She was the Assistant Director of PAHO from 2003 to 2008.[9] She served as the Assistant Director-General of Health Systems and Services at the World Health Organization in 2008–12.[5][6] She was elected PAHO director in September 2012 and took up the position, which has a five-year term, in February 2013.[6] She also serves as honorary Vice-President of the American Public Health Association.[10]