RESUMEN
The Central American initiative, where the expression "HEALTH: A BRIDGE FOR PEACE" was used for the first time, was built on the belief that Health transcends political divisions and can be a key factor in fostering solidarity and peace between people and nations. From 1983 to 1991 the PAHO/WHOs office of Strategic Planning, in close cooperation with the Ministries of Health of Central America, coordinated an innovative strategy to achieve agreement between conflicting parties, through consensus generated by a program of action in which, similar health problems were identified and joint projects/programs developed. This process of inter country analysis and cooperation in a "neutral field" as Health was expected to facilitate the understanding and lasting peace among the countries and groups involved in armed conflicts or continuous tensions leading to armed conflicts. Although this was proved in the case of the Central American region, the experience demonstrated that it requires, from health workers, a broad understanding of the political, economical and social aspects beyond the traditional administrative approach in public health. The initiative followed specific criteria organized and agreed upon by representatives of the countries and supported by several cooperation agencies and governments outside the region.It is essential to follow carefully special activities and steps like the participation of local professionals, political authorities, mobilization of support and resources, identification of priority areas and organization of multi country working groups for the preparation of regional and national heath programs. In the case of Central America, the initial phase of the plan included: organization of health services, maintenance and repair of hospital equipment, development of human resources, provision of essential drugs (including an inter country rotating fund for purchase of essential drugs), control of tropical diseases, particularly malaria and dengue, child survival, environmental sanitation, women health and development, management of health service and food and nutrition. For each area, national professionals with cooperation of experts from the participating agencies developed project-profiles that were used for mobilization of financial resources. The projects targeted each one of the Central American countries and also entire region reinforcing the principle of cooperation among countries. Special pledging conferences were organized with participation of professionals from the affected countries and representatives from donor agencies and international cooperation organizations. High level authorities from the countries were motivated to summit meetings and signature of peace agreements. Supporting external countries acted as witnesses and assured the enforcement of the agreements Two aspects should be clarified: First: Although cease-fires were promoted, using the immunization of children to achieve the acceptance of parties in conflict, it is important to note that this kind of specific campaigns should be inserted inside a comprehensive net of activities included in the general program otherwise no lasting results could be achieved. A misinterpretation was made by different authors writing about the strategy Health as a Bridge for Peace referring only to ceasefires or days of tranquility as the essence of the methodology. Second: This strategy emphasizes the importance of development rather than pure assistance. Although the external resources are important, to reach lasting results and sustainability it is essential the participation of the local/national professionals and a clear commitment of the national authorities. It is necessary the full understanding of the health determinants and to use this notion in the development of the projects organized in the affected areas or countries. Health care alone, although important, is normally utilized in the assistance phase or programs with the risk of interruption if not based in the local development of facilities and training of human resources as envisioned in the strategy.