Background: The world is currently unprepared to deal with the drastic increase in global migration. There is an urgent need to develop programs to protect the well-being and health of migrant peoples. Increased population movement is already evident throughout the Americas as exemplified by the rising number of migrant peoples who pass through the Darien neotropical moist broadleaf forest along the border region between Panama and Colombia. The transit of migrant peoples through this area has an increase in the last years. In 2021, an average of 9400 people entered the region per month compared with 2000–3500 people monthly in 2019. Along this trail, there is no access to health care, food provision, potable water, or housing. To date, much of what is known about health needs and barriers to health care within this population is based on journalistic reports and anecdotes. There is a need for a comprehensive approach to assess the health care needs of migrant peoples in transit. This study aims to describe demographic characteristics, mental and physical health status and needs, and experiences of host communities, and to identify opportunities to improve health care provision to migrant peoples in transit in Panama. Study design and methods: This multimethod study will include qualitative ( n = 70) and quantitative ( n = 520) components. The qualitative component includes interviews with migrant peoples in transit, national and international nongovernmental organizations and agencies based in Panama. The quantitative component is a rapid epidemiological study which includes a questionnaire and four clinical screenings: mental health, sexual and reproductive health, general and tropical medicine, and nutrition. Conclusion: This study will contribute to a better understanding of the health status and needs of migrant peoples in transit through the region. Findings will be used to allocate resources and provide targeted health care interventions for migrant peoples in transit through Darien, Panama.

Community case management by community health workers has substantially reduced malaria across the Greater Mekong Subregion and Central America. To sustain current and achieve further reductions in malaria, surveillance and delivery platforms must be redesigned to ensure their continued use by key populations.

Background Panama is one of eight countries in Mesoamerica that aims to eliminate malaria by 2022. Malaria is concentrated in indigenous and remote regions like Guna Yala, a politically autonomous region where access to health services is limited and cases are predominately detected through intermittent active surveillance. To improve routine access to care, a joint effort was made by Guna Yala authorities and the Ministry of Health to pilot a network of community health workers (CHWs) equipped with rapid diagnostic tests and treatment. The impact of this pilot is described. Methods Access to care was measured using the proportion of villages targeted by the effort with active CHWs. Epidemiological impact was evaluated through standard surveillance and case management measures. Tests for differences in proportions or rates were used to compare measures prior to (October 2014-September 2016) and during the pilot (October 2016-September 2018). Results An active CHW was placed in 39 (95%) of 41 target communities. During the pilot, CHWs detected 61% of all reported cases from the region. Test positivity in the population tested by CHWs (22%) was higher than in those tested through active surveillance, both before (3.8%) and during the pilot (2.9%). From the pre-pilot to the pilot period, annual blood examination rates decreased (9.8 per 100 vs. 8.0 per 100), test positivity increased (4.2% to 8.5%, Χ2 = 126.3, p < 0.001) and reported incidence increased (4.1 cases per 1000 to 6.9 cases per 1000 [Incidence Rate Ratio = 1.83, 95% CI 1.52, 2.21]). The percent of cases tested on the day of symptom onset increased from 8 to 27% and those treated on the day of their test increased from 26 to 84%. Conclusions The CHW network allowed for replacement of routine active surveillance with strong passive case detection leading to more targeted and timely testing and treatment. The higher test positivity among those tested by CHWs compared to active surveillance suggests that they detected cases in a high-risk population that had not previously benefited from access to diagnosis and treatment. Surveillance data acquired through this CHW network can be used to better target active case detection to populations at highest risk.

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The 1970s marked a significant opportunity for improving primary health care globally. Yet, political will and widescale investment to achieve “health for all” vastly diverged in countries across the Americas in the decades that followed. Distinct ideologies and models of health care emerged following commitments to social investment, equity, and community participation at Alma-Ata. In the 1970s, Costa Rica scaled up its national health system and increased broad social investment. In Panama, the establishment of the Ministry of Health in 1969 coincided with broad state investment in primary health care, yet the emergence of neoliberal models based on efficiency and privatization in the decades that followed undermined efforts toward health equity. Models of state-sanctioned investment and policies diverged in their framing of ideas about the right to health, characterized by broad social investment in Costa Rica addressing the structural factors of ill health versus financing stratified health systems and select biomedical interventions in Panama. These case studies describe the historical, political, economic, and social dimensions that account for the distinct framing of ideas about right to health and health equity and enabled Costa Rica to diverge as a country with one of the most effective health systems in the region.