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Strategic and Programmatic Orientations, 1999–2002 2003 Pan American Health Organization Strategic and Programmatic Orientations, 1999–2002 Annual Report of the Director – 2003 We are committed to health for all, to the primary care strategy, to health promotion, and to the reduction of inequities and social exclusion. Mirta Roses Periago Inauguration Speech as Director of PAHO Strategic and Programmatic Orientations, 1999–2002 strategies for reducing exclusion, and support the countries in their efforts to Health improve collective insurance systems. Systems and These activities were carried out within the framework of cooperation between PASB and the Government of Sweden Services through the Swedish Agency for Inter- national Development (SIDA) and be- Development tween PASB and the International Labor Organization (ILO). The former effort supported Latin American countries in “Public Health in their efforts to address social exclusion in health and to promote social protec- the Americas” tion strategies. Projects were carried out in Ecuador, the Dominican Republic, Initiative Guatemala, Honduras, Mexico, Para- guay, and Peru. In 2002, the main lines of work in the area of health policies and systems were In order to support a diagnosis of the the extension of social protection in exclusion situation, a research protocol health; the reorientation of sector re- was developed to define social exclusion forms; the strengthening of national in health and identify its leading causes health authorities’ capabilities to provide and characteristics. The Dominican Re- leadership and guidance; and health eco- public, Ecuador, Guatemala, and Para- nomics, financing, and regulation. Tech- guay have already completed their diag- nical cooperation aims at ensuring that noses by applying the protocol, and these processes are firmly grounded in the Honduras, Mexico (D. F.), and Peru have development, execution, and evaluation begun the process. of national health policies and objectives. Ecuador and Guatemala launched a social dialogue to create awareness of Extension of Social the problem of exclusion in health, its extent, and the need to reduce or elimi- Protection in Health nate it. This will help promote consensus The strategy for extending social pro- among social actors on the most appro- tection in health strengthens Member priate methods and mechanisms for for- States’ capabilities to expand access to mulating policy and increasing social health care through activities designed protection in health. The most impor- to generate information on the extent of tant result of the social dialogue will be exclusion to health care in the countries, the development of a concerted action increase social dialogue as a way to plan. A protocol to implement social di- reach consensus on the most appropriate alogue is being designed in support of 21 Annual Report of the Director – 2003 Pan American Health Organization countries that have agreed to participate Strengthening the in this activity. National Health Health sector reforms designed to im- Authority’s Leadership prove collective insurance systems were supported in Ecuador and Peru. The ob- and Guidance Role jective is to strengthen the health system’s One of the most important challenges capacity to provide social protection to its in carrying out health sector reforms is citizens, regardless of their ability to pay, the need to strengthen the health author- through mechanisms aimed at the cre- ity’s leadership and guidance role. The ation and extension of protection systems health authority’s main responsibilities and the promotion of a more integrated include the performance of essential and appropriate regulatory system that public health functions, such as State’s will be of use to the entire health sector, responsibility over health at the central, and not just the public sector. intermediate, and local levels. This re- quires the development of tools for as- In addition, through their joint work to sessing the performance of those func- extend social protection in health, PASB tions. These tools identify strengths and and ILO have been working since 1999 weaknesses in the practice and infra- to launch a regional initiative promoting structure that support the essential func- the systematic diagnosis of exclusion in tions, thereby reinforcing the institu- health, identifying solutions, and taking tional capacity to improve public health the necessary steps to support Member operations. The Pan American Sanitary Bureau States in their efforts to minimize social worked with 41 countries and territories exclusion and strengthen institutional The health sector’s transformation re- to assess the performance of 11 essential capacity to extend health protection. The quires a clear determination of its scope public health functions. Among other proposal includes the development of and function, as well as the need to im- benefits, the assessment resulted in training methodologies and tools, re- plement the concepts on which it is improved training of the health force and search, and the exchange of successful based. To accomplish this, the Bureau better professional practices. experiences and recommendations. cooperated with 41 countries and terri- tories to assess the performance of 11 es- One of the most important support sential public health functions. This ex- measures for these activities is the man- ercise provided the basis for evaluating date that Member States gave PASB and the national authorities’ performance in the ILO Directors in 2002, requesting exercising public health functions and that they disseminate the conceptual in developing an agenda for improving basis of exclusion in health and the means them through national and international for combating it throughout the countries cooperation. of the Region. Both institutions also were asked to work with Member States to pro- The assessment carried out within the mote social dialogue in this regard and to framework of the “Public Health in the specify the cooperation mechanisms nec- Americas” initiative yielded the follow- essary to support the process. ing immediate results: 22 Strategic and Programmatic Orientations, 1999–2002 • Public health and its essential func- access to effective and efficient health tions in the Americas were defined. services. The interest in assessing the • A framework for evaluating the per- health systems’ performance increased formance of essential public health the pressure on them to strengthen their functions applicable to all countries capacity. To this end, the initiative’s sec- of the Americas was established; it ond phase, which began in 2002, focused respected the organizational struc- on the development, redefinition, and ture of each country’s own health implementation of new tools and on the system. formulation of methodologies for sup- • Public health practice was assessed porting the countries in strengthening in each country, gauging the extent their national capacities. to which essential public health functions are performed. To monitor the progress of reforms, 33 countries participating in the initiative The assessment also yielded other re- have completed the first draft of their sults, which, in addition to strengthening health systems and services profiles; with technical cooperation in the preparation the exception of Canada, Haiti, Suri- of comprehensive development pro- name, and the United States, they also grams, encouraged cooperative activities have completed a second version. A com- among countries and among areas in dif- parative regional analysis of health sector ferent countries. Moreover, the assess- reform progress was concluded. The on- ment led to an ongoing improvement of going monitoring and evaluation process the tool, its implementation at subna- makes it possible to develop national, tional and local levels, the development subregional, and regional progress re- of an analytical framework of the fund- ports on problems identified in the health ing for essential functions, improved sector reform processes, and fosters com- training of the health workforce, and im- parative analyses and the exchange of proved professional practices. The book experiences among countries. Based on Public Health in the Americas was pub- the information obtained with the profile lished; it lays out an innovative theoret- methodology, PASB recently undertook a ical and conceptual reassessment, the second evaluation of the reforms. methodology, and the Regional results of the assessment. The initiative also produced a sectoral analysis methodology that can be used as a guide for the comprehensive and sys- Health Sector Reform tematic analysis of health sector perfor- Initiative in Latin mance and, in turn, promote a solid foun- dation on which to formulate health America sector reform policies and strategies. The The health sector reform initiative in methodology was successfully pilot tested Latin America is designed to support the in Costa Rica, Cuba, Guyana, Nicaragua countries’efforts to reform their health and Paraguay. As a result of these trials sectors so as to promote a more equitable and the contributions of experts, the 23 Annual Report of the Director – 2003 Pan American Health Organization methodology is being revised and ex- Health Economics, panded. A chapter on HIV/AIDS was in- corporated, underlining the urgency of Funding, and strengthening the health systems and Expenditures services to address this pandemic. Technical cooperation in health eco- An investment master plan published nomics and funding was
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