ORAS: Our Goal for the Future Is to Achieve Health Sovereignty Through Developing Regional Competencies

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ORAS – CONHU, a new partner to Copenhagen Institute for Futures Studies, facilitates subregional integration of best practices in public health in the member countries (Bolivia, Chile, Colombia, Ecuador, Perú and Venezuela), as well as in the observer countries (Argentina, Brazil, Cuba, Spain, Guyana, Panama, Paraguay, Uruguay and the Dominic Republic). Its objective is to assist member countries in advancing the health of their populations, and to coordinate efforts made by members individually or collectively. ORAS develops subregional systems and methodologies to enhance the state of health in member countries, while coordinating and promoting concrete actions, plans, and programmes. We talked with Dr. Maria del Carmen Calle, ORAS Executive Secretary.

Dear Dr. Maria del Carmen Calle, we are aware of your extensive experience and commitment in the health sector in Perú, could you share with us an experience stands out?

Good morning, it´s a pleasure for me to have this conversation with CIFS. As the Executive Secretary of the ORAS-CONHU, the Andean Health Organization, I and my team work with six Ministries Bolivia, Chile, Colombia, Ecuador, Perú and Venezuela. 

I was the Vice-Minister of Public Health in Perú, it was in 2018 and we had many things to work and I think that one of the principal achievements that we had, we had the healthy feeding regulation, that´s very important in our country, because this law was from 2013, but we didn´t have the regulation how to implemented it, and when I was the Vice-Ministry and before the Director of the strategic interventions in Public Health, we made it possible. One of the problems in Peru and in every part of the world is overweight and obesity and this was very important. The second thing that I would like to remark is our vaccination schedule. It was very important in 2018 that we add other vaccinations. In Latin America, we have a very complete vaccination schedule, and many people go and have the vaccination. We don’t have those problems, that we see in other parts of the world, about not vaccinating the children. We worked with migrants. There were many other things, very important.

Another position that I think that was very important is being Regional Advisor in Adolescent Health in the PAHO in Washington, DC, in 2015. It was very important because we began the evaluation of that regional plan of adolescence and youth, that was presented in 2018. It was very clear that adolescence is not just a transitional period, but it’s very, very important. Now with the pandemics, we have many, many problems with mental health illnesses.

The Andean Health Organization, of which you are now Executive Secretary, has half a century of experience already, integrating healthcare in the countries in which it is present in LATAM. From your perspective, how do you think the approach to healthcare has been transformed during this time? How would you summarize this trajectory? 

In the 90s we were talking about the neoliberal approach, with privatization. But after 2000, when we have the General Observation 14 of the United Nations, when we recognized that health is a human right, things have changed a little bit. In ORAS-CONHU, in the mission and the vision are related to two principal things. First of all, make, contribute, so that everybody who lives in the six countries can have a right to health. Without health, we have nothing. The pandemics have shown us that. It is one of our principles, our guideline. The other one is inequities between the countries, iniquities in the country, inequities in the local people. We will work with that. We must work so these inequities, especially in health, this gap cannot be so long as it is now. We have a roundtable in an organization on ways to fight against these inequities in health. This roundtable is an Andean roundtable, where representatives of the health ministries from the six countries are present.

In Latin America there is still a great challenge for the organizational and management capacity of national health systems, in this sense, what does public health represent for ORAS? 

Public health is really the centre of our work, but we must understand what public health really is about. There are many definitions, but I think that when we talk about public health we are talking about the science and an art of preventing diseases to make life a little bit longer and to promote, but not just to promote with the government, but to promote with some actions that are from the society’s, not just the government. We have very clear that we are the result of our interaction between us and our social context. It’s not just to have better services. It’s not just to have better clinics. We have to work to change this structural inequity. We are talking about poverty, economic status, education and gender and interculturality. This kind of intersectionality that we see in our people. That’s the idea of public health, the main thing in our work.

How do you see the concept of equality in access to health care being included in the ORAS agenda? 

A4: We think that everybody needs an adequate health in the course of life. I’m not talking only about children. I’m talking about everybody. If they need to, they have to have access to the services, but mainly they have to have conditions that promote health. Conditions means housing, clean water, no air pollution, those things are related to health. Hence, for us these services are very important, but equally important are social determinants. We have to work with all of them. That’s the idea of ORAS-COHNU.

In relation to the previous question, what do you think are the most common challenges in the multiple activities carried out by ORAS?  Can you share with us how you and your team have overcome them? 

A6: First, the team of ORAS-COHNU consists not just of the people who work with me in Lima, Peru, in the Executive Secretariat. The team I think are more than 200 people that are in the six countries, because we work together, meeting the (health) ministers two times a year. We met with national health authorities once a month. It may be a meeting with a minister or a vice-minister. We have 18 committees, we have three subcommittees and six teams and one round table on inequities, and the Andean net of communicators. When we talk about the committees, for example, we have a committee of non-communicable diseases, where we have worked very hard and have now approved the Andean policy for prevention and control of overweight and obesity in the six countries. Now, in this moment, we are finishing the policy on cancer. Oncological diseases are a huge problem, not just in my countries, but all around the world. We are also currently beginning an investigation in new-borns to know exactly how we are to gain efficiency. Our services, our uses in neonatology, so we can have a better approach to learn neonatological problems. And we are beginning, in one week or two weeks, capacity building on interaction with the indigenous populations. In our countries, we have numerous indigenous populations, and we have to respect their beliefs, they do have many things they can teach us.

Another thing that is very important is climate change. We have a regional plan in climate change. We’re working now with hospitals to make it possible that the carbon footprint that they have decreases. We have been in COP25 and we are going to be in the COP27.

Principally, our team believes that health is everybody’s right, everybody has a right to enjoy the best level of health possible. It is closely related to our work against inequities, mainly in health.

I understand that you are currently developing two projects, one related to hepatitis and the other to strengthen diagnostics of tuberculosis, perhaps you can tell us the expected impact of these projects and if you have any more in the pipeline? 

The project on tuberculosis is the second phase of a project that began in 2017. The idea is to have the best laboratories, not just on a national, but supra national level. The first phase was with 20 countries, which is beyond the Andean area. Currently, we are working with seventeen. The idea is that these laboratories have all the capacity to get a diagnosis with opportunity, with quality.

The other is hepatitis. We’re talking about hepatitis in general, but we know, the only hepatitis now that has a treatment is hepatitis C and we are working so that there are no gaps between the countries when we pay the treatment. That’s very important for us. Now we have won a project with the BID for genomic surveillance.  That is very important. Not the six countries, only four countries, but we are working and going forward.

We know of failed attempts to transfer good health practices from one region to another, in your experience, what do you consider to be the most important in this aspect and what recommendations would you leave us with? 

Well, if we would talk of what practices, you know, first thing of all is that not every practice has the same outcomes in different contexts.  This is very clear, we have some innovative things, but some decades ago.  We talked about that vaccination week in the Andean Region, and now is the week of the Americas.  We began that in the 1990s.  Another experience relates to weeks dedicated to preventing pregnancy.  Teen pregnancy is a very important problem.  Here in the Andean region, we cooperate with COMISCA, that includes countries from the Central America, the Dominican Republic.  They organize their weeks.  I think that this initiative will expand.  Also, we are cooperating with the Directors of Immunization and Vaccination Programmes, in the six countries.  We employ webinars, another good practice from the pandemics. Since May 2020 we have conducted 120 webinars.  It’s a very good practice.  The idea is to exchange knowledge.  In these webinars we have been the recognized experts from all the world, like Michael Marmot.  We do technical meetings as well, for real use cases.  There are many other areas of engagement.  We were involved in negotiation of prices to treat AIDS.  We negotiated prices for malaria treatment.

In this era of globalization and digitalization, how do you see the future of regional health integration between communities? 

I think that the integration must be stronger. Countries alone don’t have all required strengths. The pandemic showed that reality. The integration is important. We have the committees; we have the meetings with the national health authorities. We are part of the Andean integration system. And we have had a meeting two weeks ago where we discussed the interaction indifferent fields like research, economics, production, and legal matters in our region. The idea is very clear. Health must be in the centre. Now the pandemics showed us that if we don’t have the health in the centre of the public policy, it will end bad, as this recent pandemic is not the last one to occur. We’ve got to deal with many things in the future. We have to be integrated.

What challenges do you see on the road to this vision of integration, and how do you think they should be addressed? 

The main challenge is that the governments want to go alone because they are responsible now. But if we talk about a long-time vision, it may be considered as missing. It is typical for Latin America. Four, five years planning, and that’s it. Then another government comes, and it’s over. It is not a sound approach. We have to revert it. The idea is to have a future vision, but I’m not talking about two, three years. I am talking about maybe 10 years. Three of the six countries have their health strategic plans for 10 years. That’s good. We’re talking about maybe a decade. The other thing is that health is more than ideologies. I think that health is more important. That’s why it is the area of our work. It doesn’t matter who is in the government, health must have its site. And when we talk about a site, we talk about the budget. We can’t have rights if we don’t have budget, and you know how important health is for the government, when you go and see how much they spend on healthcare. One of our achievements last year was that the six ministries said that they were going to increase the budget for mental health. A very important decision.

We are very excited about the ORAS – CIFS collaboration project, could you share with us what you expect from this collaboration that we are initiating? 

We’re enthusiastic about this agreement because we found important coincidences in the front lines of work. Such as a focus to improve access to quality care throughout life. In this field, we are already developing work with the countries in relation to the course of life and healthy aging, ACD, neonatology, among others. Going from cure and rehabilitation to promotion and prevention. That’s the shift we have to do. And I think that your organization, CIFS, does things the same way. We think that data science and digital solutions are very important. We have to be very clear about that, we need competences and infrastructure to do data science and to implement digital solutions ourselves. The pandemic has increased exponentially from our own work to continue from home, to reach further advances in telehealth. ORAS-COHNU has ensured continued work and promoted internal learning spaces with technical meetings, webinars and so.

The other thing that I think is very important is these kinds of association, alliances between health systems. In Latin America, we have very fragmented health systems. I believe that we must do joint effort, maybe through public and private partnerships. We must promote advances in science and technology. We must go forward. The goal is to achieve a health sovereignty through developing regional competencies. We can’t wait for the North to tell us when it will be possible to receive the equipment, such as venting respirators. In the pandemics, it became very clear that we have to have our own things.

What do you include in the concept of health sovereignty?

I include production of vaccinations, equipment, medical supplies, it means strengthening the regional production capacity. That’s not the only thing. We have to have better data. If you don’t have good data, you may not take good decisions. We also need infrastructure. We need human recourses that know how to do it. We need a team, not one or two persons, but many persons who have capacities, competencies, abilities to make it possible. I think that is very important. We also need to have a hat of a politician on. Health policies are important, as they will not do anything here, unless it’s a law.

You mean also need legal and regulatory changes?

It’s worrying that our region has so much corruption. It’s not unique for my region, but when I say we need laws and regulations, many people answer to me “Why? Everybody do what they want to do”.  Now, we have to do things in the correct way. That’s the idea we have, and don’t forget about social justice and environmental justice is very important for us. We are not just talking about humanity. We believe in one health, we believe in our health, the health of animals and all the climate and the environment.