Since its founding, the Pan American Health Organization (PAHO) has been a catalyst for cooperation among its Member States in efforts to protect and promote the health of their respective populations. This Pan American collaboration is grounded in the understanding that the Region�s countries have shared health conditions and concerns, and that their historical, political, and geographical ties can facilitate effective joint action to address common problems.
The �value added� of Pan Americanism in health can be seen clearly in the results of PAHO�s regional public health plans, subregional initiatives, and Technical Cooperation among Countries (TCC) program. In 2007�2008, PAHO supported and promoted strategic planning in all these areas, as well as in the Organization�s flagship Pan American initiative, Vaccination Week in the Americas.
During the sixth annual Vaccination Week in the Americas (VWA), held April 19�26 2008, more than 56 million people in 44 countries were vaccinated, making this the most ambitious VWA since the initiative was first launched in 2003. Planning was a central part of the initiative, and PAHO provided support in this area to every participating country. This included guidance in defining goals, strategies, and priority populations; coordinating activities at the national level and in border areas; defining indicators for measuring and reporting results; and budgeting for vaccines, cold chain equipment and other supplies, training, operational expenses, supervision and monitoring, and evaluation. PAHO also provided guidance in planning the countries� communication and social mobilization campaigns.
One of the major highlights of Pan American health efforts in 2007�2008 was the approval by PAHO Member States of the Health Agenda for the Americas, a mutually agreed-upon set of principles, priorities, and areas of action for health planning at the national, subregional, and regional levels (see Chapter 1). During 2007�2008, PAHO technical cooperation helped Member States advance in planning at the country, subregional, and regional levels, on all eight lines of action in the agenda (see also Chapter 2).
The Health Agenda for the Americas 2008�2017, from its conception to its approval, was an initiative by, for, and of the countries of the Americas. The concept for the agenda was first proposed by PAHO�s 2006 Subcommittee on Planning and Programming as a collective vision of the Region�s health priorities and agreed-upon lines of action for addressing them. A steering group led by Panama and including Antigua and Barbuda, Argentina, Canada, Chile, Cuba, and the United States-later joined by Brazil and Mexico-developed a draft through a process that included a series of teleconferences and two live meetings held in Panama City. In January 2007, Bolivia, Colombia, Costa Rica, the Dominican Republic, Ecuador, Peru, Uruguay, and Venezuela joined the effort, along with the Andean Health Agency�Hip�lito Unanue Agreement (ORAS�CONHU) and the Amazon Cooperation Treaty Organization (OTCA), at the 3rd Meeting on International Cooperation in Health in Chile. This was followed by a broad-based consultation process that brought feedback from stakeholders at the national, regional, and global levels.
Chile provides an example of the consultation process that took place in countries around the Region. Chile�s Ministry of Health organized meetings with the country�s leading public health departments-from the University of Chile, the Pontifical Catholic University of Chile, and the Border University (UFRO)-to discuss the working draft of the agenda and receive inputs. Regional health authorities held meetings with local stakeholders for the same purpose. Chile�s feedback was pooled with similar contributions from other PAHO Member States and organizations including the World Bank, the Inter-American Development Bank (IDB), the Central American Integration System (SICA), the U.N. Food and Agriculture Organization (FAO), the U.N. Economic Commission for Latin America (ECLAC), the U.N. Development Fund for Women (UNIFEM), the U.S. Agency for International Development (USAID), and the Latin American Association of Public Health Schools.
The final Health Agenda for the Americas 2008�2017 was formally launched in Panama City in June 2007 at the opening of the General Assembly of the Organization of American States (OAS) in the presence of United Nations Secretary-General Ban Ki-moon, OAS Secretary-General Jos� Miguel Insulza, President Mart�n Torrijos of Panama, 20 ministers of health, and ministers of foreign affairs from throughout the Region.
One of PAHO�s most important roles is that of ensuring that health is a top priority on the Region�s political agenda and a key part of national and regional development planning. Toward this end, PAHO monitored and participated throughout 2007�2008 in the planning and follow-up activities of the Region�s leading regional political-technical forums, including the Summit of the Americas, the Ibero-American Summit, the Summit of First Ladies, Spouses and Representatives of Heads of State of the Americas, and more than a dozen working groups and commissions sponsored by the Organization of American States (OAS).
PAHO also worked closely with the Region�s integration systems through the PASB�s subregional programs, which became independently staffed and budgeted starting in 2006. In 2007�2008, PAHO promoted strategic planning in several subregional initiatives.
In the Andean region, PAHO supported the development of a joint Subregional Strategy for Andean Cooperation in partnership with agencies of the Andean Integration System, other U.N. agencies, the Spanish Agency for International Development Cooperation (AECID), and other partners. PAHO also provided key support for the planning and implementation activities of the Andean Health Agency�Hip�lito Unanue Agreement (ORAS�CONHU), including the development of a joint Strategic Plan 2009�2012. In addition, PAHO participated in meetings of the Executive Committee of the Andean Border Health Plan (PASAFRO) and provided technical support for the implementation of its 2008 Operative Plan.
PAHO, through its subregional HIV/AIDS program based in Colombia, also provided crucial support for the development and implementation of the Andean Plan for a Health Sector Response to HIV 2007�2010, which was approved by the Meeting of Andean Health Ministers (REMSAA) in 2007. PAHO assisted with subregional situation analyses of monitoring and evaluation systems and of HIV-status stigma and discrimination in Andean countries, and with the development and implementation of subregional strategic plans in both areas. This work was supported by a subregional inter-agency HIV team made up of members from ORAS�CONHU, UNAIDS, PAHO, and other partners.
Health Agenda for the Americas
Action Area
PAHO�s subregional program worked in partnership with ORAS-CONHU to create a new Andean Plan for Development of Human Resources in Health, which was approved by the 2008 Meeting of REMSAA. PAHO also worked with ORAS�CONHU to organize training for health professionals involved in policymaking on human resources in health, and to strengthen information and knowledge for decision-making.
As a member of the International Consortium for Human Resources for Health (HRH) for Health Care, PAHO partnered with Dalhousie University in Canada and the Ministry of Health of Brazil to provide training to teams from Jamaica�s Southeastern Regional Health Authority and from the state health departments of Minas Gerais and Ceará on the use of information to forecast human resources needs and assess policy options. In the Caribbean, PAHO partnered with the Ministry of Health of Jamaica to organize a meeting on human resources planning in Kingston in July 2007, where more than 150 participants from 15 Caribbean countries discussed areas for cooperation in human resources development and formulated draft strategies to address education, distribution, retention and recruitment, needs-based planning, and migration issues.
In 2007�2008, PAHO continued to support the Caribbean Cooperation in Health Initiative, currently in its third stage (CCH III). PAHO�s Caribbean Program Coordination (OCPC) is working with CARICOM�s secretariat to improve monitoring and evaluation of the initiative�s activities. PAHO also provided assistance during 2007�2008 to CARICOM in establishing the new Caribbean Public Health Agency (CARPHA).
In Central America, PAHO and the Spanish Agency for International Development Cooperation have provided support for the development of a Health Agenda for Central America and the Dominican Republic, which seeks to reduce inequities in health and improve quality of life. PAHO has worked with health authorities to develop a draft agenda and has helped organize national intersectoral consultations to discuss and refine it. In Guatemala, for example, PAHO�s Country Office helped form a special commission made up of representatives of the Ministry of Public Health and Social Assistance, the Guatemalan Social Security System, the Presidential Secretariat for Women (SEPREM), and PAHO, to carry out consultations and work on key aspects of the agenda. The final document is expected to be presented to the Council of Health Ministers of Central America (COMISCA) in late 2008. It will be aligned with both the Health Agenda for the Americas 2008�2017 and the CARICOM�SICA (Central American Integration System) Plan of Action.
One of PAHO�s most important tools for promoting strategic planning is its regional public health plans. These provide a conceptual framework and specific strategies and actions that have been collectively agreed upon by the countries of the Americas as the best means to address priority problems in health. The plans encourage a strategic approach to health action and help ensure standard criteria and indicators for monitoring and evaluation. During 2007�2008, PAHO developed four new regional health plans for approval by the 48th Directing Council:
PAHO also continued promoting the implementation of previously approved plans, including regional plans for HIV, malaria, Chagas� disease, tuberculosis, maternal health, and chronic diseases.
Health Agenda for the Americas
Action Area
The Regional Strategy and Plan of Action for Cervical Cancer Prevention and Control, finalized during 2007�2008 for presentation at PAHO�s 48th Directing Council, seeks to reduce deaths and illnesses from cervical cancer by strengthening countries� capacities to implement comprehensive prevention and control programs. It proposes seven lines of action: conducting a situation analysis; intensifying information, education, and counseling; fortifying screening and pre-cancer treatment programs; establishing or strengthening information systems and cancer registries; improving access and quality of cancer treatment and palliative care; generating evidence to facilitate decision-making regarding the introduction of HPV vaccines; and advocating for equitable access and affordable comprehensive cervical cancer prevention. The plan places immediate priority on strengthening current programs and considering the introduction of new technologies, particularly visual inspection with acetic acid (VIA) and direct HPV DNA testing. It calls on health authorities to partner with community, national, and international organizations, including women�s groups, to carry out the lines of action.
Health Agenda for the Americas Action Area
With support from PAHO, the countries of the Caribbean have made planning a central focus of their efforts to fight noncommunicable diseases (NCDs), which account for more than one-half of all illnesses and deaths and the majority of health costs in the subregion. As co-secretariat (with CARICOM) of the Caribbean Cooperation in Health Initiative, PAHO is helping to revise a Regional Plan of Action for NCD Prevention and Control, as called for by Caribbean heads of state at a special CARICOM Summit on Non-Communicable Diseases, held in September 2007. Nine of 13 Caribbean countries have drafted or begun implementing national NCD strategies, most within the framework of PAHO�s Regional Strategy on an Integrated Approach to the Prevention and Control of Chronic Diseases Including Diet, Physical Activity, and Health. In 2007, PAHO organized a subregional workshop on the Regional Strategy as a basis for planning and provided training to ministry of health professionals from 10 countries in the use of cost-effectiveness analysis and strategic thinking in policymaking and advocacy on NCDs. In 2008, PAHO sponsored a meeting of Caribbean experts on cardiovascular disease, which focused on planning prevention and control programs. CARICOM leaders are aiming to provide 80 percent of people with chronic diseases a package of preventive services and treatment based on regional guidelines by the year 2012.
PAHO played a catalytic and technical role in the development of joint strategies to respond to outbreaks of yellow fever in South America in early 2008. Working with health authorities from Argentina, Bolivia, Brazil, Paraguay, Peru, Uruguay, and Venezuela, PAHO experts helped identify priorities and lines of action for responding to and containing outbreaks, including vaccination and strategies to reduce breeding sites of Aedes aegypti, the disease�s mosquito vector. PAHO also assisted the countries with communications planning, emphasizing the importance of clear, transparent, and timely public outreach.
Health Agenda for the Americas Action Area
In 2007�2008, PAHO provided ongoing support for country and regional planning in two critical areas of international health security: the new International Health Regulations (IHR) and avian flu and pandemic influenza preparedness. PAHO has worked with three regional integration systems-ORAS�CONHU, MERCOSUR, and RESSCAD (Health Sector Meetings of Central America and the Dominican Republic)-to promote the dissemination of the regulations, the designation of national focal points, and the drafting of implementation plans at both the country and subregional levels. As of April 2008, 25 of the Region�s 35 countries were participating in PAHO surveys to monitor progress in implementation of the regulations. Twelve countries had conducted national assessments of their core surveillance and response capacities, as required by the IHR, and 12 reported having a national public health emergency response plan, also called for by the regulations.
In the area of avian and pandemic influenza, PAHO country offices provided ongoing technical support for national preparedness and response planning, as well as health protection for United Nations staff and their families, procurement of pharmaceuticals, and the development of contingency and business continuity plans for U.N. agencies at the country level. In addition, during 2007�2008, PAHO continued using its pandemic preparedness assessment tool, based on WHO�s Checklist for Influenza Preparedness, to gauge Member States� progress in preparedness planning and implementation. The assessments showed that the average level of preparedness of Latin American and Caribbean countries had increased from 43 percent to 50 percent between 2006 and 2007, with the greatest improvements in Central America, Mexico, and the Southern Cone countries.
In the Caribbean, PAHO helped Member States strengthen their surveillance systems for unexpected health events during the 2007 Cricket World Cup and then helped them build on those efforts to develop National Pandemic Preparedness Plans. Ongoing PAHO technical cooperation in capacity-building, development of planning tools, and simulation exercises are helping to strengthen both pandemic preparedness and IHR compliance throughout the Region.
Three PAHO Technical Cooperation among Countries (TCC) projects during 2007�2008 focused special efforts on the area of planning.
Belize, Costa Rica, Cuba, the Dominican Republic, and El Salvador participated in a 2007 PAHO TCC on implementation of the new International Health Regulations (IHR). The project included the development of a methodology and assessment instrument specifically for these countries to evaluate their core surveillance and response capacities and planning proposals to address the identified gaps. The project also produced strategies to improve the functioning of each country�s National IHR Focal Point.
PAHO partnered with the Caribbean Environmental Health Institute (CEHI) and countries of the Eastern Caribbean in a TCC project to develop the Strategic Collaborative Plan 2008�2012 for sustainable development and environmental health. The strategy seeks to strengthen PAHO and CEHI technical cooperation, promote joint action among the countries, and make better use of resources to improve health and environmental conditions in the subregion.
Peru and Uruguay participated in a PAHO TCC aimed at strengthening cooperation in fighting hydatid disease. The project included the formulation, in collaboration with Uruguay�s National Commission on Zoonoses, of a Plan for the Prevention and Control of Hydatidosis in Peru. The plan falls within the framework of the Southern Cone Project for Hydatidosis Surveillance and Control, supported by PAHO and the U.N. Food and Agriculture Organization (FAO).