Three Decades of Monitoring Palliative Care Development in Latin America: A Thematic Analysis of Regional and National Strategies.

Abstract

Monitoring the development of palliative care (PC) is essential for guiding public policy, allocating resources, and reducing health inequities. Since the 1990s, Latin America has implemented various assessment strategies; however, their evolution, methodological diversity, and regional impact have not been systematically analyzed. To analyze PC monitoring strategies implemented in Latin America between 1994 and 2025, categorizing them by monitoring domains and methodological approaches. We conducted a qualitative document study analyzing global, regional, and national reports. Inductive thematic analysis was used to classify 44 identified strategies based on the World Health Organization Public Health Strategy pillars: policy, education, services, and medicines, including emergent dimensions such as research and community empowerment. Monitoring efforts were further categorized by Evaluation Levels (Advanced, Institutional, Intermediate, Technical, and Initial) to assess their strategic contribution to national health systems. Forty-four monitoring initiatives were identified across 18 countries. The results reveal a methodological shift from participatory workshops (n = 16) and expert missions (n = 17) toward structured surveys and continuous national observatories. While access to essential medicines was the primary driver of early monitoring (1994-2010), recent strategies in countries such as Argentina, Colombia, Mexico, and Uruguay have adopted multidimensional frameworks. Significant heterogeneity persists, with Southern Cone countries demonstrating advanced institutionalization, while others remain dependent on external technical audits. PC monitoring in Latin America has matured from sporadic situational diagnostics to structured comparative benchmarking. To close remaining gaps, the region must move toward harmonized, sustainable monitoring systems that integrate community empowerment and specialized pediatric care into national health agendas.