Paulo César Ribeiro de Castro, current director of the Polytechnic School of Joaquim Venâncio Polytechnic School of Health (EPSJV/Fiocruz), which is hosting the Executive Secretariat of the Network since 2005. The purpose of this interview is to discuss some issues and begin discussions which certainly will be part of the agenda of the 3rd General Meeting to be held on November 7th and 8th in Recife, in the Northeast of Brazil.
Four years after the 2nd General Meeting in Rio de Janeiro, EPSJV/Fiocruz, in its role as Executive Secretariat of RETS, invites all members of the network to another meeting, this time being held in Recife. In your opinion, which is the relevance of these face-to-face meetings?
Firstly, I want to remember that I took over the direction of EPSJV very recently and that my knowledge on RETS has to follow the discussion on the topic in EPSJV and especially the recent conversations I have had with the team that works with the management of the Network daily. Hosting the Executive Secretariat is a signal of recognition of the work done by the School in the area of education of health technicians, but also brings a great responsibility to us.
Regarding the question itself, it is important to highlight that the networks, by definition, can only be established through communication among its members. It is the contacts among them that enable the exchange of information and, sometimes, working together. RETS brings together members of many countries and the communication among them and the Executive Secretariat usually occurs through the internet or by phone. This type of communication is important, if we consider the purely operational aspects, but it lacks the richness of personal contact, the face-to-face discussion.
These meetings, which unfortunately can´t occur more frequently, are essential in forming new bonds between people and strengthen the existing ones. On a face-to-face meeting, you can exchange ideas warmly. It's great when we can personally meet those people with whom we interact only by phone or email. For being face-to-face, the General Meetings tend to strengthen the Network as a strategy for cooperation between the institutions involved.
The goal of the 2nd General Meeting of RETS was raising discussions on consolidation of primary health care in the education of health technicians. This time, according to the promotional material, the central theme of the meeting is the network itself as a space of knowledge production and as a work strategy. Why did you choose this topic?
I think we must rescue a little history of the network to answer this question.
RETS was created in 1996, after performing in 16 countries of the Americas, a multicenter study on the education of health technicians. This study, coordinated by the Pan American Health Organization (PAHO), showed a bad situation, a negative scenario, quite worrying for all people who, even at that time, understood the importance of the human element in health systems.
Encouraged by PAHO, the countries that were present at a meeting in Mexico to discuss the results of the research decided to create the Network, which Executive Secretariat was given to the University of Costa Rica. After five years of operation, RETS was deactivated.
In 2004/2005, the Polytechnic School becomes a WHO Collaborating Center for Education of Health Technicians and Paho requests the School to assume the Executive Secretariat and work, with its support, to reactivate the Network which, in its second phase shall also include institutions of Portuguese-speaking African countries and Portugal.
At this time, and with much effort of EPSJV, there is a growing of the Network and strengthening of joint efforts. Thereafter it is proposed, under both the South American Council of Health (Unasur-Health) and the Community of Portuguese-speaking Countries (CPLP), the creation of a network of Health Technical Schools and government agencies that deal with the subject. In 2009, at the 2nd General Meeting of RETS, are created RETS-Unasur and RETS-CPLP, which start working as sub-networks of RETS.
The case is that, by its own nature, the work of the Network has some weaknesses such as the fluidity and fragility of the links that hold together its nodes. Overcoming this difficulty requires a very intensive labor, since there is a tendency of dispersion and attenuation of the initiative over time. This happens for several reasons, regardless of the effort that EPSJV as Executive Secretariat, does to maintain the initiative.
What kind of problems do you mean?
Well, I think the most important one has to do with the low institutionalization of networks and the mobility of people in institutions. Each time there are changes in the structure and frameworks of governments, schools, professional associations and even Paho, there is a breakdown of the existing links and we have to start from the beginning. This is a job that has no end and that is very exhausting. The staff who deals directly with the Network has an example that is paradigmatic. Once, it took over three months for a process to enter a Ministry in the South American RETS to be finalized. On the following week, because of the elections and, consequently, changes in the structure of government, new officers were named and those three months of work were lost.
If this happened only with one member or another, I think we would be able to meet this challenge. But this happens all the time and, even though we have a team that works exclusively dedicated to RETS and its sub-networks, we can´t deal with all changes happening; sometimes we don´t know which are these changes.
Another delicate issue is that the education and work of health technicians receives quite varied attention of the countries of the Network. Some give more importance to the subject, and it favors us. In others, however, this area is not yet established or is relegated to the background, which makes our work much more difficult.
Do you think the Meeting can solve this problem?
It is not about solving the problem. The idea is to make everyone think a little about the Network and on their own responsibility regarding the initiative. Today, RETS is going through a time of high fragility, despite having a quarterly magazine and a website and being represented in many forums, virtual or not. Such fragility decreases the potential of the Network as cooperation strategy and makes everyone a little frustrated.
What we hope is that this meeting might even decide on the feasibility of the initiative, because if there is not a greater commitment of individuals and institutions, the work loses its meaning. Today, Paho, which encouraged the creation and later the reactivation of RETS is quite off work and this is a serious problem to us. It is also necessary that the member countries of UNASUR and the CPLP, which proposed and approved the creation of subnets, give us more support on the institutionalization of processes. That is to say, each one must do his part and I think that is what we have to discuss at this meeting.
EPSJV have been trying to maintain the initiative and it is not easy. We have, under the Coordination of International Cooperation, represented by Grácia Gondim, a three-person team devoted entirely to RETS, in addition to many other workers of the administrative area of communication and IT, who spend a great time of their jobs dedicated to the Network. This, plus the printing of the magazine and the continuing work of translation, among other things, is an expense too great for the school and the Ministry of Health of Brazil, which provides the resources we need. We do this because we believe in the Network as an important tool for improving the education of technical workers in the health field, and more than that, because we believe that it is critical to strengthen the national health systems. The point is that we can´t do this isolated, without the assistance of the other members. As I said before, RETS can only continue to exist if all members take a formal commitment.
There is no use in approving a work plan at the Meeting if you do not take it to your institutions and do not discuss it internally. We have an incredible tool in our hands, but we need to decide what to do with it.
How are the Work Plans of the Network and its Sub Networks established?
Well, the Work Plan of Rets-CPLP is prepared based on the guidelines set by the Strategic Plan for Cooperation in Health, signed by countries in 2009 and which is still in operation. In the case of RETS-UNASUR, it was based on the Five Year Plan outlined by the body. This is fundamental, since networks do not exist only to exist; they are working strategies able of enhancing, through the exchange and collaborative work, knowledge produced by each of its members in pursuit of a larger goal.
In the case of RETS, the work plan is defined according to their regimental objectives.
Which is EPSJV, as Executive Secretariat of RETS, proposing to these work plans?
In fact, we just draw a proposal to be presented and discussed by all members present at the meeting. This horizontal discussion is a characteristic of networking. You can´t impose anything to anyone. Moreover, one of the agendas of the meeting is the definition of the institution that will host the Secretariat of RETS and its sub networks in the coming years.
Our idea, however, is to propose a work plan simple and feasible. We believe that the Network should concentrate its forces on projects to resume its central and original unique objective, which is functioning as a space for the production and dissemination of knowledge in the area of education and work of health technicians.
Otherwise, we insist on the need to improve the communication system of the network in order to expand the exchange of information among members and the general public through our website, magazine and social networks. The communication, however, can´t be an end itself. It must serve the interests of the Network, disclosing what partners do and publish bringing topics of interest for the discussion of everyone and disseminating data and knowledge able to enrich our work and foster technical cooperation within the Network and among members who have issues in common.
In your opinion, how is the Network contributing to give visibility to the work of health technicians?
Traditionally, worldwide, there is a certain devaluation of the technical work that reflects an outdated view which sees doing and thinking separately and with different degrees of importance. We defend and fight for the consolidation of a more integrated view of the technician as a worker who makes, but also think about his work and about the system in which he is inserted, proposing necessary changes. That is the discussion we try to bring to society. What kind of technician should we educate to make health systems more effective and efficient, but primarily, to meet the needs of the whole population?
How this may influence public policy makes on the sectors of health, work and education?
Although the famous World Report on Human Resources, published by WHO in 2006, reaffirms the importance of these workers, who represent the majority of the workforce for the industry, the attentions are still primarily focused on the education of doctors and nurses.
The Network can bring the voice of health technicians, regardless of their level of training - higher, mid-level or elementary, depending on the country - to some institutional spaces and important discussion forums. The result of our efforts can´t always be perceived immediately, but we continue fighting tirelessly for the authorities and, on some occasions, the health technicians, can better understand their role.
You have already talked about the purpose of the November meeting, but what would you say about the program of the meeting and the results expected?
Well, the idea is to start the meeting on November 7th, with a lecture followed by discussion. For this we have already confirmed the presence of the former president and current coordinator of the Center for International Relations of Fiocruz, Paulo Buss, who participated directly in the creation of RETS-CPLP and RETS-UNASUR. On the same day, in the afternoon, there will be two activities. At first, a fast accountability of the Executive Secretariat and the launch of the new website of the Network. Then, a round table, for which we have already confirmed the presence of Mónica Padilla, of PAHO / WHO, which will discuss the major problems we are facing, hoping to help us drawing some strategies to face these problems.
On November 8th, in the morning, there will be specific meetings of each sub network (RETS-Unasur and RETS-CPLP). In the afternoon, at the final plenary, will be discussed the work plan of RETS and held the election of the new headquarters of the Executive Secretariat of the Network for the next four years, among members who applied. Another point of discussion on the agenda will be an update of the regiment of RETS and its sub networks, which work similarly, but have some specific characteristics. In the case of RETS, this is necessary because some things have changed since the Network was created and we need a regiment that reflects the current reality of work. In the case of sub networks, the idea is trying to harmonize what they have in common, respecting their differences.
About the results, we expect to close the meeting with the work plans approved and regiment changes already defined. Also, we are thinking about the possibility of writing a document to support improving the education of health technicians to be delivered to the organizers of the 3rd Global Forum on Human Resources for Health, which will also be held in Recife, from November 10th to 13th. For the first time, RETS is officially represented at the Forum, which is an important victory to us.