PAHO presented the Regional Vaccine Initiative, which addresses the need of countries in the Americas to:

• accelerate the process of vaccine introduction by means of promoting inter-institutional and inter-country agreements for vaccine research and development and production;
• develop and/or strengthen national capabilities to conduct epidemiological surveillance of vaccine-preventable diseases at the central and local levels;
• Stimulate inter-country collaboration to improve laboratory confirmation of vaccine-preventable diseases.
• Establish a network of communication to disseminate technical information on vaccines and immunization.

In support of the II Summit Declaration, PAHO’s ongoing work in the area of vaccine and immunization has involved developing closer ties at the political level to keep immunization and self-sufficiency in vaccines used in national programs high on the agenda. PAHO is working with the First Ladies of the Americas on the goal to eradicate measles from the Americas by the year 2000; with the countries’ legislative branch, to establish laws that ensure national financing of recurrent cost of vaccines and other inputs; with the private sector, to ensure their insertion into immunization and surveillance activities; and, at the local level, with municipal governments to guarantee the implementation of immunization programs. Emphasis has also been placed on developing a network of communication that encourages the use of immunization data to make decisions at the technical and policy levels.

In the areas of vaccines, emphasis has been on initiating and/or assisting in the implementation of priority inter-institutional and inter-country projects and in the harmonization of quality control methodologies in the Americas. Meetings with National Control Authorities have reviewed sub-regional initiatives to adopt the four functions recommended by the World Health Organization for non-producing countries, to assure the quality of vaccines used in immunization programs. These are: licensing, lot release, post marketing surveillance and access to National Quality Control Laboratories. At the meeting in Costa Rica a plan was elaborated to facilitate the adoption of the four functions. In Panama, a proposal was developed that harmonizes the requirements for vaccine licensing in Central America and the Dominican Republic, and a course program was presented on vaccine licensing and documentation analysis. PAHO also assisted countries in developing a data bank of licensing lot release, quality control testing and post marketing surveillance of all vaccines used in the sub-region.

Meetings held:

• First Meeting of National Control Authorities for Vaccine Quality, Costa Rica, 9-10 March, in Costa Rica.
• The Second Meeting of the National Control Authorities of Vaccine Quality in Central America and the Dominican Republic was held October 1-2 in Panama.
• First Meeting of the Incorporation of the Private Medical Sector in National Immunization Programs, August 19-20, Honduras.
• Panel on Measles Eradication, 8^th Conference of Wives of Heads of States and Government, September 28-30, Chile.
• EPI Meeting of the Southern Cone, April 28-30, Montevideo.
• 12^th EPI Meeting of Central America, Mexico, Cuba and the Dominican Republic, May 27-29.
• 8^th EPI Meeting of the Andean Region, May 11-13.

• Follow-up Meeting on Measles Eradication in the Southern Cone Second, November 16-18.
• 15^th EPI Caribbean Meeting, December 16-18.
• Meeting on Conjugated Vaccines, 5-6 November, Uruguay

During a meeting scheduled early November, representatives from the vaccine-producing countries of Mexico, Argentina, Chile, Brazil, and Cuba will elaborate a strategy for regional technical cooperation toward the development of conjugated vaccines. Countries will provide an update on the progress achieved in this area and establish specific areas of collaboration among each other. Areas of common interest are: selection and distribution of polysaccharide producing strain culture media and purification methods

PAHO has placed high priority on developing and/or improving national surveillance capabilities of vaccine-preventable diseases, in terms of technical know-how, logistics, training and management. This has become particularly critical given the ongoing process of health reform and decentralization. On one hand, PAHO is seeking to strengthen the new regulatory role of the central government on immunization, on the other, it is collaborating in building technical and managerial capabilities to carry out immunization and surveillance activities at the local level, as well as forming partnerships with the private medical sector. At the same time, PAHO is addressing the need to have uniform and quality laboratory tests and results of vaccine-preventable diseases, and it is offering technical and managerial advice on how to build a surveillance, laboratory and logistical infrastructure to accommodate the introduction of new vaccines of public health importance.

Obstacles

• Major obstacles include ensuring the sustainability of immunization programs, in terms of the basic vaccines already being used as part of the Expanded Program on Immunization, and those being introduced to national immunization schedules, such as Haemophilus influenza type b (HIB) or measles, mumps and rubella (MMR). Countries still need to prioritize the establishment and/or strengthening of epidemiological surveillance systems for vaccine-preventable diseases.

• With decentralization, countries need to clarify and strengthen the roles of the local and central levels, in order to maintain immunization and regional immunization goals a priority. This will include expanding the partnership with other actors and with other sectors within the government in the areas of surveillance, and information dissemination on the importance of vaccination to prevent diseases.

A plan will be presented to the Summit of Presidents of Central America on November 18, for the joint purchase of drugs. To this purpose a Joint Central American Negotiation Commission will be created which will be responsible for the joint drug negotiations, its follow up, and evaluation.

• Strengthen and make flexible the legal framework of respective countries in order that the Central American Commission can conduct negotiations on behalf of the states that it represents.
• Promote the mechanisms that make it possible to facilitate the payment to the suppliers, so that the terms agreed upon can be respected for the cancellation of the invoices.
• Offer political, financial, and administrative support to the Commission.

1. Summary of Recommendations from the Summit

Areas of Action:

1. Strengthen and improve existing national and regional networks of health information and surveillance systems, so that stakeholders have access to data to address critical health issues in order to support appropriate clinical and managerial decisions.
2. Development, implementation, and evaluation of needs-based health information systems and technology (IS&T)
3. IS&T, including telecommunications, to support: epidemiological surveillance, operation and management of health services and programs, health education and promotion, telemedicine, computer networks, and investment in new technologies.

a. The Presidential Declaration made clear that all countries of the Americas have a common stake in improving access to and delivery of healthcare through communications and information technology.

b. Efforts involving the Pan American Health Organization and other stakeholders in fulfilling that mandate will necessarily concentrate on the public sector but must involve the private sector to result in a significant impact on the health of individuals and communities.

c. Joint investment and development involving users, governments, academic and financing institutions and agencies, technical cooperation agencies, and industry interests are seen as necessary, and projects have been started with the participation of the two major financing institutions in the Region, the Inter American Development Bank and the World Bank.

d. Partnerships with the informatics industry are absolutely fundamental and, in the case of general informatics tools, the industry practically drives the solutions. A concerted effort is needed to secure a clearly defined and specified partnership with the informatics industry at the global and national levels aimed at application development at acceptable cost.

e. Transfer of knowledge, technical support, facilitation of the exchange of experiences between countries, and fostering the use of appropriate technology and knowledge assets.

f. Promote bilateral and multilateral collaboration. The Inter-American Development Bank, the World Bank, and other financial and technical cooperation institutions will support the programs and activities.

3. Collaborative Work realized with the Inter-American Development Bank

1. PAHO and the IADB Health Component of the Informatics 2000 Initiative

A set of recommendations regarding strategies, priorities, and areas for immediate action emerged from the Expert Consultation Meeting on Telecommunications in Health and Healthcare, held in November 1996 in Washington, and from five technical meetings of the Informatics 2000 Health Task Force, held during the year of 1997 and 1998 in Miami, Mexico City, Washington, Santiago, and Washington organized in collaboration with PAHO. The recommendations reflect the experience of over 300 professionals of the Region. They were reiterated at the Sector Leaders Roundtable and at the Fourth Health Task Force Session, held on April 17^th, in Santiago, Chile, on the occasion of the Second Presidential Summit of the Americas. This consultative group, known as the Regional Health Informatics Initiative, is coordinated by the IADB and technical orientation of PAHO.

4. Follow-up Meetings / Conducted and Planned

Conducted

• July 2, 1998:  Fifth Meeting of the Health Task Force Group Washington, D.C.

Planned

• December 1998:  Sixth Meeting of the Health Task Force Group

• First Quarter 1999:  Functional Specifications for Health Services Information Systems 

1. Antecedentes

La inquietud por el uso de tecnologías apropiadas en la provisión de servicios de saneamiento básico existe en los países de la Región desde hace bastante tiempo. Universidades, ONGs, empresas prestadoras de servicios de saneamiento básico, centros de investigación y la propia OPS a través de su División de Salud y Ambiente, de sus Representaciones y del Centro Panamericano de Ingeniería Sanitaria y Ciencias del Ambiente (CEPIS), vienen desarrollando trabajos en ese sentido. Así, por ejemplo, en este momento en el CEPIS se está desarrollando un estudio para el uso de sistemas de desinfección del agua y alimentos a nivel domiciliario, que a muy bajo costo daría condiciones para que las poblaciones que carecen de servicios de agua potable o donde estos funcionan intermitentemente, puedan desinfectar en sus propios domicilios el agua de bebida y los alimentos de consumo crudo, y, asimismo, se ha creado una unidad especializada que con el apoyo de la Cooperación Suiza realiza proyectos experimentales de saneamiento básico para las poblaciones rurales y urbano marginales, a través de los cuales se promueve el uso de tecnologías adecuadas. En este mismo sentido, la Representación de la OPS en Bolivia, a través de su Proyecto Tecnológico en Saneamiento Ambiental, PROTESA, está impulsando la utilización de la bomba manual flexi-OPS y de otras tecnologías simplificadas en las poblaciones de las áreas rurales; y la Representación de la OPS en Nicaragua ha desarrollado un filtro casero para agua de bebida. En todos estos trabajos, la tecnología se ve como uno de los medios de conseguir la sustentabilidad de las soluciones, y con ese mismo propósito, en varios casos, se busca agregarlos a actividades que permitan mejorar los ingresos de las poblaciones.

2. Estrategia adoptada

Con el propósito de maximizar los esfuerzos que se vienen llevando a cabo en la Región para adoptar el uso de tecnologías adecuadas en la provisión de servicios de saneamiento básico, y facilitar de esa forma el acceso a esos servicios por parte de las poblaciones más desfavorecidas de los países, se adoptó como estrategia principal el establecimiento de un programa regional para la promoción del uso de tecnologías adecuadas en saneamiento básico.

Ese programa buscaría integrar en una red, desde el CEPIS, a las instituciones de los países de la Región que vienen trabajando en el campo en referencia, de forma que puedan con facilidad identificarse las tecnologías adecuadas existentes y las que vayan siendo desarrolladas, evaluarse, normalizarse y divulgarse a través de los medios más adecuados. La divulgación incluiría la preparación de guías, que gradualmente integrarían un vademecum de las tecnologías de éxito comprobado, que, además de dar todo su detalle técnico, indicarían en cada caso las condiciones que requieren para su uso, sus costos y toda información que facilitase su utilización. Esa divulgación se haría básicamente a través de la Red Panamericana de Información en Salud Ambiental, REPIDISCA.

La divulgación se haría también a través de acciones de capacitación, en las que se buscaría que el uso de tecnologías adecuadas se incorporase, en los niveles que corresponda, a los sistemas educativos de los países de la Región, en lo posible, mediante cursos a distancia. El programa prepararía material didáctico y propondría esquemas para la formación de personal especializado en la escala requerida.

El programa, por último, haría una evaluación permanente de la evolución de la situación sanitaria de las áreas deprimidas de los países de la Región e identificaría aspectos en los que la investigación de aspectos tecnológicos fuera necesaria, y promovería e inclusive realizaría proyectos de investigación para atender esas necesidades.

3. Trabajos en Curso

El programa regional para la promoción del uso de tecnologías adecuadas en saneamiento básico, que se adoptó como estrategia principal para el cumplimiento de la Iniciativa 3 del Plan de Acción de la Cumbre de Santiago, ya ha sido formulado y se ha dado inicio a su ejecución, utilizando los recursos disponibles en la Organización y los que se pueden conseguir en alianzas con otras instituciones.

Así, se están dando los primeros pasos para la creación gradual, en torno al CEPIS, de la red de agencias e instituciones que estén utilizando tecnologías adecuadas, en la forma que plantea el programa en referencia. De esa forma esta vinculándose al PROTESA, de la Representación de la OPS en Bolivia, con el CEPIS. La experiencia que de este modo va a ganarse, permitirá la integración a la red de otras representaciones que tienen proyectos para el uso de tecnologías apropiadas en saneamiento básico.

Se ha comenzado, por otra parte, el proceso para la identificación, evaluación y preparación de guías de divulgación de las tecnologías de éxito reconocido, las que, poco a poco, integrarían el vademecum en que se aspira a reunirlas. Este trabajo esta realizándose de manera conjunta con el Programa de Agua y Saneamiento del Banco Mundial, y, nos está permitiendo, en una primera etapa, reunir experiencias de Bolivia, Perú y Ecuador. Se han identificado estas experiencias y se están preparando las guías correspondientes.

Finalmente, se está organizando una reunión regional, que se realizará el año próximo, en la que se examinarán las formas cómo se viene desarrollando en los países la tecnología apropiada en saneamiento básico, cómo se viene divulgando y su nivel de utilización, para a partir de ese examen, proponer medidas que permitan hacer más intenso el uso de la mencionada tecnología.

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