15 September 2017
Alicia Miranda Duke, head of studies and research at the Salvadoran Institute for Access to Public Information, describes the challenges to protecting patients’ healthcare information. The European Union programme EUROsociAL+ is contributing to this process by promoting the exchange of experiences between Latin American and European countries
In El Salvador, few topics go as unnoticed in public and media agendas as the management of medical records. The irony is that these documents contain sensitive personal information on the health of thousands of people that should be protected with the highest quality standards. This issue is even more important in the public healthcare sector (Encuesta de Hogares de Propósitos Múltiples (Multi-Purpose Household Survey) 2014, DIGESTYC-MINEC).
Between January and March 2017, the Institute for Access to Public Information (IAIP) carried out a series of interviews with key staff in the Ministry of Health (MINSAL) and the Salvadoran Social Security Institute (ISSS) to gather preliminary information on some aspects of document management and personal data protection. The information will help the IAIP, as the governing body in this area, to issue guidelines regarding these matters. A complex reality was revealed by these first interviews.
In terms of standardisation, at least six documents were found that contain different criteria for handling medical records. However, there is no standard management process for the entire public sector. For example, filing documents has become a problem that is literally overwhelming the public health system. Although it is not the same at all care centres, there are warehouses in which these documents are stored with no other criterion than their weight in kilos.
Another finding was that there is little or no knowledge about ARCO rights (Access, Rectification, Cancellation and Opposition to information). On the one hand, there are healthcare operators that do not guarantee full exercise of these rights and, on the other, users who do not demand them. But how to demand a right that is not known by those who must guarantee it?
In the interviews, challenges in managing medical records appeared one after another. Almost all the interviewees agreed on the need to migrate to single electronic formats. Something that, among other benefits, would permit the interoperability of the information. In other words, having access to the medical history of a patient for an operation from wherever he or she might be. But although there are ample arguments in favour, the possibility of migrating collides with another reality: Implementing this would require a significant financial investment. Preliminary data, provided by both institutions, show that this would be an investment of approximately $40 million. But, even in a favourable scenario, standardising management does not end with migrating to an electronic format. In fact, whatever action is taken to implement it, at least two initial challenges must be faced.
Firstly, standardising the documentary management and personal data protection of records that are currently kept on paper. In other words, what to do with what there is. Secondly, a commitment by all those involved in managing these documents, apart from the MINSAL operators.
The IAIP, as the body governing document management and personal data protection, could simply issue guidelines and verify that they are complied with. But is this what interests us? Delimiting our involvement in these two actions would mean denying an extremely complex reality that finds expression in many dimensions. The management of medical records, in this case in the El Salvador public health sector, requires, first of all, an in-depth institutional dialogue that will permit the design of a path toward the necessary changes. To do this, it is also necessary to know how similar processes were developed in other countries in Latin America and the European Union. Otherwise, however well-designed the regulation is technically, it would not be sustainable over time.
Alicia Miranda Duke is the head of studies and research at the Institute for Access to Public Information (IAIP) in El Salvador
11 November 2016
El acceso a la Justicia de los ciudadanos está en la base de las garantías judiciales que tienen la consideración de derechos humanos.
No country or community can function peacefully if its inhabitants are unable to assert their rights in an established system of justice or defend themselves against accusations brought against them. Access to justice by citizens is based on legal guarantees that take into human rights consideration.
Nonetheless, in reality we face numerous difficulties in applying them in a practical and effective way. And, regrettably, when this is the case we see the natural consequences – greater levels of social inequality or high rates of violence – which are often attributed to other factors, such as poverty, when in reality poverty is not a cause but rather an effect, and precisely an effect of the fact that, among other factors, many people are excluded from justice.
The mechanisms for accessing justice should be designed for citizens in general, they should be properly contemplated at the legislative level, and they should also be given the necessary resources to function adequately. Some countries have a more pressing need for cooperation in order to address these needs.
For those of us working to defend the rights of citizens, it is very difficult to not see the tremendous challenges worldwide facing people with disabilities, displaced people and refugees, minorities, victims of trafficking and exploitation, persons deprived of their liberty, and people living in endemic poverty. We are talking about hundreds of millions of people.
The General Council of Spanish Lawyers, through its participation in cooperation actions, often focuses on working to ensure that the most vulnerable groups have access to protection of their rights through the justice system under the same conditions as their neighbours.
We have successfully undertaken numerous projects of this type in some European countries and, above all, in Latin America. We might highlight, for their representativeness, some implemented in collaboration with FIIAPP within the framework of European cooperation programmes such as EUROsociAL.
23 June 2015
Posteado en : Entrevista
Colombia has a solid anti-corruption policy, and the European Union's EUROsociAL programme, led by the FIIAPP, is supporting it in achieving its objectives
Colombian President Juan Manuel Santos signs the decree partially regulating the country’s transparency law (January 2014).
In 2014, Colombia passed the Law on Transparency and Access to Public Information for the purpose of reducing corruption levels in the country. According to public opinion polls, corruption is a major concern of the population. It has nearly the same importance as security, violence and unemployment issues.
The Colombian Secretary of Transparency, Camilo Enciso, in this video analyses the role of the EUROsociAL programme in implementation of the Law on Transparency and Access to Public Information.
Complete interview with Camilo Enciso here
18 June 2015
EUROsociAL, the European Commission programme for social cohesion in Latin America, participated in European Development Days in Brussels.
The year 2015 is key for cooperation. Declared the European Year of Development by the European Union, its mid-point coincided with its flagship event, European Development Days, which brought together people from five continents in Brussels with a significant African presence (an exception to the logical European majority), dozens of public institutions (also with a clear European Union majority), bilateral agencies and international bodies, fewer DNGOs than expected, and a small but media-covered presence by the private sector, with special attention to Melinda Gates and the Gates Foundation championing health issues.
Three auditoriums, 16 laboratories (or small conference rooms), 5 meeting points, 44 stands, 4 press areas and 2 television broadcasting sets, numerous cameras and a good turnout, without reaching the attendance levels of ARCO or FITUR to give a close-at-hand example. In short, a true cooperation fair.
But beyond the staging, it was possible to learn a great deal from others and to invite them to take an interest in the themes that EUROsociAL proposed in Brussels: Europe and Latin America, their cooperation relationship, social cohesion policies, and the reality of the two regions during the crisis and at the present time. An interesting thematic and geographic “exception” in an agenda more focused on Africa and Asia and on sectors such as migration, health and food safety.
As far as the rest was concerned, the theme of inequality was very important, and here the FIIAPP also participated along with think tanks like ODI and DIE, and the World Bank; gender equality with the presence of AECID; reproductive rights; the Ebola crisis; food safety with an impressive stand by the FAO (including planters made of rubber tyres made in Guatemala); and the fresh proposals of young international leaders.
Constant foot traffic (with a look that was more white-collar than NGO) peppered by musical performances, photographic exhibitions, improvised interviews… an event with a paperless spirit in which the technological assistance was lacking (or failed) as the WiFi was not up to the deployment arranged by the organisers, as the participating institutions are called in Brussels.
This decisive year for development will bring us another three milestones: the third conference on development financing (Addis Ababa, Ethiopia, 13th-16th July); the special summit on sustainable development (New York, 25th-27th September), where the Sustainable Development Goals (SDG) are to be approved, and the summit on climate change (COP21, Paris, December).
As for the #EDD2015 tweets, they’re already talking about 2016.
By Enrique Martínez, EUROsociAL communication and visibility officer
20 May 2015
Posteado en : Reportage
In the week when the OECD is presenting its report on the economic progress of Latin America, we bring you the reality of Argentina thanks to EUROsociAL.
The European Union cooperation programme for Latin America, EUROsociAL, focuses its work on social cohesion and development in various Latin American countries. One of them is Argentina, where work is being done on several projects for access to justice and prevention of violence in collaboration with the Ministry of Justice.
Kids in the “Jóvenes con más y mejor trabajo” [Young People With More and Better Jobs] programme of the Access to Justice Centre of Santiago del Estero mounted a campaign against institutional violence. Among their actions, the mural created with the slogan of the campaign, “No me pongas la mano encima” [Don’t lay a hand on me], an “open-mike radio show” and a street performance stand out.
The IDLO, the international organisation that supports justice, (with the collaboration of EUROsociAL), held a workshop in Santiago del Estero Province to train young people on how to create their own campaigns to raise awareness about rights, and there was almost no debate: “institutional violence”—and in particular the mistreatment young people experience at the hands of the police—would have to be at the centre of their actions.
According to the IDLO, in Argentina, kids going about their business on the streets know that being detained, chased and possibly arrested by a police patrol on its rounds is a real possibility.
In most cases, there is no real motive for this. The most habitual pretext is “having the face of a criminal” or “looking suspicious”—their appearance is what makes them suspicious. Wearing a track suit or a baseball cap is an aggravating factor. One minute you’re talking to your friends, and the next you’re up against the wall with your things scattered on the pavement and a pair of hands frisking you looking for weapons or drugs.
Since 2013, EUROsociAL has been consolidating various tools for access to justice policies oriented towards different vulnerable groups: besides the young protagonists of this story, it has championed migrant women’s right to justice in Costa Rica, women victims of violence in Honduras, women victims of human trafficking in Chile, the indigenous population in Peru, and African-descended young people in Brazil”.
07 May 2015
Going to the hospital in Popayán, in Colombia, can turn into an odyssey costing up to 100,000 pesos (€35), a luxury most people can't afford.
A European citizen takes an average of 15 minutes to reach a doctor, but in Colombia territorial dispersion represents a barrier to ensuring access to healthcare services. The city of Tambo, the country’s second largest in surface area, is one such example. There, in an area of 3,280 km2 with some 60,0000 inhabitants (94% in remote rural areas), there is one doctor for every 7,500 inhabitants, well below the national average (15 per 10,000 inhabitants). And from one community, it can take several hours, on horseback or in a car, to reach the closest medical centre. Under these conditions, reaching the hospital in Popayán, the capital of the department, can turn into an odyssey costing up to 100,000 pesos (€35), according to Eduardo Villa, physician and manager of the hospital of Tambo. A luxury beyond the reach of most of the inhabitants of one of the poorest departments of the country, in which the average per-capita income is 250,000 pesos[ii] (€100).
These factors explain, in part, the city’s dramatic perinatal mortality rates in recent years: 34 per 1,000, double the national average and nearly 10 times greater than in Spain. When he arrived at the hospital in 2012, Dr Villa decided to address this problem by seeking the support of key stakeholders in this mainly indigenous and rural territory: traditional doctors and midwives. This meant adding the experience of Western medicine to the experience and ancestral knowledge of midwives. Dr Villa created groups for exchanges and training with the aim of improving monitoring of pregnant women, and prevention and detection of high-risk pregnancies. Luis Amaro, midwife and traditional doctor, was a member of one of these groups. He’s been attending births in isolated indigenous communities, day and night, all his life. Since he’s started participating in the midwife group, he now quickly identifies high-risk pregnancies and sends the patients to the hospital.
Another initiative launched by the hospital was the opening of a “hotel for pregnant women”, to facilitate early admission of women with high-risk pregnancies at no charge. The result of these two measures combined is noteworthy: in less than three years the perinatal mortality rate in the city fell decisively, approaching zero.
This module represents a new paradigm for Colombian health policies and aims to achieve “quality access to healthcare services”, in the words of Fernando Ruiz, the Deputy Minister of Health, “so that problems are mainly resolved at the primary healthcare level”. The model is focused on family and community medicine, for care that is closer to patients, understands their social context, and puts the accent on pro-health and preventive healthcare. To do this, 5,000 family doctors will be trained over the next 10 years. The model also aims to reduce territorial gaps in healthcare through the opening of clinics closer to the population, the creation of “mobile health brigades”, and a system of incentives for family doctors in remote areas. Implementation of the new model is already underway in the department of Guainía after a three-way negotiation with the local authorities and indigenous representatives. In 2015 it will be implemented in other departments to achieve full coverage in the territory by 2016. The opening of another 15 university programmes in Family Medicine is also anticipated.
EUROsociAL, the cooperation programme of the European Commission with Latin America for social cohesion, supported the Colombian Ministry of Health in designing the model, sharing the experiences of France and Brazil in the area of healthcare in remote areas, and that of the United Kingdom, Spain and Mexico in the area of family medicine. The aim is to ensure the right of all citizens to healthcare so that in within a few years the success of El Tambo is not the exception in Colombia.
Peggy Martinello, Senior FIIAPP Expert in the EUROsociAL Programme