No. XXIX RESSCAD AGREEMENTS, ANTIGUA GUATEMALA 2013 STRATEGIC INFORMATION AND / OR COMMENT 1.1 XXIX RESSCAD GUT Agreement 1: Governance and access to water with a human rights approach Prioritize in legislative agendas and national development plans of the countries of Central America and the Dominican Republic, the incorporation of public policies to fulfill the human right to water and sanitation, identifying specific actions to ensure that everyone has the right to have a sufficient amount of water that meets the quality standards of the countries; as well as sanitation services which are affordable, accessible and culturally acceptable; such services should also be provided in a participatory, accountable and non-discriminatory manner based on ethnicity, social class, gender. Belize Water Services Limited (BWSL) provides water for more than 75% of the population of Belize. The rest of the population is supported by the Ministry of Rural Development (113 rural water systems). 1.2 Prioritize the establishment of a regional policy on governance in water and sanitation. This policy should define the responsibility of steering the sector, monitoring the quality of services and must have a comprehensive knowledge management component that includes identifying inequities among population groups. Administration occurs through various levels - the Public Utilities Commission that is in charge of tariffs and development capital; Public Health which monitors water quality; the Ministry of Finance who works in conjunction with the IDB; the Caribbean Development Bank and the World Bank. 1.3 It is a priority that the health ministries of the countries of Central America and the Dominican Republic strengthen health surveillance of water systems; that physical, chemical and bacteriological parameters is to monitor, especially Surveillance of the quality of water systems is mandated by law for the Ministry of Health of Belize. Surveillance is systematic for piped water in both urban and rural areas, rudimentary water systems, and wells. National coverage for drinking water is 96.5% (99.2% urban, 94% 1
1.4 1.5 agrochemicals such as pesticides and heavy metals that can help build risk maps and perform monitoring of concentrations of chemical parameters in the population to determine the impact of pollution and direct investments. Promote national and regional sanitation agendas as a development proposal on "Management of Waste and Waste Water in Central America and the Dominican Republic" as an instrument to seek funding for implementation. Socialize the consolidated country reports of Honduras, El Salvador and Panama, Monitoring of Country Progress in Water and Sanitation (MAPS) and Information System in Rural Water and Sanitation (SIASAR) and promote its expansion in the countries of the region where it is not being implemented. rural). Bottled water is consumed by 32% of the population (piped water consumed by 23%), with about 50 companies producing bottled water. Chemical screening is not routine but done for specific reasons such as PH, nitrates, conductivity, total dissolved solids, sulfate, chloride, and fluoride. Nationally, the Solid Waste Management Authority is implementing the Solid Waste Management Project funded by the IDB and OFID (OPEC Fund for International Development). The objective is to improve waste management in the Western Corridor. A regional sanitary landfill and two of four transfer stations have been constructed and are operational. Since August 2013, the landfill has been receiving an average of 2,000 tons of waste per month for environmentally sound disposal. Under this same project a consultancy is being carried out to prepare a National Solid Waste Management Policy Strategy and to update the National Solid Waste Management Plan. The Ministry of Rural Development is supported by the United Nations Development Programme (UNDP) through the Millennium Development Goals. This support is financial as well as through the review of the Water Board Legislation. BWSL is investing BZ$ 3M in Belize City in the water system. 2
2.1 XXIX RESSCAD GUT Agreement 2: Status of drug addiction in the continent and its impact in Central America. Maintain an integrated approach to the problems arising from substance abuse at the highest priority level within the ministries of health. The National Drug Abuse Control Council works with the Ministry of Education in programs such as: a) Interventions for drug use prevention. Treatment commences once users are identified; b) Parenting Program - A pilot program in which addicts, particularly children, from dysfunctional families are identified and a counseling program commences along with the parents; c) Drug Prevention Program - Vulnerable secondary schools are identified; d) Apprentice Program Apprenticeship Programs are implemented with the assistance of NGOs 2.2 2.3 Ratify the recommendations emanating from the XXVIII RESSCAD and monitor its implementation. Report at the next RESSCAD progress in implementing the recommendations of the XXVIII RESSCAD. XXIX RESSCAD GUT Agreement 3: Drugs and technologies: regulation, national authorities and drug access. 3
3.1 3.2 Request that the authorities of the institutions of the Health Sector of Central America and the Dominican Republic support the Drug Regulatory Authorities of the countries for their development and strengthening as provided in the Plan of Action to Strengthen the Regulatory Authorities of Central America and the Dominican Republic, so that people may have access to effective, safe and good quality drugs. Also that this item be included in the agenda of the official regional forums. Strengthen health authorities to have a structure, resources, and updating the regulatory framework in order to fulfill its role of monitoring and evaluation of health monitoring technology through the establishment of an institutional framework for making decisions based on the evaluation of health technologies, strengthening of human resources and promoting networking and collaboration with regulatory authorities Reference accredited by PAHO. The bidding process is a process utilizedd by the Ministry of Health to acquire pharmaceutical products for use in public health facilities. The selected products are derived from the formulary. There is also a Tender Committee, which selects the items based on the bids submitted by over 30 suppliers of pharmaceuticals and medical equipment. The committee is composed of 2 pharmacists, 2 finance officers, and a procurement officer. The chairman is a doctor. The selected products are purchased by the successful supplier(s) who enter into a contract with the Government of Belize to procure, store in their warehouse, and distribute the tendered items to the facilities of the Ministry of Health. The contract is valid for two years. The National Engineering and Maintenance Center (NEMC) is the entity within the Ministry of Health responsible for the maintenance of medical equipment nationwide. This unit advises the Ministry of Health on the specifications for the purchase of new equipment. 4
3.3 To request that the Technical Secretariat of RESSCAD formulate a regional policy that allows the development of an assessment system, introduction and management of new health technologies, particularly biotechnology drugs, diagnostics, medical devices, radiation therapy services, transplantation of cells, tissues and organs and blood services, including a legal framework, instrumentation and procedures for implementation, in order to help improve the quality of care to patients, improving access, cost effectiveness, equity, availability, timeliness, rational use and safety of the same. At this time Belize does not implement regulatory functions for diagnostic equipment products. 3.4 Adoption of Good Manufacturing Practices (GMP) of WHO Report 32 of 1992, giving a maximum of 24 months for the industrial restructuring of the pharmaceutical industry in Central America and the Dominican Republic, requesting of each manufacturer an annual restructuring and investment verification plan by the national regulatory authority and request international support for co-financing of the conversion plans. 3.5 Implement a regional reference laboratory in the field of biological and biotechnological products, to evaluate both the products already on the market and future innovations and submit a progress report at the next RESSCAD. 5
3.6 Create the Central American Network for the assessment of health technologies, which would start functioning within one month convened by the RESSCAD Technical Secretariat and SE- COMISCA to the counterparties identified by each country. This network should formulate, with the support of TS-RESSCAD, a procedural manual for the authorization of health technology products and utilize primarily virtual communication to streamline costs and staff time involved. 4.1 XXIX RESSCAD GUT Agreement 4: Towards the Elimination of Neglected Infectious Diseases in Central America and the Dominican Republic. That intersectoral actions and national and international partnerships be prioritized to combat Neglected Infectious Diseases with partners, including the mobilization of resources and donations. This initiative involves implementing culturally relevant interventions described in the PAHO/WHO Resolution CD49.R19, the development and implementation of integrated national control plans and elimination of neglected Infectious Diseases addressing social determinants in the context of promoting primary care: social participation, local development and monitoring and health research. The Ministry of Health of Belize is working with relevant stakeholders in the diagnosis and treatment of diseases such as Chagas, leishmaniasis, and other geo-helminthiasis entities. The Ministry has also partnered with the Ministry of Education and PAHO / WHO for the treatment of helminthiasis infections in school age children with the provision of albendazole every six months (May and November).Research for helminthiasis in at risk school children and to identify the incidence/prevalence of Chagas disease in school children has been with the assistance of the Japanese Government through the Japan Social Development Fund) Medications for leishmaniasis is more available in the Department of Defense. 6
4.2 That in RESSCAD 2014 the progress made since 2013 is reviewed and governments are urged to continue working and expanding their efforts to achieve the goals set in the 2015 resolution CD49.R19 on Neglected Infectious Diseases and other poverty related diseases. National Control Plans exist for the identification and treatment of helminthiasis in at risk populations. 5.1 XXIX RESSCAD GUT Agreement 5: Health equity through actions in primary health care that affect social determinants. Through the leadership of ministers and ministries of health, influence the development of policies and sectoral programs to help reduce health inequities, especially those that affect the social determinants of health. The Ministries of Health, Education, and Human Development have collaborated on several projects / programs to reduce health inequalities. Programs include educational assistance for vulnerable children, employment programs for young males with limited skills, a gang suppression program aimed at reducing violence, and access to employment for women through educational programs. In an effort to mitigate the effects of poverty, social welfare programs have been introduced as Building opportunities for Our Social Transformation (BOOST), a cash assistance of US$50 per month for women age 65 and older and for men age 67 and older. A significant progressive measure has been the revision of the 2013 National Gender Policy, a framework document addressing gender inequities through structured processes involving stakeholders at all levels. The development of the 2014-2024 Health Sector Strategic Plan led by 7
5.2 6.1 As part of the primary care strategy to renewed health, perform both local and national intersectoral actions that ensure access to safe water and sanitation, food security and nutrition, education and health promotion, having an impact on improving health conditions of our people. XXIX RESSCAD GUT Agreement 6: Emergency medical care to people in transit insured by social security institutions in Central America and the Dominican Republic. Request support from RESSCAD members for progress in the discussion and approval of proposal "Procedure for Emergency Medical care for foreign patients insured by Social Security institutions who are CISSCAD members the Ministry of Health with collaboration of partners in health, strategically aligns our national health goals focusing on the wellness approach and there is a renewed commitment to participate in reducing health inequities, particularly those that affect the social determinants of health. Multisectoral initiatives are being initiated or improved nationally to strengthen primary health care. Within the Ministry of Health, service areas such as the Maternal and Child Health Unit, Public Health, Health Education and Community Participation Bureau, and Nutrition collaborate to improve water and sanitation, food security and nutrition, education and health promotion. Protocols and procedures have been established to provide for minimum standards of services and care in accordance with the core principles of Primary Health Care. Health promotion is conducted through a network of 287 health workers located in rural communities. All migrants have access to health services provided by the Ministry of Health. Social Security does not provide primary health care services. 8
XXIX RESSCAD GUT Agreement 7: Chronic Kidney Disease of nontraditional causes 7.1 7.2 7.3 Support the Declaration of San Salvador-COMISCA-of April 26, 2013 and the WHO CE Resolution 152/25 in OPS (and its ratification in the Governing Body), applying them to their respective sectors. Promote coordinated action in the health sector represented in RESSCAD to investigate the social determinants, risk factors, epidemiological studies of population and geographical characterization in the countries of the region. Urge the institutes of health of Central America, their coordinated participation in clinical epidemiological research, economic evaluations and comprehensive response to the disease. Belize is in the process of signing the Declaration. The Ministry of Health of Belize has taken particular interest with regard to the existence of Chronic Kidney Disease that can be attributed to diseases such as diabetes, hypertension, congenital malformations, and renolithiasis. The Ministry of Health, in collaboration with private hospitals, subsidizes service to a number of individuals who require dialysis treatment. Our research agenda is pending. It is included in the draft Strategic Plan for Noncommunicable Diseases. 7.4 Request water institutions, ministries of environment and agriculture to strengthen the regulatory framework to ensure compliance with mandatory standards on the import, smuggling, storage, sale, advertising, distribution, use and disposal of chemicals in accordance with international commitments signed. 9
7.5 Request that countries, as requested by the Resolution 152/25, participate in the mechanism of the PAHO strategic fund for medications and supplies and in the regional joint negotiation mechanism to improve drug quality and obtain more competitive price products (drugs and supplies) for the care of patients. 7.6 Promote the coordinated action of the health sector in Central America and the Dominican Republic to expand coverage and improve the quality of prevention, early detection, industrial hygiene and occupational health, timely and comprehensive treatment, with emphasis on communities of high risk. 7.7 Request the RESSCAD Technical Secretariat the mobilization of resources to revive PLAGSALUD to be included in the ERC surveillance model of nontraditional causes. 10