Developing a National Program: Brazil Case Study: Vera Luiza da Costa e Silva, MD, MBA, PhD

Transcription

1 Learning Objectives Discuss lessons learned in Brazil Discuss the framework of capacity that needs to exist for tobacco control Developing a National Program: Brazil Case Study Vera Luiza da Costa e Silva, MD, MBA, PhD Tobacco Control and Consumer Health Risk Assessment Unit Pan American Health Organization 2 What Do We Mean by Capacity? Who Is Involved in Capacity Development? Capacity Capacity building Capacity development The combination of people, institutions, and practices that permits countries to achieve their development goals* A process by which individuals, groups, institutions, organizations, and societies enhance their abilities to identify and meet development challenges in a sustainable manner The process by which individuals, organizations, institutions, and societies develop abilities (individually and collectively) to perform functions, solve problems, and set and achieve objectives Individuals and groups Key skills and knowledge required to perform functions Organizations Management systems and business processes Institutions Governance Parliament The role of private sector and civil society Sources: *World Bank. (2003). Canada International Development Agency. (1996). United Nations Development Programme. (1997). 3 4 Components of the Capacity Building Process People Tobacco control cell Focal point/coordination mechanism Staff members Committees and task forces Professional development/ regular training 5 6 1

2 Place Policy Where the program is housed Area of work, organizations involved Infrastructure, equipment, basic materials Networking States, municipalities, provinces Existing plans of action Strategies Laws, regulations Cost-effective interventions Communication and the seduction process Linking with existing health care framework 7 8 Policy Partnership Existing plans of action The civil society Strategies Laws, regulations Cost-effective interventions The private sector Ethics and collaboration with the private sector Communication and the seduction process Stakeholders in general Multi-sectoral focus The tobacco industry 9 10 Provider (Funds) Making Decisions on Capacity Development: Scenario Sources of funds Regular versus extrabudgetary funds Funding gaps Resource allocation Existing fund raising exercise

3 The Capacity Building Process in Brazil Capacity Development: 1985 to 1991 The Unified Health System: SUS Federal level State level Municipal level Strong participation of the civil society Initial phase (1985 to 1991) Sanitary Pneumology Agency (Brasilia) with support from the Department of Chronic Diseases/National Cancer Institute (INCA, Rio de Janeiro) and the National Institute for Lung Disease (CRPHF, Rio de Janeiro) Development of first national tobacco control plan Development of a national state and municipal network within the Public Health Care System (SUS) Creation of National Tobacco Control Day, 1986 Image source: adapted by CTLT from Ministry of Health Brazil. (2007) Capacity Development: 1992 to 1998 Capacity Development: 1999 to 2005 Infrastructure building phase (1992 to 1998) INCA with support from Pneumology and CRPHF INCA assumed coordination role for cancer prevention, including tobacco control Creation of the Committee to negotiate the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) First national conference: non-governmental organization (NGO) involvement Growth phase ( ) INCA (Rio de Janeiro) and the National Health Surveillance Agency (ANVISA, Rio de Janeiro and Brasilia) Tobacco products registered Advances in legislation and regulation Involvement of other federal agencies Secretary of Sanitary Surveillance (SVS) Secretary of Health Assistance (SAS) Capacity Development: 1999 to 2005 Capacity Development: 2006-Present Growth phase (1999 to 2005) Development of guidelines for cessation within the health care system and creation of the quitline (SUS provision of free cessation services and free Nicotine Replacement Therapy [NRT] and bupropion) Brazil ratifies the FCTC Creation of a multi-sectoral government committee (CONICQ) for the implementation of the FCTC Reduced emphasis and support for state and municipal activities Consolidation phase (2006 and beyond) INCA, ANVISA, SVS, SAS, and other partners at the Ministry of Health SVS and ANVISA sending resources to states and municipalities Inter-ministerial agenda for implementation of the FCTC Building of a tobacco products analysis lab Work on smoke-free environments Capacity building for cessation

4 People: Training People: National Commissions National Committee for the Control of Tobacco Use Ministry of Health Ministry of External Relations Ministry of Agriculture Ministry for Development, Industry, and Trade Ministry of Finance Ministry of Justice Ministry of Labor and Employment Ministry of Education Ministry for Agrarian Development CONICQ Ministry of Health Ministry of External Relations Ministry of Agriculture Ministry for Development, Industry, and Trade Ministry of Finance Ministry of Environment Ministry of Communication Ministry of Justice Ministry of Labor and Employment Ministry of Education Ministry for Agrarian Development Image sources (left to right): Brazilian National Cancer Institute, INCA. (2001). (2003). (2007) Place: The Network Place: The Network Image source: da Costa e Silva, V.L. Images source: Ministry of Health Brazil Policy: International Leadership Policy: Brazil Chairmanship of the negotiation process and preparation for the Conference of Parties (COP): WHO FCTC Ambassador Celso Almorim Ambassador Luiz Felipe de Seixas Correa Images source: da Costa e Silva, V.L

5 Policy: Addressing the Supply Side Policy: The Regulatory Authority of ANVISA Images source: da Costa e Silva, V.L. Images source: Ministry of Health Brazil Policy: Smoke-free Places Initiative Policy: School-based Program Images source: Ministry of Health Brazil. Images source: Brazilian National Cancer Institute, INCA Policy: Smoking Cessation Initiatives Policy: World No Tobacco Day Commemoration Images source: Brazilian National Cancer Institute, INCA. Images source: da Costa e Silva, V.L

6 Partnership: NGOs and Health Professional Groups Tobacco Control Capacity Development Results: Brazil Currently 200 organizations working on tobacco control Source: adapted by CTLT from SRF, MDIC, McKinsey and Company, ETCO Tobacco Control Capacity Development Results: Brazil Brazilian adults (> 15 years of age) smoking prevalence (%) 1989: 32% of total adult population* 2003: 18.8% of total adult population Opportunities Program is highly regarded both domestically and internationally Program has 20 years of history Program was able to block tobacco industry opposition and obtain ratification of WHO FCTC Municipalities and states do have minimum infrastructure Growing population awareness and many public health professionals committed to program Source: *Instituto Brasileiro de Geografia e Estatistica. (1989). INCA/SVS NCD Survey. (2003). Multi-annual planning and integration in health agenda at the federal level Challenges Challenges Improve collaboration with more multi-sectoral activities Develop a capacity to evaluate the program on a regular basis Enhance participation of local level in planning Improve quitline response: currently the largest number of calls in the world (over two million per year) Invest in capacity building, need better methods and strategies; ensure that there is personnel to carry program activities Improve coordination with other state agencies Secure funding from federal government for state and local levels

7 Summary Look for partnership and collaboration Tobacco control must bring partners together and take advantage of current infrastructure Two hands clap and there s a sound. What is the sound of one hand? Chinese proverb 37 7