Rio de Janeiro, november 2013

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Unasur countries discuss management and financing of health in BoliviaRepresentatives of eleven Unasur member

countries have took part at the Workshop “Management, Financing and Participative Management Models in the South American National Health Systems”, which was held in Santa Cruz de la Sierra, with the cooperation of the Bolivian government. Between October 31st and November 1st, delegates discussed on management and financing of health systems in the region to promote universalization of access to health.

This workshop is complementing the actions carried out by the ISAGS in 2013, related to the universalization of health systems. Last February, the Institute organized the conference on “Universal Health Systems: objectives and challenges”, with Asa Cristina Laurell. In September, ISAGS launched the English version of the book “Health Systems in South America”.

The Bolivian Vice-Minister of Health, Martin Maturano (read in page 4), praised ISAGS and Unasur for the initiative, which had the presence of the Pro Tempore Presidency of the South American Health Council (CSS), held by Suriname. Before the workshop, it was also held the first meeting of the Universal Systems Technical Group. The director of health insurances of Bolivia and coordinator of the group, Freslinda Flores, talked about the importance of health as a universal right and highlighted the necessity of regional integration. “It is impossible the integration of South America without the knowledge of the other, it’s an inescapable way.”

Health Reform and IntegrationIn the first day, the issues were health

reforms and regional integration in South America. PAHO/WHO consultant in Uruguay Miguel Galeano spoke about the right to health and said nowadays health systems

have three common challenges: access equity, financing and health results, quality and sustainability.

The economist from IPEA (Brazil) Carlos Octávio Ocké added that the “State seeks to reduce expenditure based on the imperatives of fiscal policy, which goes against the universal health systems”. In his opinion, in one hand no countrie has managed to build a unified and universal system and, on the other hand, “in all the countries there are both a public and a private sector”.

Financing of Health Sector

Director of the University of Chile’s Public Health School Oscar Arteaga opened the debate on health system’s funding. According to him, the last reform had the goal of “integrating public and private sectors, defining guarantees for the citizens and enhancing the healthcare and health system management models, as well as establishing more solidarity and unified regulations”.

Professor Wellington Sandoval from the International University of Ecuador said the amount of social policy investment is still very irregular in South American countries and it is “practically impossible to reach universality”.

Management and Social Participation

The coordinator of the Masters degree in health policy and management of the Argentinian University of Bologna, Carlos Vassallo, said it is important to learn with that experiences that have been implemented

because “issues like fragmented care and breaches in access are consequences of a lack of a health model that includes: care, management and financing”.

In the second day of the workshop, the countries presented their experiences in participative management. They talked about institutionalized mechanisms of social participation and permanent hearing of opinions and claims from the population, as well as intersectoral practices, monitoring and assessment tools of citizen participation, according to guidelines put forward by ISAGS to the countries prior to the event.

ISAGS’ Chieff of Office Mariana Faria stated “health, more than a public asset, is a right. We must be aware, but the private sector has the clear goal of not to guarantee the right, but instead their own profit”. Ecuadorian Osvaldo Zepeda affirmed “the participation generates somehow social capital and cohesion, which is a social determinant”.

Workshop organized by ISAGS, in cooperation with the bolivian government, and held in Santa Cruz de la Sierra, gathered 11 countries

Technical Group on Universal Systems of the South

American Health System held its first meeting

Workshop “Management, Financing and Participative Management Models in the South American National Health Systems”

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READ MOREISAGS launches its 2nd book, “Health Surveillance in South America”Page 2

Secretary of S&T and Health Strategic of Brazil holds its conferencePage 3

Unasur is important to universal system, says Bolivian Vice MinisterPage 4

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ISAGS presents its 2nd book, “Health Surveillance in South America”, during a regional symposium

Institute and RINC discuss partnership in congress about cancer

ISAGS launched in october the book “Health Surveillance in South America: an epidemiological, environmental and health-related vision”, its second publication, in the VI Brazilian Symposium on Health Surveillance (Simbravisa) and the II Pan-American Symposium on Health Surveillance, which took place in Porto Alegre (Brazil). The volume was launched during the thematic panel “Challenges and Perspectives for Health Surveillance in South America”, with the presence of the ISAGS Executive Director, José Gomes Temporão, and of Jorge Venegas, former Minister of Health in Uruguay. The panel was moderated by José Agenor da Silva, former Minister of Health in Brazil from 2006 to 2007 and director of the National Health Surveillance Agency (ANVISA). Representatives of Brazil, Bolivia, Chile, Ecuador, Guyana, Paraguay and Suriname participated.

Venegas highlighted the heterogeneities in the region under the demographic, epidemiological and social development viewpoints and expressed that surveillance is a political, financial and social challenge for South American countries. “We need to carry out surveillance activities in order to act and for that, we need to have reliable information on health conditions, as this will allow us to make the right decisions and at the same time to disseminate and enforce them.”

The former minister also pointed out the dengue epidemic as a great challenge for the region and made a warning on the need to fight the emerging non-communicable diseases (NCDs). “Nobody speaks about accidentality. The proportion of equivalence, incidence of mortal victims in car accidents is much higher at present. Health surveillance is never mentioned in chronic depression. That will be a problem for our society”, he said.

After Venegas’ presentation, Temporão

The 5th International Cancer Control Congress (ICCC5) was held in Lima, Peru, from November 3 to 6, 2013. The event’s opening session was composed of ISAGS’ Executive Director, Dr. José Gomes Temporão, alongside the Director of the Pan American Health Organization (PAHO), Dr. Carissa Etienne, the Health Minister of Peru, Midori de Habich, and the Coordinator of Network of National Cancer Institutes (RINC) of Unasur, Dr. Luiz Antonio Santini.

Temporão highlighted the similarities between the objectives of ICCC5 and of the South American Health Council (CSS) in creating structuring networks and emphasized the importance of cooperation between RINC and ISAGS: “We should take advantage of international cooperation to close gaps, reduce inequity and improve our people’s quality of life.”

Etienne congratulated RINC for the work of its operational groups and for the progress achieved and talked about the importance of South-South and North-South collaboration and dialogue in efforts to guarantee universal access to cancer prevention and control services. Midori de Habich, addressed her country’s reform process and stressed the importance of the Plan Esperanza, Peru’s National Cancer Plan, which aims to promote the universal coverage.

In parallel to the Congress, ISAGS and RINC discussed a cooperation and a letter of commitment for the development of collaborative projects that could increase the control of cancer in the countries of South America. The Executive Secretary of RINC, Walter Zoss, emphasized the importance of the partnership by stating that is very difficult to establish consolidated projects if there is not a platform for exchange of experiences and information about countries. The RINC also held meetings of its Operative Group on Prevention and Control of Uterine Cancer and its Management Board and presented the Virtual Health Library on prevention and control of cancer.

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Representatives of seven Unasur countries participated of the book’s presentation

presented the new ISAGS book and took up again the context of idealization also during the preparation of the book on “Health Systems in South America”, which was published by the Institute in 2012: “It was crystal-clear for us all that within the chapter on surveillance a deeper insight and a more detailed vision were necessary”.

Temporão emphasized the last chapter of the new volume that refers to the construction of a political agenda for the future and reinforced the question involving demography. “All countries worldwide have to face problems caused by demographic transitions, and it is importance to understand how this process impacts on the health surveillance structure”, he said.

When the panel discussion was over, the book was launched during the event and distributed to experts in the area of different countries. Eduardo Hage, one of the organizers, highlighted the ineditism of the publication. “This is the first publication to address the topic in a consolidated manner, for the region, both as regards the conceptual aspects related to health surveillance as well as in relation to the organization of systems and the development of actions in the field”.

The book includes reflections on the topic discussed in two workshops organized by the ISAGS in 2011: Health Surveillance and Sanitary Surveillance in South America. The english version of the publication will probably be available in november for free download in ISAGS website.

“All countries worldwide have to face problems

caused by demographic transitions”

José Gomes Temporão

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ISAGS Director, José Gomes Temporão, in the ICCC5

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‘Science and Technology is the major health issue of 21st century’, says Carlos Gadelha in conference

ISAGS NEW ADDRESSThe South American Institute of Government in Health (ISAGS) changed its address in October and is now located at Av. Rio Branco, 151, 19th floor, remaining in downtown Rio de Janeiro (Brazil). The Institute’s new telephone number is +55 21 2505-4400. This relocation is in line with the institution’s objective of improving its infrastructure and providing more welcoming and adequate facilities for its staff, visitors and guests in order to enable the exchange of knowledge and experiences for the benefit of South American integration of health policies.

RETS-UNASUR MEETINGThe Network of Technical Health Schools of Union of South American Nations (Unasur) held its 2nd meeting on this month of November, in Recife (Brazil). There were also held the RETS’ 3rd General Meeting and RETS-CPLP’s (Community of Portuguese-Speaking Countries) 2nd Meeting. During the meeting, representatives from RETS’ member institutions and national leaders, responsible for the education policies of health technicians, analyzed the network as a means of producing knowledge about education and work of health technicians.

RESP AND HUMAN RESOURCES Also in Recife, the Network of Public Health Schools (RESP) and the Human Resources Technical Group - both of them form the South American Health Council (CSS) - held a joint meeting on November 8th. The meeting addressed the Government Health Schools’ guidelines and RESP’s research on public health education in the countries of South America. Additionally, the representatives of the countries prepared a statement from Unasur for the Third Global Forum on Human Resources for Health, which was held between 10 and 13 November.

MINISTER OF VENEZUELAThe President of Venezuela, Nicolás Maduro, announced in the first week of November Francisco Armada as the new Minister of Health, replacing Isabel Iturria, who held the post since April this year. Armada has exercised the same office between 2004 and 2007, and returns now to the ministry to boost social health programs in the program Barrio Adentro and then assuming new “special tasks”, according to the president Maduro. The new Minister of Health will also accumulate the position of Chief of the “Estado Mayor de la Salud”, created in August this year.

The Secretary of Science and Technology and Health Strategic Products of the Ministry of Health of Brazil, Dr. Carlos Augusto Grabois Gadelha, said in a conference on October 17th held by ISAGS that the challenge of science and technology is ‘“the great question of 21st century” and that we need to discuss the basis that a universal health requires. According do Gadelha, “the productive base generates income and employment, creating an articulation with the social dimension.”

The conference “Innovation, Access and Development: the political and theoretical perspectives on the health economic-industrial complex”, which lasted about two hours, was broadcast online in real time and had simultaneous translation to English and Spanish . Approximately 300 people from various countries, especially in South America, followed the live event and were able to send questions to Carlos Gadelha in the second part of the conference. The entire conference will be available to the end of November in the three languages on the website of ISAGS.

Carlos Gadelha was one of the leaders of the process to devise and implement the Health Economic-Industrial Complex (CEIS) in Brazil, together with ISAGS Executive Director, Dr. José Gomes Temporão. He holds a PhD in Economics from UFRJ, is the Coordinator of the Master on Policy and Science, Technology and Innovation in Health Management of ENSP-Fiocruz and was vice-president of Fiocruz in the area of Production and Innovation in Health.

Gadelha started the lecture, which counted with the presence of visitors from many countries

HEALTH CONEXION

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Francisco Armada, new Health Minister of Venezuela

Secretary of S&T and Strategic Health Products of Brazil opened workshop held by ISAGSof the region, stating that its purpose is to deepen relationship between access to health systems and technological innovation, once “there is no development by making more of the same”.

According to Gadelha, the theme is not new and refers to the theorists of development as Raúl Prebisch and Celso Furtado, who has pointed to the importance of innovation in this sense. For the Secretary for S&T of Ministry of Health, “there is no health as citizenship if there is not a production base that leads to health care access”. “Social and economic orders are two sides of the same coin. There’s no progress in social order if there’s no progress in economic order”.

Workshop on “Access, Industrial Development and Innovation in health”

After Carlos Gadelha’s conference, there were held the 5 thematic panels of the workshop “Access, industrial development and innovation in health”. On October 17th, was held the panel “Proposal of Health Policies: integration of economic and social development”, with the Vice-president of the Production and Innovation in Health Department of Fiocruz, Jorge Bermudez, Reinaldo Guimarães, Director of the Brazilian Fine Chemicals Biotechnology and Specialty Industries Association, Juan Pablo Jimenez, of ECLAC, and Oscar Cetrángolo, of the Universidad de Buenos Aires.

On the following day, the panels were “Dynamics of innovation and sanitary regulation adaptation: perspectives”, “Funding and Investment Dynamic in the Health Complex”, “Production Structure: industrial development in coordination with public interest” and “Health services: dimensions of social protection in the context of the innovation and demographic dynamics and health policies.”

Read the publication “Health Surveillance in South America” in bit.ly/ISAGSLibrary and watch the debates of the Workshop

“Access, Industrial Development…” in isags-unasur.org

Dr. Carlos Gadelha holds a trilingual conference about “Innovation, Access and Development” in ISAGS headquarters

“Social and economic orders are two sides of the same coin.

There’s no progress in social order if there’s no economic progress” Carlos Gadelha

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ISAGS-UNASURExecutive Director: José Gomes Temporão Head of Office: Mariana Faria Technical Coordinator: Henri Jouval

INFORMATION AND KNOWLEDGE MANAGEMENTCoordinator: Camilla Ibiapina ISAGS Report Editor: Amaro GrassiTeam: Flávia Bueno, Felippe Amarante and Mariana Moreno

Contact: comunicacao@isags-unasur.org Phone: +55 21 2505 4400

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.

INSTITUTIONAL

The Vice Minister of Health from Bolivia, Martín Maturano, opened last October 31st the Workshop “Management, Financing and Participative Management Models in the South American National Health Systems”, organized by ISAGS with the bolivian government. In the occasion, Maturano said that “solidary construction among brother countries may enable that the right to health be exercised with no discrimination, from a intercultural point of view and of social participation and control”. In the workshop, the Vice Minister gave an interview to ISAGS Report.

Currently, what are Bolivia’s main challenges for achieving a universal health care system?

First, the political mandate of President Evo Morales’ national government provides an unmistakable direction for universal health access and full exercise of the right to health for all Bolivians. In that sense, we have made great strides in the preparatory stage for implementation of a universal health system. Now, our goal is to involve all stakeholders, especially those associated with the issue of health systems: professionals, social organizations, joint actions to push this very important project, the issue of a universal health system, which is political and social mandate, and a priority of President Evo Morales’ administration.

Unasur, through its Health Council and ISAGS, has also been acting to promote the universalization of health, which is the subject of the workshop held in Santa Cruz de la Sierra. What is the relevance of the bloc to the development of the Bolivian system?

It is very important the solidary support, the support in terms of complementarity and reciprocity among Unasur member countries. This workshop is very important for us since it will give us a chance to explore positive experiences, with concrete aspects to serve as examples for Bolivia to implement, deepen and advance its universal health system. Undoubtedly, this workshop will also allow us to position the theme of universal health system in the political agenda in addition to verifying that our progress and our goals are not opposed to South American countries’ common goals of achieving free and universal health access for all its inhabitants.

Besides universalization, Unasur’s priorities include issues such as human resources, access to medication, social determinants of health and surveillance. Currently, what is the importance of the regional health integration process and what are its challenges?

Without a doubt, issues related to the aspects of Human Resources are key

Deputy Minister of Health from Bolivia, Martín Maturano, opened the workshop about management and financing health systems

Unasur support is very important to advance towards a universal system, says the Bolivian Vice MinisterMartín Maturano, Vice Minister of Health of Bolivia, gave an interview to the ISAGS Report

to promoting change, and implementing and applying the universal health system. Regarding this issue, we as government, undoubtedly, have advanced considerably not only in terms of the quantity of human resources incorporated into the entire system, but also in terms of quality required of human resources. In that sense, we have implemented very important programs such as the APS (primary health care) medical residency, for example, which are specialized doctors, holistic, first-class doctors, whose specialty is mainly focused on holistic approaches to medicine, including traditional medicine, interrelationships among all sectors of society and social participation. Such positive experiences will allow us to have adequate human resources, who are especially socially committed to the right to health and to collective health.

One of the most important issues on the global health agenda, in addition to universal access, is the Post 2015 Development Agenda. What is the role of health in sustainable development goals and how can South America influence global discussions?

The Millennium Development Goals have been the indicators devised from the perspective of the currently prevailing social and economic model. I believe that the post-2015 agenda must be based on a holistic view, not only analyzing diseases, but also addressing the social determinants of health, in addition to the balance and harmony with Mother Nature. Otherwise, we will continue with the process of the capitalist system that does not respect the rights of Mother Earth, and undoubtedly, our efforts will have been in vain because the issue of health will continue to be vulnerable because of the environmental imbalance.

“The Post 2015 Agenda must be the based for

the integrality, but also in addressing the social

determinants of health and balance and harmony with

Mother Nature”