Minutes VII Meeting of the Consultative Council of ISAGS

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Minutes VII Meeting of the Consultative Council of It was held at the headquarters of the South American Institute of Government in Health ( / UNASUR), Rio de Janeiro, Federative Republic of Brazil, on April 11 and 12, 2018, the VII Ordinary Meeting of the Consultative Council of. Participated in person representatives of Technical Groups of Surveillance and Response in Health and Health Promotion and Action on Social Determinants, and of the six Structuring Networks of the South American Health Council, in addition to and representatives of the Ministries of Health of Bolivia, Brazil and Guyana. The coordinator of the Technical Group for Development and Management of Human Resources also participated. The list of participants appears as ANNEX I and the agenda as ANNEX II to the present minutes. OPENING The meeting was chaired by the Executive Director of, Mgs. Carina Vance Mafla, who opened the session, welcoming the participants and requesting a round of presentations. It was reported that the post of Specialist in Social Determinants of Health of is vacant, and that the Institute is going to initiate the selection process as soon as possible. READING OF MINUTES VI MEETING CC As has been traditional, the participants reviewed the minutes of the VI Ordinary Meeting of Consultative Council, held on April 19 and 20, 2017. This document is included as ANNEX III. BALANCE OF ACTIVITIES IN 2017 A presentation was made on the activities developed by in the year of 2017, noting that it was a year of achievements in the institutionality of (ANNEX IV - activities of 2017). The participants welcomed the actions undertaken by and highlighted the need for block action. It was highlighted that the participation of in various forums allows them to map common actions and be more efficient so as not to duplicate efforts. In this regard, it was suggested that use as input in its activities the results of the study conducted by the Observatory of Social Participation of MERCOSUR. PRESENTATION OF PLANNING OF THE 2018 AOP BY SPECIALISTS The specialists presented the planning of the 2018 AOP of the Institute. (ANNEX V - POA 2018). In the area of Health Systems and Services, the activities planned for 2018 are: the implementation of the health asymmetry monitoring indicators platform; the online White Paper on Health Systems; the holding of a Workshop on Integrated Health

Services Networks; and a course on good practices in policies and management of human resources in health. In the area of Social Determination of Health, research will be conducted on the barriers to the promotion of healthy eating policies; and the systematization of existing mechanisms in South America for participation in the governance of health in the region. From the area of Health Surveillance, three priority topics were presented that are being developed in 2018: the strengthening of capacities for public health emergencies within the framework of the implementation of the International Health Regulations; the implementation of the South American Disaster Risk Management Plan; and the study on risks, threats and vulnerability in relation to climate change in the South American region. In the area of Medicines, a study on the judicialization of medicines is planned; a faceto-face seminar on the contribution of the evaluation of health technology assessment in the updating of the national basic lists of medicines; and a study on the patentability criteria of medicines with a public health approach in the legislation of the UNASUR countries. The members of the Consultative Council highlighted some issues that they consider important for the region and that could be addressed from, such as the measles outbreak in the region and the relevance of vaccination as a social pact. The importance of sustaining that the WHO Global Immunization Plan maintain the established goals was reiterated. The importance of not stigmatizing migration and not blaming migrants for outbreaks of disease was stressed. It was also suggested to include a discussion on biological medicines and biosimilars and their impact on health systems. Finally, the Consultative Council mentioned the importance of addressing the production and supply of medicines that are not of economic interest to the pharmaceutical industry and / or for neglected diseases. PRESENTATION OF THE FINANCIAL SITUATION OF The Executive Director presented a report on the financial situation of UNASUR and, and warned that the sustainability of the activities they carry out depends on the financial contributions of the member countries and is being affected. The members of the Consultative Council expressed great concern regarding this situation, since this has already impacted the execution of the Institute's activities in 2018. PRESENTATIONS OF RESEARCH, COMMUNICATION AND INTERNATIONAL RELATIONS ACTIVITIES A proposal of visiting researchers was presented, through which the representativeness of the countries at could be broadened and networking promoted towards the production of knowledge in the health area. The proposal is under study by and was favorably received by the Consultative Council.

Subsequently, a presentation was made on communication strategies, including communication products such as Health to the South magazine, the Institute's weekly online newsletter and participation in social networks (ANNEX VI). The new website was also presented, which is already available and will be refined in the coming weeks, and the SurMAS Platform (Monitoring of Health Asymmetries), which presents information on the health systems of the 12 countries of South America. The platform aims to advance to also contain information, analysis and studies on the internal asymmetries of the countries. It was requested to include in the new website the minutes and documents of the meetings of the South American Health Council, for public consultation. Likewise, it was suggested to incorporate a space on the site on the Sustainable Development Goals (SDGs), since these objectives are a reference for the work of and the countries. In relation to the SurMAS platform, it was suggested to include an analysis that explains the differences in the methodologies of the main institutions (WHO, PAHO, World Bank and ECLAC) in terms of their data and statistics collection. It was also requested to consult with countries on the data published on the platform. From International Relations, the First South American Course on Government Health was presented, which is part of the 2018 AOP of and will be developed with the support of the Center for International Relations in Health of Fiocruz (CRIS / Fiocruz) and the area of international relations of FLACSO Argentina (ANNEX VII). The Consultative Council welcomed the project, and was available to receive suggestions and comments that could strengthen the initiative. SESSION OF THE TECHNICAL GROUPS The session of the Technical Groups had the participation of representatives of the Surveillance and Health TG; of the TG of Social Determinants of Health; and the Human Resources for Health TG (ANNEXES VIII, IX and X). The presentations focused on the assessment of articulated work with an intersectoral perspective. The members of the Consultative Council stressed the importance of leadership in the coordination of the groups, which facilitates the convergence of agendas and joint work. In the same way, the difficulties of some groups in maintaining activities in the face of budget restrictions in the countries and problems of internal organization were underlined. SESIÓN DE LAS REDES: After the presentation of the Technical Groups, the presentations of the Structuring Networks followed, with representatives of the Network of Offices of International Relations in Health (REDSSUR ORIS); the Network of National Institutes of Health (RINS), the Network of Public Health Schools (RESP), the Network of Technical Health Schools (RETS), the Network of National Institutes and Institutions of Cancer (RINC), and the Network of Disasters Risk Management (GRIDS) (ANNEXES XI, XII, XIII and XIV).

The importance of strengthening internal communication between the ministries of health and the entities and institutions that make up the networks was mentioned. In the same way, the members of the Consultative Council mentioned that many activities and initiatives carried out by the TGs and Networks are opportunities for the joint positioning of the countries in multilateral fora. FUND OF COMMON INITIATIVES OF THE SOUTH AMERICAN HEALTH COUNCIL AND POSSIBLE FUTURE PROJECTS Next, the Regulation for the Execution of the Common Initiatives Fund of UNASUR (FIC), approved in December 2015 by the Council of Ministers of Foreign Affairs (ANNEX XV), was presented. In addition, a balance was made of the execution of the FIC projects developed within the scope of the South American Health Council: the Drug Price Bank of UNASUR, the Mapping of Productive Capacities of Drugs in South America and the Platform for the Exchange of Experiences and Assistance Technique for the Control of Cervical Cancer in South America (ANNEX XVI and XVII). The members of the Consultative Council mentioned the importance of presenting new projects to the FIC Fund for the year 2019. The RINS mentioned the project already presented and approved by the South American Health Council, on the impact of environmental changes on the occurrence of health emergencies and that is pending evaluation by the FIC Committee of the General Secretariat. The RETS, in turn, referred to the project on the situational analysis and the formulation of education policies for technical workers in health, already submitted to the Pro Tempore Presidency, but which is pending evaluation and approval by the Health Council. DISCUSSION OF COMMON PROBLEMS, IDENTIFICATION OF COOPERATION OPPORTUNITIES The participants had the opportunity to discuss the common problems, for the identification of collaboration possibilities between GTs, Networks and (ANNEX XVIII). The importance of strengthening the coordination of the Groups and Networks, making intersectoral articulations, delimiting the fields of action, of giving greater visibility to the activities of the TGs and Networks, of clearly establishing the objectives and activities of each instance, of strengthening internal communication and articulation with other for a and international and subregional organizations. METHODOLOGY OF THE AOP AND PROPOSALS FOR 2019 Next, the methodology for the preparation of the Annual Operating Plans of (ANNEX XIX) was presented, and feedback was requested from the Consultative Council regarding the preparation and prioritization models used for the AOP. A presentation was made with proposals from team for its Annual Operating Plan 2019 (ANNEX XX). In the area of Health Systems and Services, a study is proposed on good practices of universal access to health; a consultation on the mechanisms for evaluating the training of health professionals; a workshop on uses and techniques of Telehealth (use of information technologies for health) to close gaps in areas of difficult

access; and an investigation on methods and evaluations of the results of the publicprivate health relationship. In the area of Social Determination of Health, it is suggested to support the implementation of the Framework Convention on Tobacco Control in South America; a seminar on addressing the different forms of violence and their impact on health; and a study on the role of municipal, cantonal or equivalent governments in the formulation of health policies in South America. For the area of Health Surveillance, the proposals are the establishment of a regional panel of institutions and experts to support the implementation of the IHR; a document analyzing the priority indicators on noncommunicable diseases; and support for the implementation of the South American Disaster Risk Management Plan. The proposals for the area of Medicines and Health Technologies are a seminar to discuss strategies to promote generic medicines; a catalog on drug price regulation in the countries; and a monitoring of regional policies on the availability and purchase of medicines. In the area of communication, it is proposed to continue with existing activities, such as publications, action on social networks, the Dialogues of the South event and the production of a virtual annual report of the activities of the Institute. On the other hand, an International Program of Diffusion of the Regional Integration in Health is proposed, with the production of thematic videos on the work topics of the Institute. From International Relations and Cooperation, the continuity of activities to monitor the actions of the councils and instances of UNASUR, the convergence of agendas among the different regional forums, strengthening the visibility of UNASUR and in world forums and the promotion of intersectoral work. In addition, it is intended to comply with the statutory activities of the Executive Direction, such as the regular meetings of the governing bodies of. It is planned to carry out the II South American Course on Government in Health. As relevant issues for the development of actions within the scope of UNASUR and proposals to be considered in the preparation of the 2019 AOP of, the members of Consultative Council mentioned the importance of including an approach on the relationship of health systems with the communities; a broader approach on the use of Telemedicine not only considering remote areas; a survey of good public health practices for regulation of drug prices; and the use of the ecological health model to better understand the relationships between the different elements that impact on health. It was proposed to consider the suggestion to hold a seminar that brings together representatives from the area of medicines of the ministries and the laboratories or health institutes of the countries, which could be done by with the support of the GAUMU and the RINS.

It was also proposed to form a UNASUR commission that addresses antimicrobial resistance with a focus on medicines. In this regard, it was suggested to systematize the national antimicrobial resistance plans in the web platform. Additionally, the possibility of bilateral cooperation between Argentina and Guyana was mentioned for the Telemedicine issue; and Argentina and Bolivia, for training of human resources in the area of antimicrobial resistance. It was stressed that these may be important elements for consideration by the ORIS Network, for the matrix of supply and demand of South-South cooperation in the region. The RINS offered its support to the telemedicine project, since the Network is already working on this issue in conjunction with the CPLP countries. The Executive Director of mentioned that she was invited to be part of two High Level Commissions on the 40 years of the Declaration of Alma Ata, one of PAHO and the other of the WHO. The Director placed these spaces at the disposition of the Consultative Council and of the countries to incorporate the South American views on primary health care and universal access to health. The Executive Director of thanked those present and with the farewell words of the delegations present, the meeting was closed on the afternoon of April 12, 2018.

ANNEX I VII MEETING OF THE CONSULTATIVE COUNCIL OF List of participants NAME Claudia Perandones Julia Ismael Teresa Rosso Bárbara Frossard Pagotto Alfredo Bravo José Noriega Karen Cummings Karen Gordon-Boyle Silvia Rosanna Brizuela Claudia Ugarte Pablo Tailanian Felix Rosenberg INSTITUTION Coordination of Network National Institutes of Health (RINS) / Argentina Coordination of the Network of National Institutes and Institutions of Cancer (RINC) / Argentina Ministry of Health of Bolivia Ministry of Health of Brazil Coordination of the Disaster Risk Management Network (GRIDS) / Chile Alternate coordination of the Technical Group of Social Determinants of Health (GTDSS) / Colombia Ministry of Health of Guyana Ministry of Health of Guyana Coordination of the Public Health Schools Network (RESP) / Paraguay Coordination of the Technical Group of Human Resources in Health (GTRRHH) / Peru Virtual participation Coordination of the Technical Group for Surveillance and Response in Health (GTVyR) / Uruguay Executive Secretary- RINS Walter Zoss Executive Secretary- RINC

Anakeila Stauffer Executive Secretariat- RETS Ingrid D Ávilla Sebastian Tobar Hermano Castro Eduardo Costa Felippe Amarante Carina Vance Mafla Gabriela Jaramillo Luana Bermudez Flavia Thedim Bueno Beatriz Nascimento Felix Rígoli Eduardo Hage Angela Acosta Executive Secretariat- RETS Executive Secretariat- RINS, RESP, RETS Executive Secretary - RESP Executive Secretariat- RESP Executive Secretariat- RESP