<\/span><\/p>\n3. Areas of Convergence and Tension<\/b><\/h2>\n
The discussion on preserving what works reveals strong consensus regarding the technical value of regional institutions, but also significant tensions concerning governance and sustainability.<\/span><\/p>\nConvergences<\/span><\/h3>\n\n- Value of Technical Cooperation:<\/b> Consensus exists on the importance of PAHO\u2019s technical cooperation, access to technical expertise, and the role of regional institutions such as PAHO, ORAS-CONHU, IDB, and CAF. <\/li>\n
- Financial Mechanisms:<\/b> Broad agreement on the need to preserve, maintain, and expand PAHO\u2019s revolving funds and other pooled procurement mechanisms.<\/li>\n
- Regional Capacity:<\/b> Wide recognition of the need to identify and strengthen existing regional capacity (e.g., centers of excellence, biological production).<\/li>\n
- Successful Models:<\/b> Recognition of the success of regional immunization programs, primary health care strategies, and the need for robust surveillance systems.<\/li>\n
- Approach to Reform:<\/b> General agreement that this is not the time to dismantle the existing \u201carchitecture\u201d, but rather to reduce duplication and fragmentation while preserving effective components.<\/li>\n<\/ul>\n
Tensions<\/span><\/h3>\n\n- Institutional Architecture:<\/b> Tension between those advocating reform of existing institutions (e.g., PAHO) and those proposing the creation of new regional structures.<\/li>\n
- Role of PAHO:<\/b> While its technical expertise is historically valued, questions persist about its role, governance, and whether the organization itself should be reformed. Some favor its integration with ministries of health, while others argue it should operate \u201cat arm\u2019s length\u201d to ensure independence.<\/li>\n
- Technical vs. Political Balance: <\/b>Debate continues over the extent to which technical institutions should engage in politically sensitive positions<\/li>\n
- Sustainability and Autonomy:<\/b> Functioning systems are threatened by declining funding. A persistent tension exists between reliance on international cooperation and the need for national ownership of successful programs.<\/li>\n
- Private Sector Engagement:<\/b> Divergent views exist on public-private collaboration, some see it as beneficial (e.g., vaccine technology transfer), while others express concern over potential conflicts of interest.<\/li>\n
- Regionalism vs. National Sovereignty: <\/b>A structure that is too weak risks irrelevance, while one that is too powerful may be perceived as a threat to national autonomy. The most viable proposal points toward a flexible and cooperative structure with horizontal governance and equitable representation, in which countries retain political control while sharing technical and informational capacities.<\/li>\n<\/ul>\n
4. Proposed Questions for Working Groups (select the questions that better allies to the group objectives)<\/b><\/h2>\n
The following key questions, drawn from the reviewed documents, are proposed to guide the reform working groups:<\/span><\/p>\nMain Questions<\/span><\/h3>\n\n- What other regional initiatives should be preserved because they function well and generate tangible benefits for the population but were not considered in this summary?<\/span><\/li>\n
- What modifications should be implemented to improve their performance, institutionalize them, or ensure their sustainability within the region?<\/li>\n
- Which of these effective initiatives are most relevant for positioning the region in global debates with greater engagement and influence?<\/span><\/li>\n<\/ol>\n
<\/p>\n
Other (Optional questions)<\/span><\/h3>\nOn Identifying and Preserving Strengths<\/span><\/h4>\n\n- Which specific mechanisms within the current architecture have demonstrated the greatest effectiveness and should be preserved unchanged?<\/span><\/li>\n
- How can we document and systematize regional \u201cbest practices\u201d to ensure their preservation throughout the reform process?<\/span><\/li>\n
- What evaluation mechanisms are needed to distinguish what should be preserved from what should be reformed?<\/span><\/li>\n
- How can countries more effectively share successful experiences across the region?<\/span><\/li>\n
- How can we ensure that reducing duplication does not inadvertently eliminate programs that are functioning well?<\/span><\/li>\n<\/ul>\n
On Institutional Reform and Governance<\/span><\/h4>\n\n- What criteria should guide decisions to reform an existing institution versus creating a new one?<\/span><\/li>\n
- How can the technical capacity of institutions such as PAHO be preserved regardless of governance reforms?<\/span><\/li>\n
- Which specific features of ORAS-CONHU could be replicated in other regional institutions?<\/span><\/li>\n
- What institutional changes are needed to protect functioning systems during processes of global architectural reform?<\/span><\/li>\n
- How can we ensure that effective elements do not depend excessively on specific personalities but are instead fully institutionalized?<\/span><\/li>\n<\/ul>\n
On Financing and Scaling<\/span><\/h4>\n\n- How can sustainable financing be secured for programs and systems that have demonstrated effectiveness (immunization, primary health care, surveillance, regional procurement)?<\/li>\n
- How can we preserve and optimize PAHO\u2019s revolving funds without allowing them to become inflexible or captured by a few suppliers?<\/span><\/li>\n
- How can the Revolving Fund model be scaled to other products and services without losing effectiveness?<\/span><\/li>\n
- How can successful models such as PANCAP or the OECS procurement system be scaled across Latin America more broadly?<\/li>\n
- What incentives can encourage countries to invest in maintaining what works?<\/span><\/li>\n<\/ul>\n
On Cooperation and Partners<\/span><\/h4>\n\n- Which successful South\u2013South cooperation models from other regions can inform strengthened cooperation in Latin America?<\/span><\/li>\n
- What role should South\u2013South cooperation play, and how can it be better institutionalized?<\/span><\/li>\n
- What role should national centers of excellence play within a strengthened regional architecture?<\/span><\/li>\n
- What role should the private sector have in preserving and enhancing effective cooperation mechanisms?<\/span><\/li>\n
- How can national ownership of successful programs currently dependent on international cooperation be reinforced to reduce vulnerability to fluctuations in external funding?<\/span><\/li>\n
- How can lessons learned during COVID-19 about rapid response and coordination be institutionalized?<\/span><\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"
A roadmap to preserve and scale proven approaches in the region. It proposes strengthening PAHO\u2019s capacity, the revolving funds, and joint procurement; consolidating regional centers; and improving coordination and making financing more sustainable.<\/p>\n","protected":false},"author":2,"featured_media":2592,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[4],"tags":[],"class_list":["post-2701","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized"],"acf":[],"_links":{"self":[{"href":"https:\/\/lacforglobalhealth.org\/en\/wp-json\/wp\/v2\/posts\/2701","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/lacforglobalhealth.org\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/lacforglobalhealth.org\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/lacforglobalhealth.org\/en\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/lacforglobalhealth.org\/en\/wp-json\/wp\/v2\/comments?post=2701"}],"version-history":[{"count":1,"href":"https:\/\/lacforglobalhealth.org\/en\/wp-json\/wp\/v2\/posts\/2701\/revisions"}],"predecessor-version":[{"id":2760,"href":"https:\/\/lacforglobalhealth.org\/en\/wp-json\/wp\/v2\/posts\/2701\/revisions\/2760"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/lacforglobalhealth.org\/en\/wp-json\/wp\/v2\/media\/2592"}],"wp:attachment":[{"href":"https:\/\/lacforglobalhealth.org\/en\/wp-json\/wp\/v2\/media?parent=2701"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/lacforglobalhealth.org\/en\/wp-json\/wp\/v2\/categories?post=2701"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/lacforglobalhealth.org\/en\/wp-json\/wp\/v2\/tags?post=2701"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}