LOOKING BACK ON ONE YEAR IMPLEMENTING THE SHARED AGENDA FOR HEALTH IN THE AMERICAS
August 2, 2001
A Shared Agenda for Health in the Americas was signed by the Pan American Health Organization (PAHO), the World Bank, and the Inter-American Development Bank on 22 June 2000. The implementation of this Shared Agenda is overseen by an inter-agency Coordination Group composed of one representative from each of the three institutions who meet on a monthly basis. Four leadership areas were identified in which the three institutions agreed to collaborate. These areas include national health accounts, pharmaceuticals, disease surveillance, and environmental health. Each of the three institutions identified focal points in the four leadership areas who agreed to form working groups that would elaborate a work plan for collaborative efforts in each designated area.
The Shared Agenda initiative has been well received in the international community. This warm reception has been expressed repeatedly in personal exchanges and in public forums, such as the recent Summit Implementation Review Group meeting of the Summit of the Americas. International partners are particularly interested in the reflection of this initiative at country level where they see an important role for IDB, PAHO, and the World Bank in bringing the international community together in a coordinated way to support the health sector development of a specific country. UN sister agencies have explicitly expressed interest in joining the Initiative.
On the occasion of the first anniversary of implementation of the Shared Agenda for Health in the Americas, the following is a review of what has been planned and accomplished at the level of the four work groups:
NATIONAL HEALTH ACCOUNTS (NHA) WORK GROUP
In the area of National Health Accounts (NHA), it was agreed to track spending on health services by individuals, governments, and others, as they have become an essential tool for informed debates of health policy.
The NHA Work Group developed the following objectives for its first year of activity:
- To generate estimates of sources and uses of financial resources in the health sector (national health accounts, or NHA) for most countries in the LAC region, as an aid to policymaking.
- To support the development of sustainable NHA systems in selected countries of the region.
- To generate and exchange critical information about resource allocation in the health sector in LAC.
- To create a sustainable "community of practice" for NHA.
- To make efficient use of the available financial and technical resources through coordinated actions.
The NHA Work Group worked with national counterparts in the Region to program funds and conduct national health account estimates. Planned activities include comparative studies, regional conferences, database creation/maintenance, as well as dissemination. Coordination and outreach was planned with the overall aim of institutionalizing national health account systems. The NHA working group reached out to include USAID because of its extensive experience and important role in promoting health accounts in the region.
As far as coordination was concerned, the NHA working group has met regularly throughout the year to produce and update a matrix of countries in the region regarding the status of their health accounts, whether there are existing initiatives, and sources of existing or potential international financial support. As a result, duplication of effort has been avoided in several circumstances, and countries were identified that were not being addressed by any of the participating agencies.
To propagate guidelines for estimating national health accounts, the work group organized a translation into Spanish and publication of the OECD Manual for "System of National Accounts". IDB provided the financing while PAHO did the Spanish translation. The translated manual has been submitted for a technical review through the OECD in Europe. Publication is anticipated in September 2001.
The NHA Work Group created a web-site (http://www.lachealthaccounts.org) dedicated to National Health Accounts in Latin America and the Caribbean to serve as a central clearinghouse for information on health accounts by sharing methodologies, data, and research in using health account information. This can also serve as a point of contact for NHA experts throughout the world. With the help of World Bank financing, a prototype of this web-site has been created, and its launching is planned for September 2001. PAHO has translated the web-site into Spanish and has made available its database on health accounts to the web for dissemination.
A course on health accounts was provided to the Caribbean by combining IDB Technical Cooperation and PAHO resources through the "Red Bobadilla". This collaboration resulted in a Caribbean-wide steering committee meeting in March. It was decided to follow up with a training course and workshop on health accounts in September.
Several countries are now embarking on health account work with support from one or more of the participating institutions, namely: Panama, Belize, Argentina, and Brazil. There are also initial discussions with Paraguay and Chile.
Discussions are under way for financial support of NHA projects with the Governments of Norway and Sweden.
PHARMACEUTICALS WORK GROUP
In the area of pharmaceuticals, it was agreed to work on improving the regulatory framework for pharmaceuticals, knowledge by consumers and retailers about the use of pharmaceuticals, and access by the poor to good quality essential drugs. The pharmaceutical work group developed a work plan along the lines of the following objectives:
- To collaborate on priority areas in the pharmaceutical sector that comprise existing working programs;
- To build mechanisms for knowledge-sharing among PAHO, the World Bank, and the IDB and their clients;
- To promote lending practices and policies that improve access to good quality drugs in Latin America and the Caribbean.
The first year of implementing the Shared Agenda resulted in a number of positive outcomes in the pharmaceutical area including improved communication, knowledge-sharing, coordination, and technical cooperation. In May 2000, technical co-operation on pharmaceutical policies between IDB, PAHO, and the World Bank was discussed during a World Bank mission in Costa Rica. In Peru, communication on pharmaceutical policies was also analyzed between the World Bank and PAHO. In Panama, there was a knowledge-sharing session between the World Bank and PAHO at a meeting of PAHO Essential Drugs Advisers. In May 2000, IDB, PAHO, and the World Bank met to discuss how best to improve coordination on pharmaceutical policies with government officials from the Dominican Republic. In the same month, similar meetings took place between PAHO, World Bank, and Fiocruz in Brazil.
PAHO continues its work in drug regulatory harmonization within the context of the Pan American Network for Drug Regulatory Harmonization. The working groups on Bioequivalence and Good Manufacturing Practices are focusing their activities in developing regional educational seminars. On the other hand, the group on Good Clinical Practices, Drug Classification and Counterfeit are studying the situation in each of their field as a starting point for developing indicators to monitor changes and harmonized agreements.
As part of this initiative, a non-governmental organization in official relations with PAHO, the United States Pharmacopoeia invited the IDB, PAHO, and World Bank for a study tour at their Rockville, MD headquarters in January 2001.
The three institutions collaborated with academia, NGOs and the private sector in holding a special seminar entitled "A Multisectoral Approach to Improve Ethical Business Practices: A Contribution to Improving Access to Medicines in Latin America and the Caribbean". This seminar was held at the Watergate Hotel on 19 September 2000, and resulted in a better understanding of the issues faced in the pharmaceutical sector, such as transparency, accountability, and security management, in minimizing corruption. The three institutions are working with the research-based pharmaceutical industry to address the issue of ethics and its relationship to improving access to health care and medicines. Workshop participants included representatives from governments, multilateral agencies, the private for-profit and not-for-profit sector, and academia.
The work group on pharmaceuticals decided that one way of increasing efficiency and effectiveness of pharmaceutical policies was to develop a "Pharmaceuticals Clearinghouse for the Americas". Two expert meetings were convened in Washington, D.C., and a concept paper has been developed to help make this clearinghouse a reality. An initial launch of a policy and data web-site on pharmaceuticals is expected in September 2001. In addition, the three agencies are collaborating on a study about improving transparency in the pharmaceutical system, financed primarily by the World Bank.
The three institutions involved are preparing an interagency paper in this component of the shared agenda. This paper is intended not only to disseminate each agency's work in pharmaceuticals, but also it will discuss the advantages and opportunities that each institution offers to countries in the area of drugs.
DISEASE SURVEILLANCE WORK GROUP
A plan of action was presented to the Coordination Group in the area of public health and disease surveillance. It was agreed that the three institutions would collaborate to strengthen regional surveillance of communicable diseases, assist in developing capacity to monitor chronic diseases, and help to develop goal-setting for health outcomes.
The Coordination Group approved a plan of action with the following objectives:
- To collaborate in strengthening regional surveillance of communicable diseases, including laboratory capacity.
- To collaborate in developing noncommunicable diseases and risk factors behavior surveillance in the Region.
- To promote the utilization of common methodology on surveillance and utilization of standard instruments between the three institutions and among the countries.
Planned activities included preparing a toolkit for formulating projects to strengthen public health surveillance. It was also planned to prepare protocols on epidemiological and laboratory surveillance of communicable diseases, and assessment of surveillance systems. The work group also agreed to develop, implement and strengthen non-communicable and behavioral risk factor surveillance. Sub-regional meetings will also be organized to present the disease surveillance and control component of the Shared Agenda.
The World Bank prepared and is submitting for review a draft of the "Toolkit for Disease Surveillance";. This will allow task managers of the IFIs, as well as consultants and national specialists, to prepare projects strengthening epidemiological surveillance and response using standardized instruments across the region. A draft of the tool kit to guide Bank staff on best practices in support of national surveillance will soon be ready for final review. This tool kit includes two parts. Part A is a reference document that provides some theoretical concepts about surveillance, as well as knowledge gained through the application of these concepts and the practice of surveillance in developing countries. Part B, the more practical one, explains how to prepare projects to strengthen surveillance systems within the Banks procedures. The final version will be posted on the web.
The concept paper for "HIV/AIDS in Latin America and the Caribbean: A Regional Study" was reviewed on 8 March 2001. The concept paper was distributed to both the IDB and PAHO. The purpose of the study is to assess the capability of countries in the region to manage the HIV/AIDS epidemic. PAHO and IDB also worked together with the Southern Cone countries in a sub-regional effort to improve the identification of health priorities and the setting of targets for each of those priorities. This included the formulation of multi-sector strategies to achieve those targets, with emphasis on health promotion and disease/injury prevention. The three agencies are collaborating at the technical level and will work together on dissemination.
ENVIRONMENTAL HEALTH WORK GROUP
The Environmental Health Work Group took more time to get organized. A continuing problem is that in the two Banks there is no group specifically dedicated to environmental health, although loans and analytical work are done in all the major areas of environmental health – water and sanitation, urban air and water pollution, and vector-borne disease control. The World Bank has prepared a background paper on environmental health for its environment strategy, with technical review and input from PAHO.
On 1 May 2001, the Shared Agenda work group on the environment met at PAHO to discuss a plan of action in this fourth leadership area. It was decided to break the Work Group down further and identify focal points in each of the three institutions for the following areas of environment:
- Water and sanitation
- Air
- Solid Waste
The Environment Work Group will serve as a steering committee for the three focal points and lines of action. Each of the sub-groups has been asked to meet in May and June to identify objectives and activities and proposed a work plan for the second year of the Shared Agenda to the steering committee.
HIGHLIGHTS
When progress to date on the Shared Agenda for Health in the Americas is considered, a number of positive outcomes have been achieved. This is impressive, as this has all been accomplished without creating any additional bureaucracy or allocating additional resources. To highlight just a few:
- For the first time, a Coordination Group of the three institutions meets monthly to share information, discuss strategy, and oversee the four Work Groups.
- The Shared Agenda is also starting to move beyond the headquarters in Washington, D.C. and country level initiatives between the three institutions are also taking place in the Dominican Republic, Nicaragua, and Peru.
- Coordination among the three institutions has resulted in real progress in achieving the goals of having national health accounts in all LAC countries within three years. Visit the web-site http://www.lachealthaccounts.org for lots of valuable information in English and Spanish.
- Increased coordination with the pharmaceutical industry in addressing corruption and governance issues in the pharmaceutical sector, moving forward on a strategy for a pharmaceutical clearinghouse.
- Extended sharing of expertise in strengthening surveillance programs in LAC through the preparation of a toolkit.
- Superior collaboration on medical waste policies and environmental assessments for health projects.
- Excellent technical cooperation opportunities in immunization, AIDS, environment, medical waste, etc.
This initiative between the IDB, PAHO and World Bank has resulted in a more efficient deployment of the comparative advantages of the three institutions involved to the benefit of the countries of the Western Hemisphere.
In the second year of implementation, we will look to consolidate the work of the four work groups, and to actively continue pursuing the options for expanding this regional cooperation down to the country level as well.
The anniversary of the initiative will be celebrated on 20 September with a half-day meeting organized by the coordination group, involving participants of all four workgroups and broader audiences of each institution. The purpose of the meeting will be to take stock of the first year’s operations, to discuss the priorities and opportunities for collaboration during the second year, and to share draft work plans.
On 20-21 April 2001, the Third Summit of the Americas convened in Quebec City, Canada. One of the 32-point Declaration calls upon Interamerican and multilateral institutions to establish greater coordination for support to the implementation and follow up of the Plan of Action. Leaders refer to the needs for "…technical cooperation in health, in a manner consistent with the Shared Agenda for Health in the Americas signed by PAHO, the IDB, and the World Bank". Leaders expressed concern with growing inequity in the Hemisphere, that manifests itself in unequal access to quality education, avoidable health disparities, lack of economic opportunity, and limited personal security. Health development can play a pivotal role in the region, since it is a prerequisite for human development and the achievement of economic and political goals. The four areas highlighted in the Health item of the Plan of Action where continued support is necessary, included: equity-oriented health sector reforms, combat of communicable diseases, particularly HIV-AIDS, reduce risks for communicable diseases, and improve connectivity and the sharing of health information. |
The members of the Coordination Group for the Shared Agenda include the following: Inter-American Development Bank Pan American Health Organization World Bank The tasks of the Coordination Group are as follows:
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For additional information on the Shared Agenda for Health in the Americas you can also visit the World Bank web site and the IDB web site.