1

PAHO/WHO Country
Cooperation Strategy
Belize
2023-2027
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TABLE OF CONTENTS Page

Foreword by PAHO/WHO Representative in Belize 4

Message from Government of Belize 5

Acronyms and Abbreviations 6

Executive Summary 8

Chapter 1- Introduction

1.1 PAHO/WHO’s Comparative Advantage 9

1.2 Country Context 9

1.3 The Role of CCS in wider health development landscape 10

1.4 Overview of WHO Policy Framework 11

1.5 GPW 13 and regional and subregional priorities 12

1.6 CCS Development Process 12

Chapter 2 - Health and Development Situation

2.1 Health Status of the Population 14

2.2 Major Health Problems 15

2.3 Health systems response in Belize 19

2.4 Cross-cutting Themes 23

2.5 Partnership and Development Cooperation 24

Chapter 3 - PAHO/WHO’s cooperation over the past CCS cycle 26

Chapter 4 - The Strategic Agenda for PAHO/WHO cooperation 29

Chapter 5 - Implementation 41

Chapter 6 - Monitoring and Evaluation 44

Chapter 7 – References 48
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FOREWORD BY PAHO/WHO REPRESENTATIVE IN BELIZE

The Pan American Health Organization, which also serves as the Regional Office for the
Americas of the World Health Organization (PAHO/WHO), seeks to provide technical
cooperation to its Member States in support of the implementation of their national
development plans and, specifically their national health strategic agenda. Belize’s National
Medium Term Development Strategy (#Plan Belize) 2022-2026 and the Ministry of Health and
Wellness’ Health Sector Strategic Plan 2014-2024 have both identified the achievement of
Universal Health Coverage through quality primary health care/integrated health service
delivery network, prevention and control of communicable and non-communicable diseases
and pandemic preparedness and response as some priority areas for action. The COVID-19
pandemic also highlighted the need to strengthen health systems and to build capacity in human
resources for health.

It is within this context that PAHO/WHO has, through an inclusive and collaborative process,
developed this Country Cooperation Strategy (CCS) for Belize for the period 2023-2027. The
CCS outlines the medium-term vision that will guide PAHO/WHO’s technical cooperation
with Belize in support of its national health strategic priorities over the next five years. Through
this strategy, PAHO/WHO will also continue to work and collaborate with United Nations
agencies, international development partners and other relevant stakeholders to achieve
universal health coverage and the Sustainable Development Goals, in particular goal number
3, “Striving to ensure healthy lives and promoting wellbeing for all at all ages”.

Belize has made advances in healthcare and is working assiduously towards strengthening the
health infrastructure and human resources for health while also addressing the determinants of
health. However, the Ministry of Health and Wellness faces challenges with the double burden
of non-communicable diseases and mental health disorders and communicable diseases. The
country is scheduled to be soon certified as having eliminated Malaria and is working towards
the elimination of mother-to-child transmission of HIV, Syphilis and Hepatitis B. Work
continues towards the improvement of the vaccination coverage in children following the
decline during the COVID-19 pandemic.

This new 2023-2027 CCS supports the national strategic priorities and commitments and was
developed using a participatory, results-based approach that involved national counterparts and
stakeholders from across several sectors. It builds on previous achievements and ongoing
support and is well aligned with key global and regional development and health agendas
including the Sustainable Development Goals and the PAHO Strategic Plan 2020-2025.
PAHO/WHO seeks to implement this CCS in partnership with the Ministry of Health and
Wellness and thus further deliver on our commitment to working towards achieving sustainable
development, health equity and universal health in support of the health and well-being of the
people of Belize.

Karen Lewis-Bell
PAHO/WHO Representative in Belize
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MESSAGE FROM GOVERNMENT OF BELIZE

The Ministry of Health & Wellness (MOHW) is moving towards providing Universal Health Coverage
to every Belizean. This entails providing quality, affordable and comprehensive health services within
a resilient environment that promotes equal health and wellbeing for all. It is my anticipation to work
with all partners who engage in health services so as to strengthen our national health system.

There are specific health problems, such as chronic diseases and external violence, e.g. that impose a
significant burden, not only to the health system, but at the family level. This impact at the family level
consequently affects the overall community wellbeing. There are other social determinants that have a
direct effect on individual and community health, such as migration and poverty.

I acknowledge that addressing the Sustainable Development Goals (SDGs), through a Whole-of-
Government Approach will contribute to address specific determinants responsible for health
challenges, and simultaneously set in place mechanisms to promote wellness. This strategic approach
will encompass addressing poverty determinants, education opportunities, provision of clean water and
sanitation, promotion and support of a good nutrition, improving childhood diseases vaccination
coverage, etc.

It is crucial to review our national health system and work along with the private sector to ensure that
the necessary organizational and functional structures are in place to ensure an improved quality of care.
Health care services need to be affordable and accessible to the population, especially to the vulnerable
groups. A first step is to strengthen the structures of the primary care network. However, I am cognizant
of the significant challenges Belize faces, being the limited human resources, to be able to match the
population growth. The continued support from PAHO/WHO has allowed us to provide significant
capacity building to the health care personnel as a means to improve effectiveness in the day-to-day
primary care interventions.

The current Health Sector Support Programme, being funded by the European Union, and implemented
by PAHO/WHO is contributing to develop disaster resiliency and environmentally friendly health
facilities. Within the institutional setting, much has been achieved but it is necessary to recognize that
emerging and reemerging diseases demand improved laboratory and imaging diagnostic capabilities.
The experience with the COVID-19 pandemic now urges us to strengthen our surveillance system so
as to be able to detect and respond to public health emergencies in a timely manner. For this reason, the
current technical assistance from PAHO/WHO on this area should be maintained. This can be achieved
through consolidation of partnerships among United Nations Agencies and diverse public organizations.
Resource mobilization can be achieved through a solid and effective intersectoral collaboration and
bilateral cooperation.

Finally, I take the opportunity to express my commitment to promote ‘Health in all Policies’, with the
support of PAHO/WHO through this cooperation strategy. This is important for promoting a healthy
lifestyle and also contributes in addressing behaviors and practices that harm the health of the Belizean
population

Honorable Kevin Bernard

Minister of Health and Wellness
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ACRONYMS & ABBREVIATIONS

AIDS Acquired Immunodeficiency Syndrome
ART Anti-Retroviral Therapy
BHIS Belize Health Information System
BWP Biennial Work Plan
CARICOM Caribbean Community
CARPHA Caribbean Public Health Agency
CCS Country Cooperation Strategy
CIP Country Implementation Plan
COMISCA Council of Ministers of Health Central America and the Dominican Republic
COVID-19 Corona Virus Disease of 2019
CPRP Country Preparedness and Response Plan
CSME CARICOM Single Market and Economy
CSO Civil Society Organization
CSU Country Support Unit
DALYs Disability Adjusted Life Years
EOC Emergency Operations Centre
EMT Emergency Medical Team
EU European Union
FA Focus Area
GDP Gross Domestic Product
GPW General Programme of Work
HIV Human Immunodeficiency Virus
HRH Human Resource for Health
HSSP Health Sector Strategic Plan, 2014 -2024
IDB Inter-American Development Bank
IMF International Monetary Fund
IHR International Health Regulations
JEE Joint External Evaluation (IHR core capacities)
KHMH Karl Heusner Memorial Hospital
M&E Monitoring and EvaluationMH Mental Health
MHDFIPA Ministry of Human Development, Families and Indigenous People’s Affairs
MNSS Mental, Neurological, Substance use disorders and Self-harm
MOHW Ministry of Health and Wellness
NCDs Noncommunicable Diseases
NDACC National Drug Abuse Control Council
NGO Non-governmental Organization
NHI National Health Insurance
PAHO Pan American Health Organization
PLISA PAHO Health Information Platform for the Americas
PUP People’s United Party
PWR PAHO/WHO Representative
SDGs Sustainable Development Goals
SHAA Sustainable Health Agenda for the Americas
SIB Statistical Institute of Belize
SICA Central American Integration System
SSB Social Security Board
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SP Strategic Priority
TB Tuberculosis
TWG Technical Working Group
UN United Nations
UNAIDS Joint United Nations Programme on AIDS
UNFPA United Nations Population Fund
UNICEF United Nations Children’s Fund
WASH Water Sanitation and Hygiene
WHO World Health Organization
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EXECUTIVE SUMMARY
PAHO is committed to ensuring that all people have access to the health care they need, when
they need it, with quality and without fear of falling into poverty. Through its work, PAHO
promotes and supports the right of everyone to good health. The Country Cooperation Strategy
(CCS) provides a country-level platform for intensive, wide-ranging dialogue on a country’s
health needs and aspirations while sensitizing partners to WHO’s General Programme of Work
(GPW) and global and regional goals. It is a unique opportunity to renew and deepen the
collaboration between PAHO/WHO and MOHW, as well as other key sectors and partners.

The foundation of PAHO/WHO’s work is Sustainable Development Goal (SDG) 3- “Striving

to ensure healthy lives and promoting wellbeing for all at all ages.” The aim is to promote
health rather than merely fighting disease, and to improve health among vulnerable populations
thus reducing inequities. No one should be left behind.

In Belize, there were 2,519 total deaths in 2021, with the 5 leading causes being COVID-19
(360; 14.3%), diseases of the heart (358; 14.2%), malignant neoplasms (273; 10.8%), diabetes
mellitus (165; 6.6%) and homicide (153; 6.1%)1. While the leading causes of death amongst
females apart from COVID-19 were all related to noncommunicable diseases (NCDs), males
were also significantly affected by homicide and unintentional injuries.

A national consultation took place in November 2022 engaging key stakeholders, decision
makers from the MOHW, UN agencies resident in Belize, other developmental partners
(especially those working with SDGs), and key non-governmental Organizations (NGOs). This
allowed involved parties to come to a consensus on the main strategic priorities (SPs)
and the related focus areas (FAs) for the CCS 2023-2027.

Strategic Priority Areas:

1. Provide expanded and equitable access to quality health services for the prevention,
detection, treatment, rehabilitation and palliative care for non-communicable diseases (NCDs)
and mental health (MH) conditions across the life course through evidence-based interventions
and intersectoral partnerships for action.

2. Increase response capacity of integrated health services to monitor, prevent, detect, treat,
control and eliminate communicable diseases including neglected infectious diseases by
addressing the determinants of health through intersectoral actions to reduce risk factors.

3. Adequate availability and distribution of a competent, skilled health workforce with access
to technology, and educational opportunities with sustainable financing.

4. Strengthen and build national and local emergency response systems with capabilities to
monitor, detect, respond, prevent and mitigate Public Health Emergencies, Disasters and
Hazards.

1 Abstract of Statistics. Statistical Institute of Belize. Source: Ministry of Health and Wellness.
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CHAPTER 1: INTRODUCTION

1.1 PAHO/WHO’s Comparative Advantage

PAHO is the specialized health agency of the Inter-American system and is the regional office
for WHO in the Americas. PAHO works with countries throughout the region to improve and
protect people’s health. PAHO engages in technical cooperation with its member states to fight
communicable and noncommunicable diseases and risk factors, to strengthen health systems,
and to respond to emergencies and disasters.

PAHO is committed to ensuring that all people have access to the health care they need, when
they need it, with quality and without fear of falling into poverty. Through its work, PAHO
promotes and supports the right of everyone to good health. During the early years of the
PAHO/WHO technical cooperation, efforts in the Caribbean were focused on approaches to
assist with health systems infrastructure development, primary health care, and maternal and
child health, along with policies to improve the health and well-being of populations at the
country level. More recently, work has been focused on the National Health Agenda.

1.2 Country Context

Socio-economic Situation
Belize is the only English-speaking country located in Central America and borders Guatemala
and Mexico. Its land mass is 8,867 square miles (22,700) sq km), and the capital is Belmopan
City.

Belize has undergone significant economic transformation due to its growing tourism industry.
It is the single largest service sub-sector, with a direct contribution of (USD $277.7M), 15.0%
of total GDP, and a total contribution generating USD $766.8M accounting for 41.3% of GDP
in 2017. This number was forecasted to rise by 3.6% in 2018 and 4.6% to USD $1,250.7M,
54.0% of GDP in 2028. Being part of the CARICOM Single Market and Economy (CSME)
also afforded the country a better negotiating position and more employment opportunities.

Belize is a small lower middle-income country with a GDP of US $4,435,62 in 2020, a decrease
from $5,078.81 in 2019. The International Monetary Fund (IMF) suggests that even prior to
the COVID-19 pandemic the country was already in recession. However, the pandemic further
impacted the economy, especially in sectors such as hotels & restaurants, fishing, wholesale &
retail trade, and transport & communication.

Political Situation
Belize gained independence from Britain in 1981 but continues to have a government structure
based on the British Westminster parliamentary democratic system with a Governor General
who is the representative of the British monarch and the Head of State. The Prime Minister is
the head of government. In November 2020, general elections were held, resulting in a change
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of political leadership from the United Democratic Party (UDP) to the People’s United Party
(PUP).

Climate and Environment

Belize is highly vulnerable to climate change and natural hazards such as hurricanes, tropical
storms, flooding, and drought. In 2019 the dry season was the worst in four decades, leading
to USD $25 million in agricultural losses, while 2020 proved to be the most active hurricane
season with effects from four storms. In 2021 Belize undertook repairs to damages in its central
districts and primary production areas. There are also plans to use a USD $2.5 million loan
from the Caribbean Development Bank to assist the government with the financing of
emergency restoration of critical infrastructure.

1.3 The Role of CCS in the Wider Health Development Landscape

The CCS provides a country-level platform for intensive, wide-ranging dialogue on a country’s
health needs and aspirations, with alignment to the Belize Health Sector Strategic Plan 2014-
2024, and the MOHW Operational Plan 2022-2023, together with global and regional goals
and mandates including the 2030 Agenda for the Sustainable Development Goals, the WHO
Thirteenth General Programme of Work (GPW 13) 2019-2023, the PAHO Strategic Plan 2020-
2025 and the Sustainable Development Health Agenda for the Americas 2018-2030. It is a
unique opportunity to renew and deepen the collaboration between PAHO/WHO and MOHW,
as well as other key sectors and partners. WHO has the scope to drastically improve the health
of the world. The GPW 13 has the potential to seize this opportunity. Basing the CCS on the
SDGs increases the chance of its success. The 2030 Agenda for Sustainable Development
views health as vital for the future of the world.

The first CCS in Belize spanned 2008-2011 and was implemented through two BWPs (2008-
2009 and 2010-2011). A mid-term review of the first CCS demonstrated that PAHO’s technical
cooperation responded to the country’s priorities but needed to focus more on new health
challenges such as NCDs, aging, global warming/climate change, and its impact on health,
health information systems and regulatory functions. Thus, the priorities identified by the 2008-
2011 CCS were extended to 2013.

The second CCS (2017-2021), benefited from the availability of financial resources from the
European Union (EU). Two principal areas of work were thereby improved: preparation for
emergencies and response to natural disasters and strengthening of the national health system.

The new PAHO Strategic Plan 2020–2025 also identified Belize as a key country, along with
seven other member states. This engendered stronger and more expedited technical cooperation
from the regional level.
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1.4 Overview of WHO Policy Framework

The CCS is PAHO/WHO’s strategic framework to guide the Organization’s work in and with
Belize. It responds to Belize’s National Health and Development Agenda, and the Belize
Health Sector Strategic Plan 2014-2024 and identifies a set of agreed joint priorities for
PAHO/WHO collaboration, covering those areas where the Organization has a comparative
advantage in order to assure public health impact. The CCS is PAHO/WHO’s corporate
framework strategy to implement the GPW 13 with a response to Belize’s needs and priorities
and addresses the Sustainable Development Agenda in health-related SDGs.

The CCS also informs and supports the development of PAHO/WHO’s programme budget and
Biennial Work Plan (BWP) for Belize and yet, as a strategic process and instrument, goes well
beyond operational planning and budgeting. It adds immense value to the PAHO/WHO Belize
collaboration through the following main ways:

• Facilitates multi-sectoral dialogue and strengthens partnerships based on Belize Health

and Development Agenda.
• Provides a strategic rationale for PAHO/WHO’s work to guide the planning process.
• Elucidates WHO’s role and contribution to the UN system that operates in Belize.
• Promotes Belize’s ownership in achieving health-related SDGs. The collaboration will
jointly identify, agree, endorse, and monitor priorities.
• Focuses assessment on Belize’s progress, in collaboration with PAHO/WHO partners,
towards joint priorities and impact targets established by the country.
• Creates communication, resource mobilization, and advocacy strategies for priority
issues as a public product boosting the visibility and accountability of PAHO/WHO
operations and results.
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1.5 GPW13 and Regional and Subregional Priorities Figure 1: GPW 13 Strategic priorities to
ensure healthy lives for all.

The foundation of PAHO/WHO work is SDG 3 - “Striving

to ensure healthy lives and promoting wellbeing for all at
all ages.” The aim is to promote health rather than merely
fighting disease, and to improve health among vulnerable
populations thus reducing inequities. No one should be left
behind. All persons in all social groups should be given the
opportunity to live healthy lives.

GPW13 has identified three strategic priorities linked to

ambitious SDG-based goals for delivering progress. The
three strategic priorities are illustrated in figure 1.

These “triple billion” targets require the joint effort of member states like Belize, along with
WHO and other partners. No single entity can achieve these goals. There must be a multi-
faceted approach demonstrating collective action and accountability.

1.6 CCS Development Process

The CCS 2023-2027 builds on the achievements of the past CCS 2017-2021 and addresses
issues of gender, equity, and human rights. The development of this new CCS 2023-2027
strictly adhered to the six-stage process outlined in the WHO CCS 2020 Guide, which are seen
in figure 2.

Figure 2: The Six Stages for Successful Development, Implementation, and Evaluation of the
CCS in PAHO/WHO CCS Guide 2020
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The PAHO/WHO Representative (PWR) in Belize is responsible for supervising and

delivering a high-quality CCS 2023-2027 and implementing, monitoring, evaluating, and
reporting its results. The PWR initiated an evaluation of the past CCS (2017-2021), the
findings of which assisted with the development of the new CCS. Consideration was also taken
of the timing of the CCS and the capacity of the Country Office to undertake the process. A
CCS 2023-2027 Technical Working Group (TWG) was established, including staff from the
PAHO country office, UN partners and persons from the MOHW, led by the PWR, and a
consultant employed to assist with the process.

A detailed analysis was conducted on all PAHO/WHO relevant documents as well as Belize
National Development Health policies and plans, including but not limited to:

• CCS Guide 2020; CCS Presentation 2022; PAHO’s Orientations for the use of the
WHO 2020 CCS Guide (Concepts and Guides adapted to the region of the Americas).
• WHO 13th GPW 2019-2023.
• The Sustainable Health Agenda for the Americas 2018-2030.
• The PAHO Strategic Plan 2020-2025.
• PAHO-adapted Hanlon Method.
• Universal Access to Health and Universal Health Coverage.
• Country Cooperation Strategy Belize 2017-2021.
• Health Situation Analysis, Belize (part of the evaluation of CCS 2017-2021).
• Belize Health Sector Strategic Plan 2014-2024.
• Belize Ministry of Health and Wellness Operational Plan 2022-2023.
• Belize Human Resources for Universal Health Strategic Plan 2019-2024.

A national consultation took place in November 2022, engaging key stakeholders, decision-
makers from the MOHW, UN agencies resident in Belize, other developmental partners
(especially those working with SDGs), and key non-governmental Organizations (NGOs). This
allowed involved parties to come to consensus on the main strategic priorities (SPs) and the
related focus areas (FAs) for the CSS 2023-2027. The implementation, management,
coordination and monitoring & evaluation of the new CSS were discussed. The CCS 2023-
2027 was developed in keeping with and taking into account other regional and international
frameworks and plans as follows:

• WHO 13th GPW.

• PAHO Strategic Plan 2020-2025.
• PAHO’s Sustainable Health Agenda for the Americas 2018-2030.
• The Sustainable Development Goals (health and health-related SDGs).
• The UN Multi-Country Sustainable Development Cooperation Framework for the
English and Dutch Speaking Caribbean 2022-2026 (UN MSDCF).
• UN Country Implementation Plan (CIP) and the United Nations entities’ frameworks
and plans.
• Other regional and international partners such as CARPHA/CARICOM,
COMISCA/SICA.
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CHAPTER 2: HEALTH AND DEVELOPMENT SITUATION

2.1 Health Status of the Population

Demographic Trends
The mid-year estimate of the total Belizean population in 2021 was 430,191 and the distribution
was 45% urban, 55 % rural.2 As reported in the PAHO Health Information Platform for the
Americas (PLISA), the annual growth rate decreased from 2.1% in 2015 to 1.3% in 2021.
Belize has a young population, but, like most other territories in the region, it is undergoing a
demographic transition with a shift in the population structure as the percentage of older
persons increases.

Source: Statistical Institute of Belize

Figure 3: Population pyramid Belize, 2022

The percentage of the population under the age of 15 years decreased from 31.8% in 2015 to
28.2% in 2021 (regional value is 24%) and the proportion of the population above 65 years
increased from 4.3% in 2015 to 5.1% in 2022 (regional value is 9.2%). The total fertility rate
has been declining steadily and fell from 2.6 in 2015 to 2.27 births/woman in 2019.
Continuation of this trend will result in sub replacement fertility. From 2010 to 2019, the life
expectancy in Belize increased steadily to the highest age of 73.9 years (71.1 for males and
77.2 for females). However, with the onset of the COVID-19 pandemic, life expectancy fell to
70.5 years in 2021 (67.1 for males and 74.3 for females). According to the Statistical Institute
of Belize, the crude birth rate in 2021 was estimated at 15.3 per 1,000 population and crude
death rate at 5.79 per 1,000 population (males 6.88, females 4.69).3

2
Statistical Institute of Belize
3
Statistical Institute of Belize. Abstract of Statistics 2021
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Mortality
Belize’s health profile reflects the trend seen in most countries of Central America and the
Caribbean of an epidemiological transition from communicable diseases (CDs) to
noncommunicable diseases (NCDs) as the main cause of deaths and illnesses.
There were 2,519 total deaths in 2021, with the five leading causes being COVID-19 (360;
14.3%), diseases of the heart (358; 14.2%), malignant neoplasms (273; 10.8%), diabetes
mellitus (165; 6.6%) and homicide (153; 6.1%)4. While the leading causes of death amongst
females, apart from COVID-19, were allNCD-related, males were also significantly affected
by homicide and unintentional injuries.

The maternal mortality ratio (MMR) per 100,000 live births peaked at 134.2 in 2018 and fell
to 57.0 in 2020.5 The neonatal mortality rate per 1,000 live births decreased from 11.6 in 2015
to 8.8 in 2021, and the infant mortality rate per 1,000 live births was 12.24 in 2020. Leading
causes of infant deaths in 2019 and 2021 were conditions originating in the perinatal period;
congenital malformations, deformations and chromosomal abnormalities; and influenza and
pneumonia. Mortality in children under the age of 5 years also decreased from 23 per 1,000
live births in 2009 to 15.38 in 2020. Influenza and pneumonia, unintentional injuries and
malignant neoplasms are leading causes of deaths in this age group.

2.2 Major Health Problems

Communicable Diseases
COVID-19: The pandemic created unprecedented demands on the already overburdened and
underfunded health system. Belize recorded its first COVID-19 case on March 23, 2020, and
introduced early measures such as closure of schools, borders, country lockdown and
declaration of a state of national emergency. A multisectoral National COVID-19 Task Force
with several sub-committees was established by the government with PAHO/WHO
participation to ensure coordination in preparedness and in the response to the pandemic. The
national COVID-19 Country Preparedness and Response Plan (CPRP) was developed
following the WHO guidelines.

As of December 1, 2022, after 5 waves of infections, Belize had 69,048 confirmed cases of
COVID-19 with 688 deaths. While case numbers were highest in younger age groups from 20-
39 years, deaths occurred disproportionately among older persons in the 50-65+ age group. 6
Most persons who died had underlying comorbidities such as hypertension, diabetes mellitus
and chronic renal failure. However, 254 deaths were reported in persons with no known
underlying comorbidities. This underscores the importance of individuals knowing their health
status via regular medical checkups as well as effective management of any disease conditions

4 Abstract of Statistics. Statistical Institute of Belize. Source: Ministry of Health and Wellness
5
Source: MCH unit MOHW
6 Source: BHIS, Epidemiology Unit, MOHW
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identified. It is estimated that, by November 2022, 63.32% of the population had received at
least 1 dose of a COVID-19 vaccine.7

Healthcare delivery was affected in various ways during the pandemic as priority was placed
on the fight against COVID-19. Visits to healthcare facilities decreased to 291,197 in 2020
from 426,327 in 2019. This was due to COVID-19 measures or fears of becoming infected and
was reflected in a decrease in vaccination coverages in 2020. Vaccination coverage for BCG
went from 95% in 2019 to 76%; DTP3 from 98 % to 79%; MMR1 from 96% to 82% and Polio
3 from 98% to 79%.8

The Inter-American Development Bank (IDB) stated in its report ‘Developing a Sustainable,
Resilient and Inclusive Belize’ that “Belizean economy will be one of the tourism-dependent
economies most impacted by COVID-19 in the world. The hit from the COVID-19 pandemic
has exacerbated the fragility of the Belizean economy, which has experienced chronic low
economic growth and increasing debt over the last 15 years.” The Statistical Institute of
Belize’s (SIB) Labour Force Survey of September 2021 reported a 9.2% unemployment rate
with 50% of unemployed persons having been without work for 12 or more months, while 38%
of unemployed persons reported job loss/business failure due to the COVID-19 pandemic.

HIV and AIDS: According to the UNAIDS Spectrum estimates 2022, the number of people
living with HIV for all ages in 2021 was 3,515 (CI 3,200– 3,700). Data from the Belize Health
information system reveals that of this number, 2,893 (82%) know their status; 1,561 (44%)
are on anti-retroviral therapy (ART); and 790 (22%) have a suppressed viral load. The HIV
prevalence among adults is 1.1 (CI 1.0-1.2), with no difference between males and females.9
Belize reported 130 newly diagnosed HIV cases in 2020 (65 males and 65 females). In the
previous years, there were 254 (2018) and 205 (2019) newly diagnosed HIV cases reported.10
This decrease in new cases noted could be partly due to the COVID-19 situation. Belize has
not achieved the 90-90-90 targets. In 2021, 42 pregnant women tested positive and there were
two cases of vertical transmission where mothers did not receive treatment because of a post-
natal diagnosis.11 In 2022, the country applied for validation of the elimination of mother-to-
child transmission of HIV and congenital syphilis.

Tuberculosis (TB): The incidence of TB has shown a decreasing trend. In 2021, 62 new cases
were diagnosed (21 females and 41 males), with 21% HIV co-infection. The tuberculosis
mortality rate per 100,000 population decreased from 5.5 in 2013 to 0.7 in 2021 with only three
TB-related deaths reported. 12

7 https://coronavirus.jhu.edu/region/belize
8 https://opendata.paho.org/en/core-indicators/core-indicators-dashboard
9 https://www.unaids.org/en/regionscountries/countries/belize
10 MOHW presentation of priority areas to PAHO GD Jul 2021
11
MOHW presentation of priority areas to PAHO Nov 2021
12
National Tuberculosis Program, BHIS, Epidemiology Unit, MOHW
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Vector-borne Diseases
Dengue: The country’s geographic location, with coastal areas below sea level and prone to
flooding, facilitates vector reproduction and spread, and increases vulnerability to outbreaks
that occur every 2-3 years. The highest record of cases (8,359) was reported in the 2019
outbreak when three dengue serotypes (DEN 1, 2, 3) were circulated and 10 dengue-related
deaths occurred. In 2021, there were 1,251 cases reported with no severe cases or deaths.

Malaria: Over the last 25 years, Belize achieved a dramatic reduction in its malaria burden,
from a peak of about 10,000 cases in 1994 to zero autochthonous cases since December 2018.
The country receives financial aid from the IDB through the Regional Malaria Elimination
Initiative (RMEI) and the program is guided by the National Malaria Strategic Plan for the
Elimination and Prevention of the Re-establishment of Malaria 2018 – 2022. With the onset of
the pandemic, surveillance for malaria was integrated into the broader COVID-19 surveillance.
After 3 consecutive years of zero indigenous cases, the country became eligible to apply for
the WHO certification of malaria elimination in December 2021 and is working towards this
with the support of WHO and PAHO. The frequent traveling of Belizean nationals to
neighboring Guatemala and Mexico, where malaria transmission still occurs, as well as an
increase in the number of immigrant workers in Belize’s agriculture and tourism industries,
pose ongoing threats of reintroduction of the disease in malaria-free areas.

Neglected diseases: The magnitude of Chagas disease is not fully known. Available data is
limited and there is the need to enhance surveillance. The blood bank conducts screening for
Chagas and identified 19 positive cases in 2019. Guidelines for surveillance and case
management of the disease were drafted in 2020. The Belize Defense Force is responsible for
the case management of Leishmaniasis. Lack of data, including entomological data to confirm
the presence of competent vectors, is a challenge. Although there have been no cases of human
rabies since 1989, outbreaks in livestock have significantly increased in recent years.13
Therefore, humans, domestic animals, and wildlife remain susceptible, underscoring the
importance of robust surveillance and provision of quality-assured vaccines to prevent cases.

Noncommunicable diseases and risk factors

NCDs continue to be a major contributor to morbidity affecting an individual’s quality of life.
They also place a heavy economic and social burden on families, communities, health systems
and economies. NCDs were estimated to account for 67% (1,400) of all deaths (2,000) in 2016
in Belize. In the same year, cardiovascular diseases (CVD) were the leading cause of NCD
deaths at (25.5%), followed by cancer at 14.3%, diabetes at 7.9% and chronic respiratory
diseases at 3.2%; the other NCDs accounted for 16.5%. Approximately 47.5% of NCD deaths
occurred in people under the age of 70 years; this percentage is high in comparison with 38.9%
for the Region of the Americas. In 2016, the probability of dying between 30-70 years

13
Becker, DJ, Broos, A, Bergner, LM, et al. Temporal patterns of vampire bat rabies and host connectivity in Belize.
Transbound Emerg Dis. 2021; 68: 870– 879. https://doi.org/10.1111/tbed.13754
 18

(premature mortality) due to NCDs was 22.1 per 100,000 population with a higher probability
for the male population (25.5%) than for the female population (18.5%).14

In 2017-2021, the Epidemiology Unit reported 1,479 cancer cases (641 male, 838 female).
During this period, the top five cancer types in females were breast cancer (36%), cervical
cancer (30%), cancer of unspecified nature (16%), colon cancer (10%) and uterine cancer (8%).
The top five cancer types in males were prostate cancer (32%), cancer of unspecified nature
(25%), lung cancer (18%), cancer of the head and neck (13%) and leukemias (12%). 15 With
assistance from PAHO, and local stakeholders, a National Comprehensive Cancer Control
Strategic Plan for 2020-2024 was developed to address the cancer situation through emphasis
on prevention, screening and early detection, evidence-based treatment and attention to
palliative care.

The commonly known risk factors for NCDs include an unhealthy diet, tobacco use, alcohol
abuse, physical inactivity and obesity. The prevalence of overweight and obesity for the year
2016 was 54.8 % (male 48.1; female 61.2). Among the youth, 7.3% of children aged less than
5 years were overweight in 2015-2016 and the prevalence of obesity in adolescents was 10.6%
(male 10.8; female 10.4).16 Belize signed the WHO Framework Convention on Tobacco
Control (WHO FCTC) on 26 September 2003 and ratified it on 15 December 2005. As a Party
to the Convention, Belize is legally bound to the treaty’s provisions. Belize has yet to make
significant progress in implementing the six MPOWER measures outlined in the FCTC to
reduce demand for tobacco products. With the assistance of the PAHO Country Office,
NDACC has drafted the National Tobacco Control Bill and National Alcohol Control Bill. The
National Tobacco Bill was updated in 2018 and PAHO supported a review in 2022.

Ageing: As the life expectancy increases, the total number of persons older than 65 years has
increased from 13,636 in 2010 to 15,520 in 2015 and 17,664 in 2020. There will be a growing
need for services related to NCDs and social support for the elderly population. Belize has a
National Council on Aging under the Ministry of Human Development, Social Transformation
and Poverty Alleviation. The council is guided by their Strategic Plan 2015-2019 to “advocate
for and facilitate the development and implementation of plans and programs geared towards
the protection of basic human rights of older persons through an integrated life cycle approach
ensuring improved quality of life.”

Adolescent Health: The main challenges faced by adolescents are in the areas of sexual and
reproductive health, and risk factors related to NCDs and mental health. The 2014 knowledge,
attitude, practice, and behaviour (KAPB) survey revealed that approximately 9% of
respondents had their first sexual intercourse before the age of 15. Although there is a
decreasing trend in the adolescent fertility rate (births per 1,000 women aged 15-19) from 71

14 https://www.paho.org/en/noncommunicable-diseases-and-mental-health/noncommunicable-diseases-and-mental-health-
data-portal-8
15 Source: BHIS, Epidemiology Unit, MOHW
16 https://www.paho.org/en/noncommunicable-diseases-and-mental-health/noncommunicable-diseases-and-mental-health-

data-portal-8
 19

in 2015 to 67.7 in 2020, it is high for the Americas where the adolescent fertility rate was
estimated at 48.3 in 2019. The mental, neurological, substance use disorders and self-harm
(MNSS) burden between 5-15 years are conduct disorders, anxiety disorders, and headaches
(approx. 18% each). To address the health challenges faced by adolescents, a National
Adolescent Health Strategic Plan (2019-2023) was developed focusing on Positive Health and
Development, Violence, Accidents and Injury, Sexual and Reproductive Health, Substance Use
and Self-Harm.

Mental Health: Mental health was integrated into the first level of in the nineties with the
introduction of psychiatric nurses at the health regions to implement the ‘community-based
psychiatric program. Redeployment of mental health nurses as part of the COVID-19 response
affected the availability of mental health professionals at the community level for a period.
According to the Country Profile 2020, mental, neurological, substance use disorder and
suicide (MNSS) cause 15% of all disability-adjusted life years and 33% of all years lived with
disability (Country Profile 2020). Around the age of 20 years, the common disorders (anxiety,
depression, self-harm and somatic symptom disorder) account for the highest burden of 41%,
followed by substance use disorders of 20%, headaches 20% and severe mental disorders
around 8%. The top three disorders in terms of Disability Adjusted Life Years (DALYs)
accounting for 40-50% of total MNSS is different for men and women (Men: alcohol use
disorders, headaches, self-harm and suicide; women: headaches, depressive and anxiety
disorders).17

Violence, Accidents and Injuries: For 2019 Belize had the fifth highest homicide rate in the
region of the Americas at 40.2 per 100,000 residents (males 70.8, females 10.3). This is much
higher than the regional value of 19.9.18 The suicide mortality rate (age-adjusted per 100,000
pop) increased from 6.9 (12.2 males, 1.6 females) in 2015 to 7.6 (13.6 males, 1.8 females).
Males are also disproportionally affected by road traffic injury mortality, with a rate of
40.3/100,000 population compared to 7.4 in females (total 23.6) 19

2.3 Health systems response in Belize

The Belize health system is currently in transformation guided by the Belize Health Sector
Strategic Plan 2014-2024 (HSSP) with the vision of “a healthy empowered, productive
population supported by an effective network of quality services and effective partnerships for
wellness.” The HSSP provides an overall framework for the country’s health priorities and
strategies and calls for multi-stakeholder participation and coordinated efforts as it seeks more
attention for the wellbeing component in health.

17 The Burden of Mental Disorders in the Americas: Country Profile, Belize; https://www.paho.org/sites/default/files/2020-
09/MentalHealth-profile-2020%20Belize_Country_Report_Final.pdf;
18 https://www.paho.org/en/enlace/homicide-mortality
19 https://opendata.paho.org/en/core-indicators/core-indicators-dashboard
 20

In its health care policy plan 2020, the current ruling PUP administration stated that it will
promote health as a basic human right, where the main goal is universal health care for the
entire population.20 The reorganization of the governance and functional structure of the
Ministry of Health and Wellness was planned to start under the component ‘health system
strengthening’ of the MOHW/PAHO/EU project.21 In early 2022, positions for three senior
Directors were introduced; Director of Public Health and Wellness, Director of Hospitals and
Allied Services, and Director of the International Health Desks.

Belize started a health sector reform process in 1998, including regionalizing the healthcare
delivery system. Four health regions headed by Regional Health Managers were formed from
the six administrative districts. All regions provide primary and secondary care. The rural
population is served at the community level through health posts (a total of 55) and health
centers (a total of 33). Outreach community services include dental health, mental health, and
communicable diseases prevention and control. Several services, such as prenatal care, and
immunization, are also provided as mobile services to remote villages. Urban-based regional
hospitals provide secondary care, while tertiary care is provided at the country’s sole public
referral hospital, the Karl Heusner Memorial Hospital (KHMH), located in the Central Health
Region.

The Joint External Evaluation (JEE) of the International Health Regulations (IHR) core
capacities which was carried out in 2016 identified several gaps in the country’s ability to
detect, assess, report, and respond to public health events. In the context of the COVID-19
pandemic response, some of the recommendations of the JEE have been addressed, such as
improved surveillance and detection capabilities and sourcing of funding to respond to future
pandemics and other threats to the health of populations.

Health Financing
The health system is dependent on public financing. Over the past ten years between 11% and
13% of the Government budget was allocated to health. WHO has proposed a public health
expenditure of 6% of GDP as a benchmark as it is associated with the health system’s progress
towards Universal Health Coverage. Belize has been slowly increasing public health
expenditure over the years and as of 2019, it stood at 4.2% of GDP. Out-of-pocket (OOP)
health expenditure above 20% presents a risk of putting households below the poverty line or
further impoverishing those who are already vulnerable. The 2019 OOP expenditure as % of
total health expenditure was 21.8 %.

The increase over the past years in financial resources for health has not led to an equitable
distribution at the district level. Per capita public health expenditure at the district level does

20Health Care Policy Plan. PUP, 2020

21Health sector support programme Belize. Better Health for Belize. https://www.paho.org/en/eu-pahowho-mohw-health-
sector-support-programme-belize-project
 21

not match with the per capita poverty gaps at the country level. There is also systematic under-
execution of resources in preventive and primary care as opposed to curative health.22

In order to effectively respond to the threat of COVID-19, while ensuring continuation of

essential services, resource mobilization and collaboration with many donor partners was
necessary. In this regard and in collaboration with the EU, PAHO reprogrammed 500,000
Euros from the EU grant “Health Sector Support Programme Belize”.

National Health Insurance

The National Health Insurance (NHI), which the Social Security Board governs, was created
in 2001 to provide a package of health services to underserved populations and geographical
areas prioritized based on income level. It purchases services from registered public and private
providers to expand mainly primary care coverage and currently serves Southside Belize City,
Corozal, Toledo and Stann Creek districts. The NHI currently provides coverage to about 40%
of the population. The roll-out to the entire country is a key priority of the government and
was mentioned as a focus area in the CCS 2017-2021. A costing and forecasting study for the
national roll out of the NHI was conducted shortly before the COVID-19 pandemic. It presents
the implications for 3 different packages and different scenarios for the phased roll-out.23 As a
response to the economic and social hardship and constraints on the public budget caused by
the COVID-19 pandemic, the Ministry of Finance reduced the NHI 2020 Annual Budget by
25%. This necessitated a temporary reduction in purchasing of services for NHI registered
members.24 The NHI budget has since returned to pre-COVID-19 levels.

Health Information Systems

The Belize Health information System (BHIS) which is now in use at most public health clinic
and hospital facilities allows for recording of patient data, and integration of data sources
electronically to facilitate data analysis and reporting of health information. The system
provides functionalities to support clinical, programmatic, and administrative functions.

A 2017 rapid assessment of the BHIS presented several recommendations to strengthen and
adapt the system including developing a governance framework, developing a vision for BHIS
and an updated functional/organizational model with an investment plan. In September 2021
an upgrade to the BHIS was provided to the Ministry of Health and Wellness through direct
technical assistance funded by the European Union.

The NHI utilizes a separate Registry and Activity Web Application (RAWA), and the MOHW
aims to establish coordination of the two systems to generate information for decision-making
and for improved monitoring and evaluation in health. An The ICD-11 tool was implemented

22 Maceira-PAHO consultant Jul 2019.Belize fiscal space analysis, Jul 2019 based on data from MOHW

23 Marchildon, PAHO consultant, Dec 2019. Costing Study and Forecast for the Expansion and Upgrade of National Health
Insurance (NHI) in Belize.
24 2020 annual report. Social Security Board. https://www.socialsecurity.org.bz/wp-content/uploads/2021/11/SSB-Annual-

Report-2020.pdf
 22

in 2020 into the RAWA supported by PAHO/WHO and it was launched live for general
availability on June 21, 2021. This is the scientifically up-to-date global standard for health
data, clinical documentation, and statistical aggregation with multiple uses including primary
care. In the context of the COVID-19 pandemic, the NHI developed a Tele-Consult Platform
proposal to facilitate tele-consultations at the primary care level to allow effective remote
patient management.

Human Resources
Having adequate human resources for health (HRH) is critical for Belize to achieve an efficient
and quality healthcare system. In 2016 the WHO recommended a health workforce density of
at least 44.5 health workers (physicians, nurses and midwives combined) per 10,000 population
to achieve the targets of the SDGs. As of 2018, Belize had a ratio of 10.8 physicians/10,000
population and 20.8 nurses/10,000 population.25 To respond to the health needs of the
population, the MOHW launched a Human Resources for Universal Health Strategic Plan
2019-2024.

The overall shortage of health workers at the first level of care is a major challenge and
geographical maldistribution of the human resources in favor of urban areas contributes to
inequitable access to health services for the rural population. The community health workers
program spearheaded by the Health Education and Community Participation Bureau
(HECOPAB) focuses on improved training for community health workers and an increase in
their number and regional coverage.

To address HRH shortages, Belize recruits medical professionals from other countries. Belize
has no medical school or faculty where physicians can be trained. In the framework of a
longstanding bilateral agreement with Cuba and the Cuba-CARICOM scholarships, Belize has
medical students trained in Cuba in addition to receiving Cuban health workers from the
Medical Brigade to work in the health system in Belize. The University of Belize offers training
in Nursing, Midwifery, Health Technology, Medical Laboratory Sciences, Pharmacy and
Social Work. Continuing education for health workers takes the form of workshops, seminars
and other instruction courses. There is a high turnover of healthcare professionals since many
leave Belize to find jobs in the United States or the Caribbean, thus the country requires
recurrent expenditures to acclimatize new health workers.

In 2020, guidelines were introduced that included a mix of strategies to strengthen the surge
capacity for COVID-19. Lessons learnt may inform HRH strategies not only for future health
emergencies, but also for sustaining and institutionalizing in the post pandemic period those
that work for common HRH challenges such as shortages, uneven distribution, training
challenges and competency gaps.

25Core Indicators, 2019, trends in the Americas Health,

https://iris.paho.org/bitstream/handle/10665.2/51542/9789275121290_eng.pdf?sequence=6&isAllowed=y
 23

2.4 Cross-cutting Themes

Gender, Equity, Human Rights and Ethnicity

Despite progress in recent years, important challenges remain in terms of addressing vulnerable
groups that have greater needs than the rest of the population. Rural and indigenous groups
remain at greater risk of poverty and poor health indicators than urban and non-indigenous
groups. Violence tends to affect more males than females; however, domestic violence afflicts
more women and children.

School enrollment, tertiary (gross), gender parity index (GPI) in Belize was 1.41 as of 2020.26
This, however, does not translate to increased employment and equitable wages. The 2021
labor force survey found that the unemployment rate for females was 13.0% compared to 6.7%
in males.27 As of February 2021, only 12.5% of seats in Parliament were held by women.28 To
achieve gender-related SDG commitments in Belize, the data gaps in key areas need to be
closed. As of December 2020, only 36.9% of gender-related indicators were available.

Gender equality, equity, human rights and ethnicity are central components of the country’s
development agenda and are core values of the HSSP. These values align with the SDGs
commitment of leaving no one behind. PAHO/WHO provides guidance and has encouraged
countries to revise and reorient their health programs to ensure the vulnerable populations have
equitable access to healthcare. Horizon 2030, the national development framework for Belize,
refers to the ethnic and cultural diversity of the population, promotes inclusion of all and
recognizes multiculturalism and collective identity as a core value. It also addresses gender
equity and aims for women performing at the highest levels of political leadership to close the
gender gap.

The Ministry of Human Development, Families and Indigenous People’s Affairs (MHDFIPA)
works in tandem with relevant partners to facilitate policy development and implement
programmes that promote social justice, equity and development with the end goal of enabling
citizens to be self-sufficient, responsible and empowered. The Women’s Department of the
MHDFIPA functions to promote gender equality and equity, facilitate economic development
and the empowerment of women, minimize the incidence of gender-based violence and
advocates for gender sensitive policies, plans, programmes, and projects. The Revised National
Gender Policy 2013, (RNGP) identifies and examines the inequities experienced by both men
and women and suggests strategies to correct gender disparities.

Climate Change and Disaster Preparedness

The Ministry of Sustainable Development, Climate Change and Disaster Risk Management
oversees implementation of the 2030 Agenda in Belize and The National Emergency
Management Organization is the primary governmental department responsible for disaster
mitigation, public preparedness, response, recovery and reconstruction in the country. The
Belize National Climate Change Office (BNCCO) was established in 2015 with the role of
facilitating the coordination of Belize’s national and international response to climate change.

26 https://www.indexmundi.com/facts/belize/indicator/SE.ENR.TERT.FM.ZS 2
27 Source: Statistical Institute of Belize. Labor Force Survey, September 2021
28 https://data.unwomen.org/country/belize
 24

Since 2016, Belize has been part of the Caribbean regional initiative supported by the United
Kingdom with financial support from the Foreign Commonwealth and Development Office
(FCDO), formerly DIFID. Five health facilities in Belize have been retrofitted to be safe,
climate-smart, disaster-resilient and environmentally friendly (Smart-Green and Safe) and
handed over to the Ministry of Health and Wellness in 2022. Further support is being provided
by the European Union for the retrofitting of six health facilities including three Regional
Hospitals, two Community Hospitals and the Central Medical Laboratory.

Food and Nutritional Security

Food security, as defined by the United Nations’ Committee on World Food Security, means
that all people, at all times, have physical, social, and economic access to sufficient, safe, and
nutritious food that meets their food preferences and dietary needs for an active and healthy
life.

The food systems of Belize have been affected by the COVID-19 pandemic, international and
multilateral economic changes, and the persistent threat of climate change effects. Belize
recognizes the importance of food security for overall human and economic development and
established The National Food and Nutrition Security Commission to serve as an advisory body
to Cabinet on matters related to Food and Nutrition Security. The Commission is chaired by
the Ministry of Agriculture, which provides oversight powers for policy and program
implementation.

The major objectives of the National Agriculture and Food Policy of Belize 2015 – 2030 are:
to ensure the development of the agriculture and food secto,to enhance the sustainable growth
of the sector; to ensure food and nutrition security; to improve the income of farmers and
processors; to create employment; and to attract private sector investment and participation in
the sector. In collaboration with the Government of Belize, the Food and Agriculture
Organization of the United Nations (FAO) and the European Union published a comprehensive
food systems profile of the country in 2022. The Ministry of Health and Wellness is in the
process of finalizing a National Nutrition Policy.

2.5 Partnership and Development Cooperation

The work of the MOHW is further supported through partnerships with regional and
international Organizations and NGOs that provide technical advice, training, and mentoring.
These include:
• the CARICOM Secretariat
• the Central American Integration System (SICA) and the Council of Ministers of Health
of Central America and the Dominican Republic (COMISCA).
• the Caribbean Public Health Agency (CARPHA)
• PAHO/WHO
• United Nations Development Programme (UNDP)
 25

• United Nations Population Fund (UNFPA)

• United Nations Children’s Fund (UNICEF)
• United Nations High Commission for Refugees (UNHCR)
• United Nations Office for Project Services (UNOPS)
• the International Organization for Migration (IOM)
• Joint United Nations Programme on HIV/AIDS (UNAIDS)
• United Nations Educational, Scientific and Cultural Organization (UNESCO)
• United Nations Entity for Gender Equality and the Empowerment of Women (UN
Women)
• United Nations Environment Programme (UNEP)
• the World Bank (WB)
• the Inter-American Development Bank (IDB)
• the European Union (EU)
• Food and Agricultural Organization of the United Nations (FAO)
• International Labour Organization (ILO)
• the International Atomic Energy Agency (IAEA)
 26

CHAPTER 3: PAHO/WHO’s COOPERATION OVER THE LAST CCS CYCLE

In 2017 PAHO/WHO, led and supported the development of the last CCS cycle to maintain a
technical cooperation focused on Belize’s priorities. The 2017-2021 CCS in Belize identified
four strategic priorities and 13 focus areas and was operationalized through the implementation
of two and a half biennial work plans (BWPs). The first three years of this CCS aligned to the
2014-2019 PAHO Strategic Plan, while the last two years aligned to the 2020-2025 PAHO
Strategic Plan.

A systematic review of the health situation in Belize and a multi-sectoral stakeholders

consultation identified the following four Strategic Priorities and related focus areas for the
2017-2021 CCS:

1. Strong and resilient health systems achieved through improved governance, leadership
and management that support universal health.
1.1. Revise and or develop national health legislation and inclusive policies to advance
health equity, the procurement of appropriate, affordable medicines and other health
technologies and strengthen intersectoral actions that address the social determinants
of health.
1.2. Redefine the health financing mechanism to include the expanded roll-out of the
National Health Insurance system to ensure equitable access to health services across
Belize.
1.3. Strengthen the Belize Health Information System (BHIS) to improve coordination with
RAWA and the comprehensive use of data for evidence-based decision making and
monitoring and evaluation.
1.4. Strengthen primary healthcare networks and the resolution capacity to meet expanding
health needs in Belize.

2. Human resources for health (HRH) management and capacity strengthened to parallel
the health needs of the growing population.
2.1. Advocate for the use of recommendations of previous PAHO HRH assessments of the
gaps and needs to ensure the recruitment, deployment and retention of a skilled
workforce that can meet the regional core indicators for HRH and equitably deliver
health services across Belize especially in the rural areas.
2.2. Build and/or reorient the capacity of healthcare professionals to meet the emerging
health trends and needs of the Belizean population.
2.3. Strengthen HRH management within the Ministry of Health to develop and/or adapt
HRH policies and plans that define the strategic direction and the integration of HRH
into other sectors.

3. Health and wellness promoted throughout the life course using an integrated primary
health care approach to reduce non-communicable diseases and their risk factors,
communicable diseases, mental health disorders, urban violence and injuries.
3.1. Support and promote the implementation of interventions and strategies that engage
and empower communities to adopt healthier lifestyles that reduce the risk factors
 27

related to developing noncommunicable diseases and/or contracting communicable

diseases.
3.2. Advocate for social programs and policies within the public sector for the early
detection and intervention to address problems related to gender-based violence, urban
violence and road safety.
3.3. Strengthen national capacities to implement comprehensive strategies that prevent and
treat mental and substance abuse disorders within a framework of human rights and
respect for human dignity.

4. Health emergencies that can become emerging threats of public health concern are
addressed.
4.1. Strengthen the coordination of the preparedness and response mechanisms to address
health emergencies including natural disasters (hurricanes and earthquakes), and the
impact of climate change.
4.2. Continue to monitor new and evolving outbreaks such as Zika and take the appropriate
response measures.
4.3. Implement the IHR external evaluation recommendations which include preparing a
multisectoral roadmap linking existing institutional and operational planning
mechanisms and structures and increasing horizontal cooperation with other countries.
The 2017-2021 CCS with Belize was operationalized through the 2018-2019 and 2020-2021
Biennial Work Plans with the participation of multiple governmental agencies, United Nations
agencies, donors, and partners in the country. PAHO/WHO technical cooperation contributed
to all but one objective (6- “Development of quality improvement framework to ensure
stakeholders accountability”) in the Belize Health Sector Strategic Plan 2014-2024.

An evaluation of the CCS 2017-2021 utilizing an online survey was completed in the first
quarter of 2021. Ninety-four percent (94%) of the respondents who were external to PAHOfelt
that PAHO/WHO remained focused on the needs and priorities of Belize even though some
priorities received more attention than others. PAHO’s technical cooperation was also
reflected by its contribution to the United Nations Multi-Country Sustainable Development
Framework (UN MSDCF), mainly priority 2 (A Healthy Caribbean). Several of the outputs
programmed during the implementation of the 2017-2021 CCS contributed to Priority Area 4
“A sustainable and resilient Caribbean”. Also, one of PAHO’s outputs (related to road safety)
contributed to Priority Area 3 “A safe, cohesive and just Caribbean”.

The implementation of the 2017-2021 CCS in Belize was impacted by the financial crisis in
PAHO/WHO (delayed payment by member states in 2019) and the COVID-19 pandemic. The
PAHO/WHO core function most used for the implementation of the 2017-2021 CCS was
“providing technical support and building sustainable institutional capacity”, followed by
“articulating ethical and evidence-based policy options”, setting norms and standards,
promoting and monitoring implementation. The PWR was changed during this cycle as well
as the only international advisor in the country office, and the delay in appointing the
replacement of the Health Systems advisor slowed the rate of technical cooperation. Reports
also showed that major challenges for the implementation of PAHO’s technical cooperation as
reflected in the CCS were related to limited human resources both in the country and PAHO’s
 28

country office. Compounding these challenges were competing agendas of multiple partners,
including sub-regional partners.

The survey suggested that the greatest results of PAHO/WHO technical cooperation during the
period of the CCS were achieved in its priorities 3 and 4 (Health and wellness promoted to
prevent non-communicable and communicable diseases and health emergencies, respectively).
The PAHO/WHO country office in Belize established and strengthened multiple partnerships
with national agencies and interested stakeholders that helped implementation of the 2017-
2021 CCS.

During the period covered by the 2017-2021 CCS with Belize, the country was able to improve
several health indicators; however, the evaluators could not determine if it was a direct result
of the CCS. See Table 1.

Table 1: Belize Health Indicators

INDICATORS Start of CCS Towards end of CCS
Life expectancy at birth (years) 74.37 (2017) 74.89 (2021)
Infant Mortality rate (per 1,000 live 14.30 (2017) 11.53 (2020)
births)
Under five mortality rate (per 1,000 live 18.10 (2017) 14.50 (2020)
births)

The following lessons learnt and recommendations from the CCS 2017-2021 should be taken
onboard to enhance this current CCS 2023-2027:
• A mid-term evaluation of the CCS
• Active participation of key stakeholders at every stage
• With limited PAHO/WHO resources, careful selection and optimization of priorities
and focus areas of CCS is needed.
• A strong involvement of the regional level and involvement of all PAHO/WHO levels
in the implementation process.
• Establish a monitoring mechanism of the implementation of the CCS.
 29

CHAPTER 4: THE STRATEGIC AGENDA FOR PAHO/WHO COOPERATION

The CCS 2023-2027 Strategic Agenda rolls out the Strategic Priorities (SPs) and Focus Areas
(FAs) for PAHO’s Technical Cooperation with Belize. These SPs constitute the medium-term
priorities for PAHO/WHO’s cooperation with the Government of Belize and will focus its
resources over the CCS 2023-2027 cycle on those SPs.

Each strategic priority identified, selected and agreed upon collaboratively is the joint
responsibility of the Belize government and PAHO/WHO. The priorities and aligned
indicators should adopt the SMART (Specific, Measurable, Achievable, Reliable, and Time-
bound) rule. Each strategic priority selected through consultation should support achievement
of the relevant GPW13 outcomes while responding to the key aspects of the Belize Health
Sector Strategic Plan 2014-2024.

The following SPs and FAs were identified by the Government of Belize in the Belize Health
Sector Strategic Plan 2014-2024 and the Belize MOHW Operational Plan 2022-2023:

SP 1: Integrated Health Services Based on Primary Health Care for improved Health
outcomes

Focus Areas:

1.1 Coordination in health service delivery among providers and stakeholders to ensure
continuity of care.
1.2 Health system organized to increase accessibility to health services in an equitable
manner.
1.3 Quality of care according to defined standards.
1.4 Efficiency and productivity in management of health services.
1.5 Basic package of services.

SP 2: Strengthening the Organization and Management of Health Services

Focus Areas:

2.1 Effective governance structures for community and provider institutions

implemented.
2.2 Policy development, strengthened legislature and development of M&E framework
for essential Public Health functions/MOHW implemented.

SP 3: Achieving Greater Equity, Cost Effectiveness and Efficiency in the Allocation and
Use of Health Resources (Improved Health financing to achieve Universal Health
Coverage)

Focus Areas:

3.1 Government commitment to defined options for health sector financing.

 30

3.2 Equity, effectiveness and efficiency in the allocation and use of funds.
3.3 Sustainable Health Sector Financing option defined and implemented.
3.4 Transparency and Accountability in Financial management.

SP 4: Strengthen Capacity for Human Resources for Health Planning to meet present and
future Health sector needs

Focus Areas:

4.1 Appropriate HRH policies, procedures, guidelines and training.

4.2 Human Resource planning and management.
4.3 Health facilities adequately staffed.

SP 5: Strengthening of the Belize Health Information System to Support Evidence based

Planning in the provision and delivery of Health Care

Focus Areas:

5.1 Monitoring and Evaluation for compliance.

5.2 Strengthen legislation to support protocols for data exchanged among entities.
5.3 Utilization of data for evidence- based planning and decision making.
5.4 Surveillance of Non-Communicable Diseases and Communicable diseases
strengthened.

SP 6: Development of Quality Improvement framework to ensure stakeholder

accountability

Focus Area:

6.1 Quality improvement Framework for all levels of the health system designed and
implemented.

SP 7: Efficient and Effective Health Infrastructure Development

Focus Areas:

7.1 Physical health environment for health care delivery to clients improved.
7.2 Rational use of Technology for health, inclusive of M&E and procurement policies.
7.3 Quality of Work environment for health workers enhanced.
7.4 Preventive Maintenance program established.
 31

In June 2021 and November 18, 2022, key stakeholders (including senior managers of the
Ministry of Health and Wellness with a broad knowledge of public health) were invited by
PAHO/WHO to meet and finalize a consolidated HANLON priority ranking for the outcomes
of the PAHO Strategic Plan. The eight top priority rankings are as follows:

Table
TOP 8 4: TopPAHO/WHO
BELIZE eight (8) PAHO Outcome
PRIORITIES Priorities
IDENTIFIED USING(indicated in green)2021
HANLON PROCESS, Identified
& 2022 by Belize
Using Hanlon Methodology (2021-2022)
RANK OUTCOMES
2021 2022 TOP 8 PRIORITIES
1 2 Countries’ capacities strengthened to prevent and control epidemics and
pandemics caused by high-impact and/or high-consequence pathogens
2 8 Increased response capacity of integrated health services networks
(IHSNs), with emphasis on the first level of care, to improve access to
comprehensive, quality health services that are equitable, gender- and
culturally sensitive, rights-based, and people-, family-, and community-
centered, toward universal health
3 3 Adequate availability and distribution of a competent health workforce
4 9 Increased response capacity of integrated health services networks
(IHSNs) for prevention, surveillance, early detection and treatment, and
Tier 2 care for communicable diseases, including vaccine-preventable diseases
5 6 Expanded equitable access to comprehensive, quality health services for
the prevention, surveillance, early detection, treatment, rehabilitation,
and palliative care for noncommunicable diseases and mental health
conditions
6 4 Strengthened country capacity for all-hazards health emergency and
disaster risk management for a disaster-resilient health sector
7 1 Risk factors for noncommunicable diseases reduced by addressing the
determinants of health through intersectoral action
8 20 Increased and improved sustainable public financing for health, with
Tier 3 equity and efficiency
10 5 Risk factors for communicable diseases reduced by addressing the
Tier 2 determinants of health through intersectoral action
13 7 Increased promotion of mental health, reduction of substance use
Tier 2 disorders, prevention of mental health conditions and suicide, and
diminished stigmatization, through intersectoral action

Table 5 below links the top five PAHO outcome priority areas identified by Belize using the
Hanlon Methodology (Table 4) with the seven broad strategic priorities identified previously
by the Government of Belize in the Belize Health Sector Strategic Plan and Operational Plan
(pages 29-30). The national consultation of key stakeholders and partners from various sectors
(government, NGO, CSO and Private sector) compared the SDGs, WHO GPW 13, the PAHO
National Strategic Plan 2020-2025 priorities, the Sustainable Health Agenda for the Americas
2018-2030 and the Belize Final Consolidated Results-HANLON Priority ranking. Together
with PAHO, these key stakeholders and partners consulted, discussed, and agreed on the key
priority areas for the new CCS, taking into consideration PAHO/WHO’s comparative
advantage.
 32

Table 5: Comparison of WHO/PAHO Priorities and Belize NSP Priorities

HANLON Belize Priorities Belize Health Strategic Plan SHAA 2030 GPW 13 SDGs
21/22 2014-2024

Risk factors for SP5: Strengthening of the Belize SP9.Reduce morbidities, Health & Wellbeing 3.4
noncommunicable diseases Health Information System to support disability and mortality from 4.NCDs prevented, treated, 3.b
reduced by addressing the evidence-based planning in the NCDs, injuries, violence and managed, and their risk
determinants of health through provision and delivery of health care mental health disorders factors controlled & mental
intersectoral action health prioritized &
improved

Countries’ capacities SP2: Strengthening the organization SP8.Strengthen national and Emergencies 3.d,
strengthened to prevent and and management of health services. regional capacities to prepare for, 2.Strengthened national, 3.3,
control epidemics and prevent, detect, monitor, and regional & global 3.9,
pandemics caused by high- respond to disease outbreaks, and capacities for better 3.d
impact and/or high-consequence emergencies and disasters that protecting people from
pathogens affects the health of the epidemics, other H.E and
population ensuring that populations
affected by emergencies
have rapid access to
essential life-saving HS,
including health promotion
and disease prevention
Adequate availability and SP4: Strengthen capacity for human SP3. Strengthen the mgt & Universal Health 3.c
distribution of a competent resources for health planning to meet development of human resources Coverage
health workforce present and future health sector needs for HHRH with skills that 3.Improved human capital
facilitate a comprehensive across the life course
approach to health
 33

Strengthened country capacity SP2: Strengthening the organization SP8. Strengthen national and Emergencies 3.3,
for all-hazards health emergency and management of health services. regional capacities to prepare for, 7. Health impacts of 3.9,
and disaster risk management prevent, detect, monitor, and climate change, 3.d
for a disaster-resilient health respond to disease outbreaks, and environmental risks and
sector emergencies and disasters that other determinants of
affects the health of the health addressed, including
population in SIDS and other
vulnerable settings
Risk factors for communicable SP5: Strengthening of the Belize SP10.Reduce the burden of Health & Wellbeing 3.b
diseases reduced by addressing Health Information System to support Communicable Diseases and 5. Accelerated elimination
the determinants of health evidence-based planning in the eliminate neglected diseases and eradication of high-
through intersectoral action provision and delivery of health care impact communicable
diseases
 34

While considering the above, during the National multi-stakeholder Consultation, together with PAHO/WHO, key stakeholders agreed on the
strategic priorities and focus areas for the new CCS. Pursuant to its rules, regulations, policies, and procedures, and subject to the availability of
funds, PAHO/WHO outlines the following medium-term vision that will guide the technical cooperation between PAHO/WHO and the
Government of Belize for the 2023-2027 CCS period:

STRATEGIC PRIORITY AREA FOCUS AREAS CORE FUNCTIONS

1.Provide expanded and equitable Promote behavioral changes through public Coordination
access to quality health services awareness and intersectoral collaboration to address a. Alignment of the national plans of different
for the prevention, detection, determinants and risk factors for NCDs including stakeholders and the inclusion of a Monitoring and
treatment, rehabilitation and Evaluation component. to ensure compliance. This will
mental health, supported by a health in all policies
palliative care for non- serve to also detect needs that may arise in the process of
communicable diseases (NCDs) approach. implementation.
and mental health (MH) b. Incorporation of Health in all Policies.
conditions across the life course
through evidence-based Intersectoral cooperation
interventions and intersectoral a. Develop/adapt and implement a model for intersectoral
partnerships for action. collaboration related to NCDs and Mental Health.

Mobilization of resources
a. Public and private sector.
b. Technical support for the creation of enabling
environments.
c. Educational Institutions.

Public awareness
a. Information, education, communication.

Policy direction, leadership and governance.

 35

Strengthen the primary, secondary and tertiary Coordination

education curriculum geared towards the promotion of a. Must reflect the holistic approach and partnership with
holistic health including nutrition and mental health. Ministry of Education (MOE) /other educational institutions,
Human Development, Agriculture, and non- governmental
Develop a policy framework to create an enabling Organizations,
environment in support of addressing risk factors b. This must be reflected in internal policies and contracts or
associated to NCDs and mental health, including Memoranda of Understanding (MOU) for which the entity is
violence and injuries. more suited and has an established governance, leadership
and financial structure.
Strengthen health systems based on leadership, c. This includes a Structured curriculum, training plan and
governance, regulatory, financial and data driven evaluation of the impact of lessons imparted and effects
frameworks: include integrated and accessible health monitored.
services that are people centered, availability of safe
medicines, use of technology, research utilization of • Intersectoral Cooperation
high-level scientific evidence in healthcare delivery, Develop/adapt and implement a model for intersectoral
and development of human resources in collaboration related to risk factors, nutrition and
health. health including Mental Health.

• Mobilization of Resources
Includes the development of national curricula that are
budgeted and implemented through participation and
inclusion of stakeholders such as PAHO/WHO.

• Public Awareness
This includes the development of strategic plans to
address the health of children /individuals or groups in
diverse settings in a holistic and comprehensive
manner. Examples include - the reduction in the
consumption of salt, screening.

• Policy direction, leadership and governance

Revisiting the scope of national alliance on nutrition.
 36

Update and integrate the legal framework to support

the activities of all strategic plans and policies
including governance, M&E and accountability
inclusive of Mental Health Management.

Approach: Capacity building is fundamental for the implementation of approved interventions. The MOHW should ensure strong partnerships with
relevant actors, such as the Police Department, MH Associations and others.

2. Increase response capacity of Strengthened and expanded “One Health” integrated a. Development of mechanisms that will integrate human,
integrated health services to surveillance system (Revision of mandatory animal and environmental health surveillance, including
monitor, prevent, detect, treat, reportable diseases and relevant standard operating identification of indicators to facilitate timely interventions.
control and eliminate procedures (SOPs)). b. Creation and/or revision of SOPs and guidelines for
communicable diseases including integrated surveillance of zoonotic conditions.
neglected infectious diseases by c. Optimize the use of the One Health platform for integrated
addressing the determinants of
analysis and reporting.
health through intersectoral
actions to reduce risk factors.
Support research and health technologies for the a. Define and execute the health research agenda based on
development and access to evidence-based public health needs.
interventions (diagnostics, vaccines and medicines). b. Establish a formal, functional and integrated Institutional
Review Board (IRB)/Ethics Committee for the submission
and review of research proposals.
c. Explore feasibility of an integrated research unit.
d. Ensure capacity building for research and health technology
development.

Capacity building and improved resources for health a. Training on integrated One Health Surveillance system,
response to Communicable Diseases. including early warning systems (EWS) for timely response.
b. Standardized training on clinical case management of
communicable diseases.
c. Enhanced local partner capacity in prevention, diagnosis,
treatment, care and reporting of communicable diseases,
 37

including decentralization of testing and screening for CDs and

procurement of necessary technology and equipment.

Support and promote the implementation of a. Create physical and virtual spaces (including social
interventions and strategies that engage and empower marketing) to promote continuous education and awareness
communities to adopt healthier lifestyles to reduce the on reportable communicable diseases to the public.
risk factors related to developing and/or contracting b. Identify, implement, monitor and evaluate effective
communicable diseases. behavioural change strategies for key populations and
vulnerable groups, including partnerships with FENSA
vetted NGOs and local community groups/institutions,
champions for health.
c. Promote an enabling environment that will empower
persons and communities to adopt healthier choices.
d. Address stigma and discrimination related to specific
communicable diseases (e.g., HIV, TB, leishmaniasis, etc.)
through risk communication and other strategies.

Approach: A multi-sectoral collaborative approach is critical in reducing risk factors and addressing the determinants of health towards prevention, care
and treatment.

3. Adequate availability and Institutionalization of an enabling environment in a. Development of inclusive Regulations and safety
distribution of a competent, which occupational and safety health standards for all guidelines.
skilled health workforce with healthcare facilities both public and private are b. Develop a public campaign on the promotion of the
access to technology, and implemented. regulations and guidelines.
educational opportunities with c. Cost analysis for implementation.
sustainable financing. d. Cabinet support and approval.

Capacity building for the health sector professionals a. Development of an awareness campaign on health
and health profession educators to strengthen professional development.
evidence-based inter-professional health practices,
 38

through the development of regional and national b. Strengthening of curricula for training in health
education centers for development. professional education.
c. Development of partnerships, NGOs, and international
o Expansion of the PAHO/WHO Virtual organizations to support training opportunities in essential
Campus (Certified and accredited health fields not available in the country.
programs).

Strengthen the management of Human Resources for a. Monitoring of the implementation of the HRH plan.
Health in the Ministry of Health and Wellness through b. Inclusion of HRH in health-related policies development.
the development of HRH policies and plans that will c. Quality improvement management system to Monitoring and
provide the strategic direction in HRH development. Supervision staff at all levels of care.

Advocate for a sustainable health financing a. Recruitment strategies that initiate from the point of
mechanism to increase the output and retention of training.
HRH professionals, and improve health technologies, b. Healthcare specialization is on the top priority list in the
and infrastructure to meet present and future government to support scholarship opportunities.
healthcare needs. c. Health care professionals are distributed based on health
indicators. Example population, epidemiological profile

Approach: i) Inter-sectorial Stakeholder consultation; Increase advocacy; Sensitization of the concept; Establish partnerships with Government, FENSA
vetted NGOs and private sector; Phased approach for the implementation; Align the WHO healthy workplace framework and model to the Belizean
context.
ii) Adjustment of the clinical environment to encourage and facilitate teaching; Development of a multisectoral national comprehensive health education
workforce development plan; Analysis of curriculum for health professional programs; Establish a comprehensive continued education program for health
professionals.
iii) Review and update the HRH plan alignment with the specific country needs; Workforce needs assessment; Assessment of the HRH’s capacities to
implement health-related policies and strategies; The transition from a Public Service Commission to a Health Services Commission.
iv) Public-private sector partnerships to increase the output of healthcare professionals from point of training; Government to consider Health education as
a priority; Ministry of Education strengthens its role in healthcare education; Training of advanced specialized health professionals based on the needs
 39

identified in the HRH data analysis; Conduct an analysis on retention strategies and alignment for the development of a national retention mechanism for
healthcare professionals; Health professional needs assessment; Compensation packages are defined specifically for healthcare workers.

4.Strengthen and build national Development of multisectoral resilient systems and Strategic risk assessments (Hazard Identification and
and Local emergency response capacities for all hazards health emergency prevention vulnerabilities)
system with capabilities to and response. -Emergency Operations plan (All Hazards)
monitor, detect, respond, prevent -Specific contingency plans for priority hazards
and mitigate Public Health (Pandemic, Emerging, Re-emerging diseases and Climate
Emergencies, Disasters and Change)
Hazards. -Food Safety and Security
-Large public events (mass gathering) planning
-Emergency risk communication
-Capacity building (Simulations/Exercises)

Reduce loss of life and maintenance of well-being Public Education.

through the reduction of impacts of disasters and -Risk management and Testing.
emergencies on individuals and communities. -Maintaining and Supporting Mental wellbeing.
-Health safety standards and guidelines (Food Security,
Pharmaceuticals).
-Post Disaster Assessment.

Save and safeguard lives, minimize property damage -Early Warning, Alert and response system. (Data Security).
to health infrastructure and improve the potential for -Activation of incident management (EOC).
better recovery. -Deployment of Rapid Response Teams, EMT.
-Establish network for communication (alternate).
-After Action Review (Monitoring).
 40

Develop implementation guides for health systems Support affected communities.

recovery in emergencies preparedness, Gender Based -Provision of Mental Health support services.
Violence and humanitarian response. -Repair/ replace vital infrastructure.

Approach: 1) PREPAREDNESS 2) MITIGATION 3) RESPONSE 4) RECOVERY

 41

CHAPTER 5: IMPLEMENTATION OF THE CCS 2023-2027

5.1 Launch
The CCS 2023-2027, once signed by both the Belize government and PAHO/WHO, will
become the reference document for PAHO/WHO’s work in Belize.

The signing of the CCS 2023-2027 commences the beginning of the implementation process
and will be followed by an official launch by the MOHW. Both the signing of the CCS and
the launch eventare excellent opportunities to increase the visibility of the joint work and goals
to assist Belize in achieving its health objectives, including the national SDG targets. The
TWG or a separate committee should be established to launch the implementation of the CCS
2023-2027 to ensure maximum visibility and engagement.

All stakeholders involved in the development of the CCS 2023-2027 as well as high level
dignitaries from the region, government and private sector should be invited to participate in
the launch event. The media should also be invited, and wide coverage of the event broadcast
on social and traditional media. An attractive brochure should be developed and disseminated
both electronically and in booklet format highlighting a summary of key areas of the CCS
2023-2027.

5.2 Coordination and Management

The implementation of the CCS will be coordinated through the PAHO country office, but
implementation will be done jointly through the entire organization at the national, regional
and global levels. The Belize MOHW and its multi-sectoral national and regional partners will
join in implementing specific priority and focal areas of the CCS. PAHO strives to achieve
implementation bearing the following in mind:
• The CCS 2023-2027 is aligned with the Belize Health Sector Strategic Plan 2014-2024,
and the Operational Plan, 2022-23. The Plan will be reviewed and adjusted as necessary.
• Review and if necessary, reallocate resources to priority areas identified in the CCS
2023-2027
• The CCS 2023-2027 will be used to generate or revive strategic partnerships for health.
• As it elucidates its aims and plans to accomplish them, the CCS 2023-2027 will be used
to demonstrate to development partners how successful mutually beneficial
collaboration can be, leading to a better delivery of results.
• The CCS process will allow for opportunities to strengthen collaboration with UN
agencies, avoiding duplication and enhancing synergies.
• The CCS 2023-2027 will make explicit the tangible contributions that UN partners
make to advance the strategic agenda.
• PAHO/WHO will consider the CCS 2023-2027 priorities for future consideration of a
new UN MSDCF.
• The CCS implementation will generate a multisectoral response to CCS priorities, as
many of the issues will require collaboration of partners outside of the health sector.
 42

• The CCS 2023-2027 will provide important information to shape planned interventions
in collaboration with UN partners engaged in issues related to the social determinants
of health.
• The CCS 2023-2027 will also stimulate the use of common UN funds for health-related
interventions and with higher visibility also attract funds from other donor agencies.

5.3 Core Resources Needed for Implementation

Financial
Health financing is both an important aspect of Health Systems planning, diagnosis and
treatment of disease and promotion of wellness. The CCS is expected to be funded through
flexible and voluntary funds from WHO and PAHO as well as through other resource
mobilization strategies. The Ministry of Health and Wellness will also contribute as needed
from its national budget.

Communication
Good communication can rally support, calm a nervous public, provide much-needed
information, encourage cooperative behaviours and help save lives. The launching and
implementation of this CCS will communicate vital information of the strategic priorities
jointly developed by a multisectoral consultation to key stakeholders. The PAHO/WHO Belize
country office will seek to improve the communication of PAHO/WHO’s work and its impact,
globally, regionally and at the country level. This will also enhance visibility and public health
positioning in the dynamic collaborative work between the MOHW and its multisectoral
partners in Belize, Central America and the Caribbean.

Human
The PWR, supported by the departments of Human Resources Management (HRM), Program
Budget and Evaluation (PBE) and Country and Sub-regional cooperation (CSC) should review
the current structure and organization of the Country Office based on the updated CCS 2023-
2027 and, if necessary, adapt the profile of the staff, the functional organization, and the
modalities of technical cooperation of the Country Office. The Belize MOHW and other
relevant partners must also ensure adequate staffing is assigned to implement the activities
under the jointly selected priorities and focus areas.

5.4 Risks
During the development of the current CCS 2023-2027 Belize was hit by category one
Hurricane, Lisa. From 2020-2022 the COVID-19 pandemic also affected Belize like the rest of
the world and impeded health programmes. The implementation of this CCS will occur in an
uncertain environment which could pose threats or cause implementers to develop new and
innovative strategies to ensure activities are completed.

Economic, political, social, technological, environmental and legal matters all have
implications for the implementation of the CCS 2023-2027.
 43

Key stakeholders have identified the following weaknesses or threats that might hinder
implementation and must be addressed:
• Poor communication among government, NGOs, private sector and other stakeholders.
• Limited political will and limited finances to spearhead national strategies.
• Limited Mental Health staff to support interventions at local level.
• Outdated or nonexistent legal framework to implement and enforce established
policies and protocols.
• Availability of human resources and skilled staff and ageing population of trained
educators.
• Community Health Workers’ high attrition due to limited compensation.
• Weakening community surveillance.
• Limited access to health technologies.
 44

CHAPTER 6: MONITORING AND EVALUATION

The CCS 2023-2027 will be carefully monitored and evaluated as the strategy develops, using
the Country Impact Framework. The M&E processes will contribute significantly when
reporting on PAHO/WHO’s contribution and impact in delivering GPW13 targets at the
regional and global levels. Even though the CCS monitoring is the responsibility of the PAHO
Belize Country Office, it should be done in collaboration with the Belize government and
involve all three of the WHO levels to ensure joint ownership of the results. Ideally, an M&E
committee would involve the three layers of PAHO/WHO (where possible) and key officials
from the Belize MOHW.

Progress in the CCS 2023-2027 implementation should be reviewed at the country level
annually. A review should also be done if they are any major changes at the country level such
as:
• New government in office or major change affecting health and national priorities.
• A crisis that changes the health situation or creates risk.
• A new UN MSDCF is developed.
• New evidence emerging concerning national public health needs or statistics.

6.1 Monitoring CCS 2023-2027 Implementation

• The M&E Committee ensures that the CCS 2023-2027 priorities are implemented in a
timely and efficient manner.
• Monitoring provides an early warning system to identify problems related to the
implementation of strategic priorities and focus areas.
• It also offers opportunities for early interventions and adjustments of strategies.
• Monitoring the CCS 2023-2027 implementation will assess how the operational plans
are accomplished using the instruments at the regional level.
• The cumulative periodical reviews will be utilized as inputs for the midterm and final
CCS 2023-2027 evaluation.

6.2 Evaluation of the CCS 2023-2027 Implementation

The evaluation process is led by the PWR who works closely with the M&E Committee and
CCS TWG. The main focus of the evaluation is to measure whether targets identified in the
country results framework have been achieved. The aim is to also determine if the CCS 2023-
2027 has contributed towards the GPWs 13 triple billion goals.

A country balance scorecard should be developed for use with the CCS 2023-2027 midterm
and final evaluation.
 45

Midterm Evaluation
The midterm evaluation of the CCS 2023-2027 should take place halfway (2025) through its
implementation. It will inform the need to adjust priorities, focus areas or any contextual needs
in Belize. The focus of the midterm evaluation is to:
• Determine if implementation of the strategic priorities is progressing as planned and if
expected achievements are on track with the country result framework.
• Identify any hindrances and potential risks that may require changes to the strategic
priorities and initiatives to escalate progress in the second half of the CCS 2023-2027
cycle.
• Assess whether any strategic priorities need revising, especially if there has been a
significant event or major emergency in Belize (e.g., epidemic/pandemic, Hurricane).

Final Evaluation
The final evaluation should be a very conclusive and comprehensive assessment conducted at
the end of the CCS 2023-2027. The evaluation framework should be developed in
collaboration with the MOHW and other key stakeholders. It should assess relevance,
efficiency, effectiveness and overall impact. The evaluation should describe the achievements,
gaps, challenges, lessons learnt, and recommendations should be made for future collaboration
between PAHO/WHO and Belize. Ideally the final evaluation should be conducted by an
external consultant. The final evaluation should commence when the CCS 2023-2027
implementation ends and feed directly into the development of a new CCS.

The United Nations Sustainable Development Goals are targets for global development set to
be achieved in 2030. The SDG targets and indicators fit well with the priority areas identified.

Strategic Priority Area Target Indicator

SP1: Provide expanded and equitable SDG 3.4 By 2030, reduce 3.4.1 Mortality rate attributed to
access to Quality health services for the by one third premature cardiovascular disease, cancer,
prevention, detection, treatment, mortality from non- diabetes or chronic respiratory
rehabilitation and palliative care for communicable diseases disease
NCDs and MH conditions across the life through prevention and 3.4.2 Suicide mortality rate
course through evidence-based treatment and promote
interventions and intersectoral mental health and well-
partnerships for action. being
SP 2: Increase response capacity of SDG 3.3 By 2030, end the 3.3.1 # of new HIV infections/
integrated health services to monitor, epidemics of AIDS, 1,000 uninfected pop, by sex, age
prevent, detect, treat, control and tuberculosis, malaria and & key populations
eliminate communicable diseases neglected tropical diseases 3.3.2 Tb incidence/100,000
including neglected infectious diseases and combat hepatitis, population
by addressing the determinants of health water-borne diseases and 3.3.3 Malaria incidence/1,000
through intersectoral actions to reduce other communicable population
risk factors. diseases 3.3.4 Hepatitis B
incidence/100,000 population
3.3.5 # of people requiring
interventions against neglected
tropical diseases
 46

SP 3: Adequate availability and SDG 3.c Substantially 3.c.1

distribution of a competent, skilled increase health financing Health worker density and
health workforce with access to and the recruitment, distribution
development, training and
technology, and educational
retention of the health
opportunities with sustainable financing. workforce in developing
countries, especially in least
developed countries and
small island developing
States

SP4: Strengthen and build national and SDG 3.d Strengthen the 3.d.1 International Health
Local emergency response systems with capacity of all countries, in Regulations (IHR) capacity and
capabilities to monitor, detect, respond, particular developing health emergency preparedness
prevent and mitigate Public Health countries, for early
3.d.2 % of bloodstream infections
Emergencies, Disasters and Hazards. warning, risk reduction and
management of national due to selected antimicrobial-
and global health risks resistant organisms
 47

NONCOMMUNICABLE DISEASES COMMUNICABLE DISEASES

EMERGENCIES HUMAN RESOURCES

 48

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&isAllowed=y
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annual-report-2020
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Appendix 1
CCS 2023-2027 Two Day Consultation Participants List
# NAME ORGANIZATION 29 30

1 Myrat Muradov Representative UNHCR X A

2 Ivorine Bulwer Director HELPAGE X A

3 Dr. Omar Aviles Medical Officer Mercy Clinic X A

4 Laura Tucker-Longsworth President Belize Cancer Society X X

5 Carmen Barrow Adminsitrator Belize Cancer Society X X

6 Lily Bowman Director General Belize Red Cross NS X

7 Deerian Buckley Wade Ministry of Blue Economy & Civil Aviation X A

8 Stephen Williams IICA X X

9 Sharrie Ciego National Garifuna Council X A

10 Ruby Nicholas Kidney Association X X

11 Ix-Chel Poot Executive Director National Council on Ageing X X

12 Christa Courtenay VP Mental Health Association X X

13 Noreen Jack PWR Belize X X

14 Edwin Bolastig HSS/A PAHO/WHO X X

15 Peitra Arana NC HSS PAHO/WHO X X

16 Alondra Izaguirre NC for NCDs X X

17 Annalisa Sandcroft NC for Surveillance of NCDs and Risk Factors X X

18 Fancis Longsworth NC H-NAP CRHSP (Primary Consultant) NS

19 David Perrera NC H-NAP CRHSP (Primary Consultant) NS

20 Verlie Lamb NC Road Crashes Project (Primary Consultant) X X

21 Ianthe Cocom NC Road Crashes Project X X

22 Zenena Moguel Communication & Visibility Consultant X X

23 Rick Rhaburn ITS/Media Communications X X

24 Ruby Dominguez Administrator PAHO/WHO X X

25 Paula Vasquez EA PAHO/WHO X X

26 Lizett Bell Chair Nursing and Midwives Council X X

# NAME ORGANIZATION 29 30
 51

27 Luiz Octavio Coimbra OAS Representative X A

28 Jorge Polanco Director Hospital Services & Allied Health, MOHW X X

29 Russell Manzanero Medical Epidemiologist, MOHW X X

30 Carmeta Douglin Consultant X X

31 Shirley Cruz Nursing Association of Belize X X

32 Jose Urbina, CEO E-Governance X A

33 Marvin Manzanero Director IA MOHW X A

34 Melissa Diaz Musa Director, PHW MOHW X X

35 Englebert Emmanuel L & A MOHW X X

36 Dianie Ek Communication MOHW X X

37 Esner Vellos NDACC MOHW X X

38 Iveth Quintanilla Mental Health, MOHW X X

39 Kathleen Cho HECOPAB A X

40 Chrystal Samouge Chief Drug Inspectorate, MOHW X X

41 Jose Coy Deputy Regional Health Manager Central X X

42 Franelda Gutierrez Western Regional Health Manager X X

43 Melinda Guerra Central Regional Health Manager X X

44 Angela Gilharry Northern Regional Health Manager X X

45 Myra Pulido Western Regional Health Manager X X

46 Jorge Sajia Southern Regional Health Manager X X

47 Arik Lima CMS, MOHW A X

48 John Bodden DFP and SPHI MOHW X X

49 Rafael Samos Dental Surgeon, MOHW X X

50 Rochelle Cabral Director CML A X

51 Kim Bautisa Vector Control MOHW A X

52 Angela Baitwabusa UNICEF A X

53 Lisseth Abarca BHIS MOHW A X

54 Lisa Johnson UB A X

55 Edward Tesecum BAHA A X

 52

56 German Alamilla Belize Diabetes Association A X

57 Shantel Pakeman Belize Medical and Dental Association A X

58 Francis Morey DD HS AH MOHW A X

59 Carla Ayres Musa Executive Director BCVI A X

60 Roby Daly Nutritionist MOHW A X

61 Tasha Cain Foreign Assistance Officer, MOFA A X

62 Monica Heredia Red Cross A X

63 Caleb Osorio UNIBAM A X

CCS 2023-2027 Two Day Consultation Participants List (VIRTUAL)

# NAME ORGANIZATION 29t 30t
h h

6 Rufus Ewing PAHO CSC/CPA Belize X

4
6 Carla Ayres ED Belize Council for Visually Impaired X
5 Musa
6 Enrique Romero ED Natioanl AIDS Commission X
6
6 Eleanor Bennett Registrar Nursing &B Midwives Council X
7
6 Javier Romero Statistical Institute of Belize X
8
6 Amilin Mendez UNDP X
9
7 Vincent Lowney US Embassy X
0
7 Samira Gongora MOHW X
1
7 Jay Coombs UN Human Rights X
2
7 Claudia Pescetto PAHO/HQ X
3
7 Audrey Morris PAHO Department of Noncommunicable Diseases and Mental Health X
4 (NMH)
7 Kathrine President BCCI X
5 Meighan
7 Dylon Elliot BCCI X
6
7 Vincent Palacio President UB X
7
7 Sharrie Ciego National Garifuna Council X
8
7 Melissa Diaz Director PH&W MOHW X
9 Musa M
 53

Regional Priorities for 2022-2023

Appendix 2

PAHO Regional Priorities for 2022-2023

Priority Outcome
Outcome
Tier No.
5 Access to services for NCDs and mental health conditions
24 Epidemic and pandemic prevention and control
25 Health emergencies detection and response
High

13 Risk factors for NCDs

23 Health emergencies preparedness and risk reduction
1 Access to comprehensive and quality health services
4 Response capacity for communicable diseases
12 Risk factors for communicable diseases
20 Integrated information systems for health
2 Health throughout the life course
14 Malnutrition
Medium

10 Increased public financing for health

16 Intersectoral action on mental health
8 Access to health technologies
7 Health workforce
9 Strengthened stewardship and governance
19 Health promotion and intersectoral action
17 Elimination of communicable diseases
3 Quality care for older people
11 Strengthened financial protection
Low

18 Social and environmental determinants

21 Data, information, knowledge, and evidence
22 Research, ethics, and innovation for health
6 Response capacity for violence and injuries
15 Intersectoral response to violence and injuries
54