Progress Report on the Implementation of Mandates Entrusted to the Pan-American Health Organization by the Second Summit of the Americas
(March 1, 1999)
As responsible coordinator, PAHO was given the mandate to develop and implement Health Technologies Linking the Americas. This initiative is comprised of three elements: access to quality drugs and vaccines, strengthening of information and surveillance systems, and, improvement in access to and quality of water and sanitation infrastructure. In addition it was determined that PAHO could play a supporting role in education, drugs, women and hunger and malnutrition.
1. Access to Quality Vaccines and Drugs
Governments will seek, through public and private efforts, or partnerships between them, to enhance the availability, access to, and quality of drugs and vaccines, especially for the most needy, by promoting efforts to safeguard the quality, rational selection and use, safety and efficacy of pharmaceutical products, with special emphasis on vital and essential drugs; and by supporting regional initiatives that by the year 2002 will facilitate research, development, production and utilization of vaccines, which will reduce the incidence of diseases, such as pneumonia, meningitis, measles, rubella and mumps
Immunization
PAHO developed a Regional Vaccine Initiative to support countries in building national capabilities to conduct epidemiological surveillance and deliver immunization programs; ensure the sustainable introduction of vaccines into routine programs; and to foster vaccine development activities that will allow countries to participate and incorporate new technologies of production for vaccines against diseases of public health importance. This initiative calls for countries in the Americas to:
Priorities/Actions
Ensure the successful completion of measles eradication by the year 2000, through strengthening of measles surveillance and guaranteeing the availability of adequate stocks of measles vaccines for routine and emergency immunization activities: PAHO is focusing on selected countries that are at high-risk for measles outbreaks. These include Argentina, Bolivia, Brazil, Colombia, Dominican Republic, Ecuador, Guatemala, Haiti, Mexico, Paraguay, Peru and Venezuela. Brazil has endorsed an emergency plan for measles eradication prepared by PAHO, which will be implemented early 1999.
Support Member Countries in reaching the entire population with immunization programs: PAHO is increasing its efforts to monitor vaccination coverage in every area of a country.
Ensure the sustainable implementation of current national immunization programs, as well as the introduction of other vaccines into routine immunization schedules, such as Haemophilus influenzae type b (Hib), measles, mumps and rubella (MMR) and yellow fever in areas endemic for the disease.
Foster inter-country collaboration in the area of vaccine production: During a meeting on Conjugated Vaccines, November 5-6, 1998 in Uruguay, representatives from the vaccine-producing countries of Mexico, Argentina, Chile, Brazil, and Cuba elaborated a strategy for regional technical cooperation, aimed at the joint development of conjugated vaccines.
Strengthen National Control Authorities to assure that quality vaccines are used in national immunization programs, as well as ensure that local vaccine production follows international standards.
Continue advocating the critical importance of immunization programs, to reduce morbidity and mortality due to common vaccine-preventable childhood diseases at the highest political level among Member Countries and with the bilateral and multilateral organizations: PAHO’s is closely collaborating with the First Ladies of the Americas on measles; with the countries’ legislative branch to establish laws that assure national financing of recurrent costs of vaccines and other inputs; and with the specialized agencies, such as the Centers for Disease Control and Prevention of the United States and the Laboratory Centre for Disease Control of Canada, on surveillance and laboratory diagnosis of vaccine-preventable diseases.
Obstacles
Increased efforts are needed to successfully conclude the goal of measles eradication by the year 2000.
Heightened attention needs to be placed on the technical, financial and logistical considerations of incorporating other vaccines of public health importance, such as Hib and MMR in routine immunization schedules.
Countries need to prioritize the establishment and/or strengthening of national epidemiological surveillance systems for vaccine-preventable diseases, and ensure that immunization programs reach all the population in all areas of a country.
With decentralization, Member 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.
The strong commitment by governments of countries that have the capacity to produce vaccines remains critical, to ensure that vaccine-producing laboratories have adequate financial and human resources to support the incorporation of the methodology to produce conjugated vaccines.
Essential Drugs:
Two key events to further the access to quality, inexpensive drugs have recently taken place:
The project for the Joint Procurement of Critical Drugs for Central America is being further developed. PAHO will thereby support countries to strengthen and make the legal frameworks of respective countries more flexible so that the joint Central American Negotiation Commission can conduct negotiations on behalf of the states that it represents. PAHO will also support countries in promoting mechanisms to facilitate payment to suppliers, so that the terms agreed upon can be respected, and offer political, financial, and administrative support to the Commission. Negotiations are also underway with the Central American Bank for Economic Integration (CABEI).
2. Strengthening Health Information and Surveillance Systems
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 the Region, in order to make appropriate clinical and managerial decisions. They will address the development, implementation and evaluation of needs-based health information systems and technology, including telecommunications, to support epidemiological surveillance, the operation and management of health services and programs, health education and promotion, telemedicine, computer networks and investment in new health technologies.
Priorities/Activities:
Development and publication of an extensive review of the Information Systems and Information Technology in Health: Challenges and Solutions for Latin America and the Caribbean.
Establishment of a Consultative Group, known as the Regional Health Informatics Initiative, coordinated by the IDB and technical orientation of PAHO.
Preparation of document "Setting Up Healthcare Services Information Systems: A Guide for Requirement Analysis, Application Specification, and Procurement", written by an international panel of experts, to be published in English and Spanish by July 1999.
Critical review study on the role of information systems in evidence-based medical practice.
Support to national initiatives (Argentina, Chile, Bahamas, Bolivia, Mexico) in the deployment of methodologies and tools for clinical care monitoring and outcomes analysis.
Support to the development of national IS&T plans for the CARICOM countries.
Development of hand-held data collection device (palm-top computer) for field use.
Implementation of Drug Registration System (SIAMED) in Brazil.
Technical support to two DATASUS projects: individual health card and hospital information system for municipalities (HOSPUB).
PAHO continues to collaborate with the Informatics 2000 Initiative, which has been recently moved to the operations side of IDB.
PAHO assisted countries in the preparation of two projects, (Venezuela, Brazil) in distance education to be funded by the IDB
Two proposals for PAHO/WHO Collaborating Centers in the area of Health Informatics were evaluated and are being forwarded for final approval by WHO (Institute for Johns Hopkins Nursing in the U.S. and the CEDISAP/INFOMED/CECAM consortium in Cuba).
Strategy meeting coordinated by NASA, with participation of the East-West Foundation, Yale University, IDB and PAHO to discuss possible partnerships in the area of distance education.
3. Improvement in Access to, and Quality of Water and Sanitation Infrastructure
Develop initiatives designed to reduce deficits in access to and quality of drinking water, basic sanitation and solid waste management, with special emphasis on rural and poor urban areas, by applying existing technologies or developing new, appropriate and effective low-cost technologies.
PAHO's focus is on the development of low cost technology for water and sanitation for the urban poor and rural environments. This effort is being lead by CEPIS and the following activities are being undertaken:
The organization of a system for the classification of technologies for water and sanitation.
The "cataloging" of technologies developed and tested by the Pan American Center for Sanitary Engineering and Environmental Sciences (CEPIS). For example: in-situ generators of water disinfectants; simplified water treatment units; school sanitation – healthy schools; manual drilling of wells, etc.
Preparation of a "Technology vademecum" for water and sanitation on paper and electronically. This consists of a catalogue of available technologies including descriptions of conditions necessary for implementation.
The coordination of a regional meeting between countries and international agencies including both the producers and the consumers of technologies, for the preparation of a plan for capturing and disseminating low cost technologies.
A major project is under negotiation for basic sanitation activities in Central America.
4. Technology Assessment
Develop mechanism for assessment of the effectiveness, cost and efficacy of those technologies to be introduced to cope with these and other relevant health problems.
Using its own resources or together with other partners, PAHO is serving as facilitator (at both the subregional and national levels) cooperating with countries in the establishment of suitable policies and mechanisms for promoting health technology assessment, which, among other things, includes: i) identifying relevant groups and national institutions in this field; ii) supporting situation analysis and the identification of needs; iii) encouraging the organization of national coordinating agencies and/or specific units; iv) facilitating coordination with international agencies, groups and networks; v) organizing workshops and seminars on health technology methodology, setting of priorities and practice; vi) establishing and/or reinforcing the mechanisms for disseminating results and sharing experiences; vii) support the evaluation of the impact of the recommendations of the assessment reports in terms of fostering the health sector authorities regulatory capacities.
At the moment, the two main constraints in this field are: i) the lack of a proper understanding on the part of many policy makers about the importance of health technology assessment for the normal development of health systems and services and the achievement of the health sector reform processes currently undergoing in the majority of the countries in the region and, ii) the absence of a critical mass of personnel trained in the methodology and practice, with appropriate access to national and international information sources.
For this reason, PAHO:
has organized (and it is going to organize) several subregional workshops for stakeholders and policy makers in Santiago (Chile, 1997), Bogot� (Colombia, 1998), Panam� (Panam�, 1998) and Havana (Cuba, 1999). In the majority of cases, this has been done in close partnership with the International Society for Technology Assessment in Health Care (ISTAHC), the International Network of Agencies for Health Technology Assessment (INAHTA), the three WHO collaborating centers on health technology assessment in Canada and the USA, and some European institutions,
has edited and disseminated 3.000 copies of a brochure titled "Developing Health Technology Assessment in Latin America and the Caribbean" to clearly establish the links between some of the major health sector reform objectives (i.e. effectiveness and quality, sustainability) and health technology assessment, and has created a web-site on health technology assessment.
has made accessible through its own web page the full text Spanish version of the MONITOR, the most credited information and alert system on medical devices,
is supporting the efforts of the recently created health technology assessment groups or units in Cuba, Colombia, Chile, and Panama, and is exploring similar lines in Mexico, Brazil, Ecuador and Argentina,
has been financing the presence of a number of professionals and policy makers in the ISTAHC Annual Conferences and other international scientific meetings on health technology and health technology assessment,
has developed (and continues to develop) specific efforts to cooperate with the countries in the management and evaluation of a number of relevant health technologies, particularly those related to clinical engineering, laboratory and blood safety, radiology and radiotherapy, oral health, clinical rehabilitation, ocular health, using in all these cases substantive amounts of both regular and extrabudgetary resources.
5. Areas where PAHO can play a supporting role
In addition to assuming the responsible coordinator role for Health Technologies Linking the Americas, it was agreed at the XV Summit Implementation Review Group, that PAHO would play a supporting role or act as a resource in the following topics of the Plan for Action:
Education (Mexico –Regional Coordinator) The Plan of Action calls for Intersectoral –Programs in education, health and nutrition as well as early childhood educational strategies will be priorities, inasmuch as they contribute more directly to plans to combat poverty. At the meeting of Education Ministers in Brasilia, PAHO proposed to play a supporting role or serve as resource in the area of education, on the basis of its expertise in the areas of health education, particularly in the health promoting schools initiative, and nutrition. The Interagency Group agreed to the proposal.
Drugs – (United States – Regional Coordinator) Under the topic Prevention and Control of Illicit Consumption of and Traffic in Drugs and Psychotropic Substances and Other Related Crimes, various references are made to the prevention of drug consumption and to drug use being a public health problem as well as an enforcement issue. The hemispheric dialogue on drugs would benefit by ensuring that the health issue, which is a universal one, is addressed. PAHO is already active through the Inter-American Drug Abuse Control Commission (CICAD) in the Hemispheric Strategy on Substance Abuse, which addresses Standards of Care, Education Programs, Epidemiological Surveillance and Social Communication. The movement for tobacco control in the Americas led by PAHO, has brought about through the approval of an Action Plan by the Ministers of Health, the beginning of a negotiative process with the OAS in the drafting of an Inter- American Convention on Tobacco Control. A convention is necessary due to the fact that tobacco control has international dimensions and it must be furthered through multi-sectoral action as well as action in the area of health.
Women - (Nicaragua Regional Coordinator) Under the Miami Summit’s Item 18, PAHO played a supporting role in Strengthening Women in Society primarily in acting as a resource in projects against domestic violence and in gender training of Health Services personnel. The Santiago Summit Plan of Action calls to eliminate all forms of discrimination and violence against women as well as to promote policies designed to improve women’s health conditions and the quality of health services at every stage of their lives. To play a supporting role on women as is set out by the Santiago Plan of Action is a continuation of work undertaken since the Miami Summit. Projects addressing violence against women continue to be a priority area for PAHO, and in addition, PAHO is organizing an intergovernmental convention on this issue in Toronto later this year. PAHO is preparing a research, training and lobbying project to show, document and correct gender inequities in public health policies and continues to work in the area of quality of care in further applying the qualitative methodology capable of identifying problems of gender equity in health care.
Hunger and Malnutrition – (Argentina - Responsible Coordinator) The Plan of Action states Give the highest priority to reducing infant malnutrition, concentrating efforts on health, nutrition and education programs for the nutrition of infants…to that end emphasis shall be given to adequate nutrition and correction of specific nutritional deficiencies specifically with vitamin and mineral supplements …
PAHO’s program in the Prevention of Micro Nutrient Deficiency is involved in the following areas:
Iodine: work to ensure countries guarantee universal consumption of iodized salt and Implement Surveillance system for detection of population at risk of IDD (iodine deficiency).
Vitamin A: assist countries to formulate national plans to eliminate Vitamin A deficiency, design and execute programs to provide children with supplements.
Iron: National programs to combat iron deficiency and anemia, promotion of comprehensive strategy including fortification of foods and supplements.
Fluoridation: To reduce dental caries in the hemisphere.