Report of the Pan-American Health Organization to the XV Meeting of the Summit Implementation Review Group, October 29, 1998

Health Technology Linking the Americas

 

I. Enhance the availability, access to and quality of drugs and vaccines, and support regional initiatives, which will facilitate research development and production of vaccines to reduce disease.

Vaccines:

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

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:

Meeting to be held:

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

Essential Drugs:

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.

In this respect PAHO will support countries to:

 

II. Strengthen and Improve National and Regional Networks of Health Information and Surveillance Systems

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.

2. Proposed General Perspective for the Development of Information Systems

Principles:

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 17th, 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

Planned

 

III.- Iniciativa 3 del Plan de Acci�n de Santiago, sobre el desarrollo y utilizaci�n de tecnolog�as efectivas de bajo costo para la provisi�n de servicios de saneamiento b�sico, que aseguren el abastecimiento de agua segura, saneamiento y manejo de residuos s�lidos.

Medidas adoptadas a la fecha

1. Antecedentes

La inquietud por el uso de tecnolog�as apropiadas en la provisi�n de servicios de saneamiento b�sico existe en los pa�ses de la Regi�n desde hace bastante tiempo. Universidades, ONGs, empresas prestadoras de servicios de saneamiento b�sico, centros de investigaci�n y la propia OPS a trav�s de su Divisi�n de Salud y Ambiente, de sus Representaciones y del Centro Panamericano de Ingenier�a Sanitaria y Ciencias del Ambiente (CEPIS), vienen desarrollando trabajos en ese sentido. As�, por ejemplo, en este momento en el CEPIS se est� desarrollando un estudio para el uso de sistemas de desinfecci�n del agua y alimentos a nivel domiciliario, que a muy bajo costo dar�a 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 Cooperaci�n Suiza realiza proyectos experimentales de saneamiento b�sico para las poblaciones rurales y urbano marginales, a trav�s de los cuales se promueve el uso de tecnolog�as adecuadas. En este mismo sentido, la Representaci�n de la OPS en Bolivia, a trav�s de su Proyecto Tecnol�gico en Saneamiento Ambiental, PROTESA, est� impulsando la utilizaci�n de la bomba manual flexi-OPS y de otras tecnolog�as simplificadas en las poblaciones de las �reas rurales; y la Representaci�n de la OPS en Nicaragua ha desarrollado un filtro casero para agua de bebida. En todos estos trabajos, la tecnolog�a se ve como uno de los medios de conseguir la sustentabilidad de las soluciones, y con ese mismo prop�sito, en varios casos, se busca agregarlos a actividades que permitan mejorar los ingresos de las poblaciones.

2. Estrategia adoptada

Con el prop�sito de maximizar los esfuerzos que se vienen llevando a cabo en la Regi�n para adoptar el uso de tecnolog�as adecuadas en la provisi�n de servicios de saneamiento b�sico, y facilitar de esa forma el acceso a esos servicios por parte de las poblaciones m�s desfavorecidas de los pa�ses, se adopt� como estrategia principal el establecimiento de un programa regional para la promoci�n del uso de tecnolog�as adecuadas en saneamiento b�sico.

Ese programa buscar�a integrar en una red, desde el CEPIS, a las instituciones de los pa�ses de la Regi�n que vienen trabajando en el campo en referencia, de forma que puedan con facilidad identificarse las tecnolog�as adecuadas existentes y las que vayan siendo desarrolladas, evaluarse, normalizarse y divulgarse a trav�s de los medios m�s adecuados. La divulgaci�n incluir�a la preparaci�n de gu�as, que gradualmente integrar�an un vademecum de las tecnolog�as de �xito comprobado, que, adem�s de dar todo su detalle t�cnico, indicar�an en cada caso las condiciones que requieren para su uso, sus costos y toda informaci�n que facilitase su utilizaci�n. Esa divulgaci�n se har�a b�sicamente a trav�s de la Red Panamericana de Informaci�n en Salud Ambiental, REPIDISCA.

La divulgaci�n se har�a tambi�n a trav�s de acciones de capacitaci�n, en las que se buscar�a que el uso de tecnolog�as adecuadas se incorporase, en los niveles que corresponda, a los sistemas educativos de los pa�ses de la Regi�n, en lo posible, mediante cursos a distancia. El programa preparar�a material did�ctico y propondr�a esquemas para la formaci�n de personal especializado en la escala requerida.

El programa, por �ltimo, har�a una evaluaci�n permanente de la evoluci�n de la situaci�n sanitaria de las �reas deprimidas de los pa�ses de la Regi�n e identificar�a aspectos en los que la investigaci�n de aspectos tecnol�gicos fuera necesaria, y promover�a e inclusive realizar�a proyectos de investigaci�n para atender esas necesidades.

3. Trabajos en Curso

El programa regional para la promoci�n del uso de tecnolog�as adecuadas en saneamiento b�sico, que se adopt� como estrategia principal para el cumplimiento de la Iniciativa 3 del Plan de Acci�n de la Cumbre de Santiago, ya ha sido formulado y se ha dado inicio a su ejecuci�n, utilizando los recursos disponibles en la Organizaci�n y los que se pueden conseguir en alianzas con otras instituciones.

As�, se est�n dando los primeros pasos para la creaci�n gradual, en torno al CEPIS, de la red de agencias e instituciones que est�n utilizando tecnolog�as adecuadas, en la forma que plantea el programa en referencia. De esa forma esta vincul�ndose al PROTESA, de la Representaci�n de la OPS en Bolivia, con el CEPIS. La experiencia que de este modo va a ganarse, permitir� la integraci�n a la red de otras representaciones que tienen proyectos para el uso de tecnolog�as apropiadas en saneamiento b�sico.

Se ha comenzado, por otra parte, el proceso para la identificaci�n, evaluaci�n y preparaci�n de gu�as de divulgaci�n de las tecnolog�as de �xito reconocido, las que, poco a poco, integrar�an el vademecum en que se aspira a reunirlas. Este trabajo esta realiz�ndose de manera conjunta con el Programa de Agua y Saneamiento del Banco Mundial, y, nos est� permitiendo, en una primera etapa, reunir experiencias de Bolivia, Per� y Ecuador. Se han identificado estas experiencias y se est�n preparando las gu�as correspondientes.

Finalmente, se est� organizando una reuni�n regional, que se realizar� el a�o pr�ximo, en la que se examinar�n las formas c�mo se viene desarrollando en los pa�ses la tecnolog�a apropiada en saneamiento b�sico, c�mo se viene divulgando y su nivel de utilizaci�n, para a partir de ese examen, proponer medidas que permitan hacer m�s intenso el uso de la mencionada tecnolog�a.

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