self-tested. Awareness of pre-exposure prophylaxis and post-exposure prophylaxis was low (8.6% and 8.4%, respectively). Among respondents who were aware, < 20% had used prophylaxis in the past 6 months. Substance use was prevalent (high alcohol risk 56.7% and cannabis use 41.4%) and 50.4% engaged in risky sex under intoxication. Depression risk was 46.1%. Qualitative findings identified three themes: individual factors, health system factors, and stigma. Conclusion: MSM in Belize face a high HIV burden driven by behavioral and structural factors. Interventions should prioritize condom promotion, pre-exposure prophylaxis scale-up, mental health support, substance use prevention, and stigma reduction.
Objetivo. Describir el cumplimiento de las intervenciones de los impulsores del modelo integrado de las enfermedades no transmisibles, con base en la iniciativa HEARTS, en Perú. Método. Se invitó a participar a todas las instituciones prestadoras de servicios de salud (IPRESS) del Ministerio de Salud que implementan la iniciativa HEARTS. La evaluación se realizó entre enero y mayo del 2025. El cumplimiento se midió mediante el índice de madurez (IM), cuyo puntaje se clasifica en cinco niveles, desde el incipiente hasta el de madurez completa. Se calculó que porcentaje de IPRESS cumplen las metas de las intervenciones de los impulsores que forman el IM para hipertensión arterial (HTA), diabetes mellitus tipo 2 (DM2) y enfermedad renal crónica (ERC). Resultados. De las 1 000 IPRESS que implementan el modelo, 92% informaron el IM para HTA, 92% para DM2 y 93% para ERC. El 82,3% de las IPRESS estaban en nivel para HTA, el 75% en nivel 1 para DM2 y el 99,5% en nivel 1 para ERC. En HTA, la meta con mayor cumplimiento fue el inicio inmediato del tratamiento farmacológico, alcanzada por el 75% de las IPRESS. En DM2, las metas que más se cumplieron fueron la entrega efectiva de los resultados del tamizaje y la optimización temprana del tratamiento, alcanzadas por el 49% de las IPRESS. En ERC, la meta de mayor cumplimiento fue la disponibilidad de un protocolo de tratamiento estandarizado, alcanzada por el 17% de las IPRESS. Conclusión. Aunque la mayoría de las IPRESS muestra un IM incipiente, algunas intervenciones se cumplieron, y se señalaron las actividades que deben priorizarse para mejorar la atención.
Objective:To estimate the prevalence of HTLV-1 infection among the family members of positive index cases referred to a specialized center in Peru and its distribution by type of relationship and presence of diseases associated with the infection. Methods:A retrospective study was conducted in which the records of the HTLV-1 Research Unit of the Alexander von Humboldt Institute of Tropical Medicine in Peru were reviewed. Index cases, defined as the first positive individual in each family group, were identified and the prevalence of HTLV-1 among their immediate family members (father, mother, siblings, children, and partners) was determined using a cluster estimator. Results:A total of 1255 index cases and 3431 family members were studied. The frequency among family members studied was 30.30%. The prevalence of HTLV-1 among family members was 36.43% (95% CI: 34.67-38.23) The specific frequencies were: 63.30% among mothers, 52.33% among fathers, 32.65% among siblings, 22.84% among children, and 57.19% among partners. Conclusion:The prevalence found suggests the existence of intrafamilial transmission in the cohort, which points to a need for further studies to identify associated risk factors. The findings highlight the need to implement a new screening strategy in the country in which close relatives of all HTLV-1-positive cases are tested. This approach should be reflected in public health policies.
Objective. To monitor compliance with national sodium reduction targets for prepackaged foods marketed in Costa Rica, and to compare it with current international standards. Methods. Nutritional labeling information was collected from products sold in two supermarket chains in 2022. Sodium content (mg/100 g), sodium energy density (mg/kcal), and compliance with national targets for 2022 and with international standards (Pan American Health Organization, 2022 and 2025; World Health Organization, 2021 and 2024) were analyzed. The results were compared with evaluations performed in 2015 and 2018 (p <= 0.05). Photographs of the labels used for comparison were obtained in 2015, 2018, and 2022. Results. A total of 7402 products were registered, of which 872 met the criteria for analysis. The highest sodium levels and greatest variability were observed in condiments (0-32 750 mg/100 g), cured and processed meats (569-4800 mg/100 g), and sauces (0-4050 mg/100 g). Subcategories (stocks, seasonings for rice, ham, sausages, tomato-based sauces, and bread with cheese) exceeded national targets. Bakery products had the lowest sodium levels and the least variability; savory bread and whole wheat bread were within the specified limits. Sodium energy density ranged from 0.8 to 86.0 mg/kcal, with 5 categories exceeding the recommended values. Compliance with national targets was 84.5%; with PAHO recommendations 43.6% and 34.7% (for 2022 and 2025, respectively); and with WHO recommendations 39.2% and 33.3% (for 2021 and 2024, respectively). There were no significant differences between 2022 and the years 2015 and 2018. Conclusions. There is no evidence of sustained progress in reducing sodium in prepackaged foods in Costa Rica. Mandatory regulatory measures are required to drive improvements in public health.
Access to medicine is a central component of the right to health. Exponential increases in the price of medicines and the emergence of high-priced innovative therapies on the market have put the sustainability of the system at risk. For this reason, the province of Buenos Aires (Argentina) changed its drug policy from historically decentralized management by each health care provider to a policy based on centralized procurement, integrated processes, increased public production of medicines, and the development of information systems. This article compares both management models (decentralized versus centralized and integrated) in terms of economics and access. Implementation of a centralized and integrated policy quadrupled the public production of essential medicines, increased access to medicines for registered users by 1 071.2%, improved the capacity to monitor traceability, and generated savings of 27.18% per unit in the procurement of pharmaceuticals compared to the usual mechanism of decentralized procurement by hospitals. In terms of impact, US$ 32 590 645.66 was saved, based on demand. Centralized and integrated management of drug procurement, production, storage, and distribution resulted in significant reductions in purchase prices, improved distribution, and optimized drug traceability compared to decentralized management models.
Intra and after action reviews (IARs and AARs) are essential for the management of public health emergencies. This article reports on the experience of developing an IAR and AAR method by the Ministry of Health in Brazil, highlighting its conceptual and organizational foundations and its application in different public health emergency contexts from 2023 to 2025, a period during which 10 evaluations were conducted nationwide. The method was developed through a participatory process, based on a literature review and consultations with national and international experts, and was validated by consensus. The reviews were carried out in partnership with state health departments, using methodologies such as in-person workshops, structured debriefings, response action assessment tools, and individual instruments, often in combination. The number of participants ranged from 40 to 80 professionals, including managers, technical staff, and representatives from multiple sectors. The duration of activities ranged from meetings lasting a few hours to 2-day workshops. The reviews revealed good practices, challenges, and next steps that informed the updating of contingency plans and the incorporation of lessons learned into national and subnational policies and guidelines, synthesized in a Guide for After Action Review of Public Health Emergencies published by the Ministry of Health. This experience underscores the importance of incorporating IARs and AARs as strategic components of public health emergency preparedness and response. The process strengthens organizational learning, enhances the legitimacy of actions, and contributes to building a culture of continuous monitoring.
