EXTERNAL RELATIONS AND PARTNERSHIPS

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. The tasks of the Coordination Group are as follows:

• Sharing information
• Identifying opportunities
• Identifying new leadership areas

Four leadership areas were identified in which the three institutions agreed to collaborate. These areas include national health accounts (NHA), 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.

As of August 2001, three of the four designated work groups: NHA, pharmaceuticals, and disease surveillance have met on a regular basis since early 2000, and drafted plans of action. These plans were then presented to the Coordination Group, and subsequently approved. The Environmental Health Work Group took more time to get organized as there is no group specifically dedicated to environmental health in the two Banks. Loans and analytical work are done at the IDB and the World Bank in all the major areas of environmental health - water and sanitation, urban air and water pollution, and vector borne disease control - but no single group is responsible for environmental health. In spite of this, the first meeting of the Environmental Health Work Group took place at PAHO in May 2001.

		National Health Accounts
		Pharmaceuticals
		Disease Surveillance and Public Health
		Environmental Health

National Health Accounts

Objectives:

1. 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.
2. To support the development of sustainable NHA systems in selected countries of the region.
3. To generate and exchange critical information about resource allocation in the health sector in LAC.
4. To create a sustainable "community of practice" for NHA.
5. To make efficient use of the available financial and technical resources through coordinated actions.

Activities

1. WB and IDB task managers will work with national counterparts to program funds and conduct NHA estimates. A complete set of estimates should be completed by the end of the year 2002.
2. Knowledge Generation, Management and Dissemination: Developing one-time estimates and on-going NHA systems provide direct benefits to individual countries, and therefore the use of loan resources is justified. However, there are a set of activities-such as comparative studies, regional conferences, database creation and maintenance, and dissemination-that provide benefits to the region as a whole, and yet are unlikely to be funded by individual countries. These activities lend themselves to coordinated, externally financed regional actions.
3. Institutionalization of National Health Accounts Systems.
4. Coordination and Outreach.

Pharmaceuticals

Objectives

1. To collaborate on priority areas in the pharmaceutical sector that comprise existing working programs
2. To build mechanisms for knowledge-sharing between PAHO, the World Bank, and the IDB and their clients
3. To promote lending practices and policies that improves access to good quality drugs in Latin America and the Caribbean

Activities

1. Develop a toolkit for managing pharmaceutical activities in health investment projects
2. Develop a pharmaceuticals clearinghouse in Latin America and the Caribbean
3. Carry out analytical and advisory work (developing a procurement model for Brazil, develop a common template for a sector study using preliminary database on Peru)
4. TRIP (Trade Related Aspects of Intellectual Property Rights) study: Study TRIPS, supported by a multi disciplinary team, who will determine the potential impact of TRIPS on access to drugs in LAC, and provide an overview of the status of each country in terms of compliance
5. Pharmaceutical training - hands on and distant learning initiatives: develop a module on the economics of pharmaceuticals (regulation and pricing models, standard setting & enforcement, price regulation, impact of regulation on innovation, and cross border effects of parallel trade)
6. Training on Good Manufacturing Standards (GMS) with PAHO & FDA including testing procedures, pharmacopoeia)
7. Improving transparency in pharmaceutical procurement by governments - build a database on pharmaceutical prices, price comparison study, and assessment of findings
8. Conduct a regional conference on pharmaceuticals between development agencies, government officials, and the private sector

Disease Surveillance and Public Health

Objectives

1. To collaborate in strengthening regional surveillance of communicable diseases, including laboratory capacity.
2. To collaborate in developing non-communicable diseases and risk factors behavior surveillance in the Region.
3. To promote the utilization of common methodology on surveillance and utilization of standard instruments between the three institutions and among the countries.

Activities

1. Prepare a toolkit for formulating projects to strengthen public health surveillance.
2. Prepare protocols on epidemiological and laboratory surveillance of communicable diseases, and assessment of surveillance systems.
3. Develop, implement and strengthen non-communicable and behavioral risk factor (BRF) surveillance.
4. Organize sub-regional meetings to present the diseases surveillance and control component of the Shared Agenda.

Environmental Health

This work group is preparing objectives to address water and sanitation, air quality, and solid wastes.