EL BLOG DE LA FIIAPP. Cooperación Española

The hospital management in Tunisia is basing its information system on that used in Spain, whose development dates back to 1985. Tunisia does not have a unified patient information system, which has a detrimental effect on the efficiency of the services it provides, including lack of control over the patient conditions to patients being kept in hospital for longer than is required for their recovery. In Tunisia, each specialist keeps a separate medical record for each patient, meaning they are not informed of any other conditions she or he may suffer. This means that health spending is not controlled and that more money than necessary is invested in some services rather than others. However, there is a solution to this cause and effect scenario.

That is why Tunisia presented the European Commission (EC) with its situation so that, through a twinning project, a second country with experience in this field might support them in their efforts to tackle the problem. The FIIAPP was finally chosen to lead the project, funded by the EC with 1.3 million euros and the Castile-La Mancha Healthcare System (SESCAM) as the collaborating body responsible for training its Tunisian colleagues in the system. The twinning manager in Tunisia, Hassan Ben Salem and Director of Studies and Planning of the Ministry of Health talked about different aspects of the project and the satisfaction of the Tunisian portfolio.

Why did the Tunisian government decide to apply for this project?
We started reforming our health system in the nineties to give hospitals more self-management powers. Since that time we have been developing a hospital information management system, but it was deficient in that it did not include medical information. This meant that we were unable to measure patients’ hospital stays in an efficient, centralised manner. This project aims to make an economic and medical evaluation of every day spent in hospital. It will initially be deployed as a pilot scheme in six hospitals and, if successful, it will be extended to other hospitals in the country.

What is the main benefit of this twinning project?
It will enable us to calculate costs per hospital and per disease. A hospital without a medical information system cannot control cost recovery or provide its patients with suitable information. This system will make us more efficient.
Does this type of system mean lower hospital administration costs?
There’s no guarantee we will spend less, but we will be able to rationalise our finances and spend better. In other words, hospitals will be funded fairly and sustainably and we will spend effectively.

This project is based on hospital management in Spain. What is your opinion of this method?

It has been a great opportunity for us to be able to use the Spanish system as a model because Spain went through the same or a similar problem as ours approximately 30 years ago. We are fortunate that Spain has agreed to this twinning and that we can benefit from this experience. We are taking this project very seriously and are open to Spanish suggestions. We are also very pleased with the cooperation between the
FIIAPP and the SESCAM.

COPOLAD, the drug abuse prevention programme in Latin America and the European Union led by FIIAPP, is holding the LA-EU Research Networks conference “Evidence-based public policies: progress and challenges”this week in Madrid for the purpose of promoting and facilitating contacts and cooperation between the researchers in attendance. Three of them, Mayra Hynes, member of the Inter American Commission for Drug Abuse Control (CICAD – OAS), Augusto Pérez, a Colombian researcher with the Latin American Network of Drug Researchers (REDLA), andRonald Simon, of the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), talk in this interview about the context and challenges to be confronted currently in the field of research on DDR in Latin America and the European Union.

What are the main obstacles to achieving Drug Demand Reduction?

Marya Hynes: In Latin America and the Caribbean, it’s knowing and understanding what to work on to implement suitable public prevention policies. Also knowing how to evaluate the policies to detect whether they’re working or not.

Augusto Pérez: The lack of government policies. A president comes to power and says one thing, then the next one says another and paralyzes everything that came before. This has happened many times in South American countries. Another problem is lack of interest when it comes to investing in research and evaluation. A vicious circle exists: if we don’t evaluate, we don’t know what works.

Ronald Simon: In the European Union, we’re in a somewhat better position in this sense, but we also have a funding problem, especially in resources for prevention. I believe that public interest in this field has declined lately.

What comes first: the demand for drugs or the supply?

MH: They’re always going to be related. And what we’re seeing, for example, in Europe and the United States, is that if you limit access to a substance and you don’t offer addicts an alternative, like treatment or social support to prevent relapses, the problem does not go away and it turns into something worse.

AP: In the case of Colombia, our problem is drug trafficking. We are producers. There are 300,000 consumers of illegal substances who need treatment, but, considering that we have over 40 million inhabitants, this is not extremely worrisome; the fact that the guerrillas are financing their activities with drug money is. There we have a problem of criminal gangs.

RS: Without demand, there is no supply; and without supply there is no demand. It’s a market. What we have to do is limit access to the substances.

What can LA contribute to the EU, and vice versa, in the reduction and prevention of drug demand?

RE: Europe is made up of different countries with different experiences and historical pasts, in addition to having enjoyed an excellent position in the last 15 years with money from Europe for drug research, which has enabled us to develop work tools. Our Latin American colleagues can study them and see if they can adapt them, or tell us we’re completely nuts (he jokes, laughing). And in the other direction, I believe we can observe how they work and look at how we work from a distance and with a critical eye. If it works, it’s a bilateral process.

AP: We have different cultures and forms of organization, but, in any case, we can share our data, and try to reach conclusions and construct theories together.

MH: To start to understand what our differences are. There is great diversity in drug use.

Is this meeting being organized by COPOLAD a good opportunity to share this knowledge?

AP: Of course.

MH: Yes, and I also think they’re paying attention, listening and responding to what was discussed in previous events.

RE: Yes, this is the right path. They are willing to listen and react to these discussions, and they are developing relationships of cooperation between people.

What are the main challenges in Drug Demand Reduction?

MH: In addition to what has already been mentioned, detecting the emergence of new drugs.

AP: Also keeping the decision-makers in this field informed. The better informed they are, the more money they will invest in research in this field.

RS: Developing additional evidence-based prevention measures, finding approaches, establishing points in common and rethinking things together.

Pedro Flores has been the director of FIIAPP since October 2013. In this interview he explains the Foundation’s goals for the coming months and his personal experience in the role.

–          How would you define the FIIAPP?

It is a public organisation with two closely linked areas of activity. On the one hand, we collaborate to the development of the countries where we work. We do this through international cooperation projects that improve the functioning of public institutions in these countries; encouraging integration and information sharing with their neighbouring countries; so that their legal frameworks, systems and public procedures become more efficient and comply with the main international conventions: and to foster the development of public policies. Examples of our activities include adapting administrative proceedings to improve citizen services, amending the law to comply with international requirements and improving the efficiency in public health systems, social protection, security, justice, transport and infrastructures, among others.

On the other hand, we enhance the international image of the Spanish Government and by extension, that of Europe. Many of our projects include exporting knowledge, best practices and models of excellence from Spain’s public sector. Our work in this area, falls within the auspices of Spanish foreign policy and allows us to strengthen Spain’s international image. At the same time, the FIIAAPP is currently one of Europe’s main international cooperation operators, which is why we work along the lines marked by European foreign policy and in accordance with the main international pacts to which the European Union is a signatory.

–          What are the main challenges facing the FIIAPP in the months to come?

The organisation has grown over the years and is now working in numerous sectors. We operate in 90 countries, which presents a real challenge to the FIIAPP workforce. The first challenge is to improve planning to adapt this growing level of activity to Spanish government interests and to include this in the main international agreements signed by Spain and by the European Union.
On the other hand, the growth of our activities portfolio requires investment in new technologies, which are being made to cut the time the institution needs to do routine tasks.

The growing number of countries in which we work also requires a larger network of collaborators with different government bodies to better coordinate all these activities. We are also going to step up collaboration with international bodies such as the World Bank, the IDB and United Nations Agencies.

–          Where will you be working in 2014?

In terms of geographical areas, we give priority to activities in Latin America, a region where we have an extensive portfolio of activities. This priority is defined in our by-laws and is also governed, as I have already mentioned, by Spanish foreign policy guidelines. Other priority areas will be West Africa and the Sahel, the Middle East and North Africa and Europe and Central Asia.

By sectors of activity, we will continue with those in areas in which we are already working, such as governance and strengthening public administration, security, justice and the fight against corruption, social policies, transport and infrastructure management, the environment and energy.

We must increase our activities in areas such as tourism, climate change and natural disaster prevention, and e-administration, matters that are being looked at by different Spanish government agencies and international bodies to set priorities.

Project assessment will also be a constant. One of FIIAPP’s hallmarks should be that it devotes its resources to programmes that work, which is why we need proven evidence of their performance. An Assessment Unit has recently been created in FIIAPP and measuring the impact of our activities will be one of the aspects included in this, starting with the most significant. In addition to this, we will give firm support to the Cooperación Española (Spanish Cooperation) assessment policy in collaboration with the Ministry of Foreign Affairs and Cooperation.

–          Professional and personal challenges of your new position.

I think it is very important that we should continue to boost the image of Spain and its institutions abroad. I am also determined to raise the profile of the work done by the FIIAPP both in Spain and beyond our borders.
Personally, I believe that the work we do at the FIIAPP is very gratifying, because we build Marca España and because at the end of the day our work improves the lives of many people in our partner countries. I aspire to this sentiment being shared by everyone who works at our institution.

Although it is obvious, one of our priorities is to beaccountable for the funds received by the organisation and to provide clear information about our activities at all times.

I hope that FIIAPP will continue in its role as an expert organisation that specialises in execution of international cooperation projects with government bodies. We will continue to give much importance to staff training and collaborative relationships with all Spanish government bodies.

According to the ‘International Transparency’ organisation, Chile is ranked 23rd in the list of the least corrupt countries and the Council is aiming to keep moving up the scale. The organisation’s chairman Jorge Jaraquemada and its General Manager Raúl Ferrada visited the FIIAPP this week to secure support from the EUROsociAL Programme in the areas of transparency and the fight against corruption.

Mr Jaraquemada. How important are transparency policies and access to information in Latin America?

I view transparency and access to public information from the point of view of State reform and modernisation. They are very important tools for restoring credibility to and for dealing with the illegality found in many Latin American institutions, particularly in political institutions.

Where is Chile with regard to the rest of Latin America in the fight against corruption?

I believe that Chile’s experience of transparency and the right to information is on the right track. Both Chile and Uruguay are in quite a strong position in Latin America in terms of low levels of corruption: Chile is ranked 23rd by International Transparency of a total of 180 countries measured. What worries me is that there has been some stagnation. What I mean is that when I look at the graphs for the last 10 years, Chile has stayed in more or less the same position. That could be worrying. I hope that transparency or the mass exercise of the right to information will make a further contribution to giving Chile a better position.

Mr Ferrada. One of the Chilean Transparency Council’s star tools is the Transparency Portal of the State of Chile, supported by FIIAPP and the Fundación CEDDET through EUROsociAL. What is its function?
The ‘Transparency Portal of the State of Chile’ project addresses an essential aspect of information access policies, which is that of citizen participation. This should be part of the DNA of all public bodies but has so far been very difficult to introduce and put into practice through successful experiences. We want to use technologies to create a permanent channel, open to citizens, where we can propose themes and get feedback or where citizens themselves can propose themes.

Do citizens respond?

We don’t believe that people should have to take to the streets when their indignation and rage boils over. That is why we must have permanent channels through which citizens are able to express their opinions and needs because, although it may seem obvious to us, this is not the case in many public actors who are there to serve the community. Politicians do not represent ideologies, they are public managers that must serve the community. People tell us they want public action in very specific areas: health, education and housing. They’ve been telling us this for five years. These are the matters that concern people most.

What do you do with the information you receive from the public?

(Jorge Jaraquemada answers)

If we analyse the information in terms of requests and demands and look at social conflict in Chile over the last three years, there is perfect coherence in terms of anticipation. In other words, the Law on Transparency, in terms of the niches in which people demand information, is an indicator of social unrest that erupts months later. This is what happened in the areas of education, the environment and regional communities that occurred in a couple of the country’s regions where there were outbreaks of violence.

(Raúl Ferrada concludes)

We have a thermometer that shows us when temperatures are higher than normal in certain areas. This is another reason for explaining to public managers that transparency is not a problem. Transparency and access to information are at the heart of public management and are very useful for public managers. It is a very good investment. We are sure of it.

Enrique Martínez. Head of communication at EUROsociAL

For Gonzalo Robles Orozco, this is a bittersweet moment to be heading the General Secretariat of International Cooperation for Development.The Spanish Cooperation Agency that he leads recently celebrated its anniversary at a time in which the crisis has required it to apply deep budget cuts. Even so, Robles has an upbeat appraisal. “The Agency arose modestly in a country that had been an aid recipient. Now we are an important stakeholder in worldwide cooperation. In every situation, we have delivered what was asked of us. We have a right to feel a certain logical satisfaction”, he pointed out.

With an undergraduate degree in Social and Cultural Anthropology and a graduate degree in Business Administration and Management from IESEP, Orozco is assuming the leadership of the Agency with a budget that been cut by 46% over the course of the legislature. A decrease in addition to the budget cuts already made by the Socialist government, he adds. Despite the criticism by social organizations of the cuts in Official Development Assistance, he believes that cooperation “is not going through a process different from that of other sectors”, such as education and health. “Spain today has certain economic conditions to meet, and if we didn’t do it, everyone in the country knows what would happen to us. There is a higher mandate, which is that we must meet our obligations to Europe”, he explained.

He does not accept the characterization of his management as one of “dismantling” this international policy as development NGOs have accused. He discreetly shifts in his office chair when he hears this and explains that he is not doing anything different from what his predecessors or the rest of the countries in the area have done. While it is true that other EU countries are cutting development assistance, Spain is the country that made the deepest cuts in 2012 (49%), followed by Italy (34%), Cyprus (26%), Greece (17%) and Belgium (11 %), according to data from the ‘Financing Development’ report published in 2013 by the European NGO Confederation.

For Orozco, the decrease in ODA does not mean, however, a loss of international importance, and he insists that he is a member of one of the United Nations working groups for preparing the sustainable development agenda for beyond 2015, when the current millennium development goals (MDG) expire. The economically crippled and diminished civil organizations of some countries where they work, where they have left programmes unfinished, do not share this opinion.

Question. Many NGOs are warning that with the cuts to Official Development Assistance, they will have to dismiss personnel and cancel projects. What would you tell them?

Answer. This needs to be explained. Cooperation is much more than grants to social organizations. Part of the problem is we haven’t known how to explain what a cooperation policy is. It includes multilateral, bilateral agreements with states, budgetary support to other countries, AIDS trust funds… And that civil society is one of the stakeholders. It’s true that the organizations are having a difficult time. But not because of this Government, which up to this year has religiously met all its acquired commitments. It’s true that the other source of financing, that of the self-governing communities and municipal governments, has undergone a very significant adjustment. The Government is not responsible for this; on the contrary, it’s the decentralized cooperation. The sum of what the self-governing communities owe to social organizations is a significant amount. Andalusia alone owes the NGOs 25 million euros.

Q. One of the working lines promoted in the current legislature is to involve the private sector in cooperation to raise funds. How much money and resources have Spanish companies contributed?

A. Spanish cooperation is very young in this area. There are only pilot experiences. In Mexico with Acciona, and other Latin American countries with the Telefónica Foundation. But really these projects have not become the general rule. What we have done is to create a protocol so that people understand what we want when we say that the private sector should come in. It isn’t, as has been said, privatization of development assistance, or us financing the private sector, but rather finding partnerships so that the participation of certain sectors leverages the development of countries, especially middle-income countries, which at this moment need a knowledge transfer. The first thing is to set up an office, then develop action guidelines, find examples among the best practices outside of Spain. And to stimulate companies and NGOs to look for partnerships. We’re trying to be a bridge with the countries we work with.

Q. So, you don’t have any data on the contribution of companies to development?

A. No, we don’t have that data.

Q. With less money, you can do fewer things. Where and in what sectors is Spain leaving a gap?

A. We are concentrating on fewer countries, but not only for budgetary reasons. This concentration is also by recommendation of the DAC [Development Assistance Committee] in its 2011 report. Comparing ourselves to our neighbouring countries, such as Germany or France, you just have to look to see that they are, more or less, in 25 countries. We were in 48. What we’re doing is to organize a responsible withdrawal, that is, not abandoning the country until all the projects are finished, and therefore it’s not immediate. This concentration process will last through this legislature, and at the end we will be in 23 countries. By sector, Spain was in practically all of them. We’ve selected eight major areas: strengthening the democratic state, human rights, basic social services, water and sanitation, food security… That is, fewer, but ones in which Spain can contribute specialization. By concentrating on geographic areas and sectors, we can better leverage our resources.

Q. Despite the drop in resources, in some Latin American countries, Morocco and Senegal, assistance has been maintained; what are the reasons why these countries are maintained and not others? What is the criterion?

A. In the first place, we’ve seen where we are contributing added value on top of other cooperation. For example, in Latin America, where if we leave there would be practically no other donor. We have certain strengths there that means, although other cooperation efforts exist, we would have a greater impact for historic reasons, language and a physical presence on the ground. We also take into account the Human Development Index compared to this impact. When your contribution, or that of cooperation in general, to the budget of the country represents 7 or 8% of GDP, that means it’s important. But if your contribution is 0.5 or 0.3 of GDP, really, even if you withdraw, absolutely nothing is going to happen in the country. By combining all these questions, we have selected certain countries. A map of cooperation in Latin America, Sub-Saharan Africa, Ethiopia, Mozambique and the Philippines emerges.

Continue reading here
Interview published in El Pais on 16 January 2014

New law in Honduras with our technical support

The new regulations, prepared with technical support from FIIAPP, will make it possible to institutionalize social dialogue in this Central American country.

On 9 January, the Economic and Social Council (ESC) Act was passed in a plenary session of the Honduran National Congress; it was ratified on Monday, 13 January. The regulation represents a new organizational and functional structure which will guarantee its stability and operating capacity through a legislative decree of constitution and an expanded and improved operating regulation for the ESC.

The most important points of this new regulation are the following:

1)      The ESC will have an indefinite duration, a special labour system, and functional, technical, financial and administrative autonomy.
2)      The opinions of the ESC may be taken into account prior to approval of draft laws.
3)      It will be able to issue non-binding views and recommendations regarding draft laws.
4)      The new structure includes the figure of a vice president and an Advisory Body.

The entire process was accompanied by advising and assistance from FIIAPP through the EUROsociAL programme and through different activities which included a visit by Honduran ESC representatives to the EU to learn the experiences of their counterparts in Spain and France, a comparative analysis of ESC regulations in the EU and Latin America, technical assistance from the Spanish ESC and a national workshop to raise awareness in Tegucigalpa, which included the presentation of the draft law to the President of the Republic of Honduras, Porfirio Lobo.

This support to the Honduran ESC is within the framework of the EUROsociAL  “Strengthening dialogue mechanisms for building consensus for social cohesion” Action being coordinated by FIIAPP and which has an operational partner in the Spanish ESC.

How does Spanish cooperation work through its various institutions in Guatemala?

We’ve basically worked in three sectors in Guatemala. The first is governance, security and justice, providing support to the Public Prosecutor, the District Attorney, and the judicial system to reinforce this system, specifically focusing on gender issues such as gender-based violence and women’s empowerment. The second sector we’ve worked in is social development in Guatemala, including rural development and everything related to basic health and education services, focusing, for example, on training small farmers in small towns to strengthen their tourist attraction, thereby maximising that potential source of income. The third sector is the cultural heritage programme and school workshops. We have accomplished very important work rehabilitating historic sites, such as the Training Centre of Antigua, and urban design, such as the redesign of Sixth Avenue in Guatemala’s capital, which has been transformed from a marginal neighbourhood to an area that is conducive to coexistence.

But in recent years, Spanish cooperation has faced a new challenge, with an even greater impact on the country.

In addition to the aforementioned, there is a fourth area, which is newer – the Spanish Cooperation Water and Sanitation Fund, which dedicates no less than 100 million dollars to Guatemala through two different channels: directly through the communities of municipalities and through the IADB (Inter-American Development Bank). Spain provides funds to the IADB, which is executed through the Institute of Municipal Development (INFOM). However, this cooperation arrangement is not new, as we’ve already worked a lot in the area of rural development, specifically in issues of water and sanitation, but now these efforts will be reinforced with the inflow of the additional 100 million dollars.

And now?

The Country’s Association Framework, or MAP (“Marco Asociación País”) was signed this June; it is an official document for regulating cooperation over the next four years, specifically focusing on two sectors. The first is to combat chronic malnutrition in the country, in line with government policies. The second is the issue of security and justice, with a very radical focus on trying to reduce the rate of violence against women, in particular the femicide rate. These are the two main areas where Spanish cooperation will be dedicating its efforts over the next few years, in addition to the Water and Sanitation Fund, which is still currently active.

Spain and the European Union are also present in Guatemala through the EUROsociAL Programme, led by the FIIAPP, in various key sectors of social cohesion, including social dialogue, social protection, justice, public finances, and regional development.

The FIIAPP is a very prestigious, well-known institution. And I think the fact that the FIIAPP is one of EUROsociAL’s main actors in this area guarantees success. And the European Union’s cooperation here, which is also Spanish cooperation because we are all the EU, is very compatible with what we do. They are dealing with more or less the same issues and coordination is good. In the near future, the European Union, which has a great deal of funds at its disposal, may maximise our expertise through delegated cooperation. This way, we can contribute our people and technical knowledge and experience in the country to the EU’s resources, which will be quite abundant over the next six years.