Published in: 09/09/2024

The Work of Ibero-American Health Networks: Opportunities for Health Diplomacy

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Sebastián Tobar

During the 19th and 20th centuries, several epidemics at the international level gave rise to Sanitary Conferences, such as the Pan American Sanitary Bureau, which forged global and regional governance in health and expanded health diplomacy as a means to address problems that transcend country borders and that need to be solved through the cooperation of various actors.

The Covid-19 pandemic highlighted more than ever the internationalization of health risks. In the current context of globalization of a production and consumption model, health and its determinants transcend country borders, making it necessary to develop new forms of global and regional governance. Mainly because of their influence on the health of populations and on health systems at the national level. In this century, global health has become more evident than ever and the greater interdependence and interconnectivity between countries challenges the traditional distinction between national sector activities and international efforts in the area of health, with the emergence of new actors.

In this context countries have to deploy Health Diplomacy, understood as an “activity of a political nature, which serves the dual purpose of improving health while maintaining and strengthening international relations”, and as a “method of chosen interaction between public health and political stakeholders for the purposes of representation, conflict resolution, improvement of health systems and the right to health for the entire population”, as defined by Kelley Lee and Richard Smith.

Sharing to Strengthen Health Systems: Lessons from a Pandemic

Responding in a coordinated manner to the needs of the population and stimulating the development of Production, Development and Inovation is key to consolidating more equitable, fair and sustainable health systems. With this objective in mind, and following the experience of the Covid-19 pandemic, between 2020 and 2023 the Ibero-American Ministerial Network for Learning and Research in Health (RIMAIS) launched the Ibero-American Virtual Conference: Coronavirus and Public Health. Its objective: to contribute to the exchange, application and transfer of knowledge, both practical and public policy, and to promote collaboration in pioneering research and social interventions.

Founded in 2005, the RIMAIS network is dedicated to strengthening national health research systems, disseminating health research policies and models, and public health learning initiatives and programs. Its purpose: to strengthen the capacities of the ministries of health of the member countries in the development of their steering role, and in public health learning and health research, based on the socialization of information and knowledge produced and reproduced by different regional initiatives. The idea: to advance in the achievement of the Sustainable Development Goals and the strengthening of the renewed Essential Public Health Functions, incorporating human rights and the universal right to health, with a focus on equity in health. The Ministry of Health of Costa Rica is the permanent Chair and Technical Secretariat of this Network.

OTHER NETWORKS: The EAMI Network is formed by Drug Authorities linked to Ministries of Health or Public Health Research Institutions - Governmental Entities of the twenty-two Ibero-American countries.

Within the framework of the Ibero-American space, we have three important health networks: the Ibero-American Network for the Education of Health Technicians (RIETS), the Ibero-American Network of Schools of Public Health (RIESP) and the Ibero-American Network of National Health Institutes (RINSI). Networking is an important tool for health diplomacy, making it possible to pool efforts around shared challenges for health systems and the health status of the population.

The concept of networks has been used for a long time in the health sector and with different meanings. In general, the concept can be used to refer to situations in which it is possible to identify interactions or exchanges between different members or nodes to address common challenges. Generally, the term is used to refer to networks of people who are linked to each other, although they may belong to institutions, thus forming institutional networks such as Health Technician Training Schools, National Institutes of Health and Public Health Training Schools and Institutions. But one characteristic is that the institutions that form a network are connected through people.

Ibero-American health networks connect people belonging to institutions, which are not constituted “in themselves”, but as “networks for” or “medium networks” so that they can provide a better response to a given health problem or to the health system, promoting collective action. In this sense, they allow the interlinking of different actors belonging to the National Institutes of Health, the institutions that train Health Technicians, the Schools of Public Health of the Ibero-American space, which voluntarily join together, allowing their articulation and making possible the exchange and combination of their efforts, experiences and knowledge to achieve common objectives or problems, which go beyond the borders of their countries.

Lessons from the Covid-19 pandemic

The COVID-19 Pandemic provided an opportunity, within the framework of a common problem affecting the whole of humanity, for virtual work and its progressive institutionalization, creating opportunities to address common problems, articulating responses for the adoption of collective measures, contributing to the strengthening of members' capacities. It was a great catalyst for networking in health in the Ibero-American space, which brought new challenges and opportunities for its operation, allowing the adoption of these virtual work modalities with potential for diplomacy and cooperation in health.

Networking is an important option for diplomacy and cooperation in health, and represents a powerful and flexible approach to strengthen capacities based on principles of solidarity and equality. The work of the three networks mentioned above allows peer learning and the production of regional public goods in health.

Finally, one of the main lessons learned in the context of the pandemic is the need to empower the members of the Ibero-American networks, encouraging participation and interaction by sharing their concerns in the search for collective solutions.

Achievements of the Ibero-American Networks

Identification of common problems	There is a need to address inequities and inequalities in health, food security and climate change and the role of the National Institutes of Health in the Ibero-American Network of National Institutes of Health. In addition to reflecting on public health training for Primary Health Care, in addition to strengthening the Schools of Public Health and Training Institutions.
Criteria or tools to address health problems or challenges	Such as the School of Government strategy promoted by the Ibero-American Network of Public Health Training Schools and Institutions. Methodologies for the territorial approach to health inequities promoted by RINSI. The adoption of technologies such as “Simulation”, which can favor health workforce training processes.
Production of regional public goods	Identification of common problems and shared responses with win-win answers. For example, in the context of the Covid-19 pandemic, the RIETS collectively constructed guidelines for the care of the elderly, for hand hygiene, and for the return to school. These guides were collectively elaborated and made available to all members of the Network.
Information and knowledge production	The networks prioritize topics and, through the development of webinars or workshops, promote the production of knowledge on common challenges.
Consensus building	Opportunity for consensus building based on the principles of equity and solidarity, placing health as a fundamental right, such as different declarations and political documents produced by the Networks, like the Declaration of Cuernavaca of the INS and the Declaration of Rio de Janeiro, in the scope of the RIETS, which emphasizes the importance of clinical simulation and proposes initiatives that seek to incorporate simulation in the courses of all health technician training institutions, promoting a humanized and intercultural approach.
Enable Strategic Planning Processes	The work within the framework of the Ibero-American Networks of INS, Training of Technicians and Schools of Public Health facilitates strategic planning processes, prioritizing common problems and structuring activities to address them, mobilizing the capacities of all members of the networks. The work plans of the three networks are the result of this strategy, which includes the joint analysis of problems.
More effective global health diplomacy	They allow the discussion of policy documents being negotiated at the level of global health governance: World Health Assembly, in Regional Health Governance: Governing Bodies of the Pan American Health Organization, allowing for the creation of joint positions that can support countries in their participation in multilateralism.
Institutional capacity building	Networking allows for an exchange among its members. Their different capacities result in a positive synergy that favors institutional strengthening. One example has been, within the framework of the Network of National Institutes of Health, that the NIH can play a priority role, for example, in the monitoring of the causes of diseases. In this way, it is a question of incorporating a role in the NIH that goes beyond the pasteurian view that focused on the causes of diseases, on viruses and bacteria, to incorporate a view on the social and environmental determinants.