XXXVIII Meeting of The PAHO Directing Council and Special Meeting of Health Sector Reform

Abstracts and Reports

444

XXXVIII

Meeting of the

PAHO Directing

Council and

Special Meeting on Health Sector Reform

The XXXVIII Meeting of the Directing Council of PAHO was held at the Or- ganization’s Headquarters in Washing- ton, D.C., from 25 to 30 September 1995. In fulfillment of a mandate arising from the Summit of the Americas (Miami, De- cember 1994), part of the Directing Coun- cil meeting was devoted to the discussion of health sector reform in the Region.

Representatives of 38 Member Govern- ments, Participating Governments, and Associate Members of PAHO attended the Directing Council meeting.’ Observ- ers were present from over 50 govern- mental, intergovernmental, and nongov- ernmental organizations. In addition, the Special Meeting on Health Sector Reform drew a number of invited participants representing the finance, planning, and social security sectors in the countries.

Dr. Aida Moreno de Rivera, Minister of Health of Panama, was elected Presi- dent of the Council. The two Vice Pres-

‘Argentina, Bahamas, Barbados, Belize, Bolivia, Brazil, Canada, Chile, Colombia, Costa Rica, Cuba, Dominica, Dominican Republic, Ecuador, El Sal- vador, France, Grenada, Guatemala, Guyana, Haiti, Honduras, Jamaica, Mexico, Netherlands, Nica- ragua, Panama, Paraguay, Peru, Puerto Rico, Saint Kitts and Nevis, Saint Lucia, Saint Vincent and the Grenadines, Suriname, Trinidad and Tobago, United Kingdom, United States of America, Uru- guay, and Venezuela.

idents were Dr. Joaquin Monasterio, Minister of Health of Bolivia, and the Honorable Peter Phillips, Minister of Health of Jamaica. Ms. Mary Lou Valdez of the United States of America served as the Rapporteur.

The opening session featured welcom- ing remarks by PAHO’s Director, Dr. George A. 0. Alleyne, and by Dr. Donna E. Shalala, Secretary of Health and Hu- man Services of the United States, on behalf of the host country. Dr. Hiroshi Nakajima, Director-General of the World Health Organization, also addressed the Council, underscoring the ever-more- complex health needs to which WHO and the Regional Offices are being asked to respond in an era of shrinking resources.

The Council held 11 plenary sessions, 3 of which served as a forum for the dis- cussion of health sector reform. Fourteen resolutions were adopted on a variety of administrative, budgetary, and policy matters. Some of the issues addressed are highlighted below.

Budget of the Pan American Health

Organization

for 1996-1997

A budget proposal for 1996-1997 to- taling US$248 372 000 was presented to the Council for its consideration. That amount represents a 1.7% increase over the 1994-1995 budget (no increase in WHO

regular funds and a 2.5% increase in PAHO regular funds). Numerous dele- gations expressed their support for the Organization’s efforts to hold down spending while striving to continue to meet critical needs. The Delegation of the United States of America reported with regret that its Government could not sup- port a budget that contained even a mod- est increase, given the likelihood that Congress would not appropriate the full amount needed to fund the U.S. contri- bution to the budget proposal. A reso-

lution (CD38.R3) approving the PAHO budget as proposed was adopted by a vote of 28 to 1.

Elimination

of Measles in the

Americas

The Directing Council approved the Plan of Action for Measles Elimination in the Americas by the Year 2000 (Resolu- tion CD38.R6). The plan calls for a re- gional initiative lasting five years (1996- 2000) at a cost of approximately US$ 53 million, of which some $7 million will come from PAHO and WHO regular budgets and voluntary funds. These re- sources will complement an estimated $650 million to be invested by the coun- tries themselves in their national immu- nization services.

Great success has already been achieved in some countries and subregions in low- ering the incidence of measles through national campaigns. Measles cases in the Region in 1994 were at an all-time low. Nevertheless, the number of susceptible children grows yearly because even when

the recommended minimum coverage

level (95%) is reached, some children are not being vaccinated, and because some vaccinated children do not become im- mune. For these reasons, the measles elimination strategy calls for periodic “catch-up” campaigns to reduce the pool of susceptibles and avoid outbreaks.

Careful fever and rash surveillance and aggressive outbreak response are also in- tegral components of the plan.

In the resolution, the Directing Council urged all Member States to adopt the strategies outlined in the Plan of Action and to allocate the necessary resources. It also requested that the Director make every possible effort to secure the inter- national resources needed to support na- tional activities.

Elimination

of Congenital

Syphilis

in the Americas

The Council reviewed the Plan of Ac- tion that deals with eliminating congen- ital syphilis as a public health problem in the Americas (see the report on p. 364). The Member States were urged to adopt the plan’s strategies and provide funding for its implementation (Resolution CD38.RB). The Director had reported at the 116th Meeting of the Executive Com- mittee in June that it was unlikely that funding at the regional level would be available for a new initiative, given the constraints of the 1996-1997 budget.

Acquired Immunodeficiency

Syndrome (AIDS) in the Americas

Much of the discussion of this topic centered on the relationship between regional efforts to fight AIDS and the Joint United Nations Program on AIDS (UNAIDS), which will begin operation in January 1996. Resolution CD38.RlO re- iterated PAHO’s commitment to collab- orate fully with UNAIDS, while the Or- ganization maintains and strengthens its ability to provide technical cooperation with respect to HIV/AIDS and STDs in its areas of expertise. PAHO is also com- mitted to continuing to consult with the other agencies that make up UNAIDS, the organizations of the inter-American system, and other interested agencies to

establish mechanisms to coordinate activ- ities. PAHO will continue to encourage the member countries to combat AIDS- which is fundamentally a health prob- lem, but one that has implications for many sectors of society-with multisec- toral participation, efficient investment of national resources, strong governmental leadership, and the technical guidance of the health sector.

New, Emerging, and Re-emerging

Infectious

Diseases

This item was included on the Direct- ing Council’s agenda as a result of dis- cussions in the Forty-eighth World Health Assembly in May 1995 and a subsequent request by PAHO’s Executive Commit- tee. ,The threat posed by these diseases has received increasing attention in re- cent years in the wake of the appearance of significant new pathogens, such as HIV, and the re-emergence of old diseases, such as cholera and dengue hemorrhagic fever.

Health Sector Reform: Equitable

Access to Basic Health Services

The Special Meeting on Health Sector Reform had the following objectives:

l To establish a regional framework for

health sector reform through a con- sensus among national govern- ments, international organizations, and bilateral agencies;

The representatives of the countries agreed on the importance of this topic, many of them citing the dengue out- breaks in Central America and the Ca- ribbean as a vivid example of the need to do more to prevent and control infec- tious diseases. The Council reviewed the Regional Plan of Action that has been prepared by PAHO to provide guidance to the countries in elaborating national plans and addressing specific problems. In Resolution CD38.Rl2, it recom- mended that the Member Governments strengthen their infrastructure for sur- veillance of infectious diseases, dissemi- nate more information on these diseases to health personnel and to the general public, and promote applied research on rapid diagnostic methods, epidemiology, and prevention. For its part, the Secre- tariat was requested to promote the mo- bilization of resources from a variety of sources, to foster the establishment of in-

. To define the objectives and mech- anisms for regional monitoring of the progress of national plans and pro- grams for health sector reform, in- cluding the role of PAHO in this process; and

l To plan the strengthening of and ex-

ternal support needed for an inter- American network to share knowl- edge and experiences on health sector reform among government authori- ties, private sector representatives, NGOs, researchers, and donors.

To prepare for this meeting, PAHO, the Inter-American Development Bank, and the World Bank had organized an inter-agency working group which also included participants from the Organi- zation of American States, the Economic Commission for Latin America and the Caribbean, the United Nations Chil- dren’s Fund (UNICEF), the United Na- tergovernmental mechanisms to facilitate coordinated action among the countries, and to encourage implementation of the Regional Plan of Action to support the activities of the Member Governments, as resources permit. The Council also asked that a technical task force be es- tablished immediately to study the fea- sibility, timeliness, and appropriateness of drawing up a hemispheric plan for the eradication of the

Aedes

tions Population Fund (UNFPA), and the United States Agency for International Development. The group met several times and also held consultations with health authorities of selected countries. Based on these meetings and consulta- tions, it drafted a document to serve as the basis for discussion at the Special Meeting on Health Sector Reform (“Eq- uitable Access to Basic Health Services: Toward a Regional Agenda for Health Sector Reform”; Document CD38/18, Rev. 1, Annex B). In addition, each Member State was asked to prepare a report on the principal problems facing the health sector and the reforms that had already been implemented or were planned. The available reports were distributed to all participants during the meeting.

The meeting consisted of an opening session at which representatives of the sponsoring agencies made formal state- ments, four panel discussions, and a closing discussion during which a reso- lution was adopted. The four panels dealt

with options for reforming health care organization, options for reforming health care financing, the process of national health sector reform (e.g., consensus building, identification of inequities, time frame, approaches, and regulatory is- sues), and monitoring and external co- operation in support of national reform processes. Participation by the Member Governments in all the discussions was intense.

The Special Meeting ended with the adoption of Resolution CD38.Rl4, which called on the Member Governments to give priority to their national health sec- tor reform processes and share their ex- periences; urged cooperation agencies to broaden their support for health sector reform, bearing in mind the particular characteristics of each country; and re- quested the Director to continue working with all parties to develop a process for monitoring health sector reform in the Americas and to coordinate establishment of a network for information exchange.

Elimination

of Congenital Syphilis

Congenital syphilis is a serious but pre- ventable disease that affects between 160 000 and 240 000 newborns in the Re- gion each year. 1 Unlike HIV and other viral sexually transmitted diseases (STDs) that infect neonates, congenital syphilis can be prevented or treated effectively in

Source: Pan American Health Organization. Plan of action for the elimination of congenital syphilis. Washington, DC: PAHO; 2 May 1995. 17 pp. (Doc- ument CE116/14).

‘Estimates of congenital syphilis cases are based on currently available syphilis seroprevalence data; over 90% of the reported prevalence rates are between

364 Bulletin of PAHO 29(4), 2995

utero. The timely diagnosis and treat- ment of pregnant women and the avoid- ance of reinfection, in addition to inter- ventions to prevent primary infection, are important tools in this process.

The occurrence of congenital syphilis can be considered a sentinel health event because it reflects failure of both disease