OFFICE OF LATIN AMERICAN CANCER PROGRAM DEVELOPMENT 

OFICINA DE DESARROLLO DE PROGRAMAS DE CÁNCER EN AMÉRICA LATINA 

(National Cancer Institute and the Fogarty International Center) 

Office of Latin American Cancer Program Development 

Oficina de Desarrollo de Programas de Cancer en America Latina 

Contents
 

Introduction....................................................................................................................................................................... 1
 

Pilot.Program.Mission..................................................................................................................................................... 3
 

Operating Principles and Processes..................................................................................................................... 3
 

Background....................................................................................................................................................................... 3
 

Cancer Health Statistics in Latin America ........................................................................................................... 3
 

Cancer Research and Health Care Networks ..................................................................................................... 6
 

Mexico ................................................................................................................................................................ 6
 

Brazil.................................................................................................................................................................... 7
 

Chile..................................................................................................................................................................... 8
 

Argentina ............................................................................................................................................................ 9
 

Uruguay............................................................................................................................................................. 11
 

Goals.of.the.OLACPD.Pilot.Program........................................................................................................................... 13
 

OLACPD.Pilot.Program.Key.Strategies.and.Multiphase.Plan................................................................................ 13
 

Phase I: Due Diligence, Knowledge Building, and Feasibility Assessment (January 2008-Ongoing)...... 14
 

Overall Plan ...................................................................................................................................................... 14
 

Status ................................................................................................................................................................ 15
 

Milestones (June 2008-January 2009 and Ongoing) ................................................................................. 16
 

Phase II: Pilot Research Studies (December 2009-February 2011)................................................................ 17
 

Overall Plan ...................................................................................................................................................... 17
 

Milestones (January 2009-February 2011).................................................................................................. 18
 

Phase III: OLACPD Full Pilot Program Implementation (January 2010-February 2011) .............................. 18
 

Overall Plan ...................................................................................................................................................... 18
 

Milestones (November 2010-September 2011) .......................................................................................... 23
 

Appendix.1.....................................................................................................................................................................A-1
 

Research and Health Care Capabilities............................................................................................................A-1
 

Mexico ............................................................................................................................................................A-1
 

Brazil................................................................................................................................................................A-3
 

Chile.................................................................................................................................................................A-4
 

Argentina ........................................................................................................................................................A-6
 

Uruguay...........................................................................................................................................................A-8
 

i 
Office of Latin American Cancer Program Development 

Oficina de Desarrollo de Programas de Cancer en America Latina 

ii 
Office of Latin American Cancer Program Development 

Oficina de Desarrollo de Programas de Cancer en America Latina 

Introduction
 

Cancer is a leading cause of death worldwide, with over 7.6 million deaths attributed to cancer in 2005. 

Moreover, reflecting similar increases expected in the United States (U.S.), it is projected that global cancer 

mortality will climb to approximately 10.3 million deaths per year by 2020. Although cancer is generally 

considered to be a disease of developed countries, factors such as population migration and aging 

populations portend that cancer is increasingly becoming a major disease threat to developing nations. 

In fact, as indicated in Table.1, these trends are already becoming evident in several countries of Latin 

America. 

Interestingly, cancer incidence and mortality trends observed for Latin American populations resemble 

those observed in the U.S. Hispanic population, where cancer is increasing. It also should be noted that 

there is little research evidence to inform an understanding of the influence of ongoing immigration from 

Latin America to the U.S. on cancer trends—in either the U.S. or the countries of origin. It is estimated 

that the U.S. Hispanic population will climb to 59.7 million and represent approximately 19% of the U.S. 

population by 2020. 

Paralleling this worldwide increase in cancer incidence and mortality, results from decades of investments 

in cancer research are producing an unprecedented explosion of information and knowledge that is forging 

an ever-increasing understanding of cancer at the molecular level. These advances promise to provide 

a foundation for the future development of evidence-based individualized cancer detection, therapeutic 

and prevention strategies, and technologies. Therefore, early in the 21st century, U.S. oncology research 

communities are pursuing myriad studies of cancer that are driving toward a new era of personalized cancer 

medicine. In the aggregate, these advances have resulted in an increased life expectancy for individuals 

with cancer and a higher quality of life for nearly all cancer patients in the U.S. and in many other countries 

around the globe. 

However, in spite of these advances in cancer research that are benefiting developed countries, cancer is 

currently ranked among the top three deadliest killers in Latin America.1 Although many of these countries 

are progressive—investing in biomedical research and screening and offering current treatments to cancer 

patients—overall research and patient care capabilities in these countries are significantly underdeveloped 

by U.S. standards. As a result, individuals in Latin America are dying from preventable diseases such as 

gastric and cervical cancers. 

These statistics—coupled with the estimate that the Hispanic population is destined to become the largest 

minority in the U.S.2 in as little as 12 years—strongly suggest that reducing the burden of cancer in the U.S. 

will depend heavily on understanding and controlling cancer in this critical population group. Interestingly, 

this understanding will require basic and clinical studies conducted collaboratively across Latin America— 

as well as among U.S. Hispanics. It is critically important to consider initiating trans-Latin American research 

programs. In the year 2000, 80% of Hispanics living in the U.S. were of Mexican origin, and data from 2006 

show that this population had since decreased to represent 65% of the total U.S. Hispanic population in 

2004. These changes reflect a significant shift in Hispanic immigration patterns to the U.S., specifically the 

increasing immigration of individuals from other Latin American countries into the U.S. Hispanic population. 

This complex picture is further complicated by the fact that the average age of the U.S. Hispanic population 



American Cancer Society. “Latin America and the Caribbean.” 



American Cancer Society. “Cancer Facts for 007.” 


 
Office of Latin American Cancer Program Development 

Oficina de Desarrollo de Programas de Cancer en America Latina 

is 27 years, and very little research is under way to examine the effects of these population changes on the 

current or future U.S. or global cancer burden. 

In recognition of the significant need and opportunities for programs across the continuum of cancer 

research and care in Latin America, the National Cancer Institute (NCI) and the Fogarty International Center 

(FIC), National Institutes of Health (NIH), have undertaken a pilot initiative to develop relevant research and 

training programs in five of these countries. The launch of the NCI–FIC Office of Latin American Cancer 

Program Development (OLACPD) correlates well with the globalization of science and health care that 

is currently under way. Latin American countries have tremendous human resources—including clinical 

networks and specimen resources—that could greatly enhance global clinical cancer research efforts. In 

addition, this pilot program will strive to increase the capability of these countries to participate and partner 

in cancer research, including the development of needed clinical trials networks, technology centers, and 

training to enhance the capability to deliver state-of-the-art cancer care to patients. 

The OLACPD will develop appropriate strategies, programs, and other actions needed to advance the 

cancer research agenda and accelerate progress against cancer for the mutual benefit of the U.S. and 

Latin America. This Strategic Plan details the status of cancer and cancer research in Latin America and 

defines the approach and strategies that will be utilized in this pilot program to achieve the goals of this 

groundbreaking NCI–FIC partnership. 


 
Office of Latin American Cancer Program Development 

Oficina de Desarrollo de Programas de Cancer en America Latina 

Pilot Program Mission
 

The mission of the OLACPD is to understand the current status of cancer, cancer research, and cancer 

treatment in selected Latin American countries and to use this information, as well as existing and new 

relationships, and capabilities to develop OLACPD programs and partnerships that both meet clinical needs 

in-country and enable joint progress in cancer research. 

Operating Principles and Processes 

The OLACPD will coordinate, develop, and administer multidisciplinary cancer research programs for Latin 

America in partnership with the FIC. To achieve this mission, the OLACPD will coordinate program activities 

with NCI Divisions, Offices, and Centers pertaining to Latin American cancer research. The OLACPD will 

maintain liaisons with appropriate Federal and non-Federal organizations, institutions, and scientists to 

inform and promote cancer research in Latin America. The OLACPD will proactively conduct program 

planning and evaluation activities in coordination with the FIC and other NIH Institutes and Centers (ICs) 

as appropriate and collaboratively track the cancer epidemiologic data of Hispanics who have come to 

the U.S. from Latin American countries. The OLACPD will make appropriate adjustments to the scientific 

direction of the program as trends arise. 

Background 

Cancer Health Statistics in Latin America 

It has been estimated that one in eight deaths worldwide are due to cancer. Cancer has caused more 

deaths worldwide than AIDS, tuberculosis, and malaria combined.3 This fact is attributed to the decrease of 

deaths from infectious diseases, urbanization and lifestyle trends, and the aging of the global population. As 

developing countries acquire Western diets, lifestyles, and risk behaviors such as smoking, it is projected 

that new cancer cases will increase significantly over the next decade and beyond. 

In Latin American countries, the high incidence of cancers associated with infectious agents (i.e., cervical, 

stomach, liver cancers) can be ameliorated or prevented through interventions such as vaccines, antibiotics, 

and improved sanitation. Lung cancer can be addressed through education on smoking and lifestyle risks. 

Data from the World Health Organization (WHO) illustrating the five major cancers that are the leading 

causes of deaths from this disease in Mexico and Central America are shown in Table.1. 



World Health Organization. 


 
Office of Latin American Cancer Program Development 

Oficina de Desarrollo de Programas de Cancer en America Latina 

Table.1:.Leading.Organ.Sites.and.Associated.Deaths.From.Cancer.in.Mexico.and.Other.Countries.of.Latin.America 

(Per.100,000,.WHO.2005) 

1 2 3 4 5 

Mexico Trachea, Bronchus, 

Lung Cancers 

Prostate Cancer Stomach Cancer Liver Cancer Cervix Uteri Cancer 

Ecuador Stomach Cancer Prostate Cancer Cervix Uteri Cancer Trachea, Bronchus, Colon and Rectum 

Lung Cancers Cancers 

Guatemala Stomach Cancer Liver Cancer Trachea, Bronchus, Corpus Uteri Prostate Cancer 

Lung Cancers Cancer 

Honduras Stomach Cancer Trachea, Bronchus, Prostate Cancer Breast Cancer Cervix Uteri Cancer 

Lung Cancers 

Nicaragua Stomach Cancer Cervix Uteri Cancer Prostate Cancer Colon and Rectum Breast Cancer 

Cancers 

Panama Prostate Cancer Stomach Cancer Trachea, Bronchus, Colon and Rectum Breast Cancer 

Lung Cancers Cancers 

Interestingly, deaths from lung cancer in Mexico reflect the trend seen in the U.S., perhaps due to proximity 

and the wide availability of tobacco products. However, cervical and uterine cancers remain major killers of 

women, likely as a result of inadequate screening and advanced cancers at the time of diagnosis. Overall, 

stomach cancer remains the major cancer causing mortality in most of these countries—a disease that can 

be nearly eradicated if appropriate diagnosis and treatment of Helicobacter pylori bacteria can become 

part of general clinical practice. Prostate and breast cancers also are prominent in the list of major sites 

responsible for mortality, with the exception of Guatemala, where uterine cancer remains a major cause of 

mortality. 

Table. 2 shows the five major organ sites that are the leading causes of mortality from cancer in eight 

countries in Latin America. As in Mexico, lung cancer is a major cause of death from cancer in four Latin 

American counties, whereas stomach cancer and cervical cancer are major causes of death in the other 

four countries. Prostate cancer is a major cause of death across nearly all of these countries, representing 

the number three cause of death from cancer in seven of the eight countries surveyed. Colon cancer and 

lymphoma appear as the second leading causes of death in at least two Latin American countries (Argentina 

and Peru), which raises interesting and profoundly important questions about their populations per se and 

the state of oncology diagnosis and treatment in those nations. 


 
Office of Latin American Cancer Program Development 

Oficina de Desarrollo de Programas de Cancer en America Latina 

Table.2:.Leading.Organ.Sites.and.Associated.Deaths.From.Cancer.in.Eight.Latin.American.Countries 

(Per.100,000,.WHO.2005) 

1 2 3 4 5 

Argentina Trachea, Bronchus, 

Lung Cancers 

Colon and Rectum 

Cancers 

Breast Cancer Prostate Cancer Stomach Cancer 

Bolivia Cervix Uteri Cancer Stomach Cancer Prostate Cancer Colon and Rectum Breast Cancer 

Cancers 

Brazil Trachea, Bronchus, Stomach Cancer Prostate Cancer Colon and Rectum Breast Cancer 

Lung Cancers Cancers 

Chile Stomach Cancer Trachea, Bronchus, Prostate Cancer Colon and Rectum Breast Cancer 

Lung Cancers Cancers 

Colombia Stomach Cancer Trachea, Bronchus, Prostate Cancer Colon and Rectum Breast Cancer 

Lung Cancers Cancers 

Paraguay Trachea, Bronchus, Stomach Cancer Prostate Cancer Corpus Uteri Breast Cancer 

Lung Cancers Cancer 

Peru Stomach Cancer Lymphomas, Prostate Cancer Cervix Uteri Cancer Colon and Rectum 

Multiple Myeloma Cancers 

Uruguay Trachea, Bronchus, Colon and Rectum Prostate Cancer Breast Cancer Stomach Cancer 

Lung Cancers Cancers 

As shown in Tables.1.and.2, although geographically separated, these regions are remarkably similar in that 

two preventable cancers—gastric and lung—are nearly uniformly the major cause of death from cancer 

across this broad array of Central and Latin American countries. Table.3 reflects the leading cancer deaths 

for the U.S. population and U.S. Hispanic population as referenced by the American Cancer Society. It is 

clear that Hispanics who relocate to the U.S. benefit from the preventive strategies employed for infectious 

agent-associated cancers such as gastric cancer. However, smoking-associated lung cancer remains the 

number one cancer killer in both populations. 

Table.3:.Leading.Organ.Sites.and.Associated.Deaths.From.Cancer:.U.S..and.U.S..Hispanic.Populations. 

(American.Cancer.Society.2006) 

1 2 3 4 5 

United States Trachea, Bronchus, 

Lung Cancers 

Colon and Rectum 

Cancers 

Breast Cancer Lymphomas, 

Multiple Myeloma 

Prostate Cancer 

U.S. Hispanic Lung and Bronchus Colon and Rectum Breast Cancer Liver Cancer Pancreatic Cancer 

Population Cancers Cancers 

Although a number of Latin American countries with various levels of research and health care delivery 

capacity are of interest as potential candidates for participation in the OLACPD pilot program, the initial 

scope will focus primarily on Mexico, Brazil, Chile, Argentina, and Uruguay, and will be expanded in the 

future as appropriate. 


 
Office of Latin American Cancer Program Development 

Oficina de Desarrollo de Programas de Cancer en America Latina 

Cancer Research and Health Care Networks: Mexico, Brazil, Chile, Argentina, and 

Uruguay 

The overall status of the research and development expertise and supporting infrastructures for both 

research and health care delivery is quite diverse across the large number of countries in Latin America. 

The following summary briefly captures an overall synopsis of these capabilities for each of the five target 

countries. A more detailed account of these country-by-country research and health care capability profiles 

can be found in Appendix.1 of this Strategic Plan. 

Mexico 

Mexico, with a population of over 109 million, is a representative and democratic republic of 31 States, a 

Federal District, and an elected president. 

Mexico’s.Health.Care.System..The Secretariat of Health is responsible for overseeing the quality, safety, 

and efficacy of drugs, reagents, immunobiologicals, and medical equipment in Mexico. It maintains national 

registries for all health supplies, regulates marketing by issuing licenses and health product registrations, 

and oversees advertising that appears in the mass media. In addition, the Secretariat of Health, with support 

from the social security institutions—especially the Instituto Mexicano del Seguro Social (IMSS)—provides 

public health care services. The social security system covers workers in the working population and 

comprises several institutions, each of which is funded by contributions from employers, employees, and 

the government. The IMSS is the largest institution in the system and serves about 80% of the covered 

population. The system also includes the State Workers Social Security and Services Institute (Instituto de 

Seguridad y Servicios Sociales de los Trabajadores del Estado), Petróleos Mexicanos, the Secretaria de la 

Defensa Nacional (Armed Forces), and the Armada de México (Navy). 

The organization of individual health services is structured by levels of care. The first level includes health 

promotion, disease prevention, and outpatient care, and the second level provides basic specialties 

at general or specialized hospitals. The third level provides specialized care of greater complexity and 

clinical and basic research involving specialized physicians supported by specialized nursing and other 

professionals. 

Universities. and. Academic. Centers. Founded in 1551, the largest public university in Mexico is the 

National Autonomous University of Mexico (Universidad Nacional Autónoma de México), which conducts 

approximately 50% of the scientific research in Mexico, with satellite campuses and research centers across 

the country. The second largest university is the National Polytechnic Institute. Both of these institutions 

are public and are complemented by several public universities in the Mexican States, most notably the 

University of Guadalajara. 

In addition to the public universities, the Monterrey Technological and Higher Education Institute (Instituto 

Tecnológico y de Estudios Superiores de Monterrey) is one of the leading private research institutions in 

Mexico, as are the Autonomous Technological Institute, the University of the Americas Puebla (Universidad 

de las Américas Puebla), and the Ibero-American University (Universidad Iberoamericana). 

4

All information was extracted and compiled from Pan American Health Organization Country Health Profiles; World Health 

Organization WHOSIS Global Database; U.S. Department of State; Social Medicine July 2008; and the Embassies of Mexico, Brazil, 

and Chile. 


 
Office of Latin American Cancer Program Development 

Oficina de Desarrollo de Programas de Cancer en America Latina 

Scientific. Research. and. Advanced. Technologies. Health care is a primary “right” in Mexico and, 

consequently, there are more physicians than Ph.D.s in Mexico. Moreover, there is a regional disparity in 

the allocation of scientific resources, with over 75% of all doctoral degrees awarded by institutions in and 

around Mexico City. 

The primary science and technology policymaking body of Mexico is the National Council for Science 

and Technology (Consejo Nacional de Ciencia y Tecnología, CONACYT). The CONACYT is a decentralized 

public body created in 1970 that comprises researchers, scientists, academicians, and government 

officials. Its focus is a national development program, which includes scholarships for mid-career and 

established researchers as well as technicians. Programs to support research—and the development of 

new industries—in fields such as energy, electronics, metalworking, and agronomy are also administered 

under the CONACYT. In addition, this body oversees a government–industry shared-risk program, research 

centers (many located in the provinces), and international scientific agreements. 

Other. Research. Networks. in. Mexico. In addition to these government-supported clinical and research 

focused-institutions and organizations, Mexico is rapidly developing capabilities in advanced technologies 

and is engaging with major philanthropic investors to build scientific capacity and participate actively in the 

world scientific enterprise. Examples of organizations that reflect these trends include the National Institute 

of Genomic Medicine, the Mexican Foundation for Health, the CARSO Foundation, and the Nacional Instituto 

de Cancerologia (INCAN). 

Brazil 

Brazil, with a population of over 190 million, is a Federal republic with 26 States, a Federal District, and an 

elected president. 

Health. Care. Systems. The Brazilian health system is composed of a large public, government-managed 

system—the Integrated Public Health System (Sistema Único de Saúde (SUS)). Private health insurance is 

widely available in Brazil and may be purchased on an individual basis or obtained as a work benefit—major 

employers usually offer private health insurance benefits. Public health care is still accessible for those who 

choose to obtain private health insurance. As of March 2007, more than 37 million Brazilians had private 

health insurance. 

Universities.and.Academic.Centers. In Brazil most health research includes physicians and scientists from 

both private and public institutions, constituting interdisciplinary teams. These include private institutions 

such as the Pontifical Catholic University of Paraná, the Pontifical Catholic University of São Paulo, and 

the Pontifical Catholic University of Campinas. Leading public institutions—such as the State University of 

Rio de Janeiro, the Federal University of Bahia, the Federal University of Ceará, the Federal University of 

Campina Grande, and the State University of São Paulo—often lead these teams. 

Scientific.Research.and.Advanced.Technologies. As noted, scientific research and the development and 

implementation of advanced technologies in Brazil are largely carried out in public universities and research 

institutions, with over 73% of funding for basic research derived from government sources. 

At the Federal government level, three major organizations fund research. The National Council for 

Scientific and Technological Development (CNPq) is the largest and most important science and technology 

organization in Brazil, with an annual budget of approximately $600 million U.S. dollars (USD). Ten national 

institutes and two directorates make up the CNPq. The Financier of Studies and Projects provides financial 

support to companies and institutions that invest in the development of new products and processes. The 


 
Office of Latin American Cancer Program Development 

Oficina de Desarrollo de Programas de Cancer en America Latina 

third organization—Fundação Coordinação de Aperfeiçoamento de Pessoal de Nível Superior—has an 

annual budget of approximately $400 million USD and stimulates the development of human resources for 

teaching and research through the awarding of scholarships, grants, and other mechanisms. 

Research funding is also provided at the State level by agencies such as the Foundation for Research 

Support of the State of São Paulo (FAPESP), the Foundation for Research Support of the State of Minas 

Gerais, and the Foundation for Research Support of the State of Rio de Janeiro. 

Cancer. Research. Networks. The INCAN is administered under the Ministry of Health, with a Federal 

mandate to lead a countrywide policy for cancer control in Brazil. It delivers cancer care within the SUS. In 

addition, the INCAN coordinates public policies, develops research activities, and disseminates practices 

and knowledge on medical oncology. One of the most prominent research networks in Brazil is the Antonio 

Prudente Cancer Research Center in São Paulo, which consists of two additional institutions, the A.C. 

Cancer Hospital Camargo and the Ludwig Institute for Cancer Research. 

Other.Research.Institutes. There are several other well-established research institutes in São Paulo State, 

including the Butantan Institute, a biomedical research center, and the Eldorado Institute, a nonprofit 

research, development, and technology innovation organization. Located in the Rio de Janeiro area, the 

Oswaldo Cruz Institute is also recognized as a scientific institution for research and development in the 

biomedical sciences and is considered the main public health research institution. 

Chile 

With a population of over 16 million, Chile is a unitary State, divided into 13 political-administrative regions, 

with a democratic government, and an elected president. 

Health.Care.System. The Ministry of Health is the lead agency in the health care sector. It formulates and 

establishes health policies; issues general standards; and plans, supervises, monitors, and evaluates 

compliance with these directives. The National Health Fund (Fondo Nacional de Salud, FONASA), the 

ISAPRE (Isapre Banmedicas) Authority, the Public Health Institute, and the Central Supply Clearinghouse 

report to the Ministry of Health. The Public Health Institute is responsible for regulating drugs and medical 

products. The overall health services system combines public and private support. Public insurance is 

provided through the FONASA, which receives contributions from its members and transfers from the 

national government to cover indigent people and to carry out public health programs. The private sector 

is represented by ISAPREs, which are health insurers. Of particular importance in cancer care is the Plan 

AUGE (Explicitly Granted Universal Access), which guarantees access to diagnosis and treatment for all. 

In addition, two major cancer charities, the Corporación Nacional del Cancer (CONAC) and the Fundación 

Arturo Lopez Perez in Santiago, fill part of the economic gap. The CONAC provides free drugs, and the 

Fundación charges according to income. 

Health.Research.and.Advanced.Technologies. Health research is carried out primarily in universities and 

research centers. To promote essential research on the country’s priority health problems, the Ministry of 

Health has developed a national research policy directed toward implementing a systematic anticancer 

policy rooted in evidence-based medicine. The National Commission for Scientific and Technological 

Research (Comisión Nacional de Investigación Cientifica y Tecnológica, CONICYT) is the advisory body 

to the government in science and technology. The CONICYT has focused its efforts on the development of 

science and technology in an effort to improve the country’s social and economic conditions. Other important 

institutions supporting science and technology research (both governmental and nongovernmental) are the 

Program of the Chilean Economic Development Agency, the National Fund for Science and Technology 


 
Office of Latin American Cancer Program Development 

Oficina de Desarrollo de Programas de Cancer en America Latina 

Development, and the Program of Development and Technological Innovation of Chile. In addition, the 

mission of the Fundación Chile—a private, nonprofit institution—is to introduce innovation and develop 

human capital in the Chilean economy through technology management, in alliance with local and global 

knowledge networks. The Genoma Chile Initiative funds genomic studies and the Center for Scientific 

Studies is a private, nonprofit corporation for the development, promotion, and dissemination of scientific 

research. 

Universities.and.Academic.Centers. Health research in Chile is conducted primarily through networks of 

academic and research centers. Participating centers span nearly all of Chile, including the Universidad de 

Chile, Pontificia Universidad Católica de Chile, Universidad de Santiago de Chile, Universidad Metropolitana 

de Ciencias de la Educación, Universidad Tecnológica Metropolitana, Pontificia Universidad Católica de 

Valparaíso, Universidad de Valparaíso, and Universidad de Antofagasta. 

Argentina 

Argentina has a population of 41 million and is a democratic republic with a federation of 23 provinces and 

an elected president. 

National.Sanitary.Policies.and.Plans. The Federal Plan of Health 2004–2007 proposes the following goals as 

the main lines for the new roles and responsibilities of the different parts of the health sector: 

•	 Strengthening of the National Ministry of Health and the Provincial Ministries in their governing duties. 

•	 Guarantees given by the regions on the assurance of universal basic health coverage. 

•	 Development of preventive and promotion programs, emphasizing primary care and respecting the 

growing mechanisms of derivation within the care network by the provinces and townships. 

•	 Protection of the financing of the established programs. 

•	 Organization of the people to promote their role in the design and implementation of the model. 

Health.Care.System. The Ministerio de Salud y Acción Social de la Nación (MSAS, Ministry of Health and 

Social Action) is the organization in charge of standardizing, regulating, planning, and evaluating health care 

activities in the country. In Argentina the health care system is organized around three main providers: 

1.	 The public sector, which supplies free clinical care for hospital inpatients and outpatients. A charge is 

made to outpatients for medicines. This sector covers about 50% of the population. 

2.	 Mutuals or social plans (around 300 in number), administered by trade unions. In these Obras Sociales, 

which are semi-public, employers and employees each pay a fixed fee. The mutuals cover the cost of 

medical care and medicines in varying proportions and differences between the fixed fees and the 

actual cost of treatment are paid by the patient. In the past, these plans have usually covered around 

45% of the population, although the percentage has fallen recently due to increasing unemployment, 

with more people resorting to seeking care within the public sector. 

3.	 The private sector, where patients meet the total cost of their medical care. This sector covers 

approximately 5% of the population. 


 
Office of Latin American Cancer Program Development 

Oficina de Desarrollo de Programas de Cancer en America Latina 

Individual.Health.Services..All provinces haves organized networks of hospitals and ambulatory services, 

some of which are very advanced. Many others have services of primary care, which are not always well 

integrated with the provincial networks, which have wider coverage and response capacity. Some provinces 

have integrally transferred the primary health care to the township level. The diagnostic support services 

in the public sector are integrated into the hospital network. In the private sector, those services are mostly 

located in the hospital network but, in the largest cities, there are usually autonomous diagnostic support 

units that provide services to the health plans. 

Health.Supplies. Within the drug market, almost all the final products are produced in the country. However, 

in the case of other medical and health supplies, those produced in Argentina represent 25% of the total. 

Although there is no updating on the size and structure of immunobiological products in Argentina, it is 

estimated that 85% of those supplies are imported and 15% are locally produced with the required quality 

standards. 

Human. Resources. The results obtained by the National Network Observatory of Human Resources for 

Health in Argentina showed that in 1998 there were 440,100 health workers (3% of the economically active 

population). Doctors represent 24.7% of such workers; dentists, 6.6%; and nurses and assistant nurses, 

19.6%. 

Health. Research. and. Technology.. The financing system for research is provided by the Science and 

Technique Ministry through the Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), 

to scientific and technological researchers of different levels who will be working in the most diverse 

institutions, both public and private. The national universities and the National Health and Environment 

Ministry—through the Undersecretary of Sanitary Relations and Health Research—contribute also to that 

financing with research scholarships. Recently, the Argentine government has established the new Ministry 

of Science, Technology, and Productive Innovation to promote research, technology, and application of new 

technologies. 

Major. Research. Networks. The Instituto Leloir is a private, nonprofit research institute that supports 

biomedical research, through 25 laboratories, that range from basic biochemistry to gene therapy. Instituto 

Leloir was founded 60 years ago, and it has positioned itself as the premier institution of basic and “applied” 

research in Argentina. With a research staff of over 170 investigators, the institute is well funded by national 

and international grants. The European Union and several private foundations as well as industry contribute 

to the overall funding of $7.5 million USD per year. For applied cancer research, the institute is affiliated with 

three major clinical hospitals: Hospital Naval (Navy Hospital), Oncology Municipal Hospital Maria Curie, 

and Instituto Roffo of the Universidad de Buenos Aires. Altogether, these hospitals receive over 3,000 new 

cancer patients per year. In addition, these clinical institutions have ample experience in implementing 

clinical trials, in particular with industry. 

Health.Sector.Expenditure.and.Financing. In 2003, 54% of health expenditures were public and 46% were 

from the private sector. Of the public expenditures, 55% were financed: 5% by Social Security and 45% 

directly from taxes. In 2002, the total health expenditures were estimated at $23.6 million USD, which 

represented a per capita expenditure of about $745 USD. The largest external financing contributions come 

from loans for projects from the Inter-American Development Bank and the World Bank. 

http://www.paho.org/English/DD/AIS/cp_032.htm 

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Office of Latin American Cancer Program Development 

Oficina de Desarrollo de Programas de Cancer en America Latina 

Uruguay 

Uruguay has a population of 3.5 million and is a constitutional republic with 19 departments and an elected 

president. 

National.Health.Plans.and.Policies..The following six health-related objectives have been established since 

the 2000–2005 period: 

1.	 Strengthen the management of public and private health care institutions. 

2.	 Adapt the supply of available services to the epidemiological characteristics and needs of the 

population. 

3.	 Make health care coverage universal by facilitating access and care at the four levels of complexity. 

4.	 Enhance the quality of services at the four levels of complexity. 

5.	 Rationalize the use of services at the Institutes of Highly Specialized Medicine. 

6.	 Promote the participation of service users and health care institutions in order to solve problems in a 

climate of trust and respect for the rights of citizens. 

Health. Care. Reform. The government’s main concern is the coverage and maintenance of the mutual 

assistance system, which means reorganizing the management of the mutual assistance associations and 

their health care models. The Integrated National Health System would provide comprehensive care to all 

people residing in the country, guaranteeing equitable and universal coverage. The system is based on 

complementary private and public sectors. The overall strategic orientation is toward primary care. The 

system favors basic health services and fosters health promotion, prevention, and rehabilitation. 

Health. Care. System. The health system is divided into public and private sectors. The public sector is 

composed of the Ministry of Public Health (Ministerio de Salud Pública (MSP)), Administration of State 

Health Services (Administración de Servicios de Salud del Estado (ASSE)), Hospital of Specialties (Hospital 

de Clínicas, Universidad de la República), Veteran’s Health Services, Police Health Services, the health 

services of the 19 States (Departamentos), the Bank of Social Welfare (Banco de Previsión Social), and 

the Medical Services of the Autonomous Entities and Decentralized Services (Servicios Médicos de Entes 

Autónomos y Servicios Descentralizados). The private health care sector consists of Collective Health 

Care Institutions (Instituciones de Asistencia Médica Colectiva (IAMC)), private hospitals, private insurers, 

institutes of highly specialized medicine, preventive medical clinics, diagnostic and treatment facilities, 

pharmacies, and exclusively private care practices. Before health care reform, primary coverage was 

provided by: (1) public subsystem (ASSE) with 48% of the population; (2) Social Security (collective medical 

care institutes); and (3) private subsystems, Instituciones de Asistencia Médica Colectiva (IAMC) with 43% 

of the population. 

Health.Supplies..The Ministry of Public Health controls the requirements and demands for registering drugs 

that are regarded as necessary, effective, and safe and are produced under conditions that ensure their 

quality. It also monitors the standards for the inspection of production laboratories, points of distribution and 

sale, and production processes. To perform this task, the Ministry has units for evaluation and registration, 

5

Social Medicine Volume 3, Number 2, July 2008; PAHO and WHO data. 


 
Office of Latin American Cancer Program Development 

Oficina de Desarrollo de Programas de Cancer en America Latina 

inspection (manufacturers, importers, distributors, and sale and disbursement sites), and laboratory analysis 

for drug quality control. The basic inspection activities focus on production laboratories or marketing and 

on products, including labeling and advertising. Several factors impede the Ministry of Public Health’s 

performance of these functions to varying degrees, among them shortages of human resources, delays in 

administrative processes, and the interests of the pharmaceutical industry. 

Human.Resources. In addition to the University of the Republic, private universities and institutes for the 

training of physicians, professional nurses, dentists, and nursing auxiliaries have been established in health 

research and technology. 

Health.Research.and.Technology. Most funding for research and technology comes from industry, Europe, 

and the National Council of Scientific and Technical Research (CONICYT). 

Major.Research.Networks. The Pasteur Institute comprises eight major units: cell biology, crystallography, 

analytic biochemistry and proteomics, animal models, bioinformatics, protein production, biophysics, and 

molecular biology. Each unit comprises highly specialized laboratories involved in specific research projects 

in the areas of microbiology, immunology, cancer, and neurosciences using proteomics, genomics, structural 

biology, and bioinformatics in a multidisciplinary setting. The Institute for Biology Research Clemente 

Estable is a government institution, subsidized by the Ministry of Health and Culture. The institute comprises 

four research programs: neurosciences, biotechnology in applied agriculture, health and biomedicine, and 

environmental sciences. 

Health.Sector.Expenditure.and.Financing. Per capita health expenditure in 1998 was $697 USD, and total 

spending on health was equivalent to 10% of GDP. Public spending (46%) and private spending (54%) were 

relatively proportional. Public spending on health accounted for 14% of overall government outlays. The 

public sector accounts for all spending on health promotion, disease prevention, and epidemiological 

surveillance. In 1998, the private sector spent approximately four times more on drugs ($266 million USD) 

than the public sector ($70 million USD). In addition, the private sector spent $975 million USD on personnel 

costs, while the public sector spent $223 million USD. 

Uruguay is a member of Mercosur or Mercosul (Mercado Común del Sur, or Southern Common Market) 

which is a Regional Trade Agreement (RTA) among Argentina, Brazil, Paraguay, and Uruguay founded in 

1991 with the purpose of promoting free trade and the fluid movement of goods, people, and currency. 

http://www.paho.org/English/DD/AIS/cp_858.htm 


 
Office of Latin American Cancer Program Development 

Oficina de Desarrollo de Programas de Cancer en America Latina 

Goals of the OLACPD Pilot Program 

The goals of the OLACPD partnership between the NCI and the FIC are to: 

•	 Develop a comprehensive understanding of the status of the disease burden and cancer research and 

cancer care infrastructures in the targeted countries in Latin America 

•	 Promote and leverage partnerships for mutual benefit across the continuum of basic and clinical cancer 

research in these countries 

•	 Build collaborative relationships across Mexico and Latin America that will enable the co-development 

and in-country sustainability of the required resources and expertise to enable cancer research and the 

conduct of high-quality clinical studies in the target countries 

In addition, the pilot program will result in a better understanding of cancer incidence and mortality in the 

diverse populations that make up Latin America. Over time, this knowledge will facilitate the design and 

conduct of clinical trials in these target countries based on their own efforts and will also provide direction 

to improve patient management of Hispanic populations in the U.S. Overall, achieving these goals has the 

potential to improve cancer medicine and control in these five countries and ultimately drive improved 

health and health care on a global basis. 

OLACPD Pilot Program Key Strategies and 

Multiphase Plan 

The OLACPD will achieve these goals through the implementation of a series of key strategies carried out 

in three phases. The overall strategic scope of the program will engage multiple institutions, organizations, 

and philanthropic and government partners across Latin America and the U.S. The elements of this “levelof-evidence” strategic approach to building the OLACPD will proceed as follows: 

•	 The foundation of the OLACPD will be established through the planning and implementation of a thorough 

“due.diligence”.process to both understand the current status of cancer and cancer research in the 

target countries and establish the high-level contacts needed for execution of the program. 

•	 In addition to due diligence and workshops, the OLACPD will seek input from a group of experts—the 

OLACPD.Expert.Focus.Group.(OLACPD.EFG)—to inform planning. 

•	 Key to the success of the OLACPD is a strong partnership that will leverage the experience and 

expertise of both the NCI.and.the.FIC..The.NCI.will.seek.to.strengthen.and.build.this.partnership early 

and throughout the pilot program. 

•	 The NCI has a long history of international collaborations and programs focused on basic and clinical 

research, and the OLACPD.will.leverage,.strengthen,.and,.where.needed,.establish.new.collaborative. 

efforts.across.the.Institute. 


 
Office of Latin American Cancer Program Development 

Oficina de Desarrollo de Programas de Cancer en America Latina 

•	 Finally, to ensure stepwise development of these strategies building toward a fully functional research 

effort in the targeted Latin American countries, a.multiphase.plan.of.specific.actions.and.milestones. 

will.be.developed.and.implemented.over.a.3-year.period. 

Phase I: Due Diligence, Knowledge Building, and Feasibility Assessment 

(January 2008-Ongoing) 

The initial phase of the OLACPD pilot program will consist of a thorough due diligence program to gain an 

understanding of both the cancer burden and the current status of cancer research and delivery of cancer 

care in the target countries and establish key contacts. In addition during this phase, a group of experts 

will be assembled to provide input to the program; the relationship between the NCI and the FIC will be 

further defined and strengthened; collaborations with existing NCI Latin America-focused programs will 

be established and/or strengthened; and strategic planning for workshops will be undertaken. This phase 

is critical to the success of the program to ensure an understanding of both the scope of the program and 

existing opportunities for partnerships. All of these Phase I efforts began in early 2008 and are well under 

way. 

Overall Plan for Phase I 

Due.Diligence.Process. A process and series of preliminary studies and investigative meetings will constitute 

a large portion of the Phase I process. The goal is to fully understand in-country needs and resources and 

identify key potential scientific and clinical participants in the pilot program. In addition, these investigative 

efforts will identify potential Federal and philanthropic partners for the OLACPD pilot program. 

Further.Development.of.Internal.Partnership.with.the.FIC. The NCI has established an active dialogue with the 

FIC and will implement the OLACPD strategies through this partnership as is most appropriate. Specifically, 

this will include the FIC’s ongoing international programs and expertise in training and capacity building 

and in international policy in the targeted Latin American countries. In return, the FIC will gain an in-depth 

understanding of the extensive research portfolio and resources of the NCI that can be jointly leveraged 

through this partnership. Current programs that are of joint interest and subject to future discussions include 

the FIC’s Clinical Research Training Scholars program, International Research Collaboration Award, and 

international Non-communicable Chronic Diseases Research Training Program. 

Ongoing.Development.of.Collaborations.with.NCI.and.FIC.Programs..A key strategy for the development of 

the OLACPD is the leverage and expansion of current NCI basic, translational, and clinical cancer research 

programs, especially the augmentation of clinical trials programs, biospecimen programs, advanced 

technology development initiatives, and bioinformatics systems in the targeted Latin American countries. In 

addition, the OLACPD will implement a strategic focus on in-country training development in partnership with 

the FIC. The OLACPD will leverage this broad range of existing NCI and FIC capabilities and relationships, 

along with new contacts, to implement a small number of pilot efforts in Phase.II and expanded initiatives in 

Phase.III through the following three key strategic programs: 

•	 Scientific and Clinical Research Pilot Program. This clinical research-oriented program will provide 

important information on treatment responses and related pharmacogenomic pathways and ultimately 

enhance ongoing international programs in Latin America. Long- and short-term training of investigators 

and clinicians and advanced application of new technologies will promote long-term excellence. A 

number of NCI programs offer opportunities to pursue these strategies through either existing efforts or 

new collaborative initiatives with the OLACPD. 


 
Office of Latin American Cancer Program Development 

Oficina de Desarrollo de Programas de Cancer en America Latina 

•	 Technology and Capacity Building Program. The programs that constitute this capacity building effort 

will provide needed information on cancer epidemiology, enhance communication among investigators, 

and improve the research infrastructure to carry out high-quality cancer research. The Office of Cancer 

Genomics, The Cancer Genome Atlas, and Cancer Genetic Markers of Susceptibility all offer opportunities 

for mutually beneficial partnerships with Latin American clinical cohorts, human tissue networks, and a 

range of advanced technology programs to augment U.S. studies and provide needed training for Latin 

American investigators. For example, the NCI’s Office of Biorepositories and Biospecimen Research 

and the NCI Center for Bioinformatics will have opportunities to adapt best practices and bioinformatics 

software for biospecimen collection, annotation, storage, and banking through new partnerships with 

the targeted Latin American countries. 

•	 Training Program. This program will ensure that the targeted countries will be able to sustain their efforts 

in high-quality basic, translational, and clinical cancer research. In fact, to a large extent, success of the 

OLACPD will depend on the development of needed training in these countries. A large number of the 

training opportunities to be pursued through the OLACPD over the next 3 years will involve leveraging 

both existing FIC and NCI programs as well as new initiatives. For example, the Cancer Centers Branch 

may benefit from a bidirectional exchange training program whereby Latin American investigators in 

the U.S. and U.S. investigators gain experience in Latin American cancer research networks. 

Development. of. the. OLACPD. Expert. Focus. Group.. A group of high-level scientific and clinical research 

leaders with knowledge and experience across the continuum of cancer research will provide expert input 

for the pilot program. The success of this pilot program relies on the balance and composition of the EFG. 

This pilot program will be enriched and well informed through the efforts of this expert group. The EFG will 

provide input on program needs and suggestions on best practices and approaches to the leadership of 

the OLACPD. The membership will represent stakeholders in Mexico, Latin America, and the U.S. who are 

experienced in developing cancer research and training programs as well as capacity building in critical 

regions of Mexico and Latin America. 

Develop.and.Implement.a.Multiphase.Action.Plan..The goals of the OLACPD pilot program will be achieved 

through a stepwise series of programs and activities designed to build a solid foundation for cancer research, 

including clinical studies and trials, within the constraints of existing in-country capabilities and available 

resources. This plan is being fully developed as part of Phase I of the overall program. 

Status of Phase I 

Due.Diligence,.Knowledge.Building,.and.Feasibility.Assessment.(January.2008–Ongoing)..Phase I activities 

are well under way, and the completion of several activities is targeted for the end of 2008 or before. The 

due diligence process has already achieved substantial progress, the EFG is being organized, and other 

aspects of Phase I—most critically, preliminary planning for the later phases of the implementation plan— 

are nearing completion. 

During Phase I, OLACPD staff members have undertaken early efforts to conduct data collection on 

cancer statistics in Latin America and engage in due diligence discussions with the targeted countries 

and exploratory discussions with relevant U.S. organizations vested in cancer research. International 

organizations such as the Pan American Health Organization (PAHO) and the WHO are invaluable resources 

for country health profiles and epidemiologic data, and these organizations will offer opportunities to 

develop key contacts. These data and this analysis will help the OLACPD determine the best approaches 

for developing the Scientific and Clinical Research Pilot Program, the Technology and Capacity Building 

Program, and the Training Program. 


 
Office of Latin American Cancer Program Development 

Oficina de Desarrollo de Programas de Cancer en America Latina 

Preliminary information will continue to be gathered and assembled to assess the current status of cancer 

burdens (both prevalence and mortality), the response of health care systems, and the location of research 

networks and their capabilities. The data will be compiled from available reference sources, including the 

WHO, the PAHO, the International Agency for Research on Cancer, and the FIC. 

In parallel, initial contacts are being made with the Ministries of Health in the targeted countries and other 

governmental agencies involved in science and technology to discuss the OLACPD pilot program as a new 

collaborative research opportunity. The OLACPD has also initiated discussions with national and local 

organizations and with societies and foundations with a cancer focus to explore interests in partnering 

this pilot program. In conjunction, these discussions will address the planning of ongoing workshops and 

conferences primarily directed toward Latin American cancer issues. Foundations and other nongovernment 

organizations based in the U.S. and Latin America are already being contacted during the initial due diligence 

process and are demonstrating significant interest. 

EFG.Staffing.and.Organization. The OLACPD is in the process of identifying experts for the EFG that will 

provide program input. The EFG will offer expert opinions to the NCI and FIC leadership on high-value 

opportunities for conducting clinical translational research in Mexico and other parts of Latin America. The 

EFG will suggest scope and provide comments on the feasibility of cancer development programs proposed 

by the NCI–FIC partnership and provide overall feedback to the NCI–FIC leadership on other proposed 

activities in the pilot program. 

Workshop. and. Conference. Organization. The exchange of scientific ideas and communication will be 

facilitated through selected workshops and conferences to identify and refine concepts and develop 

scientific questions specific to issues and barriers in Latin America. Workshops will have a dual purpose: 

to provide needed short-term training for the conduct of clinical trials and to provide an advanced curricula 

format to inform current methods, technologies, and procedures as needed in the respective target countries. 

Conferences will also focus on teaching and information exchange through poster presentations, seminars, 

and symposia to promote networking and collaborations. 

Milestones for Phase I (June 2008-January 2009 and Ongoing) 

Phase I activities represent foundational and, in many cases, ongoing steps for the establishment of the 

OLACPD. The following milestones represent progress anticipated in Phase I in 2008 and beyond: 

• Completion of due diligence—end.of.2008 

• Selection and confirmation of the EFG—September.2008 

• Introduction to and substantive discussions with Ministries of Health in target countries—end.of.2008 

• Key contacts identified and discussions under way—2008.and.beyond.as.appropriate 

• Workshop and conference planning—December.2008.and.beyond.as.appropriate 

• Site visits to targeted Latin American countries completed—end.of.2008.and.beyond.as.appropriate 


 
Office of Latin American Cancer Program Development 

Oficina de Desarrollo de Programas de Cancer en America Latina 

Phase II: Pilot Research Studies (December 2009-February 2011) 

Pilot studies will be designed to provide information both on the in-country cancer burden and to leverage 

existing resources for the mutual benefit of the partners. Careful attention will be paid to lessons learned so 

that more mature programs in clinical networks, advanced technologies, and training development can be 

created and implemented in Phase III. 

Overall Plan for Phase II 

In the second phase of the OLACPD pilot program, initial pilot research studies will be collaboratively 

planned with the targeted countries based on need and existing capabilities. For example, in instances 

where high-quality existing capabilities are present to conduct limited clinical investigations, small studies 

of high-mortality cancers will be given priority, especially for those diseases where philanthropic funds 

exist to match government funds from the U.S. and the respective targeted countries. 

Scientific.and.Clinical.Research.Pilot.Program—Pilot.Research.Studies.(Figure.1). Selected pilot studies 

will be carried out in collaboration with U.S. academic research institutions and their respective counterparts 

in Mexico and other countries in Latin America. Figure 1 illustrates the objectives and short- and long-term 

strategies for what is anticipated to be primarily small clinical trials with correlative science studies. These 

pilot studies will investigate those regions where an acute identifiable need exists (e.g., gastric cancer in 

Chile, classification of cervical cancers in some areas of Mexico) or where there is an ongoing study that will 

benefit from a U.S. cancer center partner (e.g., University of Mexico, or the M.D. Anderson Cancer Center). 

Specific issues regarding ethics (local and U.S.), regulatory compliance, and best practices will be studied, 

and approaches will be developed to address key gaps. The lessons learned from these initial studies will 

help the OLACPD develop long-term strategies as well as harmonize NIH policies and procedures to the 

specific cultural and legal circumstances extant in Mexico and other Latin American countries. 

Clinical Research 

Networks 

Pilot Research 

Studies 

Correlative Science 

Biomarker Studies 

Clinical Trials 

General Objective 

To conduct high-quality 

clinical cancer research to 

improve cancer care in 

Mexico and other countries 

of Latin America 

Phase II 

Long-Term Strategy 

Establish the necessary 

clinical research infrastructure 

to allow collaborative 

participation in high-quality 

research 

Figure.1:.Overview.of.Scientific.and.Clinical.Research.Pilot.Program 

 
Office of Latin American Cancer Program Development 

Oficina de Desarrollo de Programas de Cancer en America Latina 

Initiatives.Planned.for.Phase.II..During Phase II, research areas for initial pilot studies to address cancer 

issues in Latin America will be identified primarily on the basis of mortality, prevalence, and in-country 

capacity to build a working partnership. To accomplish these initiatives, this phase will include organizing 

regional workshops on topics ranging from short-term training for specific techniques or procedures to 

protocol development and design. Efforts will also be made to enhance or set up needed regional review 

board and ethics committee(s) to harmonize (where possible and appropriate) processes and procedures 

between local and U.S. regulatory policies. For example, these programs could cover protocol review groups 

and data safety monitoring committees. Also, it may be prudent to investigate the possibility of augmenting 

regional institutional review boards with comparable U.S. partners versus changing in-country practices. 

These committees will be vital to adapting the appropriate policies and best practices needed to govern key 

functions such as data management, biospecimen collection, stewardship, and annotation, which will be 

critical to virtually all collaborative programs. 

Milestones for Phase II (January 2009-February 2011) 

The following milestones represent progress anticipated for Phase II: 

• Regional review committee(s) set up and engaged for targeted studies—end.of.first.quarter.2009 

• Standards and policies adapted for biospecimen annotation, storage, and delivery in target countries— 

end.of.first.quarter.2009 

• Short-term joint training on conduct of clinical trials—January.2009-January.2010 

• Opening pilot studies on breast, cervical, and gastric cancers—targeted.for.April.2009 

• Announcing first Request for Application (RFA) or Program Announcement (PA)—June.2009 

• Review and assessment of pilot studies—ongoing,.completed.by.October.2010 

Phase III: OLACPD Full Pilot Program Implementation 

(January 2010-February 2011) 

Phase III will focus on capacity building in the targeted countries to enable the conduct of basic research, 

acquisition and integration of advanced technologies, and development and/or clinical research to move 

toward evidence-based cancer treatment and diagnostic and preventive strategies. 

Overall Plan for Phase III 

Lessons learned in Phase II of the pilot program will be used in Phase III to set goals and establish more 

expanded programs in clinical research and clinical networks, advanced technologies, and training 

development in targeted countries. Clinical research expertise and supporting in-country infrastructure 

will be assessed during and at the completion of pilot studies in Phase II to provide a foundation for the 

collaborative performance of high-quality cancer research, especially translational and clinical research. 

Phase III will also focus on the implementation of best practices programs in areas such as biospecimen 

acquisition and stewardship and bioinformatics. The expansion of successful programs in Phase III will 

depend on continuing to build a base of government and philanthropic support for the range of initiatives 

needed across the cancer research continuum required to address specific in-country needs. 


 
Office of Latin American Cancer Program Development 

Oficina de Desarrollo de Programas de Cancer en America Latina 

Establishment.of.Regional.Clinical.Cancer.Networks.(Figure.2). Latin American countries have established 

health care centers, academic institutions, and research centers as separate entities. As shown in Figure.2, 

the OLACPD will leverage these existing networks through the establishment of regional support offices, 

or “hubs.” These regional installations will serve to simplify and facilitate logistics and other needs as 

appropriate. 

As seen from the PAHO Country Health Profiles, cancer research is conducted through a number of consortiatype arrangements with academia and research centers. The health care centers are able to facilitate clinical 

trials or treatment trials more effectively under the social medicine system than can be easily accomplished 

in the U.S.. These Latin American research networks also provide health care management for cancer 

patients. It is anticipated that these existing networks can be leveraged through collaborations between 

the NCI and the FIC through the OLACPD pilot program for the benefit of both the U.S. and the targeted Latin 

American countries. These types of partnerships promise to improve clinical and translational research 

in Latin America and inform research overall on cancer in the U.S. Hispanic population. All studies will be 

structured with clear milestones and outcomes to provide maximal benefit to the partners. 

• Translation Services 

• Development of Contractual Arrangements 

• Policies for Collaborations 

• Reports 

Infrastructure 

Supported for 

Research 

Studies 

Communications 

Logistics 

Support 

• Organization of Site Visits 

• Coordination of Cofunding 

Opportunities 

• Support for Monitoring Clinical 

Research 

• Record-Keeping of Clinical 

Research Studies 

• Coordination of Logistics of 

Clinical Research Studies 

• Support for Short-Term Training 

• Meeting Support for Clinical Research Studies 

• Coordination of Conferences and Workshops 

• Logistical Support to Travelers 

Figure.2:.Overview.of.Regional.Clinical.Cancer.Networks 

Based on the consortia arrangement, academic institutions, research centers, and health care centers offer 

the opportunity to model research networks that resemble existing experience and expertise in the NCI 

Cancer Centers Program. One of the major strategies of Phase III is to identify and further develop robust 

Regional Clinical Cancer Networks in the targeted Latin American countries and work with these groups 

to establish accreditation programs as centers of excellence in cancer research. A program to assess the 

capacity of these networks to perform at a high level in terms of conducting high-quality clinical cancer 

research will depend on their capabilities and their compliance in areas such as ethics, regulatory policies, 

technologies and infrastructure, and the supportive business infrastructure. 


 
Office of Latin American Cancer Program Development 

Oficina de Desarrollo de Programas de Cancer en America Latina 

Technology.and.Capacity.Building.Pilot.Program.(Figure.3). The goal of this strategic element of the pilot 

program is to adapt advanced technologies and assist the targeted countries in building the in-country 

research capacity needed for basic, translational, and clinical cancer research through mutually beneficial 

partnerships. Several of these programs will by necessity focus on building valuable infrastructure for 

personalized medicine. Figure.3 illustrates that specific resources targeted for development include (virtual) 

tumor and biospecimen banks, cancer registries, caBIGTM-compatible bioinformatics infrastructures, and 

regional centers of advanced technology. 

Technology and 

Capacity Building 

Program 

Cancer Registries 

Bioinformatics 

Cancer Registries 

Bioinformatics 

Phase II 

Long-Term Strategy 

Develop sustainable 

technological infrastructures 

to support the conduct of 

high-quality clinical cancer 

research 

Phase I 

Short-Term Strategy 

Support the initial 

development of infrastructures 

to conduct high-quality 

clinical research 

General Objective 

To adopt advanced 

technologies, management 

of human specimens, and 

data management to improve 

and build the research 

capacity for clinical cancer 

research and collaborations 

Regional Centers 

of Advanced 

Technology 

Regional Centers 

of Advanced 

Technology 

Virtual Tumor and 

Specimen Bank 

Virtual Tumor and 

Specimen Bank 

Figure.3:.Overview.of.Technology.and.Capacity.Building.Pilot.Program 

In selected countries, virtual tumor and biospecimen banks will be enhanced or established to make 

biospecimen resources available to the international research community. This is a challenging undertaking, 

and the OLACPD will employ a number of resources to achieve this goal. Specific tools developed by 

the NCI will be engaged and adapted for the purpose of enhancing in-country current bioinformatics 

platforms. Participating institutions in Mexico and other Latin American countries will be encouraged to 

adapt established standard operating procedures to design and maintain high-quality repositories with 

well-annotated specimens. Appropriate procedures and logistics regarding tissue sharing, shipping, and 

handling will be addressed in a collaborative fashion between Latin American research networks and the 

NCI. 

The OLACPD will also support and enable the establishment of cancer registries to facilitate the generation 

of valid information on cancer prevalence and mortality rates in the targeted Latin American countries. This 

strategy will be implemented stepwise, first, by adapting existing international cancer registry standards 

to the cultural and legal circumstances of the targeted countries and, second, by establishing processes 

that will allow investigators to monitor cancer trends and effects on cancer care. It is planned that cancer 

registries will be initially developed as pilot programs and that respective countries will assume responsibility 

and ultimately integrate these resources into their long-term health care strategies. In partnership with the 

NCI Center for Bioinformatics, it is anticipated that these countries will be able to develop interoperable 

platforms and exchange data on cancer on an international basis. 

0
 
Office of Latin American Cancer Program Development 

Oficina de Desarrollo de Programas de Cancer en America Latina 

Application technologies such as computational biology and informatics developed for cancer research are 

complex and expensive and require high-level training. However, to achieve the goals of the rapidly moving 

fields that make up cancer research today, the OLACPD will endeavor to enable the target countries with the 

needed base level of expertise and infrastructure to establish regional centers of advanced technology— 

initially supported through seed funds and subsequently supported through in-country resources. This is 

a complex mission that will include adapting a range of advanced technologies such as genomics and 

proteomics. It will be critical that these technologies are well understood and properly applied in these Latin 

American countries to keep pace with 21st century cancer medicine. 

Depending on needs and opportunities, several approaches will be used to fund these technology and 

capacity building programs in the targeted countries. These will include mechanisms such as RFAs and 

PAs, and every effort will be made to leverage cofunding opportunities for this critical effort. The OLACPD 

will also develop appropriate business models to support this initiative to ensure future in-country support 

and self-sustainability. 

Training. Pilot. Program. (Figure. 4).. It is anticipated that training development through the OLACPD will 

begin in Phase II of the pilot program. As shown in Figure.4, the overall goal of this program is to create a 

cadre of basic and clinical scientists who will over time assume leadership for the advancement of cancer 

research in the targeted Latin American countries. It is anticipated that three classes of training programs 

will be important to meet the goals of the OLACPD pilot program, including training in clinical research; 

traditional postdoctoral and sabbatical training; and training in advanced methodologies, techniques, and 

technologies. 

A major goal of the OLACPD will be the initiation of programs that will support the development of basic 

and clinical investigators to conduct cancer research. This program will also complement the development 

of clinical networks. Several strategies will be employed to achieve this goal, including training basic and 

clinical investigators in cancer research to attract the next generation of investigators, increasing the 

current pool of outstanding researchers in clinical research, and improving clinical cancer care through 

training beyond cancer researchers to include nursing and other professionals. The “north–south” type 

of program will be employed as appropriate to train Latin American investigators in the U.S. However, the 

“south–south” type of training programs (in-country) will be utilized in countries such as Mexico, Chile, 

Brazil, Argentina, and Uruguay, where the appropriate facilities and environment exist on a regional basis. 

The Training Program will focus on different levels of training (postdoctoral, fellowship, sabbatical, visiting 

professorship, etc.) and will be funded through the most appropriate mechanisms. For example, the RFA 

and PA mechanisms will facilitate collaboration among the many NIH institutions such as the NCI–FIC Noncommunicable Chronic Diseases Research Training Program. The experience of the FIC in these areas will 

be sought in designing and developing training development programs for the OLACPD. 


 
Office of Latin American Cancer Program Development 

Oficina de Desarrollo de Programas de Cancer en America Latina 

Training 

Program 

Phase II 

Long-Term Strategy 

Promote excellence in science 

and sustain basic and clinical 

research experience 

General Objective 

To develop a robust 

pipeline of basic and clinical 

investigators to sustain a 

level of expertise to conduct 

clinical cancer research 

Conferences and 

Workshops 

Conferences and 

Workshops 

Training: Basic and 

Clinical Research 

Sabbaticals, Visiting 

Professorships 

Postdoctoral and 

Fellowship 

Training Programs 

Figure.4:.Overview.of.Training.Program 

A major focus of the training experience for nearly all investigators will be to provide access to instruction in 

the application of newly established technologies and methodologies. This type of training will be critical to 

establishing and sustaining a strong cadre of cancer researchers at all levels. To accomplish this goal, the 

OLACPD will seek to establish partnerships between existing cancer research networks in Latin American 

and U.S. cancer centers. The goal of these training development programs will go beyond providing direct 

training in technologies to promote the development of the technical and intellectual resources needed to 

build local capabilities. Achieving this goal will promote international collaborations of high-quality research 

standards within and outside Latin America. 

Funding. for. Clinical. Research. Networks. through. Partnerships. As shown in Figure. 5, the OLACPD will 

seek to fund the planned novel networks through a combination of U.S. and Latin American government 

and philanthropic resources. It is anticipated that a combination of partners could range from north–south 

collaborations, such as U.S. partnerships with Latin American entities, to south–south collaborations for 

in-country translational research. 


 
Office of Latin American Cancer Program Development 

Oficina de Desarrollo de Programas de Cancer en America Latina 

Cosponsorships 

(U.S./Foreign) 

Public-Private Partnerships 

Matching Funds 

Targeted Studies 

NCI/FIC Funding 

Grants 

Contracts 

Regional Fundings 

Federal/Local Governments 

Academic Institutions 

Contributions 

(U.S./Foreign) 

Philanthropic Funding 

In-Kind Services 

Resources 

Figure.5:.Funding.OLACPD.Programs.Through.Partnerships 

To further support this concept, and achieve many of the key strategies outlined, the OLACPD plans to 

develop an appropriate business model that would allow the establishment of two to three regional clinical 

cancer networks as illustrated in Figure.2. This concept will be further explored during Phase II of the pilot 

program to determine whether strategically locating these types of offices will facilitate the work of the 

OLACPD. 

Milestones for Phase III (November 2010-September 2011) 

The following milestones are anticipated to monitor progress in Phase III: 

•	 Implement the Phase III strategy for the Scientific and Clinical Research Pilot Program, including formal 

acknowledgment and launch of regional clinical cancer networks and selected full-scale clinical trials 

initiated with appropriate correlative science studies—December.2010–February.2011 

•	 Implement long-term strategy for the Technology and Capacity Building Program, including launch of 

selected regional centers of advanced technology, cancer registries with international accreditation, 

and virtual tumor and specimen banks under way—January.2011–July.2011 

•	 Implement long-term strategy for the Personnel Development Program, including appropriate 

mechanisms for training (e.g., FIC partnerships, RFAs, PAs); development of partnerships for 

technologies/methodologies training; and expansion of the Personnel Development Program to include 

regional training programs—December.2010–June.2011 


 
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Oficina de Desarrollo de Programas de Cancer en America Latina 

Appendix 1 

Research and Health Care Capabilities of Mexico, Brazil, Chile, Argentina, and 

Uruguay 

Mexico 

Policies. and. national. health. plans: The “National Development Plan, 1995–2000” was established as a 

priority for combating inequity among persons, genders, productive sectors, and geographical regions. 

The health policies implemented along the same lines were oriented toward the reorganization of the 

system to expand its coverage and provide more efficient and effective services and to deal with prevalent 

diseases and the new health challenges that have arisen from the changes in the national epidemiologic 

and demographic profile. The provisions of this plan include free choice of family physician, family health 

insurance for those who can pay, decentralization of services, a basic health care package at the municipality 

level, reorganization of the system under the Secretariat of Health, and separation of financing and service 

delivery within the Instituto Mexicano del Seguro Social (IMSS). To meet the second objective, 11 program 

areas were established for disease prevention and health promotion and in-service research. 

Health.sector.reform: In fulfillment of the National Health Sector Reform Program 1995–2000, the system 

was opened to the population with the capacity to pay and resulted in an increase of the insured population 

from 48 million to 55 million. The population without regular access to health care services was reduced to 

500,000 persons. The Secretariat of Health has concentrated more on regulation of the sector and less on 

direct delivery of services. Extensive managerial training has been provided, and measures have been taken 

to improve quality control. In 2000, the Specialized Health Insurance Institutions were created to provide 

comprehensive private health insurance and new financing systems were tested. 

Health. system: The social security system—which covers workers in the formal economy (58 million in 

2000)—comprises several institutions, each of which is funded by contributions from employers, employees, 

and the government. The IMSS is the largest institution in the system and serves about 80% of the covered 

population. The system also includes the State Workers’ Social Security and Services Institute, Petróleos 

Mexicanos, the Armed Forces, and the Navy. The legal framework of the sector is based on two general 

laws: the General Health Law and the Social Security Law. Several Mexican states have their own legislation. 

Within the framework of the North American Free Trade Agreement (NAFTA), intergovernmental groups 

of the U.S., Mexico, and Canada work to harmonize legislation concerning products and health-related 

services. The Secretaría de Salud de México (SS) provides leadership of the health system. Private health 

services are fragmented—48% of the 31,241 beds of private hospitals in 1999 were located in establishments 

with fewer than 15 beds. The SS provides care of unequal quality and with variable prices. Nongovernmental 

organizations provide important development in areas such as reproductive health, domestic violence, and 

AIDS and other diseases, working increasingly in a coordinated way through networks. 

Organization.of.regulatory.actions: The Secretariat of Health is responsible for overseeing the quality, safety, 

and efficacy of drugs, reagents, immunobiologicals, and medical equipment. It maintains national registries 

for all health supplies, regulates marketing by issuing licenses and health product registrations, and oversees 

advertising that appears in the mass media. The verification, analytical control, and evaluation of drugs and 

supplies are performed by Secretariat of Health laboratories or authorized third-party institutes. Potable 

water supply and sanitation services are the responsibility of municipalities. Each state has its own law or 

6

All data in this section have been extracted from Pan American Health Organization materials. 

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code on potable water, as well as a water commission that provides the municipalities with technical and 

financial support. Private enterprise provides water on a very small scale. The use of chemical substances 

is authorized by the General Directorate of Environmental Health under the Secretariat of Health, and the 

Intersecretaria Commission on Pesticide, Fertilizer, and Toxic Substance Control is responsible for their 

regulation and marketing as well as for controlling their effects on health and the environment. Air quality is 

monitored in 14 cities of the country by stations that measure the most critical atmospheric contaminants. 

The General Directorate for the Sanitary Quality of Goods and Services, in collaboration with the National 

Public Health Laboratory, is responsible for monitoring health-related products and services. Between 1998 

and 2000, 24% of the water samples packaged for human consumption had microbiological problems. 

Organization.of.public.health.care.services: Public health care services are provided by the Secretariat 

of Health with support from the social security institutions, especially the IMSS. Programs of community 

health include health promotion and disease prevention activities in homes, schools, and workplaces. The 

SS and the Secretariat of Public Education offered a health program for school children and adolescents in 

30,000 schools and also carried out the Healthy Schools Initiative. Since 1998, all health institutions utilize 

the ICD-10 for classification of mortality. The drinking water infrastructure covered 88% of the population in 

2000; 23 states had coverage higher than 85%, and 5 states had coverage lower than 70%. In 2000, 95% of 

the drinking water was disinfected. Sewage disposal services covered 76% of the population in 2000, and 

5 states had coverage higher than 85%, 17 states had between 70% and 85% coverage, and the remaining 

10 states had coverage lower than 70%. In 2000, 76% of the population had access to sewage services and 

excreta disposal—urban population, 90%, and rural, 37%. There is an official standard for handling hospital 

waste and the majority of such waste is incinerated. 

Organization. of. individual. health. care. services: The organization of individual health care services is 

structured by levels of care. The first level includes actions of health promotion, disease prevention, and 

outpatient care. It also includes basic sanitation, family planning, prenatal care, puerperium and newborn 

care, surveillance of nutrition and growth of the child, immunization, case management of diarrhea, 

antiparasitic treatment, care for respiratory infections, prevention and control of pulmonary TB, prevention 

and control of hypertension and diabetes mellitus, accident prevention and initial management of lesions, 

social involvement, and prevention and control of cervical cancer. The second level provides basic 

specialties at general or specialized hospitals. Outpatient care and hospitalization are available and, in 

general, diagnostic imaging and laboratory support services are also provided. The third level provides 

specialized care of greater complexity as well as clinical and basic research of specialized physicians with 

support of specialized nursing and other professionals. In 1997, the Program of Education, Health and Feeding 

was launched for families in extreme poverty and provides monetary support, educational fellowships, 

nutritional supplement to children younger than 5, pregnant women, and women who are lactating. In 2000, 

some 2.6 million families from 31 states benefited from this program. 

Health. supplies: The national and international pharmaceutical industry is made up of more than 

150 companies. In 2000, they produced more than 95% of drugs for domestic consumption. The sixth edition 

of the official Mexican pharmacopoeia was published in 1994, followed by supplements in 1995, 1997, and 

2000 updating the specifications for drug manufacturing and for marketing in the country. 

Human.resources: In 1999, the rates of physicians, nurses, and dentists per 100,000 had not varied from 

recent years. In 1999 they were 131, 182, and 9, respectively. In that same year, 62,951 physicians and 

29,365 nurses worked in private hospital units. There were 1,033 programs of health sciences. In terms of 

largest numbers, 545 of them are at the specialized level and 297 at the bachelor’s degree level. By area of 

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knowledge, the largest numbers were medicine (509) and dentistry (167). There were 79,524 students in the 

78 schools of medicine in 1999, with 77% at public schools. 

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Brazil 

National. health. policies. and. plans: The national health policy is based on the Federal Constitution of 

1988, which sets out the principles and directives for the delivery of health care in the country through the 

Unified Health System (Sistema Unico de Saude (SUS)). Under the constitution, the activities of the federal 

government are to be based on multiyear plans approved by the national congress for 4-year periods. The 

essential objectives of the health sector were improvement of the overall health situation, with emphasis on 

reduction of child mortality, and political-institutional reorganization of the sector, with a view to enhancing 

the operative capacity of the SUS. The plan for the next period (2000–2003) reinforces the previous objectives 

and prioritizes measures to ensure access to activities and services, improve care, and consolidate the 

decentralization of SUS management. 

Health.sector.reform: The current legal provisions governing the operation of the health system, instituted 

in 1996, seek to shift responsibility for administration of the SUS to municipal governments, with technical 

and financial cooperation from the federal government and states. Another regionalization initiative is the 

creation of health consortia, which pool the resources of several neighboring municipalities. An important 

instrument of support for regionalization is the Project to Strengthen and Reorganize the SUS. 

Regulatory.actions: Procedures for the registration, control, and labeling of foods are established under 

federal legislation, which assigns specific responsibilities to the health and agricultural sectors. In the 

health sector, health inspection activities have been decentralized to the state and municipal governments. 

The environmental policy derives from specific legislation and from the Constitution of 1998. 

Public.health.care.services: The main strategy for strengthening primary health care is the Family Health 

Program, introduced by the municipal health secretariats in collaboration with the states and the Ministry 

of Public Health. The federal government supplies technical support and transfers funding through the Piso 

de Atençao Básica. Disease prevention and control activities follow guidelines established by technical 

experts in the Ministry of Public Health. The National Epidemiology Center, an agency of the National Health 

Foundation, coordinates the national epidemiological surveillance system, which provides information about 

and analysis of the national health situation. 

Individual.health.care.services: In 1999, 66% of the country’s 7,806 hospitals, 70% of its 485,000 hospital 

beds, and 87% of its 723 specialized hospitals belonged to the private sector. In the area of diagnostic 

support and therapy, 95% of the 7,318 establishments were also private. Some 73% of the 41,000 ambulatory 

care facilities were operated by the public. Hospital beds in the public sector were distributed as follows: 

surgery (21%), clinical medicine (30%), pediatrics (17%), obstetrics (14%), psychiatry (11%), and other areas 

(7%). In the same year, 43% of public hospital beds and one-half of the hospital admissions were in municipal 

establishments. Since 1999, the Ministry of Public Health has been carrying out a health surveillance project 

in Amazonia that includes epidemiological and environmental health surveillance, indigenous health, and 

disease control components. With $600 million USD from a World Bank loan, efforts are being made to 

improve the operational infrastructure by training in human resources and research studies. An estimated 

25% of the population is covered by at least one form of health insurance; 75% of the insurance plans are 

offered by commercial operators and companies with self-managed plans. 

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Health.supplies: Brazil is one of the world’s largest consumers of drugs, accounting for a 3.5% share of the 

world market. To expand the access of the population to drugs, incentives have been offered for marketing 

generic products, which cost an average of 40% less than brand-name products. In 2000, 14 companies 

were authorized to produce generic drugs, and about 200 registered generic drugs were being produced in 

601 different forms. In 1998, the National Drug Policy was approved, whose purpose is to ensure the safety, 

efficacy, and quality of drugs and promote rational use and access by the population to essential products. 

The responsibility for national production of immunobiologicals is entrusted to public laboratories, which 

have a longstanding tradition of producing vaccines and sera for use in official programs. The Ministry of 

Public Health invested some $120 million USD in developing the capacity of these laboratories. In 2000, the 

supply of products was sufficient to meet the need for heterologous sera, such as those used in vaccines 

against tuberculosis, measles, diphtheria, tetanus, whooping cough, yellow fever, and rabies. In 1999, quality 

control of transfused blood consisted of 26 coordinating centers and 44 regional centers. 

Human.resources: In 1999, the country had some 237,000 physicians, 145,000 dentists, 77,000 nurses, 26,000 

dietitians, and 56,000 veterinarians. The national average ratio was 14 physicians per 10,000 population. In 

1999, of the 665,000 professional positions, 65% were occupied by physicians, followed by nurses (11%), 

dentists (8%), pharmacists and biochemists (3.2%), physical therapists (2.8%), and other professionals (10%). 

An estimated 1.4 million health sector jobs are occupied by technical and auxiliary training. 

Health. sector. expenditure: In 1998, national health expenditure amounted to $62 million USD, which 

corresponded to nearly 7.9% of the GDP. Of that total, public spending accounted for 41.2%, and private 

expenditure accounted for 58.8%. 

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Chile 

National.health.policies.and.plans:.The policies and plans defined for the period 2000–2006 established the 

following strategic goals: (1) stress the importance of citizen health rights; (2) reform the finance system; 

(3) prepare a program for equitable access to health services; (4) modernize the social safety net for health; 

(5) improve health guarantees in the public sector; (6) develop a government health promotion policy; 

(7) monitor respect for the rights of members of the private health insurance plans (Isapres Banmedica, 

ISAPRE); and (8) institutionalize the quality of care. The Ministry of Health’s short-term goals (2000–2002) 

were to provide timely access to care, respect for the health rights of citizens by adhering to the patients’ 

Bill of Rights, and creation of a national program of user participation. 

Health. sector. reform. strategies. and. programs: To advance reform, the government established an 

interministerial committee in 2000. The basic proposal establishes a guaranteed plan that is binding on the 

public insurer Fondo Nacional de Salud (FONASA) and the private insurers (ISAPREs) and ensures effective 

and timely treatment of the most frequent, most serious, and most costly diseases. Priority is placed on 

primary care, and the family and community health teams will be strengthened. In structural terms, the 

reform is intended to create a solidarity fund, financed by government contributions and three-sevenths of 

the mandatory health care quotas, which will finance a guaranteed plan for the members of the FONASA 

and the ISAPREs. 

Health.system: The Ministry of Health is the lead agency in the sector. It formulates and establishes health 

policies; issues general standards and plans; and supervises, monitors, and evaluates compliance with 

them. The Health Services, the FONASA, the ISAPRE Authority, the Public Health Institute, and the Central 

Supply Clearinghouse report to the Ministry of Health. There is also an Environmental Health Service in the 

Santiago metropolitan region. The Public Health Institute is responsible for regulating drugs and medical 

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inputs. The health services system is mixed. Public insurance is provided through the FONASA, which 

receives contributions from its members and transfers from the national government to cover indigent 

individuals and to carry out public health programs. The private sector is represented by ISAPREs, which 

are health insurers. Services are delivered by public and private suppliers. The vast majority of primary care 

establishments depend on “communes,” and the hospitals are under the direction of the Health Services. 

There are a series of clinics, centers, laboratories, and pharmacies managed by private individuals or 

companies. The FONASA covers 63% of the population and the ISAPREs 23%. The remaining 14% of the 

population is covered by other private plans (such as the armed forces plan) or has no insurance at all. 

Organization.of.health.regulatory.actions: Health care is regulated by rules that form part of the Ministry 

of Health’s programs. The programs define coverage, frequency of contacts between users and service 

providers, and the responsibilities of the different levels in the system. The Health Services directorates 

are responsible for regulating public and private health care establishments located in the territory of the 

respective Health Service. 

Health. supplies: The drug market is governed by a series of regulations on standards for products and 

distribution and sales chains and is affected by factors such as the significant market share of generic 

drugs, the large presence of national laboratories, and the existence of the Ministry of Health’s Central 

Supply Clearinghouse. There are no price controls on medications. Generic drugs account for 38% of the 

total pharmaceutical market. 

Food.quality: A new regulation governing food safety has been promulgated. There is also a control and 

hygiene program with national coverage and coordination, which is supported by the national network of 

bromatological laboratories. 

Prevention.and.control.programs: The Ministry of Health’s basic programs (children, women, adults, and 

oral health) have been designed to take a comprehensive approach, including promotion, prevention, 

treatment, and rehabilitation. The Ministry of Health has established specific prevention programs, including 

immunization, food supplements, control of respiratory diseases, prevention of traffic accidents, control of 

the Red Tide, and eradication of Chagas disease. There are also programs that detect uterine cervix and 

breast cancers with coverage of 60% and 30%, respectively. 

Health.analysis: The Public Health Institute carries out epidemiological surveillance in cooperation with 

the Ministry of Health’s Epidemiology Department. Through the National Control Department, the Public 

Health Institute monitors the national system for control of pharmaceutical products, food, cosmetics, 

pesticides for sanitary and domestic use, and medical articles. With regard to potable water and excreta 

disposal services, in 1998, 99% of the urban population had access to potable water through public systems, 

90% had access to sewage systems, and 4% had access to mainly septic tanks and soakaways. Of the 

urban population, 1% (115,000 people) had no water service, and 7% (853,000 people) had no adequate 

sewage disposal system. Pollution prevention and control studies indicate that metering equipment should 

be installed in the cities of Rancagua, Temuco, Valparaiso, and Viña del Mar. 

Organization.of.individual.health.services: The public health network comprises ambulatory and hospital 

facilities offering services of differing complexities. They include 196 general hospitals, 20 high-complexity 

hospitals, 526 primary care clinics, 1,840 rural health posts and medical stations, and 73 establishments of 

other kinds. There is 1 clinic for about 28,500 people (1 per 17,100 if only FONASA members are considered). 

There is 1 rural post for every 1,900 rural dwellers, considering only FONASA members, who represent an 

estimated 14.6% of the total population. The country has about 30,000 hospital beds, or 1 bed per 5,000 people 

(or 1 bed per 3,000 FONASA beneficiaries). In 1998, there were approximately 1 million discharges from 

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public hospitals. Acute treatment is provided by emergency services in hospitals and emergency primary 

care services. The main private hospital and clinics also offer emergency care. Auxiliary diagnostic and 

therapeutic services are offered by the public and private sectors. In the public sector, the services are 

located in hospitals and respond to demand generated by ambulatory services and hospitals. 

Human. resources: The country had 17,467 physicians in 1998 (18 physicians per 10,000 population). It is 

estimated that just 8,000 of the country’s 18,000 nurses worked in the public sector. In 2000, the public health 

sector employed 90,000 people, and administrative and service staff members accounted for one-third of 

the total. 

Health. research. and. technology: Health research is carried out primarily in universities and research 

centers. The government, through the National Science and Technology Council, provides incentives for 

health research that has targeted basic sciences and clinical areas more than public health. To promote 

essential research on the country’s priority health problems, the Ministry of Health has developed a national 

research policy on health policies. 

Health. sector. expenditure. and. financing: In 1999, average per capita spending for the total beneficiary 

population of the FONASA and ISAPREs was $279 USD ($245 USD for FONASA beneficiaries and $362 USD 

for ISAPRE beneficiaries). The public sector is financed from government contributions, quotas, and 

copayments by members of the public system and operating system. In 1999, this distribution was 54%, 

39%, and 7%, respectively. In 1990, the figures were 41%, 53%, and 6%, respectively. Direct contributions by 

municipalities, which averaged $8.50 USD per capita in 1998, should be added to these figures. Spending on 

health accounted for 17.1% of public social spending in 1999. As a percentage of the GDP, health spending 

rose from 2.0% in 1990 to 2.8% in 1999. 

Technical. cooperation. and. external. financing: In 2000 external technical cooperation was received for 

projects on the quality of life, mental health, epilepsy, measures of equity in health, and HIV/AIDS. Efforts 

were made to seek lines of work shared with the United Nations system and between it and its national 

counterparts. 

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Argentina 

National sanitary policies and plans: The Federal Plan of Health 2004–2007 proposes the following as main 

lines for the new roles and responsibilities of the different parts of the sector : 

•	 Strengthening of the National Ministry of Health and the Provincial Ministries in their governing duties. 

•	 Guarantees given by the regions on the assurance of the universal basic coverage. 

•	 Development of preventive and promotion programs, emphasizing primary care and respecting the 

growing mechanisms of derivation within the care network by the provinces and townships. 

•	 Protection of the financing of the established programs. 

•	 Organization of the people to promote their role in the design and implementation of the model. 

Health.system:.The Argentine health system has two important characteristics. First, it is very decentralized 

to the provincial level. The second important characteristic is the historical role that workers have played 

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in the country. During the 1950s, the main instrument to finance health care was the responsibility of the 

workers’ unions constituted in the so-called Social Works (Obras Sociales). Even today, those Social Works 

represent more than 300 organizations with their corresponding health care plans, whose effectiveness is 

irregular. The Ministry of Health publishes basic standards about the provision of health services and the 

conditions of functioning of those services. 

Prevention.and.control.of.diseases: The Program of Maternal and Infant Health Care protects women and 

children at risk. It emphasizes prenatal care, delivery of care, and control of the health and development of 

children. The vaccine coverage increased progressively during the 1980–2002 period. Since 1990, vaccine 

coverage has been higher than 80% in all provinces and, since 1995, higher than 85%. In 2002, the national 

coverage was 93.8% for Sabin (third dose), 92.5% for DPT (third dose), and 95% for measles vaccine. The 

program against human retrovirus and AIDS provides charge-free antiretroviral drugs to the uninsured 

population, supports the determinations of viral load, and develops informative actions directed to the 

general public and focuses those actions on high-risk groups. 

Health.analysis: The National Program of Health Statistics (NPHS) provides statistics on living conditions 

and health problems, delivering data on vital statistics (marriages, birth rate, mortality), morbidity, hospital 

productivity, and availability and usage of health resources for the process of management on various 

levels. The National System of Epidemiological Surveillance (NSES) is responsible for the register of 

Mandatory Medical Notifications. The NSES consolidates, on a weekly basis, the data of those diseases 

whose notification is mandatory, as well as associated laboratory data. 

Drinkable.water.and.sewage.disposal: In the entire country (urban and rural areas), the drinkable water 

and/or drainage services are operated by 1,548 companies or bodies. Of these organizations. 68% are private 

companies and the remaining 32% are state-operated bodies. The coverage of drinkable water in 2001 was 

77%, but there is inequitable distribution of these services. 

Food.protection: The development of local and provincial systems of food protection is currently a priority 

within the preventive approaches based on the use of good practices of food rendering (processing), 

analysis of risks, and control of critical points. The communication of risks has been strengthened through 

educational campaigns using mass media, education programs in schools, and development of educational 

materials for use in different fields. Argentina coordinates the Codex Alimentarius Latin America Committee 

and the Salmonella and Pulse Net surveillance networks for the region. 

Individual.health.services:.All provinces have organized networks of hospital and ambulatory services, some 

of which are very advanced. Many others have primary care services, which are not always well integrated 

with the provincial networks, which have wider coverage and response capacity. Some provinces have 

integrally transferred the primary health care to the township level. Diagnostic support services in the public 

sector are integrated into the hospital network. In the private sector, those services are mostly located in 

the hospital network, but in the largest cities, autonomous diagnostic support units usually hire services 

with health plans. 

Health. supplies: Within the drug market, almost all the final products are produced within the country. 

However, in the case of other medical and health supplies, those produced in Argentina represent 25% of 

the total. Although there is no updating on the size and structure of immunobiological products in Argentina, 

it is estimated that 85% of those supplies are imported and 15% are locally produced with the required quality 

standards. In the Bases of the Federal Health Plan 2004–2007, the importance of the Drugs National Policy 

(DNP), which was incorporated in 2002, ratifies and establishes a new regulatory framework with clear and 

set rules that benefit the sanitary system. That policy was defined initially in the Need and Urgency Decree 

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No. 486/2002, which established the sanitary emergency in the national territory and was ratified by the 

Law of Use of Drugs by their Generic Name (No. 25,649). The absolute priority assumed by the DNP is the 

promotion of population access to the drugs. According to international experience, the principal strategies 

that were defined were the regulation of the drug market and the direct provision of drugs to persons 

without the economic resources to buy medicines from drugstores. The national government guaranteed, 

from 2004 to 2007, through the REMEDIAR program, the supply of drugs for mostly ambulatory treatments to 

5,300 Centers of Primary Health Care in the country. The REMEDIAR program allows response to 80% of all 

patient visits in those centers. 

Human. resources: The results obtained by the National Network Observatory of Human Resources for 

Health in Argentina showed that in 1998 there were 440,100 health workers (3% of the economically active 

population). Doctors represent 24.7%; dentists, 6.6%; and nurses and assistant nurses, 19.6%. 

Health. research. and. technology: The financing system for research is unusual. It consists of awarding 

positions and doctorate scholarships, given by the Science and Technique Ministry through the CONICET, 

to scientific and technological researchers of varying levels who will be working in the most diverse 

institutions, both public and private. The national universities and the National Health and Environment 

Ministry through the Undersecretary of Sanitary Relations and Health Research also contribute through 

research scholarships. 

Health.sector.expenditure.and.financing:.In 2003, 54% of the health expenditure was public and 46% was 

private. Of the public expenditure, 55% was financed by Social Security (5%) and directly from taxes (45%). 

In 2002, the total health expenditure was estimated at $23.6 million USD, which represented a per capita 

expenditure of about $745 USD. The largest external financing contributions come from loans for projects 

from the Inter-American Development Bank and the World Bank. 

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Uruguay 

National.health.plans.and.policies: The following six main health-related objectives have been established 

for the 2000–2005 period: (1) strengthen the management of public and private health care institutions; 

(2) adapt the supply of available services to the epidemiological characteristics and needs of the population; 

(3) make health care coverage universal by facilitating access and care at the four levels of complexity; 

(4) enhance the quality of services at the four levels of complexity; (5) rationalize the use of services at the 

Institutes of Highly Specialized Medicine; and (6) promote the participation of service users and health 

care institutions in order to solve problems in a climate of trust and respect for the rights of citizens. The 

Ministry of Public Health has established a program, under an agreement with the principal health care 

institutions, to overcome the crisis affecting the Collective Health Care Institutions (CHCI) and to maintain 

job opportunities. Reducing the prices that the public pays for drugs is one of the priorities established by 

the Ministry of Public Health. Prices could drop significantly, as much as 40%, if an agreement were reached 

between the Ministry and the chambers representing domestic and foreign laboratories. 

Health. sector. reform: The government’s main concern is the coverage and maintenance of the mutual 

assistance system, which means reorganizing the management of the mutual assistance associations and 

their health care models. To this end, the Minister of Public Health convened the Intersectoral Commission 

for the Strengthening of the Mutual Assistance System. In 2000 and early 2001, the Ministry conducted a 

number of CHCI management audits to analyze the financial status of the institutions. The audits reflected 

the debt situation of the CHCIs. 

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Health.system: The public health system in Uruguay comprises two sectors: public and private. The public 

sector is made up of the institutions under the Ministry of Public Health, through the State Health Services 

Administration (ASSE); University of the Republic (University Hospital); Armed Forces Health Service; 

Police Health Service; Social Welfare Bank; health services of autonomous and decentralized agencies; 

and services delivered by the 19 departments. The private health sector consists mainly of the collective 

health care institutions, which are private, nonprofit organizations that are formed and operate under the 

provisions of Law No. 15,181 and its regulatory decrees. There are some 48 CHCIs that provide medical 

care to almost one-half of the population through prepaid comprehensive health insurance. There are also 

several private sanatoriums, which provide private medical care to high-income groups; most of them lease 

their services to the CHCIs and offer partial insurance coverage. In terms of coverage, the ASSE serves 

33.7% of the population; the CHCIs, 46.6%; the Armed Forces Health Service, 4.2%; the Police Health Service, 

1.8%; and other institutions, 1.2%. Some 11.7% of the population does not have formal coverage, and there 

are no data for 0.9%. Partial medical insurance has been expanding rapidly since the early 1980s. 

Organization.of.public.health.care.services: In the area of maternal and child health, the Ministry of Public 

Health has promoted activities aimed at newborns weighing less than 1,500 gm and at sudden infant death, 

especially at home. It was anticipated that starting in 2001, professional assistance would be provided free 

of charge to all women receiving care in the public sector. 

Potable.water,.excreta.disposal,.and.sewerage.services:.The coverage of potable water services is high in 

Uruguay (98% of the total population). Sewerage service coverage is 80% in the urban area of Montevideo. In 

urban areas in the provinces, such services are provided to one-half of the population. The State Sanitarian 

Works Administration (OSE) has set in motion plans for the treatment of effluents in large cities and has 

proposed other solutions appropriate for small towns. Of the country’s population, 46% is connected to the 

sanitation system and 48% eliminates wastewater “in situ.” 

Food. safety: Uruguay has traditionally had a high level of food hygiene. The year 1994 saw the start of 

intersectoral coordination and structuring of institutional and technical resources for food safety. The 

National Advisory Commission for Foodstuffs was formed. It operates within the orbit of the Ministry of Public 

Health and consists of representatives of the national and municipal public sector, chambers of industry and 

the food trade, and consumer organizations. The System for the Epidemiological Surveillance of Foodborne 

Diseases, which is coordinated by the Ministry of Public Health, provides nationwide coverage. 

Organization.of.individual.health.care.services: There are 76 blood collection centers in Uruguay, 51 of 

which process blood. Transfusions are regulated by a number of laws and decrees. 

Health. supplies: A broad legal framework regulates the importation, production, distribution, sale, and 

advertising of drugs. The Ministry of Public Health controls the requirements and demands for registering 

drugs that are regarded as necessary, effective, safe, and produced under conditions that ensure their 

quality. It also monitors the standards for the inspection of production laboratories, points of distribution and 

sale, and production processes. To perform this task, the Ministry has units for evaluation and registration, 

inspection (of manufacturers, importers, distributors, and sale and disbursement sites), and laboratory 

analysis for drug quality control. The basic inspection activities focus on production laboratories or marketing 

and on products, including labeling and advertising. Several factors impede the Ministry of Public Health’s 

performance of these functions to varying degrees, among them shortages of human resources, delays in 

administrative processes, and the interests of the pharmaceutical industry. 

Human. resources: As of December 31, 1999, there were 12,486 physicians (39.5 per 10,000 population), 

2,613 professional nurses (8.2 per 10,000 population), and 4,050 dentists (12.8 per 10,000 population) in 

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Office of Latin American Cancer Program Development 

Oficina de Desarrollo de Programas de Cancer en America Latina 

Uruguay. The training of human resources for health is not planned. In addition to the University of the 

Republic, private universities and institutes for the training of physicians, professional nurses, dentists, and 

nursing auxiliaries have been established in recent years. In general, there is a surplus of physicians and a 

shortage of professional nurses. 

Health.research.and.technology:.Very little research in health technology is conducted in Uruguay, and it is 

performed outside the Ministry of Public Health. Records are not available to estimate the number of clinical 

trials for evaluating the efficacy and safety of new procedures. 

Health.sector.expenditure.and.financing: Per capita health expenditure in 1998 was $697 USD, and total 

spending on health was equivalent to 10% of GDP. Public spending (46%) and private spending (54%) were 

relatively proportional. Public spending on health accounted for 14% of overall government outlays. The 

public sector accounts for all spending on health promotion, disease prevention, and epidemiological 

surveillance. In 1998, the private sector spent approximately four times more on drugs ($266 million USD) 

than the public sector ($70 million USD). In addition, the private sector spent $975 million USD on personnel 

costs, while the public sector spent $223 million USD. 

External.technical.cooperation.and.financing: Both the World Bank and the Inter-American Development 

Bank (IDB) cooperate with the Ministry of Public Health and other institutions in the area of social 

services. Cooperation focuses on such areas as the decentralization of the Ministry’s health care services, 

improvements in the identification of beneficiaries, and the training of human resources to manage the 

services. The Ministry of Public Health, in coordination with PAHO, continues the activities indicated in 

the Agreement between Uruguay and the Region of Emilia-Romagna, Italy, in the area of mental health. On 

several occasions in the 1998–1999 period, the PAHO/WHO Country Office in Uruguay provided advisory 

services in the area of health services management, with a view toward strengthening the Dr. Manuel 

Quintela University Hospital. 

http://www.paho.org/English/DD/AIS/cp_858.htm 

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