Regional Cooperation: Bolivia - Brazil - Peru

1. Regional Cooperation: Bolivia - Brazil - Peru USAID/Bolivia

2. Highlights • August 1999, Bolivia: USAID/Bolivia Infectious Diseases Initiative finalized, contains an objective to strengthen regional cooperation on priority infectious diseases and epidemiological surveillance. • 1998, USAID/Peru shares with USAID/Bolivia documentation of its Project Vigia. In 2000, USAID/Peru considers strengthening regional cooperation on infectious diseases in its new strategic framework. USAID/Bolivia

3. Highlights • March 2-4, 2000, Santa Cruz, Bolivia: regional conference on yellow fever hosted by the MOH/Bolivia, included delegations from Peru, Brazil, PAHO and researchers from the United States. The meeting was called to better inform MOH/Bolivia as it develops a national plan for prevention & control of yellow fever. Technical presentations were made by all groups and published in official proceedings. • One key result was a research investigation to determine whether strains of Aedes aegypti found in endemic areas of Bolivia are able to become infected by genotype 2 of YF virus, and if so, also able to transmit infection to an animal model. USAID/Bolivia

4. Highlights • March 2000, nationwide, Bolivia: A team from USAID/Peru and the national immunization program, MOH/Peru, conducted an external evaluation of the national immunization program (PAI) of Bolivia. Their findings were presented to the interagency coordinating committee on immunization, and were endorsed and subsequently implemented (in coordination with MOH/Bolivia and PAHO). • Since then, all recommendations were included in the workplan of the PAI/Bolivia. One finding was that PAI and IMCI programs in Bolivia were isolated from one another, resulting in opportunities lost. A national meeting was held in October 2000 among managers from all of the health departments, who subsequently developed plans for the integration of PAI and IMCI activities at the department and district levels (coordinated by MOH/Bolivia and PAHO). USAID/Bolivia

5. Highlights • April 18 - 19, 2000, Porto Velho, Brazil: a regional meeting on priority infectious diseases (malaria, yellow fever, dengue, HIV-AIDS, measles, surveillance) was held. Key results of working groups were disseminated. • It was decided that a follow-up meeting take place in Bolivia and should also include participants from Peru. The meeting was facilitated by the regional PAHO office, Brasilia. Present were counterparts from Brazil and Bolivia at national and regional levels. USAID/Bolivia and USAID/Brazil also attended. USAID/Bolivia

6. Highlights • April - May, 2000: Lima - Iquitos - Piura, Peru: A team of 3 Bolivian health technicians were sent with the support of USAID/Bolivia and PAHO/Bolivia to join antimalarial drug efficacy trials being conducted by MOH/Peru (National Institute of Health/Peru) and scientists from the Naval Medical Research Institute Detachment (NAMRID) in Peru. • Results of these trials enabled the Bolivian team to develop the protocols for similar trials to be conducted in Bolivia starting in January 2001. USAID/Bolivia

7. Senior MOH/Bolivia official observing Bolivian team in training at antimalarial drug efficacy trial field site in Iquitos, Peruphoto: (J. Chang, USAID/Peru) USAID/Bolivia

8. USAID/Bolivia

9. Highlights • May 2000: Lima, Iquitos, Peru: A team from MOH/Bolivia and USAID/Bolivia visited the facilities of NAMRID in Callao, the National Institute of Health/Peru, the Office of Epidemiology, MOH/Peru, and USAID/Peru’s Project Vigia in Lima. Team also observed on-going antimalarial drug efficacy trial sites in Iquitos, all in coordination with USAID/Peru. USAID/Bolivia

10. MOH/Peru, MOH/Bolivia, NAMRID, NIH/Peru, USAID/Peru, USAID/Bolivia & PAHO- all working together toward developing regional protocol for treatment of vivax and falciparum malaria.photo: (J. Chang, USAID/Peru) USAID/Bolivia

11. Highlights • June 2000, La Paz, Bolivia: A team of advisers from NAMRID/Peru, USAID/Peru, the National Malaria Program/Peru and the National Institute of Health/Peru attended meetings with the Bolivian national malaria committee in order to provide technical insight in the development of Bolivia’s national malaria strategic plan (in coordination with MOH/Bolivia and PAHO). USAID/Bolivia

12. Highlights • July 2000: Cobija, Bolivia: The launching of the national malaria plan was held with representation from the Government of Bolivia (President of Senate and Minister of Health), departmental prefects and mayors from endemic municipalities, PAHO, UNICEF, NAMRID/Peru, MOH/Peru, USAID/Bolivia, and a number of NGOs. • One result of this meeting: an interagency coordinating committee on priority infectious diseases and surveillance called Comite Interagencial del Escudo Epidemiologico was formed and had its first meeting in September 2000 facilitated by PAHO. Follow-up meeting held in March 2001. USAID/Bolivia

13. Highlights • October 2000: Foz do Iguazu, Brazil Regional technical advisory group meeting (TAG) on immunization was conducted under the coordination of PAHO/W and support by USAID/LAC. Representatives from Brazil, Peru and Bolivia attended in addition to most of the countries in Latin America. The final document and papers presented were distributed on a CDR. One result of this meeting was preparation by Brazil, Bolivia and Peru for the follow-up meeting in Bolivia in 2000. USAID/Bolivia

14. Highlights • November 2000, Cobija, Bolivia:A trinational meeting on malaria and other priority infectious diseases was held in Cobija, Pando Department. Results of the meeting were distributed (coordinated by MOH/Bolivia and PAHO). • One result: Brazilian and Bolivian teams worked closely in containing dengue outbreaks in Pando and Acre in February 2001. USAID/Bolivia

15. Highlights • December, 2000: Guayaramerin, Cobija, Santa Cruz, Bolivia: EHP team, which also included a malariologist from NAMRID/Peru, a member of NIH/Peru, and director of Institute of Tropical Medicine, U. Cayetano/Peru, conducted feasibility study for development of regional vectorborne diseases research & training center in Bolivian amazon in coordination with MOH/Bolivia and PAHO. • Another activity included assessment of national plan for dengue by an EHP consultant from Panama. Findings were presented to MOH/Bolivia which agreed to include both management and financial plans and commitment to supporting 75% of costs via TGN and counterpart funds over the next 5 year period. Both Peru and Brazil have expressed some interest in such a center during previous regional meetings. USAID/Bolivia

16. Highlights • March 2001: Bolivia: The Chief of the Office of Epidemiology, MOH/Peru and an information systems specialist from his office will assist the MOH/Boliva (Office of Epidemiology) in development of its computerized epidemiological surveillance system and website. (in coordination with IDB and PAHO. USAID/Bolivia

17. Highlights • January 2001: Bolivia: USAID/Bolivia considers supporting the placement of a malariologist/ consultant* via PAHO to work directly with the national malaria program in order to strengthen its activities; and to support several technical assistance activities in support of national tuberculosis program (agreed upon formally in March 2001 under USAID/LAC Bureau AMR initiative). • * It may be possible that this person also plays a roll with regard to the developing LAC Bureau Amazon Basin Initiative. USAID/Bolivia

18. Highlights • 2001: Bolivia (tbd): The Ministry of Health, Office of Epidemiology plans to host a meeting of epidemiology chiefs from the Andean nations to consider the feasibility of regional training course on epidemiology developed by CDC - FETP (Field Epidemiology Training Program), and to share lesson’s learned with previous FETP courses (in coordination with PAHO and IDB). • Bolivians from border depts. (Pando/Beni) attend epidemiology courses at U. Cuzco/Peru. USAID/Bolivia

19. Highlights • 2001, Peru (tbd): The MOH/Peru and USAID/Peru have agreed to host a follow-up trinational meeting on priority infectious diseases and epidemiological surveillance. USAID's LAC Bureau has indicated interest in attending in order to utilize this forum to further develop its new Amazon Basin Initiative that will focus principally on strengthening prevention and control of malaria in the region. USAID/Bolivia

20. Highlights • December 2001, Bolivia (tbd): A regional conference is planned to present to tuberculosis chiefs from the region the field tested, interactive computer-based training program on tuberculosis case management (DOTS), for the first time in Spanish (in coordination with OMS-OPS). USAID/Bolivia

21. Highlights • March 2002, Bolivia (tbd): A regional conference will be held to present to IMCI (Integrated Management of Childhood Illnesses) chiefs from the Latin American region to present the final, field tested version of an interactive computer-based training program on IMCI, for the first time in Spanish (in coordination with OMS-OPS). USAID/Bolivia

22. Benefits • Strengthens South-South cooperation, which is well received by respective Ministries of Health • Strengthens inter-institutional communications and capacities of regional institutions - PAHO, USAID, IDB • Cost-effectiveness • Strengthens program sustainability USAID/Bolivia

23. Challenges • Logistics: common frontier areas are some of the most logistically challenging for all countries concerned. • Politics: Peru and Bolivia both will face national elections in the coming year, which could be a distraction to existing priorities. • Optic: Bolivia an Peru - outward; Brazil - inward. • Technical resources: Peru and Brazil more advanced. Bolivia in catch-up mode. USAID/Bolivia

24. Site visits to malaria research stations along the Amazon - outside of Iquitos, Peru photos: J. Chang, USAID/Peru USAID/Bolivia

25. Photos: J. Chang: USAID/Peru USAID/Bolivia