Fiocruz Amazônia develops project to strengthen health in the Triple Border

Fiocruz Amazônia and the University of Washington have partnered to implement, along with several other educational and research organizations, the INSIGTH Project, aimed at promoting the strengthening of health surveillance in the Triple Frontier region (Brazil, Peru and Colombia), with a focus on endemic infections such as malaria, tuberculosis, dengue, sexually transmitted infections (STIs), viral hepatitis, waterborne diseases, and fevers of unknown origin – all emerging diseases that affect the most vulnerable populations of the three countries. The project will be funded by the Centers for Disease Control and Prevention (CDC-USA), for the development of joint actions between the countries, with support from the Pan American Health Organization (PAHO), National University of Colombia, Fiocruz Bahia, the Health Surveillance Foundation Dra Rosemary Costa Pinto (FVS-AM), Universidad Nacional de la Amazonía Peruana, the Departments of Health of Leticia and Tabatinga, and local representatives from Santa Rosa, in Peru.

Project Insight aims to promote the strengthening of health surveillance in the Triple Frontier region (photo: Fiocruz Amazônia)

It is a pilot project and part of a cooperation agreement between the CDC, the International Training and Education Center for Health at the University of Washington (UW I-TECH), and Fiocruz Amazônia. For two days (June 13 and 14), representatives of health, teaching, and research institutions from the three countries met at the headquarters of the National University of Colombia, in the city of Leticia (bordering Tabatinga), for the presentation of the project and the situational diagnosis of health in the Triple Frontier region. The project will be coordinated by the Health Situation and Care Management Laboratory for Indigenous Populations and other vulnerable groups (SAGESPI), at Fiocruz Amazônia. The director of Fiocruz Amazônia, Adele Benzaken, highlighted the importance of the initiative, as it contributes to the strenghtening of surveillance in the border area with prevention, diagnosis, and treatment actions, adding to other initiatives already underway in the region, focused on the indigenous and dweller population from the Javari Valley and the Peruvian and Colombian Amazon. "The objective of this meeting was to present the project and discuss feasible proposals for action strategies, built in a collective and participative way by the three countries", explains Benzaken.

In addition to Brazil, Colombia and Peru, INSIGHT intends to operate in the region of Brazil's Triple Frontier with Paraguay and Argentina. UW I-TECH's Regional Director for South America, Fernanda Freistadf, explains that the INSIGHT Project is part of CDC's global program, the GHPDI, which aims to increase governments' access to more accurate, complete, and rapidly available public health data to detect, monitor, investigate, and respond effectively to public health problems. "We have a cooperation agreement with the US CDC and, within this funding mechanism, the goal is to strengthen health surveillance in two triple frontiers in South America. Here, in the Triple Frontier between Colombia, Brazil, and Peru, we are working in collaboration with Fiocruz and the support of partners in Tabatinga, Leticia, Santa Rosa, and Iquitos to identify what are the needs in relation to surveillance and in which areas it will be possible to intervene and support so that we can have practical results", she said.

The project should last until September 2024, with a schedule of meetings and gatherings to discuss data and define activities. "This first moment was for diagnosing the needs, presenting the project, and proposing actions that can be carried out", said Fernando Herkrath, a researcher from Fiocruz Amazônia, head of SAGESPI and one of the coordinators of the project. According to him, the meeting generated several proposals, among which are to work with national and international mechanisms for the signing of a tripartite agreement, training of professionals, including indigenous and non-indigenous community health agents, definition of local protocols, periodic meetings to analyze the situation, preparation of joint epidemiological bulletins from the three countries for priority diseases, standardization of data from each country to facilitate information sharing and analysis, and consolidation of a common notification and response network between the countries.

"By identifying the needs, we can develop an action that provides results, not one that does not leave the paper", assesses Freistadf, highlighting the importance of the partnership with Fiocruz Amazônia, given the opportunity to expand the University of Washington's projects in Latin America. Adele Benzaken highlights the importance of the partnership with Fiocruz Bahia for the definition of health surveillance strategies in the region. Present at the meeting, Vinícius de Araújo Oliveira, public health technologist and researcher at the Center for Data and Knowledge Operation in Health (CIDACS), of Fiocruz Bahia, explains that he intends to contribute to the project through the implementation of the Digital Health Surveillance, a new line of health surveillance supported by digital data, which is being developed by CIDACS.

The project should run until September 2024, with a schedule of meetings to discuss data and define activities (photo: Fiocruz Amazônia)

"We need to understand what this field research will look like to understand the work process that generates the data and how they are used by local workers and managers to make decisions", says Vinicius, adding that the strategies should allow for greater agility and transparency in the exchange of information in the Triple Frontier of Brazil, Peru, and Colombia. "It becomes a challenge because this city (Leticia) is very peculiar, practically a trinational city, with a very large informal integration among the health teams," he points out, remembering that the challenge is to think how this flow of communication, alerts, feelings, perceptions of the surveillance agents of each country can become an institutionalized flow, respecting the sovereignty of the countries and allowing a quick response to alert situations.

In this sense, the managing director of the Amazonas Health Surveillance Foundation – Dr. Rosemary Costa Pinto (FVS-RCP), Tatyana Amorim, present at the meeting, assessed the project as an important step towards the strengthening of health surveillance in the Triple Frontier territory. "Each country has its own health information system with its own peculiarities, and it is in this sense that we seek, through the formalization of the international agreement, to advance in the trinational health situation room", she said. At the end of the meeting, the participants were able to see the facilities of the Frontier Laboratory, in the city of Tabatinga, and the Health Department of the city of Leticia.

Frontiers in South America

South America has a great extension of frontiers, many of them binational and trinational, situation that worries the Pan American Health Organization (PAHO). Carlos Arosquipa, consultant for PAHO's Sub-Regional Program for South America, explains that PAHO has been working for several years in the scope of the frontiers, where processes have been developing which can be more vulnerable for the populations that live in these areas. "In the frontier regions, we have many integration processes. In South America, frontiers are not physical, they are virtual. Populations move very dynamically, and this also makes it much easier for diseases to spread from one country to another. The pandemic has shown us that we must strengthen our actions at the frontier level, not only to keep them safer for those who live in these areas, but also to ensure that the population can travel and move around in good conditions", he said, referring to the project as an opportunity, supported by PAHO, to develop good practices and joint work models between country governments and local players to improve the health of populations in these territories.