Rio de Janeiro, April 2014
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Aspa-Health furthers integration among south american and arab countries
Minsa Peru
Health ministers’ meeting culminates by identifying strategic issues set out in the Lima Declaration
Health ministers and authorities from Aspa meet for the first time in Lima, Peru
A forum for sharing experience, which produced declarations of consensus in the health field – that is perhaps a fair description of the first Meeting of Health Ministers called by the Summit of South American and Arab Countries (Aspa), on 4 April, Lima, Peru. The meeting, on the theme of ‘Universal Health Coverage, Universal Health Systems and Social Determinants’, produced the Lima Declaration, a political document in which the 34 signatories set out 20 points of convergence. The authorities also approved recommendations for pursuing a work plan for the two-year period 2014-2016, which will produce concrete measures for coordination and cooperation among the nations. ‘All of us here are committed to a conception of health that goes beyond the biomedical approach, to relate with the outcomes of government actions, such as eradication of poverty and social inequalities. More than ever, health has to be talked about as a policy horizontal to all other policies’, declared Peru’s Minister of Health, Midori de Habich, during the opening ceremony. From the outset of the Summit, the Peruvian delegation argued that the Lima Declaration should express the importance of ensuring sufficient funding for universal systems and universal coverage, and this point was included in the document.
Set up in 2005, Aspa is a cooperation mechanism that brings together the 12 member countries of the Union of South American Nations (UNASUR) and the current 22 members of the League of Arab States (LAS): Saudi Arabia, Algeria, Bahrein, Qatar, Comoros, Djibouti, Egypt, Arab Emirates, Yemen, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Mauritania, Oman, Somalia, Sudan, Tunisia and the Palestinian Authority. “This meeting reflects both regions’ interest in the health field and the need for us to work together to introduce common programmes with a view to the future”, said Faeqa Saeed Al Saleh, Head of the LAS Social Affairs Sector. At the closing of the meeting, Al Saleh, announced that scholarships will be granted through Aspa to foster scientific research to benefit the regions, thus contemplating one of the points of the Declaration. Sharing experience In the two days prior to the ministerial meeting, technical groups from the delegations began discussing the topics set as priorities in 2012 by the Heads of State and Government meeting in the 3rd Aspa Summit, also in Lima. Introductory technical presentations on the health situation in the two regions served as a starting point for the preparatory discussions. Suriname, Pro-Tempore Chair of the South American Health Council (CSS),
was represented by Miriam Naarendorp, who introduced the Council, detailing the context of its inception as part of the UNASUR framework and its 2010-2015 Five-year Plan. The CSS also invited the ISAGS to present the book Health Systems in South America: challenges for universal, comprehensive, equitable care (2012), which traces a panorama of health in the region from the countries’ own standpoints. “The presentations were productive as a means to acclimatise the delegations to such different specific realities, which gradually revealed their common challenges”, observed Chief of Staff Mariana Faria, representing the ISAGS. The Arab countries presented the strategic objectives and achievements of the LAS Council of Health Ministers, and described successful primary health care measures in Iraq and expertise in disease control during Islamic holy days, such as the pilgrimage to Mecca. With the Fifa World Cup approaching in South America, the latter roused wide interest. The Saudi Arabia delegate also talked about conduct of surveillance in response to the appearance of Middle East Respiratory Syndrome (MERS), which was diagnosed in humans for the first time in April 2012. Since then, the World Health Organisation (WHO) has confirmed 178 cases of the disease in six League member countries. The disease is caused by a type of corona virus, from the same viral family as SARS, which caused an epidemic in Asia in 2003.
READ MORE Aspa can help cultivate relations in international forums Page 2 Americas celebrate World Health Day Page 3 Antonio Santini: “The role of social leader and mobiliser in support of cancer control in the region is intended to extend the reach of RINC projects” Page 4
Lima Declaration recommends alliance-building in international forums
Oscar Farje / Andina
At least two of the 20 points addressed in the political document are related to coordinated efforts and orchestrating common positions
Arab and South American countries may present common positions at 67ª World Health Assembly to take place May in Geneva, Switzerland
Health authorities meeting in Peru have signalled an unprecedented alliance between Arab and South American countries through Aspa-Health as an opportunity for the 34 nations to work convergently in world health policy-making. Two of the 20 points set out by the Lima Declaration relate to coordinating efforts and orchestrating common positions in international forums, such as the 67th World Health Assembly (WHA), to take place from 19 to 24 May in Geneva, Switzerland.
In this connection, the policy document advocates universal health systems and universal coverage, and also endorses the authorities’ conviction that health should be built into the Post-2015 Development Agenda as a priority. Another point mentioned is that this requires stronger health governance to respond to social, political and environmental determinants. Other highlights of the Declaration are directed to coordinating efforts and sharing experience. Chronic Non-Communicable
Diseases (CNCDs), particularly cancer, were regarded as the main challenge facing Aspa countries. The authorities are considering a cooperation mechanism that involves the Network of National Cancer Institutes. In addition to CNCDs and communicable diseases, the health ministers expressed the wish to advance in care for mothers and children, older adults and persons with disabilities. Another topic whose importance was recognised by Aspa was the effects of climate change on human health.
More Doctors Programme is already meeting demand from Brazil’s municipalities Programme reaches government target in April with the addition of 13,000 doctors providing coverage to 46 million Brazilians municipalities, providing coverage to 46 million Brazilians. This will meet 100% of the local government demand diagnosed by a Ministry of Health (MoH) survey. “No longer will we have that unacceptable situation of municipalities with no doctor”, declared President Dilma Rousseff in a programme broadcast on public radio. More Doctors operates on the basis of enrolment by municipalities interested in receiving health personnel. Brazil’s MoH, however, aware of the difficulties that prevent some municipal governments from adhering to the programme, actively detected demand and listed 310 towns with extremely poor social and health indicators. “This is a new chance for municipalities with high social vulnerability which missed the opportunity to enrol last year. We are going to ensure that their populations are not disadvantaged by a lack of doctors in primary healthcare”, stressed Minister of Health, Arthur Chioro.
Launched last October, the programme is divided into cycles (this is the fifth), in which doctors – whether or not born or trained in Brazil – are invited to enrol and undergo selection and capacity building.
Rondon Velloso / MS
In Brazil, assuring care at primary health centres is the responsibility of the country’s 5,570 municipal governments. One recurrent problem, even for metropolises such as São Paulo, has been the lack of doctors to serve the population of underserved areas. Mayors in outlying areas also face obstacles in engaging and retaining health personnel. For years now, the Ministry of Health has attempted to address the problem through policies, such as the Family Health Strategy, to improve the quality of primary health care. Nonetheless, surveys continued to identify high rates of dissatisfaction. The federal government then resolved to tackle the problem by calling in health professionals from abroad, even if this meant displeasing Brazil’s medical associations. That, briefly, is the story of the More Doctors programme, which this month will reach the milestone of 13,235 doctors working in more than 4,000
Minister Arthur Chioro at inaugural lecture to welcome and evaluate More Doctors
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World Health Day focuses on vector-borne diseases
HEALTH CONNECTION
Among the most prevalent in the Americas are malaria, yellow fever and Chagas disease
Window screens and other simple measures help prevent vectors
Mosquitos, flies and ticks – these diminutive creatures that represent enormous threats were on the agenda of World Health Day celebrated on 7 April. This year, the day’s theme was vectorborne diseases. The Pan-Americana Health Organisation (Paho) reports that half the population of the Americas, that is 500 million people, is at risk of contracting one or more of this type of disease, of which the best known in the region are malaria, dengue, yellow fever and Chagas disease. A more recent scenario has seen authorities also alerting to an epidemic of chikungunia, a disease with characteristics similar to those of dengue. On the day, Paho director Carissa Etienne took part in a conference at the organisation’s offices in Washington. Etienne mentioned advances in disease control in the Americas, but drew attention to the spread of mosquitoes and other vectors into new habitats and their resistance to insecticides and drugs. Malaria continues to be one of the chief endemic diseases in South America. In Paraguay, the Ministry of Health reports that, from 2000 to 2012, cases of malaria were reduced by 60%. In the same period, the number of deaths from malaria in Paraguay fell even further, by 72%. Another UNASUR country that has progressed considerably in combating the disease is Colombia. Last November, it won the Paho-sponsored competition Malaria Champions of the Americas. That recognition was given to the results of the Programa Malária Colômbia (PMC), an international cooperation project funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria, which works in coordination with Colombia’s Vector-Borne Disease Prevention and Control Programme to complement its activities. PMC’s goal is,
by 2015, to reduce the number of cases by 40% and the number of deaths from malaria by at least 95%. In 2010, the year the project started, the Paho recorded 115,884 cases. Two years later, the figure had been halved. Dengue fever, another scourge of the South American region, accounted for more than 1.8 million cases in 2013. However, some countries are setting the pace in combating the disease: there were no notifications in Uruguay, while Chile recorded only 39 cases. Over the past four years, Argentina reduced the number of cases of dengue by 90%, recording 2,718 cases, against the 26,923 notified during the epidemic that swept the country in 2009. This month, Venezuela launched the campaign ‘For mosquitos, not even water’, designed to raise awareness of methods of preventing the Aedes aegypti mosquito, which transmits dengue. In order to reinforce dengue control measures, the Paho is developing a new surveillance protocol now being trialled in Argentina, Brazil, Peru and Colombia. With symptoms similar to those of dengue, chikungunya fever figures as one possible threat to the American continent. First recorded in the Caribbean, chikungunya was one of the topics at the 8th Meeting of the South American Health Council and Brazil’s Ministry of Health has issued an alert on the disease. The Paho director considers it still too early to say whether the virus will spread and become as big a problem as dengue: “The truth is that we have to be prepared for every eventuality. We consider the work of vigilance to be very important and we are taking measures to reduce the vectors, among them the dengue mosquito, which is one that transmits chikungunya. Public health must always prepare for the worst possible scenario”, she added.
The UNASUR High-Level Working Group on Disaster Risk Management met for the first time from 8 to 10 April in Santiago, Chile. The meeting, called to draw up a regional action plan in the wake of the 8.2 magnitude earthquake that hit the country on April 2, was attended by member-country authorities and experts in civil defence, civil protection, humanitarian aid and disaster risk management. The delegates are currently evaluating a proposal by Chile, the group’s current Pro-Tempore Presidency, to prepare a manual on humanitarian cooperation.
ISAGS SUPPORTS MEETINGS Next month, the ISAGS is supporting the organisation of three important meetings for the South American Health Council. The Meeting of the Network of National Health Institutes (RINS) will be held in Petropolis, Brazil, from 7th to 9th May. The following week, two technical groups will be meeting: the WG on Human Resource Development and Management (GTRRHH) is scheduled to meet on the 12th at the ISAGS offices in Rio de Janeiro, while the WG on Universal Health Systems Development (GT-SUS) will hold its second regular meeting, also in Rio, on the 17th.
WORLD HEALTH SUMMIT The regional edition of the World Health Summit (WHS), focussing on Latin America, took place in Sao Paulo from 6 to 8 April. This scientific and medical forum provided the opportunity to discuss the challenges facing the region on five key themes: Healthy Life Expectancy; Health in Mega-Cities; Increased Research Capacity to Incorporate Technologies; Management of Health Systems to Ensure Universal Coverage; and Health Education. At the close of the event, one of the organisers – the M8 Alliance of Academic Health Centres, Universities and National Academies – issued a document with recommendations for improving the quality of health systems.
Divulgation
S. Hollyman / WHO
WG MEETS AFTER EARTHQUAKE
DIivulgation INCA
Interview: Luiz Antonio Santini
At its last meeting, the South American Health Council (CSS) tasked the coordinating committee with evaluating and approving the regulations of the UNASUR Network of Cancer Institutes (RINC). It is intended that the regulations will formalise a change of name to the Network of National Cancer Institutions, and define how members and associates are categorised. The network is also preparing to appoint Peru’s first lady, Nadine Heredia, as leader and social mobiliser in combating cancer in the region. In this interview, network coordinator Luiz Antonio Santini also talks about the activities of the group on cervical cancer, which is considered one of the RINC’s priorities. What is new in the regulations? The proposal for the RINC’s present name – Network of National Cancer Institutes – arose from the eagerness to have a network to foster relations and cooperation among nationallevel public institutions with responsibility for developing and executing cancer policies in UNASUR countries. At the time, though, not enough thought was given to countries that actually had national cancer institutes with that attribution. In some countries, national cancer institutes are responsible only for hospital management. That was why we felt it appropriate to correct the name to Network of National Cancer Institutions. As regards approval of membership categories, it was taken into account that the cooperation
Cervical cancer group projects align with request from Council of Heads of State and Government to give priority to rapid-response health issues for vulnerable populations
initiative on cancer in Latin America originated before the UNASUR, because it arose in the context of the International Cancer Control Congress (ICCC2), in 2007, when the Latin American-Caribbean Alliance for Cancer Control was established. The RINC was formed in 2011, incorporating countries of the Alliance. When we drafted the regulations, we considered that UNASUR countries would be members, while countries like Cuba, Panama and Mexico, which are in the Alliance, would be associates. The RINC expects the regulations to be approved by September. How did the name of Peru’s first lady come up to lead mobilisation to prevent and combat cancer? The first lady’s name was put forward by the Peruvian representatives at the last meeting of the RINC Management Collegiate in Lima, in November 2013. The meeting was held in connection with the ICCC5, at which the first lady gave the closing address. At that time, Peru was commemorating one year of its ‘Plan of Hope’, designed to improve comprehensive care for cancer patients, and Heredia’s involvement with the cause was outstanding. The suggestion to invite her to take on the role of leader and social mobiliser on cancer prevention and control is intended to extend the reach of the network’s projects, particularly with regard to cervical cancer. At the RINC’s suggestion, the initiative of appointing a political figure,
which is unprecedented in the UNASUR, was approved at the last meeting of the Council of Ministers. Nadine Heredia will be coming to Rio de Janeiro, probably in May, for the appointment ceremony. The RINC would like to involve the ISAGS in that process, and it has already been proposed to the Peruvian government that she also visit the Institute. The cervical cancer group has a number of projects in progress. What is the importance of these activities in the context of UNASUR priorities? The group is one of the network’s priorities and has five projects planned, three of which are to begin in 2014. These are projects that respond to the Five-year Plan and also to the orientation from the Council of Heads of State and Government to give priority to rapid-response health matters for vulnerable populations. That is the case with cervical cancer, which can be prevented if basic measures are taken. One of the projects is intended to provide a monitoring system with basic indicators on the disease for countries lacking in technology. There is a project on Visual Inspection with Acetic Acid, a method that can be used as an alternative to cytology for detecting cervical cancer in populations with difficulties in accessing the health system. Capacity building in applying the procedure will be given for health technicians by the Institute of Neoplastic Diseases, in Lima, and by the National Cancerology Institute, in Bogota. The third project is to develop a manual for HPV testing, in cooperation between the RINC, the PAHO and the National Cancer Institute of Argentina (INC). What is the network’s agenda for the coming months? In the first half of the year, we have the appointment of Nadine Heredia, in May, and a meeting of Argentina’s INC to set up the team that will develop the HPV testing manual. In the second half, the RINC Management Collegiate will hold its annual meeting in Bogota to mark the 80th anniversary of the Cancerology Institute of Colombia. In addition, there is an invitation from the Ministry of Health of Paraguay to reactivate the RINC Breast Cancer Control Group, at a meeting to be scheduled.
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 Report: Mariana Moreno and Maíra Mathias Team: Daniel Pondé, Felippe Amarante, Flávia Bueno and 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.