On the streets of Tegucigalpa or San Salvador or Santo Domingo or in the capitals of five other Central American countries, few people would be able to provide an answer to this question: What is the Council of Ministers of Health of Central America’s (COMISCA)?
Despite the understandable lack of awareness, COMISCA has emerged as an important—and effective—mechanism for improving public health across the region. It has unified eight disparate nations into a singular force in the fight against leading causes of death and illness. CDC is one of COMISCA’s prime partners.
COMISCA’s mandate and reason for existence, in fact, is both straightforward and crucial: improve public health in a part of the world beset by health challenges, strained budgets, and technical limitations by joining forces and combining resources. The idea is that by locking arms, sharing data and logistics, and agreeing on a public health blueprint, people in every country will be better protected from illness.
That is good news for the member countries: Belize, Costa Rica, Guatemala, El Salvador, Honduras, Nicaragua, Panama, and the Dominican Republic. COMISCA is led by ministers of health from the countries with the Council’s chair rotating every 6 months.
Since its creation in 1991, COMISCA has shown promise almost from the start. Results, in fact, can already be found in each of the member countries. The ethos is captured in the title of a 2009 document outlining the goals and targets for 2010–2015: “United for the Health of Our People.”
Some of the goals are obvious. Consolidating national surveillance systems and sentinel integrated viral and bacterial diseases is one. Joining forces in a unified and comprehensive way in battle against HIV/AIDS is another. Refining the system for detecting influenza and other infectious diseases to make it more sensitive, accurate, and universal is yet another legitimate aspiration.
Its potential for success and capacity to join forces are the main reasons why CDC not only recognizes COMISCA’s promise but why CDC has fully embraced the organization by offering both financial and technical support, becoming CDC’s most important strategic partner.
CDC, in fact, is currently COMISCA’s largest funding partner, providing approximately $1.3 million per year. Laboratories and disease surveillance are two of the major focuses in the partnership. That emphasis is underscored by CDC’s five-year cooperative agreement with COMISCA designed to develop a regional public health surveillance and laboratory network in the region.
The agreement, which was finalized in 2010, provides funding and technical guidance necessary to create a more robust and effective surveillance network and an upgraded laboratory system. It also includes tools to improve emergency preparedness for Central America and the Dominican Republic while enhancing regional cooperation.
At its core, the goal is to build a more comprehensive surveillance platform that can effortlessly share public health information while also supporting the regional implementation of WHO/PAHO International Health Regulations.
Those are lofty but sufficiently vague goals. In real-life, on-the-ground terms, COMISCA has, in recent years, been a conduit for
- Providing and orchestrating technical assistance and training to better detect and respond to the influenza pandemic in Central America. As part of that effort, it developed the “Guide to Respiratory Disease Surveillance of Nicaragua”; provided critical supplies and inputs to the National Laboratory of Honduras; and produced newsletters and other materials with product information and influenza surveillance results.
- Working to integrate and harmonize the assortment of surveillance systems for HIV/AIDS used across the region. A key element of this effort is identifying gaps and needs in the surveillance network.
- Creating a web portal to make it easier to share information.
- Working broadly to meet International Health Regulations including upgrading tools and systems for detecting disease. These improved early warning tools “allow the use of historical data and…algorithms tailored to the country…[and to] issue alarms on abnormal behaviors of different diseases monitored by the information systems of the country.”
- Developing protocols and guidelines for updating, strengthening, and standardizing laboratories across the region. A key element is sharing experiences to strengthen the entire systems. For example, Dominican health officials would share their experience and lessons learned in the diagnosis of cholera.
It’s a strong record with numerous and demonstrable achievements. But the challenges are also large and demonstrable which means the work of COMISCA and its partners, including CDC, is far from finished.