Strengthening National Public Health Institutes in Mesoamerica and the Dominican Republic

1
Strengthening National Public Health Institutes
in Mesoamerica and the Dominican Republic
Towards a Mesoamerican Public Health Institute
Miguel Ángel González Block Jorge Motta Silvia
Magali Cuadra Hernández Luz María González
Robledo Laura Magaña Juan Francisco Molina
2
Table of Contents

• Framework for assessing public health capacity
• Project aims and methods
• Preliminary results
• Conclusions

3
Framework for defining National Institutes of
Public HealthInternational Association of
National Public Health Institutes (IANPHI)

• Science-based organization or network of
  organizations
• Provide national leadership and expertise
• Multi-faceted, including people with a wide range
  of skills and experience
• Perform critical public health functions
• A trusted source of counsel for policy- and
  decision-makers
• Part of government (usually under the Ministry of
  Health) or closely attached to it

4
Core NPHI functions Essential Public Health
Functions (PAHO)

• Evaluation and analysis of health status
• Public health surveillance
• Prevention programs and health promotion
• Social participation in health
• Planning and management
• Regulation and enforcement
• Evaluation and promotion of equitable access to
  health services
• Human resource development and training
• Quality assurance in personal and
  population-based health services

5
NPHI as Single Agencies

• National scope of influence and recognition
• Limitations on political influence
• Scientific basis for programs and policies
• Focus on the major public health problems
  affecting the country
• Adequate human and financial resources
• Adequate infrastructure support
• Linkages with key organizations
• Accountability

6
Multi-agency NPHIShould function as a single
agency

• Leadership capable of ensuring that the
  organizations function as one
• A clear definition of each organizations
  responsibilities
• Agreements that allow for swift and efficient
  data sharing
• Procedures for notifying emergencies
• Capacity to share resources while responding to
  emergencies
• Consistent policies regarding human issues, data
  integrity, and privacy

7
Project aim and methods
8
Aim of the Project
Contribute to strengthening the essential public
health functions in Mesoamerican countries and
the Domincan Republic by

• Analyze the current assets of the regions
  national public health institutes or like
  organizations
• Support a coordinated development plan
• Propose a regional public health capacity
  development consortium

9
Project Objectives

• Conduct a situation analysis of essential public
  health functions in existing NPHIs or like
  organizations
• Generate a medium-term NPHI consolidation plan
• Develop a proposal for a Mesoamerican-DR
  technical support consortium

10
Methodology
A. Situation analysis of existing NPHIs and other
organizations with NPHI potential

• Establish a tri-national technical team with
  Costa Rica, Panama and Mexico, led by INSP
• IANPHI analysis toolkit Self-applied on-line
  survey
• Observations and interviews with leaders from
  NPHIs and like organizations
• Develop a benchmark to assess country capacity
  situation
• Validate the results among participating
  institutions  

11
Case 1 Panama
Participating organizations

• Ministry of Health
• 1.1. Hospital del Niño Santo Tomás. (HNST)
• 1.2. Dirección Nacional de Farmacias y Drogas
  (DNFD-Min)
• 1.3. Programa Nacional de ITS/VIH y SIDA
  (PNVIH/SIDA-Min)
• 1.4. Departamento Nacional de Epidemiología del
  Ministerio de Salud de Panamá. Public
  organization. (DNEp-Min)
• 2. University of Panama
• 2.1. Centro de Investigación de Medicamentos y
  Tóxicos. Facultad de Medicina, (CIMT-UP)
• 2.2. Instituto de Alimentación y Nutrición,
  Universidad de Panamá. Public organization.
  (IAN-UP)
• 3. Instituto Conmemorativo Gorgas de Estudios de
  la Salud
• 4. Instituto de Investigaciones Científicas
  Avanzadas y Servicios de Alta Tecnología. Public
  organization. (INDICASAT)

12
Case 1 Panama
Function Surveillance, infectious diseases
Strength Weakness Action
HNTS Gorgas PNVIH/Sida-Min DNEp-Min
HIV/AIDS
Strengthen network
Malaria TB
HNTS Gorgas PNVIH/Sida-Min DNEp-Min Indicasat
Vaccine coverage other infectious diseases
HNTS Gorgas PNVIH/Sida-Min DNEp-Min
13
Cont Case 1 Panamá
Function Surveillance of non-infectious diseases
Strength Weakness Action
Nutritional status
HNTS Gorgas PNVIH/Sida-Min DNEp-Min
Strengthen organizations and networks
Tobacco addiction
IAN-UP
Chronic diseases
Maternal child health
CIMT-UP PNVIH/Sida-Min DNEp-Min
HNTS
Injures occupational health
HNTS Gorgas PNVIH/Sida-Min
Mental health
DNEp-Min
Gorgas CIMT-UP PNVIH/Sida-Min DNEp-Min
Others
14
Cont Case 1 Panamá
Function Outbreak control
Strength Weakness Action
Gorgas PNVIH/Sida-Min DNEp-Min
Strengthen HNST and CIMT-UP
HNST (none)
Epidemiological assistance
Gorgas PNVIH/Sida-Min DNEp-Min Indicasat
Laboratory assistance
HNST (some)
Another type of assistance
HNST (some) CIMT-UP
DNFD_Min PNVIH/Sida-Min
15
Cont Case 1 Panamá
Function Disaster mitigation
Strength Weakness Action
PNVIH/Sida-Min DNEp-Min
To share experiences of participating in
large disasters (better practices)
CIMT-UP (some)
Make plans to protect population health
HNST PNVIH/Sida-Min DNEp-Min
Have participed with others organizations
CIMT-UP (some)

HNST (some) CIMT-UP PNVIH/Sida-Min DNFD_Min
Have experience in big disasters
16
Development of a regional initiativeThe
Mesoamerican Public Health Institute
17
Demographic and Health Indicators for Countries
in Mesoamerica

Source Organización Panamericana de la Salud,
Área de Análisis de Salud y Sistemas de
Información Sanitaria. Iniciativa Regional de
Datos Básicos en Salud Sistema de Información
Técnica en Salud. Washington DC, 2005.
18
Common health problems in Mesoamerican region
Main Health Problems
Mesoamerica
Belize

Over 500,000 pregnant
1
Population
0.3 M
Southern Mexico
Poverty
28
Population 118.5 M
women have no prenatal
Unvaccinated children 2
Population
35 M
attention and 19 no
Poverty
22
Maternal mortality ND
Poverty 18
childbirth care, annually
Unvaccinated children 4
Honduras
Maternal mortality
63
Population
6.8

Poverty
13
Over 15 million people
2
Unvaccinated children 13
are at high risk for
Maternal mortality 108
Nicaragua
dengue and malaria,
Guatemala
Population
5.5
annually (13 of total)
Poverty
37
Population
12.7 M
Unvaccinated children 13
Poverty
27

Over 700,000 new borne
Maternal mortality 86
3
Unvaccinated children 9
Maternal mortality 148
children have no basic
vaccination, annually,
El Salvador
(26 of total)
Population
6.7 M
Poverty
21

Over 400,000 children
Unvaccinated children 4
4
Maternal mortality 71
are malnourished (15
Colombia
Costa Rica
of total)
Panam
á
Population
44
Population
4.3
Poverty
21
Population
3.2
Poverty
8
Unvaccinated children 14
Poverty
14
Unvaccinated children 11
Maternal mortality 73
Unvaccinated children 6
Maternal mortality 36
Maternal mortality 66
Mesoamerican Initiative
Sources
CEPAL, CONEVAL, ONU, UNICEF, OMS, OPS,
19
The context of the MPHI
Mesoamerican Integration and Development Project
Mesoamerican Public Health System
Mesoamerican Public Health Institute
20
Mesoamerican Public Health System DIAGONAL
STRENGTHENING OF HEALTH SYSTEMS FOR THE SCALING
UP OF VERTICAL INTERVENTIONS
Regional Disease Control Programs
Strategic Development
Vaccination
Nutrition
MCH
Vector s
MPH I
Technical support
Analysis research
Surveys
Teaching Training
21
MPHI organization

• A virtual network within Mesoamerica and other
  countries
• Public health institutions focusing on strategic
  development and an organic relationship with the
  national health authorities
• Governed by a Board and supported by a Regional
  Coordination Mechanism and a Secretariat
• Responsible to the Mesoamerican Public Health
  System governing bodies

22
MPHI Objectives

• Contribute to the develoment of MPHS governance
• Support MPHS technical capacity, monitoring and
  evaluation
• Facilitate regional initiative integration with
  national health systems

23
MPHI mission and vision
Mission Network of academic institutions
contributing towards national health sytems
strengthening to improve population health
through the production and utilization of
regional public goods Vision Together, develop
regional strategies to support country knoweldge
and capacities to confront public health
challenges
24
MPHI Founding Board
Mexico
National Institute of Public Health Colegio de la
Frontera Sur (ECOSUR)
Nicaragua
Guatemala
Centro de Investigaciones y Estudios de la Salud
(CIESS)
Universidad de San Carlos Faculty of Medicine
Costa Rica
Instituto de Nutrición de Centro América y
Panamá (INCAP)
University of Costa Rica
El Salvador
Universidad de El Salvador Faculty of Medicine
Panamá
Instituto Conmemorativo Gorgas de Estudios de la
Salud
25
MPHI action lines Supported by Mexicos MInistry
of Health and the Carlos Slim Foundation

• Mesoamerican Capacity Strengthening Program
• Mesoamerican Graduate Education Program
• Mesoamerican Program for Technical Support and
  Knowledge Transfer

26
Conclusions

• Under the IANPHI concept framework, strategic
  alliances can be identified for strengthening
  public health at the national and regional
  levels.
• The present capacity analysis will serve to
  orientate the mission and action plans of such
  strengthening efforts
• Leadership exists at the highest presidential,
  ministerial, donor and national institute levels
  for conducting such strengthening efforts.
• The Mesoamerican Public Health System will
  constitute thematic networks with regional
  functions.
• The Mesoamerican Public Health Institute can
  operate as a consortium of centers of excellence