1. Leaders in International Health Program
Cooperation and Diplomacy in Health Module
2012 Session
COOPERATION IN HEALTH DEVELOPMENT IN LATIN AMERICA AND THE CARIBBEAN IN THE GLOBAL CONTEXT: CHALLENGES AND OPPORTUNITIES
Dr. Rebecca de los Ríos
Principal Advisor
External Relations, Partnerships and
Resource Mobilization

2. Milestone that marked a shift: 2000 Millennium Summit

3. Global Meetings on Cooperation for Development
Millenium Development Goals (MDGs)
Why use graphics from PowerPointing.com?
Monterrey Consensus
Commitment of 0.7%
World Develop-ment Summit
Doha Declaration on Financing for Development
Forum on Cooperation for Development
ECOSOC
Forum on Cooperation for Development
ECOSOC
2002
2003
2005
2008
2010
2011
1st High-Level Forum in Rome
Harmonization
III Forum Action Agenda of Accra
High Level Forum on SSC
Bogota Declaration
II Forum
Paris Declaration
IV Forum Busan Korea 3

4. Have the member countries of the CAD fulfilled their commitment?
If they had fulfilled their commitment, the annual amount available would be 300 billion dollars. But it is only 133 billion dollars. What to do?

5. Paris Declaration: Global Commitments of Donors and Partners
The Paris Declaration on the Effectiveness of Development Aid is an international treaty that establishes global commitments of donor and recipient countries to improve the delivery and management of aid with the objective of being more effective and transparent. The treaty was signed in March of 2005 by more than one hundred donor and recipient countries, international agencies and multilateral organizations.
The PD is a roadmap to increase the impact of development aid on key targets such as reducing poverty and inequality, increasing capacity and accelerating achievement of the Millenium Development Goals (MDGs).
The Paris Declaration has five key principles:
The appropriation of the implementation of aid by recipient countries:
Developing countries exercise effective leadership over their development policies and strategies, and coordinate development actions;
The alignment of strategies of donor countries with recipient countries:
Donor countries should base their aid on development strategies, institutions and the host country procedures;
The harmonization in the focus and actions among donor countries:
Donor countries coordinate among themselves, simplify their procedures and share information to avoid duplication and poor coordination; Results focused: Donor and recipient countries focus on the results themselves, which are measured using established evaluation frameworks.
Mutual accountability:
Donors and developing countries commit themselves to be mutually accountable for the results of development aid.
One of the most important components of the PD is the inclusion of measurable indicators and targets to ensure the quality and effectiveness of aid. Another is the commitment of donor countries to base their aid on poverty reduction strategies of recipient countries, and the commitment of recipient countries to reform their national systems, if needed, to improve their management capacity of resources for development.
Agreed upon by those who signed and/or endorsed the Agenda of Aid Effectiveness

6. The agreements continually changed: A New geopolitics of cooperation for development
Second High Level Forum on Joint Progress toward Enhanced Aid Effectiveness (Harmonisation, Alignment, and Results
It proposes improvement in the areas of ownership, partnerships and delivering results..Capacity development also lies at the heart of the Agenda for Action.
There is a reconigtion of the role of Soutth-South Cooperation
Busan has been an expression of shifting geopolitical realities: For a New Global Partnership for Development

7. What Happened in Health: Expansion and Presence of New Actors Financing Global Health
Taken from “Financing Global Health 2011: Continued Growth as MDG Deadline Approaches” Institute of Health Metric and Evaluation. University of Washington 7

8. New Actors Appear: Public-Private Partnerships, NGOs

9. Multiple Global Initiatives9

10. Where are Latin America and the Caribbean in the Global Context?
Taken from “Financing Global Health 2011: Continued Growth as MDG Deadline Approaches” Institute of Health Metric and Evaluation. University of Washington

11. How has international aid grown since the Millennium Summit?
Variación porcentual de la asistencia para el desarrollo de la salud
The magnitude and pace of growth of HDA in LAC before and after the Summit showed a very different trend from aid growth that occurred in other regions of the world. As can be seen, between LAC with East Asia Pacific were the regions most favored by financial flows of HDA, a situation that has changed dramatically since 2001, particularly for LAC.
Source: De Los Ríos R, Arósquipa C, Vigil-Oliver W. Rev Panam Salud Publica. 2011;30(2)133–43

12. Growth Dynamics: Volatile and Cyclical
Financiamiento de la asistencia internacional para el desarrollo de la salud (ADS) por fuente en la Región de América Latina y el Caribe (desembolsos en millones de dólares constantes de 2009)
Source: Done by PAHO/WHO based on IHME DAH Database Country and Regional Recipient Level Database Seattle, United States: Institute for Health Metrics and Evaluation (IHME), 2011; retrieved: Jan 2012
Note: Abbreviations: CAD: Development Aid Committee (DAC); BIRF: International Bank for Reconstruction and Development; IDA: International Development Association; BID: Inter American Development Bank (IDB); GAVI: Global Alliance on Vaccines and Immunizations; FBMG: Bill and Melinda Gates Foundation

13. There are differences according to the per-capita income of countries

14. Financing by Developed Countries
Official Health Development Aid according to group of entry of countries by year, (Millions of U.S. Dollars at constant prices 2010)
Source: De Los Rios, R; Vilanova Carmen based on Credit Reporting System . OECD.Stat Extracts, date retrieved: March-April, 2012 ;
Note: According to World Bank data, the high income countries are Antigua & Barbuda, Barbados, Netherlands Antilles, Turks & Caicos, Trinidad & Tobago; middle-high income countries are Argentina, Belize, Chile, Costa Rica, Cuba, Dominica, Grenada, Jamaica, Mexico, Panama, Saint Kitts & Nevis, Saint Lucia, Saint Vincent & the Grenadines, Suriname, Uruguay, Venezuela; low-middle income countries are Bolivia, Brazil, Colombia, Ecuador, El Salvador, Guatemala, Guyana, Honduras, Nicaragua, Paraguay, Peru, República Dominicana; low income country is Haiti; Regional/multi-country includes the region and sub-regions of Central America, South America and the West Indies

15. Alignment with Regional Health Problems?
Ayuda oficial al desarrollo (AOD) por tema de salud en América Latina y el Caribe (acumulado )
Source: Developed by PAHO/WHO based on statistics of the Creditor Reporting System. OECD.Stat Extracts, date retrieved: March-April, 2012
Notes: Medical services and research: includes academic training of the health personnel and medical services specialized in medical research
Basic Health: includes basic health, basic health infrastructure, training staff in basic health and health education
Infectious diseases: includes control of infectious diseases, malaria and tuberculosis
Reproductive health and family planning: includes reproductive health, family planning and training of staff working in reproductive health and family planning

16. Who are the principal cooperating countries?
Ayuda Oficial al Desarrollo en Salud (AOD-S) según país cooperante en América Latina y el Caribe, (Millones US$ precios constantes 2010)
Source: Developed by PAHO/WHO from the statistical database of the OECD Creditor Reporting System, date retrieved: March-April, 2012
NOTES: Nordic countries include: Denmark, Finland, Norway and Sweden
The rest of the countries include: Australia, Austria, Belgium, France, Greece, Ireland, Italy, Luxemburg, United Kingdom and Switzerland

17. How has International Aid to Governments for the Development of Health behaved before and after the year 2000?
Total expenditure (TE) in health related to the public and private production of goods and services in LAC in 2008 was estimated at U.S. $ 312 billion, resulting in an expenditure of US$ 536 per capita which represents the highest ratio reached thus far in the region. HDA that year represented 0.37% of TE, equivalent to U.S. $ 2.0 per capita. Annex 1 shows that over the period the relative weight of HDA channeled to governments with respect to public expenditure on health (PEH) maintained similar proportions ranging between 0.44% and 0.18%.
Source: De Los Ríos R, Arósquipa C, Vigil-Oliver W. Rev Panam Salud Publica. 2011;30(2)133–43.

18. What is the variation of Public Health Expenditures before and after the year 2000?
GPS-F: Public spending on health as a source. This refers to government expenses that are financed by internal sources. Source: De Los Ríos R, Arósquipa C, Vigil-Oliver W. Rev Panam Salud Publica. 2011;30(2)133–43.

19. Challenges: Donor Relations
Promote less circumstantial cooperation, focusing on capacity development and processes aimed at facilitating greater sustainability.
A partnerships where donors meet the internationally agreed upon principles such as harmonization, alignment, coordination and above all, the recognition of the stewardship role of governments.

20. Importance of Evidence and Information for Dialogue with Donors
August Vol. 30, No. 2
NÚMERO ESPECIAL SOBRE SALUD INTERNACIONAL / SPECIAL ISSUE ON INTERNATIONAL HEALTH
El financiamiento internacional para la cooperación al desarrollo de la salud de América Latina y el Caribe
Rebecca De Los Ríos, Carlos Arósquipa y William Vigil-Oliver
An article was recently published in the special issue of the Pan American Journal of Public Health in order to more widely disseminate information regarding analysis of international aid in health. To improve access to and use of information, a space was opened on the International Aid in Health for Latin America and the Caribbean in the Regional Public Health Observatory of PAHO. With these products the PAHO Secretariat develops its ability to provide current and relevant information on these issues and support decision-making processes.
Ayuda Oficial para el Desarrollo de la Salud según países receptores, donantes y años

21. Challenge in the models: Innovative cooperation
Changing the paradigm, seeking non-traditional funding mechanisms, articulating actors, establishing alliances and partnerships (public-private partnerships, joint civil society, academia, etc.)
Mobilizing resources, ideas, innovations, and capacities of countries in the region to mutually beneficial partnerships.

22. Opportunities
Countries have better capacities and knowledge to share: leadership of middle income countries.
Health problems are increasingly shared.
The answers and solutions are becoming more collaborative

23. Regional leadership promoting cooperation among countries for the development of health.
PAHO was a member of the UN interagency group that was organized in conjunction with the Panamanian Government and the First South-South Cooperation Fair of Latin America and the Caribbean. It was during the Fair that the Cooperation Portal among Countries was launched; PAHO also participated sharing its experiences, in debates and discussions about the present and future of south-south and triangular cooperation for the Region and the role of Multilateral Organizations. During the Fair, PAHO launched the cooperation among countries platform.

24. The exchange of knowledge and joint learning: A necessity for cooperation in health.
With the new launching of these forms of cooperation, the need to visualize and document the experiences and results of different arrangements and cooperation mechanisms has been identified and recommended in various international forums and multilateral agencies have been called to fulfill a role in this endeavor. The design and launching of the Portal on Cooperation between Countries has been put forth as an essential tool for the exchange of knowledge and learning. PAHO’s Area for Knowledge Management and Communication collaborated on the design and programming of the Portal. One of the tools of the portal for the exchange of knowledge is the "case histories". With the support of consultants funded by this component, a survey of knowledge-sharing tools as developed by various multilateral organizations was undertaken; and, based on the characteristics and needs of the health sector, the guidelines and tools of ‘case histories’ of the PAHO portal were designed. This tool has been institutionalized as the standard to be used to systematize and publish the experiences of cooperation between countries that are supported or sponsored by PAHO. The portal and its tools are available to all organizations, institutions and individuals who want to share their experiences in health cooperation.
Click to see the history of the cases in the Portal

25. Muchas Gracias Thank You Muito Obrigada
We hope that this presentation will provide you with elements that foster discussions and debates
Muchas Gracias
Thank You
Muito Obrigada