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brazilian international health activities bulletin health cooperation brazilian international health activities bulletin fiocruz additional information 4 interview new health minister reaffirms priority for international cooperation 6 president lula with medication banner research brazilian cooperation for development has nearly doubled in the last 5 years drugs 7 brazil and mozambique move forward with unprecedentent technology transfer to fight aids brazil transfers technology to produce aids drugs african country begins the construction of the first 100 public capital company of this segment in the continent in his 12th and final visit to africa as president of the republic which took place on november 9 and 10 luiz inacio lula da silva brought up good news to increment the broad range of cooperation initiatives between brazil and mozambique lula and the then health minister jose gomes temporao reaffirmed brazil s commitment to build an antiretroviral factory an unprecedented project for the transfer of brazilian technology aimed at the production of hiv/aids drugs the two authorities have also announced that the company vale will donate usd 4,5 million to the completion of works adding up to mozambican s government counterpart construction works began in late april of the current year the machines ordered by farmanguinhos started being received in maputo and are being stored at the supply center of the ministry of health of mozambique also the arrival of the team hired to provide advice on international standards of certification throughout the execution of works was confirmed for the month of may the cooperation between the two countries to fight a major public health problem in mozambique ­ namely the high prevalence and mortality of people infected with hiv ­ was an idea launched by president lula in 2003 during his first trip to south america brazil takes over coordination of the south american network for international offices and international health cooperation 7 uruguay and paraguay integrated health networks are the focus of cooperation with brazil 8 africa human milk banks gain ground in the continent grupo temático de cooperação internacional em saúde ministério da saúde continuation in page 2 nº 4 may 2011 1

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editorial in december 2010 the last month of his second term president luiz inacio lula da silva paid a symbolic visit to mozambique an important south-south cooperation partner of brazil the visit resulted in the signing of several cooperation projects lula s presence also served to reaffirm brazil s commitment to the initiative of building a factory for antiretroviral drugs and other medication the presence of brazil s former president led the involved parties to expedite arrangements for the progress of works at that time mining company vale also confirmed its collaboration with the project donating funds to the adaptation of existing facilities under the government of president dilma rousseff south-south cooperation shall confirm its relevance to brazilian foreign policy guaranteeing the continuity of these important international commitments the international technical cooperation agenda has attained consistency and geographic diversity thus ensuring a strong contribution to the country s external action the willingness to share solutions proven effective designed under similar or close development conditions along with the effective transfer of knowledge and technology illustrate the solidarity of brazilian cooperation making it relevant to the priorities of our partners the very organization of the unified health system key instrument of public health policy in brazil has attracted the attention of some partners an extensive survey on brazilian governmental international cooperation was conducted jointly by the institute of applied economic research ipea and the brazilian cooperation agency abc of the ministry of external relations the survey scales for the first time the overall activity within the federal government published in january 2011 the aforementioned work is supported by statistics and financial figures and serves to objectively document the areas and priorities of brazilian cooperation a recommended reading for those interested in international affairs it is also expected that this work increases the awareness of government players involved about the need to adjust specific aspects of the legislative framework to the new reality of brazilian international cooperation in order to better organize its procedures in 2011 brazil succeeded peru at the coordination of the southamerican network of international advisories offices and health cooperation from unasur redesur-oris the establishment of the network was strongly encouraged by the international advisory office for health affairs aisa the network s purpose is to strengthen regional cooperation in health through the institutional strengthening of international divisions of ministries of health in south american countries as well as the development of common priorities obviously all initiatives follow the guidelines of unasur south american health council finally it is with especial satisfaction that the current edition of the cooperation in health bulletin publishes an interview with the new minister of health alexandre padilha in his previous positions minister padilha gathered broad experience conducting the main topics of the government agenda his background experience will undoubtedly be advantageous for dealing with the complexity of international health defending the position of brazil in favor of a more inclusive and equitable global health eduardo botelho barbosa special advisor for international health affairs 2 drugs continuation the african country since brazil s aids control program is a global benchmark the country gathers enough experience and is thus accredited to make its technical expertise available to mozambique the disease affects approximately 15 of the adult population of the country and figures reach 23 in the capital maputo to make matters worse as of today less than 12 of mozambicans diagnosed with the disease have access to medication in brazil the federal government provides free treatment to all patients which are currently about 200 thousand challenges the factory will be the first 100 public pharmaceutical unit resulting from south-south cooperation in africa between 2003 and 2004 political discussions took place resulting in the technicaleconomic feasibility study given its complexity and uniqueness the proposal had to overcome several challenges from identifying sources of funds to the choice of manufacture training of local partners engineering licenses and studies in order to accelerate the process the brazilian government negotiated with vale ­ a brazilian company that operates coal mines in mozambique a financial donation for the completion of the works of the factory like other complex processes of technology transfer the project is divided into stages initially the factory will only pack the medicines sent from brazil production stage itself shall begin by the end of 2012 by 2014 the completion of all technology transfer is expected the project provides for the annual production of 226 million arv tablets or capsules and 145 million units of other medication thus allowing mozambique to supply drugs to other african countries portfolio in the brazil-mozambique technology transfer portfolio there are five aids drugs and 16 other medications for other purposes such as anti-inflammatory and antihypertensive drugs anti-parasitic drugs and corticoids among others overall 21 allotments of medication are to be donated without the need of paying royalties to brazil each pro-

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brazilian international health activities bulletin duct is estimated between usd 100 thousand and usd 200 thousand currently 80 of the funds to purchase medication in mozambique come from donor countries by implementing the factory the country also takes up a new strategic position with the acquisition of technological knowledge in the public production of medication in line with current international standards of good manufacturing practices gmp therefore mozambique is moving forward to reduce dependence besides increasing the country s self-sufficiency in this sector furthermore there s also the possibility of converting current donors into partners of the initiative mozambican health minister alexander manguele welcomed the initiative it means a lot before in order to face one of the most serious public health problems we could only rely on preventive measures with the factory implemented here we will produce the drugs we need and be able to save lives stages for the first phase of the project the ministry of health of brazil has earmarked brl 13,6 million for purchasing equipment and training the professional staff who will work at the mozambican medication corporation inc the estimated total investment is brl 36 million which also includes the transfer of technology for the production of 21 drugs technical and managerial training of mozambican professionals validation and registration among others to execute the project the brazilian ministry of health appointed the institute of pharmaceutical technology farmanguinhos oswaldo cruz foundation/fiocruz the main public laboratories producing medication for the unified health system sus other brazilian national institutions also have a complementary role in the partnership first the national health surveillance agency anvisa which fosters the strengthening of the local mozambican regulatory agency with that country s support followed by the brazilian cooperation agency abc of the ministry of external relations which promotes the training of mozambican technicians in brazil and fiocruz mozambican technicians at the art factory in mozambique the factory site is located in matola a town on the outskirts of maputo the site was acquired in 2008 by the mozambican government the area has a total of about 20.000 m² with 3.000 m² of constructed area and an unused area of 2.000 m² inside a warehouse which will be adapted for the installation of the new pharmaceutical factory about 90 employees will work at the site all of them will be mozambicans and will undergo training activities provided by brazilians cooperation timeline in 2003 the brazilian government launched the idea of setting up an antiretroviral drug production unit in mozambique the following step consisted on developing a technical-economic feasibility study which took place between 2005 and 2007 the study resulted in the official commitment for the purchase of the area for the new pharmaceutical factory during the visit of president lula to mozambique in october 2008 once the area had been purchased the subsequent steps for the implementation of the project began as follows the registration of medicines in mozambique the purchase of equipment the training of technical and managerial experts technical and administrative assistance to pharmaceutical production which is already underway and will continue up to 2014 a sad reality mozambique faces a sad reality over 670 thousand children are orphaned because parents lost their lives in the fight against aids the country is among the ten most affected by hiv worldwide with a prevalence rate of 15 among adults in all there are about 1,7 million infected in a population of 21,4 million people according to the local office of the joint united nations programme on hiv/aids unaids 200.000 mozambicans are treated with art the factory is expected to gradually expand production to meet all the demands for treatment in the country other projects in addition to the pharmaceutical factory the ministry of health supports several other health programs in mozambique the ministry participates in the activities of the trilateral agreement between brazil mozambique and the united states to control hiv/aids it offers a masters of health science in research and laboratory in cooperation with the national health institute -ins/ministry of health of mozambique misau having graduated its first class of researchers in 2010 it develops activities that contribute to the reduction of maternal newborn and child mortality rates in cooperation with misau ­ such as training on-duty professionals and implementing the human milk bank and the lactation center also the ministry supports the polytechnic education in health among other partnership initiatives nº 4 may 2011 3

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alexandre padilha interview foto padilha brazil s new minister of health ratifies priority to international cooperation and says the country supports the global movement in favor of universal health systems 4 how do you see the role of international relations ­ particularly that of international cooperation ­ and what is its relevance to health actions and policy international cooperation is a priority for the ministry of health and is implemented in partnership with the ministry of external relations cooperation agreements have not only a humanitarian role they also contribute to consolidating the efforts of the brazilian foreign policy in the last few years we have witnessed a remarkable growth in our cooperation with developing countries both in terms of projects and partners this is particularly true regarding our neighbors in south america and countries of the cplp brazil s foreign policy understands south-south cooperation as a manifestation of the country s international solidarity brazil has become a reference in many health programs and we have been working to expand our partnership with other latin american countries among our current ongoing projects 24 aim to implement human milk banks eight of which in south america in addition there are tens of projects in the fields of stds hiv/aids blood and blood products primary health care sanitary surveillance and others according to the brazilian cooperation agency health and agriculture are the bulk of the brazilian international cooperation brazil has played a leading role in both bilateral and multilateral cooperation initiatives in a number of fields including health care in that context unasur s south american health council is a recognized integration forum what are the benefits of brazil s leadership to the country and the region as a whole over decades we have built up our regional governance in all aspects of health initially through mercosur acto and a number of bilateral treaties the challenge now is to focus efforts and expand the governance of the union of south american nations unasur which must have its own identity and represent more than what it already does hence the importance of proposals and initiatives that have been discussed since the end of 2008 and are embodied in our five year plan for unasur s health council to promote integration in south america to the health of all this articulation has given the country and the region a large representation in international health forums an example was the presentation of unasur s position at the 2010 world health conference in geneva to defend the right of access to drugs as public goods privileging social interests over commercial ones you said you took the minister s seat committed to the history of brazil s sanitary reform which among other breakthroughs made health a constitutional human right what other values and concepts adopted today by the brazilian he alth system do you consider could be a model to other countries in brazil we have an inclusive public health care model all citizens have full universal and free access to health care through sus the brazilian unified health system this includes from simple ambulatory care to more complex surgical procedures such as organ transplantations we can affirm sus is indeed an important tool to promote human dignity and fight poverty based on the breakthrough achieved by sus demands for international cooperation from other developing nations have increased significantly technical cooperation can replicate successful experiences and some brazilian programs and policies in countries with similar social and economical reality as is the case of human milk banks implemented in more than twenty countries in africa and latin america and support to structuring health care systems in latin america brazil has advocated the access to essential drugs through public heath care in international forums worldwide there has been strong opposition particularly from the pharmaceutical industry how is opening a facility to manufacture drugs to treat patients with hiv aids in mozambique part of the brazilian strategy we believe it is essential for developing nations to produce and commercialize generic drugs we

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brazilian international health activities bulletin have been using our experience to help other nations that need this type of medicine africa for example desperately needs action to curb the spread of hiv/aids in mozambique only it is estimated that 1.7 million people in a population of 20 million live with the virus which means that at least 15 of the country s adult population has been infected for comparison an estimated 630 thousand people live with the virus in brazil today in 2008 we opened an office of the oswaldo cruz foundation fiocruz in maputo and in 2010 we took the first steps towards implementing a facility to manufacture antiretroviral drugs in mozambique this is doubtlessly an innovative international cooperation initiative that entails great efforts from both brazil and mozambique under the representation of brazil in international health forums ­ such as paho who unasur health and others ­ what new proposals can the country be expected to advocate to expand ac cess to health services those who need it brazil supports the global movement in favor of universal health systems which is gaining momentum health enables sustainable socioeconomic development as a fundamental social policy it should be seen as an investment and not as an expense with underprivileged classes for example we are closing a cooperation agreement with uruguay to support restructuring of the public health system which guarantee full operation of health care in fact the principle of universal access in our region has been supported by mercosur and unasur health sectors and is also mobilizing the who we expect the adoption of resolutions to defend it at the next world health assembly in may this year what other global agenda issues will you prioritize regarding the promotion of ac cess to medication we have been working with the who on negotiations to prepare to respond to the influenza pandemics on debates on forged medical supplies and on developing alternative mechanisms to finance research and development this is definitely one of our priorities we are willing ­ politically too ­ to share our experiences with our partners in that context we have also prioritized support to haiti in order to rebuild the country s health system south-south cooperation is part of the global health agenda and brazil has become an increasingly important player in that specific field we are convinced cooperation must seek sustainable results and the effective replication of brazilian solutions and policies that promote autonomous more solid health policies we do not wish to impose solutions but to acknowledge our partners particularities and help them enhance their own policies and responses in the field of public health cplp project monitoring and evaluation are topics of course in cape verde a short-term course was held between march 14 and 18 of 2011 in praia cape verde the course aimed at disseminating content and technical skills on techniques and strategies for monitoring and evaluation of projects of international cooperation in health the course accounted on the participation of representatives from angola brazil cape verde guinea bissau mozambique portugal and sao tome and principe the initiative was carried out by the executive secretariat of the community of portuguese language countries cplp and the ministry of health of brazil it was run via the projects division of the international advisory office for health affairs dproj aisa in partnership with the german agency for international cooperation giz dproj/aisa archive participants of the monitoring and evaluation course and the joint united nations programme on hiv/aids unaids in brazil the school of public health sergio arouca ­ ensp of the oswaldo cruz foundation was in charge of the methodological coordination the course inaugurated the center for specialized medical training of the cplp an initiative of cplp s technical health group with the purpose of training technicians from portuguese-speaking countries on health-related issues nº 4 may 2011 5

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survey investment in international cooperation brazilian investment in international cooperation from 2005 to 2009 achieved the total figure of about usd 2.9 billion at current values the annual investment in cooperation in that period nearly doubled from about usd 384.2 million to over usd 724 million these and other data can be found in the document brazilian cooperation for international development 2005 to 2009 the result of a partnership between the secretariat for strategic affairs of the presidency of the republic sae pr the institute of applied economic research ipea the ministry of external relations mfa and the brazilian cooperation agency abc published december last year brazilian investment in international cooperation included modalities of humanitarian assistance scholarships for foreigners technical scientific and technological cooperation and contributions to international organizations providing for the exchange of good practices in national public policies through the brazilian cooperation for international development he said the director of abc marco farani stressed the importance of the survey for the formulation of future cooperation actions the overall view provided by the report reveals potential synergies between the different modalities of cooperation from brazil to other countries offering the prospect of designing actions with more effectiveness due to the combination of components once dealt with in isolation he said humanitarian assistance and technical cooperation alone were responsible for an even more significant growth in terms of annual investment almost six times greater from brl 28.9 million in 2005 to brl 184.8 million in 2009 in the specific context of technical scientific and technological cooperation the study with sustainable results in addition more than just increasing investment the strategy also included diversifying the application of resources both in horizontal south-south cooperation and triangular partnerships with foreign governments and international organizations federal funds allocated only for technical cooperation reached brl 252.6 million over the same period tripling from 2005 to 2009 cooperation in health pochmann points out projects of strategic importance for cooperation in health i those of human milk banks implemented in latin america and the caribbean africa portugal and spain concerning the transfer and adoption of the technology developed in brazil ii actions to rehabilitate the haitian health system through the implementation of emergency care units donation of ambulances improvement of health surveillance and training of local health professionals iii dissemination of successful practices with regard to hiv and aids in 23 countries in latin america asia and especially in africa farani also highlighted the singularity of brazilian cooperation in the health sector brazilian cooperation in healthcare has the mark of prioritizing the development of local capacity in recipient countries based on the sharing and adaptation of good practices adopted in brazil which have been subject of increasing interest from other governments he said from this year on the survey is expected to be carried out on an annual-basis processing of data from 2010 has already been started a full version of the document is available at http www.ipea.gov.br/portal/images stories/pdfs/book_cooperao brasileira.pdf 6 progression of annual funds allocated for technical scientific and technological cooperation ­ 2005 to 2009 in millions of brl 100 90 80 70 60 50 40 30 20 2005 2006 2007 2008 2009 source 2010 brazilian cooperation for international development survey the president of ipea marcio pochmann highlights the contribution of the study to both internal and external structures of the country the initiative called for a dialogue with numerous representatives from various sectors of the federal public administration directly involved in emphasizes the brazilian diplomacy with solidarity which contributes to intensifying relations with developing countries ­ primarily encompassing programs of structural approach that is those characterized by actions in recipient countries that can develop individual and institutional capacity

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brazilian international health activities bulletin paraguay and uruguay health care networks the brazilian ministry of health in partnership with the german international cooperation agency giz and the support of the brazilian cooperation agency abc mre promoted discussions and the preparation of projects to structure integrated health care networks in paraguay and uruguay with the presence of the most important health authorities of both countries the project in paraguay aims to lay the foundations for the operation of health care networks with two pilot projects in uruguay the project will be implemented in four departments provinces ­ three of which on the brazilian border ­ and is part of a broader proposal do reform the country s health system considering the brazilian experience with the implementation of giz the brazilian ambassador joão carlos de sousa gomez the minister of health of uruguay daniel olesker the german ambassador karl otto köning and the uruguayan asse president mario córdoba in the meeting opening session the sus unified health system the projects are part of the efforts of the international advisory office of the brazilian ministry of health aisa to implement struc turing projects that are capable of producing more substantial results to strengthen health care in countries considered priority to the brazilian cooperation redessul brazil hosts 1st south american cooperation forum at a meeting held in lima peru in late 2010 brazil took over the coordination of the south american network of international advisory offices and international cooperation in health redessul ­ oris for 2011 the handover was made by the peruvian ministry of health oscar raul ugarte ubilluz at the occasion brazilian representative mauro figueiredo head of the project division of the international advisory office in health highlighted the achievements of the peruvian coordination and the challenge of translating institutional breakthrough into concrete achievements to the realities of the countries in the field of international cooperation figueiredo also pointed out the relevance of formalizing the network into unasur s structure by means of a specific determination which would result in greater political support and consequently enhanced sustainability the main points of the agenda under brazilian responsibility include organizing the 1st south american forum on international cooperation in health to be held in the second half of november in rio de janeiro the forum will gather some three hundred participants from south america and representatives of international organisms and cooperation agencies to outline the main strategies for cooperation in health in the region the ultimate objective is to strengthen current international cooperation practices developed by the ministries of heath of unasur member countries fostering more integration and the implementation of new approaches to international cooperation discussions will contemplate four major themes international cooperation and humanitarian aid global topics in health unasur redessul and other regional integration initiatives and partnership and cross-sector issues in the position of redessul coordinator brazil also needs to face the challenge of enhancing communications of international advisory offices with international organisms cooperation agencies partners in general and the populations of member countries an important instrument to achieve this goal is the redessul ­ oris newsletter the first issue of which is expected in the first semester of 2011 in addition brazil is coordinating the preparation of a diagnostic technical cooperation supply and demand of south american countries the document will also introduce the countries best practices as well as their cooperation needs this initiative counts on the support of the brazilian cooperation agency abc the german international cooperation agency giz and the united nations population fund unfpa nº 4 may 2011 7

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milk bank brazil expands human milk bank program to africa agreements signed with mozambique cape verde and angola include the installation of human milk banks purchase of equipment technology transfer and training of professionals in these countries within the period of two years based on such transfer of technology and professional training these countries will be able to create in the future a network of human milk banks just like the one in place in brazil therefore being able to expand neonatal care and increase the ability to reduce infant mortality fernandes figueira institute institute fernandes figueira iff under the oswaldo cruz foundation oswaldo cruz foundation coordinating institution of the human milk bank network in brazil will be in charge of implementing the initiatives mentioned above dproj/aisa 8 technicians from the ministry of health of brazil and those from lucrecia paim maternity hospital ­ angola knowledge brazil donates 13,000 publications to africa the publications were donated in 2010 by the ministry of health to the who blue trunk libraries project and are to be used in rural areas of portuguese-speaking countries in africa the works deal with themes such as community health epidemiology oral health food and nutrition and sti and aids each blue trunk library has a collection with an average of 180 items including books reports and manuals kept in a blue metal box for easy transport and storage the brazilian ministry of health has provided 80 of such publications the blue trunk library is part of the eportuguÊse network a who platform to provide support for the development of health professionals in the following countries angola brazil cape verde guinea-bissau mozambique portugal sao tome and principe and east timor cgdi/ms blue trunk libraries on their way to africa note courses on project monitoring and evaluation organized by dproj aisa in brasilia in september and october 2010 and mentioned in cooperation in health no 3 page 3 had the support from the german agency for international cooperation giz the united nations programme on hiv aids unaids the pan american health organization paho who the state health secretariat of pernambuco and the national school of public health escola nacional de saúde páublica ensp fiocruz which imparted the courses similarly for the first international seminar on men s health in the americas held in brasilia in september 2010 mentioned on page 5 the ministry of health counted on partnerships with the united nations population fund unfpa giz unaids and paho who for more information visit http portal.saude.gov.br/portal/saude/visualizar_texto.cfm?idtxt=35101&janela=1 expediente cooperação saúde é uma publicação da assessoria de assuntos internacionais de saúde aisa com o apoio da assessoria de comunicação do ministério da saúde ­ ascom editor responsável eduardo botelho barbosa ­ chefe da assessoria de assuntos internacionais de saúde coordenação editorial mauro teixeira de figueiredo ­ chefe da divisão de projetos/aisa/ms coordenação de redação carlos andrade revisão diagramação e projeto gráfico ascom/ms tiragem 3.000 exemplares colaboradores aisa/ms ascom/ms agência brasileira de cooperação ­ abc/mre centro de relações internacionais cris/fiocruz instituto fernandes figueira iff/fiocruz farmanguinhos/fiocruz departamento de dst aids e hepatites virais coordenação geral de documentação e informação ­ cgdi/ms e coordenação geral do programa de controle da malária ­ cgpncm/ms os artigos assinados não refletem necessariamente as posições do ministério da saúde e são da exclusiva responsabilidade dos seus autores endereço ministério da saúde esplanada dos ministérios bloco g sala 425 ­ edifício sede ­ brasília ­ distrito federal ­ 70.058-900 ­ www.saude.gov.br apoio impressão tradução:

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