PAHO Member States share many similar health challenges, but each country also has its own unique problems, strengths, and priorities in public health. This makes a one-size-fits-all approach to technical cooperation wholly inadequate. Recognizing this, and following similar action by WHO, PAHO in 2005 adopted a Country Focus policy to tailor its in-country activities to each Member State�s individual priorities and needs.
Under the Country Focus policy, PAHO�s technical cooperation is guided by a Country Cooperation Strategy (CCS) developed with and for each PAHO Member State. The CCS provides a medium-term (4�6 years) strategic framework that details PAHO�s roles and functions in supporting each country�s progress in national health development. The CCS is PAHO�s own country-specific plan for stimulating and supporting national planning efforts and promoting continuity in public health programs, plans, and policies over the medium term.
The development of the CCS is a participatory process that seeks input from different levels of government and across sectors, while drawing on relevant frameworks, planning tools, and best practices identified by PAHO and other partner institutions. Each CCS is carefully aligned with PAHO�s own Strategic Plan and thus linked with the global and regional mandates of PAHO. The strategy also draws on and feeds into the Common Country Assessments (CCA) that are part of U.N. efforts to harmonize its agencies� in-country work through the Development Assistance Framework (UNDAF).
By late 2007, PAHO had developed CCSs for 27 Member States, with each CCS serving as the basis for the biennial work plan of the respective PAHO Country Office.
In line with the U.N. Millennium Development Goals, Cuba has set 2015 as a target date for meeting a series of priority health goals laid out in its National Health Plan. PAHO is supporting these efforts through a Country Cooperation Strategy (CCS) developed in close consultation with the Ministry of Health. The PAHO CCS identifies 14 technical cooperation priorities, including:
The PAHO CCS for Cuba takes a decentralized approach, with separate components for each of eight provinces that are among the country�s neediest. The CCS also is aligned with the U.N. Development Assistance Framework (UNDAF) for Cuba, falling within the �health and food security� line of technical cooperation, one of five areas of U.N. agencies� in-country work.
The CCS is PAHO�s own strategic planning tool at the country level, but one of the Organization�s overarching priorities is to stimulate strategic planning by the country itself. In 2007, PAHO country offices throughout the Region provided support and encouragement for country-level strategic planning in health. PAHO�s technical cooperation in this area included training and workshops for ministry of health and other key personnel in the principles and practices of strategic planning, situation analyses and needs assessments, and reviews and recommendations for legal frameworks for planning. PAHO also played an important role in facilitating broad-based participation in the strategic planning process and promoted the inclusion of strategic objectives based on the regional health priorities-the �Areas of Action�-laid out in the Health Agenda for the Americas.
PAHO, in conjunction with the Joint United Nations Program on HIV/AIDS (UNAIDS), is supporting Argentina's efforts to improve strategic planning on HIV and sexually transmitted infections (STDs) for 2008�2011, building on and providing continuity to earlier efforts in this area. In 2007, PAHO helped the Ministry of Health�s Office on HIV and STDs mobilize broad-based participation in a �Process of Updating the Strategic Response to HIV/AIDS in Argentina.� A centerpiece of the process was an Expanded National Consultation, which brought together actors from government and nongovernmental organizations in health as well as other sectors, followed by a series of five two-day workshops. Participants worked together to develop a situation analysis, identifying needs at the national, provincial, and local levels, as well as a series of lines of action within a strategic planning framework. In 2008, PAHO is providing technical cooperation to operationalize these strategies through yearly operative plans at the regional level that are consistent with the national plan.
In the Bahamas, PAHO�s Country Office provided technical support for the development of a new strategic plan for the country�s public health services during 2007�2015. As part of these efforts, PAHO organized a workshop on strategic management for public health managers and key program staff. The workshop reviewed the social determinants of health, national health policy formulation and the importance of broad stakeholder participation, the strategic analysis and planning processes, logical frameworks, and results-based management.
PAHO�s Country Office in Belize is supporting a new National Health Agenda 2007�2011 that was developed through a participatory process involving health managers and staff from the country�s four health regions, members of civil society, PAHO, and other international development partners. PAHO is helping the Ministry of Health formulate a plan to make the National Health Agenda operational, using a multisectoral approach and mechanisms for monitoring and evaluation. In addition, with support from WHO�s Health Metrics Network, PAHO is helping the ministry develop a strategic plan for strengthening the country�s health information systems. PAHO is also supporting national plans and policies in tobacco control, mental health, and strengthening of the public health functions of the State.
In 2007, PAHO�s Country Office in Bolivia provided support for the government�s new socioeconomic development plan, �Bolivia: Dignified, Sovereign, and Productive.� PAHO worked through seven lines of action, including addressing the social determinants of health and promoting the concept of health as a human right; providing technical support for the constitutional reform process; supporting the development of a single, universal system of health coverage; and strengthening the State�s steering role in public health.
Health Agenda for the Americas
Action Area
In Brazil, PAHO is helping the Ministry of Health use strategic planning for institutional strengthening as part of a larger national program of goals and investments known as Mais Sa�de (�More Health�). PAHO is assisting in three areas: identifying and assigning the responsibilities and contributions to Mais Sa�de for different secretariats, foundations, and agencies within the Ministry of Health; performing an institutional diagnosis of the Ministry of Health and formulating a proposal for its strategic restructuring; and diagnosing problem areas for implementation of restructuring as well as developing a proposal to address these through process reengineering.
Health Agenda for the Americas
Action Area
PAHO�s Country Office in Colombia signed an agreement in late 2006 with the Department of Antioquia under which PAHO provided technical cooperation to help systematize the objectives of three key departmental social and health strategies: Primary Health Care, Integrated Attention to Prevalent Childhood Diseases (AIEPI), and Food and Nutritional Security. On the basis of this work, PAHO helped the department develop a proposal for incorporating the three strategies into the departmental and national Social Protection System, using an integrated management model and focusing on sustainability, efficiency, and optimal use of resources. The proposal aims to position Antioquia�s Social Protection System as a pioneer in increasing social protection and access to quality health services.
In the Dominican Republic, PAHO�s Country Office supported the Ministry of Public Health and Social Assistance in a process of intersectoral consultations that led to the relaunching of the country�s 10-year Health Plan 2006�2015. PAHO also provided support for the ministry�s planning in other areas, including human resources development and management, child and maternal mortality, and pharmaceuticals.
PAHO�s Country Office in Quito assisted with the formulation of the health section of Ecuador�s new constitution and, in collaboration with the ministries of health of Brazil, Chile, Paraguay, and Uruguay, supported the development of a Proposal for Transformation of the Health Sector. The Country Office also helped Ecuador develop strategic plans for prevention and control of HIV/AIDS, tuberculosis, and malaria, which formed the basis of funding proposals presented to the Global Fund to Fight AIDS, Tuberculosis, and Malaria.
Health Agenda for the Americas
Action Area
PAHO�s �Faces, Voices, and Places� initiative seeks to empower some of the most vulnerable communities in the Americas to ensure that they benefit from efforts to advance the Millennium Development Goals (MDGs). As part of the initiative, PAHO has worked with the community of Nab�n, Ecuador, helping to revise and systematize their Municipal Development Plan to better address the economic, social, and environmental determinants of health; strengthen primary health care strategies; and apply lessons learned to advance along the lines of the MDGs. Developed by the community itself, the municipal plan has six components: institutional strengthening, local economic development, natural resources management, comprehensive health, child and adolescent health, and strengthening of human resources. PAHO has promoted a process of �critical reflection� in the community and assisted with information gathering and analysis to support the plan�s revision, and has coordinated support from international cooperation agencies for the plan�s implementation.
PAHO�s Country Office in Guyana has provided critical support to the Ministry of Health�s strategic planning efforts, offering training to key staff in the logical framework approach and in principles of strategic planning. PAHO also provided support in the subsequent development of a series of strategic public health plans, including a new HIV/AIDS Strategic Plan, a Malaria Strategic Plan, a Tuberculosis Strategic Plan, a Vector Control Strategic Plan, a Noncommunicable Disease Control Strategic Plan, an Influenza Pandemic Plan, and a National Health Plan 2008�2012. The Country Office also helped with the evaluation of Guyana�s National Plan for Health 2003�2007.
PAHO�s Country Office in Managua provided support in the area of health for Nicaragua�s new planning process, known as National Short-Term Planning (PCP). The process seeks to integrate planning by different institutions of the state, ensuring alignment as well as harmonization of the contributions of international cooperation agencies. PAHO�s focus has been on helping to consolidate the steering function of the Ministry of Health. PAHO has provided technical assistance in analyzing a number of existing laws governing the planning process, including the General Health Law, the Law on Autonomy, the General Education Law, the Law on Municipalities, the General Law on Water and Its Regulation, the Law on Sovereignty, and laws on Citizen Participation and Nutritional Security. PAHO has also assisted with the development and presentation to the National Assembly of new laws including the Health Career Law, the Tobacco Law, the Law on Divers, a law on Traditional Medicine, and the Water Committee Law.
PAHO also assisted with the development of the health component for Nicaragua�s new National Plan for Human Development (PNDH), which seeks to end discrimination and exclusion and to enable Nicaraguans to exercise their full economic, social, cultural, and environmental rights.
Six countries and territories of the Eastern Caribbean-Barbados, St. Lucia, Dominica, Anguilla, St. Kitts and Nevis, Grenada, and Montserrat-have approved national strategic developments plans that are currently being implemented with support from PAHO and other partners, including the European Union, the U.K Department for International Development, and the World Bank. PAHO is providing technical cooperation to address special challenges in the health sector, including limited resources and competencies for implementation of plans and the need for stronger systems for monitoring and evaluation.
PAHO is also supporting national participatory efforts to improve strategic planning in health by bringing together multidisciplinary, multisectoral teams to evaluate health system performance, identify key problems, and prioritize health directions and interventions. This work has helped broaden the base of stakeholders involved in health development and has raised the profile of health as a strategic component of national development. In addition, PAHO is helping the countries put planning into action by moving from strategic directions and performance indicators to operational planning and implementation, and from planning to budgeting and the allocation of resources.
Health Agenda for the Americas
Action Area
PAHO�s Country Office in Haiti supported the strategic planning process behind the government�s new Free Obstetric Care (SOG) program for pregnant women and newborns, the first step toward the creation of a national system of social protection in health for mothers and children. PAHO assisted with planning for the reallocation of resources derived from international humanitarian assistance to finance the new program and helped create and implement a training program for Ministry of Public Health staff in stakeholder analysis, methodologies for costing health packages, conceptual frameworks, and the design of social protection in health schemes. In addition, PAHO supported the National Forum for the Realignment of Health Reform, a major social dialogue initiative and part of national development planning, to facilitate multisectoral alliance-building in support of the realignment of the health sector reform process around the creation of the social protection system. PAHO also was a key partner to the Ministry of Public Health in preparing the health component of Haiti�s National Strategic Document for Growth and Poverty Reduction 2008�2010.
PAHO�s Country Office in 2007 provided key technical support for the development of Honduras�s Strategic Health Sector Plan 2012, part of the country�s national Strategy for Poverty Reduction (ERP). PAHO led an ongoing Health Sector Roundtable (Mesa CESAR) made up of representatives from government, civil society, and more than a dozen international cooperation agencies active in Honduras. The roundtable served as a platform for analysis, dialogue, coordination, and consensus for the development of multiyear budgets and strategic plans for the health sector as a whole and for the country�s Social Security Institute (IHSS) in particular. The CESAR roundtable also actively assisted in the development of a new National Strategic Plan for Chagas, the 3rd National Strategic Plan for HIV/AIDS 2008�2012, and a National Strategy for the Accelerated Reduction of Maternal and Child Mortality 2008�2015.
In Jamaica, PAHO�s Country Office participated in the multisectoral process of developing the new National Development Plan 2030. PAHO provided general guidance for the health component of the plan, which provides a planning framework for moving Jamaica to �developed nation� status over the next 22 years. In addition, PAHO helped the Ministry of Health update a number of existing plans and develop several new ones, including the National Health Plan 2006�2010, the Ministry of Health Strategic Plan 2006�2015, the National Strategic Plan for HIV/STIs 2008�2012, and the Sexual and Reproductive Health Plan.
PAHO provided key support in 2007 for the development of Peru�s first National Health Plan in 20 years. The process was broadly participatory, with consultations involving representatives of professional and health workers� associations, private service providers, the social security system and other public institutions, and regional governments. Regional health plans were developed through similar processes in La Libertad, Arequipa, Ancash, and Callao.
Health Agenda for the Americas
Action Area
PAHO�s Country Office in Paraguay provided key support for the formulation of a National Strategic Plan for the Development of a Health Information System 2007�2011 (SINAIS). PAHO participated as a member of an interagency technical team that analyzed the health system�s information needs, defined priorities, and identified a series of goals, strategies, lines of action, and budgeting implications for the development of a health information system over a five-year period. The final plan sets eight strategic objectives, including the establishment of a national policy and legal framework that ensures the right to health information, strengthening human resources, and strengthening the physical and technological infrastructure for the health information system at the national, regional, and local levels. Other members of the interagency team included the U.S. Agency for International Development�s (USAID) Measure Evaluation program and representatives of Paraguay�s departments of biostatistics; programming, monitoring, and evaluation; health services; health surveillance; and surveys, statistics, and censuses; among others.
Health Agenda for the Americas
Action Area
In Peru, PAHO partnered with 12 United Nations and other international cooperation agencies starting in 2006 to spearhead the �Fight against Malnutrition Initiative,� an effort to build national political commitment to reducing hunger. The initiative has since become the basis of international support for the government�s CRECER National Strategy, a multisectoral strategic plan that addresses the social determinants of hunger, including education, environmental and living conditions, and access to health care. CRECER falls under the direction of Peru�s Council of Ministers (PCM) and is coordinated by the Inter-Ministerial Commission on Social Affairs (CIAS), which joins the ministries of health, education, women and development, housing, and economy and finance. PAHO and its partner international agencies continue to play a key advocacy and support role for the CRECER strategy at the national, regional, and local levels.
PAHO�s Country Office in Paramaibo supported the development of Suriname�s Multi-Annual Development Plan 2006�2010 and during 2007 geared its technical cooperation to addressing health priorities laid out in the plan. This included support for an inter-sectoral approach to food production and security and to water and sanitation, greater emphasis on primary and secondary prevention in primary health care, greater community participation, prevention and early detection of chronic diseases, extending primary and secondary health care coverage to people living in the country�s interior and rural areas, and achieving the health-related MDGs.
In Trinidad and Tobago, PAHO�s Country Office, as chair of the U.N. Country Theme Group on HIV, led the development of a Joint Program of Support for HIV control and prevention to guide the in-country work of U.N. agencies in this area. With UNAIDS, PAHO organized training for members of the U.N. team on joint execution and monitoring of the plan and sponsored an assessment of gaps and different agencies� strengths for addressing them.
In Uruguay, PAHO supported the creation of a new National Road Safety Unit in the Office of the Presidency, which will coordinate national efforts in the area of traffic safety. PAHO also supported the development of legislation and plans relating to the basic pillars of the country�s health sector reform, including the creation of a National Health Fund (FONASA) and the decentralization of the State Health Services (ASSE).