Quarterly Report

QUARTERLY REPORT March – June 2010

BACKGROUND

The Executing Unit of the project “Environmental Health Surveillance System in the Amazon Region” is located within the Permanent Secretariat of the Amazon Cooperation Treaty Organization (ACTO), which functions based on the mandates issued by its eight Member Countries (Bolivia, Brazil, Colombia, Ecuador, Guyana, Peru, Suriname and Venezuela). The Project is financed by the Inter-American Development Bank (IDB) and receives technical cooperation from the Pan-American Health Organization - World Health Organization (PAHO-WHO), the Oswaldo Cruz Foundation (FIOCRUZ), the Association of Amazonian Universities (UNAMAZ) and Oswaldo Cruz Foundation (IEC), among others. Its organizational structure is formed by the Regional Technical Committee, National Project Committees, Frontier Committees and the Interagency Advisory Committee, and is supported by the Ministries of Foreign Affairs of all the Member Countries.

PROJECT OBJECTIVES

The Project aims to adopt a concerted operational and instrumental framework that is compatible with the International Health Regulations, with prioritized indicators and strategies, to institutionalize environmental health surveillance within the national health systems of the Amazon region. In this sense, it seeks to improve decision making capacity within the national institutions (Ministries of Health and other) and coordination with regional institutions to reduce morbidity, mortality and impairments in the population resulting from environmental changes and damages.

COMPONENTS

The Project has three components:

Definition and consensus of the operational framework Identification of regional guidelines and instrumental and diagnostic materials Jointly managed pilot projects of the operational and instrumental framework

3.1 Component 1. Definition and consensus of the operational framework

This component is geared to developing a regional operational framework for Environmental Health Surveillance containing the guidelines, indicators, standards, parameters, protocols and methodologies that exist at the national and international levels, but endowed with the flexibility it needs to be adapted to each country's regulatory framework. The process will require a concerted methodology to define systematization activities and thematic lines of action. This will ensure the development of a consensual public good that can be feasibly applied at the various levels of management.

The initial activity of this component consists in conducting situation assessments of the environmental health surveillance systems in each ACTO Member Country taking into account existing legal instruments and in coordination with health surveillance and information systems and other official information sources. These assessments will be used to establish the Baseline of the Amazon Region's Environmental Health Surveillance Systems and agree upon priorities, areas of action and indicators for environmental health.

3.2 Component 2. Regional instrumental and diagnostic guidelines

This component will consist of identifying and concerting regional guidelines regarding the best procedures to detect and control environment-related diseases and risk factors in the Amazon region. It will also indicate training and capacity-building needs (standardized laboratory techniques, GIS for epidemiological and environmental use, among others) for Member Country human resources by sectors and levels. Efforts will furthermore be coordinated with FIOCRUZ, UNAMAZ and IEC, Brazil, among others.

3.3 Component 3. Jointly managed pilot projects of the operational and instrumental framework

This component will operationally implement the system, and validate and evaluate the instruments and methodologies developed in priority frontier zones (tri or binational) using a participatory, intersectoral, strategic, sustainable and integrated approach, by administrative levels.

It will also promote training for rapid action teams, the healthy environments initiative and environmental education as mechanisms to develop local response capacity to face the environmental risks that threaten the Amazonian population.

EXPECTED RESULTS

The Project will provide an Operational Framework for Environmental Health Surveillance, Regional Instrumental and Diagnostic Guidelines and Best Practices, systematized and disseminated experiences and lessons learned, with the purpose of strengthening the National Health Systems of the Amazon countries in their environmental health components.

ACTIVITIES DEVELOPED

5.1. - Revision of the technical project documents The following materials and documents were examined to determine the Project's integrity, the progress made and the pending tasks and activities: Project Document Annual Operational Plan (AOP) Procurement Plan Minutes of the December Meeting Correspondence sent and received

5.2 Compliance with the Brasilia Workshop Minutes

A Regional Project Start-up Workshop was held in Brasilia on 10-12 December 2009 with the participation of Ambassador Mauricio Dorfler, Executive Director of ACTO, Antonio Giuffrida of the IDB, Diego Gonzales, Mara Oliveira and Teófilo Monteiro of the PAHO Technical Unit for Sustainable Development and Environmental Health and Sergio Portella of FIOCRUZ.

Also present were delegations of the Ministry of Health and Sports of the Plurinational State of Bolivia, Ministry of Health of the Federative Republic of Brazil, Ministry of Social Protection of the Republic of Colombia, Ministry of Public Health of the Republic of Ecuador, Ministry of Health of Peru, Ministry of Health of the Republic of Suriname, and Ministry of Popular Power for Health of the Bolivarian Republic of Venezuela.

The points agreed upon in the meeting were set forth in the Minutes of the Regional Start-up Workshop of the ACTO/IDB project “Environmental Health Surveillance System in the Amazon Region” and are detailed below together with the measures taken in compliance thereof by the Project's Regional Executing Unit (REU) and by the ACTO/PS

Execution: As a necessary first step to formalize the beginning of the project activities, the ACTO/PS will send a note to the Member Countries, when applicable, asking them to renew the appointment of members to the Regional Technical Committee (COTEC) and to communicate the establishment of their National Technical Committees.

ACTO sent two notes to the Member Countries - ACTO/PS 781/2009 of 18 December and 5 March 2010 - requesting their compliance with point above. So far confirmation has been received from Suriname and Brazil, as well as a communication from the Ministry of Health of the Plurinational State of Bolivia that will be formalized by the Ministry of Foreign Affairs. Nevertheless, most of the sectoral health entities of the Member Countries have already named their COTEC Representatives. The REU is insisting informally, and will do so formally (through the appropriate channels), for the countries' official compliance with this agreement.

The ACTO/PS will formally set-up the Interagency Advisory Committee together with the other organizations that are part of the Project and will notify the Member Countries.

The REU sent a note to PAHO requesting the appointment of its representative to the Interagency Committee on April 4 and received an answer on April 20. As such, the Interagency Committed already includes the following official representatives: Dr. Diego Gonzales and Mara Oliveira - PAHO/WHO, Antonio Giufridda - IDB, Dr. Antonio Restrepo - ACTO Health Coordinator, and Dr. Marilyn Aparicio - Head of the Regional Executing Unit, as well as national experts of the ACTO countries.

The REU will be led by a Coordinator, as established in the REU Charter and in the corresponding Terms of Reference.

The new REU began its activities according to the REU Charter and to the specific Terms of Reference.

An agreement was reached to set up a Regional Technical Committee for the Project, subject to the ad- referendum approval of Guyana. A Chair rotation system by inverse alphabetical order of the Countries was agreed upon for the COTEC meetings, beginning with the Bolivarian Republic of Venezuela.

According to this last point and considering that the REU Charter instructs the REU to present quarterly reports, with the onset of the COTEC activities it was deemed important to hold a distance work session with the participation of all the COTEC members. For this meeting (scheduled for June 9) the COTEC members were invited to go to their national PAHO offices to participate in the session according to the following agenda

Coordinator's Report on the activities developed so far. 10-minute report per country representative on the establishment of the National Committee and on the List of Experts to be consulted in the different stages of the project. Analysis of the Terms of Reference for the country consultancies and agreement on future actions.

However, the meeting was postponed at the request of the Bolivarian Republic of Venezuela through note N. °II. 2,B11.E3 of the Venezuelan Embassy in Brasilia.

The Countries tasked the REU with obtaining the support of the Interagency Advisory Committee and experts with adequate knowledge and experience to develop the Project's conceptual framework. Contact was also recommended with other entities that address the topic such as FIOCRUZ, IEC, UNAMAZ, the European Union and the Institute for Research and Development (IRD), among others.

Following this instruction the REU organized an internal work session on June 10 in Brasilia with the participation of PAHO/WHO, FIOCRUZ, IDB. UNAMAZ was also invited but could not participate due to a previous engagement. One of the main goals was to identify areas of cooperation for the project partners. These were defined as follows: FIOCRUZ

Training and exchange. Immediate courses can be proposed for two levels (community and post-grad). Development of technology projects, integration with UNAMAZ, editing and publishing. Will seek opportunities for joint meetings in consonance with the Pan-Amazonian Network agenda to maximize existing financial resources and take advantage of the fact that the players involved are similar or the same. (Rio Branco and Suriname)

PAHO/ WHO Brazil

Despite lacking funds, it offers its technical capacity (HR), knowledge and documents such as the "Health in the Americas" report, the Indicators Development Process and the approved "Country Profiles" for Health and Climate Change, among others. It also makes available PAHO management tools such as the Illuminate System, the List Serv Network Creation Tool and Web 2.0, among others.

5.3 Contact with the COTEC Country Representatives

Documents were examined and the personal data of COTEC members was updated, including e-mail addresses, telephone numbers and other contact data. An up-to-date COTEC list was prepared. The REU began functioning and is maintaining informal contact with the COTEC representatives of each of the Member Countries through phone calls and internet requesting their participation in preparing activities and in the project's joint implementation.

Production of Technical Documents

Work Plan

Preparation of the Work Plan in accordance with the project objectives, background and planned components, as presented to ACTO. The Plan responds to the Terms of Reference, the initial AOP (already approved) and the Minutes of the meeting held in December 2009 with the COTEC members. However, it still needs to be approved in the regional workshop being organized for Caracas.

List of Capacity-building Activities

Preparation of the list of capacity-building activities that will be required by the project and submitted to the COTEC members and Foreign Affairs Ministries of the ACTO Member Countries for consideration.

Terms of Reference

The Terms of Reference for the first country consultancies were formulated. These will be responsible for preparing the Inventory for the construction of a baseline regarding Environmental Health Surveillance Systems in the Amazon Region, in consonance with the project objectives, background and planned components, as submitted to the countries through Verbal Note ACTO/PS 304/2010 of 25May10.

With these Terms of Reference the Member Countries and the REU will begin the tasks and activities of Component 1.

Operational Plan Progress has been made in preparing the new Project Operational Plan to be analyzed and approved in the Regional Workshop in Caracas. Administrative Meetings

With Ambassador Mauricio Dorfler and Mr. Flávio Sotomayor to get to know the functioning and characteristics of ACTO as well as the project's background.

With Ambassador Mauricio Dorfler and Mr. Antonio Restrepo to meet the new ACTO Health Coordinator and begin joint activities.

Meeting to review the Work Plan with Mr. Antonio Giuffridda of the IDB, to continue the technical and administrative activities for the execution of the project, and to present the progress made.

With Leise Villela de Toledo of the IDB regarding the training course on IDB financial and administrative procedures to advance the project.

With PAHO/WHO environmental health professionals in Brazil to advance the project, negotiate technical support and coordinate the preparatory workshops.

Informal meeting with Dr. Carlos Felipe Almeida D’Oliveira of the Brazilian Ministry of Health, who is driving transboundary projects with various Member Countries, with a view to developing synergies.

Meetings with environmental health surveillance professionals of the Brazilian Ministry of Health to coordinate project-related activities.

Meeting with the project's administrative support professional Mr. Napoleão Fagundes to begin its financial activities.

5.5 Organization and Coordination of Project Activities

Organization and coordination of the First Internal Project Workshop held on 10 June 2010 with representatives of the IDB, the Brazilian Ministry of Health, FIOCRUZ, PAHO/WHO and ACTO health professionals.

Organization and coordination of the First Distance Workshop programmed for 9 June 2010 at PAHO/WHO and postponed at the request of Venezuela.

Organization and coordination of the Regional Workshop for the Approval of the Work Plan, the AOP, and other project documents, to be held in Caracas, Venezuela, on a date to be defined.

5.6 Participation in Events

Participation in the World Health Day 2010 on April 7 at the PAHO/WHO Brazil Headquarters.

Participation in the workshop “Environmental Health in Brazil - State of the Art and Prospects” (8Apr10)

Participation in the workshop “PAHO/WHO Web 2.0" (8Jun10)

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Selected based on pre-defined criteria (representativity, installed capacity, organizational development, national commitment).

ENVIRONMENTAL HEALTH SURVEILLANCE SYSTEM IN THE AMAZON REGION Project ACTO/IDB ATN/OC-10774-RG 2010

June 2010 – Marilyn Aparicio Effen. Coordinator PVSA. ACTO / IDB