Since 2003, various efforts have converged to promote
and facilitate important progress in PAHO's institutional development. Thus, effective advances have been made on the five objectives of the Pan American Sanitary Bureau's Strategic Plan 2003–2007: to respond better to countries' needs; to promote new modalities of technical cooperation; to become a regional forum; to become a knowledge-based learning organization; and to improve management practices.
The institutional building process has been informed by
the recommendations of several teams that have analyzed the Organization from different perspectives–the Working Group on PAHO in the 21st Century, which looked at the Organization in light of strategic public health challenges in the Americas; the United Nations Joint Inspection Unit of the United Nations, which examined the application of results-based management; and the internal and external auditors. The shared goal has focused on strengthening PAHO's work as an instrument for national health development, improving country support, strengthening health practices, and effectively contributing to the operation of health systems. Over time, several results have been achieved and many activities have enhanced and strengthened initiatives already under way. All in all, this learning and growth experience has involved the entire organization.
In 2005, the Executive Committee formed a Working Group on the Rationalization of Governance Mechanisms, in order to review some of PAHO's governing bodies and issue recommendations regarding the operations and goals of the Subcommittee on Planning and Programming; the Subcommittee on Women, Health, and Development; and the Standing Committee of Nongovernmental Organizations. It also reviewed the selection process for the Director of the Pan American Sanitary Bureau and improvements of internal rules and procedures of the governing bodies.
In terms of harmonizing work with WHO's General Work Program, focal points have been redefined in terms of work areas in all of WHO's regions. These focal points have been working within an active network, a modality that has facilitated the definition and distribution of responsibilities among WHO components and levels to achieve previously determined goals. This, in turn, has improved the flowof resources to achieve expected results agreed upon by member countries. Since 2005, WHO has allocated US$ 30 million in global resources to the Americas (from both regular and voluntary contributions). In addition, Canada has become the first country to contribute specific voluntary resources for PAHO's institutional building, and it closely monitors the fair allocation of global resources for work in
the Region and for priority countries of the Americas.
In terms of finances, in 2004 the Governing Bodies approved the Strategy to Increase the Collection Rate of Quota Contributions, which includes: making the current state of quotas due accessible through PAHO's Intranet and Internet; accepting payments in local currency; promoting the payment of quotas throughout the fiscal year; and assigning this task to PAHO Representatives and upper-level managers as one of their key responsibilities. In 2005, PAHO experienced and institutional historical marker: every Member State, Participating Member, and Associate Member made some payment toward their assessed contributions, something that had not happened since 1990.
In 2005, income from extra-budgetary or voluntary funds amounted to US$ 64.3 million, an increase of approximately 25% over the same period in the previous biennium. The amount received for assistance to mitigate natural disasters increased exponentially, from US$ 800,000 in 2004 to US$ 9.5 million in 2005. It should be pointed out that several of the leading voluntary donor governments are following a modality of integrated and multi-annual programming support, which shows their greater confidence in the Secretariat's capability. Voluntary contributions for specific regional projects have also increased, gathering more importance in terms of volume and time, which makes it possible to reach more ambitious results and to reduce transaction costs.
Ongoing dialogue and participation have been sustained in order to define country programs in line with national goals, WHO's General Work Program, and global goals. This has been clearly reflected in the evaluation processes of the Biennial Program Budget (BPB) 2004–2005 and 2006–2007. Subregional BPBs have also been prepared, and a new version of the AMPES/OMIS system for project management was installed; this version incorporates the recently approved regional policy program and budget, with its new subregional level. The harmonization process has been bolstered by follow-up visits from Country Support Unit analysts designed to sharpen coordination processes among national and global programs and objectives. Results and lessons learned from the evaluation have been incorporated into each Unit's the planning, programming, and budget..
As part of the definition of new technical cooperation modalities, a conceptual framework was prepared for the Regional Public Health Plans. It is designed to achieve greater coherence with regional mandates and priorities and to standardize PAHO planning and programming terminology. These plans constitute a strategic and convergent instrument that seeks to coordinate all levels and partners in development (agencies, nongovernmental organizations, financial institutions, and civil society), so as to successfully meet common goals and objectives. This process will move forward with the review and adjustment of the current Regional and Subregional Plans; it will serve as a basis for the formulation of new plans; and it will be incorporated into the process of refinement of instruments of the American Region Planning and Evaluation System (AMPES). It should be remembered that AMPES has been widely praised by auditors and members of PAHO for more than 20 years, and that it is one of the fundamental elements for advancing results-based management.
The work of the Pan-American centers is better coordinated with that of the Country Offices, and their resources and activities are being progressively incorporated into the biennial program budget, agreed on by every Country Office and respective ministry of health. In pursuit of the strategy approved by the Governing Bodies, and in close collaboration with the Government of Argentina, the Pan American Institute for Food Protection and Zoonoses (INPPAZ) closed, and technical cooperation on food protection was reorganized. Regional technical cooperation in water and basic sanitation has been assigned to the Pan American Center for Sanitary Engineering and Environmental Sciences (CEPIS), which now functions as a unit within the Area of Sustainable Development and Environmental Health. Technical cooperation on women's and maternal health has been assigned to the Latin American Center for Perinatology and Human Development (CLAP), which now functions as a unit within the Area of Family and Community Health. The assignment of responsibilities and technical cooperation resources for nutrition also was reviewed in order to adapt it to the Strategy and Regional Action Plan that the Governing Bodies are currently discussing. Some positions that were located at Headquarters were decentralized to some countries, although they retained their regional responsibilities. For example, the newly created regional, subregional, and inter-country positions, whose headquarters were headquartered country offices or Pan American centers.
Extraordinary advances have been made in placing countries at the center of PAHO's technical cooperation, steering programs toward attaining results, and involving all levels and components of the Organization.
The Country Cooperation Strategy (CCS) constitutes a key element of technical cooperation from which transformations in countries are implemented. In the last four years, CCS has been established in Bolivia, Costa Rica, Guyana, Honduras, Mexico, Nicaragua, and Venezuela. It is in the final approval phase in Colombia, El Salvador, Guatemala, Jamaica, Suriname, and Trinidad and Tobago. It is currently under way in Cuba, Panama, Peru, the Dominican Republic, and Uruguay; and it is slated to begin in October 2006 in the Bahamas. Argentina, Belize, Brazil, Chile, Ecuador, and Haiti have decided to initiate CCS in 2007.
The Region of the Americas is the first to implement a multi-country cooperation strategy, which includes Barbados and the eastern Caribbean countries (Antigua and Barbuda, Dominica, Grenada, Saint Kitts and Nevis, Saint Lucia, and Saint Vincent and the Grenadines), in an experience shared with the Islands States of the Western Pacific. Subregional CCS experiences have begun to be implemented through dialogue with institutions of integration. Rapid evaluations were conducted of the 10 CCS in the Region, which made it possible to analyze both the contents of the documents produced and the processes involved in their preparation.
As a way to face current circumstances and to respond to PAHO's mandates and relations arising from the new challenges of international public health, a decision was made to launch a process of strategic assessment and resource alignment (SARA), through an ongoing cooperative dialogue with the PAHO Staff Association. Current and future international cooperation scenarios involve technological advances and also call for periodic adjustments in the responsibilities and mission of each section of the Secretariat, taking into account that the individual and collective capacities of Member States continue to evolve and be modified. The SARA process seeks to align programs with necessary resources so that these programs can be adequately and strategically carried out, to determine the necessary infrastructure and skills, and to facilitate the development and training of existing staff, as well as to adequately guide the recruitment of new personnel to help fulfill the established programming mandates.
An analysis of functions and responsibilities has led to planning the structure of units and areas, mainly at Headquarters, and to the creation of the Unit of Institutional Development, which builds upon the prior experience of the Management Team for Organizational Change. One of the responsibilities of this new unit is to monitor PAHO's progress in results-based management, which is a system aimed at providing all managers with the means to perform their work in the most effective and efficient way, while at the same time guaranteeing accountability. Another task involves coordinating the progress of the 11 initiatives of the "Road Map for Institutional Transformation," most of which have already completed their terms of reference and presented several intermediate and final results.
The Code of Ethical Principles and Conduct for staff performance was adopted, which includes statements of conflict of interests where applicable, as well as confirmation of staff's understanding and commitment to its fulfillment. A mediator was selected and the Ethics Officer post was established and filled; this person will be a key figure in implementing the system required by the new Code.
Many activities were carried out to coordinate and forge associations and strategic partnerships and, above all, to strengthen coordination of PAHO activities with those of other agencies in the United Nations system and the Inter-American system. Among the many interinstitutional activities, worthy examples include, given their importance and timeliness, the Review and Implementation Group of the Summit of the Americas and the coordinated activities related to avian flu.
In order to strengthen the harmonization and alignment of international cooperation for the greater effectiveness of development assistance, PAHO's participation in and coordination of the Round Table of Donors in Health and Reform in Honduras deserves mention. The Round Table is formed by several bilateral and multilateral cooperation organizations, such as the Japanese International Cooperation Agency (JICA), Canadian International Development Agency (CIDA), the Inter-American Development Bank (IDB), the World Bank (World Bank), the United Nations Children's Fund (UNICEF), the United Nations Population Fund (UNFPA), World Food Program (WFP), and the U.S. Agency for International Development (USAID).
Another example of intersectoral activities was establishment of a strategic partnership between health (health and safety of workers in the health sector and expertise of human resources), education (health promoting schools and prevention of HIV), work (health and safety of workers and prevention of HIV), and the environment (water, chemicals and healthy environments for children and workers). In this partnership, social protection and healthy environments are come together, as do the mandates of the Summit of the Americas and strengthening of efforts to reach the millennium goals. Inter-ministerial meetings were held between the health sector and the agriculture sector, and between the health sector and the environment sector, as well as tripartite meetings that included the health, environment, and labor sectors.
In order to promote and strengthen new modalities of work, interdisciplinary working groups were created to strengthen the quality of technical responses in the Secretariat and in the countries. Examples include alert and response groups exist to address epidemics; the regional strategy and action plan on nutrition and development; the regional strategy on an integrated method for chronic disease prevention and control, and the Regional Plan on HIV/AIDS 2006–2015.
Technical tools also have been developed to facilitate the establishment of virtual sites for collaboration with international partners. To this end, SharePoint sites are maintained for the Health Analysis and Information Systems, the Millennium Development Goals, the Study Group on Pandemic Influenza, the Technical Advisory Committee on HIV and STIs, the Ibero-American Networks on Standards of Clinical Practices, and the members of the Americas who are part of the Executive Board of WHO, to name a few. To date, more than 40 participation and collaboration sites have been created, each with three to 50 secondary sites. On average, more than 300 employees and members interact through these sites, and more than 2,000 consultations are made weekly.
The establishment of partnerships and associations with other international community agencies encourages joint efforts to address the unfinished agenda, protect achievements, and face new health challenges in the Region. For example, PAHO collaborates closely with the Organization of American States (OAS) to link health priorities in the Region with the political agenda of the continent. To this end, PAHO participates as a member of the Summits Working Group and of the Summit Implementation Review Group (SIRG). As such, the Organization supports the implementation of the Declaration and Action Plan of the Summits of the Americas and takes part in organizing the coming Summits.
In coordination with the OAS Secretary General, PAHO has been participating in the meetings and Inter-American conferences of ministers of sectors other than the health sector. For example, it has participated in the Conference of Labor Ministers held in Mexico on health and occupational safety; the Inter-American Meeting of Education Ministers in Trinidad and Tobago, where PAHO was in charge of coordinating intersectoral efforts in the struggle against HIV/AIDS; the Meeting of the Ministers of Health and the Environment, held in Mar del Plata; and the meeting of Ministers and other top officials in social development held in Venezuela, where a preliminary version of the Social Charter of the Americas was discussed.
Joint efforts with agencies of the Inter-American system include work with the Inter-American Commission on Human Rights (IACHR), the Inter-American Commission of Women (CIM), the Inter-American Commission of Control of Drug Abuse (CICAD), the Inter-American Commission of Control of Terrorism and Crime (CICTE), the Inter-American Institute for Cooperation on Agriculture (IICA) and the Inter-American Development Bank (IDB).
To this end, and in order to meet the goal of health for all, PAHO has been working to strengthen its existing networks. Worth mentioning are the Healthy Municipalities and Communities Network, which makes it possible to coalesce efforts to promote healthy populations; the Avian Surveillance Network, whose role is essential in preparing for and responding to a possible pandemic; the Network for Harmonization and Pharmaceutical Regulation, which is one of the most important initiatives in the Region in that it permits the availability of safe, effective, high-quality pharmaceutical products, thus contributing to the protection of public health; and the Health Promoting Schools Network, which helps promote and care for the health of future generations and their families and communities, as well as to establish and maintain healthy study and work environments. The Observatory of Human Resources in Health is yet another example of this cooperative work, since through a network of national groups, the issue of human resources has been able to be introduced into health policies and national planning processes.
In this context, and by devising other cooperation strategies, it is important to point out that at the XV Ibero-American Summit, held in Salamanca, Spain, in 2005, four Ibero-American health networks were established, which will submit progress reports at the next Summit scheduled for November 2006 in Uruguay. These Ibero-American networks are: the Donation and Transplant Network, coordinated by Spain; Drug Policies Network, coordinated by Argentina; Public Health Teaching and Research Network, coordinated by Costa Rica; and the fight against Tobacco Consumption Network, coordinated by Brazil.
As a founding member of the regional directors' group of cosponsor agencies of the United Nations Joint Program on HIV/AIDS (UNAIDS), PAHO has continued to organize and attend the permanent meetings to strengthen the UN's response to HIV/AIDS in Latin America and the Caribbean. PAHO also is part of the UN team of regional directors in Latin America and the Caribbean; this team–normally reserved for the Regional Directors of the member agencies of the Executive Committee of the United Nations Group (United Nations Development Program, UNICEF, UNFPA and WFP)–meets quarterly to coordinate the joint actions of these agencies in the Region. Among the main themes addressed is the UN reform process, joint missions in priority countries and the coordinated support for country development (particularly in Haiti), interagency coordination under PAHO's leadership on avian flu and a possible influenza pandemic, the impetus to advance the Millennium Development Goals, and administrative issues linked to UN reforms, such as the Program of Common Services throughout the Region, in which PAHO participates actively and whose principal advantages have been saving resources by incorporating economies of scale, simplifying administrative management, and process transparency. Several of these subjects will be addressed at the meeting of the regional directors' team of the United Nations in Latin America and the Caribbean, to be held at PAHO Headquarters from 31 August to 1 September 2006. As host, PAHO will present the latest advances achieved in the field of immunization, and will launch the website "Faces and Places" on the MDGs in the Region.
In 2005, a progress report on the application of TCC was submitted, including final reports on PAHO-supported projects. All the material was made available to the public on the Country Support Unit's Web page. TCC is a concrete example of the advantages of forging and consolidating health alliances among countries and their institutions on behalf of the most vulnerable populations in the Americas. TCC is one of the modalities of technical cooperation that figure prominently in PAHO's new work management strategy, along with the promotion and strengthening of the National Excellence Institutions, the use of Collaborating Centers, and Decentralized Technical Cooperation. This cooperation strategy has been supported since it began in 1998. Each country of the Region has participated with some project, in subjects such as sustainable development, health information and technology, universal access and health services, disease control and risk management, and family and community health. During 2005, all the priority countries as established by the Organization—Bolivia, Guyana, Haiti, Honduras and Nicaragua—actively participated in TCC projects, reflecting the regional generosity and solidarity in sharing resources and overcoming disparities in health.