UNASUR
Report
South American Institute of Government in Health
Rio de Janeiro, march 2013
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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.
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"The topics were very interesting, made from a very important critical standpoint about the concepts we apply in health" Natália Roca, Representative of Argentina’s Health Ministry
"I think she managed to systematize the two great trends about Universal Coverage in a way that I rarely have seen" Paulo Buss, Director of Fiocruz’ Center of International Relations
"This kind of Conference is central: it disseminates opportune discussions and encourages the debate among countries with different systems and models" Jorge Bermudez, Vice-President of Production and Innovation in Health of Fiocruz
"This debate is very important: it allows the strengthening of the worldwide and continental articulation on health debate as in ensuring right" Dr. Asa Cristina Laurell gives conference on Universal Health Systems in ISAGS
Ana Costa, CEBES’ President
ISAGS hosts trilingual Conference by Asa Cristina Laurell On February 21, ISAGS hosted researcher Asa Cristina Laurell for the Conference "Universal Health Systems: obstacles and challenges", which was broadcasted live through the internet and simultaneously translated into English and Portuguese. During the two-hour broadcast, 1635 visits from 30 countries in three continents were reported, some of them gathering dozens of people. At the end, the participants – academics, public health
managers and stakeholders – sent their questions by e-mail, Twitter and Facebook. Researchers, health managers and Unasur Governments’ representatives attended the Conference, held at the ISAGS headquarters, in Rio de Janeiro, and also made questions to the lecturer. Recognized as one of the most important names in Latin American social medicine, Asa Cristina Laurell is a surgeon, has a master degree in public health-
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epidemiology and a doctorate in sociology. She has published more than 50 scientific papers and ten books, apart from having been Health Secretary in Mexico City–DF from 2000 to 2006. In her lecture, Dr. Asa Laurell addressed issues such as Universal Health Coverage and the Right to Health, among others. For its March issue, ISAGS Report has chosen excerpts from the speech (see page 2). The lecture full video is available in three languages on ISAGS website.
UNASUR
Report
South American Institute of Government in Health
collects regressive cross–subsidies, concentrating public resources at the expense of health care and public services. These deficiencies of public services formed the essence of health reforms.”
Executive Director of ISAGS, José Gomes Temporão, and Dr. Asa Cristina Laurell
Read some excerpts from the lecture of Asa Cristina Laurell "Much is said today about Universal Health Coverage, a discussion led by supranational organisms and private organizations. But we, from the Social Medicine trend, have also been speaking about this subject for a long time. Hence, I say it is a concern of everyone, yet little understood, due to a misunderstanding. The intent of this presentation is to contrast somehow what is a Universal Health System and what are Health Insurances so we can think more clearly, even if in reality [these two models] are merged.”
ASA CRISTINA LAURELL CONFERENCE
What universal coverage? “There are two major conceptions regarding the Universal Health Coverage. One proposes that, to solve the problems of systems and achieve Universal Coverage, it is necessary to introduce the competition, the market and the pluralism of managers and service providers. This trend proposes the introduction of health insurances. The other conception states a decommodified Unified and Public Health System, i.e., in which the market does not operate and, most important, in which it is not required to hold a health insurance or pay for service in order to access the system.”
“Universal Health Systems: goals and challenges”
Total number of conexions: 1635 users
Health problems in LatAm “Health systems in Latin America are currently segmented and underfunded. This is a widespread reality. Historically, Social Security is the strongest segment. Health Ministries are weak, have little regulatory capacity or are merely in charge of public health tasks. The private sector grew during the gaps between public systems and
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Insurance Model “In Latin America, universal coverage was not achieved in any of the cases [by the insurance system]. There is a problem of adverse selection – when people do not acquire coverage because they do not need to –, and moral hazard – when those not considered good ‘objects’ to the coverage are excluded. There is also a misunderstanding between population and service coverage, because service packages are differentiated according to the type of insurance – basic, medium, very good – at the expense of equality and equity. Access to services is not guaranteed and there is a clear inequality.” Universal System Model “There has been a significant increasing in access and use, yet incomplete, as well as a strengthening of medium and low complexity services, although lacking of infrastructure and staff. In all cases, Universal Systems in Latin America remain segmented. They are systems that still embody the legacy of neoliberal reforms, and are currently quite complex.”
Access ISAGS hotsite with multimedia material about the conference of Dr. Asa Cristina Laurell in bit.ly/ZfIJPQ
UNASUR
Report
South American Institute of Government in Health
WHO holds meeting in favor of Universal Health Coverage On February 18-19, senior representatives of Ministries of Health and Social Development of 27 countries, as well as health sector stakeholders, met in Geneva (Switzerland) to discuss the progresses and challenges to achieve Universal Health Coverage. Convened by the World Health Organization (WHO), in partnership with the World Bank, the meeting resulted in the participants’ decisive support to the concept of Universal Coverage: the right of everyone, regardless of financial capacity, to access health services without compromising the family economy. Representatives advocated the need for a political agreement of highest level in order to achieve health coverage universalization. Their speeches evinced, however, the differences in strategy among countries in the pursuit of the same goal: on one side, those who have given greater attention to poor and vulnerable populations; on the other side, those who are already persisting on the universal health system model (read more beside). In the opening speech, WHO Director-General, Margaret Chan, affirmed that, since the publication of the “2010 World Health Report: health systems financing”, organized by WHO, more than 70 countries have asked for support to move towards Universal Health Coverage. According to Chan, that objective "is receiving increasing support", and "countries that attained that purpose are sharing their experiences". UN General Assembly and WHO Executive Board Last December, UN General Assembly approved a resolution requesting
Representatives of 27 countries and actors in health during WHO Meeting on Universal Health Coverage
member countries to ensure universal access to health services, to continue investing in their health care systems and to avoid that citizens disburse resources for access to health services. That issue was again approached during the 132ª WHO Executive Board Meeting, held last January. In a report to the Board, WHO Secretariat accounted progresses in health coverage universalization and its connection to progresses towards the Millennium Development Goals. Sustainable Development Goals post 2015 Another issue discussed in the meeting held by WHO last month, with great appeal among participants, was the inclusion of the Universal Health Coverage as one of the Sustainable Development Goals (SDGs) post 2015. The content of the relation between health and sustainable development had also been dealt in the resolution approved by the UN General Assembly. At WHO Council Meeting, participants discussed a report on the definition of SGDs Post-2015, emphasizing the Universal Coverage and the Concept of Healthy Life Expectancy, as well as changings in the global health agenda, health as a human right, equity, and health determinants.
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Health stakeholders question the idea of Universal Coverage Despite the prominence given to the idea of Universal Health Coverage in recent WHO and UN meetings, academics, social movements and healthcare stakeholders question the inequalities the concept may hide. In her lecture, Dr. Asa Cristina Laurell pointed out the differences between the idea of Universal Systems, which recognizes health as a right, and insurance, which may be based on health as a commodity. In an interview to ISAGS Report last month, ISAGS Executive Director, José Gomes Temporão, highlighted the vagueness of the concept. "There is talk about Universal Coverage or Universal Insurance, but nothing is said about the process content," he affirmed. In early February, Helen Clark, the worldwide administrator of UN Development Programme (UNDP), affirmed that the unavailability of health services "can lead a family to poverty, forcing children to leave school". In 2012, social movements gathered at the 3rd People’s Health Assembly, in South Africa, praised the growing attention given to the universalization, but questioned the minimum insurance model and the "basic packages of attention".
UNASUR
Report
South American Institute of Government in Health
Colombia recognizes health as a right in health reform
Four Unasur countries discuss access to medicine
The Colombian Government has announced late February some of the main decisions of the project concerning Health Reform, which will be submitted to Congress next March 16. The recognition of health as a human right is one of the most important issues, according to the Minister of Health and Social Protection, Alejandro Gaviria. The Colombian health system coverage, however, will not be fully implemented at the beginning, the reason why bills regarding "principles and mechanisms of gradual extension of the fundamental right content," will be defined, said Gaviria. "The new Mandatory Health Plan [POS] will include all that is reasonable, and there will be a list of negatives, i.e. list of exclusions." Colombia has discussed its reform system since last year, and the recognition of health as a right is one of the main demands of health stakeholders. The reform also stipulates the creation of a single fund backing the financing of the system called MiSalud, which will cease EPS (Health Care Providers) financial intermediation, and the extinction of Fosyga, a fund that transfers resources to EPS.
The access to medicines featured on the agenda of four South American countries during the month of February. Argentina, by means of Anmat, defined new requirements for the registration of medical products, strengthening the Agency role. In Venezuela, Sundecop announced the development of a regulatory framework for all medicines. Brazil announced to have doubled the availability of new medicines in the Unified Health System and quadrupled the analysis of new technologies, both due to the creation of Conicet (National Committee for the Incorporation of Technology) in 2011. Peru, in turn, showed advances in the fight against counterfeit drugs as a result of intensifying the operations of health authorities, by means of 405 actions during the year of 2012. Also last month, PAHO and the Americas’ Regulatory Agencies have agreed to use a single platform against drugs adulteration and counterfeiting. The three Unasur agencies – Anvisa (Brazil), Invima (Colombia) and Anmat (Argentina) – and those of Cuba, Mexico, USA and Canada attended the Meeting of the National Regulatory Authorities of the Americas Regional Reference (ARNr).
New Health Minister of Uruguay, Susana Muñiz
Uruguay inducts Susana Muñiz as Health Minister On February 25, Maria Susana Muñiz Jiménez was appointed as the new Health Minister of Uruguay, replacing Jorge Venegas. She affirmed that during her administration she will prioritize health decentralization and promised to submit a plan with that goal in the coming weeks. According to the new Minister, the currently Uruguayan health situation is "better" than before the last health care reform in the Country, in 2007, but there is still much to progress, mainly in the countryside. To that end, she called upon the contribution of universities and unions of the sector. Another issue highlighted by Muñiz was the primary health attention. Susana Muñiz has a doctorate in Medicine and since 1997 works in the Public Health field as manager, researcher and teacher, having taken up several positions in the structure of ASSE (State Health Services Administration).
ISAGS visits Unasur Secretariat-General, Peru and Suriname
ISAGS representatives during a visit to the Unasur Headquarters
MANAGEMENT OF INFORMATION AND KNOWLEDGE Coordinator: André Lobato Advisors: Amaro Grassi, Flávia Bueno e Manoel Giffoni comunicacao@isags-unasur.org
From January 28 to February 2, ISAGS Executive Director, José Gomes Temporão, and his Chief of Staff, Mariana Faria, visited Unasur Secretariat–General in Quito (Ecuador), Peru and Suriname – these latter, the current and the next Pro Tempore Presidency of the bloc. The meetings discussed the PPT transition between the two countries, the World Health Assembly, to be held in May, and the assessment of the Quinquennial Plan of the South American Health Council. At the end of February, ISAGS paid another visit to the Secretariat–General, this time with its representatives from the management of knowledge and information, administration and project areas. The aim was to foster the exchange of information between the two Unasur bodies.