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


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:



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.


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:

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:

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: