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PERMANENT COUNCIL OF THE ORGANIZATION OF AMERICAN STATES
SPECIAL COMMITTEE ON INTER-AMERICAN SUMMITS MANAGEMENT

OEA/Ser.G  CE/GCI-11/95
29 September 1995
Original: English

REPORT OF THE PAN AMERICAN HEALTH ORGANIZATION TO THE SPECIAL COMMITTEE ON INTER-AMERICAN SUMMITS MANAGEMENT


PAN AMERICAN HEALTH ORGANIZATION
Pan American Sanitary Bureau, Regional Office of the
WORLD HEALTH ORGANIZATION
525 TWENTY-THIRD STREET, N.W., WASHINGTON, D.C. 20037, USA

8 September 1995

Ambassador Harriet C. Babbitt
U.S. Mission to the Organization of American States
ARA/USOAS, Room 6494
Department of State
2201 C. Street NW
Washington, D.C. 20520

Dear Ambassador Babbitt:

Thank you for your letter dated 25 August. 1995, requesting the Pan American Health Organization (PAHO) to report on the progress being made in implementing the Summit of the Americas initiatives. Enclosed please find a copy of a document prepared for the 116th Meeting of PAHO's Executive Committee, held last June, on "Implications of the Summit of the Americas for the Pan American Health Organization", which provides detailed information on our follow-up activities.

In addition, PAHO is coordinating and/or participating in the following activities:

The Conference on Health Sector Reform cosponsored by the Inter-American Development Bank (IDB) and the World Bank (IBRD), and with the participation of ECLAC, OAS, UNFPA, UNICEF, and USAID will be held at PAHO Headquarters in Washington D.C., on 29-30 September 1995. This Conference will focus primarily on health cam financing and organization of health services.

The Pan American Conference on Health and Environment in Sustainable Human Development cosponsored by IDB, IBRD, OAS, UNDP, and UNEP, which will take place in Washington D.C., on 1-3 October 1995 and constitutes another step in the continuous effort to promote the health-environment agenda in the Americas.

Our Organization was also represented in the Technical Preparatory meeting for the First ladies' Conference that will be held in Paraguay next October. PAHO will introduce the health related agenda items, including measles elimination, reduction of maternal mortality and violence against women. PAHO is providing support in the process and will continue supporting the countries in the follow-up of these initiatives.

In addition, in the context of UNAIDS, PAHO has prepared a Regional Plan of Action for AIDS control, which is being discussed with other regional and United Nations agencies.

I trust that you will find this information helpful.

Sincerely yours,

George A.0. Alleyne
Director
Encl.


Executive committee of the directing council
PAN AMERICAN HEALTH ORGANIZATION

Working party of the regional committee
WORLD HEALTH ORGANIZATION

116th Meeting
Washington, D.C.
June 1995
Provisional Agenda Item 4.4 CEI 16/11 (Eng.)
2 May 1995

ORIGINAL: ENGLISH

IMPLICATIONS OF THE SUMMIT OF THE AMERICAS FOR THE PAN AMERICAN HEALTH ORGANIZATION

The objective of this paper is to inform the Members of the Executive Committee on the Summit of the Americas that took place in Miami on 9-11 December 1994 and its implications for PAHO, in terms of specific follow-up actions. The Summit brought together leaders from 34 countries of the Western Hemisphere. Worldng sessions were conducted on Economic Integration and Trade Liberalization, on Assuring Sustainable Development, and on Strengthening Democratic Institutions. In addition to the discussions of the Heads of State, the First Ladies convened a Symposium on the Children of the Americas on 10 December.

The preparation of the Summit required extensive consultations at the technical and political levels. PAHO had a very active role in the inclusion of health and environmental protection in the Summit's Plan of Action, under the theme "Ensuring Sustainable Development."

This document was presented to, and incorporates the comments of, the 24th Meeting of the Subcommittee on Planning and Programming. It is presented to the Executive Committee to allow it to analyze the implications of the Summit for PAHO and to offer its views on the follow-up actions proposed by the Organization.

CONTENTS

Executive Summary
1. Background
2. Preparatory Activities
3. Summit Outcomes
4. Summit Follow-up
5. Governmental Follow-up Activities
6. PAHO Follow-up Activities
6.1. Environment
6.2. Health Sector Reftyrrn
6.3. Acquired Immunodefitiency Syndrome (AIDS)
6.4. Children
6.5. Other Matters

EXECUTIVE SUMMARY

The Summit of the Americas took place in Miami on 9-11 December 1994. It brought together leaders from 34 countries of the Western Hemisphere. In addition to the discussions of the Heads of State, a Symposium on the Children of the Americas was convened by the First Ladies.

The Summit covered a wide range of themes which were distilled into a declaration of principles: Partnership for Development and Prosperity: Democracy, Free Trade, and Sustainable Development in the Americas, and a Plan of Action.

PAHO is undertaking several follow-up activities, in conjunction with the governments, the Economic Commission for Latin America and the Caribbean (ECLAQ, the Inter-American Development Bank (IDB), the Organization of American States (OAS), the World Bank, and other parties.

Health Sector Reform. A conference of ministers of health and finance on health reform mechanisms will be convened on 29-30 September 1995. The conference will review several aspects of the reform process, such as mechanisms, finances, and the definition of the role of PAHO in the monitoring process.

Environment. PAHO, with the U.S. Environmental Protection Agency (EPA) and other governmental, international, and nongovernmental organizations, will implement portions of the "Partnership for Pollution Prevention." Actions include:

-- Development of two projects, to phase out lead from gasoline and to promote safe use of pesticides. PAHO will work with the IDB to seek seed-funding for these initiatives.

-- Preparations for the Pan American Conference on Health and the Environment in Sustainable Human Development, in Washington D.C., on 1-3 October 1995.

-- Participation in and sponsorship of two conferences on lead contamination in Mexico and the United States of America in 1995.

Acquired Immunodeficiency Syndrome (AIDS). A regional plan of action for AIDS control. has been prepared and will be presented to the 116th Meeting of the Executive Committee in June 1995.

Children. PAHO will be the lead agency of the health task force, preparing the plans for measles elimination and maternal mortality reduction. On 7 April 1995, on the occasion of World Health Day, the First Lady of the United States of America, Mrs. Hillary Rodham. Clinton, launched the Measles Elimination Program at PAHO and committed US$ 8 million from the U.S. Agency for International Development (AID) for its implementation. Progress will be reported to the Summit of First Ladies to be held in Paraguay in October 1995.

1. Background

The Summit of the Americas 1994, a starting point for inter-American relations in the XXI century, was convened by President Bill Clinton of the United States of America in Miami on 9-11 December 1994. It was the first inter-American meeting of Heads of State since they met in Punta Del Este in 1963.

The Summit brought together the leaders of 34 countries of the Western Hemisphere. Working sessions were conducted on Economic Integration and Trade Liberalization, on Assuring Sustainable Development, and on Strengthening Democratic Institutions. In addition to the discussions of the Heads of State, the First Ladies convened a Symposium on the Children of the Americas on 10 December.

PAHO was represented at the Summit by Dr. Carlyle Guerra de Macedo, Dr. George A. 0. Alleyne, and Dr. Irene Klinger. Dr. Alleyne was the keynote speaker at the Symposium on the Children of the Americas, where he made a presentation on "The Development of Our Children: The Health and Education Dimension."

2. Preparatory Activities

Preparations for the Summit involved extensive consultations at the technical as well as the political levels, and an extensive process of exchanges took place on each resolution. PAHO had a very active role in the promotion of health as a featured subject under the theme of "Ensuring Sustainable Development. " The general areas of health were discussed mainly with the U.S. Agency for International Development (AID) and environmental matters with the U.S. Environmental Protection Agency (EPA).

3. Summit Outcomes

The Summit covered a wide range of themes which were distilled into a declaration of principles: Partnership for Development and Prosperity: Democracy, Free Trade, and Sustainable Development in the Americas, and a Plan of Action. The document sets out the goals of the Summit, and the Plan of Action spells out the concrete activities to be undertaken with that purpose. Explicitly mentioned is the expected role of the inter-American organizations, particularly the Economic Commission for Latin America and the Caribbean (ECLAQ, the Inter-American Development Bank (IDB), the Pan American Health Organization (PAHO), and the Organization of American States (OAS).

The Declaration and the Plan are organized along four aspects of the Summit:

-- Preserving and strengthening the community of democracies of the Americas.
-- Promoting prosperity through economic integration and free trade.
-- Eradicating poverty and discrimination in our Hemisphere.
-- Guaranteeing sustainable development and conserving our natural environment for future generations.

The health sector was specifically addressed in these documents, in the context of the sustainable development concern.

In the declaration of principles, the countries were called upon to continue a strong political involvement in, inter alia, sustainable development and health, by convening meetings, of ministerialand senior-level officials in these areas. PAHO is expected to, contribute its expertise to facilitate the follow-up actions.

The Plan of Action is very specific. In terms of equitable access to basic health services, it states that governments will:

-- Endorse the maternal and child health objectives of the 1990 World Summit for Children, the 1994 Narino Accord, and the 1994 International Conference on Population and Development, and reaffirm their commitment to reduce child mortality by one-third and maternal mortality by one-half from 1990 levels by the year 2000.

-- Endorse a basic package of clinical, preventive, and public health services consistent with World Health Organization, Pan American Health Organization, and World Bank recommendations and with the Program of Action agreed to at the 1994 International Conference on Population and Development. The package will address child, maternal, and reproductive health interventions, including prenatal, delivery, and postnatal care, family planning information and services, and HIV/AIDS prevention, as well as immunizations and programs combating the other major causes of infant mortality. The plans and programs will be developed according to a mechanism to be decided upon by each country.

-- Develop or update country action plans or programs for reforms to achieve child, maternal, and reproductive health goals and ensure universal, nondiscriminatory access to basic services, including health education. and preventive health, care programs. The plans and programs will be developed according to a mechanism to be decided upon by each country. Reforms would encompass essential community-based services for the poor, the disabled, and indigenous groups; stronger public health infrastructure; alternative means of financing, managing and providing services; quality assurance; and greater use of nongovernmental actors and organizations.

-- Strengthen the existing Inter-American Network on Health Economics and Financing, which serves as an international forum for sharing technical expertise, information, and experience, to focus on health reform efforts. The network gathers government officials, representatives of the private sector, nongovernmental institutions and actors, donors, and scholars for policy discussions, analysis, training, and other activities to advance reform; strengthens national capabilities in this critical area; and fosters Hemisphere-wide cooperation.

-- Convene a special meeting of hemispheric governments with interested donors and international technical agencies to be hosted by the IDB, the World Bank, and PAHO to establish the framework for health reform mechanisms, to define PAHO's role -in monitoring the regional implementation of country plans and programs, and to plan strengthening of the network, including the cosponsors' contributions to it.

--Take the opportunity of the annual PAHO Directing Council Meeting of Western Hemisphere Ministers of Health, with participation of the IDB and donors, to develop a program to combat endemic and communicable diseases, as well as a program to prevent the spread of HIV/AIDS, and to identify sources of funding.

-- Urge the March 1995 World Summit for Social Development and the September 1995 Fourth World Conference on Women to address the issue of access to health services.

With regard to environmental protection, the Plan of Action requires governmentsto:

-- Strengthen and build technical and institutional capacity to address environmental priorities, such as pesticides, lead contamination, pollution prevention, risk reduction, waste and sanitation issues, improved water and air quality, access to safe drinking water, and urban environmental problems, and to promote public participation and awareness.

-- Develop and implement national action plans to phase out lead in gasoline.

-- Strengthen national environmental protection frameworks and mechanisms for implementation and enforcement, and include sustainability criteria and objectives in national and other development strategies.

-- Undertake national consultations to identify priorities for possible international collaboration.

-- Support democratic governmental mechanisms to engage public participation, particularly from members of indigenous and other affected communities, in the consideration of policies regarding the environmental impact of development projects and the design and enforcement of environmental laws.

-- Convene a meeting of technical experts, designated by each interested country, to develop a framework for cooperative partnership, building on existing institutions and networks to identify priority projects. These projects will initially focus on (a) the health and environmental problems associated with the misuse of pesticides, and (b) the impacts of lead contamination from gasoline and other sources. Subsequent activities could address waste, air, water quality, marine pollution from ships and other sources, and problems associated with urbanization.

-- Promote the participation of organizations, such as the IDB, the Multilateral Investment Fund '(MIF), the World Bank, -PAHO, the OAS, and nongovernmental actors and organizations, as appropriate, to finance, develop, and implement priority projects.

-- Develop environmental policies and laws with the goal of ensuring that economic integration of the Region occurs in an environmentally sustainable manner.

-- Establish mechanisms for cooperation among government agencies, including the legal and enforcement areas, to facilitate environmental information exchange, technology cooperation, and capacity-building.

-- Develop compatible environmental laws and regulations at high levels of environmental protection and promote the implementation of international environmental agreements.

-- Discuss progress on implementation of the international and national activities described above at the 1996 Summit Conference on Sustainable Development in Bolivia and at subsequent annual sustainable development ministerials.

On the occasion of the Summit, PAHO signed an agreement on cooperative activities with the EPA as part of the environmental agenda of the Summit. The memorandum "recognize[s] the importance of environmental protection to the health and well-being of present and future generations of the Western Hemisphere," and the two organizations declared that they wish to share and exchange expertise, knowledge, and resources to promote technical cooperation on environmental and health issues.

Concurrent with the Summit of Heads of State, Mrs. Hillary Rodham Clinton hosted a Symposium on the Children of the Americas for the First Ladies. Mrs. Clinton chose this opportunity to discuss progress made in the Region on health and education issues and on ways to contribute to the health and education initiatives of the Summit.

With regard to the issues and responsibilities related to the health of children identified by the First Ladies, their influence in placing health high on the development agenda was acknowledged. Areas such as elimination of measles, immunizations, health of the indigenous populations, and reduction of maternal mortality were identified as needing to be tackled throughout the entire continent.

4. Summit Follow-up

The Plan recognizes that the primary responsibility for its implementation lies with the governments and civil societies of the countries. At the same time, existing organizations are called upon to implement the package of initiatives as appropriate.

The public and private sectors are expected to collaborate in a number of initiatives. Those relevant to health are "Equitable Access to Basic Health Services" and "Partnership for Pollution Prevention," as well as a follow-up on the Symposium on the Children of the Americas. Health issues are also included in other joint private and public sector activities, such as drug traffic prevention, strengthening democracy, and invigorating society and conununity participation.

5. Govermnental Follow-up Activities

The following international meetings related to health that will require preparation and consultations have been identified:

-- meeting between governments, donors, and technical agencies to establish health reform mechanisms (United States of America, September 1995); meeting of First Ladies (Paraguay, October 1995);

-- Pan American Conference on Health and the Environment in Sustainable Human Development (United States of America, October 1995);

-- Summit Conference on Sustainable Development (Bolivia, 1996), second meeting of Heads of States of the Americas with annual follow-up. It should be recalled that governments are committed to:

-- endorse the maternal and child health objectives of the 1990 World Summit for Children, the 1994 Nariflo Accord, and the 1994 International Conference on Population and Development; endorse a basic package of health services;

-- develop and update country action plans or programs for reforms to achieve child, maternal, and reproductive health goals and ensure universal, nondiscriminatory access to basic health services; strengthen the existing Inter-American Network on Health Economics and Financing;

-- convene a special meeting of hemispheric governments with interested donors and international agencies to establish the framework for health reform mechanisms;

-- develop a program to combat endemic and communicable diseases, as well as a program to prevent the spread of HIV/AIDS;

-- urge the Fourth World Conference on Women in September 1995 to address the issue of access to health services.

6. PAHO Follow-up Activities

In preparation for its contribution,, and as a. follow-up, PAHO is undertaking several activities, internally and in consultation at the senior level with AID, the IDB, the World Bank, and other inter-American institutions such as ECLAC and the OAS.

6.1. Environment

PAHO will continue to collaborate with the EPA and other government, nongovernmental, and international organizations to implement portions of the Partnership for Pollution Prevention, as outlined in the Plan of Action., This will include development of two projects, one to phase out lead from gasoline and another to promote safe use of pesticides. Both these projects involve several countries. PAHO will work with the IDB to seek seed-funding for these initiatives.

Preparations for the Pan American Conference on Health and the Environment in Sustainable Human Development, with the cosponsorship of the World Bank and possible cosponsorship of the IDB, are under way. The Conference is planned to take place in Washington, D.C., on 1-3 October 1995 and constitutes another step in a continuous process to enhance the health-environment agenda in the Americas.

PAHO is a participant in two conferences on lead contamination, one held in Washington, D.C., in March 1995, and another to take place in Mexico in May 1995. PAHO sponsored portions of the U.S. conference, in partnership with EPA.

As a result of the Memorandum of Understanding signed between PAHO and EPA at the Summit, EPA seconded two employees to PAHO for collaboration on health and environment projects in the areas of air quality and envirom-nental health information.

6.2. Health Sector Reform

The Conference on Health Sector Reform will be held at PAHO Headquarters in Washington, D.C., on 29-30 September 1995. The Conference will focus primarily on health care financing and organization of health services. It will review:

-- the Regional Framework for Sectoral Reform Mechanisms;
-- strengthening of the Health Economics and Financing Network;
-- the role of PAHO in monitoring the reform process.

A task force was put together for this purpose, with representation from the IDB, PAHO, and the World Bank, into which AID, ECLAC, the OAS, UNICEF, and UNFPA were later incorporated. An interagency retreat is planned for May 1995 to review papers, and a preparatory meeting will be held at the end of June with the participation of several ministers of health attending PAHO's Executive Conunittee Meeting. The objectives of the conference will be presented at several regional meetings of health ministers that will take place before the conference. The PAHO Governing Bodies will have the opportunity to review the papers before they are issued. PAHO has also been requested to present this information at a conference on the subject to beheld by the European Office of WHO.

6.3. Acquired Immunodeficiency Syndrome (AIDS)

The Pan American Health Organization, in the context of the new Joint United Nations Program on AIDS (UNAIDS), has prepared a regional plan of action for AIDS control, to be discussed with other regional and UN agencies as well as with the multilateral banks and bilateral cooperation agencies. The plan and the promotional efforts that will be carried out in the next few months to support the countries in their efforts to prevent and control AIDS are being presented to PAHO's Executive Committee in the context of the updating of AIDS activities.

6.4. Children

PAHO, together with AID and the Office of the First Lady of the United States of America, has devised an agenda of concrete activities leading up to the Paraguay Meeting of First Ladies in October 1995. PAHO will be the lead agency of the health task force organized to prepare the plans for the measles elimination and the maternal mortality reduction programs.

Progress in these two areas is as follows:

Measles Elimination. The First Lady of the United States of America participated in the launching of this initiative at PAHO on the occasion of World Health Day, 7 April 1995. Local activities were organized with the First Ladies of the PAHO Member States in conjunction with this. A plan was devised and funding is been sought.

Reduction of Maternal Mortality. Based on the reviews of the Regional Plan adopted by PAHO in 1990 and reviewed in 1992, a number of activities are being prepared to be evaluated at the meeting of First Ladies in Asunci6n, Paraguay, in October. The technical committee met in Atlanta at the end of April, and specific plans for high-risk countries are being developed. A regional project could result from this effort, funding for which might be requested from the international community.

6.5. Other Matters

PAHO has participated in several meetings on overall follow-up to the Summit. It is considering participation in the relevant sections on health in a forum on integration through international trade (i.e., technology and health services), an environmentally friendly infrastructure, and tourism.


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