Rio de Janeiro, March 2014
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South American Health Council meets in Suriname UNASUR Health Ministers and membercountry representatives met in Paramaribo, Suriname, on 20 March, for the 8th Meeting of the South American Health Council. In addition to the host country, which occupies the Pro Tempore Presidency of the Health Council, the meeting was also attended by delegations from Argentina, Brazil, Colombia, Chile, Ecuador, Guyana, Paraguay, Peru, Uruguay and Venezuela. The discussions addressed items on the global health agenda, including chronic non-communicable diseases and positions for the forthcoming World Health Assembly, in addition to matters related to ISAGS, such as approving the Annual Operating Plan and the special extension of José Gomes Temporão’s mandate as Executive Director of the Institute. In his opening address, Suriname’s Minister of Health, Michael Blokland, thanked Argentina for its support in organising the event and drew special attention to support from the ISAGS: “As soon as we occupied the chair of the Health Council, in August 2013, our first step, jointly with the Institute, was to plan this meeting, which was last held over a year ago”, he declared. Minister Blokland also took the opportunity to welcome Guyana, which was taking part in a Council meeting for the first time the country was represented by its Minister of Health, Bheri Ramsaran. The Council addressed chronic noncommunicable diseases, a priority issue in the UNASUR Five Year Plan, and decided to organise a meeting to update on the subject and to evaluate the importance of setting up a corresponding technical group. Special attention was given to the food and beverage industry and to combating obesity. The authorities also discussed communicable diseases such as dengue and chikungunya, viral disease transmitted by the mosquito Aedes aegypti, the same that transmits dengue, and by the Aedes albopictus mosquito. In the context of preparations for the 67th World Health Assembly, to be held from 19 to 24 May in Geneva, the Pro
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Health Council meeting approves ISAGS Operating Plan and confirms reappointment of José Gomes Temporão to head the Institute
South American authorities received ISAGS statements of accounts during the 8th Meeting of the UNASUR Health Council
Tempore Presidency presented a summary of the World Health Organisation’s (WHO) Executive Board resolutions and recommendations for the meeting and underlined the importance of the UNASUR’s presenting common positions. In addition to the five items already agreed by the bloc (access to medicines, inter-sector actions to develop health and equity, health on the post 2015 agenda, health human resources and people with disabilities), which were forwarded to the WHO in January, the country representatives, coordinated by the Pro Tempore Presidency, are to discuss and draft further declarations. ISAGS at the meeting Other highlights of the Health Council meeting were its approval of the ISAGS 2014 Annual Operating Plan and submission of the Institute’s 2013 annual report [more on page 2]. ISAGS also presented its statements of accounts of the last year, as required by Article I of its bylaws as a legal personality. The Health Council decided exceptionally to extend José Gomes Temporão’s mandate as ISAGS Executive Director for the period from July 2014 to July 2016 and to set up a working group to evaluate the ISAGS’ work. Comprising representatives of Argentina, Brazil, Ecuador, Paraguay, Suriname, Uruguay and Venezuela,
the group’s functions will also include reviewing the ISAGS bylaws and following up the ratification process of the Institute’s host agreement and the engagement of international staff. The group will submit its conclusion during the forthcoming Health Council meeting in September in Uruguay, which will be occupying the Pro Tempore Presidency of the UNASUR. The Health Council also discussed the 1st Meeting of Ministers of Health of the Summit of South American and Arab Countries (ASPA), which will be held from 2 to 4 April in Lima, Peru [see more on page 2]. The 8th Health Council Meeting was preceded, on 18 and 19 March, by a meeting of its Coordinating Committee, also in Paramaribo.
READ MORE Summit of South American and Arab Countries focuses on health Page 2 Minister Arthur Chioro and José Gomes Temporão meet to discuss ISAGS Page 3 Ligia Giovanella- “The investigation of the diverse PHC models in place in South America will reveal trends, challenges and also successful experiences” Page 4
South American and Arab countries orchestrate health efforts ASPA brings Health Ministers of its 34 member countries together for the first time For the first time, the 34 countries that make up the Summit of South American and Arab Countries (ASPA) are to discuss health with a view to establishing a common plan of action. This unprecedented meeting of the ministers responsible for the field will take place on 4 April in Lima and will be preceded, on 2 and 3 April, by a technical meeting, which will inform the discussions. The preparations for the meeting formed part of the agenda for the 8th Meeting of the South American Health Council (CSS), where it was agreed that the ISAGS will produce a summary with regards to health in the Arab Countries. The meeting will also mark the official incorporation of the CSS as an entity representing the UNASUR countries, which together with the League of Arab States (LAS), will have a seat at ASPA meetings.
The meeting will be directed to four main themes – health systems; disease prevention and control; health promotion and the social and environmental determinants of health; and preparation, surveillance, response and humanitarian aid – which include some burning issues, such as innovation and technology transfer between countries and universal health coverage. The ASPA was first proposed in 2003, when Brazil’s president at the time, Luiz Inácio Lula da Silva, conducted his first diplomatic mission to the Middle East. The ASPA was officially set up in 2005, during the 1st Summit of Heads of State and Government, in Brasilia, as a mechanism for its member countries to extend cooperation and share experience. This was followed by meetings in Doha, in 2009, and Lima, in 2012, where the authorities decided that the Health Ministers should meet.
In addition to the UNASUR member countries, the ASPA comprises Saudi Arabia, Algeria, Bahrein, Qatar, Comoros, Djibouti, Egypt, United Arab Emirates, Yemen, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Mauritania, Oman, Palestine, Syria, Somalia, Sudan and Tunisia.
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ISAGS launches report on activities developed in 2013 during SHC meeting
Transparency: report summarises each of ISAGS activities in 2013
The Annual Report, which the Institute presented at the 8th Regular Meeting of the South American Health Council (CSS), is designed to offer a panorama of the ISAGS’ activities during 2013. The report covers four thematic dimensions. The opening chapter, devoted to knowledge and communication, highlights three mappings – primary health care models (see more on page 4), public health training programmes, and regional drug production capabilities and related policies – and the reformulation of ISAGS chief communication tools. Three workshops and conferences were held on issues proposed in the 2012-2015 Three-year Plan, and were broadcast
live with simultaneous interpretation in three languages. Endeavours pursued jointly with the CSS Technical Groups and Networks was recorded, as were the 3 rd Meeting of the Consultative Council and the first course proposed by the ISAGS, on policy governance and social determinants of health, given in partnership with the Working Group on Social Determinants of Health. The section on inter-sector collaboration reported closer relations with the Secretariat General and other UNASUR bodies, as well as events and high-level visits. Finally, the report closed with advances in institutionalisation, including the ISAG’s gaining legal personality,
receiving its first UNASUR funding, moving to new premises and engaging seven officials in national-level positions. Also during the CSS meeting, in addition to presenting its 2013 Report, the ISAGS approved its second Annual Operating Plan, for the year 2014. The document is divided into four key focus areas (Information and Knowledge Management, Social Determination of Health, Universal Health Systems and Political Economy of Health). Activities scheduled include holding one workshop on primary health care, another on intellectual property and public health, and publication of a journal on the post-2015 agenda and the sustainable development goals.
Minister of Health of Brazil and Executive Director of ISAGS in discussions to strengthen the Institute HEALTH CONNECTION Executive Director in talks on host agreement and definitive installations On 6 March, Brazil’s Minister of Health, Arthur Chioro, received Executive Director of ISAGS, José Gomes Temporão, in his office in Brasilia to discuss how to strengthen the Institute. Temporão congratulated Chioro, who took over the portfolio in February this year, and talked about the importance of collaboration among the countries of South America to foster public health policies, also stressing the activities of the UNASUR Health Council in this context. Temporão took the opportunity to express his gratitude for Brazil’s having nominated him for reappointment as Executive Director of the ISAGS for a further two years. He also requested the
PROFILE OF THE URUGUAYAN SYSTEM
Minister’s support in expediting submission of the ISAGS host agreement to Brazil’s Congress, given that the document has been with the Office of the Presidential Chief of Staff since November 2013 and has yet to be ratified by Congress. The Minister promised to make every effort to support the ISAGS’ institutionalisation. With that purpose in mind, Temporão made yet another request: “I would like to draw attention to the negotiations with the Brazilian government on permanent premises for the ISAGS, that is, a space granted by Brazil which will afford the Institute all the conditions necessary for it to set up appropriately in Rio de Janeiro”.
On 13 March, the Mercosur Health Systems Observatory (OMSS) presented the descriptive profile of the Uruguayan Health System. The event was attended by Uruguay’s Minister of Health, Susana Muñiz, who underlined the studies importance to better-informed policy making. The Observatory has now released profiles on Argentina and Brazil. The OMSS methodology is an adaptation of the one developed by the European Observatory in connection with the ISAGS proposal to produce the profiles, which resulted in the book Health Systems in South America (2012). The report, which can be accessed on the OMSS web site, is authored by Gilberto Rios, a researcher currently working as a consultant to the ISAGS on the PHC mapping (see more on page 4).
Executive Director thanks Chioro for nomination to continue as head of ISAGS
PAHO: dengue surveillance protocol at trials stage Eight countries have adopted the measures, which are to be implemented in the last quarter of 2014 Sadly, the figures for dengue fever are still very high. In 2013, 2.3 million cases were recorded in the Americas, just over 1.8 million of them in South America. The figures are from the Pan-American Health Organisation (PAHO), which on 5 March called on representatives of governments in the region to validate the new Generic Dengue Fever Surveillance Protocol. With this initiative, the PAHO hopes to standardise data collection in the Americas and so inform decision making for prevention and control. Meeting in Panama, national heads of several countries’ dengue control and epidemiological surveillance programmes approved the protocol, which is at the trial stage. Serving as laboratories for the Americas, Argentina, Brazil, Costa Rica, Colombia, El Salvador, Mexico, Panama and Peru adopted the measures. The PAHO expects the protocol to be ready for introduction in the fourth quarter of this year.
The history of dengue notifications dates from 1779, when the first cases were recorded in Asia, Africa and North America. The disease re-emerged in South America in the 1970s, coming from the Caribbean and affecting Colombia and Guyana. Since the 1990s, it has become established as one of the region’s main public health problems among communicable diseases, except in Chile and Uruguay, which in 2013 recorded 39 and no cases, respectively. In that light, dengue prevention and treatment actions are included in the South American Health Council’s 2011-2015 Five-year Plan. Dengue is also addressed in the book Health Surveillance in South America, published last year by the ISAGS. This year, on 7 April, World Health Day will draw attention to vector-borne diseases, such as dengue fever, which is transmitted by the Aedes aegypti mosquito.
The Andean Health Organisation – Hipólito Unanue Agreement (ORAS-CONHU) held the 34th Meeting of Ministers of Health on 26 and 27 March in the Galápagos Islands, in Ecuador. There Colombia, currently chair of the organisation, handed over to the host country. On the agenda for approval were the Andean Intercultural Health Policy and the proposal of basic health indicators. In addition to the countries above, the ORAS-CONHU includes Bolivia, Chile, Peru and Venezuela.
HEALTH SUMMIT IN COLOMBIA Approximately 200 health experts and leaders met in Medellin on 27 and 28 February for the ‘National Summit for Health’, called by Colombia’s Ministry of Health and Social Protection in the framework of the health system reform process ongoing in Colombia since mid-2012. Thee conferences, panels and roundtables at the event addressed subjects such as concepts of health, health sector reforms around the world, the right to health, health system funding in Colombia, the most feasible model of assurance for Colombia, guaranteeing quality in provision to the public and so on.
Sergio Gonzáles
Erasmo Salomão
ORAS-CONHU GATHERS HEALTH MINISTERS
to address the social determination of the health-illness process. There was a reaction to this, of course, originating from international organisations such as the Rockefeller Foundation and Unicef [United Nations Children’s Fund], which argued that such a broad goal was unachievable. Accordingly, countries should direct their policies to selective care, to certain costeffective procedures and a minimum basket of health services targeting the poorest populations. In the 1980s and 90s, neoliberalism was calling the tune and that view gained ground.
Interview: Ligia Giovanella
In 2013, the ISAGS embarked on a Mapping of Primary Health Care (PHC) Models in South American Countries. As provided for in the Institute’s Annual Operating Plan, the project will furnish an unprecedented panorama of how PHC is organised in the region, identifying successful experiences, challenges and trends in introduction of PHC. In this interview, Ligia Giovanella, project coordinator and permanent faculty member of the Postgraduate Programme in Public Health at the National School of Public Health of the Fiocruz, talks about the mapping, as well as reconsidering important milestones in PHC and contextualising the disputes surrounding the concept. What can we expect of the mapping? Although there is a vast literature on PHC in countries in the region, what is lacking is a South American panorama developed on a single research template. In that respect, the mapping is an unprecedented initiative. Investigation of the diverse PHC models in place in the 12 countries of South America will reveal trends, challenges and also successful experiences. We will have more data on how care is provided, organised and coordinated, labour forces, funding,
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The research will inform governments, enabling them to identify regionally or locally strategic policies and facilitating decision making and strengthening the UNASUR as a whole
management and social participation, through to issues like inter-sector and intercultural approaches. In short, the research will inform governments, enabling them to identify regionally or locally strategic policies and facilitating decision making and strengthening the UNASUR as a whole. Are there many conceptions of PHC? The concept of primary care can be seen to change over time. Like other concepts in the collective health field, it is the subject of disputes that derive from differing understandings and positions on guaranteeing the right to health. The key milestone is the International Conference on Primary Health Care, held at Alma Ata [then part of the former Soviet Union] in 1978, and its declaration, which laid the foundations for the ambitious World Health Organisation goal that countries would achieve ‘Health for All’ by 2000. Alma Ata represented a turning point in the understanding of comprehensive PHC as a fundamental strategy for reorganising both the model of care and health systems themselves, with the realisation that guaranteeing the right to health is inseparable from the economic and social development of nations, and involves participation by other sectors
And what about today? Has comprehensive PHC retaken that ground? There is a process internationally that has been characterised as a revitalisation of PHC and has to do with a return to the more comprehensive conception. Even the WHO produced a report in 2008 [30 years after Alma Ata] returning to that integrated, comprehensive view of health systems, no longer ‘poor care for the poor’, but spurring countries on with the slogan ‘Primary Health Care: now more than ever’. Recently, South America has led important changes in models of social protection and also in health system organisation. In that regard, the mapping will be an opportunity to discuss conceptions of PHC and also to investigate whether primary care is helping build universal health systems. How does the mapping stand now? What are the next steps? The work first kicked off in November 2013, when the ISAGS selected five expert consultants. In January and February, these researchers – divided up by regions – went out into the field, where they collected information thanks to collaboration from the countries’ Ministries of Health and the support of the Universal Health Systems Technical Group, ISAGS’ partner in the undertaking. The results will be presented and discussed at the workshop ‘Primary Health Care approaches and strategies to retain health workers in remote, vulnerable zones of South American countries’, to be held by the Institute from 13 to 15 May in Rio de Janeiro. Finally, the research material will result in a book.
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.