66th WHA discusses WHO Reforms and Health in the Post-2015 Framework

ISAGS Report premieres its new Graphic Design

Rio de Janeiro, may 2013

Read more on the Editorial in page 2

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66th WHA discusses WHO Reforms and Health in the Post-2015 Framework World Health Assembly takes place from May 20th to 28th in Geneva, Switzerland Representatives from the over 190 member countries of the World Health Organization (WHO) will gather, from May 20th to 28th, in Geneva (Switzerland) for the 66th session of the World Health Assembly. During the meeting, some of the main issues in the global health agenda should be discussed, like WHO Reforms, the place Health should occupy in the Post 2015 Development Agenda, Universal Health Coverage, the Social Determinants of Health and others.

The World Health Assembly (WHA) is the main decision making authority of WHO and is responsible for defining the Organization’s priorities, appointing its Director-General and supervising its financial and budget policies. WHA gathers every year during the month of May for its Annual Session, when WHO strategic agenda is discussed for the following 12 months.

For the 66th WHA, debates from discussions held on the WHO’s 132nd Executive Board Session (EB 132) are expected. It took place in January and pointed out among its priorities the Organization’s Reform. According to the EB 132 report to WHA, some issues must be discussed, like the establishment of principles for the relationship of WHO with private entities and Non-Governmental Organizations, the role of WHO in global health governance, as well as the harmonization of the Regional Committee’s’ activities.

66th World Health Assembly wil discuss the Project of the 12th General Work Programme 2014-2019 Discussions on the WHO must include also the Project of the 12th General Work Programme 2014-2019, which establishes the agency’s priorities for the term that starts next year, and the Report from the Consultative Expert Work Group: Financing and Coordination, not to mention the 2014-2015 budget for WHO. Another priority issue on the global health agenda that must be debated on the 66th WHA is Health on the Post-2015 Health Agenda, which seeks to establish the new Sustainable Development Goals (SDG), as replacing the Millennium Development Goals (MDG). According to the EB 132 Report to WHA, during the Session that took place in January the participants evaluated the process of the global consultations triggered in 2012 after the Sustainable Development Conference Rio + 20 to discuss the new SDG. They stated

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66th World Health Assembly takes place between May 20th and 28th in Geneva (Switzerland)

that they hope the issue will be debated in the 66th WHA. Social Determinants of Health and Universal Coverage Other than these two issues, debates on the Social Determinants of Health (SDH) are expected in the 66th WHA discussions agenda. In a Report on the subject to the Assembly, WHO Secretariat points out the Social Determinants’ approach as being fundamental to the Organization’s actions and defends its inclusion in the Project of the 12th General Work Programme. The priorities related to the subject were defined in the Rio Political Declaration on Social Determinants of Health, issued in 2011 during the World Conference on SDH, which where already debated on the 65th WHA last year.

Universal Health Coverage, an objective that has being gaining momentum lately, was also the theme of a WHO Secretariat’s Report. In the document, two fundamental aspects of this concept are highlighted – universal access to healthcare and financial protection – as well as the progress made by some medium-income and low-income countries in the matter. The

issue, though, rises criticism by governments and multiple actors in the health sector, who see the necessity of strengthening the development of Universal Health Systems based on the principle of health as a right, and not only as a service.

At last, during the nine days of the 66th WHA, issues like Neglected Tropical Diseases, Non-Communicable Chronic Diseases, falsified medicines and human resources, among others, must also be discussed.

READ MORE • South American Health Council hosts an Extraordinary Meeting during the 66th WHA - Page 2 • ISAGS hosts workshop on “Critical Nodes of the Social Determinants of Health” - Page 3 • Interview: Dr. Monica Bruckmann speaks about natural resource policies on Unasur - Page 4

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Informe EDITORIAL

ISAGS Report premieres new Graphic Design ISAGS Report premieres its new graphic design in this edition. It was designed with the goal of making it more attractive and open to participation.

Giving this tool a new appearance also means strengthening it as a space of communication and of the discussion and diffusion of ideas, information and knowledge in health and related areas.

The South American Institute of Government in Health stresses then its commitment to the mission convened by the Heads of State and Government of the Union of South American Nations (UNASUR) in its foundation on June 2011, which is to foster the exchange of knowledge and the critical analysis in the fields of politics and governance in health.

In this sense, the new ISAGS Report seeks to provide a new platform designed to enhance the processes of information and knowledge dissemination to both technicians and leaderships in the health sector of the UNASUR member countries. This is why the Institute’s monthly publication will make available from this edition on new resources and formats of dissemination of best practices and evidences on health management in South America and in the world.

By doing this, ISAGS aims to contribute to the strengthening of the regional integration project leaded by UNASUR, promoting specialized knowledge in the public health field and enabling a more substantial exchange among the various actors in the sector. It aims still to provide a mean to strengthen the interaction among the governments

ISAGS stress its commitment to the critical analysis in the field of health of the 12 member-countries of the bloc.

The new Graphic Design is also aimed to make available to the managers of the South American Health Council’s Structuring Networks and Technical Groups a media to disseminate its works and also critical knowledge of its members’ interest. With this purpose, the Report will present the main activities of the six Structuring Networks and the five Technical Groups of the South American Health Council – one of UNASUR Sectoral Councils.

The “Health Connexion” section, that premieres in this edition of ISAGS Report (page 3), provide the readers with information about the activities of all Health Council’s sectors by making available to those a space for the diffusion of its meetings and deliberations. The “Schedule” section (page 4) will feature the most important events of health of the month in the region and in the world.

The “Editorial”, which also premieres in this edition however will only be publish occasionally, will bring institutional messages from ISAGS on issues of health or the political context of South America in general. The interview section (page 4) will provide a space to public managers, members of the Academy and leaderships from various areas of knowledge. Moreover, the menu bar “See more” (page 1) will redirect to other contents within the Report.

ISAGS Report wishes, then, to get closer to its audience by providing quality content through a renovated and dynamic media that is open to the participation of actors committed with the South American integration project.

South American Health Council promotes meeting during the Assembly to discuss common positions Meeting, announced by the Pro Tempore Presidency of Peru, should happen on May 20th The South American Health Council (CSS) will In its intervention about Health on the Posthost an Extraordinary Meeting during the 66th 2015 framework, Ecuador’s delegation stated its World Health Assembly Session to discuss common “deep acknowledgement of the importance” of a positions of the Union of South American Nations Development Agenda, whose definition process (UNASUR) concerning issues of the WHA agenda. will occupy a significant space of the debates in The meeting was convened by the Peruvian Pro the years to come and will be an important part of Tempore Presidency (PPT) and should happen on the health agenda. To UNASUR, Post-2015 must the 20th in Geneva. Health ministers of the bloc’s incorporate the Social Determinants of Health member states are expected. and go beyond the concept of Universal Health The South American Institute of Government in Coverage, notwithstanding its relevance.

Health, which is part of the Health The representative of UNASUR Council, will be represented expressed still the regional bloc’s by its Executive Director José support to the Report of the UNASUR at the EB132 Gomes Temporão, and by its Consultative Group on Research Member-countries of the South Head of Office Mariana Faria. and Development – a position American Health Council interDuring the 65th WHA, last that was already expressed in the vened in the following issues: year in May, CSS also had 65th WHA – due to the highlight an Extraordinary Meeting that given to “one of the most relevant • Health in the Post-2015 closed with the definition of challenges to the region’s health • Social Determinants of Health the bloc’s priority courses of systems”: the incentive to • Special Needs action within the meeting and sanitary innovation concerning • Research and Development resulted in a highlighted joint diseases that affect developing • Falsified medicines UNASUR action in the defence countries disproportionally.

• WHO Budget Policy of themes of interest.

According to the Report, the Some of the bloc’s common current paradigm of incentive to positions were already witnessed during the 132nd research and development doesn’t meet the needs Session of WHO Executive Board, which took place of these countries. in January. In that occasion, Ecuador spoke in the At last, the Ecuadorian delegation made a critical name of UNASUR. As the only representative of statement about the biannual Budget 2012-2013, the bloc in the organ, the country made statements pointing out the difficulty to “determine in a clear on five subjects: Special Needs; WHO Reform; way the priorities of the program areas (…), Health in the Post-2015 Development Agenda; which affects the coherence between the General Report of the Consultative Group on Research Programme of Work and the Budget”. It stated and Development; and Budget 2012-2013. still, on behalf of UNASUR, its concern about the Other themes that concern the bloc are Social diminishing proportion of WHO resources coming Determinants of Health and Falsified Medicines. from voluntary contributions.

Extraordinary Meeting of the South American Health Council in the 65th WHA (2012)

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ISAGS presents trilingual workshop on “Critical Nodes of the Social Determinants of Health” The Opening Conference was broadcasted online live with simultaneous translation

Dr Romulo Paes de Sousa (in the centre) at the opening Conference of the Workshop on Social Determinants of Health

Between May 6th and 8th, ISAGS presented the workshop “Critical Nodes of the Social Determinants of Health” that gathered specialists, academics, public managers and representatives from UNASUR countries to debate the relationship between social determination and development patterns. The event’s opening conference, that was presented by Dr. Romulo Paes de Sousa, former Executive Secretary of the Brazilian Ministry of Social Development, was broadcasted live through the Internet and was simultaneously translated into English and Spanish.

During about two hours of the event’s streaming, there were connexions from all of the Americas.

In the end of the opening conference, participants were able to send questions to the lecturer through e-mail, Facebook and Twitter. Entitled “Recent changes in the social protection policies of Latin American countries: what we have learned”, the presentation provided an outlook of the recent evolution in terms of social development policies in the region and its future perspectives.

According to Dr. Romulo Paes de Sousa, Latin America presented data that shows more expressive advancements in terms of poverty and inequality reduction in the last decades. Among the factors he pointed out as key in the process are the social protection policies, like welfare systems and health; and income transfer policies, that include the Brazilian “Bolsa Família” and the raising minimum wage policy, which has also been quite substantial in Brazil in the last decade.

Other facts that contributed to this, according to the lecturer, were the initiatives related to labour rights and urban transition that is common to various countries in South America, mainly in the big cities. Paes de Sousa also spoke of the challenge of setting up universalizing policies, like those in the health sector, which involves the dilemma between universalizing the public services and its efficiency, which reflects in the satisfaction rate of the population and, then, the

government’s approval rate.

Dr. Romulo Paes de Sousa was the Executive Secretary of the Ministry of Social Development and, on the 6th of May, he took up the direction of Centre Rio+, created by the Brazilian government in partnership with the United Nations Development Programme (UNDP), which aims to enable research and knowledge exchange, and to promote the international debate on sustainable development. The opening of the Centre is the main legacy of the Conference Rio + 20, that took place in Brazil in June 2012.

Intersections between social development and health policies After the Conference, the workshop on “Critical Nodes of the Social Determinants of Health” began and closed only on Wednesday (8th). The theme of the debates where the relations between social development and health policies, and the role of health in the Post-2015 Development Agenda.

The Debates Table of the workshop counted with Jaime Breilh, director of the health area of Universidad Andina Simón Bolívar (Ecuador); Roberto Passos, from the Institute of Applied Economics Research (IPEA, from Brazil); Marcelo Mondelli from the Social Institute of Mercosur (ISM); and Paulo Buss, from Fiocruz.

During the Workshop, Working Groups were assembled to debate the Action Plans of the UNASUR Council of the Social Development and of the Technical Group on Health Promotion and Action on the Social Determinants of Health, which is part of UNASUR Health Council.

Conexion Health Medicines and Defense In April, Argentine Ministry of Defense promoted the seminar “Public Production of Medicines in the Fields of National Defense and UNASUR”, in which ISAGS participated through its representative Dr. Monica Sutton, Technical Health Consultant for Industrial Complex of Health and Regulation. Authorities and professionals of health and defence sectors from the countries of South America also participated. Among the meeting’s objective were the elaboration of a strategic plan for the production and distribution of medicines.

The Director of the Centre of Strategic Studies in Defence of UNASUR Alberto Forti highlighted that the production of medicines reduces external dependency and strengthen the national sovereignty. Recently, Argentina proposed the definition of a Plan of Action to the bloc’s Defence Council for the creation of a South American Medicine Production Project, in partnership with the Health Council and ISAGS. Health Institutes Network The Network of National Institutes of Health (RINSUNASUR), one of the six Networks that are part of the CSS, carried out last month its 2nd Ordinary Meeting in Quito, Ecuador, where it was discussed the role of the National Institutes in the development of research in science and technology, control of diseases transmitted by vectors and Quinquennial Plan. At the end, the Director of Ecuador’s National Institute of Research in Public Health, Dr. Juan Carlos Pérez, was elected General Coordinator of RINS-UNASUR. Risk of Disaster Management Also last month, representatives from the countries of UNASUR held a high-level conference about research and human resources formation in integrated management of environmental risks and cases of disasters. Gathered in Lima, the delegates agreed to propose to the bloc the creation of a Working Group, responsible for dealing with the issue in an integral perspective. According to the official document of the meeting, developing actions in the area is an urgent need. The Network of Risk Management and Disaster Mitigation is currently part of the South American Health Council.

PPT of Health Council in ISAGS Peruvian Health Ministry and Pro Tempore President (PPT) of the South American Health Council (CSS) Midori de Habich visited on April 25th the headquarters of ISAGS in Rio de Janeiro.

During the meeting, the Minister highlighted the need to advance in UNASUR institutionalization and the importance of regional policies in the human resources area – mainly on the formation of professionals and the establishment of career plans – and the universal access to medicines.

Executive Director of ISAGS José Gomes Temporão, who hosted the Minister, stated that “it is ISAGS’ mission to strengthen the bloc through its regional actions”. In its tour in Brazil, Midori de Habich also visited the Health Ministry in Brasilia and Fiocruz and INCA in Rio.

Check the coverage of the Opening Conference of the Workshop on “Critical Aspects of the Social Determinants of Health”

by Dr. Romulo Paes de Sousa at bit.ly/TallerIsagsDSS ISAGS Director José Gomes Temporão and Midori de Habich

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“The reserves of natural resources are a strength in South America”, says researcher UNASUR General Secretariat’s Adviser Monica Bruckmann speaks about the new Research Group

Dra Monica Bruckmann, Unasur Adviser and Coordinator of the Research Group on Natural Resources

In an interview to the ISAGS Report, Dr. Monica Bruckmann speaks about the recently created UNASUR General Secretariat’s Research Group of Natural Resources, which will be under her coordination and will be located at ISAGS. She also spoke of a regional strategy on the subject and its relations with the health area. Peruvian sociologist and PhD in Political Science, Bruckmann is a professor and researcher at the Federal University of Rio de Janeiro (UFRJ). She is currently an advisor at UNASUR. She will be one of the lecturers at the South American Conference on Natural Resources and Integral Development of the Region that will take place in Venezuela from May 27th to 30th.

established the Research Group that is beginning its works in Rio de Janeiro. The idea, however, is to start up a regional coordination with research institutions in the areas of natural resources, scientific and technologic innovation, biodiversity and environment. And this research team is settling at ISAGS. Another command fo the Presidents of Unasur was the organization of the South American Conference on Natural Resources and Integral Development of the Region that will take place in Caracas (Venezuela) from the 27th to the 30th of May.

UNASUR established recently, by determination of its Council of Heads of State, a Research Group on Natural Resources.

What is the goal?

The General Secretariat has been working in a strategy for the utilization of natural resources towards the promotion of the regional development that overcome the extractive phase.

There is an urgent necessity and an awareness that it is necessary to diminish the environmental impact and to add value to the natural resources, which includes industrialization and scientific and technological development to support this process.

The general lines of this strategy were defined in a document presented by the General Secretary to the Council of Heads of State and Government in november 2012. The proposal was widely welcomed and carrying out a study on the strategic natural resources of South America was commanded.

Because of this, the General Secretariat

“Universalizing health is one of the most important issues in UNASUR” What strategies have been developed in this sense by UNASUR? Our region has been historically an exporter of raw materials with no added value. What we see in the beginning of the century is that the region remains in this position. According to the Economic Comission for the Latin America - CEPAL’s data, from 1995 to 2008 raw materials without added value went from 38% to almost 70% of total exports of Latin America to China. It indicates a process of reprimarization of exports when the region would have full condition to add value.

Then, the starting point is to identify the strengths of South America and the dimension of its reserves of strategic mineral resources. The region

ISAGS-UNASUL Executive Director: José Gomes Temporão Head of Office: Mariana Faria Coordinator: Henri Jouval INFORMATION AND KNOWLEDGE MANAGEMENT Coordinator: Camilla Ibiapina ISAGS Report Editor: Amaro Grassi Team: Flávia Bueno, Manoel Giffoni and Mariana Moreno

has almost 96% of the lithium reserves, 98% of niobium, 46% of copper, important reserves of zinc, bauxite and fossil mineral like gas and oil.

It owns the biggest concentration of biodiversity and almost 30% of the fresh water reservoirs of the planet, not to mention its potential for clean energy production, not only hydroelectric, but also geothermic, wind and photovoltaic.

In this sense, the Unasur General Secretariat took to the Council of Heads of State a proposal of strategic courses of action to leveraging natural resources. These include four strategic axes: economic management, to foster value adding and industrialization; scientific-technologic management towards innovations applied to industrialization and diminishing of environmental impact during the extraction; environmental management that incorporates the necessity of environmental preservation; and social management.

Which relations can be drawn between the areas of natural resources and health? And which policies can be developed to articulate these two dimensions?

I have the impression that the debate about the strategic dimension of the natural resources is in its beggining at the Sectoral Councils of Unasur.

Despite of being a new theme on the political agenda, it is becoming more dense. On health, in particular, the researches in biotechnology open huge possibilities of immediate application. One of the aspects that we discussed recently here in ISAGS is the possibility of creating a research project in this area, with the participation of institutions and researchers of all the region.

We have a huge collection of medicinal plants that are used by the traditional medicine, a big concentration of biodiversity, natural gene banks as in Galapagos (Ecuador), among other potencialities for the development of this field. As to the area of biotechnology, it doesn’t mean only to bring us closer to top-notch scientific production, but also the possibility of applying this knowledge in the production of medicines oriented towards universalizing health access.

This is one of the fundamental elements that concern ISAGS, but also the Health Council. The production of medicines also provides financial returns on investment to the financing of research.

It has a great social potential. Universalizing health is one of the most important issues in UNASUR and of any democratization process in the continent.

SCHEDULE • 20-28/05 - 66th World Health Assembly • 20/05 - Meeting of UNASUR Health Council • 29-30/05 - Meeting of the High-Level Panel on the Post-2015 Development Agenda • 05-08/06 - National Conference for the Revolution on Free and Public Health in Bolivia

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.

Contact: comunicacao@isags-unasur.org Phone: +55 21 2215 1858

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