Colombia puts forward Reform Bill that acknowledges health as a right

UNASUR

Report

South American Institute of Government in Health

Rio de Janeiro, april 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.

Colombia puts forward Bill that acknowledges health as a right The Government of Colombia presented a proposal of Reform to their Health System on March 19th.

The proposal recognizes health as a fundamental constitutional right and changes the system’s funding model. President Juan Manuel Santos himself registered the Bills that are part of the proposal; he asked the Congressmen to give it a priority so it can be approved until June, when the current legislature is over.

“This project ratifies the principle that health is a fundamental right of Colombians. It enables us to increase the benefits of the subsidized system and the contributory system so we can have a unified system to all”, said President Santos. “[The reform] must transform our health system into a model in which all Colombians are safe and enjoying a health system that meets their expectations”.

According to the government, the presented proposal is the result of a broad dialogue process and coordination with civil society and members of the health sector. The

debate started last year when the subject was defined as a priority.

The proposal is divided into a Statutory Bill and an Ordinary Bill, both of which may go through the legislative procedures jointly in the Congress.

“There are two reforms on the table: the Statutory Law, made up by 14 articles that redefine the fundamental objectives of the system, which is aimed to be the guiding framework of our system; and the Ordinary Law, that presents the path towards achieving these objectives”, said the Minister of Health and Social Protection Alejandro Gaviria, that leaded the debates, as he accompanied President Santos in the deliverance of the Projects.

According to the government, most part of the objectives defined by the Law 100 of 1993 – the last significant reform of Colombia’s Social Security System – were achieved, but the adopted model ended up with problems like the “fragmentation of the health system, which incentives agents to extract incomes instead of accomplishing the health objectives for the population”.

“These problems generated a systemic crisis situation, in which attempts to solve it made clear that the capacity of these agents to defend their interests overlapped the regulatory capacity of the Ministry of Health and Social Protection”, stated the Government in the justification presented along with the Ordinary Bill. Read more on page 2.

President Juan Manuel Santos and Minister Alejandro Gaviria present the Health Reform Laws

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South American Institute of Government in Health

Government Proposal modifies funding and restructures EPS Among the main points of the Health Reform presented by the Colombian Government, there are: the change in the system’s funding – that will then be made from a single fund of public resources –; the restructuring of the Entities of Health Promotion (EPS in Spanish) and the creation of a Unified System and a Single Health Plan.

Regarded as a critical point in the Colombian system, the funding model will no longer distinguish the contributory system – financed by the State, companies and workers – and the subsidised system – aimed towards the poor. Salud Mía, a public entity, will then manage all the system’s resources. Fosyga, the current fund that manages part of the system’s funding, will be eliminated.

EPS entities, which also manage the resources in the current model, will no

longer do it. They will solely manage the provision of services with transfers from Salud Mía. These entities currently have an articulating role in the Health System. As they accumulate resources management functions and the provision of services, they are in the centre of irregularity allegations.

Mi Plan (Unified Health Plan), on the other hand, should replace the current Compulsory Health Plan (POS, in Spanish) – that covers a limited number of services. This will represent an increase in the system’s coverage. Initially, however, a list of

Read more about Colombia’s Health System on the book “Health Systems in South America…”, organized by ISAGS at bit.ly/sistemadesaludencolombia

excluded procedures will be kept. The intention is to reach the objective of integrated health care gradually.

Other points that are present in the Reform Project are: the strengthening of the Health Superintendency, responsible for supervising the service providers; and establishing a maximum rate for medicine price readjustments. See more below.

COLOMBIA HEALTH REFORM

See the main points of the proposal presented by the Colombian government

Statutory Law Project

Ordinary Law Project

HUMAN RIGHTS Establishes health as a fundamental constitutional human right STATE’S ROLE The assurance of the right to health to all Colombians becomes a duty of the State UNIFIED SYSTEM

MI PLAN

INTEGRALITY Guarantees the provision of health services within a concept of integrality in health FINANCING

PAHO analyses the regional overall situation in “Health in South America – 2012” The Pan-American Health Organization (PAHO) launched the publication “Health in South America – 2012” last month. It outlines an overall situation of health and the region’s health systems and policies.

The new edition refreshes the former “Health in South America – 2008” that was produced as an input for UNASUR Health Council and its 2010-2015 Quinquennial Plan, which guides ISAGS 2012-2015 Triennial Plan.

According to the document, “the political, economical and social contexts have presented stable progress over the last decades (…) However, this progress has been unequal among different population groups”.

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SALUD MÍA Creates the Salud Mía, an entity that will manage all system’s resources EPS The EPS will no longer manage resources; alternatively, they will manage services SUPERSALUD Superintendencia Nacional acquires more power to supervise service providers MEDICINES Foresees the establishment of a limit to the readjustment of medicine prices

Furthermore, changes in the demographic epidemiologic profiles have resulted in a change of priorities in the public health agenda and in a need for redefinition of the health actions in the countries of South America.

The document highlights, moreover,the “processes of development, modernization and sectoral reforms” in health. For the health systems in the region, the result has been the “radical changes in the organization, access and performance”.

The publication can be fully downloaded at bit.ly/10lscgf. In November, ISAGS launched a book “Health Systems in South America: challenges to universality, integrality and equity”, available for reading and download at bit.ly/LivroIsags.

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South American Institute of Government in Health

Meeting asserts the importance of Health to Post-2015 Development

ECLAC Conference debates Sustainable Development in Latin America and Caribbean During the Conference on Sustainable Development organized by the Economic Commission for Latin America and the Caribbean (ECLAC), authorities from various countries in region agreed on the urgency of creating a global, unified, integral and equitable agenda.

2012

2013

SDG Working Group

Process Discussion

2015

2014

Content Generation

Negotiations and Debate SDG Working Group report (68th UN GA Assembly)

SDG Working Group and Secreteriat (comprised of 30 member states)

Agreement

SDG Working Group UN SG process UN external consultations

SDS Network

External stakeholders Member states negotiation input

HLP Report (May 2013)

High Level Panel (HLP) and Secretariat

SG Report (Sept 2013) Member state debates

UN-led Process

UN Task Team

Agreement?

Thematic Consultations Country Consultations Global Conversations (online consultations)

Non-UN Activities

The High Level Dialogue on Health in the Post-2015 Agenda gathered 50 specialists in Botswana on the 5th and 6th of March, including Health Ministers, international agencies directors and civil society members from all over the world. The objective was to discuss the priorities of the area in the new Sustainable Development Goals (SDG).

After two days of debate, the participants agreed upon the necessity to deepen the advances of the Millennium Development Goals (MDG), especially in terms of child mortality and access to vaccines and antiretroviral medications. At this point, however, there should be a focus in equity and universality, identified as two of the biggest problems to the global health agenda.

Beyond that, they highlighted the central role of the Non-communicable Chronic Diseases, the urgency in strengthening health systems and its financing models and, finally, the importance of seeking coverage and universal access to health services.

The report with the results of the Dialogue will be reviewed and finalized in April. It will serve as subsidy to UN High Level Panel on Post-2015 that will be presented to the Secretary General of the United Nations in May.

Three processes are providing input into the post-2015 dialogue

Non-UN Activities (e.g., civil society, foundations, private sector) research and consultation

UN High Level Groups gather to discuss new SDG Besides Health in the Post-2015 Development Agenda, two other high level groups gathered in March in order to discuss the definitions of the SDG: the Open Working Group of UN General Assembly on the 14th and 15th in New York in its first meeting since its creation in January; and the High Level Panel of Eminent Persons on Post-2015 Development Agenda, that gathered in Bali (Indonesia) on the 27th.

The meetings are part of a global consultation process triggered in 2012 after the United Nations Conference on Sustainable Development Rio+20.

The objective is to discuss the definition of new development goals

The meeting took place in Bogota (Colombia) from the 7th to the 9th of March and was aimed at providing a follow-up to the Post-2015 Development Agenda and Rio+20, as part of the global consultation process leaded by the UN. The participants, mainly authorities from the region, experts and UN agencies, highlighted the growth with social inclusion, social equality and protection and, also, environmental sustainability as keys to the definition of the new SDG. Alicia Bárcena, Executive Secretary of ECLAC, said that the region “is going

that will replace the MDG. See above the Post-2015 schedule.

In the meeting that took place in New York City, the participants highlighted the importance of goals like poverty and hunger eradication, decent job generation, environmental sustainability, gender equality and healthy lifestyle. UN Secretary General Ban Ki-moon highlighted the role of health in the Post-2015 Agenda. The Working Group must present a proposal of SDG to the UN General Assembly in September.

The Panel that gathered in Bali highlighted the need for a global partnership to define a coherent Post-2015 Agenda based on principles of equity, respect for humanity, sustainability, solidarity and shared responsibilities. The final report of the Panel will be presented to the UN Secretary General at the end of May.

through an unprecedented moment of unity and, therefore, has a historical opportunity of rethinking development with equality in its core”.

Alicia Bárcena, Cepal’s Secretary, during the Conference

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South American Institute of Government in Health

3rd Meeting of the Consultative Council discussed the role of ISAGS in the region The 3rd Meeting of ISAGS Consultative Council took place on the 25th and 26th of March. Topics like the perspectives of institutionalization and intersectoriality within UNASUR, the importance of the institute in the formulation of common positions for the region in the regional and global health agenda were debated.

Apart from the original members of the Consultative Council – made up by Coordinators of Technical Groups and Networks of the South American Health Council (CSS) – participated at the meeting representatives of UNASUR General Secretariat, of the Peruvian CSS Pro Tempore Presidency (PPT), of the Centre of Strategic Studies on Defence (CEED), of the South American Council of Social Development and of the host country’s Health Ministry, Brazil.

In its opening session, ISAGS Executive Director José Gomes Temporão emphasized the relevance of the meeting and the potential of a

Executive Director of ISAGS, José Gomes Temporão, opens the III Meeting of the Consultative Council

broader dialogue about transversality in a context of deep transformations that are impacting the region’s health systems, like the demographic, food and technological challenge.

Adriana Mendoza, representing the General Secretariat, highlighted the importance of formulating common positions within UNASUR regarding the health international agenda in forums like PAHO and WHO. The director of CEED Alfredo Forti emphasized the intersectoriality and the importance of “acting along with the Councils and the General Secretariat of UNASUR”.

Bloc will accompany elections in Venezuela and Paraguay in April

UNASUR leaders paid their respects to President Hugo Chávez The UNASUR Council of Heads of State and Government manifested their “deepest grief” because of the passing of Venezuela’s President Hugo Chávez on the 5th of March, referring to him as a “decided driving force to the South American unity and integration”.

In an official Communiqué, the bloc’s presidents mentioned that it was “because of his visionary impulse, in April 2007, the creation of UNASUR was decided in Isla Margarita (Venezuela)”. “President Chávez will last (…) as a symbol of a generation of Statesmen that consolidated the cement of the South American identity and unity”.

Representing the Social Development Council, Henrique Salles Pinto affirmed that intersectoriality is essential to the region’s social development. He highlighted the creation of Human and Inclusive Social Observatory with the support of ISAGS. Among the other debated topics there are the strategic guidelines for 2014, the 2012-2015 Triennial Plan and the strategic orientations of UNASUR in the global health agenda. On the 27th, the Pro Tempore Presidency met with the Networks and the Technical Groups, which are part of the South American Health Council.

Unasur countries’ Presidents pay honors to Hugo Chávez

UNASUR General Secretariat also expressed their grief for the passing of an “integration pioneer and the promoter of Patria Grande (Great Motherland)”. The bloc’s Secretary General Alí Rodríguez Araque said it is an “irreparable loss”.

In the days that followed the passing of Chávez, UNASUR presidents went to Caracas to pay their last respects to the Venezuelan leader. At least eight of the bloc’s countries decreed official mourning.

MANAGEMENT OF INFORMATION AND KNOWLEDGE Coordinator: André Lobato Advisors: Amaro Grassi, Flávia Bueno e Manoel Giffoni comunicacao@isags-unasur.org

UNASUR will carry out missions to accompany two presidential elections that will happen in the region this month: in Venezuela on the 14th; and in Paraguay on the 21st. Paraguay is suspended from the bloc since the coup d’état that expelled President Fernando Lugo from the office in June 2012. Its return is conditioned to a return to democratic normalcy.

In March, the 1st Meeting of the South American Education Council took place in Lima. A consolidation of the “South American citizenship” is one the new Council’s priorities. The Council was created last November. At the same time, the 1st Meeting of Tourism Ministers of UNASUR happened in Quito so as to adopt a common Working Plan.