PERMANENT COUNCIL OF THE ORGANIZATION OF AMERICAN STATES SPECIAL COMMITTEE ON INTER-AMERICAN SUMMITS MANAGEMENT
INTER-AMERICAN CENTER FOR STUDIES ON SOCIAL SECURITY
P O BOX 99087, 10100 MEXICO CITY
My dear Mr. Ambassador:
This letter is in response to your communication relative to resolution AG/RES. 1349 (XXV-O/95) of the General Assembly of the Organization of American States, which entrusts the Permanent Council over which you preside with the responsibility of calling upon regional and subregional government agencies and institutions to lend their support in implementing the initiatives contained in the Plan of Action emanating from the Summit of the Americas.
Allow me to transmit herewith the report of activities carried out between February 1996 and February 1997 by the Pan American Network on Health Economics and Financing (REDEFS), of which this Center has had the honor to serve as Executive Secretariat since the Network began its operations in 1994.
In the hope that I have fulfilled your request, I reiterate to you the assurances of my highest consideration.
REPORT OF THE EXECUTIVE SECRETARIAT OF THE INTER-AMERICAN NETWORK ON
HEALTH ECONOMICS AND FINANCING
Health economics has been a specialization within the study of economics which provides the field of health with the theoretical and methodological bases for understanding the determinants of health, assigning them an economic value, and evaluating the response of organized society, as well as providing support for decisions in regard to the allocation and use of resources. The objective is to ensure the efficiency, quality, and equity of health programs and services.
Within the current context of sectoral reform and/or modernization, the Inter-American Network on Health Economics and Financing (REDEFS), through its program of activities, has continued to contribute toward decision-making in the selection of alternatives available for achieving the aims mentioned above.
It responds to the countries' need to adapt their health and social security systems to the new political, economic, and social realities arising from the globalization of economies and the pressing challenge to extend coverage to the entire population in the face of a crisis that reflects the high social cost of economic recession, the employment situation, and structural adjustment policies.
With this context in mind, the present report reviews the work undertaken by REDEFS between February 1996 and February 1997 to promote and strengthen the development of health economics in the areas of training, research, and information dissemination, among others.
1.1 Creation of REDEFS
The Inter-American Network on Health Economics and Financing (REDEFS) was created on March 16, 1994, in Buenos Aires, Argentina, with the signing of a cooperation agreement between the World Bank through its Economic Development Institute (EDI), the Pan American Health Organization, and the Inter-American Center for Social Security Studies (CIESS).
The mission of REDEFS is to promote and strengthen training, cooperation, and the exchange of information in the area of health economics and financing among specialists in the countries of the Americas who are concerned with this area.
Point 17 of the Plan of Action of the Summit of the Americas, held in Miami in 1994, recommends strengthening the Inter-American Network on Health Economics and Financing so that it can serve as an international forum for the sharing of technical knowledge, information, and experiences in the area of health system reform.
3. OBJECTIVE OF THE REPORT
This document reviews the work accomplished by the members of REDEFS during the period cited toward strengthening national capacity in the field of health economics and financing and fostering the exchange of experiences and information on the economic theories, methods, and instruments that have been enlisted to contribute to the health services reform process in countries both within and outside the Americas.
The Network currently includes a total of 16 national groups and associations in the field of health economics, plus individual members from the following countries: Argentina, Bolivia, Brazil, Canada, Chile, Colombia, Costa Rica, Cuba, the Dominican Republic, Ecuador, El Salvador, Guatemala, Honduras, Jamaica, Mexico, Nicaragua, Panama, Paraguay, Peru, Saint Lucia, Spain, Switzerland, Trinidad and Tobago, United Kingdom, United States of America, Uruguay, and Venezuela.
In 1994 the Network started out with fewer than 100 members; by the end of 1995 it had enrolled 257 professionals; and currently the number comes to a total of 636 members. This latest figure represents an increase of more than 100% over the year before and a growth of 400% compared with its first year of existence. It can therefore readily be said that during this period REDEFS was able to strengthen its structure, expand its outreach, and add to its capacity for concrete support action.
During the past year REDEFS maintained its proactive stance, as reflected in the organization and development of nine technical-level seminars for the strengthening of national groups, conducted in Brazil, Colombia, Uruguay, Trinidad and Tobago, Argentina, Bolivia, Ecuador, Peru, and Chile. In addition, it undertook two case studies, one in Ecuador on private health expenditure, and one in Trinidad and Tobago on the estimation and analysis of private corporate health expenditure. This training and exchange of experiences benefited a total of 904 participants, including upper- and mid-level officials, researchers, and teachers from various institutions in the region.
The tasks were approached through cognitive orientation and sensitization on topics relating to economics and health. In addition, efforts were directed toward training technical personnel who already had some background in the field but were in need of updating in order to serve as multipliers of this knowledge both in the services and in universities.
All these activities had the support of social security institutions, ministries of health, universities, research centers, and nongovernmental organizations and took into account the needs of the particular host countries.
The ever-larger number of participants in the courses served to bring together national experiences from a total of 24 countries: Argentina, Bolivia, Brazil, Canada, Chile, Colombia, Cuba, Ecuador, Guyana, Honduras, Italy, Jamaica, Mexico, Netherlands, Nicaragua, Paraguay, Peru, Spain, Switzerland, Trinidad and Tobago, United Kingdom, United States of America, Uruguay, and Venezuela.
Equally impressive was the representation by type of institution, which included social security institutes, ministries of health and finance, universities and centers of higher learning, private enterprises, and international agencies, among others.
An analysis according to the participants' area of work shows that they came from the fields of economics and finance, medical services, planning and administration, teaching, and research. They were mostly economists, physicians, and other professionals with related objectives.
· Teaching Staff and Consultants
The instructors and presenters in the various program activities warrant special mention. This phase of work benefited from contributions by specialists from the ministries of health and finance from various countries in the region; health economics groups and associations belonging to the Network; the universities of Chile, Bocconi (Italy), Limburg (Netherlands), Barcelona (Spain), and Javeriana and Antioquia (Colombia); and international organizations and agencies such as WHO, PAHO, the World Bank, CIESS, and the International Development Research Center of Canada, among others.
The growth in the number of professional members prompted the preparation of a directory of REDEFS members, which will be ready in final form by the end of the current month.
In addition, volumes continued to be collected for the Health Economics Reference Shelf, which currently has 155 books, publications, technical documents, and specialized journals, through which it has been possible to continue providing support for individuals interested in the different areas of health economics, as well as for the training programs.
In November 1996 the Executive Secretariat began to prepare a Web site for the Network, thus enlisting technological progress to promote the work of REDEFS members in an increasing larger audience.
5. THE STRENGTHS OF REDEFS
Strengthening and dissemination both within and outside the region: The results of the foregoing events have enhanced the prestige of REDEFS among institutions and individuals in the countries, as reflected in the steep rise in membership in 1996 in terms of both individuals and national groups.
The training needs in the Latin American countries in the field of health economics continued to be addressed.
It has been possible to achieve constant and increasingly in-depth levels of training. Seminars began to be offered for mid-level officials and technicians, and recently new courses have been added that offer training for trainers.
Experiences continued to be exchanged in this field with developed countries both in the region and elsewhere.
The Inter-American Network on Health Economics and Financing was able to continue the successful accomplishment of its programmed activities this year thanks to support from the World Bank, the Pan American Health Organization, the Inter-American Center for Social Security Studies, and the REDEFS member national groups.