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Chile Ambiente Corporation
Corporacion Chile Ambiente
Coordinator of the National Committee
National Committee for Health Reform
Mining and Energy Minister Lawrence Golborne met with Hernan Sandoval of the Chile Ambiente and Patricio Rodrigo of the Consejo de Defense de la Patagonia during the first session of a planned dialogue with political and social stakeholders about the construction of HydroAysen.
The MLI meetings began on the evening of 15 November with a dinner discussion featuring Honorable Soccoh Kabia, Minister of Health and Sanitation in Sierra Leone; Dr. Salif Samake, Director of Planning and Statistics, Ministry of Health in Mali; Dr. Hernan Sandoval, former Executive Secretary of Chile's Health Reform Commission under then President, Ricardo Lagos; Ms. Rosann Wisman, Director of MLI; Dr. Francis Omaswa, Senior Advisor to MLI; Dr. James Stansbury of the MLI monitoring and evaluation firm, EnCompass, and Ms. Lucy Crawford and Ms. Alison Ion, MLI Program Associates.
Participants had the opportunity to hear a brief preview of the next day's session featuring a case study of Chile's health reform from Dr. Sandoval. Dr. Sandoval, who was appointed by President Lagos as the Executive Secretary of Chile's Health Reform Commission, led the dialogue. Between 2004 and 2006, Dr. Sandoval was the Chilean Ambassador in France and he currently is President of Chile Ambiente Corporation. Dr. Sandoval is also an advisor to WHO's Commission on Social Determinants of Health.
Ambassador SandovalDr Hernan SandovalChilean Ambassador Dr Hernan Sandoval is also coordinator of the National Committee for a Better Health for the Chilean People.His seminar ,After Pinochet , Health Care Reform in Chile, will focus on the reform, prioritised by the current government, of the privatised health system imposed by Chile,s military regime in the 1980s. Dr Sandoval said: veloped a social and sanitary policy to allow the poorest sectors of the population to have access to the prevention of diseases and medical care.The health system and the sanitary supervision of the population have been improving ever since.
"Scientific knowledge has been one of the basic pillars of our proposal for reform, especially the knowledge about equity," according to National Committee for Health Reform executive secretary Hernan Sandoval, a chief health adviser to Chilean president Ricardo Lagos.
Such evidence about health inequity is having an impact on health policy in Chile, according to Sandoval. This is in no small part due to the work of a small team of researcher/advocates called the Chilean Health Equity Gauge, a group actively involved in the reform process.40 The team in Chile is part of an international network focused on monitoring national inequities in health and health care services and committed to closing the gap in health status between different socioeconomic groups.41 The work of the Equity Gauge includes an innovative fusion of research, advocacy, and direct participation with stakeholders, and it has been described as an "extraordinarily effective alliance,"42 particularly in terms of building relationships between researchers and key decision makers. As part of its work, the group has produced and disseminated several reports on the problem of health inequities in Chile, as well as potential solutions.43 "The combination of advocacy and knowledge is very powerful," says Sandoval, who has worked with the group since 1999.44 A key achievement of the Equity Gauge was helping to develop and write specific health objectives for the Chilean government for the 2000–2010 decade. It has also been officially commissioned to monitor and disseminate data on health inequities as the government attempts to close the health status gap between different socioeconomic groups in Chile.45 Asked whether individual pieces of research evidence had been utilized directly in specific policy decisions, Sandoval said the impact of the evidence about health inequity was more cumulative and indirect—what might be called an "enlightening" use of evidence. Describing an interdependence between research and policy, he pointed to the fact that one of the major slogans of the Lagos party in Chile is "Desarrollo con Equidad" ("Development with Equity").46 One practical strategy for reducing health inequity being used in Chile's current reforms is a dramatic boost to the role and funding of primary health care. In 2000, at the time of the election of the Lagos government, primary care in Chile received just 12 percent of the health care budget and was still widely viewed as a "second-class system," mainly there to service the poor—essentially the poor cousin of the hospital and specialist sector. Yet in just four years, primary care's share of the national health budget has jumped to 18 percent, and there are plans to increase that to perhaps as much as 30 percent with ambitious programs involving 60 new facilities across the nation.47 Reformers such as Sandoval who believe social determinants play a key part in health see the new role of primary care as a critical interface between society and the medical system, between "public action for health" and "specific health services," as he puts it. The reforms are about enhancing the role of primary care, integrating it better with other parts of the system, and trying to change public perceptions about health and health care services. "One of the big problems is people still think they are going to find health solutions with specialists or in hospitals. We have to show that improving primary care can improve health."48 A senior health aide to President Salvador Allende in the early 1970s, Sandoval is enthusiastic about the current prospects for health reform in Chile and the use of evidence in the process. In February 2004 Sandoval attended a seminar in London, sharing the Chilean experiences of reform with policymakers in the National Health Service. Adding a historical perspective to the current changes, he explains that, in his view, although many of Chile's physicians and their representative organizations had fought hard for an end to dictatorship and the return of democratic political reform, the push for fundamental reform of the health system took a backseat—until now.49 37Author's interview with Hernan Sandoval, executive secretary, National Committee for Health Reform, 2004 (hereafter Sandoval interview).
Dr. Hernan Sandoval, who was appointed by President Lagos as the Executive Secretary of Chile's Health Reform Commission, led the dialogue.