ISAGS´ Report June 2014

Rio de Janeiro, June 2014

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UNASUR common positions make Global Health agenda move forward

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The positions presented during the 67th WHA influenced the resolutions approved in plenary and demonstrated the importance of regional integration

S H C m e e t s o n t h e 2 4 th d u r i n g t h e A s s e m b l y

This year again, the South American Health Council (SHC) expressed consensual positions among the 12 countries of UNASUR, during the 67th World Health Assembly (WHA), which took place in Geneva from May 19 to 24. In an extraordinary meeting, the SHC agreed that ten positions would be presented regarding the following themes: vaccines, disabilities, monitoring of the Millennium Development Goals, Post-2015 Agenda, repercussion of the exposure to mercury, health contribution to social and economic development, access to essential medicines, strengthening of the regulation systems and follow-up of the Recife Political Declaration on human resources and of the report presented by the Consultative Expert Working Group on Research and Development.

In this edition of ISAGS Report, the national coordinator for Uruguay, Andrés Coitiño, and the alternate national coordinator for Colombia, Catalina Góngora, talk about two of the positions presented by the bloc, which made the Global Health agenda move forward.

Minamata Convention Resolution 67.11 addresses the role of the WHO and of the Ministries of Health towards the impacts of the exposure to mercury and its components in public health, and the implantation of the Minamata Convention.

According to Andrés Coitiño, the Convention should strengthen the WHO as well as the member States and it is an important landmark in the direction of the prioritization of health policies associated to environment and working conditions.

“Neither the WHO nor the States should stay behind this new achievement of health diplomacy. Minamata is a model environmental convention, in which intersectorality is not only an empty phrase, but it gathers what we have expressed in UNASUR: the articulation between the policies of different sectors, aiming to maximize and contribute to healthy lives, addressing social, economic and environmental determinants”, affirms Coitiño.

The national coordinator reinforces that the support of the WHO’s Secretariat is key to the elaboration of guidelines for the appliance of Minamata, particularly for the reduction and elimination of medical products containing mercury. “We have encouraged the Secretariat to carry out a consultation to States as to identify priority actions for the health sector”, he says and completes: “Our hope is centered in the role of States. The Ministries of Health have not always been involved by their peers in environment when it comes to concerting national policies. Real intersectorality is the challenge”.

Research and Development Regarding the report presented by the Consultative Expert Working Group on Research and Development, the plenary adopted decision 67.15, which relates to the financing mechanism for R&D, to the governance implied in its coordination and to the scope of the diseases that could be object of investigation.

“I believe that UNASUR had influence capacity and the results are in accordance with our interests.” evaluates Catalina Góngora. The alternate national coordinator explains that the draft decision, written by France, intended to concentrate its efforts in type III diseases, which affect mainly poor countries, but the participation of the bloc and also of Argentina, Bolivia and Colombia in the discussions, was important in order to

consider what had already been approved by the 66th WHA, in a resolution that express the need to investigate type II diseases, which affect developing countries, and those of type I, according to the specificities of these nations.

As stated by Catalina, another key point of the draft decision, from UNASUR’s point of view, relates to the WHO’s initiative to make the Special Programme for Research and Training in Tropical Diseases Fund – known as TDR –, a privileged financing mechanism. As reported by her, thanks to the debates previous to the approval, “it was possible to clarify that follow-up and evaluation indicators will be used in the projects, that even with the use of TDR as a possible financing mechanism, other mechanisms will still be explored, that the financing under the TDR will not be limited to tropical diseases, and that it will analyze a way to include States in its governance and identify how to reach sustainable financing”.

Catalina, as well as Coitiño, reinforces the importance of the protagonist role of the member States. “The Group was highly illustrative about the importance of involving States in the definition of the priorities on research, of converging R&D with health systems and response capacity, and of managing to turn the results into public goods. For that purpose, it is necessary to have participative States.

Besides, the presence of the States is extremely relevant in a scenario of high conflict of interest”, she concludes.

Read the complete article on ISAGS’ website.

READ MORE ISAGS completes three years in July Page 2 Colombian Court approves Statutory Health Law Page 3 Ilona Kickbusch: “It can be really important, particularly to the countries of the South, to work together in Global Health Diplomacy” Page 4

ISAGS completes three years of commitment with the regional integration on health

Celebrated on July 25, the 3rd anniversary of the Institute marks the advancements in the accomplishment of the Triennial Plan

The South American Institute of Government in Health (ISAGS) completes three years on July 25. The date marks ISAGS advancements in the execution of the Triennial Plan 2012-2015 wich emphasizes on the areas of the Social Determination of Health, Universal Systems and Political Economy of Health. Those priorities are the result of the discussions which occurred during the first semester of the Institute’s activities, when there were held five workshops, which gathered 207 experts from the 12 member countries of UNASUR. The mentioned priorities also derive from the 1st Meeting of the Consultative Council of the Institute. The organ is responsible for the formulation of recommendations concerning the planning, management, execution and evaluation of the programmes developed by ISAGS. The Institute’s anniversary will be celebrated during the 4th Meeting of the Council, which will take place in Rio de Janeiro, from July 22 to 24.

At the occasion, there will also be a debate on the Annual Operating Plan for 2015, the year which closes the Institute’s Triennial Plan.

Actions in 2014 ISAGS started the year with its efforts focused on the consolidation of the Universal Systems, through the discussion of the structuring role of the Primary Health Care. José-Manuel Freire, head of the International Health Department of the National Health School of the Carlos III Health Institute (Madrid, Spain), presented the Spanish experience in a conference watched live by 27 countries. The conference opened the seminar ‘Primary Health Care Approaches and

strategies for the permanence of professionals in remote and underserved areas in the South American countries’, which gathered representatives from the 12 countries in May. At the opportunity, the Institute presented the results of the Mapping of Primary Health Care Models in the region. The ongoing research will be consolidated in a book, which will be launched in 2015.

In the area of the Social Determination of Health, ISAGS launched, in June, the open call for its first scientific journal. With the theme: ‘Post2015 and Sustainable Development Goals: the South American Vision’, the bilingual publication aims at fostering the political-strategic debate on the construction of the new United Nations agenda and its implications for human and environmental health, from the perspective of the South American nations. Researchers interested in contributing to the journal must submit their articles, essays, debates and critical analysis in Spanish or English to the e-mail address revistapos2015@isags-unasur.org until July 20.

The journal will be released in November.

Still concerning the SDH, ISAGS will hold, in 2014, its first course. The interdisciplinary course ‘Intersectorial Public Policies and the

Social Determination of Health’ is directed to managers and leaderships of the South American countries and will be partial distance-learning based, with the support of a distance learning platform. The course results from a partnership established between the Technical Group on SDH and the Institute, which also encompasses the development of an Indicators Database.

The area of the Political Economy of Health is working on the planning of the seminar ‘Intellectual Property and Public Health: reflections and trends in South America’, in October. The event will be held in Buenos Aires in partnership with the Technical Group on Universal Access to Medicines (GAUMU), with which ISAGS also develops the Mapping of Regional Capacities in the Production of Medicines and Medicine Policies.

Altogether, ISAGS hopes to take decisive steps regarding the accomplishment of the results expected from the Triennial Plan, which are the construction of critical mass capable of formulating proposals that broaden its potential for regional inclusion and integration and the strengthening of knowledge networks of the UNASUR countries.

World No Tobacco Day celebrated with advancements in the South American region

U r u g u a y l a u n c h e s I n t e r n a t i o n a l C o o p e r a t i o n C e n t e r o n To b a c c o C o n t r o l a n d B r a z i l r e g u l a t e s s t r i c t e r l e g i s l a t i o n American countries, informed the minister of Health, Susana Muñiz, at the opening ceremony of the Center, which was recognized last May by the WHO Framework Convention on Tobacco Control Secretariat as a knowledge hub on tobacco free environments, health advertence and treatment against smoking.

The minister of Foreign Affairs participated in the launching event and highlighted the importance of the antismoking actions as an essential part of the State’s sovereignty on the protection of the population’s right to health.

“Those rights are inalienable and immutable, and we are responsible for taking these measures forward.” he said. The country was in the spotlight of the world news in 2012 when the Philip Morris Company, based on a bilateral commerce treaty with Switzerland, decided to sue Uruguay for some measures adopted, such as the antismoking warnings in cigarette packs.

Still with regard to the celebrations, on the last 31st, the Brazilian Ministry of Health announced the regulation of the Antismoking Law, which had been sanctioned in December 2011. The country now counts with stricter mechanisms that include the end of cigarette advertisement, the extinction of designated smoking areas – spaces destined to the use of tobacco in places like companies and restaurants –, and the intensification of alert messages in cigarette packs.

MSP Uruguay

Celebrated on May 31, the World No Tobacco Day was marked by advancements in health public policies of the South American Nations. On the date, Uruguay launched the International Cooperation Center on Tobacco Control (CCICT), the first service of its kind in the Americas, which aims at researches and technical support to countries that wish to strengthen actions in the area. Brazil, likewise, celebrated the regulation of the Antismoking Law, which establishes stricter rules for the use and commercialization of tobacco.

Located in Montevideo, the CCICT will foster the exchange of information between specialized organisms, promoting the extension of Uruguay’s international cooperation on the issue. The country is currently developing actions in collaboration with Ecuador and Paraguay. “At the moment, we are able to offer cooperation to any of the

Minister Susana Muñiz and authorities inaugurate CCICT

Brazil develops surveillance app for the Cup

HEALTH CONNECTION

“Healthy Cup” is free and is available in Spanish, English and Portuguese location of public and private hospitals and drugstores with the support of maps.

To access the tool, it is only required to be over 13 years old, to register and to download it at www.saudenacopa.com/webapp.

Also regarding the World Cup, the Brazilian National Health Surveillance Agency (Anvisa) approved a resolution that regulates the provision of health services in mass events of national interest. Among the main rules are: the responsibility of the event organizer for the guarantee of the provision of urgency and emergency health services, the displacement of patients to a higher complexity service when necessary and the categorization of the food services in A, B and C, based on criteria that evaluate the hygienic health aspects of greater impact on the consumers’ health.

FIGHT AGAINST CANCER

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Developed by the Health Surveillance Secretariat of the Brazilian Ministry of Health in collaboration with the health secretariats of the host cities and with international institutions, the Healthy Cup app allows the fast detection of diseases during the World Cup. The tool was designed for mobile devices and web browsers and is part of the project of enhancement of the participative surveillance of the Brazilian Unified Health System (SUS).

The free app, available in Portuguese, English and Spanish, was created to function as a complementary information channel, in order to map the occurrences of similar symptoms in a determined location. Besides contributing for the monitoring of surveillance, the fan is be able to access information such as the

Nadine Heredia, the first lady of Peru and president of the Nationalist Party of the country, received the honors of the Network of National Cancer Institutes (RINC/UNASUR) for her nomination as leader and social advocate for prevention and control of cancer at the Brazilian National Cancer Institute (INCA) on May 29.

During the ceremony, which counted with the participation of ISAGS’ executive director, José Gomes Temporão, Heredia affirmed that “the South American community can count on her as an ally for the construction of a continent free of advanced cancer”.

Health System´s Reform progresses in Colombia Constitutional Court approves law that recognizes health as a fundamental right of the Colombians

MinsSalud Colombia

HEALTH INEQUITY

Minister of Health and Social Protection, Alejandro Gaviria, celebrates the decision of the Colombian Court

The recognition of health as a fundamental right, the establishment of control over medicines prices and the guarantee of access to all patients without distinction by economic reasons.

These are some of the main guidelines of the Colombian Statutory Health Law, approved by the country’s Constitutional Court on June 5.

The law, composed by 25 articles, was presented by the government in 2013 and had already passed through other Senate commissions. When talking about the approval, the minister of Health Alejandro Gaviria affirmed that the achievement is a historical mark: “It is the first time in the country that a right of social and economic character is regulated by our political constitution. The most important fact is that we managed to reach the

guarantee of health as a fundamental right”, he highlighted.

Besides the recognition of health as a right, the code establishes that public resources that finance health must have a specific destination and cannot be directed to objectives other than those enumerated by the Constitution. The law also highlights the importance of the citizen participation in the formulation of public policies, in the monitoring and in the control of the evaluation system of health results.

For the full approval of the law, there is also the need of a joint debate with the Senate and the Chamber of Deputies.

Gaviria explained that the core of the discussion is the definition of the nature of the administrators and managers, which can be of mixed, private or public character.

The Commission of The Lancet Magazine – University of Oslo on Global Governance for Health launched on May 30, in Rio de Janeiro, the report The political origins of health inequity: prospects for change, in Portuguese. The report shows that the political determinants of health, such as the policies implemented after the global economic crisis, the action of transnational medicine and food corporations, and the intellectual property rules are the main factors which affect the health of the population of developing countries. The commission is formed by Brazil’s national coordinator for the South American Health Council, Paulo Buss.

SUSTAINABLE DEVELOPMENT The Rio+ Centre, a legacy of the Rio+20 Conference on Sustainable Development, is now online. The website www.riopluscentre. org gathers analyses and perspectives for the equitable and sustainable development and makes available the access to the platform Rio Dialogues, created by the United Nations Development Programme and by the Brazilian government with the intention of stimulating the participation of civil society in the debate about the subject. The centre is directed by Rômulo Paes, lecturer at the workshop on Social Determinants of Health, which took place at ISAGS in May 2013.

On May 30, a new World Health Organization (WHO) Collaborating Center was launched in Rio de Janeiro. For the next four years, the Global Health Center of Fiocruz – Cris, will act on the areas of Global Health and SouthSouth Cooperation. The occasion was marked by the conference of Dr. Ilona Kickbusch, Director of the Global Health Programme at the Graduate Institute of International and Development Studies, in Geneva. At the interview, Kickbusch talks about the concept of Global Health Diplomacy (GHD), about the importance of South-South cooperation and about the arising of new actors in the global diplomacy scenario. She also points out the challenges Health needs to face regarding the negotiations for the Post2015 Development Agenda.

How do you define global health diplomacy and what is the context that brings together this new field or concept?

We define global health diplomacy (GHD) as negotiating for health in contrast to other interests. There is, of course, a valuable base of GHD which is based on equity and human rights and also on the hope that, through health and health diplomacy, one can improve the relationship between states that, otherwise, do not have good relations. So

The South-South cooperation is about giving technical cooperation, building infrastructure and strengthening capacity and I believe that is the type of cooperation we need in the future health is used in foreign policy to create better relationships but, on the other hand, it can lose out if the foreign policy has other interests. Therefore, what we are trying to find is where one can find alignment between health and foreign policy interests. Some foreign ministers have even pronounced themselves about making health a goal of foreign policy and, therefore, having it contribute to development and peace. Of course, in real life there are huge power differences between the countries. Therefore, those power differences and these political interests also manifest themselves in GHD. That’s why it can be really important, particularly to the countries of the South, to work together in GHD in order to formulate their interests and to make sure that the global agreements also reflect them. In addition, there is a big challenge in terms of capacity building and training and as to really bringing together the health foreign policy of the countries of the South.

How is the South-South cooperation articulated with the concept of global health diplomacy and governance?

It’s very important to take SouthSouth cooperation forward because it is a different model of cooperation. The model of the West has very much been

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Interview: Ilona Kickbusch

a donor and recipient kind of approach, also very project focused, defining discrete disease entities, like malaria or tuberculosis, and moving forward.

Whereas the South-South cooperation is about giving technical cooperation, building infrastructure and strengthening capacity and I believe that is the type of cooperation we need in the future.

How do you analyze the arising of new actors – as UNASUR – in the global scenario and how can this help facing the challenges to ensure health as a right and public good?

If we look at the whole and at the various venues of GHD, we can see that because of the power in balance, more and more regional groupings and what we call “clubs” are coming together. Therefore, for example, you have UNASUR, which is working together and has health as part of its work, you have the lusophone countries, and many others. We are seeing that these groupings and policy networks that were built for other reasons are now becoming much more important for health and will be particularly important if we look at the Post-2015 Agenda.

Today you said that a lot of work must be done in the next year if we want to see health in the core of the Post-2015 Agenda. Why? The Post-2015 health agenda is now going to be negotiated by the colleagues in foreign policy and they need to understand the health priorities. They will be discussing these priorities in the regional groupings and in their clubs and that’s where Brazil can play a very important role. Brazil is in the G-20, in many regional clubs and in the BRICS grouping. Therefore, we really hope that its approach to health, which is based on determinants, on governance for global health – and not just global health governance –, and is also committed to equity, will come into the core of the Post-2015 Agenda, so that we look at sustainability and health together and find a way to address the unsustainable production and consumption which is so harmful to our health.

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: Maíra Mathias 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.