Number 1 [2008]  
August, 2008

"The recognized interdependency that marks this new century has overcome the distance between the local and the global, the individual and the collective, the micro and the macro, the biological and the environmental, making the global nature of threats and the global capacity to respond to them increasingly evident. In this regard, we have the ability to coordinate our activities, increase our connectivity, create networks for collaboration, and enlist new actors and  institutions to confront the risks and specifically protect  the most vulnerable among us."

Dr. Mirta Roses Periago
PAHO Director
February 1, 2008

During 2008, the Area of Health Systems and Services of the Pan American Health Organization/World Health Organization (PAHO/WHO) launched the new Leaders in International Health Program as a continuation of the successful "Residency in International Health" program which existed for over 20 years. Dr. Mirta Roses approved the new decentralized model with 8 participating countries in the pioneer group (Argentina, Belize, Bolivia, Chile, Colombia, Ecuador, Guatemala and Peru). A brief call for applications resulted in approximately 80 applicants, of which 20 participants were selected. This first generation of participants will finish the program in the third week of November, 2008.

In recognition of the importance of communication and dissemination of the new vision and objectives of the Program, as well as its new format, the institutional alliances for the design of the educational modules and other experiences, we are opening a new space of communication with the Electronic Bulletin in International Health.

This new Bulletin is intended to serve as a means for the dissemination and reflection upon selected topics in International Health and to provide information regarding the participants’ milestones and experiences in this new phase. The Bulletin aims to provide an iterative environment between the participants and the international community in order to: a) provide information on the Leaders in International Health Program; b) disseminate and reflect upon relevant topics related to health and international relations; c) create a space for discussion and sharing of opinions; d) share studies and information; e) analyze news about public health issues; and f) call attention to international treaties and agreements related to country team’s topics. This Bulletin will have strong linkages with the International Health Virtual Situation Rooms managed by the country teams and will serve to provide information on the participants’ work in the program. Given its electronic format, the Bulletin will be open to comments and suggestions from readers and interested parties.

The Bulletin is guided by the principles and ethics of PAHO and will serve as a link for the work undertaken by countries in the area of health and international relations. This space will foster the relationship between former participants in the Training Program in International Health and new participants in the decentralized phase; in addition to the academic institutions and centers that are collaborating with the Program in the design and implementation of the virtual education models. These institutions and centers include: The University of Valle-CISALVA; The National School of Public Health, University of Antioquia; FIOTEC of Rio de Janeiro, Brazil and the Health Surveillance Agency (ANVISA) of Brazil; the Institution of Nutrition of Central America and Panama (INCAP); the PAHO/WHO Country Office in Peru; and the regional and country offices of PAHO/WHO, along with other institutions and individuals with interest and actions in international health.

This first edition is intended to inform interested parties of the new Leaders in International Health Program and its contributions to the countries of the region; to present the new participants involved in the 2008 Program; to describe some of the steps in the development of the new Program and important members that have collaborated and continue to collaborate in this collective effort; and to introduce the International Health Virtual Situation Rooms (SSSI) as an innovative working tool.

We wish to recognize the PAHO/WHO Country Offices committed to the Program, without whose collaboration, political will and technical support, it would have been impossible to develop a decentralized program that makes optimal use of the Virtual Campus for Public Health, a space that proves to be of much utility for new leaders in international health. The support of PAHO/WHO Director Dr. Mirta Roses was imperative in choosing the 8 countries for the 2008 generation, as well as was the technical support of the PAHO/WHO Area Managers who, both directly and through their technical resources, have supported and contributed to the success of all the program’s phases and activities.

Future editions of this Bulletin are open to comments and suggestions and we invite you to continue to be informed by and participate actively in the creation of this bulletin.


Pedro Brito
Area Manager, Health Systems and Services


The Bulletin in International Health is a publication developed by the 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 from academia and practice in the areas of public health and international relations. Contributors include the Program’s participants, representing eight countries in the Region, national health officials, university professors, and PAHO/WHO country and regional officials.

Each edition of the Bulletin will focus on a specific international issue. While the majority of the thematic issues will be derived from the participant’s country projects, other topics of interest in the area of international health will be explored as well. Some of the topics being considered for upcoming editions include access to medicines, conflict, nutrition, health systems and services and Official Development Aid (ODA). Each edition will include an analysis of the issue from an international health perspective and will incorporate information from a variety of sources, including periodicals, the main supranational treaties and agreements related to the topic, databases and statistical information resources, scientific publications, interviews with stakeholders and other relevant actors, and public opinion surveys.

Most of the information for the Bulletin will be gleaned from the International Health Virtual Situation Rooms which are developed and managed by country teams composed of the Leaders in International Health Program participants, the PAHO/WHO Country Office and national health officials. The Bulletin will therefore enable the participants to synthesize and share what they have learned through the International Health Virtual Situation Rooms with other international health workers, national, regional, and international health officials, universities, and non-governmental organizations and international agencies. If you want to see the topic of each country and its participants click here.

The Bulletin’s design enables people outside of the Program to learn more about international health issues and opportunities as well as the Program itself. By utilizing an electronic format, contributors to the Bulletin can share multi-media files with their audience. These include videos, voice recordings, links of interest and more. Additionally, a digital bulletin can reach a larger audience than a traditional publication and because it has the capacity to become interactive in the future, the Bulletin’s larger, more diverse audience and multi-media capabilities will lead to a more balanced, transparent and dynamic publication.

The Bulletin in International Health’s next issue will focus on Conflict, Violence and Illicit Trade from an International Health Perspective, which was the topic of module 3 of the Program.

Panama, Panama
29 January – 1 February, 2008


From 29 January to 1 February 2008, the Methodological Workshop for the Development of the Leaders in International Health Program 2008 took place with the purpose of finalizing the definitive operational proposal for the Leaders in International Health Program of the Pan American Health Organization (PAHO) for 2008. The workshop formed part of the renovation of the Training Program in International Health at PAHO, which operated from 1985 until 2006, and trained 182 professionals from 32 countries in the Region. The efforts to renovate the Program arise from the need to ensure its relevance and that it responds to the needs of the countries in the Region in the development of leadership in international health, to expand its reach and to reevaluate the development of its didactic strategy. A multidisciplinary and inter-sectoral group, comprised of public health experts, education specialists and designers from 11 countries of the Region, contributed in an important way to the design of the new Program, providing key elements and perspectives from such distinct fields and work environments as the ministry of health, international relations, academia and international cooperation agencies dedicated to health and development.


Quito, Ecuador

1 – 2 May, 2008

The Workshop for the Pedagogical Development of the Leaders in International Health Program 2008, which took place in Quito, Ecuador on May 1-2, 2008, had as its goal to finalize the educational proposal for the development, implementation and evaluation of three virtual modules for the Leaders in International Health Program 2008. The participants, who came from distinguished universities and institutions in the Region, have assumed the responsibility for the design, implementation and evaluation of their respective educational modules. The modules and the institutions responsible for their development are:

Conflict, Violence, and Illicit Trade:
    University of Antioquia, Colombia
    CISALVA, University del Valle, Colombia

Nutrition, Food Trade and Development:
  Institute of Nutrition of Central America and Panama (INCAP), Guatemala
    PAHO/WHO Country Office in Peru

Access to Medicines and other Technologies, Trade and International Agreements:
  Foundation for Scientific and Technological Development in Health (FIOTEC), Oswaldo Cruz Foundation (FIOCRUZ), Brazil
  National Health Surveillance Agency (ANVISA), Brazil


Dr. José Antonio Pagés - PAHO/WHO Representative, Argentina. Dr. Pagés comments on the decentralized model of the Leaders in International Health Program and the benefits that it offers for the Pan American Health Organization/World Health Organization (PAHO/WHO) and the Program participants in Argentina.

Dr. Caroline Chang Campos - Minister of Public Health, Republic of Ecuador. Dr. Chang Campos expresses the significance of the Leaders in International Health Program and its contributions for national health development and the actions of Ecuador within the sub-regional, regional and international context.

Article from Ecuador - The Leaders in International Health Program was recently reviewed in the PAHO Ecuador Report. The article examines how the Program builds capacity among the participants from Ecuador regarding complex issues in International Health and the Program’s contribution to the development of health systems in Ecuador.


Program Structure 2008

The Pan American Health Organization (PAHO/WHO) recognizes that health systems of the 21st century must confront new challenges to achieve national and international health goals in the face of a globalized world. The right to health, human security in health, the introduction of new technologies, the opening of borders to trade, the growing migration of populations, and the expansion of regional and subregional integration processes have created new and urgent demands on States. Health leaders are increasingly required to formulate and implement actions that take into account bilateral, subregional, regional and global treaties and agreements. More than ever, health leaders must also act across sectors in order to achieve balance between economic growth and social development in today’s market economy, and to comply with regional and global mandates in a global environment comprised of new actors, alliances, and structures. This scenario requires the training of human resources with a profound understanding of international forces and their impact on health, thereby enabling them to effectively analyze, define, advocate and project their national health interests within this complex global environment.

Within this context, the PAHO/WHO Leaders in International Health Program aims to contribute to the development of the Health Agenda for the Americas 2008-2017 by strengthening the capacity of countries in the Region to understand, act upon and positively influence the international determinants of health, to promote their national interests, and to achieve intersectoral health agreements in the international arena, at all times guided by the principle of greater global equity in health.

The newly renovated Program incorporates an updated curriculum, new problem-based learning modules, a decentralized operating model and a variety of virtual and practical experiences to enhance participants’ capacity to analyze the principal concepts, theories, actors, forces, and processes related to the field and practice of international health, and to integrate learning into their countries’ contexts. Through their experience in the Program, participants develop the competencies needed to fulfill six essential functions as they relate to international health: situation analysis, policy design and decision-making, negotiation and advocacy, project management and cooperation, generation and dissemination of knowledge, and communication.

For the launching of the 2008 program, a total of eight countries were prioritized; these are: Argentina, Belize, Bolivia, Chile, Colombia, Ecuador, Guatemala and Peru. Through a competitive process that included more than 80 applicants, 20 participants were selected. As per the stipulations of the Program, the participants form country teams, some of which are inter-sectoral, and work together to develop country situation rooms, organize thematic seminars and generate elements for the virtual bulletin in international health. In addition, some country teams are collaborating with other country teams to develop a topic of mutual interest, creating a sole project that is enriched by their distinct perspectives.

The 2008 Leaders in International Health Program began on 19 May in the participants’ respective countries under the coordination of the Program and the PAHO/WHO Country Office. During this two-week period, participants engaged in different activities, discussions and visits in relation to the principal health and development challenges facing the country and the region as well as the main actors involved in the same, and began to define their projects to be developed later in-country in coordination with PAHO/WHO, government and other authorities. Participants proceeded to Washington, DC for a three-week intensive training in international health. They are currently in their countries where they continue to function in their normal employment capacity on a part-time basis, while devoting a minimum of 50% of their working hours to the Program. Participants maintain close ties with the PAHO/WHO Country Office, particularly the PAHO/WHO Country Representative, allowing them to experience the technical as well as the diplomatic and political dimensions of international cooperation. They engage in a program of work and learning opportunities involving PAHO/WHO and other relevant local actors in international health, including country-based offices of the United Nations and other multilateral and bilateral agencies, sub-regional entities, non-governmental organizations and academic institutions. These experiences are reinforced through a series of problem-based virtual modules, fomenting a community of practice and learning that reaches beyond the program participants. The three thematic virtual modules are: Conflict, Violence and Illicit Trade from an International Health Perspective; Nutrition, Food Trade and Development; and Access to, Medicines and other Technologies, Trade and International Agreements. The program culminates in November 2008 with the presentation of final projects over a one-week period in a country of the Region.


An important aspect of the Leaders in International Health Program (LIHP) is the establishment of the Virtual Situation Rooms in International Health in the participating countries in the Program. There exists a great deal of international experience with regard to situation rooms within the health sector, offering enormous potential to support decision-making processes at high levels and to contribute to the resolution of conflicts and crises, and the analysis of opportunities in rapidly-changing environments, among other potential applications.

The LIHP defines a situation room as a "virtual space to analyze and reflect upon information regarding international health issues that has been compiled from a variety of sources and that examines them in terms of their international health determinants and the key forces included in the international health conceptual framework in order to strengthen national institutional capacity for decision-making in Health and International Relations" (SSSI, 2008). Unlike observatories, situation rooms are normally used in emergencies or when more immediate decisions are required and tend to involve primarily those actors with the greatest proximity to the decision.

The main purpose of the international health situation rooms within the LIHP is to contribute to the generation, systematization and synthesis of information that reflects diverse positions regarding strategic issues or problem areas in international health and that involve inter-country relations (SSSI, 2008). The Program proposes to develop iterative virtual situation rooms based on the utilization and synthesis of dynamic and structured informational sources related to relevant international health topics. In this manner, a community of practice is formed with regard to specific country topics thereby bringing together program participants and other stakeholders to dialogue and analyze relevant international health situations and issues. Information gleaned from the situation rooms will also serve as input for the Bulletin in International Health of the LIHP.

Each participating country in the LIHP will develop a situation room in which information on the international health topic chosen by the country will be compiled and analyzed. The principal sources of information for the room will be the supranational agreements and treaties related to the topic, news, databases, statistical information, scientific publications, and the opinion of relevant actors and the general public. The rooms will be administered by the PAHO country offices, national authorities, and the Program participants. A regional situation room has also been established and will include information of interest on international health and the forces that form part of the conceptual model.

The decentralized nature of the LIHP situation room and its openness to different information sources allows it to be more dynamic, creating an environment in which the participants can explore the relationship among international health forces and their country topic, thereby contributing to the decision-making process.

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