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December 2008 Edition

48TH PAHO DIRECTING COUNCIL
Ministers Commit to New Action in Health


(L. to r.) PAHO Assistant Director Socorro Gross, WHO's Wim Van Lerbeghe, PAHO Director Mirta Roses, and 48th Directing Council President José Gomes Temporão, of Brazil. Photo by DavidSpitz/PAHO

Ministers of health and high level delegates from countries throughout the Americas gathered at Pan American Health Organization (PAHO) headquarters in late September for the 48th meeting of PAHO's Directing Council.

The ministers pledged new health action in a number of priority areas, including diabetes, cervical cancer, newborn health, vector control, adolescent health, and blood safety (see boxes below).

A special guest at this year's meeting was World Health Organization (WHO) Director-General Margaret Chan. She applauded PAHO's efforts to focus attention on primary health care and the benefits of health systems organized around its basic principles.

"The health problems you will be addressing during this session take us back to the basics, back to the values, principles, and approaches of primary health care," Chan said. "Primary health care looks more and more like a smart way to get health development back on track."

Among other actions, the 48th Directing Council endorsed:

  • The elimination of river blindness (onchocerciasis) in the region's six endemic countries (Brazil, Colombia, Ecuador, Guatemala, Mexico, and Venezuela) and the interruption of transmission of the O. volvulus parasite by the year 2012. The ministers pledged support for the Onchocerciasis Elimination Program for the Americas (OEPA), which has already dramatically reduced river blindness through mass use of the drug ivermectin.
  • Stepped-up efforts to prevent violence and injuries and promote safety, including efforts in the health sector but also involving government, civil society, law enforcement, and the judicial sector in prevention.
  • The improvement and harmonization of health information systems in PAHO member countries through the Regional Plan of Action for Strengthening Vital and Health Statistics.
  • Consideration of ratification by each PAHO member country of the WHO Framework Convention on Tobacco Control (FCTC) and implementation of its six MPOWER recommendations for tobacco control.
  • Implementation in the PAHO region of WHO's Global Strategy and Plan of Action on Public Health, Innovation, and Intellectual Property,which promotes research, technological innovation, and technology transfer in the pharmaceutical, scientific, and manufacturing sectors.

PAHO Director Mirta Roses presented the ministers her annual report, which highlighted PAHO's support for strategic health planning in its member countries and its own Strategic Plan 2008-2012.

Also during this year's meeting, the Pan American Health and Education Foundation (PAHEF) honored Cesar Victora of Brazil with the 2008 Abraham Horwitz Award for Leadership in Inter-American Health, for his outstanding dedication and contribution to maternal and child health in the Americas. The 2008 PAHO Award for Administration went to Hugo Villar Teijeiro of Uruguay for his work in decentralization of health systems management and training of human resources to manage health systems at the national and regional levels.

The Directing Council meets every year to discuss the region's top health challenges and strategies for addressing them.

 

 

 

Tackling Diabetes

The number of people living with diabetes in Latin America and the Caribbean is expected to more than double--from 13.3 million to 32.9 million--between 2000 and 2030. Diabetes is already the leading cause of death in Mexico and affects one in 10 people in a number of the region's cities, where changing dietary and activity patterns are most pronounced.

Diabetes is strongly related to modifiable risk factors including obesity and overweight, physical inactivity, and high-calorie diets with poor nutritional value. Contributing contextual factors include market forces, changing demographics, technological advances, poor government policies, and lack of awareness and action by civil society.

Taking these into account, the 48th Directing Council endorsed a PAHO plan to tackle the diabetes epidemic with prevention and management measures at both the individual and population levels. It calls for public policies that help make the healthy choice the "easy choice," for example, providing opportunities for physical activity and healthier eating in schools and the workplace, mandating stricter nutritional labeling, and developing guidelines on responsible marketing of food to children and adolescents.

The plan also calls for better diabetes surveillance and monitoring and adequate funding for primary health care programs that ensure early detection and proper treatment, particularly control of complications involving the kidneys, the feet, blood pressure, blood sugar, and cholesterol.


Fighting Cervical Cancer

Women in Latin America and the Caribbean are seven times more likely to die of cervical cancer than women in North America, where screening programs based on the Pap smear have dramatically reduced rates of the disease. The 48th Directing Council approved a new strategy that addresses problems that have kept cervical cancer rates relatively high in a number of PAHO member countries. These include limited access to diagnostic and treatment services, low awareness of the importance of screening, and generally poor coverage, organization, and follow-up in screening programs.Also important are gender issues, particularly sociocultural factors that affect women's ability to demand and utilize cervical cancer services.

The PAHO strategy calls for upgrading prevention and treatment programs and integrating them into community-based primary health care services. It also calls for expanding the use of alternative screening technologies. These include direct DNA testing for the human papillomavirus (HPV) and the "screen and treat" approach, which uses visual inspection with acetic acid (VIA) followed by immediate treatment of precancerous cells. In PAHO-supported studies,"screen and treat" has proven as or more effective than the Pap smear when used in low resource settings.

The strategy also calls for social communication efforts to raise awareness of the importance of screening and urges countries to examine the cost-effectiveness of adopting newly available HPV vaccines.


Saving Newborn Lives

Child (under age 5) mortality in Latin America and the Caribbean has declined significantly in the past 10 years, but reductions in newborn mortality have not kept pace. Every year in the region, more than 190,000 babies--over 500 per day--die during their first 28 days of life. PAHO's Directing Council approved an action plan to save newborn lives by ensuring essential health care for mothers and children throughout the life cycle, including adolescence, preconception, pregnancy, delivery, and childhood.

The plan calls on PAHO member countries to develop national strategic plans for improving newborn health and to ensure that, by 2012, at least 80 percent of births are attended by skilled caregivers. The PAHO plan calls on countries to improve maternal, newborn, and child health services by upgrading standards of care and through training and education of health workers. It also urges countries to promote universal access to child and maternal care through insurance mechanisms, community-based programs, and strong referral systems, with special attention to vulnerable groups and intercultural approaches. At the community level, the plan calls for promoting basic good health practices, including proper nutrition for mothers, immunization against tetanus, clean and safe deliveries, early recognition of danger signs, exclusive breastfeeding, safe sex, protection against violence, prevention of early pregnancy, and education of girls.


Managing Disease Vectors

Vector-borne diseases such as malaria, dengue, and Chagas' disease continue to be a public health problem in Latin America and the Caribbean. They disproportionately affect the health of poor and marginalized populations and can become a serious obstacle to local and national development. With climate change and expansion of human settlements into new habitats, the risk of these diseases is expected to increase.

For some of these diseases, particularly dengue and Chagas, vector control is the only means of prevention. Yet in many countries, national vector control programs have been neglected over the years and today lack the resources and specialists they need to mount effective control efforts.

To address these problems, PAHO's 48th Directing Council endorsed a strategy for Integrated Vector Management aimed at optimizing the use of resources and providing a sustainable, ecologically sound approach that will reduce dependency on insecticides and protect populations over the long term. The strategy proposes multidisease approaches to epidemiological and entomological surveillance, rational use of pesticides, social mobilization, and treatment of affected people. It also calls for review and improvement of countries' legislative frameworks for vector control and for more cooperation between the health sector and other sectors, more crossborder activities, and more sharing among countries of expertise, joint action plans, and research.


Adolescent Health

Young people ages 10 to 24 make up nearly one-quarter of the population of Latin America and the Caribbean today. How they grow and develop will have a major impact on the region's future.

Most habits that are detrimental to health begin in adolescence and youth and produce health problems in adulthood. These include smoking, risky sexual behavior, violent behavior, poor diet, and abuse of alcohol and drugs. Young people from poor, marginalized, or single-parent families are at greater risk.

In general, policies, programs, and services targeting adolescents and youths tend to take a vertical, problem specific approach, for example, focusing on HIV, pregnancy, alcohol or drug abuse, violence, or the family. Research suggests that these approaches result in duplication of efforts and have less impact than approaches that address interrelated health outcomes, associated behaviors, and the common origins of behaviors. The Directing Council approved a new PAHO strategy that takes a comprehensive approach, seeking better coordination within the health sector as well as with other sectors that impact adolescent health. The strategy calls for increased resources to scale up quality health services for adolescents and youths, and urges the collection of data disaggregated by age, sex, and ethnicity to improve planning, policymaking, and legislation related to adolescent health. It also calls for cultural sensitivity and greater involvement of youths, families, communities, and schools in these efforts.


Improving Blood Safety

Timely access to safe blood supplies is critical to every country's health system and is a major factor influencing infant and maternal mortality rates and survival of victims of traffic injuries and other major traumas. Latin America and the Caribbean havemade advances in screening and blood collection but still face major challenges in maintaining an ample and safe blood supply.

PAHO's 48th Directing Council reviewed progress on countries' implementation of the PAHO Regional Plan of Action for Transfusion Safety 2006–2010. Only nine countries in Latin America and the Caribbean have achieved the goal of collecting more than 50 percent of their blood units from voluntary donors, the safest means of blood collection. Only nine countries have begun implementing national quality assurance programs, and only 15—roughly half of PAHO member countries—have prepared national guidelines for the clinical use of blood.

To speed progress in this area, the Directing Council called for all countries to: designate a specific entity within their ministries of health to be responsible for planning, oversight, and operation of the national blood system; make careful estimates of the annual need for blood components and the financial resources needed to cover those needs; and establish a network of volunteers to educate the community and promote voluntary blood donation. The delegates also set a target date of 2010 for eliminating all mandatory patient replacement of transfused blood through family donations.


 
 
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