Rio de Janeiro, september 2013
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Suriname takes on the Presidency of Unasur Health Council
Among Suriname’s priorities are the Post 2015 agenda, Noncommunicable Diseases and Social Determinants of Health According to Dr Blokland, among the priorities Suriname will have whilst leading the CSS will be issues like the Post 2015 Development Agenda, Non-Communicable Diseases (NCDs) and Social Determinants of Health (SDH), which are three of the most important items in the global health agenda. In July, the World Health Organization released a report in which it defends a SDH approach for the Post 2015, as seen in the last issue of ISAGS Report. Another issue to be highlighted in the PPT of Suriname will be the policies of access to medicines, one of the five lines of action of
Suriname’s Minister of Health, Michel Blokland, holds a meeting with ISAGS delegation; in detail, the book “Health Systems…”
the Health Council’s 2010-2015 Quinquennial Plan. According to the minister, Suriname aims to integrate the actions of the Technical Group of Universal Access to Medicines (one of the five Council’s TGs) with the initiatives of CARICOM (Caribbean Community) and of the Pan-American Health Organization (PAHO). “We are in an unique position to play a central role in promoting the America’s integration and cooperation”, he stated. Regional Integration and WHO In the next few months, still according to Dr Blokland, there will be actions aimed at exchanging experiences among the member countries of Unasur in areas like anti-smoking measures, NCDs and fight against cancer, through the Network of National Cancer Institutes (RINC), which is one of the Council’s six networks. “We must take a through look on each country’s best practices and see where can we all benefit from it, since all of us have done something against the NCDs epidemics, for example”. The Surinamese Minister pointed to the importance of the fact his country, along with Argentina and Brazil, is joining WHO’s Executive Board. The three countries
were elected during the last World Health Assembly in May. “Unasur is privileged for having these countries on the Executive Board. The CSS has already been very active in the negotiations, especially in the case of counterfeit medicines. And now, with these three members, we will have a much stronger presence to present our collective claims if we act together”, stated the minister. At the end of the visit, the Institute’s Head of Office Mariana Faria presented the minister with a slimmed down version of the book “Health Systems in South America: challenges to the universality, integrality and equity”, published in 2012. The full version of the interview with Dr Blokland is available at ISAGS website (also in Portuguese and Spanish).
READ MORE • Meeting formalizes the return of Paraguay and the Paramaribo Declaration - Page 2 Book of researcher and WHO report discuss “universality” in health Page 3 “We need to understand the relations between development and SDH” - Page 4
Suriname takes on this month the Presidency Pro Tempore (PPT) of Unasur Health Council (CSS) for the first time. The challenge is to advance in the regional integration and lead the bloc in a period of important definitions in the global agenda. “One of our priorities will be to align the bloc’s agenda to the great issues of the global agenda” stated the country’s Health Minister Dr Michel Blokland in an interview to ISAGS Report. Suriname has already been in charge of Unasur’s PPT since August 30th, when it held the 7th Ordinary Meeting of the Council of Heads of State and Government of the South American bloc (more details on page 2). The official transfer of the Health Council’s presidency was bound to happen in the early days of the current month. Dr Blokland hosted ISAGS delegation in a visit at the end of August. The purpose was to nurture closer ties and offer support to Suriname during the transfer of the PPT. In the occasion, the minister highlighted the importance of strengthening the partnership between the two organs and thanked ISAGS, which, in its turn, committed to permanently support Suriname in the 12 months it will lead the Unasur Health Council.
“The priority will be to align the bloc’s agenda to the great issues of the global agenda” said Health Minister Dr Michel Blokland
The Council of Heads of State and Government of Unasur during the 7th Ordinary Meeting, held in Paramaribo (Suriname)
Meeting of Heads of State formalizes the return of Paraguay and closes with Paramaribo Declaration
Unasur Summit on the 30th marked the transference of the Pro Tempore Presidency to Suriname The 7th Ordinary Meeting of the Council of Heads of State and Government of Unasur, which took place on the 30th of August, marked the transference of the Pro Tempore Presidency (PPT) of the South American bloc to Suriname. It also formalized the return of Paraguay after the 14-month suspension and closed with the Paramaribo Declaration, where the organ’s constitutive principles were strengthened, like democracy, Rule of Law, human rights and South America as a zone of peace. The document also emphasizes the will to create a South American identity. In the occasion, Surinamese president Dési Bouterse highlighted to seven of the region’s leaders the importance of taking up the bloc’s PPT for the first time. In the final declaration, the Council of Presidents “expresses its satisfaction” for the fact and committed to contribute to the implementation of established goals in the coming 12 months. Suriname will be in charge also of the Electoral Council, the Culture Council, the Social Development Council (alongside with Venezuela), and the Defence Council (alongside with Colombia), not to mention the Health Council, for which it will count on ISAGS support. The South American leaders pointed out furthermore the work carried out by Peru whilst in charge of the PPT in the previous year. The country’s PPT focused on “strengthening Unasur’s institutionalisation”. Peruvian President Ollanta Humala highlighted in his speech before the Heads of State the importance of “advancing towards the union of our peoples”. The Paramaribo Summit also formalised the end of the suspension of Paraguay. The country was suspended from the bloc in
June 2012 after the deposition of the then president Fernando Lugo. The measure was revoked on the 15th of August with the inauguration of the new Paraguayan President Horacio Cartes, who attended the meeting in Suriname. In this sense, the Meeting of the Council of Heads of State marked the official return of Paraguay to the condition of full-member of the bloc.
“Having Suriname in the PPT will be an opportunity to deepen the integration spirit and the union of all South American peoples” In turn, Unasur Secretary General Alí Rodríguez Araque presented a management report, in which the consensus around the importance and acknowledgement of natural resources as being the integration’s dynamic axe for the South American development was highlighted. Alí Rodríguez also gave prominence to the opening of the Centre of Communication and Information (CCI) in the headquarters of the General Secretariat in Quito (Ecuador), which counted with the support of ISAGS and of the Centre for Strategic Studies on Defence (CEED). The meeting was finalized with the Paramaribo Declaration, where the Heads of State of Unasur paid a special tribute to former Venezuelan President Hugo Chávez, and thanked for the work developed by Peru on the presidency. It states that having Suriname on the bloc’s PPT is a great opportunity to “deepen the integration spirit and the union”.
Representatives of 38 Latin American and Caribbean countries approved the Montevideo Consensus on Population and Development last month. The document includes a range of recommendations on the issue for governments of the region and highlights the importance of measures aimed at guaranteeing the universal access to sexual and reproductive health services in the health systems. The 1st Meeting of ECLAC’s Regional Conference on Population and Development was carried out between the 12th and 15th of last month in Uruguay’s capital. The conference, organized by ECLAC, Uruguay and UNFPA, gathered 24 regional and international organisms and around 160 Non-Governmental Organizations. In its final text, 120 measures related to eight points identified as central. The third point, on sexual and reproductive health, defended “policies that ensure people may exercise their sexual rights and take decisions freely and responsibly”. The participating countries committed, then, “to revise legislations, rules and practices that restrict the access to sexual and reproductive health services, and to guarantee the universal access”. A round table debating the challenges to the universalization of access to sexual and reproductive health services took place during the conference, in which the Public Health Minister of Uruguay Susana Muñiz, the Public Health and Social Protection ViceMinister Fernando Ruiz, and the Ecuadorian Health Minister Carina Vance participated. Muñiz pointed out the importance of bringing consensuses to the International Conference on Population and Development Cairo+20 in 2014. She also highlighted the advancements of Uruguay in the past few years. Vance spoke of the importance of the Health National System, consolidated by the 2008 Ecuadorian Constitution, for the universalization of access to the reproductive and sexual health services. The health issue, approached in a transversal manner, was also included in the topics of: sexual and reproductive rights of youngsters; healthcare with emphasis on the ageing of the region’s populations; and gender equality.
ECLAC conference in Uruguay highlights sexual and reproductive health
Minister Susana Muñiz leads round table in the meeting
REFORM IN PERU
Researcher’s book and WHO report analyze ‘universality models’ in the health systems Both publications approach “universal health coverage” based on two different points of view implementing this model. “The [first] reform generated a growing lack of protection in health as disbursements increased (…), and this leaded the supranational organs to propose a second reform that could guarantee the ‘universal coverage’”, says the researcher in the introduction. Dr Laurell, one of the foremost researchers in social medicine in Latin America, gave a trilingual conference on February at ISAGS “Universal Health Systems: objectives and challenges”, which was broadcasted online in real time. WHO’s annual report, on the other hand, asserts that “universal coverage allows countries to guarantee that their citizens have access to the health services they need not having to go through serious economic hardship due to outof-pocket payments”. Also according to the document, investment in research is the best way health systems based in coverage or based in universal coverage model can adapt to the countries’ realities.
Review highlights the book ‘Health Systems...’ The book review published by Dr Ana Cristina Souto from the Federal University of Bahia’s Institute of Collective Health pointed out the importance of the publication “Health Systems in South America: challenges to the universality, integrality and equity” as it provides a panorama of the region’s twelve countries. According to the researcher, the book, which was released by ISAGS in 2012, adds up to the work that has been developed by the Institute and Unasur. The review is available on ISAGS website in Portuguese, and also translated into English and Spanish. The book, whose translation into English is being finalized, was presented in two conferences in the month of August. Mariana Faria, ISAGS
Head of Office presented it during the round table Brazil in the Social Movement for the Health of the Peoples (MSP), which took place in Rio de Janeiro. The event is a preparatory stage of the 1st Latin American MSP Assembly that will be held in Cuenca, Ecuador. “Health Systems...” was also presented in the opening of the Public Health Conference of the Province of Santa Fé (Argentina) by the Venezuelan doctor and former ISAGS technical consultant on Health Policies and Systems Oscar Feo.
REFORM IN BOLIVIA
The Bolivian government stated that the National Conference for a Revolution in Public and Free of Charge Health should take place in October, though it still doesn’t have a defined date. The departmental stages must happen in September. The conference’s goal is to debate the measures that guarantee the access universal, free of charge and quality health services for the Bolivians. The government also stated that Mi Salud, a programme launched in June, aims at being an early stage of the future Unified Health System, as it incorporates issues like promotion and prevention.
HEALTH SCHOOL IN URUGUAY
On August 30th the first course of the School of Government in Public Health of Uruguay was formally established in an open ceremony. A module on Health Systems and Services and Social Protection was developed in a course that will train 65 workers of the National Integrated Health System (SNIS). The Health Minister Susana Muñiz and representatives of PAHO/WHO attended. PAHO/WHO gave assistance to the creation of Government School, an initiative that also counted with the support of the Network of Public Health Schools of Unasur.
The Operative Group on Cancer Registry, one of five groups of Unasur Network of National Cancer Institutes (RINC), met in Rio de Janeiro between August 6th and 7th. ISAGS Executive Director José Gomes Temporão participated on the opening table of the event alongside with RINC’s coordinator and General Director of INCA Luiz Antonio Santini, and David Forman, Director of IARC’s Information Sector on Cancer. After two days of the debate, the group defined a work plan to boost the expansion of cancer registries in the region and evaluated the proposal of building a regional hub partnering with IARC.
Access Asa Laurell’s “The Impact of the ‘Popular Insurance’…”, “Health Systems…”, WHO Report, and Ana Cristina Souto’s book review on bit.ly/ISAGSLibrary
Two publications released last month debate the concept of “universality” in different health system with different points of view. In “The Impact of the ‘Seguro Popular’ in the Mexican Health System”, researcher Asa Cristina Laurell analyzes the effects of the “universal coverage” model implemented in Mexico by the programme mentioned in the title. In the “World Health Report 2013”, the World Heath Organization (WHO) debates how investment in research can help the countries in reaching the “universal coverage” from models adapted to their needs. In her book, edited by CLACSO (Latin American Council on Social Sciences), Laurell revisits the origins of the “universal coverage” model developed by the World Bank in the 1990s. Then, she places Mexico’s “Seguro Popular” programme in the second stage of the Health System reforms in Latin America, which were carried out with the objective of
During the opening of the 7th Meeting of the Health Intergovernmental Commission, which took place in the city of Pucallpa, Peru, the country’s Health Minister Midori de Habich affirmed that the Peruvian government is strongly committed with the universalization of fundamental healthcare. Midori pointed out that the on-going reform aims at expanding the population rights and at reducing infrastructure problems by seeking equity in policies of social inclusion. She also highlighted the importance of the participation of regional authorities in the process.
Opening round table in the meeting of the RINC
‘We need to understand the relation between development and SDH’ “I hope the Sustainable Development Goals are broader and more complex”, said the researcher Sakiko Fukuda-Parr to the ISAGS Report
What are the critical aspects of health on the Millennium Development Goals? Let me start with my concerns about the MDGs, the positives, what we have learnt from the MDGs. The MDGs are eight goals, none of which is anything that anybody would disagree with like putting every child in school, and everybody has access to clean water. However the problem is that as a development agenda, this is too simple for something complex like development and poverty. And important issues in development like equality, equity, making sure that you are respecting people and expanding human dignity, all of these things are not included in this agenda. So the MDGs are very powerful because they give you the simple list of measurable, concretes targets, but precisely the reason why they are a problem is when they are interpreted like a comprehensive development agenda and priorities. Considering that health is a precondition to development, how do you analyze the importance of the multi-sectoral approach and the vision that health is an outcome of other policies? This is precisely the problem with the MDGs. By setting these quantitative targets they create an incentive for organizations to be very focused on a particular result. So it encourages what you called vertical approaches to health programs, for example: only doing vaccinations, only developing fortified foods to deal with hunger, but, health is a result of education, gender equality,
Sakiko Fukuda-Parr is economist, professor of International Relations at the New School University in New York, worked in the United Nations Development Program from 1979 to 1985 and was Director of the Human Development Report from 1995 to 2006. Fukuda-Parr talked to ISAGS report during a lecture organized by the Center for International Relations in Health (CRIS), from Oswaldo Cruz Foundation, Brazil. The professor addressed a critical review of the Millennium Development Goals, subject of her next book that must be published on 2014. Researcher Sakiko Fukuda-Parr, former UNDP and former Director of World Report on Human Development
education of women, women having control of their house’s entire budget, so on. Then also health is an input into better education outcomes, better qualified workers, more productive workers, therefore economic growth. All these things and even democratic participation, health and education are necessary conditions to improve democratic participation. So we need to understand the connection between all of these things, these problems, the social determinants of health and not just economic determinants or biological determinants of health. I think we can use these global goals and the sustainable development goals might be useful, it is difficult to put everything that is important in a simple set of goals. As to the Sustainable Development Goals, I hope they will be comprehensive and far-reaching. Maybe they have to be less simple. Development is a shared commitment, in this context, what is the relevance of regional blocs, such as Unasur? I think is very important for regional blocs to be active. In international negotiations, by formulating the sustainable development goals or the post 2015 agenda, you are basically engaging a process of negation among governments. There are nearly 200 governments and in order for the voices of these particularly developing countries and smaller countries to be reflected and heard, I think we need these regional group and
groups of sub regions and groups of likedminded countries. That’s all is very important. What was your role in the United Nations Development Program and how is going to be your book about the Millennium Development Goals? I have been working for many years and I started my career actually at the World Bank and then I moved to UNDP where I worked most in Africa, and then I worked for ten years as Director of Human Development, The Global Human Development Report, and this was a tremendous privilege because it was working really with the best intellectuals on development, starting obviously with Amartya Sen [Indian economist, creator of the Human Development Index], who was very generous with his time and contribution, working with us on the Human Development Report so it was a very exciting period work with UN. Now I work as an academic, I’m professor at New School in New York and I have been doing research on MDGs for several years and now there is a book that should be coming out perhaps next year. The book is going to be how the MDGs were created.
• 11-13/09 - 66th Session of the WHO Regional Committee for South-East Asia • 16-19/09 - 63rd Session of the WHO Regional Committee for Europe • 30/09-04-10 - 65th Session of the WHO Regional Committee for the Americas/ 52nd Meeting of the PAHO/WHO Directive Council
INSTITUTIONAL ISAGS-UNASUL Executive Director: José Gomes Temporão Head of Office: Mariana Faria Technical Coordinator: Henri Jouval INFORMATION AND KNOWLEDGE MANAGEMENT Coordinator: Camilla Ibiapina ISAGS Report Editor: Amaro Grassi Team: Flávia Bueno, Felippe Amarante and Mariana Moreno
This is the report from the South American Institute of Government in Health (ISAGS), the think tank on health of the Union of South American Nations (UNASUR) that aims to contribute to improving South America government quality in health by means of leadership training, knowledge management and technical support to health systems.
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This is the report from the South American Institute of Government in Health (ISAGS), the think tank on health of the Union of South America...