| 4. In which ways is the initiative creative and innovative?
|
|
The initiative integrates the Aviation, Defense and Health sectors with the purpose of saving and/or improving quality of thousands of lives through the transportation of human organs, by using Collaborative Decision Making CDM techniques.
In addition, it is a genuinely collaborative initiative, which has the support of all involved, without any public funding, of any kind, even without legal obligation to the parties.
• The initiative uses available room at commercial aircrafts to transport human organs, tissues and medical teams, pro bono;
• The initiative granted access to the Ministry of Health to a high technology air navigation command center to help management human organ transportation;
• The initiative allows transportation of blood and medical teams, free of bureaucracy on calamity events.
• The initiative allows previous verification of the meteorological conditions of the destination airports, avoiding human organ losses by the allocation of non-viable routes;
• The initiative allows previous consultation on the operational situation of the flights (delays, cancellations, maintenance), avoiding the allocation of non-viable flights; and
• The initiative allows priority requests made by CNT, speeding up the transit of the medical teams / human organs and tissues through the terminals as well as of aircraft during the taxi and approach stages.
|
|
| 5. Who implemented the initiative and what is the size of the population affected by this initiative?
|
|
The initiative was implemented by a working group coordinated by the Civil Aviation Secretariat – SAC, in which took part:
• Ministry of Health (represented by the National Transplant System - SNT and the National Transplant Center – CNT)
• Ministry of Transports Ports and Aviation Civil (represented by the Civil Aviation Secretariat – SAC)
• Ministry of Defense (represented by the Department of Airspace Control - DECEA)
• National Civil Aviation Agency (ANAC)
• Representatives of the largest domestic airlines (GOL, LATAM, AZUL, AVIANCA and PASSAREDO)
• Brazilian Airline Companies Association - ABEAR.
• Representatives of the main airport operators (INFRAERO, GRUAirports, BHAirport, INFRAMERICA, RIOGaleão International Airport, and Viracopos Airport)
• National Association of Airport Administrators (ANEAA)
CNT manages the logistics for human organs, tissues and medical teams, according to the agreement signed, through collaborative decision making with the help of airlines, airports and Air traffic control. Every month, CNT uses an average of 370 flights to transport an average of 570 items, in 2016 alone CNT moved close to 7.500 items, among those 1525 medical team members and over 4.000 human organs and tissues (52 hearts, 251 livers, 871 kidneys, 179 bone marrows, 1289 corneas, and others).
Between 2013 and 2016, CNT transported close to 30.000 items, among those 4.000 organs and 12.000 tissues (cornea, bone marrow, bones, skin…).
|
| 6. How was the strategy implemented and what resources were mobilized?
|
|
Diagnostic
Initially, a group of professionals from SAC / MTPA, Infraero and SNT / CNT were created to run a diagnostic of the system. The group identified the key stakeholders in the process, their expectations and needs, and the technical feasibility of the project. It was clear that the discussion should be broad and involve the airport operators INFRAERO and the private operators, summing up the 66 largest airports, concentrating more than 90% of domestic air traffic. Subsequently, the concessionaires of the Airports Granted to the private initiative were involved. In addition, it was defined that the focus should be the domestic carriers TAM, GOL, AZUL, AVIANCA and PASSAREDO, responsible for 99.6% of the market.
Action plan
An action plan was defined to map and design flow charts for the main processes in 2011, to understand the processes and the system, and to identify problems and their possible causes. During this period, a database was created containing the history of the number of items transported and flights used, by airline, which enabled the establishment of indicators to monitor the results of the initiative.
The problems identified by the group were discussed in meetings between June and September 2012, which focused on solving the problems and allowed the maturation of the processes, with the simplification of stages, standardization and institutionalization of communication.
Deployment
By January 2013, the working group begun the implementing the agreed changes. Airlines have provided institutional contact on duty with power to authorize transportation and ticket issuance. The proposed changes were linked to the employees of all those directly involved in the transport and began to integrate the training of the field teams of airlines and airports.
Also in the first semester of 2013 began the drafting of the Cooperation Agreement for pro bono transport of human organs for the purpose of transplants, by the same Working Group. The document had its preliminary version finalized in December 2012, but after more detailed evaluation from the point of view of regulatory and legal impact, more time was needed for discussions.
In addition, during this period, the process of hiring the employees who would work for the CNT in Rio de Janeiro began.
Throughout the year 2013, there was follow-up of the process, followed by the discussion of the content of the agreement.
The final version of the final document was signed in December 2013 and brought with it an improvement in the flow of communication among those involved, resulting in a significant growth in the number of transplant-related items transported per year
Costs
The initiative is an agreement for pro bono transport of human organs, tissues and medical teams, without disbursement of resources by the Ministry of Health.
The airlines assume the cost of air transportation. Costs for boarding fees of the medical teams are assumed by the airlines and by the airport operator, depending if the last is a subscriber of the agreement.
The Ministry of Health assumes the responsibility of conducting training for employees involved in transportation, both airlines and regulatory agencies, when requested by the representatives of the companies.
The workstation of the CNT professionals in Rio de Janeiro, was made available by CGNA, and the team that works there is maintained and subordinated to the Ministry of Health.
There was no specific budget for the Working Group, the meetings were held in Brasília-DF and the expenses of displacing servers / employees to participate in meetings held by each agency / entity.
After 2016, costs for the operation of a military aircraft, used for extremely urgent cases, are carried by the Ministry of Defense.
|
|
| 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
|
|
The initiative was implemented by a working group coordinated by the Civil Aviation Secretariat – SAC, in which took part:
• Ministry of Transports Ports and Aviation Civil (represented by the Civil Aviation Secretariat – SAC)
Servants: Raquel Velho, Paulo Possas, Gustavo Canuto, Marco Porto, Aline Rebouças
• Ministry of Health (represented by the National Transplant System - SNT and the National Transplant Center – CNT)
Servants: Heder Murari Borba, Evelyn Heinzen, Patrícia Freire
• Ministry of Defense (represented by the Department of Airspace Control - DECEA)
Servants: Cel Bertolino, Cel Medeiros and Cap. Arnaldo
• National Civil Aviation Agency (ANAC)
Servants: Herberth Guedes, Leonardo Boszczowski, Luiz Pimenta, Luiz Cavallari
• Representatives of the largest domestic airlines (GOL, LATAM, AZUL, AVIANCA and PASSAREDO)
Servants: Edson Pires (GOL), Tatiane Viana (LATAM), Patrizia Xavier (AZUL), Marcio Antonio Ribeiro (AVIANCA) and William Agatz (PASSAREDO)
• Brazilian Airline Companies Association - ABEAR.
Paulo Roberto Alonso and Victor Celestino
• Representatives of the main airport operators (INFRAERO, GRUAirport, BHAirport, INFRAMERICA, RIOGaleão International Airport and Viracopos Airport)
Servants: Dunia Aleixo (INFRAERO), Antonio Montano (GRUAirport), Paulo Cesar Rangel (BHAirport), Josmário Brito (INFRAMÉRICA), Herlichy Bastos (RIOGaleão Airport) and Marcelo Mota (Viracopos Airport)
• National Association of Airport Administrators (ANEAA)
João Tabalipa Ferreira and Douglas Rebouças de Almeida
|
|
| 8. What were the most successful outputs and why was the initiative effective?
|
|
The initiative expanded and facilitated access to the pro bono flights of the participating airlines, by increasing the number of items and medical teams that have access to air transport, this helps saving and improving the lives of thousands of people every year. The list that follows contains concrete outputs to illustrate the success of the initiative:
• Between 2011 and 2013, there was a 139% increase in the number of flights used by CNT;
• Between 2013 and 2016, there was a 214% increase on the number of health professionals transported by the initiative. 2.781 professionals were transported in that period;
• Between 2013 and 2016 over 16.000 items were transported under the cooperation agreement;
• The cost of transportation of medical teams between 2013 and 2016, generated savings of approximately U$ 310.000;
|
|
| 9. What were the main obstacles encountered and how were they overcome?
|
|
The first obstacle encountered was the difficulty in understanding the limitations and needs of those involved while discussing complex and eminently technical issues in the health and civil aviation sectors. The solution to this problem came naturally from the exchange of knowledge and information in the discussions of the Working Group. In addition, CNT took the initiative to promote the "First Logistics Forum for Distribution of Organs for Transplantation in Brazil", in the city of Pirenópolis-GO, on October 24 and 25, 2013, which assisted in the Leveling of the knowledge of both the health professionals involved in the transplant process, and the representatives of aviation and transportation.
Another obstacle faced was the difficulty of articulation among those involved, which was solved in part by the narrowing of relations, under the coordination of SAC, and partly by the transfer of CNT activities to Rio de Janeiro and the use of the Collaborative model Decision Making - CDM.
Another point of attention was the need to guarantee security in the shipment of teams/material by means of the x-ray inspection. Prior to the initiative, it was not a rule to inspect through x-ray the material before entering the aircraft. The term of cooperation has established the understanding that all items and teams must undergo security inspection prior to shipment. A debate began with ANAC for the issue of regulations regulating the issue. On May 15, 2015, Portaria n. 1,155, which disposed of the subject and pacified the question, allowing safer operations and making possible to include bone marrow on the agreement by the end of 2015.
The transport of human hearths and lungs were particularly difficult due to its very narrow window of opportunity (4 hours) for successful transportation and transplant. That was partially addressed by putting one military plane at CNT’s request.
|