1. Pan American Health Organization Pan American Sanitary Bureau Regional Office for the Americas for the World Health Organization

2. Pan American Health Organization 2001 2 Partnerships for Advancing Health in the Americas Collaboration between CDC and PAHO David Brandling-Bennett Pan American Health Organization

3. Pan American Health Organization 2001 3 A Brief History of PAHO 1902 - Established to help American republics prevent the spread of diseases without impeding travel or trade 1924 - Pan American Sanitary Code defines functions of PAHO 1949 - Becomes the WHO Regional Office for the Americas 1950 - Recognized as the specialized health agency in the Inter-American system

4. Pan American Health Organization 2001 4 How Does PAHO Function? A presence in every country Country-specific and regional programs A technical cooperation agency, not a funding agency Promotes cooperation among countries Relies on partnerships for technical and financial resources

5. Pan American Health Organization 2001 5 What is Technical Cooperation? Building internal capacity to address national and regional health needs The functions of technical cooperation –Training –Setting norms and standards –Mobilizing resources –Disseminating information –Research

6. Pan American Health Organization 2001 6 The Benefits of Partnership Skills and knowledge are mobilized and resources are shared Experience builds expertise Common interests and approaches are developed Further knowledge is gained and shared Awareness of how to transfer and build capacity is enhanced

7. Pan American Health Organization 2001 7 Some Areas of Collaboration in Infectious Diseases Poliomyelitis Measles Influenza HIV/AIDS STIs Tuberculosis Dengue Hemorrhagic fevers Foodborne diseases Malaria Chagas disease Lymphatic filariasis Onchocerciasis Cysticercosis Rabies Plague Equine encephalitis Hepatitis

8. Pan American Health Organization 2001 8 Some Areas of Collaboration in Infectious Diseases, cont’d Infectious disease surveillance Response to epidemics and emergencies Drinking water disinfection Antimicrobial resistance Response to emerging infections Building public health laboratory capacity

9. Pan American Health Organization 2001 9 Some Other Collaborations Tobacco control Reproductive health Maternal mortality Birth defects Nutrition Oral health Violence Injury surveillance, prevention, control Lead poisoning Environmental epidemiology Toxic hazards Occupational health Insecticide quality control Diabetes Blood lipids Physical activity

10. Pan American Health Organization 2001 10 Some Other Collaborations, cont’d Behavioral risk factor surveillance Non-communicable disease surveillance Essential public health functions Public health performance assessment Laboratory management and performance Disease classification Mortality data analysis Geographical information systems U.S.-Mexico border health

11. Pan American Health Organization 2001 11 Polio-infected countries (map as of 27 June 2001) 253 cases* 350,000 cases * EPI data as of August 2001 Polio Eradication Progress, 1988-2001*

12. Pan American Health Organization 2001 12 Source: PAHO/WHO * Data as of 18 August 2001 - 384 confirmed cases # Coverage data for children <1 year of age Catch-up campaigns Follow-up campaigns Routine infant vaccination coverage (%) Confirmed cases (thousands) Vaccination coverage and reported number of measles cases Region of the Americas, 1980-2001* #

13. Pan American Health Organization 2001 13 PAHO Measles Laboratory Network CDC, Atlanta CAREC, Trinidad INH, Venezuela CCG, Panama LDI, Argentina FIOCRUZ, Brazil IPK, Cuba Inst. Adolfo Lutz, Brazil LCM, Uruguay LHU, Haiti LNSP, Dominican Republic LR, Costa Rica LCMSP, El Salvador LNR, Guatemala CNDR, Nicaragua Laboratories testing via EIA IgM Serology Canada INDRE, Mexico INS, Colombia INS, Peru INH, Ecuador ISP, Chile LCSP, Paraguay Cenetrop, Bolivia

14. Pan American Health Organization 2001 14 Salmonella Drug Resistance by Site (1998/1999) 0 5 10 15 20 25 30 Lima (N=23) Callao (N=33)Sta Cruz (N=12)NARMS 98 (N=1466) ChloramphenicolCiprofloxacin GentamicinNalid. Acid Sulfa/Trim TetracyclineCephalothin Kanamycin % Resistant

15. Pan American Health Organization 2001 15 Potential Problems in Collaboration Tendency to do the job rather than transfer and build capacity Unclear lines of supervision and responsibility Need to report back to the head office before decisions are taken Lack of familiarity with how to work with multiple partners

16. Pan American Health Organization 2001 16 Elements Essential for Success Technology must be appropriate, evidence-based, and sustainable Mutual respect, shared commitment, open communication Adequate human and financial resources Longer-term commitments when needed Consistency with regional and global objectives

17. Pan American Health Organization 2001 17 Conclusions We must work to build capacity and generate resources so that progress is sustained internally. Collaboration usually involves multiple partners, including several government agencies, NGOs, universities, and others. Situations may change quickly, requiring sensitivity and flexibility.