REGIONAL HIV AND AIDS PROGRAMME IN LATIN AMERICA AND THE CARIBBEAN ABC/GIZ/MS - SUMMARIES AND LESSONS LEARNT 2007-2012

 
REGIONAL HIV AND AIDS PROGRAMME IN LATIN AMERICA AND THE CARIBBEAN ABC/GIZ/MS - SUMMARIES AND LESSONS LEARNT 2007-2012
Regional HIV and AIDS Programme in Latin America and the Caribbean

     Regional HIV and AIDS
Programme in Latin America
        and the Caribbean
                ABC/GIZ/MS

                                        Summaries and
                                        lessons learnt
                                              2007-2012

           1
REGIONAL HIV AND AIDS PROGRAMME IN LATIN AMERICA AND THE CARIBBEAN ABC/GIZ/MS - SUMMARIES AND LESSONS LEARNT 2007-2012
REGIONAL HIV AND AIDS PROGRAMME IN LATIN AMERICA AND THE CARIBBEAN ABC/GIZ/MS - SUMMARIES AND LESSONS LEARNT 2007-2012
Regional HIV and AIDS
Programme in Latin America
        and the Caribbean
                ABC/GIZ/MS

                Summaries and
                lessons learnt
                      2007-2012
REGIONAL HIV AND AIDS PROGRAMME IN LATIN AMERICA AND THE CARIBBEAN ABC/GIZ/MS - SUMMARIES AND LESSONS LEARNT 2007-2012
Regional HIV and AIDS Programme in Latin America and the Caribbean

The Regional HIV and AIDS Programme in Latin America and the Caribbean – ABC, GIZ, MS

Summaries and lessons learnt, 2007-2012.

PUBLICATION COORDINATION:

ORGANIZATION:

Claudia Herlt (GIZ)

Olaf Horstick (GIZ)

EDITORIAL COORDINATION (Correction, style and text):

Claudia Herlt (GIZ)

Olaf Horstick (GIZ)

Wófsi Juri G. de Souza (ABC)

Jonas Deusch (GIZ)

Inga Söllner (GIZ)

TRANSLATION:

Rapport Traduções e Interpretações Ltda.

Confluir Tradução e Interpretação Ltda - ME

DESIGN and LAYOUT:

DUO Design Serviços de Edição Gráfica Ltda - ME

PRINTING:

Gráfica XXX

First Edition:

200 copies

Photographs:

Archives of the Regional HIV and AIDS Programme in Latin America and the Caribbean.

Published and produced in Brasília, Brazil.

November, 2012

                                                                4
REGIONAL HIV AND AIDS PROGRAMME IN LATIN AMERICA AND THE CARIBBEAN ABC/GIZ/MS - SUMMARIES AND LESSONS LEARNT 2007-2012
Regional HIV and AIDS Programme in Latin America and the Caribbean

Table of contents

 7     Acknowledgements
 9     List of abbreviations
14     The GIZ Regional HIV and AIDS Programme in Latin America and the Caribbean: a summary

16     I. Introduction
16     1. History of Brazil – Germany Trilateral Cooperation on HIV and AIDS
17     2. Principles of the cooperation as a basis for joint action
21     3. Triangular cooperation in the Regional HIV and AIDS Programme
22     4. Gender in the Regional HIV and AIDS Programme
23     5. Innovation and knowledge management in the Regional HIV and AIDS Programme

24     II. Projects 2010-2012
24     1. Sexuality education and HIV and AIDS prevention in schools
26     2. Strengthening of health systems in rural areas in Uruguay
28     3. Men´s health in Latin America

30     III. Projects 2007-2009
30     1. The regional AIDS network of the Catholic Church / RELCALC-SIDA
32     2. Strengthening of the national HIV and AIDS response in Uruguay
34     3. Contributing to the Caribbean answer to the HIV and AIDS epidemic
36     4. Strengthening of the response to HIV and AIDS in MERCOSUR border regions
38     5. AIDS prevention for high mobility populations
40     6. Integrated health care delivery services in Ecuador, Peru and El Salvador
46     7. Monitoring and evaluation in the Dominican Republic, Ecuador and Panama
52     8. Strengthening of civil society
54     9. Support of the Horizontal Technical Cooperation Group (GCTH)
56     10. Support of health research

58     List of references

                                                                      5
REGIONAL HIV AND AIDS PROGRAMME IN LATIN AMERICA AND THE CARIBBEAN ABC/GIZ/MS - SUMMARIES AND LESSONS LEARNT 2007-2012
Regional HIV and AIDS Programme in Latin America and the Caribbean

                                                         6
REGIONAL HIV AND AIDS PROGRAMME IN LATIN AMERICA AND THE CARIBBEAN ABC/GIZ/MS - SUMMARIES AND LESSONS LEARNT 2007-2012
Regional HIV and AIDS Programme in Latin America and the Caribbean

Acknowledgements

“From South - South cooperation to trilateral cooperation
and towards a horizontal approach”

When the German Agency for Technical Cooperation (GTZ as it
then was) and the Brazilian National AIDS Programme took the
first steps to work together in 2003, it passed unnoticed that
they were, in fact, resuming a partnership born three decades
earlier. In 1978, the Buenos Aires Plan of Action launched an
initiative entitled Technical Cooperation among Developing
Countries (TCDC), a concept that has since been extensively
promoted by the G77.

The Millennium Development Goals (MDGs) launched in 2000
and accepted as an international framework for development            much can be achieved through triangular (or South – South
activities, set tangible targets for national governments and         - North) cooperation between Brazil, a traditional European
development institutions. In the current global scenario of           donor, and a third - developing - country. In view of the com-
scarce funding and declining development cooperation from             parative advantages of each of the players involved, such an
traditional donor countries, changes have had to be made.             approach offers excellent prospects.
The traditional donor countries have set new criteria and in-
creasingly demand improved effectiveness and sustainability           The fact that South - South cooperation and triangular coop-
of results. In this respect, the Paris Declaration in 2005 was a      eration are assuming a higher profile in international circles
milestone, as signatory countries pledged to improve efforts          was evidenced by the United Nations High Level Conference
and to abide by principles of harmonization, ownership, align-        on South - South cooperation, held in Nairobi, Kenya in 2009,
ment, results, and mutual accountability. The aim of the Accra        and the latest High Level Forum on AIDS Effectiveness, held in
Agenda for Action, signed in 2008, was to accelerate the rate         Busan, Korea in December 2011.
of progress.
                                                                       Different triangular cooperation approaches have been tried.
In parallel to this, new partners such as Brazil and the oth-         Sometimes, such cooperation entails a financial contribution
er BRICS (Brazil, Russia, India, China and South Africa), and         from a traditional donor, a technical contribution from an
emerging economies such as Mexico and Chile were taking up            emerging country, and a project implemented in a third recip-
the concept of horizontal South - South cooperation. Build-           ient developing country.
ing upon principles first enunciated in the TCDC, the essen-
tial elements of South - South cooperation consist of sharing         For projects under the Regional HIV and AIDS Programme for
knowledge and experiences. In such exchanges, the tradition-          Latin America, the Caribbean (LAC) and Africa, the German
al concept of donor and recipient countries no longer applies:        Agency for International Cooperation (GIZ) at the behest of the
rather, exchanges of knowledge and experience occur hori-             German Ministry of Economic Cooperation and Development
zontality, among equals.                                              (BMZ) has partnered with the Brazilian Cooperation Agency
                                                                      (ABC) and the Ministry of Health of Brazil in a new approach,
In Brazil, a great expansion of South - South cooperation took        known as horizontal cooperation. Under this approach, three
place under the presidency of Luiz Inácio Lula da Silva (2002-        or more partners plan, implement, and evaluate each step of
2009). Most of these technical cooperation initiatives were in        the project together.
the form of exchanges of knowledge and capacity building.
According to the Brazilian Cooperation Agency (ABC) the main          The common basis for such horizontal South-South-North
aim of such cooperation activities was to forge ties between          cooperation in the field of HIV and AIDS is a demand driven
Brazil and other developing countries, by means of exchanges          approach, in line with experience accumulated under Brazil’s
of technical knowledge and the strengthening of State institu-        National HIV and AIDS Plan and Unified Health System (SUS)
tions. Brazil is not a signatory of the Paris Declaration, which it   as well as facilitation, knowledge, and methodologies devel-
considers too closely aligned with the vision and values of tra-      oped through German experience in the field of international
ditional donors. It does, however, subscribe to such values as        cooperation projects. Another feature of such cooperation is
promoting democracy and human rights in partner countries,            its multisectoral scope, since it encompasses such themes as
alongside traditional donors. With such values in common,             health, education, a gender and human rights approach, and

                                                                      7
REGIONAL HIV AND AIDS PROGRAMME IN LATIN AMERICA AND THE CARIBBEAN ABC/GIZ/MS - SUMMARIES AND LESSONS LEARNT 2007-2012
Regional HIV and AIDS Programme in Latin America and the Caribbean

participation of civil society. Furthermore, it is underpinned by     vided unique experience for staff at all administrative levels
the assumption that systemic and countrywide approaches               in the participating countries over the past six years, and has
lead to better results and more sustainable outcomes. In ef-          produced a wealth of shared experiences and lessons learned.
fect, HIV and AIDS is the crosscutting theme that permeates
an array of issues, including: strengthening of health care           This publication aims to contribute toward public debate on
systems, based on the principles of the Alma Ata Declaration          new approaches to international cooperation. The Hypotheses
of 1978 and the Brazilian SUS experience of decentralisation;         in the Boxes are lessons learnt but are also meant to stimulate
participation of civil society; health promotion and preven-          discussions. Though well aware that not everything is perfect,
tion programmes; and national strategies on men’s health and          we apologise for having omitted some of these valuable expe-
sex education. Thus, horizontal cooperation is based upon a           riences. Of one thing we are certain, however: the key to suc-
common understanding, on the part of cooperating partners             cess lies in identifying new ways of coping with the problems
that sustainable results can be achieved by learning from the         of this world, and in fostering mutual understanding.
national strategies of other countries. One of the main com-
ponents for achieving such results is joint development of a          We thank the BMZ, the ABC and the Brazilian Ministry of
practical monitoring and evaluation (M&E) system.                     Health, and all other partner governments and organizations,
                                                                      especially UNAIDS, DFID, UNESCO, UNFPA and PAHO for their
For a number of countries in the LAC region, as well as African       many years of support. We also thank all of our colleagues
countries of the Portuguese Speaking Community (CPLP) the             who, with so much dedication and trust, made this work possi-
establishment of such a system has become a goal in itself.           ble for the well being of all peoples of the region.

Within Latin America, South - South cooperation in the field of
health has flourished, especially among the twelve countries
of the Union of South American Nations (UNASUR). The first            Brasilia, November 2012
initiatives of South - South - North cooperation were launched
with support of the German International Cooperation Agen-            Dr Claudia Herlt
cy (GIZ, formerly GTZ), within the scope of UNASUR - SALUD.           Programme Director
However, owing to termination of the programme in Decem-              GIZ Regional HIV and AIDS Programme
ber 2012, further follow-up has been postponed.

Nonetheless, it is foreseen that after December 2012, conti-
nuity will be given to all projects of the second phase of the
Regional HIV and AIDS Programme. In ten countries of the LAC
region, sexuality education programmes will proceed under
the guidance of a joint committee, with assistance from UNES-
CO and UNAIDS. Moreover, this is likely to serve as an example
for implementation of regional initiatives in East and Southern
African Countries, within the scope of an ongoing sexuality ed-
ucation project supported by German Ministry for Economic
Cooperation and Development (BMZ) and UNESCO. Work will
also proceed in the field of men’s health, in the form of a Brazil-
ian bilateral project with Chile and with Ecuador.

Within the framework of its rural health reform programme,
the Uruguayan government plans to expand the scope of tri-
lateral cooperation activities to all departments of the country.
Equipment and installations furnished through German Fi-
nancial Cooperation (KfW) are an essential component of this
programme.

The Regional HIV and AIDS Programme, together with its Bra-
zilian Partners, documented on the following pages, has pro-

                                                                8
REGIONAL HIV AND AIDS PROGRAMME IN LATIN AMERICA AND THE CARIBBEAN ABC/GIZ/MS - SUMMARIES AND LESSONS LEARNT 2007-2012
Regional HIV and AIDS Programme in Latin America and the Caribbean

List of abbreviations

A

ABC                                                                              Brazilian Cooperation Agency
(pt.: Agência Brasileira de Cooperação)

AISA                                                                             International Health Advisory
(pt.: Assessoria de Assuntos Internacionais de Saúde)

AOP                                                                              Annual Operations Plans

ART/V                                                                            Antiretroviral therapy/drugs

ASICAL                                                                           Latin American and Caribbean Association for Integrated
(es.: Asociación para la Salud Integral y Ciudadanía en América                  Health and Citizenship
Latina y el Caribe)

APLAFA                                                                           Panamanian Association for Family Planning
(es.: Asociación Panameña para el Planeamiento de la Familia)

B

BMZ                                                                              German Ministry of Economic Cooperation and Development
(dt.: Bundesministerium fuer wirtschaftliche Zusammenarbeit und
Entwicklung)

Brazilian Ministry of Health:                                                         Brazilian Ministry of Health:
   • DAB (Departamento de Atenção Básica)                                                • DAB: Department of Primary Healthcare
   • DARA (Diretoria de Articulação de Redes de Atenção à Saúde)                         • DARA: Coordination for Healthcare Networks
   • SGEP (Secretaria de Gestão Estratégica e Participativa)                             • SGEP: Secretariat for Strategic and Participatory
                                                                                         Management

C

CARICOM                                                                          Caribbean Community

CEDAPS                                                                           Health Promotion Centre
(pt.: Centro de Promoção da Saúde)

CEDEP                                                                            Paraguayan Centre of Population Studies
(es.: Centro Paraguayo de Estudios de Población)

CEDES                                                                            Centre of State and Society Studies
(es.: Centro de Estudios de Estado y Sociedad)

CEDRO                                                                            Centre of Information and Education for the prevention of
(es.: Centro de Información y Educación para la prevención del                   drug abuse
abuso de Drogas)

CHART                                                                            Caribbean Regional VIH y SIDA Training Network
(es.: Red Regional del Caribe de Capacitación de VIH y SIDA)

CHRC                                                                             Caribbean Health Research Council
(es.: Consejo del Caribe de Investigación en Salud)

COASCE                                                                           Coalition of Latin America NGOs on AIDS, Prison and Incarceration
(es.: Coordinadora de ONGs de las Américas sobre SIDA, Cárcel y Encierro)

                                                                                  9
Regional HIV and AIDS Programme in Latin America and the Caribbean

CONAVIH                                                                  National Committee for Prevention and Control of HIV
(es.: Comisión Nacional para la Prevención y Control del Virus de
Inmunodeficiencia Humana)

CPLP                                                                     Community of Portuguese Speaking Countries
(es.: Comunidad de los Países de Lengua Portuguesa)

CRN+                                                                     Caribbean Regional Network of People Living with HIV and AIDS
(es.: Red del Caribe Regional de Personas viviendo con HIV/Sida)

CRNM                                                                     CARICOM Regional Negotiating Machinery

CVC                                                                      Caribbean Vulnerable Communities

D

DFID                                                                     UK Department for International Development

F

FIOCRUZ                                                                  Oswaldo Cruz Foundation

FLACSO                                                                   Latin American Social Sciences Institute
(es.: Facultad Latinoamericana de Ciencias sociales)

FMP                                                                      Manuel Pérez Foundation

G

GCTH                                                                     Technical Horizontal Cooperation Group

GIZ                                                                      German Agency for International Cooperation
(dt.: Gesellschaft fuer internationale Zusammenarbeit)

GIZ: Fusion of GTZ, DED and InWEnt

H

HIV                                                                      Human Immunodeficiency Virus

HSS                                                                      Health System Strengthening

I

ICTC                                                                     International Centre for Technical Cooperation (Brazil)

ICW                                                                      International Community of Women living with HIV/AIDS

IDB                                                                      Inter-American Development Bank

K

KfW                                                                      German Financial Cooperation
(dt.: Kreditanstalt fuer Wiederaufbau)

                                                                    10
Regional HIV and AIDS Programme in Latin America and the Caribbean

L

LAC                                                                     Latin America and the Caribbean

LACCASO                                                                 Latin American and Caribbean Council of Non- Governmental
(es.: Consejo Latinoamericano y del Caribe de Organizaciones No         Organizations with HIV and AIDS services
Gubernamentales con Servicio en VIH/SIDA)

LACEN                                                                   Central Public Health Laboratory of the Federal District
(pt.: Laboratório Central de Saúde Pública do Distrito Federal)

LGBTI                                                                   Lesbian, gay, bisexual, transgender and intersexual

M

M&E                                                                     Monitoring and Evaluation

MDG                                                                     Millennium Development Goals

MINSA                                                                   Ministry of Health (Peru)

MoH                                                                     Ministry of Health

MS                                                                      Ministry of Health (Brazil)

MSM                                                                     Men who have sex with men

MSP                                                                     Ministry of Public Health (Uruguay)

MSPAS                                                                   Ministry of Public Health and Social Assistance
(es.: Ministerio de Salud Pública y Asistencia Social)

N

NAP                                                                     National AIDS Plan

O

OECS                                                                    Organization of Eastern Caribbean States

OEI                                                                     Organization of Latin American Countries for Education, Sci-
(es.: Organización de Estados Iberoamericanos para la Educación,        ence and Culture
Ciencia y la Cultura)

                                                                         11
Regional HIV and AIDS Programme in Latin America and the Caribbean

P

PAHO/WHO                                                                    Pan American Health Organization/ World Health Organization

PANCAP                                                                      Pan Caribbean Partnership against HIV & AIDS

PCI                                                                         International Cooperation Programme (Brazil)

PEM                                                                         Strategic Multisectoral Plan
(es.: Plan Estratégico Multisectorial)

PEN                                                                         National Strategic Plan
(es.: Plan Estratégico Nacional)

Peruvian Ministry of Health:                                                Peruvian Ministry of Health:
   •   DGSP (Dirección General de Salud de las Personas)                       •   DGSP: General Directorate of People’s Health
   •   ESNITSS (Estrategia Nacional Prevención y Control                       •   ESNITSS: National Strategy for Prevention and Control
       de las ITS, VIH y Sida)                                                     of STIs and HIV and AIDS
   •   CENSI (Centro de Salud Intercultural)                                   •   CENSI: Intercultural Health Centre
   •   DGE (Dirección General de Epidemiología)                                •   DGE: General Directorate of Epidemiology

PHC                                                                         Primary Healthcare

PLWHA                                                                       People living with HIV/AIDS

PN-AIDS                                                                     National AIDS Programme

PPL                                                                         People deprived of freedom
(es.: Personas privadas de la libertad)

PPNN                                                                        National Police
(es.: Policía Nacional)

R

REDLA+                                                                      Latin American Network of People living with HIV/AIDS
(es.: Red Latinoamericana de Personas viviendo con VIH o SIDA)

REDLACTRANS                                                                 Latin American and Caribbean Network of Trans-People
(es.: Red de Latinoamérica y el Caribe de Personas Trans)

REDTRASEX                                                                   Latin American and Caribbean Sex Workers Network
(es.: Red de Trabajadoras Sexuales de Latinoamérica y el Caribe)

RELARD                                                                      Latin American Damage Reduction Network
(es.: Red Latinoamericana de Reducción de Daños)

S

SENPLADES                                                                   Ecuadorian National Planning and Development Secretariat
(es.: Secretaría Nacional de Planificación y Desarrollo del Ecuador)

SNiS                                                                        National Integrated Health Programme (Uruguay)
(es.: Sistema Nacional Integrado de Salud de Uruguay)

STI                                                                         Sexually Transmitted Infection

SUS                                                                         Unified Health System (Brazil)
(pt.: Sistema Único de Saúde)

                                                                       12
Regional HIV and AIDS Programme in Latin America and the Caribbean

T

TCP           Technical Cooperation Project

TCDC          Technical Cooperation among Developing Countries

U

UNAIDS        Joint United Nations Programme on HIV/AIDS

UNASUR        Union of South American Nations

UNESCO        United Nations Educational, Scientific and Cultural Organization

UNFPA         United Nations Population Fund

UNGASS        United Nations General Assembly - Special Session

               13
Regional HIV and AIDS Programme in Latin America and the Caribbean

The GIZ Regional HIV and AIDS Programme in Latin America and the Caribbean:
a summary for phase 1 (2007- 2009) and phase 2 (2010- 2012)

Since the mid 1990s, the spread of HIV and AIDS in Brazil has           2. Health personnel
been stabilised, through a successful programme involv-
ing comprehensive, multisectoral, integrated approaches                    •   Support for long-term personnel planning
throughout the entire health care system and involving all
sectors of society. In the process, Brazil has acquired expe-              •   Training and further training of health personnel
rience that it is now sharing with other countries, mostly in
Latin America and Africa, but also in other regions of the              3. Health information
world. Germany has joined forces with Brazil in spread-
ing this knowledge to other countries, by contributing its                 •   Information systems for health facilities
extensive technical experience of development issues,
through triangular cooperation in specific projects. During                •   Platforms for health education and information
the first phase, the government of the United Kingdom
supported the projects financially, DFID being an important             4. Governance
like-minded partner of GTZ.
                                                                           •   Decentralisation
The overall approach entails country demand driven definition of
priorities, followed by joint development and implementation, and          •   Good governance
is often described as horizontal or triangular cooperation, South -
South cooperation or South – South - North cooperation. The out-           •   Participation of civil society
standing feature of this approach is negotiated collaboration among
multiple partners to create synergies, and building upon the particu-
lar strengths and comparative advantages of each partner.
                                                                        Projects and results 2010 - 2012
Gender and health equity are crosscutting themes in such co-
operation, with a special focus on marginalised groups and on           By the second phase of the Programme, vertical approaches
populations most affected by HIV and AIDS. Another key fea-             to HIV and AIDS had been abandoned; and comprehensive,
ture is HIV mainstreaming, whereby the Regional Programme               systemic, countrywide approaches had been adopted to
seeks to ensure that HIV and AIDS programmes are integrat-              address the HIV/AIDS epidemic.
ed into health care systems, with the net effect that national
health systems are strengthened.

Knowledge management and innovation have also been                      Sexuality Education
a key element, as evidenced by the experiences of the Re-
gional Programme 2007 - 2012 documented in this pub-                    Argentina, Chile, Peru, Paraguay, and Uruguay drew up or
lication. All activities and goals were oriented by the ex-             enhanced their national policies on sexuality education,
perience of Brazil’s National AIDS Plan and Unified Health              and the themes of sexuality education and HIV prevention
System (SUS).                                                           were incorporated into national curriculums. Intersectoral
                                                                        committees were established to oversee implementation of
Activities included                                                     these policies and, by 2011, they were reaching over 80,000
                                                                        teachers and 1.5 million students. To ensure sustainability of
1. Health services                                                      the project, a Latin American Network for Sexuality Educa-
                                                                        tion was established, with support from UNAIDS/UNESCO/
    •   Improvement of access to health services                        UNFPA and GIZ. More recently, Bolivia, Colombia, El Salvador
                                                                        and Guatemala have also joined the initiative.
    •   Management of health facilities

    •   Networking for exchanges of knowledge and experience

                                                                  14
Regional HIV and AIDS Programme in Latin America and the Caribbean

Integrated health care services in rural areas                        Strengthening of the response to AIDS
                                                                      in border regions of MERCOSUR
In Uruguay, integrated approaches were developed for pro-
vision of rural healthcare services, thereby improving access         The CICT, GIZ and MERCOSUR, in an alliance with seven munic-
to enhanced primary healthcare, including HIV and AIDS pre-           ipalities on the borders of Argentina, Bolivia, Brazil, Venezuela,
vention and treatment. The drafting and implementation of             Colombia, Paraguay and Uruguay set up bi-national committees
strategic plans and establishment of monitoring systems has           to respond to the spread of HIV and AIDS in especially vulnerable
contributed toward strengthening the national health system.          boarder regions. Binational work plans and joint activities for HIV
                                                                      prevention were among the outcomes of this project.
Men´s health

Ecuador, Chile, and Uruguay are currently defining a strategy
for men’s health, with a focus on high-risk behaviours, HIV pre-      AIDS prevention for high mobility populations in Peru
vention, and access to healthcare, maintaining a gender per-
spective, with the aim of reducing early mortality.                   The aim of the project was strengthening of HIV prevention for
                                                                      high mobility and indigenous populations in Peru, given that
                                                                      studies have drawn attention to the high vulnerability of these
                                                                      groups. Technical cooperation between the Ministry of Health
Projects and results 2007 - 2009                                      of Peru, CICT, DFID and GIZ provided support for decentralisa-
                                                                      tion of HIV prevention services into the interior of the country,
Regional AIDS Network of the Catholic Church / RELCALC-SIDA           with a view to reaching these populations.

The aim of the project was prevention of HIV in remote areas, by
means of strengthening the catholic church’s regional network
for HIV and AIDS prevention and restructuring its regional ex-        Integrated health care
ecutive secretariat in Porto Alegre. Twenty two Latin American
countries participated in this initiative. Cooperation partners in    Between 2007 and 2009, within the scope of the Regional HIV
this project were the AIDS Pastorate, the Brazil based Interna-       and AIDS Programme in Latin America and the Caribbean, GTZ,
tional Centre for Technical Cooperation (CICT), GIZ and DFID.         in cooperation with Ministries of Health, CICT and DFID, carried
                                                                      out a project for strengthening the response to STIs and HIV and
                                                                      AIDS, through provision of integrated health care services in three
                                                                      Latin American countries: Ecuador, El Salvador and Peru.
Strengthening of the National Response to HIV/AIDS in Uruguay

In Uruguay, the ICTC, alongside the Uruguayan Ministry of Pub-
lic Health (MSP), GTZ and DFID developed a national action            Monitoring and Evaluation
plan and adopted other measures to strengthen its national STI,
HIV and AIDS programme. This initiative included participation        During the same period, GIZ, CICT and DFID, together with the
of civil society and HIV self help groups, using a human rights       national AIDS programmes of Ecuador, the Dominican Repub-
based approach in the national HIV and AIDS policy. One of the        lic and Panama, were engaged in a project for implementation
main objectives was HIV prevention in border regions.                 of monitoring and evaluation systems.

                                                                      Furthermore several minor projects were supported, especial-
                                                                      ly in health research and strengthening civil society.
Contributing to the Caribbean Response to the HIV epidemic
                                                                      In conclusion, in the two phases of the Regional HIV and AIDS
The fifteen member countries of CARICOM and PANCAP drew up a          programme numerous activities have been successfully sup-
work plan to strengthen PANCAP’s STI, HIV and AIDS programme,         porting the national responses to HIV and AIDS, using a health
with a special focus on human rights and participation of civil so-
ciety and of HIV self help groups. The project, which included par-
ticipation of FIOCRUZ, CICT, GTZ and DIFD, PAHO and WHO, also
addressed improvement of monitoring and evaluation systems.

                                                                      15
Regional HIV and AIDS Programme in Latin America and the Caribbean

I. Introduction

1. History of Brazil – Germany Trilateral                          health care delivering systems, incorporating HIV and AIDS
   Cooperation on HIV and AIDS                                     as a crosscutting programme within primary care. The tri-
                                                                   angular cooperation was extended to include countries in
The very successful triangular coopera-                                        Africa, (South/South and trilateral cooperation)
tion against HIV and AIDS has been de-                                              based on the Heiligendamm G8 and G5
veloped through grants of the German                                                  processes, with UNAIDS, UNESCO, UNFPA
Federal Government, with the Ministry                                                  and PAHO as partners
for Economic Cooperation and Develop-
ment (BMZ), executed by the German Inter-                                             2012: Merging of DED, GTZ and InWEnt
national Cooperation (GIZ, formerly GTZ),                                           into GIZ.
from 2003 to 2012.
                                                                      December 2012: Closure of the Regional HIV and AIDS
2002: First contacts: After the Barcelona AIDS                       Programme due to a funding decision of BMZ. However, the
conference, Brazil’s national AIDS programme                        principles determined by the Regional Programme continue
and GTZ discussed prospects for a joint coopera-                   with an institutionalised South - South collaboration of the
tion with other countries.                                         Brazilian counterparts and other countries in Latin America,
                                                                   the Caribbean and Africa.
2003-2005: PCI: First trilateral cooperation initiatives with 5
Latin American countries within the scope of Brazil’s Interna-     2003-2012: Total German Government Grant: EURO 11.350,00
tional Cooperation Programme (PCI)

2005: The Brazilian Government, together with UNAIDS found-
ed the International Technical Cooperation Centre (CICT) for
international cooperation on AIDS.

January 2006 to December 2006: The trilateral cooperation
with CICT extended its scope to other countries

January 2007 to December 2009: The HIV and AIDS Regional
Programme: In the first phase, the trilateral cooperation ex-
tended to over 20 countries, in support of national strategies
for combating AIDS.

A total of 11 trilateral cooperation projects and 3 multilateral
regional projects were carried out - the latter with more than 5
countries participating. Institutional support for the Horizon-
tal Technical Cooperation Group (GCTH) and the CICT. Coop-
eration with UNAIDS. Partnership with the UK Department for
International Development (DFID)

2009: Following an external evaluation, the CICT was nation-
alised and the national AIDS programme (PN-AIDS) incorpo-
rated into the Ministry of Health (MoH).

January 2010 to December 2012: During the 2nd Phase of
the Regional Programme with new partners, the Brazilian
Cooperation Agency (ABC) and the International Health Ad-
visory (AISA) of the MoH, the concept of trilateral coopera-
tion was further refined. In line with state of the art health-
care practices, the programme focused on strengthening

                                                             16
Regional HIV and AIDS Programme in Latin America and the Caribbean

2. Principles for cooperation as a basis for joint action             Selection process for joint cooperation projects

The principles for the triangular cooperation as developed in                   1. Demand for technical cooperation
the Regional Programme are based upon accumulated experi-                             from the partner country
ence of South - South cooperation. These principles underpin
actions during each project phase (planning, implementation
and evaluation).                                                                                 YES

These principles are:

    1. All projects should be demand driven and country led                       2. The project complies with the
                                                                                      agreed scope of cooperation?
    2. All projects should be aligned to national policies and
       the strategic planning of partner countries.
                                                                                                 YES
    3. The beneficiary country shall lead the cooperation pro-
       cess in each project phase

    4. Each step of the project shall be subject to agreement                   3. Brazil (ABC/AISA) considers if it is
       of all partners (Brazil, Germany and partner countries)
                                                                             suitable for a trilateral cooperation approach.

    5. All projects shall include and use local and regional
       knowledge and experiences. External knowledge and                                         YES
       experiences may serve to complement local knowl-
       edge/experiences provided they strengthen local ini-
       tiatives and strengthen sustainability
                                                                                   4. Germany (GIZ) considers if it
    6. All projects shall aim to strengthen and consolidate
                                                                            participates in the trilateral cooperation project
       health systems of partner countries

From the experience in the Regional Programme a step-by-                                         YES
step process has been developed and applied for the projects
in the triangular cooperation:

A. Choosing projects
                                                                                  Joint preparation of the technical
                                                                                         cooperation project
A.1. Selection process

Project selection shall always be driven by demand for coop-
eration from the partner country. In view of the high demand
for healthcare cooperation projects with Brazil and the Ger-
man Cooperation, it has become necessary to assess demands,
to select those that can be addressed and, more specifically,
choose those to include in the trilateral cooperation.

During a planning workshop, held by ABC, Ministry of Health
and GTZ in March 2011, criteria for cooperation in the field of
health were defined. If a project fulfils agreed criteria for coop-
eration, firstly Brazil examined whether it is suitable for trilat-
eral cooperation with Germany. If so determined, GIZ assesses
whether the project complies with guidelines established by
BMZ, and whether it is eligible for such cooperation.

                                                                      17
Regional HIV and AIDS Programme in Latin America and the Caribbean

A.2 Joint project preparation – ABC, MoH,GIZ                           The Technical Committee

If all of the parties are in agreement that a trilateral approach is   Members (technical staff ): Ministry of Health of the partner
appropriate, a cooperation project is drawn up with the part-          country, AISA, GIZ
ner country, defining objectives, strategies, goals and inputs
to be provided by each of the partners. During planning work-          Responsibilities:
shops the partners have the opportunity to discuss details of
                                                                           •   Prepare Annual Operations Plans (AOPs)
the project. It should be underlined that this process must be
perceived as an integral part of joint cooperation.
                                                                           •   Coordinate technical cooperation with the technical
                                                                               departments of the Brazilian Ministry of Health and
                                                                               with those of partner countries during project imple-
A.3 Cooperation with other players in international cooperation                mentation

During this phase possibilities for cooperation with other play-           •   Constantly monitor progress of the project
ers, such as UN agencies, should be assessed. Such coopera-
                                                                           •   Prepare project documentation
tion can help to streamline cooperation activities and ensure
that partner countries derive the maximum benefit from ac-
tions carried out.

B. Establishment of a management structure

Once agreement has been reached and a formal Technical
Cooperation Project (TCP) signed, a management structure
should be established to conduct joint work processes.

This structure should include a coordinating committee and a
technical committee:

The Coordinating Committee

Members (management level): Ministry of Health of partner
country, ABC, AISA, GIZ.

Responsibilities:

    •   Provide strategic guidance for the project and decide
        on any changes that may be needed

    •   Approve Annual Operations Plans (AOPs)

    •   Evaluate annual and final outcomes of the project

    •   Resolve problems at the policy level, when necessary

                                                                 18
Regional HIV and AIDS Programme in Latin America and the Caribbean

Coordinating Committee
Members: MoH of partner countries, ABC, AISA, GIZ

   •   Provide strategic guidance for the project and decide on any necessary changes

   •   Approve annual operations plans (AOPs) for the project

   •   Evaluate annual and final outcomes of the project

Technical Committee                                                                Technical areas
                                                                                   in Brazil and
Members: Technical staff responsible for the proj-
ect at the MoH of partner countries, AISA, GIZ
                                                                                   in the other
                                                                                   country
   •   Prepare AOPs
                                                                                       •   Support preparation of the
   •   Coordinate technical cooperation neces-                                             AOP
       sary for project execution
                                                                                       •   Implement activities
   •   Monitor progress of the project
                                                                                       •   Monitor and evaluate
   •   Document all phases of the project                                                  activities and processes

                                                                                       •   Document activities

                                                           19
Regional HIV and AIDS Programme in Latin America and the Caribbean

C. Project execution

The project shall be carried out jointly: All parties will be in-
formed about all activities and frequent meetings will be held.
Progress and setbacks will be monitored and assessed and, if
necessary, the strategy will be reviewed.

To this end, the coordinating committee will hold regular meet-
ings to evaluate processes, adjust strategies (if necessary) and re-
solve any policy problems that may arise; whereas the technical
committee shall promote constant exchanges of information.

Wherever necessary, joint workshops and missions will be
held, however, not all activities need be carried out with the
presence of all partners. What is important however is that
throughout project execution the process shall be monitored
jointly at all times.

D. Monitoring

A monitoring and evaluation plan shall be drawn up and
agreed by all parties, and revised and adjusted by the technical
committee, as may be necessary. Other players will be involved
in monitoring as the need arises. Results shall be disclosed by
the coordinating committee on a regular basis.

E. Evaluation

The coordinating committee shall assess progress no less than
once each year. Moreover, at least one evaluation workshop shall
be held each year, with participation of all relevant players.

  Triangular cooperation has the potential for overcoming
  geographical and cultural differences when the countries
  working together share similar cultural traits and values.

                                                                20
Regional HIV and AIDS Programme in Latin America and the Caribbean

3. Triangular cooperation in the Regional HIV                        Knowledge transfers from Brazil to other countries have been
   and AIDS Programme                                                optimised by combining the knowledge of local contexts and
                                                                     needs provided by the third country, with Brazilian technical
Triangular cooperation between Brazil, Germany and other             expertise, complemented by German experience of develop-
countries of Latin America and the Caribbean or African part-        ing, facilitating, monitoring and evaluating strategic interna-
ners is one of the principal features of the Regional HIV and AIDS   tional cooperation processes.
Programme for Latin America and the Caribbean. The term is
often used interchangeably with South - South Cooperation or,        In the light of outstanding outcomes achieved in these and
more specifically, South – South - North Cooperation.                previous projects, the concept of knowledge transfer has, in it-
                                                                     self, attained significant value and potential. Moreover, in view
Under triangular Cooperation, as applied in this programme,          of the recent international consensus in favour of encouraging
partners develop projects together, define common objec-             and supporting South - South dialogue and the new aid effec-
tives, implement activities and prepare a framework for mon-         tiveness agenda, the need for a more inclusive dialogue be-
itoring and evaluation, benefiting from the comparative ad-          tween cooperation partners has become evident, in line with
vantages offered by each partner.                                    the spirit of the Paris Declaration, the Heiligendamm Process,
                                                                     the Accra Plan of Action 2008, and the 8th Millennium Devel-
With the Regional HIV and AIDS Programme, based on the               opment Goal.
experience of Brazil’s integrated, multidisciplinary national
AIDS programme and its extensive experience in the im-               Triangulation is currently viewed as a new approach for com-
plementation of its own Unified Health System (SUS), third           bining the strengths of so-called traditional donors and the
countries in Latin America, the Caribbean and Africa have            partners of South - South cooperation. Furthermore, the im-
had the opportunity to address the challenges of HIV and             portance of joint participation in the formulation of public
AIDS through strengthening their health care systems with-           policies can hardly be overstated, it being a necessary step for
in their own local contexts.                                         institutional capacity development.

The concept of triangular cooperation

                                                                                         An example of Synergies:

                                                                                         Country 1:
                                                                     Synergies           Technical expertise, with
                                                                                         an integrated, multisectoral approach, in
                                                                                         response to the HIV and AIDS epidemic
                               Country 1
                                                                                         Country 2:
                                                                                         Local knowledge,
                                                                                         setting of priorities, logistics

                                                                                         Country 3:
                  Country 2                Country 3                                     Expertise in
                                                                                         international collaboration,
                                                                                         project design, monitoring and evaluation

                                                                     21
Regional HIV and AIDS Programme in Latin America and the Caribbean

4. Gender in the Regional HIV and AIDS Programme

In view of its relevance for health, behaviour, risk factors and
exposure to disease, gender is a crosscutting theme in all plan-
ning for health under the Regional HIV and AIDS Programme.
Indeed, a gender perspective underlies development of all
interventions for protecting the population against HIV and
AIDS, since the most vulnerable populations are also, histori-
cally and globally, among the most stigmatised and discrimi-
nated against, owing to gender issues and roles.

  Working on gender issues means adapting to the needs
  of men, women and LGBTI

When addressing gender themes, the Regional Programme
                                                                    Nonetheless, the role of the Regional HIV and AIDS Programme
acknowledges that gender is not limited to the dichotomy of
                                                                    in promoting men’s health should not be overlooked. Surveys
men and women: but rather, that certain categories (lesbian,
                                                                    have revealed that, in the Latin America and Caribbean Re-
gay, bisexual, transgender and intersexual - LGBTI) cannot be
                                                                    gion, life expectancy for men tends to be some 8 years lower
included into either of these two. Respect for gender diversity
                                                                    than for women. To address this discrepancy, in partnership
and for the rights of such minorities is crucial when address-
                                                                    with the Brazilian Government, the Regional Programme has
ing such themes. Acknowledgment and respect for gender
                                                                    launched triangular cooperation projects for men’s health, so
diversity is of special importance in the healthcare context. A
                                                                    as to ensure that pathologies typical of men receive the same
broader concept of gender and the mainstreaming thereof en-
                                                                    priority at health care services as those relating to the health of
ables inclusion and acceptance of the special needs of LGBTI
                                                                    women, children and adolescents.
population facing marginalisation in many other contexts.
                                                                    In summary, gender issues, gender equity in health care, gen-
Furthermore, mainstreaming of gender themes in healthcare,
                                                                    der diversity, and respect for the rights of LGBTI minorities are
as promoted under the Regional Programme, is acknowledged
                                                                    a crosscutting theme that permeates all aspects and strategies
to be one of the most effective strategies for achieving gen-
                                                                    under the Regional HIV and AIDS Programme.
der equity. By promoting gender as a crosscutting theme, the
Regional Programme consolidates a gender perspective into
formulation, monitoring and analysis of policies, programmes
and projects, thereby ensuring equal access to healthcare ser-
vices for all women, men and LGBTI individuals. However, a
mainstreaming strategy does not preclude initiatives directed
specifically towards any one of these groups.

The Regional Programme has corroborated the fact that,
among its partner organisations and in government bodies
of the countries of the Latin America and Caribbean region,
women conduct most operative services, whereas men occu-
py most executive and decision-making positions. This in itself,
and the need to promote change in power relations within
workplaces, is a strong argument for maintaining a gender
focus in all activities, programmes and projects sponsored by
GIZ in the region.

In all work carried out under the Regional HIV and AIDS Pro-
gramme in countries of the region, a gender perspective, cou-
pled with a human - rights approach and combating of dis-
crimination on the basis of sexual orientation or diversity, have
always been at the centre of efforts to bring about changes in
mores and attitudes, and in breaching the near monopoly of
men over decision-making on public-policy issues.

                                                              22
Regional HIV and AIDS Programme in Latin America and the Caribbean

5. Innovation and knowledge management in the                      stored in databases of the GIZ document management sys-
    Regional HIV and AIDS Programme                                tem (DMS). Information exchanges took place through regular
                                                                   meetings of technical groups and also through national and
Innovation and knowledge management are among the crosscut-        international conferences, and addressed a number of issues,
ting themes of the GIZ Regional HIV and AIDS Programme. Both are   including HIV and AIDS, general healthcare, and monitoring
considered integral components of the programme, since innova-     and evaluation.
tion is based on new knowledge, and new knowledge cannot be
translated into practice except by a process of innovation.        The high visibility achieved by the programme internationally,
                                                                   and especially in countries of the Latin America and Caribbean
Among a number of innovative processes that have been pur-         region, bears witness to its capacity to generate and dissemi-
sued throughout the programme, the following two stand out:        nate new knowledge and contribute toward innovation.

   •   On a strategic level, the emergence of triangular coop-
       eration, whereby partners contribute through a syner-         Global challenges of HIV and AIDS require international
       gistic process, according to their particular capacities,     responses, guided by best practices and implemented
       represents a new approach to international develop-           through South – South (S-S) or South – South – North
       ment activities. This innovative cooperation approach         (S-S-N) cooperation, under which equity is guaranteed in
       was embraced by countries interested in pursuing co-          all actions and cultural adaptation is a key element
       operation under the programme and by the Brazilian
       Cooperation Agency (ABC) of the Ministry of External
       Relations and the International Health Affairs Advisory
       (AISA) of the Ministry of Health

   •   On a technical level, though the programme was
       targeted at HIV and AIDS, since 2005 activists world-
       wide have advocated that responses to the epi-
       demic should not take the form of isolated vertical
       programmes, but rather, should be integrated into
       existing healthcare services and should encompass
       health promotion, preventive and curative strate-
       gies, in the form of horizontal programmes. The Re-
       gional Programme adopted this innovation in 2010,
       and has since focused on systematic approaches
       and strengthening health care systems while, at the
       same time, enhancing the quality of services target-
       ed specifically at HIV and AIDS.

Experience acquired during the various activities and projects
conducted under the programme has contributed towards
knowledge management, one of the crosscutting themes
of the programme. Knowledge management was already a
strong component within GIZ, which considers itself a learning
organisation. Documentation of experiences was thus an im-
portant part of the work and, alongside sharing of information
and making knowledge available to all parties, contributed to-
ward the success of project management.

Documentation of the programme entailed production of: 1)
peer reviewed reports; 2) peer reviewed conference contribu-
tions; 3) best practice guidance; 4) regular reporting to fund-
ing agencies and partners; and 5) this final publication.

All documentation was distributed in printed form and elec-
tronically via the Internet. Furthermore, all information was

                                                                   23
Regional HIV and AIDS Programme in Latin America and the Caribbean

II. Projects 2010 – 2012

                        1. Sexuality education and HIV
                       and AIDS prevention in schools
 Duration                           2007-2012
 Objectives                         •  Strengthening Public Policy for sexuality education
                                    •  Strengthening sexuality education programmes and HIV prevention in schools
                                    •  Harmonization of public policies and strengthening of linkages between health and educa-
                                       tion sectors
 Cooperation Partners               Brazilian Ministry of Health, the Ministry of Education, UNAIDS, UNESCO, UNFPA, and initially the Bra-
                                    zil-based International Centre for Technical Cooperation (ICTC), after 2009: ABC, Ministry of Health.
                                    CEDEP (Paraguay), FMP (Uruguay), CEDRO (Peru), CEDES (Argentina), OEI (Chile)
 Participating countries            Argentina, Brazil, Chile, Paraguay, Peru and Uruguay. Since 2011: Bolivia, Colombia, Guatemala
                                    and, since 2012: El Salvador

                     Research shows that comprehensive sexuality education fosters behaviours that reduce risk factors for HIV
                     transmission. Providing students with information and education helps them acquire the life skills needed to
                     reduce their vulnerability to HIV infection and is the theme of a pledge assumed under the UNGASS Declara-
  Context

                     tion of Commitment on HIV/AIDS in 2001. The importance of strengthening sexuality education programmes
                     and HIV prevention in schools, and of addressing discrimination, social exclusion and stigmatisation of HIV
                     positive children and adolescents was recognised at the “Cairo+10” event, in 2004. In the Mexico City Minis-
                     terial Declaration on “Educating to Prevent” in 2008, Ministers of Health and of Education of Latin American
                     and Caribbean countries agreed to promote comprehensive sexuality education, with a gender sensitive,
                     non discriminating focus, taking into account a diverse range of manifestations of sexuality, with a view to
                     strengthening the autonomy of adolescents and young adults on human rights related subjects. The decla-
                     ration also highlighted the importance of a multisectoral response.

                     The project was launched with a seminar at which representatives of the Ministries of Health and of Educa-
                     tion and members of civil society organisations in the 6 partner countries agreed to a set of common objec-
                     tives, strategies and guidelines for the implementation of sexuality education and HIV prevention policies.
                     Based upon this consensus, each country developed its own national work plan. During the project exe-
                     cution phase (2007 - 2009) each country established a multisectoral management committee for sexuality
 Project execution

                     education, including representatives from the Ministries of Health and of Education and members of civil
                     society organisations, responsible for the implementation of the project at the national level. The committee
                     received support from a national consultant, selected by national authorities and contracted with funding
                     from GTZ/UNAIDS/CICT. National policies and work plans were drawn up and implemented, and progress
                     was monitored through regular regional workshops. The work continued during the consolidation phase, in
                     2010, featuring reflection on the strengths and weaknesses of implementation.

                     In 2011, Colombia, Bolivia and Guatemala joined the project, whereas El Salvador joined in 2012. Since 2011,
                     a regional network or “Community of practice” known as CoPSexEd has been developed to facilitate contin-
                     ued technical exchanges of experiences between countries.

                     South - South cooperation mechanisms have been adopted and have proven efficient tools for mutual sup-
                     port, given that many of the countries involved faced similar challenges with regard to HIV prevention in
                     schools. Historical and cultural proximity has facilitated exchanges of scientific and technological knowl-
                     edge, experiences, and lessons learned. Horizontal technical cooperation activities have also stimulated de-
                     velopment of new and innovative tools for HIV prevention in schools.

                                                                   24
Regional HIV and AIDS Programme in Latin America and the Caribbean

Currently, all participating countries have included sexuality education and HIV prevention as part of the
school curriculums and are planning to follow up with these programmes, either with national funding or by
incorporating sexuality education into programmes sponsored by the Global Fund. Between 2007 and 2011,
an estimated 83,000 teachers were trained, and sexuality education reached more than 1,500,000 pupils
in the participating countries. Further outcomes of the programme were: (a) greater donor harmonization,
resulting from participation of international and multilateral partners in national and regional management
committees; (b) multisectoral harmonization, achieved through the setting up of multisectoral management

                                                                                                                   Results
committees, proved crucial for coordination of the entire process, which in turn led to coordinated actions
based on common objectives in the field of sexuality education and HIV prevention in schools, at the same
time enhancing efficiency and strengthening national capacities to address challenges posed by the HIV
pandemic; (c) through nationally led implementation, ownership of the processes was enhanced; (d) a hor-
izontal cooperation approach to technical cooperation between countries was supported by international
and multinational stakeholders; (e) implementation of the regional South - South cooperation project has
caused Ministries of Education to assume control over sexuality education and HIV prevention in schools.
This is a major change since, traditionally, Ministries of Health have led the response to AIDS. However, in
view of the multisectoral impact of the epidemic, involvement of Ministries of Education is crucial for a stron-
ger and more effective national response. Thus, stronger national policies on HIV and AIDS prevention have
had the effect of assisting in increasing access to sexuality education.

    Regional coordination of countrywide implementation has resulted in stronger national responses.

                  Multi-sectorial approaches once achieved contribute to sustainable results.

                          For effective HIV Prevention the Ministry of Education needs
                         to take the lead in evidence-based teaching on HIV and AIDS.

                                                             25
Regional HIV and AIDS Programme in Latin America and the Caribbean

                     2. Strengthening of health systems
                           in rural areas in Uruguay
      Duration                              2010 - 2012

      Objectives                            •    Strengthening primary health care services
                                            •    Horizontal integration of the response to HIV and AIDS

      Cooperation Partners                  The Brazilian Cooperation Agency (ABC), the Brazilian Ministry of Health, the Uruguayan
                                            Ministry of Public Health (MSP) and GIZ

      Participating countries               Brazil, Uruguay

                      The population of Uruguay is predominantly urban and provision of health care services in rural areas has
                      tended to be neglected.

                      The Government of Uruguay is currently engaged in a project for strengthening the health care system
 Context

                      through promotion of integrated services throughout the Uruguayan Integrated Health System (SNiS). Build-
                      ing upon Brazil’s extensive experience of establishing its own Unified Health System (SUS) in areas of low
                      population density, a triangular cooperation project was launched, targeted at localities with population of
                      less than 5,000. The project gave priority to decentralisation and participation of civil society in budgetary
                      decision making, health prevention programmes, and knowledge transfers, while making full use of Uru-
                      guayan local knowledge; Brazilian technical expertise; and German experience in management of interna-
                      tional cooperation projects.

                      The project was initially launched in four departments (Artigas, Rivera, Cerro Largo, Rocha), which cover an
 Project execution

                      area of about 45,500 km² and have a total population of approximately 353,000. They were chosen in view
                      of their migratory populations, because they encompass border regions, or the fact that they are the ven-
                      ue for large scale infrastructure projects. Horizontal transfers of knowledge under the project entailed the
                      establishment of strategic planning, standards, and routines for the management of integrated healthcare
                      networks based upon Brazilian experiences, with priority awarded to participation of users of the health care
                      system and civil society. Such knowledge transfers contributed toward the building of health care networks
                      within the SNiS, by linking different subsystems, regulating information flows, integrating reference and
                      counter reference systems, stimulating exchanges of experiences on health care network management, and
                      training of health professionals. Technical assistance provided by the various departments of the Brazilian
                      Ministry of Health (DAB, DARA and SGEP) was complemented by financial cooperation provided by the Ger-
                      man Government through KfW. With grant funding amounting to 5 million Euros it was possible to improve
                      health facilities in remote regions and improve the quality of technical equipment.

                      For the first time, the planning of integrated healthcare system network is being carried out at the local
 Results

                      (department) level in Uruguay. Moreover, Uruguay has now merged its response to HIV and AIDS into its
                      integrated health system, thereby achieving synergies and greater efficiency. The national rural health
                      plan is now being expanded from the original four departments, to encompass all rural areas of Uruguay.
                      Moreover, a decree has been issued establishing that, in 2012, the process of strengthening the health care
                      system will be extended to other departments, and will cover all of Uruguay by 2014.

                                                                    26
Regional HIV and AIDS Programme in Latin America and the Caribbean

Thus, knowledge transfers effected under the programme have had impact beyond the scope of the project,
and have demonstrably affected the national planning process. The process launched under the cooperation
project has enhanced planning procedures and led to the establishment of integrated health care delivery
networks throughout the country.

The project has stimulated dialogue between the national and regional levels, which in turn, has resulted in prepa-
ration of action plans. Indeed, the cooperation project has led to the establishment of a model that endows in-
tegrated health care system networks with a formal structure. By mid 2012, implementation of this structure was
well underway. Routines for reference and counter reference of primary health care have been defined as a vital
component for strengthening integrated delivery networks. Primary health care has thus been consolidated as
the point of entry for health system users, thereby improving and expanding access to services.

To ensure sustainability and effectiveness, in each department a monitoring and evaluation plan has been
prepared, and committees set up in order to ensure their implementation.

                                                                                                                         Results
While the focus of the project was rural areas with populations of less than 5,000, the integrated networks
approach is expected to contribute toward better health for the entire population. Over the long term, the
development and implementation of an integrated health care model will lead to greater access to health
care services for the entire Uruguayan population (some 3.53 million people). Moreover, an integrated health
care approach will ensure higher quality of service, including improved access to HIV and AIDS testing and
treatment, gender sensitive sexual and reproductive health services, and will benefit from stronger civil so-
ciety participation in the definition and implementation of healthcare policies. This expectation is in line
with PAHO/WHO recommendations that regard integrated delivery networks as important contributors to
universal coverage and access, providing comprehensive, integrated and continuous care, at lower cost, and
a better response to the health needs of the population (PAHO 2008).

The recent international consensus in favour of encouraging and supporting the South - South dialogue
and the new agenda for aid effectiveness require a more inclusive dialogue between cooperation partners
(Paris Declaration 2005, Heiligendamm Process, Accra Agenda for Action 2008, MDG 8). In this context, this
project provides a prime example of the value of triangulation as a new tool for combining the strengths of
traditional donors with the capacities of providers of South - South cooperation.

              S-S Cooperation has proven successful in settings with similar cultures (SNIS-SUS).

                   Leadership of the recipient country leads to a greater sense of ownership.

         A jointly prepared M&E System adds to the sustainability of outcomes of S-S-N cooperation.

Through national strategies, governments can expand successful experiences from priority regions to entire countries .

                               Alignment can lead to countrywide implementation.

                                                               27
You can also read
NEXT SLIDES ... Cancel