7 RANKING (out of 136) SCORE (1-7 best) BORDER COMPLIANCE (hours) DOCUMENTARY COMPLIANCE (hours) BORDER COMPLIANCE (hours) DOCUMENTARY COMPLIANCE (hours) ARGENTINA 94 4.0 21 30 60 192 BOLIVIA 112 3.8 48 192 114 96 BRAZIL 110 3.8 49 18 63* 120 CHILE 21 5.3 60 24 54 36 COLOMBIA 85 4.1 112 60 112 64 COSTA RICA 57 4.5 20 24 80 26 DOM. REP. 78 4.2 16 10 24 14 EQUADOR 81 4.1 96 24 24 120 EL SALVADOR 74 4.3 38 9 40 13 GUATEMALA 69 4.3 36 48 72 32 HONDURAS 86 4.1 88 48 96 72 MEXICO 51 4.6 20 8 44 18 NICARAGUA 76 4.2 60 48 72 16 PANAMA 58 4.5 24 16 24 6 PARAGUAY 107 3.9 120 24 48 36 PERU 54 4.5 48 48 72 72 USA 22 5.2 2 2 2 8 URUGUAY 66 4.4 120 24 13 72 VENEZUELA 136 2.9 288 528 240 1,090 AVERAGE (LatAm) 76 4.2 64 56 121 101 AVERAGE (OECD) 22 5.2 12 3 9 4 HOW DO LATIN AMERICAN COUNTRIES MEASURE UP ON TRADE FACILITATION? TIME TO EXPORT TIME TO IMPORT Source: World Economic Forum 2016 Enabling Trade Index & the World Bank Doing Business Project (June 2016) *  AdvaMed Note: The World Bank index does not systematically include regulated medical products in its methodology; the AdvaMed/ABIIS/ABRAIDI corrected measurement of the border compliance import time of medical devices into Brazil is 360 hours. 6 www.abraidi.org.br 7 http://www.abiis.org.br/assets/posicionamento-sobre-os-atrasos-na-liberação-de-insumos-e-produtos-sujeitos-à-vigilância-sanitária-em-portos%2c-aeroportos-e-fronteiras--05.07.16.pdf Case Study: Brazil Companies report long timeframes to clear medical technology through air and seaport customs in Brazil, principally due to an increasingly critical bottleneck of the regulatory inspection procedures conducted by the ANVISA PAF division (ports, airports, borders). In 2016, these delays increased to over 60 days versus the previous 5-day average6 at a cost to the Brazilian health system of USD 196,000,000 (BRL 660,000,000).7 While Brazil has ratified the WTO Trade Facilitation Agreement (TFA), the Brazilian government TFA implementation timeline does not anticipate systematic relief of this issue until 2020. AdvaMed welcomes and supports efforts by ANVISA to address the bottlenecks through a combination of the following measures: •  Implementation of increased risk assessment: Simplified procedures for low-risk (class I and II) medical devices; •  Modification of the ANVISA personnel rules which would allow relocation and assignment of PAF staff and resources to critically delayed ports; •  Implementation of an integrated and dynamic digital electronic system, eliminating all paper documents and allowing remote inspection of port documentation; and •  Increasing emergency PAF funding and staffing to reduce the backlog until the average import times fall back within the 5-day window.