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 The International Health Bulletin is a publication developed by the Edmundo Granda Ugalde Leaders in International Health Program (LIHP) of the Pan American Health Organization/World Health Organization (PAHO/WHO). The purpose of the Bulletin is to contribute to the dissemination of information on international health issues among Program participants and other relevant actors who work in the areas of public health and international relations, enabling them to learn more about the LIHP, as well as relevant issues and opportunities related to international health.
This issue of the Bulletin focuses on one of the LIHP’s core modules, namely, that of International Cooperation and Health Diplomacy. The article, written by the module coordinator, Dr. Evelyn Martinez, highlights the objectives and main contents of the module as well as illustrates the application of the module content to two projects from the LIHP 2013. This issue also includes information about the LIHP 2013 and 2014 cohorts as well as upcoming events in the field of international health. Finally, the issue discusses some of PAHO’s accomplishments in extending the reach of the LIHP through decentralization.
 The Edmundo Ugalde Leaders in International Health Program (LIHP) 2014 was launched on 10 June 2014 with a bilingual, virtual event that linked over 100 individuals gathered across 28 countries and served to both honor the LIHP 2013 graduates and welcome the new cohort of leaders. During the ensuing months, the LIHP 2014 participants completed a set of virtual learning modules related to international health issues and are currently in the process of finalizing and presenting their country projects, which address real-life priority public health issues in their country or region.
As we reflect on 2014, we recall the remarks of Dr. Carissa F. Etienne, Director of the Pan American Health Organization (PAHO), in her keynote address directed towards the participants during the opening ceremony: “You are current and future leaders and decision makers. You are creators, drivers and implementers of policies and programs. And this makes you a special group of people. Over the years, PAHO, through its Leaders in International Health Program, has contributed to the development of public health leaders in the region. We hope to continue to contribute towards your development as leaders and empower you to join the call to action to move the world closer towards the achievement of universal health coverage.”
Dr. Etienne also noted the importance of the LIHP in providing a framework that facilitates inter-sectoral, inter-disciplinary, and inter-country cooperation and exhorted participants to seize the unique opportunity within the program to collaborate towards innovative and collaborative solutions. Dr. Etienne remarked, “This is a tremendous opportunity that as a group you can take a holistic view of confronting the challenges of this region in reaching its goal of health and wellbeing…. We hope that as you come together, as you pull your ideas together, that hopefully PAHO can gain from your insight.”
 The module, International Cooperation and Health Diplomacy, has been an integral part of the LIHP since its introduction into the curriculum in 2009. The module is considered to be one of the core LIHP modules and has as its objective ‘to analyze cooperation in health by studying the foreign policies of countries, the influence of different actors and their implications for international relations and cooperation in health as well as the different types and modalities for the management of international cooperation that facilitate the development of basic competencies in the field of international health.” (Study Guide 2014)
To achieve this, the following specific objectives were defined: (1) Describe the origin and evolution of international cooperation and its modalities as well as the theoretical bases of international relations (Conceptualization); (2) Analyze international cooperation in health, actors and global alliances and their relationship with countries' foreign policy. Analyze health diplomacy (Critical and argumentative analysis); (3) Apply the LIHP international health conceptual model to the different country topics in order to generate criteria that will be translated into actions aimed at strengthening or improving international cooperation within and between countries (Proposals).
The starting point for this module was to reflect on the LIHP international health conceptual model and the analysis of the international relations, foreign policies and models of development of the countries and their influence on international cooperation, maintaining the premise of health as a human right and the center of multiple public policies. This was attained by analyzing the theoretical and conceptual bases of international relations as well as by looking at international cooperation in its broadest sense, including its history, evolution, concepts, modalities and determining factors so as to enable the participants to analyze from a critical perspective the way in which States undertake, channel and utilize international cooperation, through the determination of its main actors, results, impact and use of cooperation to benefit the health of populations. This allows for the development of skills and competencies in areas such as: advocacy, negotiation, development of agreements as well as the production and dissemination of knowledge. (see learning path).
The module is organized in three components, each of which corresponds to a study unit:
- Unit I: From the theoretical to the conceptual: international relations, health diplomacy, international cooperation, modalities, governance and effectiveness of aid.
- Unit II: From an understanding of the problem to its critical analysis: foreign policy (policies, priorities and modalities for the management of cooperation); actors, their relationships and geopolitical coincidences; integration processes, alliances, associations and the approach to health issues.
- Unit III: Integration of content: Integration of content into country projects.
Each unit is comprised of basic and complementary readings, activity guides and presentations by invited experts on the chosen topics. These are addressed either in general sessions or in subgroups with specific tutors. The latter allow the participants to more fully develop the topics that have been previously presented and share their concerns, knowledge, experiences and perceptions about the situation in the countries as regards to the topics covered. This process also provides input to participants as support for the development of the activities related to each component.
The personal experience of each participant plays a fundamental role in the input and focus of these sessions. The different thoughts and considerations of the participants are also reflected in the module activities. Those activities undertaken in 2014 are described below.
- Interactive Forum: Theoretical and conceptual basis of international cooperation in health. Cooperation within integration processes
A guide was designed for the development of the forum, which included key questions that would prompt critical reflection and analysis on the main actors and trends in international cooperation in health in the Region, the correlation between the focus of cooperation and health priorities, the role of global alliances and the agendas of integration bodies. The forum allowed for a spontaneous, rich and productive exchange that represented an extension of the group sessions and in which not only were the participants able to provide their opinions but which also served as a space for the exchange and dissemination of information on different topics, contributing in this way to the collective development of knowledge.
- Presentations by teams on integration processes: CARICOM, SICA, UNASUR, ORAS-CONHU, ALBA, MERCOSUR, CELAC with emphasis on the approach to health problems from a sub-regional perspective
These sessions were preceded by an expert presentation that helped contextualize the current sub-regional integration processes in Latin America and the Caribbean. Subsequently, participant groups gave presentations on the integration processes in which their countries participate, analyzing the role of the same in the approach to health problems. It is worth noting that various participants play a protagonist role in these sub-regional entities, which contributed to the debate and critical reflection on the topic.
This activity was introduced into the 2014 cohort and included two sessions: a main conference that addressed conceptual and theoretical aspects of negotiation techniques; and a second session within subgroups that promoted the sharing and analysis of real-life case studies involving negotiations among participants. This enabled participants to strengthen their knowledge in this area.
- Application of module content to country projects
An orientation guide and proposal for analysis was developed to facilitate the application of the knowledge gained in the different thematic units to the country project topic previously chosen by the participants. This project is continually enriched as the participants advance through the Program.
Although all the country projects benefited from this exercise, those projects that had as their focus cooperation, international relations and/or diplomacy were particularly enriched. By way of example, we will examine two projects from the 2013 cohort whose focus for analysis was international cooperation.
International cooperation and health diplomacy between PAHO, UNASUR and ACTO
This project was developed by participants working with PAHO/WHO, the Union of South American Nations (UNASUR) and the Amazon Cooperation Treaty Organization (ACTO) and whose interest was to characterize the areas of inter-institutional cooperation and converging health agendas of these three organizations in countries of South America. The project hoped to develop a proposal for ‘inter-agency’ cooperation, with a flexible mode of work that would allow the three entities to bridge agendas, generate proposals and advance towards a common goal.
Analysis of the convergence between the foreign policy and the national health policy of Ecuador in order to define lines of action in international relations as regards to health issues
This project was developed by the Ecuador country team and had as its objective to examine the convergence between the foreign policy of Ecuador and its national health policy as a way to help guide processes related to international relations in health.
Foreign policy was one of the main areas that the group tried to address, based on the policies of Ecuador that are enshrined in its constitution and the National Plan of Good Living. The group also analyzed the model of development of Ecuador which prioritizes human development and places the individual above capital gain and strives to provide good living for all Ecuadorians. The project explored the “lines of action related to national health priorities as well as those related to Ecuador’s foreign policy, looking for potential convergences, so as to analyze a possible confluence between both policies of the State and strengthen the country’s management of health issues at the international level”. (Reference: final document by group)
In both cases, the module contributed to the development of the projects, allowing participants to broaden their perspectives regarding cooperation in health, the actors involved and the role of foreign policy in the development of health agendas.
 As mentioned in previous bulletins, the country project that LIHP participants develop during the year constitutes the applied part of the Program. This experience allows participants to identify and analyze a particular problem or situation related to public health in their country, sub-region or region from an international health perspective. They are encouraged to delve into the international determinants and commitments surrounding the issue and propose solutions or actions that resolve or improve the same, giving preference to those which require collaboration and intersectoral or supra-national agreements. Participants work individually or in small groups over the course of several months and receive feedback and input on their work from other participants, mentors, PAHO/WHO technical experts and members of their communities of practice.
This bulletin highlights the country projects developed by the 2013 cohort. These projects, which were concluded in 2014, spanned a variety of topics, including, among others, international cooperation, non-communicable diseases, migration, international health regulations, mental health, millennium development goals, access to medicines, environmental health and health systems.
The year 2015 marks the 30th anniversary of PAHO’s international health program. Since its inception in 1985, the Program has evolved from an onsite program at PAHO headquarters in Washington, D.C. to its present virtual format. This has allowed PAHO to reach an ever-growing number of professionals and expand to approximately 500 the number of professionals who have shared solutions and ideas for the region’s pressing public health problems. More information on this occasion will be included in the next issue.
 The international health seminars organized by the LIHP have as their objective to explore more in depth and reflect upon current international health issues in order to contribute to the decision making processes and the development of public health policies in the countries. In 2014, the LIHP hosted a virtual seminar entitled “Ebola: Challenges for health services in preparedness and response in the Americas”. The bilingual seminar, which took place on 19 November 2014, brought together over 100 participants from more than 20 countries. Expert panelists addressed topics related to preparedness and response, the challenges facing health professionals in the Region as well as some of the perceptions regarding the epidemic, human rights and freedom. The agenda and recording of the seminar can be found in this link.
 In early 2008, the Edmundo Granda Ugalde Leaders in International Health Program (LIHP) developed a strategy to promote the continued education of public health leaders with a vision of the international context and global diplomacy. This process incorporated the involvement of the PAHO/WHO regional technical programs, renowned academic centers in the Americas and the PAHO/WHO Country Offices in the Region.
Among the positive results attained by this initiative has been the active development of an international health conceptual model that guides the LIHP curriculum. This model, together with the learning path, and based on theoretical and conceptual analysis, critical reflection and positive action proposals, has resulted in an innovative design for the interaction among the tutors, mentors and participants of the Program. In addition, approximately 300 professionals, organized into seven cohorts, have been trained through the Program, benefiting innumerable public health projects.
In order to continue extending the reach of the LIHP, it was decided to work with decentralized modalities that are closer to the national and subregional contexts. Many positive results have been obtained to date of which the following merit highlighting:
- The training of a select group of coordinators of the Cuban Medical Brigades through a decentralized modality of the LIHP that supported the PAHO/WHO priority countries in the Region: Bolivia, Guyana, Haiti, Honduras, and Nicaragua. The following countries were subsequently added: Belize, El Salvador, and Guatemala. This challenge was supported by the Ministry of Public Health of Cuba, PAHO/WHO and the National School of Public Health of Cuba through a Technical Cooperation Agreement (TCC) signed by the countries involved. This initiative resulted in the training of over 40 participants between the years 2009 and 2011 who interacted with and enriched the Program and technical cooperation processes. These efforts also contributed to the creation and strengthening of the Department of International Public Health (currently called the Department of International Public Health and Medical Education) in the National School of Public Health of Cuba.
- The National School of Public Health of the University of Antioquia in Medellin, Colombia in 2009 offered to explore the possibility of accreditation for the LIHP. The Ministry of Education of Colombia in March of 2011 approved the Specialization in International Health of the University of Antioquia. To date, one cohort has graduated from the Specialization and applications are currently being received for the 2015 program. The academic committee of the National School of Public Health is in the process of approving a modality that will allow LIHP graduates who successfully completed that Program to register for a semester at the University of Antioquia and defend a thesis or county project before a panel to qualify for the title of Specialist. Those interested in the Specialization or the possibility of accrediting their experience in the LIHP can contact Dr. Juan Eduardo Guerrero Espinel, Coordinator, Specialization in International Health, guerrero.espinel@gmail.com.
- The creation of a ‘Residency’ Program in International Health in the PAHO/WHO Country Office in El Salvador. The program is directed towards government personnel, with particular emphasis on professionals within the Ministry of Health (MINSAL) and the Salvadoran Social Security Institute (ISSS), as a technical cooperation strategy directed towards the institutional strengthening of human resources with new knowledge and skills that will benefit the country’s development. According to the agreement signed between the government of El Salvador and the PAHO/WHO office in the country, at the same time that these professionals undertake technical functions in the country offices, the country office advisors transfer to them their own knowledge, technology and experiences, so that they can be trained in professional methods, techniques and practices. Since 2013, the program incorporated another component through which a select sub-group of the ‘residents’ – who were also selected for the LIHP – are given the opportunity to participate in the LIHP at the same time that they undertake their residency in the country office. This allows for an even greater integration of theoretical and practical knowledge and experiences related to international health and technical cooperation. To date, 20 professionals have benefited from the Residency Program, of which four have also participated in the LIHP.
- The development of face-to-face and virtual courses and seminars on topics related to international health that are organized and led by Program alumni in various countries of the Region.
These events provide reason for optimism within the LIHP Coordination, which aims to continue the process of decentralizing the Program with the support of the LIHP International Health Academic Network. In this sense, the LIHP has always promoted the participation in the Program of professors and researchers from renowned universities so as to encourage them over time to assume greater academic responsibilities at the national and international level. In addition, PAHO/WHO will continue supporting the efforts of the different institutions of the LIHP International Health Academic Network to offer courses, seminars, certificates programs, specializations, and possibly in the future, masters degrees that enrich the experience of training human resources in international health, thereby expanding the institutional capacities in the countries.
It is worth noting that the most important decentralization process is that of the development of the Program directly in the countries, with the support of the national institutions and PAHO/WHO Country Offices. Today, through their work in the countries, participants have made invaluable contributions towards the development and implementation of policies, programs and projects related to international health.
 
The International Convention of Public Health will take place at the Convention Center in Havana, Cuba from 20-24 April 2014 with the title, “Health For All, Universal Coverage”. The event is sponsored by numerous national and international institutions and will take place in Spanish, English and Portuguese. The event is intended to provide an opportunity for participants to discuss current and future challenges to public health in the world as well as look at new processes for the renewal of primary health care and their implications for health services.
In addition to the main conference, the event will also include a satellite event on medical cooperation and international health organized by the Department of International Public Health and Medical Education of the National School of Public Health of Cuba http://www.convencionsalud2015.sld.cu/index.php/convencionsalud/index/pages/view/cooperacionmedica-saludinternacional.
This event builds on the previous encounter in 2012 during which a number of current and former LIHP presented their country projects as well as other research related to international health. The results of this event were reported in the last issue of the International Health Bulletin.
To read more about the main topics and requirements for submitting an abstract for the convention, visit http://www.convencionsalud2015.sld.cu/index.php/convencionsalud/2015.
 Interested professionals are invited to apply for the Edmundo Granda Ugalde Leaders in International Health Program 2015. Information and the application form can be found at:
http://www.paho.org/hq/index.php?option=com_content&view=article&id=10208%3Acall-applications-2014-edmundo-granda-ugalde-leaders-international-health-program&catid=1939%3Aleaders-international-health-program-&Itemid=2099&lang=en.
Individuals can also request additional information by contacting INTLHLTH@paho.org. The deadline for applications is 15 February 2015.
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