Política industrial farmacéutica, un requisito clave para la autonomía sanitaria de Colombia / Pharmaceutical industrial policy, a key requirement for health autonomy in Colombia

Colombia depende de la importación de medicamentos, así como de gran parte de los materiales (principios activos y excipientes) requeridos para su elaboración; problemática que genera consecuencias sanitarias y macroeconómicas, las cuales se agudizan en el contexto de desindustrialización nacional y de disrupción tecnológica. De esta manera, se acepta que la disponibilidad y acceso a medicamentos y otras tecnologías sanitarias esenciales son un requisito fundamental para alcanzar la autonomía sanitaria de un país. Por lo tanto, resulta imprescindible coordinar esfuerzos entre diversos sectores sociales para desarrollar una agenda pública enfocada a la creación de condiciones que fortalezcan las capacidades científicas y tecnológicas de la industria farmacéutica local, y con ello, mejorar el suministro farmacéutico del país. En el presente documento se presentan conceptos teóricos y prácticos que deberían ser considerados en la definición y materialización de una política pública encaminada a fortalecer la industria farmacéutica y favorecer la autonomía sanitaria de Colombia.

Colombia has a notorious dependency on the importation of medicines, as well as a large part of the materials (active ingredients and excipients) required for their manufacture. This problem generates health and macroeconomic consequences, which are exacerbated in the context of national deindustrialization and technological disruption. In this way, it is accepted that the availability and access to medicines and other essential health technologies are a fundamental requirement to achieve the health autonomy of a country. Therefore, it is crucial to coordinate efforts between several social sectors to develop a public agenda focused on creating conditions that allow strengthening the scientific and technological capabilities of the local pharmaceutical industry, thereby, improving the country's pharmaceutical supply. This document presents conceptual and practical topics that should be considered to defining and materializing a public policy aimed at strengthening the local pharmaceutical industry and favoring Colombia's sanitary autonomy.

From Intention to Action: Nurses as Policy Advocates for Asthma Care in Schools.

Nurses are familiar with policy at the federal, state, local, and institutional levels, but drafting a policy memo might be new to some. School nurses may have an interest in writing a health policy memo on their own, with colleagues, as part of a nursing organization, or with students who are interested in learning about policy development, school health, and safety. The intention of writing a policy memo is to offer a concisely written analysis of an issue, including background, landscape, and available options, along with recommendations for action to persons in authority, such as congressmen, senators, local officials, or school boards. The first section of this article serves as an exemplar of a policy memo, using the public health topic of asthma. Next, the article focuses on barriers to policy development for this condition in schools and offers selected strategies to address those barriers. While a discourse concerning barriers is not a typical component of a policy memo, this section shows how school nurses can draw on evidence to consider the best way to make positive change. To construct a sturdy argument for change, school nurses need to appreciate potential counterarguments, which is why this exemplar is included.

Welsh 2013 deemed consent legislation falls short of expectations.

Wales, in 2013, was the first country in the United Kingdom to pass legislation introducing presumed (or deemed) consent for organ donation, and remains the only one. It was introduced in an attempt to increase the number of life-saving transplants taking place in the UK, in a move that policy makers hoped would mirror Spain's success. More recently, pressure has been mounting for England to follow suit, with a public consultation currently in progress. However, the Welsh system has been far from a success, raising the question of why campaigners are so adamant that it should be replicated. Before the Welsh Government introduced the Human Transplantation (Wales) Act there had been no strong evidence to suggest it would make a difference, with countries boasting both high organ donation rates and presumed consent legislation demonstrating no clear causal relationship between the two facts. In addition, a recent report evaluating the Act has highlighted its failure to improve donation rates, and has even presented some potentially concerning statistics that may suggest a negative impact. This paper first considers presumed consent in other countries - Spain and Brazil - before illustrating the underwhelming progression of Wales' new system and the need to look to other options.

Discursos interpretativos y prácticas deliberativas: propuesta metodológica para formulación de políticas públicas sanitarias en Colombia / Interpretative speeches and deliberative practices: a methodological proposal for the formulation of public health policies in Colombia

RESUMEN Objetivo Formular políticas públicas sanitarias en escenarios de gobernanza local mediante la participación comunitaria, requiere reconocer la interacción de todos los actores sociales mediante enfoques argumentativos. Métodos A partir de un enfoque hermenêutico crítico, se utilizó un método retórico argumentativo para la formulación política desde un escenario socio céntrico, a partir de un diálogo de saberes entre la comunidad e instituciones locales, que permitieron identificar y comprender problemáticas sociales relevantes en salud, relacionadas con primera infancia y familia. Resultados Se construyó una política pública integral armonizada con programas sociales en salud existentes, para intervenir aspectos en referencia a la primera infancia, infancia, adolescencia y familia, donde las soluciones y su implementación parten de un núcleo participativo que trasmuta lo existente hacia algo inherente a la comunidad. Conclusiones El enfoque argumentativo en las políticas públicas reconoce el núcleo dialéctico de la política acercando la comunidad a los entes gubernamentales mediante la participación ciudadana activa en procesos de identificación, implementación y puesta en marcha de políticas sociales.(AU)

ABSTRACT Objective To propose public health policies in local governance scenarios through community participation; this requires recognizing the interaction of all social actors through argumentative approaches. Methods Considering a critical hermeneutic approach, an argumentative rhetorical method was used to conduct a political formulation from a socio-centric scenario, based on a dialogue of knowledge between the community and local institutions, which allowed to identify and understand relevant social problems in health, related with early childhood and family. Results A comprehensive public policy was built in accordance with existing social health programs to intervene aspects referring to early childhood, childhood, adolescence and family. Solutions and their implementation arise from a participatory nucleus that reconciles institutional political interests and social needs of the local community. Conclusions The argumentative approach in public policies recognizes the dialectical nucleus of politics by bringing the community closer to government entities through active citizen participation in processes of identification, implementation and execution of social policies.(AU)

Social stigma, legal and public health barriers faced by the third gender phenomena in Brazil, India and Mexico: Travestis, hijras and muxes.

AIM AND METHODS: The aim of this article is to provide a narrative literature review of the 'third gender' phenomenon in Brazil ( Travestis), India ( Hijras) and Mexico ( Muxes), considering the social stigma, the legal and health aspects of these identities. RESULTS: These three groups share similar experiences of stigmatisation, marginalisation, sexual abuse, HIV infection, infringement of civil rights and harassment accessing health services. Brazil, India and Mexico public services for the third gender conditions are still very scarce and inadequate for the heavy demand from potential users. DISCUSSION AND CONCLUSION: Although all three countries have used legislation to promote provision of comprehensive healthcare services for third gender, there is still strong resistance to implementation of such laws and policies. Brazil, India and Mexico face a huge challenge to become countries where all human rights are respected.

Sociopolitical Categories Evaluated in Nutrition Programs and Policies in Latin America / Categorías sociopolíticas evaluadas en programas y políticas nutricionales en América Latina / Categorias sociopolíticas avaliadas em programas e políticas nutricionais na América Latina

Abstract The evaluation of nutrition programs and policies has traditionally focused on analysing the impact and biological outcomes of their actions. Objective: To examine whether evaluations of nutrition programs include the following sociopolitical categories: (a) the right to food; (b) citizenship building; (c) civil participation in public policies; (d) women's empowerment; and (e) territoriality in policy planning. Methodology: A comprehensive literature review of articles and documents that evaluate food and nutrition programs carried out in different Latin American countries and published during 2005-2013. Results: It was found that the evaluations carried out generally do not use these categories. In the cases where they are used, the conceptual development applied to the evaluation process is still incipient. Discussion: This study analysed the sociopolitical categories of: the right to food; citizenship building; civil participation in public policies; women's empowerment; and territoriality in policy planning, and found that although these categories are not prioritised when nutritional programs in Latin America are assessed, in most cases they form the basis of these programs. Conclusion: Social protection nutrition programs demand new objectives and actions. It is necessary to apply evaluation criteria that account for these new underpinnings in order to establish consistency between government institutions' discourse, and the reality of their efforts.

Resumen La evaluación de programas y políticas nutricionales se ha enfocado tradicionalmente al análisis del impacto y resultados biológicos de las intervenciones. Objetivo: Examinar si las evaluaciones a programas nutricionales incluyen las siguientes categorías socio-políticas: (a) El derecho a la alimentación, (b) La construcción de ciudadanía, (c) La participación ciudadana en las políticas públicas, (d) El empoderamiento de la mujer y (e) La territorialidad en las políticas de planificación. Metodología: Revisión integrativa de la literatura sobre artículos y documentos de evaluaciones a programas alimentarios y nutricionales en países de América Latina publicados entre 2005 y 2013. Resultados: Se encontró en general que en las evaluaciones no se indaga por estas categorías; en los casos en que se hace su desarrollo conceptual aplicado a los procesos de evaluación es incipiente. Discusión: El principal hallazgo es que las categorías sociopolíticas analizadas no se encuentran entre las prioridades en la evaluación de programas nutricionales en América Latina, aunque en la mayoría de los casos son la base de estos programas. Conclusión: Los programas nutricionales de protección social demandan nuevos objetivos e intervenciones. Es necesario aplicar criterios de evaluación con nuevas bases, con el fin de dar coherencia entre los discursos de las instituciones gubernamentales y sus acciones.

Resumo A avaliação de programas pras políticas nutricionais focava tradicionalmente ao estudo do impacto e os resultados biológicos das intervenções. Objetivo: Examinar sim as avaliações aos programas nutricionais incluem as seguintes categorias sócio-políticas: (a) O direito pra alimentação, (b) A construção da cidadania, (c) A participação da cidadania nas políticas públicas, (d) A apropriação, por parte da mulher e (e) A territorialidade nas políticas de planificação. Métodos: Revisional integracionista de a literatura sobre artículos e documentos dessas avaliações aos programas alimentares e nutricionais em países da América Latina publicados entre 2005 e 2013. Resultados: Se encontrou em geral que nos exames nem se pergunta por estas categorias; nos casos que se faz seu desenvolvimento conceitual aplicado aos processos de avaliação é um cisco. Discussão: O principal achado é que as categorias sociopolíticas analisadas não se encontram entre as prioridades na avaliação de programas nutricionais na América Latina, ainda que na maioria dos casos são a base de estes programas. Conclusão: Os programas nutricionais da proteção social demandam novos objetivos e intervenções. É necessário aplicar critérios de avaliação com novas bases, com o fim de dar coerência entre os discursos das instituições governamentais e as suas ações.

Developing local health policy: Profiling needs and opportunities in the Municipality of Quito, Ecuador.

We describe the steps taken and analysis applied in developing a local health policy agenda for the city of Quito, in Ecuador. In 2014, the Health Commissioner's Office of the Municipality of Quito analyzed the city's epidemiological health profiles, social determinants of health, the legal authority of the Municipality, and relevant literature to understand the city's health burden and develop a Ten-Year Health Plan (2015-2025). Results revealed that Quito's population suffered from noncommunicable chronic diseases (diabetes and hypertension) and identified the primary risk factors (poor nutrition, physical inactivity, and resulting overweight or obesity). Other common conditions included respiratory diseases, mental health conditions, deaths and injuries from motor vehicles, violence, and physical insecurity. The plan emphasized health promotion and disease prevention with the aim of transforming citizens' health perceptions with their active participation by fostering public and private intersectoral commitment to improve the quality of life of the population .

Distinctive distribution of HPV genotypes in cervical cancers in multi-ethnic Suriname: implications for prevention and vaccination.

Suriname is ranked as high-risk country for cervical cancer, but recent national data of HPV prevalence and distribution in cervical cancer is scarce. In a retrospective cross-sectional study, cervical cancer incidence, HPV prevalence and HPV-type-specific distribution were investigated in all cervical cancer cases (n = 111), diagnosed in two consecutive years. HPV presence and type-specific prevalence were determined in paraffin-embedded biopsies utilizing master-nested multiplex PCR assays, targeting 14 HPV types. The age-standardized incidence rate of cervical cancer was 22·4/100 000 women, justifying revision of the current international ranking of Suriname. Eleven HPV types were detected, with the most common types in descending order of frequency: 16, 18, 45, 66, 58/52/35. HPV16 was predominant, although with markedly low presence (25%). HPV16 or 18 infections were detected in 43% of the cases, while 28% were untyped, implicating a divergent HPV-type distribution in Suriname with significant variation in the prevalence of less common high-risk virus types and/or presence of HPV16 variants. HPV-type distribution differed between ethnic groups. A vaccination efficacy of just 28-30% was anticipated, next to an uneven vaccination impact in different ethnic groups, cautioning Suriname and other multi-ethnic countries to tailor the information presented to different ethnic communities.

Agriculture and food security challenge of climate change: a dynamic analysis for policy selection

This study presents an empirical examination of climate change related to vulnerability impacts on food security and remedial adaptation options as a suitable strategy by prioritizing needs over a 50-year period. An Empirical Dynamic Commutable General Equilibrium Model for Climate and the Economy (EDCGECE) is applied using future strategies for Malaysia against a baseline scenario of existing conditions, following the top-down options. The model takes into account various climatic variables, including climatic damage, carbon cycle, temperature and rainfall fluctuation, carbon emissions, vulnerability and carbon concentrations, which were adapted from national observational predictions of climatic changes caused by global warming from 2015 to 2065. The results prioritize climate change mitigation for the future. Specifically, this study estimates Malaysias food sustainability prospects without adaptation actions and with 5 % to 20 % adaptation actions overtime in different adaptation scenarios, as contrasted with the baseline. The results indicate that food sustainability cost in the baseline in 2015 is 859.3 million US Dollar (USD), which is about a 30-35 % shortage compared with the national targets, and that the shortage will rise over time to USD 987.3 million in 2065. However, the cost of applying different levels of adaptation for food sustainability over time is rising considerably. However, the residual damage also decreases with all adaptation actions in the different scenarios. Thus, adaptation shows a positive sign for Malaysias agricultural sectors. As growth values are positive and show rising trends, therefore the projected adaptation policy can be effective for food sustainability for sustainable future strategies in Malaysia.

Agriculture and food security challenge of climate change: a dynamic analysis for policy selection

This study presents an empirical examination of climate change related to vulnerability impacts on food security and remedial adaptation options as a suitable strategy by prioritizing needs over a 50-year period. An Empirical Dynamic Commutable General Equilibrium Model for Climate and the Economy (EDCGECE) is applied using future strategies for Malaysia against a baseline scenario of existing conditions, following the top-down options. The model takes into account various climatic variables, including climatic damage, carbon cycle, temperature and rainfall fluctuation, carbon emissions, vulnerability and carbon concentrations, which were adapted from national observational predictions of climatic changes caused by global warming from 2015 to 2065. The results prioritize climate change mitigation for the future. Specifically, this study estimates Malaysias food sustainability prospects without adaptation actions and with 5 % to 20 % adaptation actions overtime in different adaptation scenarios, as contrasted with the baseline. The results indicate that food sustainability cost in the baseline in 2015 is 859.3 million US Dollar (USD), which is about a 30-35 % shortage compared with the national targets, and that the shortage will rise over time to USD 987.3 million in 2065. However, the cost of applying different levels of adaptation for food sustainability over time is rising considerably. However, the residual damage also decreases with all adaptation actions in the different scenarios. Thus, adaptation shows a positive sign for Malaysias agricultural sectors. As growth values are positive and show rising trends, therefore the projected adaptation policy can be effective for food sustainability for sustainable future strategies in Malaysia.(AU)

Health sector reform and reproductive health in Latin America and the Caribbean: strengthening the links.

Many countries in Latin America and the Caribbean (LAC) are currently reforming their national health sectors and also implementing a comprehensive approach to reproductive health care. Three regional workshops to explore how health sector reform could improve reproductive health services have revealed the inherently complex, competing, and political nature of health sector reform and reproductive health. The objectives of reproductive health care can run parallel to those of health sector reform in that both are concerned with promoting equitable access to high quality care by means of integrated approaches to primary health care, and by the involvement of the public in setting health sector priorities. However, there is a serious risk that health reforms will be driven mainly by financial and/or political considerations and not by the need to improve the quality of health services as a basic human right. With only limited changes to the health systems in many Latin American and Caribbean countries and a handful of examples of positive progress resulting from reforms, the gap between rhetoric and practice remains wide.

What are the links between research and policy?

PIP: A descriptive study was conducted by Ana Langer, Population Council's Regional Director in Latin America and Caribbean, and her colleagues on the influence of research on health policy decision making in Mexico. Four programs within the Mexican Ministry of Health were examined: those concerned with AIDS, cholera, family planning, and immunization. Data were obtained through in-depth interviews with 67 researchers and Ministry of Health officials, extensive documentary research, and case studies. Overall, it was noted that four elements figure in any interaction between research and policy: the content of the research and policy, the actors involved, the communication process, and the context of research and policy. Both the researchers and decision-makers mentioned the quality of research as influential in promoting its use in policy. The investigators noted a ¿mutual intellectual disdain¿ between researchers and decision makers, with members of both groups wanting to be recognized as the greatest contributor to the control or solution of the problem. Local and international groups were identified as actors that promote the use of research in decision making, and many informants mentioned the importance of informal contacts between researchers and decision-makers. In addition, the relative stability of Mexico's government has facilitated the incorporation of research and policy, although the centralized government structure has sometimes hindered it. Strikingly, only few participants mentioned the role of the public in influencing connections between research and policy.^ieng

Urban equity and urban health: using existing data to understand inequalities in health and environment in Accra, Ghana and Sao Paulo, Brazil.

PIP: This paper presents the research methodology that applied existing data to the study of environmental and health inequalities in Accra, Ghana, and Sao Paulo, Brazil. After an introductory section, the paper considers why more research in this area is necessary and the reasons why information on cities in the South is lacking. The third section describes the aims and methods of the study by 1) looking at the development of the methodology, a form of descriptive epidemiology that uses existing data on morbidity and mortality rates to explore and describe the intra-urban distribution of health and environmental conditions in each location; 2) discussing the creation of an index of socioenvironmental deprivation based on judgements about the validity and quality of data on various socioeconomic and environmental indicators made by working groups in each location; and 3) reviewing data collection techniques and problems with data quality. Section 4 summarizes the results of the study by first noting that the study proved that existing data can be used to identify the extent of intra-urban differentials in environmental and health conditions and then presenting the results of the data analysis that exposed the myth of urban benefits by revealing the unequal distribution of socioeconomic conditions and exposed the myth of urban health by revealing the inequalities in life chances between groups in each setting. The concluding section explores the relevance of these results in environmental and health terms. A main achievement of the study was to introduce a method that allowed planners and policy-makers to work together to devise complex definitions of deprivation using existing data and to use the resulting information for actual decision-making to reduce inequalities.^ieng

Identity politics: implications for gender analysis policy and training.

PIP: As attention has shifted from a concern for citizenship, equality, and welfare to ideas of empowerment, equity, and governance, the locus of competition over power has rested with "identity politics," a recognition of cultural diversity that claims the legitimate right to produce alternative definitions and symbols of identity in public space. The change in identity formation from universal/national to fractured/tribalizing has implications for gender relations in contexts where patriarchal power controls production and reproduction. Except for feminism, all discourses in the current competition over identity politics are patriarchal. A look at the forces of change that shifted the process of modernization to a process of globalization reveals that, while modernization tends to standardize, globalization embraces the contradictory forces of universalizing and diversifying trends. Issues of identity and inequality were not problematic until the modern and the traditional subsumed each other and, thus, revealed the inherent contradictions of modernization. The diversifying forces that jeopardize the transnationalization of identity into membership in a "human society" include 1) language differences among the working classes, 2) growing global inequalities, and 3) collective memories of antagonistic histories. An analysis of gender based on identity politics can be conducted on a macro-level to understand the reluctance of central governments to initiate certain interventions, competing needs, new contradictions, changing gender roles, and the importance of promoting a global social contract.^ieng

[Activities of CEPAR]. / Actividades del Cepar.

PIP: Ecuador's Center for Studies and Promotion for Social Development (CEPAR) has been active in the areas of health and social development. A baseline survey for the project "Strengthening Basic Health Services" is nearing completion. In cooperation with four US universities, CEPAR is conducting a survey of migration, employment, and gender relations. Several meetings have been held regarding legislative reform affecting health and health services, such as the proposed law regarding private sector health activities. Approval of a law to guarantee permanent supplies of vaccines and other materials for the immunization program was a significant achievement. A network of institutions offering postgraduate public health programs is being developed. CEPAR helped organize an international seminar on health sector reform in Latin America, a conference on primary health care and the reform process, and the First Latin American Workshop to Aid Reform of the Health Sector. CEPAR continues to carry out demographic, socioeconomic, and epidemiologic analyses of provinces and cantons, most recently Cuenca, Esmeraldas, and Pastaza. A seminar and several studies on national health spending are underway. Various studies and workshops were carried out in different provinces and cantons on communications, data sources, health promotion, and other topics. CEPAR has participated in a forum of nongovernmental organizations in several activities designed to promote consensus regarding health policy.^ieng

[On the health sector crisis]. / A proposito de la crisis del sector salud.

PIP: The chronic crisis in Ecuador's health sector is an indication of the general deterioration of the country, whose multiple unmet needs signify a condition of underdevelopment. Theorizing on health problems should not be allowed to substitute for action. Developing a health policy giving priority to the most disadvantaged sectors will require a development model with a participatory character that promotes equity and solidarity and does not benefit the macroeconomy exclusively. The political will of all sectors must be committed to development of a national health system. A well-coordinated regional system of services, comprising integrated levels of care with functioning referral systems, is needed. The existing network of services must be made to function effectively, without strikes or suspension of activities. The government has a constitutional, legal, and moral obligation to provide health care. Ecuador directs about 6% of the gross national product to health, with 1.6% financing the Ministry of Public Health, which attends to at least 60% of the population. A country like Ecuador--with a very poor population--should not require copayment for services. Ecuador needs an environmental policy to guarantee a healthy food supply, treat sewage, and control use of pesticides--measures which will reduce health care costs in the long run. Finally, it is necessary to improve attention to the human values of medical practice.^ieng

Making it happen: the programme. Developing a gender policy with partner organisations.

PIP: Oxfam staff in Latin America and partner women's organizations were brought together through the Women's Linking Project (WLP) Conference in Thailand to discuss gender. The presence of partner organizations and experts at the conference helped to overcome impasses on theory and provided a wealth of practical experiences. The WLP consultative methodology was introduced in El Salvador, with Oxfam establishing a consultative group to ensure a broad and representative input to the formulation of policy and practice. A number of key individuals and groups were the change agents through which Oxfam UK/Ireland developed a gender policy fitting to the Salvadoran context. Organizational strategy aimed to strengthen the autonomy, organization, and capacity of the women's movement; contribute to the struggle against violence against women; promote research on the situation and condition of women; train women's grassroots leaders; introduce a gender focus as a criteria for the formulation and selection of projects with both women's and mixed organizations; establish a permanent consultation mechanism with women's organizations; and work with other international agencies on gender issues.^ieng

[Girls of today, women of tomorrow]. / Ninas de hoy, mujeres de manana.

PIP: In many countries, girls are discriminated against in nutrition, education, health care, and other areas, to the detriment of their personal development. Nongovernmental organizations (NGOs) concerned with promoting women's rights have come to regard the problem of girls' rights as very serious. Attention to girls in the past was focused on adolescent pregnancy or on social problems such as violence or child prostitution. But in the view of the NGOs, gender equity will be impossible to achieve as long as discrimination against girls continues. In addition, limiting the opportunities of girls will inevitably limit their potential contributions to society. The UN General Assembly in September 1989 approved the Convention on the Rights of Children, the principal goals of which were to eliminate malnutrition, preventable diseases, and illiteracy. The World Conference on Children in 1990 was attended by representatives of over 150 countries, who specified concrete goals. Measurable progress has occurred. UNICEF estimates, for example, that 2.5 million fewer children died on 1996 than in 1990, but it is probable that over half of the children in Latin America and the Caribbean live in poverty. In 1990, nearly 1 million children under age 5 in the region died of preventable diseases, and some 7 million were estimated to be malnourished, 1 million seriously. Infant mortality rates indicate that most countries of the region have improved their health status, but the rate has apparently increased in Haiti, Bolivia, and Peru. The Pan American Health Organization and the Demographic and Health Surveys have accumulated data indicating that excess mortality has occurred among girls 1-4 years old in at least 9 countries of the region. Some evidence suggests that health care is less likely to be sought for girls than boys. Domestic violence and sexual abuse are a serious problem for girls and women, but many countries continue to avoid the issue. The 1993 UN Declaration of Human Rights, the 1994 International Conference on Population and Development in Cairo, and the 1995 UN World Conference on Women in Beijing all approved measures for protection of girls. The Platform of Action approved in Beijing specified actions to be taken by governments and NGOs to end discrimination against girls.^ieng

[Gender and population: another challenge for equality]. / Genero y poblacion: otro desafio para la equidad.

PIP: The author discusses the consideration of gender and women's status in demographic investigations. The need for a more humane conception of public policies is considered. The use of an approach to try to eliminate sexism in social policies is examined, with a focus on biological reproduction, mortality and morbidity, migration, and spatial distribution.^ieng

[Seeing with the eyes of the woman]. / Mirando con ojos de mujer.

PIP: A Colombian representative to the forum of nongovernmental organizations (NGOs) at the Fourth International Conference on Women in Beijing reflects on the structure and achievements of the Conference. This article also presents a table comparing strategic objectives of the Beijing Conference Platform of Action with objectives affecting women in the Plan of Action of the International Conference on Population and Development in Cairo. The NGO forum was held in Huairou, some 50 kilometers from Beijing, and attended by nearly 20,000 women. An average of 350 workshops, panels, and other activities of all kinds took place each day. The forum was a place for networking and also a place of protest. The distance of the forum from Beijing, the difficulties encountered by participants in their travel arrangements, and the prompt disconnection of equipment at 10:30 each evening demonstrated the determination of Conference organizers to isolate and control the forum. A few NGOs invited by the U.N. participated in the plenary sessions of the Conference. The excluded NGOs were able to make their presence felt by pressuring the official delegations of their countries, by participating in preparation of positions and documents prior to the Conference, and by lobbying at the caucuses during the Conference. The Conference provided opportunities for sharing information, establishing contacts with other NGOs, and searching for ways to convert the international agreements into local realities. In the Conference Declaration, the participating governments reaffirmed their commitment to promoting equality, development, and peace, and to the advancement and empowerment of women. NGOs should use each specific item in the Platform of Action to which attending governments committed themselves as tools in their efforts to further the interests of women.^ieng