RESPONSIBLE COORDINATOR REPORT ON HEALTH
BY THE PAN-AMERICAN HEALTH ORGANIZATION,
JANUARY 1996 

Summit of the Americas Fifth Meeting of the Summit Implementation Review Group Santiago,
Chile -- January 22, 1996

 The Summit of the Americas held in Miami, December 9-11, 1994, through both its Declaration of Principles and Plan of Action prompted a series of important actions by governments and by the Pan American Health Organization (PAHO) during 1995.

Item 17 of the Plan of Action, Equitable Access to Basic Health Services, mandated a series of actions by governments to improve the quality of, and access to, basic health services and to reduce child and maternal mortality. PAHO is pleased to report steady progress toward the goals of Item 17 in the year after the summit and to report that all meetings mandated by Item 17 have been held.

Governments have continued to demonstrate their strong support for the goals of the 1990 World Summit for Children, the 1994 Narino Accord and the 1994 Conference on Population and Development and to reflect in their international policy statements and domestic policies their commitment to reduce child mortality by one-third and maternal mortality by one-half from 1990 levels by the year 2000.

Governments are committed in principle to the concept of basic packages of clinical, preventive and public health services as defined in Item 17. Progress is being made, in general, at the policy level. Scarce resources, however, severely limit the ability of many countries to assure that their commitments effectively address child, maternal and reproductive interventions. Immunization programs are moving forward at a significant pace in all countries, a notable achievement. The restructuring of the Global AIDS Program, under United Nations auspices, is proceeding at a slow pace which may weaken regional efforts in this critical area.

Health sector reform and country action programs to achieve child, maternal and reproductive health goals and assure access to basic services remain core commitments of countries to achieve the goals of Item 17. Health sector reform has emerged as a major topic of public debate in many countries of the region with the goal of effective delivery of health services on an equitable basis being the key goal of policy reforms.

At the international level, PAHO, together with its cosponsors, has fulfilled the mandate of Item 17 of the Plan of Action to convene a conference "to establish the framework for health reform mechanisms, to define PAHO's role in monitoring the regional implementation of country plans and programs. .. ." This meeting, "The Conference on Health Sector Reform," was held in Washington from September 29-30, 1995 at PAHO's headquarters in cooperation with the IDB, World Bank, GAS, ECLAC, UNFPA UNICEF, USAID, and the Canadian Government. The conference provided important information for countries to utilize in assessing their own health sectors and assisted international agencies, including PAHO, in strengthening their roles in supporting and monitoring achievement of the summit's health goals.

Special note must be made of the critically important role of the First Ladies of the Americas in achieving the goals of Item 17. Both at the Miami Summit and at the Paraguay Meeting of the First Ladies in October, 1995, the First Ladies have made significant contributions toward progress in each of their countries on issues such as infant mortality, maternal and child mortality, violence against women, and sexually transmitted diseases. At their meeting in Paraguay, the First Ladies adapted a joint "Declaration of Paraguay" recognizing the important links between health and education of both mother and child and detailing eight specific activities the First Ladies will pursue in support of the mandate embodied in Item 17 with respect to maternal and child health. The First ladies also recommended a series of specific strategies and programs to improve the health of women and children.

PAHO has been honored to be actively involved in supporting the First Ladies' activities. The First Lady of the United States, Hillary Rodham Clinton, launched the Measles Elimination Program at PAHO and committed $US 8 million from the U.S. Agency for International Development (AID) for its elimination. By mid-December PAHO was able to announce that measles had dropped to its lowest level ever, down from 23.000 in 1994 to only 4,500 cases in 1995.

In fulfillment of the mandate of Item 17, at its September, 1995 meeting, the Directing Council of PAHO adopted a new regional plan for countering the threat of new, emerging and reemerging diseases. In addition, PAHO has continued to give priority attention to assisting governments "combat endemic and communicable diseases" as called for in the Plan of Action.

HIV/AIDS remains a major health concern throughout the region. The adequacy of international efforts to combat this disease remains unclear as the program moves from coordination by the World Health Organization to management by a consortium of agencies under United Nations control. PAHO continues to work with governments, the Inter-American Development Bank and other donors to identify sources of funding to combat HIV/AIDS.

Many governments of the Americas, as well as PAHO and other regional organizations, were active in assuring that the World Summit for Social Development and the World Conference on Women addressed the issue of access to health services as called for under Item 17 of the Plan of Action. Both summits included commitments to equitable health access which are consistent with the goals of the Summit of the Americas.