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

We are talking more and more about migration, but we don’t always have the necessary information that would allow us to understand the root causes that lead a group of people to voluntarily or forcibly change cities or countries; but if we think about it, forced migration and human trafficking have determined the history of humanity. That is the case of the colonisation period, when Europeans played the leading role in the slave trafficking business, exploiting between 10 and 15 million people from the same countries of origin as for large part of the migrants that, today, are trying to reach Europe.

Migration has also been a major presence in my life. My mother is Finnish and my father is Spanish, and in the last ten years I have lived in various countries in Europe, Asia and Africa. In my case, migration was motivated by a desire to learn and find new professional opportunities. Like thousands of other people, I wanted to have the chance to improve my quality of life.

Since March I have been working as the institutional coordinator in the ECI Niger project, which has allowed me to gain a deeper knowledge of the complex nature of migratory movements. In my last mission to Niamey, I was able to talk to a group of craftspeople I had met in 2009, when I was working for the Spanish Agency for International Cooperation for Development. They remarked that for the past couple of years they have been unable to obtain visas that would allow them to travel to Europe and sell their jewellery in crafts fairs. This situation, on top of the drop in the numbers of tourists visiting Niger and other countries in the region, is having a major impact on their families’ economies, impoverishing them and creating a great deal of frustration on the part of the craftspeople due to their inability to sell their wares. This is also the case of various young with whom I spoke who said that they had seen a reduction in opportunities to obtain study grants, to participate in exchange programmes or to acquire some type of work experience in Europe.

Despite these impediments, and considering that Niger is one of the leading centres of operation for human trafficking networks, the percentage of the Nigerien population that migrates to Europe is relatively low. These networks, connected to Europe, profit directly from the situation of vulnerability of thousands of migrants.

The Nigerien government is aware of this situation and is acting through the ECI project, funded by the EU Emergency Trust Fund, in the fight against organised crime and human trafficking. The Directorate-General of the National Police of Niger asserts that often the victims of human trafficking themselves are unaware that they are being trafficked, do not know their rights, and are in most cases exploited by the traffickers.

Helen Pardo is the coordinator of the ECI Niger project to fight against organised crime and human trafficking in Niger.

“It’s a paradigm change, something historic”, stressed Jolita Butckeviciene, Programme Director for Latin America and the Caribbean of EuropeAid. “It’s not just investing in development, it’s investing in all of us”, asserted Neven Mimica, the European Commissioner for Development. “We are entering a new policy era, not only for European Union institutions but also for the joint action of the Member States”, concluded Federica Mogherini, High Representative of the European Union for Foreign Affairs. European Development Days 2017 can’t be understood without the new European Consensus on Development, an agreement that aligns EU development policy with the Sustainable Development Goals (SDG) and the 2030 Agenda.

But the EDDs also left behind many images and messages. Culture played an important role in the colourful village. Without culture, there is no future, that is the message. Young people and women were also prominent in the spaces for dialogue, more present than ever in this edition. They are the protagonists of development.

Partnership formation recovered its usual networking space in Brussels. For example, FIIAPP, within the framework of the Practitioner’s Network, the platform that unites the main European development agencies. Sharing stand and space in a debate on mobilisation of European public expertise, FIIAPP cited its experience managing the Cuba-EU Expertise Exchange programme, expanding horizons and generating complementarity with other programmes like EUROsociAL+.

And, as always, the reunions of old friends. As if in a typical joke about nationalities, a Spanish ex-FAO, a Swedish ex-ASDI and a Peruvian ex-DUE, all with new horizons, with their gaze fixed on not leaving anyone behind, got together in a huddle.

Enrique Martínez is a communication and visibility officer in EUROsociAL+.

Some time ago I had the chance to talk to an investigation official of the national police of a Latin American country at a meeting I was invited to attend as an evaluator.

A great deal is being done in this area through the technical support of institutions, including Spanish ones, whilst scrupulously avoiding the application of “models” from other countries to a national reality that is totally foreign and extremely complex. The United States, for example, has focused particularly on the issues of drugs and youth gangs. In Spain, we have great experience, and here I can mention, for example, the work done in Guatemala to reduce the number of crimes against life and amount of violence against women.

The official I was speaking with said that, in his country, the police are under great stress, that they’ve been doing their job under great pressure for several years, and that many of them would like to leave the field and get a university degree or do something else or, at least, have a better system of shifts that would give them more down time.

He also told me that they had learned that a small number of criminals commit the vast number of crimes, and that if there are, say, 10,000 homicide victims annually, these could be attributed to some 1,000 aggressors. That is, with a little investigation, with good police instincts and better coordination between prosecutors, judges and law enforcement, the problem of citizen insecurity could be handled much better.

“Don’t leave us on our own”, he said, worried about the low level of support they had internally and the idea that these issues could cease to be a cooperation priority. That’s probably the way things are seen by some people who are tired of supporting an institution that we can characterise as weak-strong-absent-present.

Weak in terms of the strategic direction, given that many bodies work on the same issues in an uncoordinated way: criminal investigation, prosecutors, judges, prisons, institutions that fight against organised crime… Strong, because at times these institutions think the only acceptable answer for society is the incarceration of young people; this accomplishes nothing except filling up prisons, where, on the other hand, there are few rehabilitation programmes to help them abandon the cycle of violence. Absent, because the police and judges are never where they’re needed, and they don’t reach many places where criminals are still being lynched. And, lastly, present, because the government is eager for media coverage and to demonstrate that citizen insecurity is its great priority, without us knowing what that actually means.

Public policy evaluation

That’s why it’s necessary to improve our diagnoses by using tools like public policy evaluation to be able to improve programmes and address these challenges that generate such contradictory responses from institutions.

And we have an extensive experience working with many institutions to be able to introduce evaluations as a requirement in implementing cooperation programmes for institutional reform. And we have also generated the necessary trust, which will enable us to conduct not only qualitative analyses but also quantitative ones, with baselines and surveys after several years.

At first glance, it seems easier to quantify the impact of aid in the case of social programmes or poverty-reduction programmes, which are where these types of evaluations have traditionally been done. However if we observe carefully from the institutional standpoint and, more specifically, from one of capacity building, there are many interesting options.

If the programmes are designed from the start with the objective of being evaluated, we could predict their impact on police performance; to give an example, the impact of one type of training or another, and eventually, the impact this has on institutional change and crime reduction, which is the important thing. It would also be a great advance, and we’re capable of doing it, to learn what effect the training of criminal investigation units has on the impunity variable. That is, in terms of how much our cooperation helps in terms of solving cases and the ability to bring them to trial.

That way the institutions themselves will be more aware of the limitations and opportunities that exist for carrying out larger-scale reforms and for gradually building a new culture of institutional development.

Miguel Angel Lombardo works at FIIAPP on South-South cooperation for public policy evaluation in Latin America.

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.

We have several long months of hard work behind us. Numerous meetings, agreements and negotiations for achieving our objective: to bring Latin American experts to our Spanish institutions to share, through our experts, our know-how, experience and knowledge.

But, what does this incredible exchange of experience really do?

After attending several opening and closing sessions for a variety of seminars – such as the ones on property law, wastewater treatment, social innovation, international taxation and the fight against tax fraud  – one comes to appreciate the enormous utility of these types of activities.

Activities that we could call specialised cultural exchanges and which have resulted in the creation of networks of experts that extend well beyond simple know-how. They end up leading to inseparable personal bonds and institutional links that turn into professional and cultural exchange networks.

This conclusion reconciles us once more with our work, if we were ever in doubt about what can be achieved by dint of effort and great determination.

It renews our faith in our small contributions in the context of international development cooperation, always focused on institutional strengthening through technical cooperation and mobilization of experts.

It also confirms that these actions are important, as they demonstrate, once again, that those who share experiences and knowledge are the people we manage to bring together for weeks at a time around a specific, always important, issue for Spanish Cooperation.

But we don’t leave it at that. We can go even further and be more ambitious with our expectations, as they demonstrate that, with these initiatives, we promote the sharing of a dose of culture and confidence in the institutions of different countries.  Because at FIIAPP we work for people, and thus we improve citizens’ quality of life which, in the final analysis, is our ultimate objective.

It is always gratifying to be able to see first-hand, through direct experiences narrated in the first person by our guests and collaborators, that the effort has paid off, that the reward is talking to you and asking you to continue working in this same direction and that, with great effort butnot much money, great and ambitious objectives can be achieved.

All of this encourages us to keep making an effort and working day after day to improve our institutions through people. Through this, we also progress and become better people and institutions.

By Isabel Ramos, Director of the Information and Special Programmes Area