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Haiti’s Recovery Won’t Happen Overnight

This blog post originally appeared on Devex.

Each morning, the bulky, unwieldy vehicle navigates an uneven, rocky path that in some areas of Haiti is a common road. Only my seatbelt keeps me from hitting the roof as I make my way to the U.S. embassy in Port-au-Prince.

A row of damaged houses and buildings in the Cité Soleil neighborhood in Port-au-Prince, Haiti. Four years after the disaster, almost 75 percent of earthquake rubble has been removed and 89 percent of the 1.5 million displaced population have left camps for alternative housing options.

A row of damaged houses and buildings in the Cité Soleil neighborhood in Port-au-Prince, Haiti. Four years after the disaster, almost 75 percent of earthquake rubble has been removed and 89 percent of the 1.5 million displaced population have left camps for alternative housing options. Photo by: Andre Mellagi / CC BY-NC-ND

A newcomer to the country, I see each day during my journey a small remaining camp for Haitians displaced by the catastrophic 2010 earthquake. Living in temporary tent shelters, they, children among them, are still waiting for a new place to call home. Then, recently, I noticed that the camp was emptying.

Almost four years after the earthquake, 89 percent of Haiti’s 1.5 million internally displaced persons have left the tent camps for alternative housing options. Almost 75 percent of earthquake rubble has been removed. Security throughout the country has improved and, recognizing the importance of employment, the government is committed to attracting foreign investment, with agriculture, tourism and the apparel industry the most promising growth areas. Health indicators are up, with improvements in infant and child mortality rates and more public access to health services.

International donors — among them the U.S. Agency for International Development — have learned lessons along the way in Haiti in terms of how we can do better.

As the country leaves behind the era of post-earthquake relief and focuses now on longer-term development, USAID is striving to build the capacity of local organizations to lead and manage development initiatives.

This necessarily involves building public and private institutions so Haitians can lead and manage their own development. On our part, we are enhancing the capacity of the Ministry of Health to manage a national healthcare system using its own human and financial resources, so it will no longer be dependent on donors. Similarly, efforts are underway to build the financial and programmatic capacity of local NGOs to provide services and advocacy that are too often provided by international organizations. The country must also advance the rule of law, a prerequisite to the creation of durable institutions and economic growth.

Every USAID mission director’s goal is to help the host country one day reach a point when it no longer needs foreign economic assistance. Indeed, all donors and development organizations should be devoted to that goal. In Haiti, this will not happen overnight. But four years after the earthquake, Haiti remains a U.S. government priority to continue and improve our efforts to help Haitians building the opportunity and prosperity they are capable of and that they are so deserving.

John Groarke is USAID Mission Director in Haiti since August 2013. An expert in international law and counter-insurgency, he previously served in hotspots like Afghanistan, Iraq, Egypt and Morocco, as well as senior legal advisor for West Africa and South Asia.

LGBT Rights in Jamaica: A Conversation with Maurice Tomlinson

From November 25th (International End Violence Against Women Day) through December 10th (International Human Rights Day), USAID joins the international community for 16 Days of Activism Against Gender Violence. During this time IMPACT will highlight  USAID’s work to combat gender-based violence.

Regina Jun, Gender Advisor for the Bureau of Latin America and the Caribbean, spoke with Maurice Tomlinson, who is an Attorney-at-Law, law lecturer on sexual rights, and HIV/AIDS advocate. He is leading an initiative, on behalf of AIDS-Free World, to have the region’s anti-sodomy laws repealed.

In 2012, Maurice was awarded the inaugural David Kato Vision and Voice Award. Maurice is featured in the Abominable Crime, a documentary that explores the culture of homophobia in Jamaica. 

Photo of Maurice Tomlinson. Credit: Maurice Tomlinson.

Photo of Maurice Tomlinson. Credit: Maurice Tomlinson.

Q1: How have the situations for the LGBT persons changed in Jamaica?

For the past 4 years, AIDS-Free World has been working to eliminate homophobia in Jamaica. This includes working with civil society groups on the island to document and respond to human rights violations against the local LGBT population. In that time, we have seen a near 400% increase in the number of reported homophobic attacks. In the last few months alone there have been several brutal assaults, including murders and home invasions.

Q2: Why is the violence against LGBT persons such an important issue in the Caribbean?

Violence against LGBT persons in the Caribbean has been identified as a significant reason that the region has the second highest HIV prevalence rate in the world. This violence drives LGBT citizens underground, away from effective prevention, treatment, care and support interventions. Jamaica, where homophobic violence is most acute in the region, has the highest HIV prevalence rate among men who have sex with men (MSM) worldwide at 33%.

Q3: What projects are you currently working on in the Caribbean?

I am working on several court cases challenging anti-gay laws across the region. These include the first ever domestic challenge to Jamaica’s anti-sodomy law, as well as a case before the region’s most senior tribunal, the Caribbean Court of Justice, to strike down the sections in the immigration laws of Belize and Trinidad which ban the entry of gays.  As part of a team, I conduct LGBT sensitivity training with police across the region and also train civil society groups on how to effectively document and report human rights violations against LGBT citizens.

Q4: What are some of the positive changes you have seen so far?

We have seen unprecedented editorial support for LGBT rights by the major newspapers across the Caribbean. There have also been positive statements from politicians — especially Minsters of Health — who underscore the need to repeal homophobic laws in order to address the region’s HIV epidemic. Mainstream civil society groups are also taking greater interest in and actively advocating for the human rights for LGBT persons.  Further, the polling pioneered in the region by AIDS-Free World on the levels and drivers of homophobia points to a small but important movement towards greater tolerance for LGBT citizens.  Finally, while the number of police attacks against LGBT persons has decreased, they still occur too frequently, especially involving LGBT citizens from the lower socio-economic strata.

Q5: In your opinion, what can be done to increase acceptance of greater sexual diversity in the Caribbean?

The visibility of LGBT persons will help to dispel some of the myths and misconceptions about sexual minorities. Once persons realize that someone they know and quite possible care deeply about is gay, this will help to humanize the issue of homosexuality.  It is easier for people to hate what they do not know. That is why AIDS-Free World has produced and tried to air tolerance ads showing positive images of LGBT persons.

Furthermore, political leaders continue to be very influential in the young nations of the Caribbean region. They can help to encourage more rational discussions about homosexuality by making unequivocal statements condemning homophobia.  Such statements would help neutralize some of the more virulent anti-gay pronouncements being disseminated by powerful religious fundamentalists across the Caribbean.

Like Maurice, USAID is committed to advancing the rights of the LGBT community, including providing support to local LGBT advocacy organizations to extend democratic governance and respect for human rights to all individuals, and creating blueprints for increased access of comprehensive healthcare services to transgender and transsexual persons. Learn more about USAID’s work against gender-based violence

Pounds of Prevention: Focus on Haiti

This installment of USAID’s Pounds of Prevention series (PDF) takes us to Haiti where we are working to reduce the risks posed by floods in Port-au-Prince. By leveraging the successes, lessons learned, and extensive mapping conducted as part of USAID/Haiti’s WINNER project, USAID is now taking specific steps to help communities in both the upper and lower Millet Ravine watersheds protect themselves from floods. Do you want to know what a gully plug is, or why pineapple plants are a part of the solution to slowing runoff and preventing erosion? Read on to find out!

The photo is of Ketlin Polinic, who is optimistic that disaster risk reduction activities in the Millet Ravine watershed will help protect her vegetable plot. Photo is from Nina Minka, USAID.

A Lesson in Holistic Care: What I Learned from Working with Transgender Women and Health Providers in the LAC Region

November 20 is Transgender Day of Remembrance.

I have collaborated closely with transgender women and health providers in Latin America and the Caribbean to learn more about the needs of transgender populations and to train health workers to provide quality services. Working alongside transgender women on needs assessments, trainings for health providers, and in the development of a blueprint (PDF) for comprehensive transgender services, opened my eyes to their experiences, gaps in existing programs that limit access to critical services, and the opportunities we need to pursue. To help you understand my recommendations, I would like to share a story I heard repeatedly from transgender women:

I was 13 years old when my family threw me out of the house because of who I am. I tried to continue my studies, but I dropped out of school because my classmates insulted me every day and sometimes hit me, and I was afraid to use the boys’ bathroom (the only one I was allowed to use) because I was afraid of being assaulted by male students. The teachers looked the other way or called me names. I have developed a thick skin because when I step out of my home, people stare, make comments and give menacing gestures. Going to a clinic is also unpleasant. I get sick like everybody else, but the nurses always assume that I am a sex worker and that I have HIV. Frequently, they give me condoms and an HIV test and send me home. One time I was jumped by four guys in the street, and I ended up in the emergency room. When one of the nurses opened my robe and saw that I am a transgender woman, she gave me a look of disgust and called me a homosexual. She must have told others about me because several nurses came, opened my robe and walked away laughing. I waited for a long time before a doctor saw me. He told me that real men do not dress like women, and that I should cut my hair and stop wearing make-up so I could get a job. I had a cut in my head that needed stitches and the doctor did not even clean the blood in my hair.

REDTRANS and Miluska staff conducting a workshop on HIV and human rights. Photo credit: Manuel Contreras

REDTRANS and Miluska staff conducting a workshop on HIV and human rights. Photo credit: Manuel Contreras

This story, and the others that I heard through this work, underscored the need for a new approach to transgender health:

  1. Prevention efforts must engage families and schools to foster supportive environments.  Transgender teens frequently experience rejection from their families and bullying in school. Homelessness, low literacy, and lack of family protection not only increase the likelihood that these teens will experience exploitation, but also severely limit their opportunities to find jobs.
  2. Many people, including health providers, do not clearly understand the spectrum of sexualities, genders, and identities. Their confusion often leads to stigmatizing attitudes and discriminating practices in health care settings, which in turn discourages transgender women from seeking care.
  3. Increasing access to counseling and testing and other HIV services should not be an end in itself. Securing the human rights of transgender communities and creating a safer environment where they can access appropriate services without fear of violence or discrimination should be the focus.
  4. Increasing access to condoms and HIV information are cornerstones of HIV prevention, but national prevention programs need to go beyond these two strategies. Policies and programs should also support employment and education opportunities for transgender persons. The pressure to put food on the table and a roof over their families’ heads can lead to poor decision making, resulting in risk-taking behaviors.
  5. Engaging transgender persons in program activities as facilitators or data collectors strengthens their technical capacities and allows them to engage with health providers and communities as professionals and peers. This can effectively dispel myths and negative beliefs about transgender women, their capacity, and their behavior.

By sharing my observations and the stories I heard, I hope to raise awareness of the issues that come into play and to encourage all of us to reconsider how our programs can better contribute to the well-being of transgender persons and their communities. We can make that commitment today on Transgender Day of Remembrance, an internationally recognized day to memorialize those who suffered or died as a result of anti-transgender hatred or prejudice.

Aysa Saleh-Ramirez, MPH is AIDSTAR-One Senior Technical Advisor at John Snow, Inc. AIDSTAR-One is funded by PEPFAR through USAID.

Haiti Holds First National Reading Championship

The finalists with the Director General and Deputy Director General of MENFP and well-known author Frankétienne. Photo credit: MENFP

The finalists with the Director General and Deputy Director General of MENFP and well-known author Frankétienne. Photo credit: MENFP

Out of 11,000 students from 172 schools, the Government of Haiti recently chose 72 finalists to attend the first National Reading Championship. From this talented bunch, six were national finalists. The two shining stars who came out on top in the final round were Bruna Samika Délomme, a fourth grader from the Northwest, and Loveda Movin, a third grader from Nippes. After participating in community reading activities during their summer, they proudly walked away as the top readers in their country.

At the event, Minister of National Education Vanneur Pierre stated that the National Reading Championship was a stepping stone in efforts toward improving the education system in Haiti. “The country is at a difficult crossroads today where education is the only tool to get the nation out of this impasse. Fortunately, the government has chosen to put the emphasis on education,” he said.

Samika Bruna Delhomme (L) of Northwest and Loveda Movin of Nippes were named finalists. Photo credit: MENFP

Samika Bruna Delhomme (L) of Northwest and Loveda Movin of Nippes were named finalists. Photo credit: MENFP

The competition has set a precedent for the nation and for the students. By acknowledging and supporting the endeavors of its brightest students, the Government of Haiti is helping to instill a culture of reading in this country and to secure a better future for its students. Ensuring that children can read in early grades often determines their future educational success, thus opening the door to greater economic opportunities in adulthood.

The National Reading Championship was hosted by USAID and the Ministry of Education, helping students like Bruna and Loveda maintain their reading competencies and comprehension during the summer vacation.  In addition, it inspired Minister Pierre to initiate Reading Fridays, which will be implemented in public schools to promote and encourage reading fluency and comprehension.

Read more about USAID’s education efforts in Haiti.

Like USAID Haiti on Facebook and follow @USAID_Haiti on Twitter for ongoing updates in the region. 

Video of the Week: Adapting to Melting Glaciers: A Partnership Approach

Through the USAID-supported High Mountain Partnership (HiMAP), Peru and Nepal are addressing the impacts and risks of rapidly melting glaciers in high mountain areas. The HiMAP brings scientists, governments officials, and local people together to share lessons learned on managing high-risk, high-impact floods caused by rapidly melting glaciers.

Learn more about USAID’s work in climate change and promotion of development based on climate-smart planning and clean technologies.

Housing Development Fuels New Hope for Haitian Families

The Haut Damier housing settlement stands neat and orderly near Cabaret off Route National 1, a main highway on the west coast of Haiti, north of Port-au-Prince. The development’s 156 pastel-painted houses received their first residents in September. The families, many of whom lost houses as a result of the 2010 earthquake and who until recently lived in tents and other substandard housing conditions, now have permanent homes, with running water and flush toilets, for the first time since the disaster.

“We are so pleased. We have never had piped-in water in the house before,” said Albert Julien, a father of a family of six.

A beneficiary prepares to move her belongings into her new USAID-funded house near Cabaret, Haiti, in September 2013. Photo credit: USAID

A beneficiary prepares to move her belongings into her new USAID-funded house near Cabaret, Haiti, in September 2013. Photo credit: USAID

The Haut Damier housing settlement, an $8.3 million housing and community development project, is one of several new settlements supported by USAID in partnership with the Government of Haiti and nongovernmental organization (NGO) partners to provide homeownership opportunities in proximity to employment and transportation hubs for earthquake-displaced families and other vulnerable households. Beneficiaries were chosen by the International Federation of the Red Cross (IFRC), in collaboration with local municipal authorities. IFRC is also partnering with USAID to assist in the move-in of the beneficiaries and help them begin a new life in the community.

Another key partner on this housing development is the Government of Haiti’s Public Agency for Social Housing, which has a team dedicated to provide management and maintenance of the housing complex. USAID will help the agency strengthen its management and governance capabilities.

The Haut Damier homes have two rooms, a bathroom with a shower, and a kitchen, and are connected to electricity and sanitation facilities. The buildings are made from locally available materials which allow the residents to repair and expand their homes as needed. To ensure structural durability, the houses meet the International Building Code earthquake and hurricane safety standards. Of the 156 houses, 16 are built with access ramps to accommodate people with disabilities, while all of the houses meet accessibility standards that include wider doorways and bathrooms.

“This will be a big change for my family,” said Etienne Masita, a mother of five. “In the tent, the children get diseases and life is difficult.”

Masita has already joined a variety of community development activities in her neighborhood. She and other incoming residents have worked five days a week tending vegetables in the gardens surrounding the houses. The IFRC-sponsored gardening project enables residents to assume responsibility for their neighborhood.

USAID’s NGO partners United Methodist Committee on Relief and IFRC are jointly providing nearly $3 million of their own funding to support community and livelihoods development programs. These partnerships along with community engagement in developing and maintaining the Haut Damier housing site are essential for creating an enriching and sustainable living environment.

The beneficiaries will be given title to their home after paying a monthly fee of about $45 for five years. This fee will help cover site management and maintenance costs, ensuring sustainability.

The new settlement, where streets are lit by solar lights at night and where residents will play a role in its future development, will significantly improve the well-being and safety for many.

“I am so thankful to USAID. We will finally get out of the tents, where we suffered so much,” said Max Fils-Aime, one of the beneficiaries slated to soon move to his new home.

Since the earthquake, USAID has helped more than 328,000 people (more than 20 percent of those displaced by the quake) find shelter solutions. These include a range of solutions from transitional shelters, repairs to damaged houses, support to host families who took in displaced people, and rental vouchers.

Resources:

Video of the Week: “Artisans in El Salvador Flourish”

USAID Small and Medium Enterprises Development Program, in alliance with SIMAN Stores, recently launched “ARTEC.A.”, a Central America-wide brand to distribute handicraft products by Salvadoran artisans in SIMAN department stores throughout the region. During the months of August and September, 30 artisans will be selling their products at the 12 SIMAN stores in El Salvador, Costa Rica, Nicaragua and Guatemala. The products include decorative handicrafts, toys, jewelry and clothing items, among others.

The USAID’s program has contributed with technical assistance to help the artisans secure sales with SIMAN, as well as innovating and improving their design, production and distribution processes. Through these initiatives, USAID/El Salvador fulfills some of the commitments made by the governments of the United States and El Salvador in the “Partnership for Growth,” specifically those related to solving the factors that cause lower productivity of tradables.

The Bright Side of Taxes: More than Just a Headache

Many people equate taxes with confusing forms, incomprehensible rules, and general feelings of frustration. Others fear potential audits or vent about the ways in which their governments spend tax revenues. People pay less attention to the positive side of taxation; namely, that the resulting revenues allow a government to provide critical goods and services to citizens.

Tax revenues support both large-scale investments in areas such as health, education, citizen security, and roads, as well as community-level goods and services, like public lighting and garbage collection. Of course, efforts to improve tax collection should go hand-in-hand with advancements in public financial management more broadly. That is, beyond simply collecting more taxes, governments should improve the way they handle and invest public resources. Low revenue collection and sub-par public financial management practices have serious implications for the everyday lives and operations of citizens and businesses.

Click to read USAID's Detailed Guidelines for Improved Tax Administration in Latin America and the Caribbean.

Click to read USAID’s Detailed Guidelines for Improved Tax Administration in Latin America and the Caribbean.

For example, countries like El Salvador are facing crumbling public school infrastructure, a lack of basic medicines in public hospitals, and delayed tax refunds to businesses. Even in Brazil, a country with tax collection levels on par with the most developed countries in the world, recent protests have highlighted citizens’ discontent with the government’s management of public resources.

Along with promoting private investment, the ability of governments to collect and manage tax revenues is fundamental to reducing their reliance on foreign aid over the long term. As the Assistant Administrator for USAID’s Bureau for Latin America and the Caribbean, Mark Feierstein, noted in testimony earlier this year:

“The most important source of development funding for nearly any country is not USAID, or any other donor, but internally generated revenue. Absent sufficient host country funding, donors alone will not produce sustained prosperity and opportunity. That is why we are initiating new programs to help national and local governments raise revenue.”

Many readers may be surprised to find that, despite recent economic and social advances in the region, many Latin American and Caribbean countries seriously struggle to collect and manage public revenues.

Last year, two researchers from the Economic Commission for Latin America and the Caribbean (ECLAC) found that tax collection rates in Latin America averaged 18.4% of GDP, or roughly half the average of 34.8% for countries (including the United States) that belong to the Organisation for Economic Co-operation and Development (OECD) and 39.2% in the European Union. More shocking is that collection rates in Latin America are significantly lower than the 24.5% average that the researchers found in Sub-Saharan Africa. Meanwhile, the World Bank has noted that Latin American countries lag behind international standards in various aspects of public financial management, such as procurement, budget execution, and independent oversight of public expenditures.

Increasingly in recent years, the international community has emphasized the need for countries to improve the collection and management of tax revenues. USAID is providing leadership on these issues throughout the Americas. Our programs are working with national governments in countries like El Salvador and Jamaica to strengthen tax administration and public financial management.

USAID is a key contributor to the U.S. Government’s Domestic Finance for Development (DF4D) policy initiative that encourages countries throughout the world to increase revenue collection, improve budget transparency, and fight corruption. For example, we are challenging local governments at the municipal level in El Salvador and Honduras to increase revenue collection and improve the management of those resources. We will reward the highest performers with additional resources for key investments related to citizen security in their communities.

Today, USAID released a new publication entitled “Detailed Guidelines for Improved Tax Administration in Latin America and the Caribbean” that will enable tax administrations (i.e., the IRS equivalent in each country) to assess their own performance against leading practices in a variety of areas, including taxpayer registration, filing and payments, collections, and audit, among others. This tool will also help USAID staff and other donors engage with tax administrations on potential areas of technical assistance and prioritize interventions.

At USAID, we want to see all countries reach a level of development where they no longer require development assistance. Helping ensure that governments can mobilize domestic resources and invest them in their own development is a key step toward reaching that goal.

Learn more about USAID’s work in improving tax administration in Latin America and the Caribbean

Realizing the Health Goals of the Panama Declaration

This blog is part of a series to coincide with A Promise Renewed in the Americas: ”Reducing Inequalities in Reproductive, Maternal and Child Health Summit,“ that was held during September 10-12 in Panama.

The Promise Renewed for the Americas conference, just held in Panama City September 10-12, was attended by over 280 people representing governments, NGOs, faith organizations, multi- and bi-lateral organizations and civil society from throughout Latin America and Caribbean (LAC) region. The conference was a call to action to address persisting inequalities in maternal and child health in the region. The Declaration of Panama signed on the first day expressed the commitment of 26 governments  and many organizations to heed that call. The conference concluded with a provisional framework for reducing health inequities for women, children and youth in the LAC region. Now that I’ve had a week to reflect on the event, I’d like to share some thoughts with the broader global health community and so many others who contribute to furthering health in LAC, focusing on: “why this conference was so important to have in the first place,” “why now?”  and “what’s ahead?”

A Promise RenewedWhy convene this meeting in the first place? In 2015, most LAC countries will meet Millennium Development Goal (MDG) 4 (child health), and many will meet MDG 5 (maternal health.) However, it is certainly too early to declare victory in maternal and child health in LAC. Some countries will not meet either MDG 4 or 5, and Haiti’s indicators will fall considerably short of its goals. Moreover, averaged, national-level statistics mask major inequalities in maternal and child health in almost all countries in the region. And, the groups with much-worse-than-average health outcomes – most notably in maternal and neonatal deaths – are LAC’s most vulnerable and marginalized populations. Often these are also people whose voice is not heard in policy-making. Further, as outlined in an article for the Journal de  Perinatología y Reproduccion Humana, the pace of progress in reducing preventable maternal, child, and newborn deaths has slowed considerably throughout the region. At the same time, the investment of international donors in the health sector in LAC has declined markedly over the last two decades. So, the capacity and resources of the region itself will have to be better focused to reduce its major “equity gaps” in maternal and child health. In this context, the Panama conference was initiated by USAID’s Bureau for Latin America and the Caribbean, and sponsored by a consortium of donor agencies, USAID, PAHO/WHO, UNICEF, UNFPA, UNAIDS, the Inter-American Development Bank, and the World Bank, to catalyze a more concerted regional effort to address those gaps.

So, why now? In addition to the convergence of the region-specific factors just mentioned, the timing of the Panama conference was important in a global context because it forged a link between the Latin America and Caribbean region and the new global movement “A Promise Renewed” (APR). That movement was launched in June 2012 at the Child Survival Call to Action event in Washington, D.C. that was hosted by the governments of Ethiopia, India, and the United States, in collaboration with UNICEF. APR aims to re-energize those working on maternal and child health world-wide, and increase attention and investments toward the goal of ending preventable maternal and child deaths within the next generation – by 2035. Several follow-up conferences in Africa and Asia have helped sub-regions and individual countries to begin development of detailed roadmaps to reach this goal. For the LAC region, reaching the global goal will require a fundamental commitment to bridging equity gaps. Going forward, we expect that LAC’s active participation in the global APR platform will lead to accelerated learning and better metrics for gauging progress.

What’s ahead? A major consensus emerging from the conference was that the true locus of control for closing these equity gaps lies in the countries of the region –their governments, civil society, academies, churches, and other institutions. The appropriate role for donor agencies is supportive, not primary, in setting goals, timelines, the route to reach them, and the metrics to measure them. Many conference participants called for a regional mechanism to help facilitate collaboration, information exchange, south-to-south sharing, and access to technical expertise to accelerate the reduction of inequities.

Following are some other key decisions and next steps that came out of the conference:

  • Conferees identified key principles to guide efforts to close equity gaps, among them: use of cross-sectoral approaches for multi-sectoral problems; a focus on marginalized populations (rather than expecting benefits to trickle-down); use of multicultural approaches; and promotion of gender awareness.
  • Conferees supported the establishment of a regional network dedicated to addressing health equity gaps, which would be open to countries, civil society, private sector, and international agencies.
  • Representatives from several countries indicated that they would initiate national, and potentially sub-national, meetings to address maternal, child and adolescent health inequities in their own countries.
  • The donor consortium agreed to continue support for the A Promise Renewed for the Americas website, to serve as a platform for virtual discussion and planning, an information repository, and mechanism for technical interchange.
  • Conferees provided ideas orally and in writing for a regional framework aimed at supporting country progress on reducing inequities. This framework, along with a limited organizational structure, will continue to be developed in the coming months, with modest funding from the seven-agency donor consortium.
  • Setting of region-wide goals for reduction of health inequities was deferred, given the diversity of circumstances and the lack of standardized data across the region that could help inform policies and decision making. There was also general agreement that imposing regional, uniform, health equity reporting requirements on countries would not be feasible or desirable at this point. However, it was widely agreed that gauging progress in reducing health inequities is essential for accountability. That will require countries to disaggregate their health data to allow analysis by geographic, economic, ethnic, and gender variables, over time.
  • Conferees also stressed the importance of LAC participation in shaping the post-MDG 2015 health development agenda.

For the LAC region, some of the most difficult challenges in maternal, child, and adolescent health still lie ahead, because they require reaching those who are hardest to reach, but the Panama conference showed that solidarity and commitment in the region are strong. The LAC region has a history of success in maternal and child health and can draw from the extensive knowledge and expertise already in the region. The Panama conference catalyzed an ambitious process that will be ongoing until, as one speaker observed, “we meet to celebrate ‘A Promise Fulfilled.'”

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