Report ISAGS June 2015

Rio de Janeiro, June 2015

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Secretary General of UNASUR advocates preventive vaccination at cervical cancer awareness campaign launch

ISAGS

The project highlights the importance of early diagnosis to reduce high mortality rates of women in South America

During the event, the authorities called upon an action to prevent cervical cancer

“The only social matter that cannot be postponed is health,” said the secretary general of UNASUR, Ernesto Samper during the launch of the campaign “South America free from cervical cancer”, held on 25th June in Lima, in the National Institute of Neoplastic Diseases (INEN). The chairman launched the initiative accompanied by the First Lady of Peru, Nadine Heredia – spokesperson of the campaign on the bloc. The intention is to make a call to society, health institutions and governments on the importance of adopting preventive measures to enable early diagnosis of the second cancer that most kills women in the continent. The International Relations coordinator of ISAGS, Mariana Faria, participated in the event.

As well as the vaccine of Human Papilloma Virus (HPV), the adoption of healthy habits and the execution of Pap test are actions that can prevent and treat the disease symptoms. At the time, Samper pointed out the high mortality rate caused by cervical cancer and stressed the importance of parental involvement in preventive process.

“We have statistics showing that more than

20,000 women could be victims of this deadly cancer [...] There is already a treatment for this kind of cancer, its security is fully established; it would be inexplicable for mothers and fathers not taking responsibility in vaccinating their daughters”.

Elected in 2014 by the South American Health Council (SHC) as a social leader concerning cancer prevention and control in South America, Nadine Heredia urged the bloc’s states, as well as civil society and the international community, to carry out joint work. “We may have differences with each other, but this is a unifying issue. We have to continue fighting against cancer through the prevention”. Nadine also highlighted the actions that have already been made and reiterated the safety of HPV vaccination.

“We have advanced a lot on the network, participating in a campaign for diagnosis and on sustainable practice (habits and nutrition).

Now we must try to explain more to the population what can help in prevention […] the vaccine can save our daughters”.

The event was broadcasted through videoconference to other countries of the bloc,

South America: Free From Cervical Cancer’s action platform: • Diagnosis, monitoring and treatment; • Strengthening of information systems; • Implementation of organized tracking strategies based on the Visual Inspection with Acetic Acid (VIA) and the immediate “See and Treat” cryotherapy; • Claim the incorporation of the HPV test in the ongoing programs; • Provide a knowledge-transfer network and give technical support to the countries that adopt the HPV vaccine.

such as Brazil, Uruguay, Chile and Argentina and other members of the Network of National Institutes of Cancer (RINC) also participated.

In Brazil, the representative of the Executive Secretary of RINC, Walter Zoss, talked about the beginning of the network and the job they have been developing through two cervical cancer control operations - exchange platform of experiences and technical assistance.

Then, the director of the National Institute of Uruguay, Álvaro Luongo, stated that cancer is not only a disease of women and youngsters, but also a social issue. The specialist said it is necessary to promote political integration among the American governments in order to modify the social factors that aggravate the situation.

Present at the event, the representative of the Pan American Health Organization in Peru (PAHO-WHO), Manuel Peña, praised the campaign and highlighted the initiative of providing specialized services in health for poor people. He affirmed that “the issue of HPV vaccination is one of the qualitative leaps that will ensure early prevention of disease”. According to information released at the International Research Centre on Cancer report (GLOBOCAN), in 2012 approximately 50% of women diagnosed with cervical cancer in South America died victims of the disease.

Also participated in the event the deputy minister of public health, Dr. Percy Minaya, the minister of foreign affairs, Ana Maria Liliane Sánchez Vargas de Rios, and the director of the INEN, Dra. Tatiana Vidaurre.

READ MORE Who selects project on indigenous health Page 2 Brazilian parliament votes ISAGS headquarters agreement Page 3 Interview with Daniel Olesker, ex minister of Uruguay Page 4

Project on indigenous health is an example of social innovation according to the WHO

Ana Lúcia Pontes

Training course developed by Fiocruz and by leaders of the Rio Negro region qualified more than 100 indigenous health workers in Amazonas

Indigenous health agents during the classes that took place in the Black River region, Amazonas

enabling them to be autonomous. Thus, local leaders wanted to qualify these ‘stakeholders’ by raising the schooling to high school and professional degree, specifically designed for the indigenous people”, she said.

During the training, there were many challenges, mainly related to communication.

According to Ana Lúcia, students had varying degrees of proximity to the Portuguese.

Routines such as attending class and taking notes of the contents were also unknown to some. “We had to reconsider the expectations of each IHA and understand that they had their own learning process”, recalled the academic, stressing the importance of group activities promoted in traditional languages. “It was the opportunity students

ISAGS

A pioneering initiative of the Joaquim Venancio Polytechnic School of Health (EPSJV/Fiocruz-RJ) and the Leônidas e Maria Deane Institute (ILMD/Fiocruz-AM) was selected by the Special Programme for Research and Training in Tropical Diseases of the World Health Organization (TDR/ WHO) as one of the best health innovation projects in the South. It consists in a technical course for indigenous community health agents (IHA), developed in partnership with the Federation of Indigenous Organizations of Rio Negro (Foirn) and the State Secretariat of Education of Amazonas (SEDUC-AM), which trained 139 professionals in the region of São Gabriel da Cachoeira.

“We will return in September this year with a team from Oxford University to produce videos and books about the whole experience, which will be presented at the WHO headquarters in December”, said the researcher and one of the coordinators of the course, Ana Lúcia Pontes.

Supervised by the physician and antropologist Luiza Garnelo (Fiocruz-AM), the course included five classes and practices modules; a total of 1440 work hours over seven years. “It is essential to say that Foirn came to us”, said Ana, “the communities of the Rio Negro region have a well - developed educational structure, with schools that are references elsewhere in the country”.

However, health had not progressed at the same pace. “The IHA did not hold elementary school degree or biomedical techniques

had to share their knowledge with each other”, she pointed out.

The relativization of the teaching methodology was not easy for the course staff. If the teacher is normally used to preparing their lessons freely, in this case there was guidance from anthropologists and researchers who knew the location.

“The goal was the empowerment of that society, so the didactics changed completely. One could not speak about food mentioning elements usually acquired in urban commerce, for example”.

According to Ana, projects like the course for IHA in the Rio Negro show that Brazil has advanced in the field of indigenous health, although there is still a long way to go. “In terms of public policies and access to services, we progressed considerably since the implementation of the 1988 Constitution [which recognizes, in Article 231, the social organization, languages, customs, beliefs and lands of the indigenous people].” The researcher stresses, however, the lack of conceptual debates about interculturalism.

“In countries like Ecuador, Bolivia and Peru, activism is intense and the agendas are more radical, perhaps because they possess a greater number of inhabitants from traditional communities. Here the theoretical production is still quite scarce”, says the researcher, who even made an immersion in an indigenous school in the city of La Paz in 2009.

In times of hi-tech, Foirn and EPSJV stood out by using a simple formula: people + education. “It is no use to offer a superficial training believing the result will be good. You have to understand how the region works.

Indigenous communities are ready to deal with us because they have accumulated 500 years of survival strategies. It is us who we were not yet able to strengthen ties with them.”

Ana Lúcia Pontes, teacher and researcher at the Joaquim Venâncio Polytechnic School of Health of the Oswaldo Cruz Foundation (EPSJV/Fiocruz)

ISAGS headquarters agreement will be voted in the Senate

Proposal that recognizes the Institute as an international organization passed the House of Representatives A ISAGS is awaiting the opinion of the Senate, as regards the approval of its headquarters agreement signed in 2012 between the Federative Republic of Brazil and UNASUR. The proposal establishing the entity’s operation in Rio de Janeiro and recognizing the Institute as an International Organization has already been approved in the House, and now depends on the decision of the Committee on External Relations and National Defense of the Senate. If approved, it will go to vote in the plenary and finally for presidential sanction.

The approval of the documents will consolidate ISAGS position as an intergovernmental entity, giving it rights and international diplomatic functions set out in the Vienna Convention of 1961.

Among the prerogatives recognized in the Convention are tax exemption for the importation of goods and local goods purchases; obtaining international legal personality; impossibility of seizure and expropriation of the Institute’s assets; equalization of the ISAGS executive director position with similar category of functions in international organizations, among other issues.

The Convention governing intergovernmental bodies understands that [the purpose of such privileges and immunities is not to benefit individuals, but rather to ensure the effective performance of the functions of diplomatic missions, in their capacity as representative of the States].

ISAGS Statute Approved in 2011 by resolution of the South American Health Council (SAHC/UNASUR), is also under treatment waiting for voting in Brazilian parliamentary bodies, and has already been approved, in June, by the Brazilian Representation in the Parliament of MERCOSUR (Parlasul). The document defines the functions and structure of the Institute, and will be submitted for approval by the House of Representatives.

Vienna Convention on Diplomatic Relations of 1961 Is a treaty adopted on 18th April 1961 by the United Nations Conference on Diplomatic Relations and Immunities, in order to regulate the branch of international law, determining rights, duties, privileges and immunities of States and of its employees during diplomatic relations with other countries. It is in force in Brazil since 1965.

Social campaigns mobilize the South America

Emblem of the campaign “Not one less”

In order to warn society about the risks of cigarette use and the HIV/AIDS prevention, as well as to draw attention to the worrying increase in cases of femicide – persecution and willful killing of women for gender reasons – countries like Argentina, Chile, Uruguay and Ecuador organized preventive campaigns and adopted restrictive measures on their territories.

Due to the increase of crimes against women in Argentina, thousands of people went to the streets, in May, in the march “Not One Less”.

The movement claimed for more protection for women and stricter punishments for violators, with repercussion in Chile and Uruguay. Also this year, in March, the Brazilian president, Dilma Rousseff, took an important step in the fight against gender violence passing a law making femicide a heinous crime.

Divulgação

South American nations launch Tobacco, AIDS and Femicide control policies

Last June, in Chile, the Ministry of Health launched the 10th campaign against the HIV/ AIDS, under the motto “Let us live as we live: always with a condom.” This year, the action is mainly aimed at teenagers and youngsters and explores sexual diversity. According to the Ministry, it is estimated that approximately 45.000 people have the HIV virus in the country, and 35 million worldwide, with 99% of cases resulting from unprotected sex.

Another area receiving great support from South American countries is the fight against smoking. Uruguay is considered a global leader on the issue, being the first country in the continent and fifth in the world to completely prohibit smoking in enclosed public spaces. Also involved in this issue, Ecuador approved, in June, a law that prohibits smoking in public places and signed the WHO protocol to eliminate illicit trade in tobacco products, becoming the third country in the Americas to ratify the norm.

According to the Pan American Health Organization (PAHO/WHO), eliminating illicit trade in cigarettes will enable countries to reduce tobacco consumption and collect millions of dollars that could be invested in health improvements.

HEALTH CONNECTION ISAGS SENDS REPRESENTATIVE TO THE HEADQUARTERS OF THE GENERAL SECRETARIAT OF UNASUR At the request of the secretary-general of the UNASUR, Ernesto Samper, the ISAGS sent the Institute’s international relations coordinator to Ecuador, in order to assess the possibility of setting up an ISAGS liaison office in the Secretariat headquarters. The initiative aims to strengthen the relationship between organizations and was endorsed by the South American Health Council.

In August, an assessment with the collaborator’s perceptions will be sent to the ministers. The decision complies with the determinations of the last council meeting minute, which highlights the importance of the Council’s role in integrating the bloc’s strategic health agenda and the UNASUR’s bodies.

EU-LAC HEALTH CONFERENCE On June 2nd, in Brussels, health experts from the European Union, Latin America and the Caribbean participated in the project EU-LAC Health Conference. On the occasion, the areas to be prioritized in cooperation between the countries were presented as well as a 2015-2020 work schedule. During the event, experts pointed out that for an effective health governance it is necessary to create a non-bureaucratic and flexible coordination structure, focusing on common challenges, for the national authorities to finance their own researchers.

ISAGS’ SDH COURSE ADDRESS INTERSECTORALITY IN HEALTH In an assessment of the Institute´s first course “Intersectoral Public Policies and Social Determination of Health (SDH)”, the coordinator Alessandra Ninnis evaluate that all the work presented were very relevant for the incorporation of intersectoral proposals in the dynamics of SDH, covering health and education areas. “They were useful for generating ideas on the improvement of management and implementation of policies and programs in the countries”, said Alessandra.

MINISTRY OF HEALTH OF ECUADOR AND PERU SIGNED HISTORICAL AGREEMENT On June, the Ministry of health of Ecuador and Peru signed an agreement in response to the threat of dengue and chinkungunya virus in the region. The pact offers free health care to people from both countries through cooperation among nations. In addition to the implementation of a reference laboratory in molecular biology – in the northern of Peru and southern Ecuador –, the alliance also provides for a Binational Communicators Network and a permanent exchange of epidemiological information and vector control interventions on the border.

the priorities of attention, public health policies, the control of resources and the definition of comprehensive benefits and medication plans; in addition to popular participation in the design and management of health services.

Interview: Daniel Olesker

Archivo Radio Nacional Uruguay

The key is decommodifying access to social services and goods

In an exclusive interview for ISAGS, the professor and former Minister of Public Health (2010-2011) and Social Development (2011-2015) of Uruguay recalls the progress of health in South America and projects the future of the sector based on the concept of social protection.

1) The book “Primary Health Care in South America” mentions the impact of sociopolitical transformations of the past four decades in the health systems of the continent. Why even nowadays it is so difficult to implement a strategy of comprehensive care in the South?

First we must recognize that there are different realities in each of the countries of South America and that fact impacts directly on the progresses of the transformations on health systems.

Particularly, health reform in Uruguay, Ecuador and Brazil represent the largest efforts in the issues of universality and equality in coverage.

Changes have been very significant in the model and the volume of financing, significant in the model of resource management, but clearly insufficient in the transformation of the care model.

There’s a reason for that, which is

the inheritance of collapsed and very fragmented systems with differential access. This situation meant prioritizing a way to build a different health system and, at least in the case of Uruguay, the priority was to build universal social health insurance to support financing. The culture of care in our country is strongly influenced by the assistance model and it has also permeated the vision of users who view health care as a cure of the disease and tend to a medicalized and laboratory analysis model.

2) Different from Europe, South America health models are characterized by high levels of privatization of services, which have resulted in the segmentation of coverage. Since its inception, UNASUR has been fighting to change this picture.

How the bloc can continue to work for achieving comprehensiveness of care?

Political changes in the countries of UNASUR are very important to rethink social policies in general and health in particular from the perspective of commodification.

Three key factors have to be considered on this regard: an increase in public spending on health reaching 6% of GDP; a regulatory state concerning

3) The PHC system is integrated into a comprehensive policy to combat poverty and guarantee the “good life”.

How can UNASUR promote multisectorial strategies in health in their countries-members, also following the Post-2015 Sustainable Development Goals of the UN? The key here is to think about a comprehensive array of social protection decommodifying access to social services and goods under the principle “from each according to his admission, to each according to his needs”; combining lifecycle policies with sectorial policies; universal policies with targeted prioritized actions; equipped with a powerful budget and popular participation at all levels.

4) South America is home to people with a vary array of different customs and backgrounds. In this context, what are the main challenges of the intercultural approach to PHC on the continent?

Health has as a central feature the social determinants. The intercultural approach should take into account the population’s quality of life, in its health aspects but also regarding education, housing among other factors.

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INSTITUTIONAL ISAGS-UNASUR Executive Director: José Gomes Temporão Technical Coordinator: Henri Jouval Coordinator of International Relations: Mariana Faria INFORMATION AND KNOWLEDGE MANAGEMENT Coordinator: Flávia Bueno ISAGS Report Editor: Flávia Rodrigues Report: Flávia Rodrigues and Karla Menezes Team: Bruno Macabú and Felippe Amarante 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.