Rio de Janeiro, February, 2014
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ISAGS Executive Director visits Pro-Tempore Presidency of UNASUR Ministerial Meeting of the South American Health Council was one of the main discussion points of José Gomes Temporão’s visit to Suriname
IUN PHOTO-J CARRIER
ISAGS Executive Director on official mission to Suriname with the Suriname’s Minister of Health
Suriname’s Foreign Minister addresses the UN
For the three days from 4 to 6 February, ISAGS Executive Director, José Gomes Temporão, was in Suriname, which currently holds the Pro-Tempore Presidency (PTP) of the UNASUR. The visit aimed to reinforce ISAGS’ support for the PTP as it prepares to hold the 8th Ordinary Meeting of the South American Health Council, composed of the 12 health ministers of the bloc’s member states. The meeting is scheduled to take place in March 20th in Suriname’s capital city, Paramaribo. On the agenda for the visit were meetings with the Minister of Health, Michael Blokland, and Foreign Minister, Winston Lackin. The meeting with the health minister discussed aspects of the agenda for the ministerial meeting in March, particularly as regards the main topics to be raised at the World Health Assembly, to take place from 19 to 24 May in Geneva, Switzerland. Meeting with the ministers, Temporão stressed ISAGS’ full support: “We are placing ISAGS at their disposal to give all necessary support. We want to reiterate
how important it is that this meeting take place, given that it has been over a year since the Council of Ministers last met. In that time, there have even been changes in the ministries [more on page 2]. Accordingly, this is an opportunity to bring the ministers together again to reaffirm our commitment to the health agenda, to the Five-Year Plan, to set out a common positions on the issues to be discussed in Geneva, and other matters”. The meeting with Minister Lackin highlighted the importance of health as a factor of continental integration in South America. The minister declared that he regards investment in health and education as of central importance and also expressed high expectations for the meeting of UNASUR ministers of health.
“This is the moment to bring the ministers together again for us to reaffirm our commitment to the Five-Year Plan” Mr Temporão also met with Marcelo Baumback, Brazil’s Ambassador in Suriname, and considered the meetings a success. “This was my first visit to Suriname and that itself I think indicates the importance we give to the fact that the
Pro-Tempore Presidency of UNASUR Suriname has held the Pro-Tempore Presidency of UNASUR since the bloc’s 7th Regular Meeting of the Council of Heads of State and Government in August 2013. In addition to the PTP the South American Health Council, Surinam also chairs the UNASUR electoral and culture councils. Also last August, a delegation from ISAGS visited Suriname to forge closer relations and offer support for transition to the PTP, then held by Peru. On that occasion, Minister Blokland received an abridged English version of the book “Sistemas de Salud en Suramérica: desafíos para la universalidad, la integralidad y la equidad” [Health Systems in South America: challenges to the universality, integrality and equity], published by the Institute in 2012. During the visit, Dr. Blokland granted the ISAGS Report, that is available in full online at the Institute’s portal: www.isagsunasur.org.
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country is working hard to hold and host the ministerial meeting”, he added.
Temporão with the Ambassador of Brazil in Suriname
READ MORE International forum discusses universal health coverage and health systems Page. 2 UNASUL meeting on Common Initiative Funds Page. 3 “Our role will continue to be to act in all spaces where the subject of the right to health is being discussed”, declares Alames General Coordinator in interview Page. 4
International forum at Brasília discusses universal health coverage and universal health systems on the basis of the right to health, what should be pursued is the idea of ‘equitable’, ‘comprehensive’, ‘quality’ universal systems. “What is being sold is a homogeneous concept that, in fact, does not correspond to what we intend by universal systems. It is impossible to guarantee equity in a system where the purchase and sale of health services predominates. Congratulations to the PAHO member states which, like UNASUR, do not accept the homogenisation of a concept which actually intends the privatisation and sale of health insurance world-wide”. During the event, Felix Rígoli, PAHO’s Director of Universal Health Systems, stated that there is no difference between WHO and PAHO vision about universal coverage: What happens is that, in the Americas region,
many countries have now incorporated the right to health into their constitutions. The WHO has 194 member countries; the diversity is far greater. Accordingly, the WHO has to take a path that contemplates many different situations, while PAHO has a set of countries that are much clearer about this path that must be taken to universalise access. So PAHO may be a little further down the road on this. The forum also presented topics such as health financing, provision in remote areas and the public-private relationship in guaranteeing access to health. The event preceded the 2nd National Experiences in Strategic and Participatory Management (EXPOGEP), organized by Brazil’s Ministry of Health, which took place, also in Brasilia, from 2 to 6 February.
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The 1st International Forum on Universal Health Coverage and Health Systems was held at the Brasilia office of the Pan-American Health Organisation (PAHO/WHO-Brazil) on 1 and 2 February. Policymakers and academics from countries including Argentina, Bolivia, Brazil, Ecuador, Paraguay and Uruguay took part in the event, which discussed conceptions and challenges in universal coverage and universal health systems with a view to strengthening the right to health. Speaking about the purpose of the meeting, Luiz Odorico, Secretary for Strategic and Participatory Management at Brazil’s Ministry of Health, called attention to the tensions between universal coverage and universal systems: ‘We have raised the idea of universal health coverage and universal health systems deliberately, to provoke. We feel this is a discussion that is already there. Here we have people who advocate universal coverage and people who argue for universal health systems. A democratic debate.’ Henri Jouval, ISAGS Technical Coordinator, who sat on the opening panel of the event, highlighted the fact that the forum’s proposed topic aligns with the priorities of the UNASUR South American Health Council. ‘This is a subject on the Council’s own agenda and, from the outset, ISAGS has been emphasising the issue of universal health systems, giving it importance and pooling knowledge, discussions and debates regionally’. After the opening panel, a round table was held on ‘Universal systems and universal coverage: innovation and challenges’. James Fitzgerald, PAHO’s representative, spoke of the principles supported by the organisation regarding universal coverage: ‘The concept is strongly linked with universality, equity, the right to health and solidarity. When we talk about developing systems towards universal coverage, we are talking about these principles to solve the inequities that still exist in regions of the Americas as regards access to services and access to health’. Fitzgerald also spoke of the importance of regulation and the need to establish legal frameworks: ‘Without an appropriate legal framework that can actually be used to assure the right to health, service provision and regulation of provision, we will not manage to attain universal access’, he declared. Paulo Buss, National coordinator for Brazil in the UNASUR Health Council and Director of the Fiocruz Centre for International Relations in Health, asserted that the concept of universal coverage is ‘restrictive’ and that,
ISAGS Technical Coordinator at opening of Brasilia forum: “ISAGS has been emphasizing the issue of universal health systems”
Brazil and Chile nominate new Ministers of Health The UNASUR’s South American Health Council has renewed its body of Ministers with the nomination of Arthur Chioro as Brazil’s Minister of Health (MOH) and with the designation of Helia Molina as the health representative of Chile. With a doctorate degree in collective health, the latest Brazil’s MOH had already occupied the
Arthur Chioro sworn in as minister on 3 February
Hélia Molina takes over the portfolio on 11 March
division as Director of the Specialized Healthcare Department from 2003 to 2005. After accepting the Ministry, Chioro reinforced his commitment with the continuity and advancement of the ‘More Doctors for Brazil’ Program. The Program, that started to be implemented during the mandate of Chioro’s predecessor, Alexandre Padilha, aims to reducing of the lack and absence of health professionals in some regions of the country. The Ministry’s goal is to reach the adhesion of 13,000 professionals until March 2014. The Chile’s new MOH is a doctor, specialized in Paediatrics and Nephrology who has also been the head of the division of Healthy Policies during Michelle Bachelet’s first mandate. Molina is a professor at the Department of Public Health of the Catholic University of Chile, a collaborator with the country’s National Cancer Forum and has coordinated national and international projects regarding paediatrics, infantile nephrology, health promotion, among others.
Fund for Common Initiatives of UNASUR is discussed
DEBATE ON HEALTH COVERAGE AND REFORM From 10 to 14 February, the public health school summer at the University Isalud, Argentina, held a series of debates on health sector reforms and universal coverage in Latin America. Former health ministers of Argentina, Ecuador, Peru and Uruguay attended the event, which addressed other issues including models of management, care, financing and health diplomacy.
CAMPAIGN AGAINST CANCER As part of World Cancer Day activities on 4 February, Argentina’s Minister of Health launched the campaign “Let’s talk about cancer”. Developed jointly in partnership with the Presidency of the Republic and the National Cancer Institute, the campaign is designed to encourage sharing of information and case on cancer through a website and messages in social networks using the hashtag #HablemosDeCancer.
‘MI SALUD’ FLOURISHING IN BOLIVIA
delegates and guests meet in Quito to evaluate FIC projects
Actions on tobacco control can save 1 million lives a year The ‘Tobacco Control Report for the Region of the Americas - 2013’ states that application of specific measures against tobacco use can avert a million deaths a year. The report, published in February by the PAHO, summarises progress in implementing the WHO Framework Convention on Tobacco Control (WHO FCTC), the first international public health treaty, which came into force in 2005. The report recommends six measures to help countries implement specific provisions of the convention: require graphic health warnings on cigarette packaging; protect against aggressive tobacco industry marketing; monitor tobacco product consumption; protect against exposure to passive smoking; support people wishing to give up smoking; and levy higher taxes on tobacco products.
HEALTH CONEXION
Production of Drugs and Drugs Policies”. The latter is being developed by ISAGS in cooperation with the Technical Group on Universal Access to Medicines (GAUMU) and with CEED, which is responsible for the mapping of military laboratories, that represent an important share of the public production. The Council of Delegates of the bloc will present the results of the meeting to the Council of Ministers of Foreign Affairs. After the meeting, the delegations headed to a guided visit through the current headquarters of the General Secretariat. Vivian Alvarado presented the stages of construction and implementation of UNASUR’s Communication and Information Centre and highlighted the importance of the partnership with ISAGS and CEED during this process. She stated that the structure now settled in Quito is ready to be relocated to the permanent headquarters in Mitad del Mundo, approximately 13 km away from Quito. It is expected that the new structure starts its operation this year.
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The Meeting of the International Cooperation Authorities of the UNASUR was held on the 10th of February, at the headquarters of the General Secretariat (SG) of the bloc, in Quito, Ecuador. The meeting aimed to formulate recommendations to ease the selection, the scope and the execution of the projects of the Fund for Common Initiatives (FIC), established by the Heads of State and Government with the purpose of sponsoring projects with potentially high impact for the South American region. ISAGS and the Centre for Strategic Defence Studies (CEED), permanent bodies of UNASUR, were invited to the meeting, which was also attended by representatives of the Ministries of Foreign Affairs of 11 countries of South America. The General Secretariat’s Head of Office, Vivian Alvarado, started the meeting by welcoming the participants on behalf of the General Secretary of UNASUR, Dr. Alí Rodriguez Araque, and reinforced that it is essential that the projects of the fund be of high impact for the peoples of the region. Humberto Molina, representative of Chile’s chancellery at the SG presented updated information about the FIC and highlighted that “the sectorial ministerial councils are integrating from the base”. Afterwards, the countries’ delegations debated about the implementation of the projects that have already been approved as well as about a system for the choice of future projects. They also highlighted the importance of monitoring and evaluating the projects and the impacts during their executions and after their conclusion. There are 11 projects approved, in all, two of them from the South American Health Council: the “Unasur Drug Price Database” and the “Mapping of Regional Capabilities in the
Suriname and Uruguay are the only countries in South America to have adopted all the measures prohibiting advertising, promotion and sponsorship for tobacco. As regards radio and television advertising, on the contrary, South American countries are doing well: these are outlawed in 10 nations. Another decisive factor in curbing tobacco use is product prices. Comparing 2008 and 2012, the South American country that made most headway in taxing cigarettes was Chile, where taxes account for 81% of the price of a package. Ecuador ranks second in taxes (73%), followed by Venezuela (71%). Argentina, Suriname and Uruguay levy taxes of more than 60%. All south American countries have signed the convention. However, rectification is still pending in Argentina.
In February, Bolivia’s Deputy Minister of Health, Martin Maturano, declared that the Mi Salud programme, designed to offer the population house-to-house medical care, is to be extended to 39 municipalities in 2014. With these new inclusions, the programme will serve all of Bolivia’s 339 municipalities. Maturano also reported that municipal governments will invest some 131 million Bolivian earmarked for equipment and medicines, and human resource recruitment.
LEADERS IN INTERNATIONAL HEALTH Until 7 March, the Pan-Americana Health Organisation will be accepting applications for the programme Leaders in International Health Edmundo Granda Ugalde. The programme is intended to prepare leaders to contribute to the implementation of the Health Agenda for the Americas 2008–2017. In order to enter the selection process, candidates should be working in public health, international relations or similar fields. The stages of the process are available on PAHO’s website.
List of candidates selected for the programme out in April
and the problems that make people get ill must be dealt with. We should not just be treating people who get ill, but preventing them from getting ill.
ISAGS
“In the name of universal coverage, they are masking a tendency to privatise and to finance private companies with public funds”
General Coordinator of the Latin American Social Medicine Association (ALAMES), Nila Heredia, granted an interview to the ISAGS Report during the 1 st International Forum on Universal Coverage and Universal Health Systems, held in Brasilia. Ms Heredia argued that universal coverage does not guarantee access to health and that the discourse on the subject rests on the assumption of a weak State so as to encourage privatisation in the health sector. In 2008, during her term as Bolivia’s Minister of Health, the right to health was written into the country’s constitution. What is the importance of the debate about universal coverage and universal health systems? This is an issue that is on the table worldwide. What the discussion is saying – which we reject (I speak for Alames) – is that there is nothing strange about the position the financial organisations are taking. Unfortunately, the WHO is also – let’s say – proposing universal coverage. Everyone is in favour of universal coverage; it is just that everyone in understands the concept differently. For that very reason, it is at the centre of
discussions in the health field, because in the name of universal coverage they are in fact masking a tendency to privatise and to finance private companies with public funds. With that discourse, what they are actually saying is that the State lacks management capacity, is deficient in human resources and, therefore, it is preferable the private sector take over, because the private sector, on a market logic, is a better manager than the public system. In practice, though, people are left completely unprotected. Not only that, but human resources are managed through contracts and for productivity. So health professionals have to produce and are then paid for their production, and that production is based on numbers. Then, as they have to cover a certain number, the care they provide is not always good. The other issue is that health personnel have to generate consumption, large numbers of tests, because that is where the private sector investments come from. To us, then, what should be at the centre of the discussion is not the right to health, but in-depth management of the right to health. Now, for there to be in-depth management of the right to health, there must be participation by the general public
In that context, can we talk about the importance of the approach based on the social determinants of health to the debate over universal coverage? When someone is treated at the primary care level, preventively, there we are confronting the issue of the social determinants of health. Helping prevent people from getting ill is not good business, though, so it is not good for the private sector for people not to get ill. Neither is it good for the sector to see health in collective rather than individual terms. So, I say that this present discussion is a Trojan horse. A whole series of things lie behind universal coverage. The health industry, along with the education industry, is one of the greediest there are. In your opinion, what should be the basis of health sector reform in Bolivia? When I was minister, we managed to get the right to health written into the constitution. But Bolivia definitely still has a long way to go for what we want to be applied. It has to deliver what it says in the constitution. It is written, the policy exists, but we have not yet managed to get the State as such to shoulder that commitment fully, rather than exclusively in terms of services. Could you talk a little about the role of the Alames? The Alames is a movement, not necessarily of professionals, which brings to the debate a logic based on advocacy for people’s rights. So, our role will continue to be to act in all spaces where the subject of the right to health is being discussed and, at the same time, to try to get each country to incorporate provision for universal health systems with free care into their constitutions. Access the english and spanish versions of the publication “Health Surveillance in South America” in bit.ly/ISAGSLibrary and bit.ly/BibliotecaISAGS
INSTITUTIONAL ISAGS-UNASUR Executive Director: José Gomes Temporão Head of Office: Mariana Faria Technical Coordinator: Henri Jouval INFORMATION AND KNOWLEDGE MANAGEMENT Coordinator: Camilla Ibiapina ISAGS Report Editor: Mariana Moreno Team: Daniel Pondé, Felippe Amarante, Flávia Bueno, Maíra Mathias e Nanci Miranda Contact: comunicacao@isags-unasur.org Phone: +55 21 2505 4400
This is the report from the South American Institute of Government in Health (ISAGS), the think tank on health of the Union of South American Nations (UNASUR) that aims to contribute to improving South America government quality in health by means of leadership training, knowledge management and technical support to health systems.