Information for all (panel 1)

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The Organizations for International Cooperation on development as well as the authorities and the civil society from developing countries agree that the use of appropriate scientific and technical information and knowledge is essential for development as well as for the overcome of social inequities, particularly in health. But how to achieve information for all?

In an encouraging illustration of how to make health information available to the public, Auki Kanaima Tituaña Males, mayor of the city of Cotacachi, Ecuador, and his wife Luz Maria, gave an uplifting account of their city’s experience in governability in the field of health. After many years of endless changes in the government at regional and national levels (17 Health Ministers in 8 years!), it became clear that no politician had a clear project for running the country.

Thanks to a decentralization program and active public participation –involving the city’s 45% indigenous, 5% black and 50% mixed race citizens – the city managed to drastically reduce the high maternal mortality rate and virtually eradicate illiteracy.

The municipality focused on improving living conditions, rather than engaging in public building works. Their policies were informed by the pre-Hispanic principles of their ancestors: “Not being idle, not being a liar, and not being a thief”. With support from PAHO and other institutions, a regional health plan was put in place, which was to articulate Western and traditional native medicine.

One of the challenges they were facing was the development of simple tools for distributing health information among the population. Pictures illustrating health risks were produced, which everyone could easily understand. All this was possible through the political will of the local government and its efforts to include everyone in its “intercultural health management system”.

For former Malian Minister of Education and current President of the African Academy of Languages, Adama Samassékou, this kind of multi-actor partnership approach is also essential if a society of shared knowledge for all is to be achieved. Inclusion, partnership and solidarity are essential requisites, which must rest on the principles of trust, transparency and commitment. He made a fervent call for multilingual tools and digital inclusion in order to overcome the language barriers and speed up the process outlined by the Millennium Goals, which at its current pace would not be reached until 2147, instead of the proposed date of 2015.

Computers at the end

Jon E. Rhode, international public health consultant and former senior health advisor for the South African Equity project, also cautioned about the use of indicators. As their name suggests, these should be used to indicate what needs action, not to prescribe what is to be done.

Staff participation is of the essence, and paper-based techniques should be used until everyone understands what the figures are to be used for. Computers should only come in at the very end of the process. One of his recommendations was “Keep it simple!”, as a little accurate information is far more useful than lots of late and inaccurate data. Workers should never be overwhelmed, and donors and authorities should clearly define their needs when requesting data. At the end of the day, the real measure of quality is the continuity of care.

Paulo Gadelha, vice president of Institutional Development and Work Management, Fiocruz, Ministry of Health, Brazil, pointed out that in face of publication and licensing figures (40% of scientific journals are published in USA and another 40% in Europe, 90% of patents in Germany, Japan and USA), the idealized vision of globalization in the 20^th Century is the last utopia. There has been no significant progress in universalization, but a hypercentralization of production and distribution. Determining factors for health are social participation, research, and performance, as became evident in the case of the AIDS epidemic. The goal of a national health policy in a country like Brazil should be the strengthening of the ethical commitment to access to scientific and technological information in the field of health as a public good. Projects such as the Virtual Health Library or SciELO (Scientifc Eletronic Library Online) are facing the challenge of creating a public space for science and not limiting themselves to its distribution.