Integrated Health Systems in Latin America and the Caribbean (IHSLAC)

The Integrated Health Systems in Latin America and the Caribbean (IHSLAC) Project is a cooperation agreement between the Government of Canada’s Department of Global Affairs Canada (GAC) and the Pan American Health Organization (PAHO). IHSLAC responds to priorities within maternal, newborn, child and adolescent health. It is implemented in 11 countries. The IHSLAC Project runs from 2016 to 2019. Its ultimate outcome is to contribute to improved health of children, young girls and women (including mothers) in situations of vulnerability in Latin America and the Caribbean (LAC).

Learn more about the IHSLAC Project

PAHO serves as both the WHO Regional Office for the Americas and the specialized organization for health of the Organization of American States (OAS). With its hemispheric membership and strong convening power, PAHO is the principal regional organization able to mobilize and coordinate hemispheric action on regional health issues, including public health threats.

Canada has been a PAHO Member State since 1971, and PAHO has a long history of collaborations with the different international development agencies in the Government of Canada.

Currently PAHO and Canada partner through the IHSLAC PROJECT

In May of 2016, the Pan American Health Organization (PAHO) and Global Affairs Canada (GAC) launched the Integrated Health Systems in Latin America and the Caribbean Project 2016-2019 (IHSLAC) to improve the health and protect the rights of women (including mothers), adolescent girls and children living in situations of vulnerability in 11 countries in Latin America and the Caribbean. From 25 to 27 May 2016, a planning meeting with the 11 countries and Canada was held in Lima, Peru.

This initiative has three main objectives: (1) strengthening health systems; (2) reducing the burden of communicable diseases; and, (3) improving nutritional practices in the targeted beneficiary populations.

As part of this initiative the Government of Canada, through its Department of Global Affairs has committed $18.5M CAD until 2019. The program activities are implemented in Bolivia, Colombia, Ecuador, Guatemala, Guyana, Haiti, Honduras, Nicaragua, Paraguay, Peru, and Suriname.

The IHSLAC Project is aligned with and responds to Canada’s international development priorities in maternal, newborn, child, and adolescent health (MNCAH) and contributes to the achievement of PAHO’s Strategic Plan’s (2014-2019). More specifically, as an integral part of PAHO programming, the project contributes to the implementation of PAHO’s 2016-2017 and 2018-2019 Biannual Work Plans (BWP). In this regard, the project feeds into 11 Country BWPs and 7 Regional BWPs. The project is implemented on the basis of Annual Work Plans (AWP) – 11 countries AWPs and a regional AWP.

Towards achieving the ultimate outcome, the project invests in three programmatic areas: Health Systems (intermediate outcome 1100); Disease Case Management and Prevention (intermediate outcome 1200); and Nutrition (intermediate outcome 1300). At an operational level, the project is focused on Increasing Access for All to Quality Health Care, Nutrition and Prevention Services through three strategic pillars, namely: SP1 – Quality of health and Nutrition Services; SP2 – Evidence-Based Prevention, Health Promotion, and Visibility; SP3 – Governance. As a contextual backdrop and in line with PAHOs 2014-19 Strategic Plan, the IHSLAC project identifies Gender, Equity, Human Rights and Ethnicity as cross-cutting themes within its programmatic and strategic scope.

The IHSLAC Project runs from 2016 to 2019. Its ultimate outcome is to contribute to improved health of children, young girls and women in situations of vulnerability in Latin America and the Caribbean.

For more information, please contact Dr. Guillermo Marquez (marquezgui@paho.org).

Below are the most recent collaboration initiatives between Global Affairs Canada and PAHO:

PAHO/GAC Initiative 2016-2019: Integrated Health Systems in Latin America and the Caribbean

PAHO/CIDA Initiative 2011-2014: Improved Health and Increased Protection from Communicable Diseases (IHIPCD) for Women, Children and Excluded Populations in Latin America and the Caribbean

PAHO/CIDA Initiative 2003-2011: Priority Communicable Diseases in South America Program (PCPCD)

Find out more about Global Affairs Canada.

The IHSLAC Project is guided by a programmatic set-up, an operational approach and 14 health thematic areas, which are all integral to the strategic implementation of activities and ensuring that the ultimate outcome of the project is always kept in sight.

The following elements constitute the project’s programmatic set-up:

1 ultimate outcome – “Improved health of children, young girls and women (including mothers) in situations of vulnerability in Latin America and the Caribbean (LAC)”;
3 intermediate outcomes. These represent the 3 programmatic areas the project focuses on i.e.
- Health Systems (intermediate outcome 1100);
- Disease Case Management and Prevention (intermediate outcome 1200); and,
- Nutrition (intermediate outcome 1300);
6 immediate outcomes. These contribute to Intermediate outcome targets;
15 different outputs. These delineate the priority operational areas resources are invested upon;
Gender, Equity, Human Rights and Ethnicity as cross-cutting themes that permeate the broader programmatic scope of the project.

The following elements define the project operational approach:

A common operational target (the why) of project investments i.e. Increasing Access for All to Quality Health Care, Nutrition and Prevention Services;
Three (3) common strategic approaches through which entities are working towards targets (the how) i.e.
- SP1 – Quality of Health and Nutrition Services;
- SP2 – Evidence-Based Prevention, Health Promotion, and Visibility;
- SP3 – Governance.

Project action is focusing on the following 14 different health-thematic areas:

Sexual, Reproductive, Maternal, Neonatal, Child, Adolescent Health
Reduction of Maternal Neonatal Mortality
Mental Health
Blood Safety
Transmitted Infections (HIV, Syphilis, Malaria, Helminthiasis)
Nutrition
Immunization
Surveillance
Research and Data Analysis
Planning and Coordination
Service Delivery and Medicines
Environment
Leadership, Participation, and Empowerment
Health Promotion and Prevention

Gender, Equity, Human Rights and Ethnicity, as cross cutting themes for PAHO, were integrated within the project from its conception.

In light of the government of Canada’s (GAC) recent adoption of its Feminist International Assistance Policy in July 2017, an effort was made to find potential Project alignment to this Policy. It is important to note that, unlike GAC’s dedicated focus on results related to women and girl’s empowerment, PAHO’s work on the CCTs aims at mainstreaming related concerns into work across the organization, including, and indeed principally, work that is not primarily aimed at impacting upon women and girl’s empowerment. That said, it is hoped that the sum of these mainstreaming efforts will help bring about such transformative change in alignment with the GAC policy.

To help illustrate, below are key examples that tangibly demonstrate the ways in which the four cross-cutting issues are being reflected in project activities.

For Gender:

In Suriname, a qualitative data collection exercise conducted highlighted differential male/female vulnerabilities and needs by exploring, among other aspects, the differences in mothering practices for baby girls in contrast to baby boys, and male involvement in reproductive task responsibilities. Findings informed tailored messages for a variety of target audiences for an exclusive breastfeeding behavior change communications effort, within the country’s National Infant and Young Child Feeding and Essential Care Strategy.

In Bolivia, through the Project, PAHO supported the development of a guide for local health authorities to facilitate participatory processes for the analysis of community health conditions. These guides enable gender-based assessments and analysis of barriers to health service access and, more specifically, to reflect upon the drivers of women’s health conditions in target communities with a women’s rights approach.

Dialogues on breastfeeding and water, hygiene and sanitation with community members from indigenous communities in Colombia represented efforts to incorporate effective women participation and inclusive dialogue in health-related decision making. Activities included participation of women from target indigenous communities with a balanced male participation and the inclusion of girls and boys resulting in increased autonomy and women empowerment.

In the Amazonian indigenous region in Peru, community planning exercises were conducted with a focused effort to involve the women’s organized movement of Women’s Alto Amazonas Federation (“Federación de Mujeres del Alto Amazonas”). This has resulted in prioritization of women’s rights and an implementation of strategies to diminish adolescent pregnancy.

In Paraguay, IHSLAC Project activities during 2017 concentrated on strengthening health service delivery in the districts Carmelo Peralta, Bahía Negra, Puerto Casado, and Puerto Peñasco, all on the Paraguay- Brazil border. The Project focused on improving treatment and diagnosis of priority diseases with a focus on gender-sensitive health service delivery models. This included, for instance, support for an ultrasound and a clinical diagnosis laboratory in order to offer care and treatment for pregnant women of the border districts, previously non-existent.

In 2017, an example of women and girls' empowerment for health was reported in the Yamaranguila province in Honduras through the promotion of active women’s participation in order to consolidate their role as community leaders. Activities focused on strengthening women´s empowerment at all levels, specifically enabling decision-making at municipal level and integrating women as fundamental actors in multi-sectoral dialogues and planning processes.

In Nicaragua, with the maternity waiting homes initiative, women’s stays in the homes are used as an opportunity to empower women and address the issue of unpaid work. Skills in entrepreneurship and food self-sufficiency are transferred during this time and go beyond the health aspects of maternal health care they receive.

For Equity:

In Ecuador, the Essential Health Service Conditions Assessment ("Valoración de Condiciones Escenciales de los Servicios de Salud") tool was applied in order to diagnose Equity aspects of accessibility to quality health services and response capacity of health establishments through evaluation of aspects such as infrastructure, training, and quality of care.

In 2017, three sub-regional consultations (South America, Central America and Caribbean) served as a platform for comprehensive regional dialogue, interpretation and prioritization of the Global Strategy for Women’s, Children’s and Adolescents’ Health goals and targets for the countries in the Americas. A set of recommendations on how to implement the Global Strategy in LAC context was brought to the attention of regional political leaders headed by President Michele Bachelet in Santiago, Chile. The Santiago Commitment to Action "Leave no woman, boy or girl or adolescent behind in Latin America and the Caribbean: Reducing inequities in health in the countries" was adopted.

In Nicaragua, through the maternity waiting homes initiative, a community level consultation was organized to inform a right to health initiative. The consultation was implemented through a network of health promotors that includes more than 7,000 voluntary community workers and more than 3,000 midwives.

In Colombia, sectorial and inter-sectorial meetings were implemented during 2017 to define the implementation routes for health promotion and elimination of barriers to access. As a result, the Ministry of Health has expanded health service provision in four new health posts in the IHSLAC Project community of Cumaribo.

For Human Rights:

Based on the Paraguay-Brazil frontier 2013 agreements with regards to the preservation of the right to health, IHSLAC Project funds supported work with civil society and health providers and sanitary authorities to guarantee the right to health by providing health services regardless of nationality, specifically for pregnant women and children.

In Colombia, multi-sectorial work was supported, through the Ministry of Health and Social Protection, to collaborate with the governor, municipal leaders, and legislative bodies to advocate for the implementation of the Integral Health Care Model (Modelo Integral de Atención en Salud-MIAS) in the Vichada Department. The MIAS guarantees the right to health as delineated by the National Development Plan and Law 1753 of 2015.

In Bolivia, for instance, a review of legal frameworks that promote the respect of the right to health for the protection of populations affected by inequalities was instituted through the advice of a Cuban expert with respect to the current legal gaps and rights violations of LGBT groups. An LGBT Health Plan was developed during 2017 and is under revision.

In Guyana, where legal age for sexual consent is at 16 years while legal access to contraceptives is 18 years of age, trainings for health providers were aimed at establishing non-discriminatory services for sexually active adolescents.

In Paraguay, the provision of services for cross-border migrant populations from Brazil included an emphasis on the principles of non-discrimination and non-stigmatization. Support to the Paraguayan health system aimed at inclusion of all populations in primary health service provision, prenatal care and immunizations for Brazilian children of migrant workers. Registries were modified to include country of origin allowing tracking of coverage of Brazilian migrant access to health services.

Self-help groups were established for psychological support and provision of legal guidance to victims of gender violence in the indigenous communities of Yamaranguila, Honduras. Group activities also promote prevention of gender-based violence and sexual and reproductive health rights.

The elaboration of a National Strategy on Sexual and Reproductive Health 2018-2022 for Haiti was guided by international human rights documents pertaining to health as a framework in the design of national health policies, plans and programs.

For Ethnicity:

In Ecuador, qualitative data was obtained from ethnographic studies that explored two thematic spheres: health, nutrition and development, and water and sanitation, among the Shuar and Achuar ethnic groups. Data was analyzed to illustrate health-related inequities and knowledge constructions related to health. The exercise included documentation of testimonies from indigenous community members. Subsequently, this data was used within a participatory process of indigenous community members in the elaboration and implementation of health action plans that address local needs.

Honduras reported support for a quantitative data collection exercise which included disaggregation of data by ethnic groups in the context of a baseline assessment to inform an intervention on social determinants of health and interculturality in the Yamaranguila and La Ceiba municipalities. This knowledge base served to establish dialogues with high-level decision makers in order to promote a national consultation for the development of a National Policy on Ethnicity and Health in an effort to implement policies based on intercultural approaches to health for diverse ethnic groups.

Participatory initiatives centered on the identification and prioritization of needs, materials validation, and participation in evaluation that promoted inclusive dialogue were conducted in Guatemala, Honduras, Ecuador and Colombia in 2017.

In Peru, human resource capacity building has focused on trainings directed at health post workers of the Awuaju- Wampis indigenous groups. Among these same groups, a culturally adapted nutrition guide for mothers was elaborated based on intercultural dialogues.

In Haiti, the GESTA training for emergency obstetric care that was originally developed in Canada, was translated to Creole language and adapted with appropriate case studies and relevant contents to the Haitian culture.

The health services of Puerto Carreño and Cumaribo of Colombia, with support of the Project, provided bilingual interpreters and the San Juan de Dios hospital hired a traditional doctor as a result of negotiations between the Ministry of Health, hospital administrators and traditional healers. In Guatemala, interventions targeted indigenous groups in remote areas with poor access to health services in order to address soil-transmitted helminthiases.

In 2017, two project countries applied the Evaluation of Essential Conditions of Health Services (Valoración de Condiciones Escenciales de los Servicios de Salud -VCE) tool which resulted in cultural adaptations for health service provision. In Ecuador, the evaluation triggered the inclusion of culturally appropriate delivery rooms while in Honduras, hospital signs were adapted as a result of applying the tool.

The Project addressed ancestral knowledge and traditional and complementary medicine in a variety of ways within policy frameworks, instruments, resources, and/or procedures.

On 9 June 2017, Canada adopted a feminist international assistance policy to advance gender equality and the empowerment of women and girls. This approach is viewed by Canada as being most effective in reducing poverty and building a more inclusive, peaceful, and prosperous world. To learn more, visit the Government of Canada's website.

In the international assistance policy, Canada affirms that "committing to a feminist approach to international assistance represents a significant shift in what we do and how we do it".

ACTION AREAS

To most effectively champion gender equality and the global empowerment of women and girls, Canada will fund initiatives that:

enhance the protection and promotion of the human rights of women and girls;
increase the participation of women and girls in equal decision-making, particularly when it comes to sustainable development and peace; and
give women and girls more equitable access to and control over the resources they need to secure ongoing economic and social equality.

To ensure that Canada’s international assistance is best able to achieve the goals of gender equality and the empowerment of women and girls, Canada will focus its efforts on six action areas.

Core Action Area: Gender Equality and the Empowerment of Women and Girls
Human Dignity (health and nutrition, education, humanitarian action)
Growth That Works for Everyone
Environment and Climate Action
Inclusive Governance
Peace and Security