Estilos de liderazgo en profesionales sanitarios peruanos

Fundamento: el liderazgo representa un rasgo importante que debe poseer toda persona encargada de dirigir un grupo. Los cambios organizacionales generados en las oficinas farmacéuticas deben ser asumidos mediante un estilo de liderazgo que permita alcanzar los objetivos y metas planteadas, con el fin de asegurar y optimizar la atención sanitaria. Objetivo: determinar los estilos de liderazgo en profesionales Químico-Farmacéuticos que laboran en establecimientos públicos y privados de la ciudad de Trujillo (Perú). Métodos: estudio descriptivo de corte transversal que incluyó 94 profesionales colegiados que se desempeñan como directores técnicos. En la recolección de datos se empleó como técnica la encuesta y como instrumento al cuestionario Multifactor Leadership Questionnaire , que constó de 36 preguntas en escala de Likert, distribuidas en tres dimensiones: liderazgo transformacional, transaccional y correctivo/pasivo/evitador. Resultados: el 82, 9 % de los profesionales laboran como directores técnicos en el sector privado; el 57, 4 % son del género femenino y más del 60 % presentan un nivel alto de liderazgo. Unidos ambos sectores, los estilos de liderazgo transformacional y transaccional de nivel alto estuvieron presente en un 28,7 % y 61, 7 %, respectivamente; el liderazgo correctivo/pasivo/evitador de nivel medio estuvo presente en 72, 3 % de los profesionales. Asimismo, el liderazgo transformacional de nivel alto estuvo presente en 62, 5 % de los que trabajan en el sector público y en 56, 4 % de los del sector privado; el estilo de liderazgo correctivo/pasivo/evitador en un nivel medio estuvo presente en más del 60 % de los profesionales de ambos sectores. Conclusiones: el estilo de liderazgo más predominante fue el transaccional.

Foundation: leadership represents an important trait that must be presented by every person in charge of directing a group of people. The organizational changes generated in pharmaceutical offices must be assumed through a leadership style that allows achieving the objectives and goals set, in order to ensure and optimize health care. Objective: to determine the Chemist-Pharmaceutical professionals' leadership styles who work in public and private establishments in the city of Trujillo (Peru). Methods: a descriptive cross-sectional study that included 94 collegiate professionals who work as technical directors. In data collection, the survey was used as a technique and the Multifactor Leadership Questionnaire (MLQ) as an instrument, which consisted of 36 questions on a Likert scale, distributed in three dimensions: transformational, transactional, and corrective/avoidant leadership. Results: 82.9 % of the professionals work as technical directors in the private sector; 57.4 % are female and more than 60 % have a high level of leadership. Together both sectors, the high-level transformational and transactional leadership styles were present in 28.7 % and 61.7 %, respectively; mid-level corrective/passive/avoidant leadership was present in 72.3 % of the professionals. Likewise, high-level transformational leadership was present in 62.5 % of those who work in the public sector and in 56.4 % of those in the private sector; the corrective/passive/avoidant leadership style at a medium level was present in more than 60 % of the professionals in both sectors. Conclusions: the most predominant leadership style was transactional.

Índice de Dependência Regional e Macrorregional: uma contribuição ao processo de regionalização do SUS / Regional and Macro-regional Dependency Index: A contribution to the SUS regionalization process

RESUMO O estudo aborda a interdependência das regiões e macrorregiões de saúde no Brasil nas internações de média e alta complexidade, no ano de 2019. Foi realizada a análise dos fluxos estabelecidos, utilizando o Índice de Dependência Regional e Macrorregional, a partir de dados secundários do Sistema Único de Saúde (SUS) obtidos no Sistema de Informação Hospitalar. Os resultados demonstram que grande parte das regiões e macrorregiões de saúde absorvem em seus territórios as internações de média complexidade, com variações entre as especialidades. Nas internações de alta complexidade, a maioria das regiões de saúde apresenta grande dependência, sendo que a assistência está concentrada em 15% delas. Entre as macrorregiões de saúde, o cenário é significativamente heterogêneo, com dependência expressiva nas regiões Norte, Nordeste e Centro-Oeste, e alta resolutividade na região Sul. Em todas as análises, o porte populacional das regiões e macrorregiões de saúde apresenta relação inversa à dependência regional e macrorregional. O aprimoramento da regionalização pressupõe a organização de uma rede de atenção à saúde que considere as desigualdades e as diversidades territoriais, a interdependência e a autonomia entre os territórios e os atores implicados, e a coordenação entre as unidades federativas, de modo a garantir cuidado integral e equânime.

ABSTRACT The study addresses the interdependency between health regions and macro-regions in Brazil in 2019, concerning both medium and high complexity hospitalizations. The analysis of the flows established was carried out using the Regional and Macro-regional Dependency Index, based on secondary data provided by the Hospital Information System of the Unified Health System (SUS). The results show that a significant number of health regions and macro-regions absorb medium-complexity hospitalizations in their territories, varying according to specialties. In high-complexity hospitalizations, most health regions are highly dependent, assistance concentrated in 15% of these. Among health macro-regions, the scenario is significantly heterogeneous: highly dependent on the North, Northeast and Midwest Regions, and highly resolutive in the South Region. Analyses show that the population size of health regions and macro-regions is inversely related to the regional and macro-regional dependency. The improvement of regionalization requires an organized health care network, one that takes into account territorial inequalities and diversities, interdependency and autonomy among the territories and actors involved, and inter-federative coordination, so as to provide care that is both comprehensive and equitable.

On the Formation Logic and World Significance of A Community of Common Health for Mankind / 中国医学伦理学

The concept of a community of common health for mankind profoundly expresses China’s important proposition of promoting the health and well-being of people in various countries and jointly maintaining global public health security, which has a distinct formation logic. The idea of a community of common health for mankind is rooted in the "real community" theory of Marxist, reflecting its value orientation in the field of global health, and highlighting the new era’s inherent requirements of "adhering to the people first". It is an organic unity of theoretical logic, value logic, and practical logic. The construction of a community of common health for mankind gathers broad consensus, highlights the distinct theme of world peace and development, responds to international concerns, and provides Chinese proposals and contributes Chinese strength for governing global public health, practicing multilateralism, and promoting the construction of new international relations.

Fortalecimento da governança regional e da rede de atenção à saúde em municípios pequenos no Brasil / Strengthening regional governance and the health care network in small municipalities in Brazil / Fortalecimiento de la gobernanza regional y de la red de atención de salud en municipios pequeños de Brasil

RESUMO No Brasil, 67,7% dos municípios têm menos de 20 mil habitantes, sendo caracterizados como de pequeno porte. O objetivo do presente artigo é sistematizar a experiência e identificar os desafios e as lições aprendidas na implantação do modelo de fortalecimento da governança regional e da organização da rede de atenção à saúde (RAS) em uma região do Brasil composta por esses municípios, que apresentam baixa capacidade técnica e orçamentária, além de fragilidades diversas relacionadas à organização da RAS. Na perspectiva do fortalecimento da governança regional e da organização do processo de trabalho da atenção primária em saúde (APS) e, por consequência, dos fluxos com os outros níveis de atenção, foi proposta a estratégia intitulada Mais Cuidado Mais Saúde, desenvolvida em parceria com a Organização Pan-Americana da Saúde/Organização Mundial da Saúde (OPAS/OMS) e o Ministério da Saúde. O projeto foi executado por meio de processos de educação permanente em saúde e fortalecimento de capacidades institucionais na região de Ivaiporã/Paraná, com oficinas descentralizadas, contemplando três eixos prioritários: integração da RAS, formação de capacidades e gestão da informação. O público-alvo foram as equipes de APS ampliada. O projeto permitiu desenvolver capacidades locais e de governança regional por meio de reflexões conjuntas a respeito do modelo de atenção à saúde, de seus componentes e das mudanças necessárias nos processos de trabalho para a promoção de saúde com foco na qualidade de vida dos usuários. Por se tratar de uma experiência que considera as fragilidades, necessidades e autonomia dos atores locais, o projeto tem alto poder de replicação e customização para outras regiões com características similares dentro e fora do Brasil.

ABSTRACT In Brazil, 67.7% of the municipalities are characterized as small, with a population of less than 20 thousand. The objective of this article is to systematize the experience and identify the challenges and lessons learned in the implementation of the model for strengthening regional governance and organizing the health care network (HCN) in a region of Brazil composed of these municipalities, which present low technical and budgetary capacity, in addition to various fragilities related to the organization of the HCN. With a view to strengthening regional governance and the organization of the primary health care (PHC) work process and, consequently, the workflow with other levels of care, a strategy entitled More Care More Health (Mais Cuidado Mais Saúde) was proposed, developed in partnership with the Pan American Health Organization/World Health Organization (PAHO/WHO) and the Ministry of Health. The project was developed through permanent health education and institutional capacity building in the region of Ivaiporã, state of Paraná, based on workshops and addressing three priority axes: HCN integration, capacity building and information management. The target audience were the extended PHC teams. The project made it possible to develop local and governance capacities through joint reflections on the health care model, its components and the necessary changes in work processes for health promotion with a focus on the quality of life of users. Because it is an experience that considers the weaknesses, needs and autonomy of local actors, the project has a high potential for replication and customization for other regions with similar characteristics inside and outside Brazil.

RESUMEN En Brasil, 67,7% de los municipios se clasifican como pequeños, puesto que tienen menos de 20 000 habitantes. El objetivo de este artículo es sistematizar la experiencia adquirida y determinar cuáles son los desafíos y las enseñanzas extraídas en la implementación del modelo de fortalecimiento de la gobernanza regional y de la organización de la red de atención de salud en una región de Brasil compuesta por municipios de este tipo, que tienen poca capacidad técnica y presupuestaria y diversas debilidades relacionadas con la organización de dicha red. Desde la perspectiva del fortalecimiento de la gobernanza regional y de la organización del proceso de trabajo en el campo de la atención primaria de salud y, por consiguiente, de los flujos asistenciales con los demás niveles de atención, se propuso la estrategia Más cuidado, más salud, formulada junto con la Organización Panamericana de la Salud/Organización Mundial de la Salud (OPS/OMS) y el Ministerio de Salud. El proyecto se ejecutó por medio de procesos de educación permanente en salud y fortalecimiento de las capacidades institucionales en la región de Ivaiporã, Estado de Paraná, con talleres descentralizados, dentro de tres ejes prioritarios, a saber, integración de red de atención de salud, capacitación y gestión de la información. El público destinatario fueron los equipos de atención primaria de salud ampliada. El proyecto permitió el desarrollo de las capacidades locales y la gobernanza regional por medio de reflexiones conjuntas sobre el modelo de atención de salud, sus elementos constitutivos y los cambios necesarios en los procesos de trabajo para impulsar la promoción de la salud centrada en la calidad de vida de los usuarios. Por tratarse de una experiencia en la cual se tienen en cuenta las debilidades, las necesidades y la autonomía de los actores locales, el proyecto tiene un alto poder de repetición y adaptación en otras regiones con características similares dentro y fuera de Brasil.

Sistemas de saúde, mecanismos de governança e porosidade governamental em perspectiva comparada / Health systems, mechanisms of governance, and governmental porosity in a comparative perspective

RESUMO O artigo apresenta uma análise comparada de dez países selecionados sobre as relações entre governança participativa, perfis socioeconômicos e sistemas de saúde com resultados sanitários e de Indicadores de Governança Global. As fontes principais foram bases de dados produzidas e/ou compiladas pelo Banco Mundial. O modelo analítico se apoia em enfoque institucionalista para tratar de proteção social e governança participativa - esta, como utilizada, recobre as noções de participação social, porosidade governamental e regulação responsiva. Os resultados mostram uma sólida convergência entre perfis socioeconômicos mais distributivos, sistemas sanitários com maior financiamento público e universalismo e melhores indicadores de governança. Esta análise reforça os argumentos sobre trajetórias institucionais socialmente virtuosas e sujeitas a reforços positivos capazes de produzir melhores resultados sociais e políticos ao longo do tempo.

ABSTRACT This paper presents a comparative analysis of ten selected countries regarding the established relationships of participative governance, socioeconomic profiles, and health care systems with health outcomes and Global Governance Indicators. Significant sources were databases produced or compiled by the World Bank. The analytical model adopts an institutionalist approach to address social protection and participative governance - the latter, as used, recovers notions of societal participation, government porosity, and responsive regulation. Outcomes show a solid convergence of more distributive socioeconomic profiles, more universalist health systems with higher government financing, and better governance indicators. This analysis supports the arguments that socially virtuous institutional paths subjected to positive feedback favor better social and political outcomes over time.

As Ouvidorias do SUS e a Rede Brasileira de Escolas de Saúde Pública: uma experiência inédita / SUS Ombudsman offices and the Brazilian Public Health School Network: a novel experience

RESUMO Este relato de experiência teve como objetivo analisar o processo de formação de ouvidores do Sistema Único de Saúde (SUS), uma parceria entre a Escola Nacional de Saúde Pública Sergio Arouca (Ensp/ Fiocruz), a Rede Brasileira de Escola de Saúde Pública (RedEscola) e a Secretaria de Gestão Estratégica e Participativa do SUS (SGEP/MS). Considerada pioneira, a formação foi desenvolvida dentro da lógica de construção participativa, envolvendo atores municipais, estaduais e nacionais das Ouvidorias do SUS, instituições/escolas de saúde pública estaduais, Conselho Nacional de Secretarias Municipais de Saúde (Conasems) e Secretaria Técnica e Executiva da RedEscola, em uma articulação de governança consertada que resultou na formação de 451 ouvidores.

ABSTRACT This experience report aimed to analyze the vocational education of ombudsmen in the Unified Health System (SUS). This project was a partnership between the Sergio Arouca National School of Public Health (ENSP/FIOCRUZ), the Brazilian Network of Public Health Schools (RedEscola), and the SUS Strategic and Participatory Management Secretary (SGEP/MS). Considered pioneering, the vocational education was developed within the logic of a participatory process which involved municipal, state and national actors from SUS Ombudsman offices, state public health institutions/schools, the National Council of Municipal Health Secretaries (CONASEMS), and the RedEscola's Technical and Executive Secretary in a consensual governance articulation resulting in the qualification of 451 ombudsmen.

La voluntad política y la gobernanza: claves en la implementación de HEARTS en el Perú / Political will and governance: keys to Implementing HEARTS in Peru / Vontade política e governança, chaves na Implementação da iniciativa HEARTS no Peru

RESUMEN El objetivo del artículo es describir cómo la gobernanza y la voluntad política han influido en la implementación de la Iniciativa HEARTS para la prevención y el control de la hipertensión arterial en el sistema de salud de Perú. Se describe el proceso de gobernanza y se realiza un análisis secundario de datos que compara los niveles basales al inicio de la fase 1 de HEARTS con los primeros seis meses de seguimiento en 34 establecimientos de salud. Se realizó la planificación y organización de la implementación de HEARTS desde el nivel nacional a través de la Dirección de Enfermedades No Transmisibles, contando con la voluntad política de la Alta dirección del Ministerio de Salud y el acompañamiento técnico de la Organización Panamericana de la Salud. La gobernanza se estructuró en 3 niveles: nacional, regional y local; la implementación se apoyó en actores claves de la academia, las sociedades científicas y las Direcciones Regionales de Salud y de las Redes Integrales. Los resultados encontrados tras los primeros meses de seguimiento evidenciaron un incremento de la cobertura y el control de la hipertensión arterial en la mayoría de los establecimientos intervenidos. El análisis de los factores claves relacionados con la voluntad política y la gobernanza en la implementación de la Iniciativa HEARTS para la prevención y el control de la hipertensión arterial demostró que las funciones de la Alta dirección, para alinear las políticas públicas y priorizar las enfermedades no trasmisibles, en coordinación estrecha y permanente entre los formuladores de política y el Ministro de Salud, tuvieron un efecto positivo en la implementación de la Iniciativa HEARTS en el Perú.

ABSTRACT The objective of this article is to describe how governance and political will have influenced the implementation of the HEARTS Initiative for the prevention and control of hypertension in the Peruvian health system. The governance process is described and a secondary data analysis compares baseline levels at the start of HEARTS phase 1 with observed levels after the first six months of follow-up in 34 health facilities. HEARTS implementation was planned and organized at the national level through the Directorate of Noncommunicable Diseases, with political support from senior management of the Ministry of Health and technical support from the Pan American Health Organization. Governance was structured at three levels: national, regional, and local; implementation was supported by key actors from academia, scientific societies, regional health directorates, and integrated networks. Results after the initial months of follow-up showed an increase in the coverage and control of hypertension in most of the participating facilities. Analysis of the key factors related to political will and governance in the implementation of the HEARTS Initiative for the prevention and control of hypertension showed that the functions of senior management—in terms of aligning public policies and prioritizing noncommunicable diseases, in close and permanent coordination between policymakers and the Minister of Health—had a positive effect on the implementation of the HEARTS Initiative in Peru.

RESUMO O objetivo do artigo é descrever como a governança e a vontade política influenciaram a implementação da Iniciativa HEARTS para a prevenção e o controle da hipertensão arterial no sistema de saúde peruano. O processo de governança é descrito e uma análise de dados secundários é realizada comparando os níveis basais no início da fase 1 do HEARTS com os primeiros 6 meses de acompanhamento em 34 estabelecimentos de saúde. O planejamento e a organização da implementação do HEARTS foi realizado no nível nacional por meio da Diretoria de Doenças Não Transmissíveis, contando com a vontade política da alta direção do Ministério da Saúde e o apoio técnico da Organização Pan-Americana da Saúde. A governança foi estruturada em três níveis - nacional, regional e local - e a implementação contou com o apoio de atores importantes do meio acadêmico, das sociedades científicas, das diretorias regionais de saúde e das redes integradas. Os resultados encontrados após os primeiros meses de acompanhamento mostraram um aumento da cobertura e do controle da hipertensão arterial na maioria dos estabelecimentos nos quais a intervenção foi implementada. A análise dos principais fatores relacionados à vontade política e à governança na implementação da Iniciativa HEARTS para a prevenção e o controle da hipertensão arterial mostrou que a atuação da alta direção para alinhar as políticas públicas e priorizar as doenças não transmissíveis, em estreita e permanente articulação entre os formuladores de políticas e o Ministério da Saúde, teve um efeito positivo na implementação da Iniciativa HEARTS no Peru.

Collaborative place-based health governance systems: stakeholders' perceptions in the Portuguese Baixo Vouga sub-region / Governança colaborativa de base local em sistemas de saúde: percepções dos stakeholders na sub-região do Baixo Vouga português

Abstract This study aimed to assess the Baixo Vouga sub-region (Portugal) governance system through 15 interviews with leaders of institutions with decision-making power and provide healthcare. The interviews were subjected to a content analysis, organized in matrices by cases, categories, subcategories, and indicators. Recording units were extracted from the interviews to produce data for each indicator. A Collaborative Place-based Governance Framework systematizing operational definitions of collaborative governance was implemented to serve as a benchmark for assessing the collaborative and place-based dimensions. The Baixo Vouga sub-Region governance system is collaborative because it is based on a shared structure of principles that translates into the services provided. It has a multilevel and multisector collaboration, and can undertake shared decisions. These dimensions could be reinforced through increased participation, autonomy, subsidiarity if more place-based information and practical knowledge were sought. The system would also benefit from an extensive adoption of bottom-up methods to formulate and implement policies.

Resumo Esta investigação tem como objetivo avaliar estas dimensões no sistema de governança da Região de Aveiro (RA) Portugal, através de 15 entrevistas feitas aos responsáveis máximos de instituições que decidem e que prestam cuidados. Na análise das entrevistas, aplicaram-se me- todologias de análise de conteúdo. Para o efeito, criaram-se matrizes por casos, sub-categorias, sucategorias e indicadores. Das gravações das entrevistas, extraíram-se unidades de registo para cada indicador. Propomos um referencial de governança colaborativa de base local que sistematiza definições operativas de governança colaborativa, servindo, depois, de referencial para o exercício de avaliação. O sistema de governança da sub-região do Baixo Vouga é colaborativo porque assenta numa estrutura partilhada de princípios transposta para o modo como os serviços são prestados. Apresenta colaboração multinível e multissetorial e capacidade de construir decisões partilhadas. Reforçar-se-iam estas dimensões com mais participação, autonomia, subsidiariedade e se se recorresse mais à informação e a conhe- cimento prático, localizado. Também beneficiaria com a adoção extensiva de metodologias de base local na formulação e na implementação de políticas.

Integration of internet health and "Healthy China" strategy / 上海预防医学

In the fifth scientific and technological revolution， information technology is the first productivity， which has a great impact on the supply and demand of medical services. Generally， internet medicine is equivalent to the combination between health industry and information technology. "Healthy China" strategy is China's "priority development strategy"， which adheres to the principle of health equity， emphasizes the integration of health into all policies， and takes co-construction and sharing as the basic path. With implementing internet medicine， "Healthy China" strategy promotes the mobility of medical service with three tools： interconnection， data and artificial intelligence. This enhances the operation efficiency of overall medical and health system， and optimizes the allocation of medical resources. The future development of internet medicine follows the double helix mode driven by technology and policy， and the policy determines the development boundary of the industry. On the basis to ensure medical safety， we should explore the possibility of internet diagnosis and treatment further， and pay attention to the fairness of resource allocation while improving efficiency， so as to realize the co-construction and sharing of health services.

Enlightenment of COVID-19 epidemic on function and layout of China-Africa friendship hospital: from global health governance perspective / 中华医院管理杂志

The globalized epidemic of the COVID-19 forced the international community to reconsider the importance and urgency of global public health in world peace and development. The authors analyzed the COVID-19 epidemic prevention and control situation in Africa, and discussed the functions and layout of China-Africa friendship hospitals from the perspective of global health governance. It was suggested that the functions of China-Africa friendship hospitals should be positioned as the high-level medical centers in Africa, regional medical and disease control linkage centers, regional health technology training centers, regional telemedicine collaboration center, and regional health policy research center.Furthermore, the layout of China-Africa friendship hospitals should respond to China′s assistance in the construction of Africa′s center for disease control and China-Africa′s cooperation plan for promoting the " one belt and one road" construction, and work together with the medical team to build a new pattern of medical integration and health care system for African disease prevention and control and medical treatment.

Review and prospect of theoretical research on Sanming medical reform based on bibliometrics / 中华医院管理杂志

Objective:To analyze the research hotspots and change trends of Sanming medical reform theory in China from 2013 to 2019, so as to provide reference for the relevant research of medical reform in China.Methods:The theoretical and empirical studies on Sanming medical reform from 2013 to 2019 in relevant databases at home and abroad were screened. The literature metrology method was used to analyze the overall trend of domestic literature. The keyword cloud method was used to analyze the research hotspots and main problems.Results:After screening, a total of 59 literatures were obtained. It was found that the reform of public hospitals was the hotspot of current research. Three medical linkage, governance system, annual salary system and medical insurance integration were the core contents of researches.Conclusions:The research of Sanming medical reform is in the initial stage of development. In the future, the research on medical reform can be further deepened around the relevant basic theories, normative and specific research, and so on.

Perfil de governança colaborativa na atenção ambulatorial especializada: uma experiência em duas regiões de saúde / Profile of collaborative governance in specialized ambulatorial attention: an experience in two health regions

Objetivos: Objetivou-se caracterizar o perfil da governança na Atenção Ambulatorial Especializada na região Sul de Santa Catarina (SC), a partir da percepção dos gestores em relação as especificidades da governança colaborativa. Métodos: A pesquisa baseou-se no modelo analítico, desenvolvido por Milagres et al. (2016). A população é formada por 23 gestores das Comissões de Intergestores Regionais (CIRs). Pesquisa de cunho qualitativo - quantitativo, aplicada, descritiva do tipo levantamento. O questionário foi o instrumento de coleta de dados e o período de aplicação foi entre julho a setembro de 2018. Foi aplicado nas reuniões das CIRs, após serem devidamente autorizadas e aprovadas. Para análises estatísticas, os dados foram organizados, codificados, tabulados no software estatístico IBM SPSS, versão 20.0®, utilizando- se de estatística descritiva. Resultados: Constatou-se que, o princípio da confiança é reconhecido por 68% dos gestores, assim como os elementos: Antecedentes em torno de 70%; Governança Contratual, 35,5%; Governança Processual em média 70% e Governança Relacional aproximadamente 64%. No entanto, observou-se que os gestores não têm clareza em identifica-los com tamanha importância. Conclusões: A adoção da gestão colaborativa está em apropriar ­ se de conhecimento, fornecendo subsídios para que seja possível o enfrentamento dos entraves, possibilitando tornar a Atenção Ambulatorial Especializada efetiva, e gerar resultados atendo as demandas da população.

Introduction: To characterize the governance profile in the Specialized Outpatient Care in the southern region of Santa Catarina (SC), based on the perception of managers in relation to the specificities of collaborative governance. Methods: The research was based on the analytical model developed by Milagres et al. (2016). The population is formed by 23 managers of the Comissões de Intergestores Regionais (CIRs). Qualitative - quantitative research, applied, descriptive of the survey type. The questionnaire was the main instrument of data collection and the period of application was between July and September 2018. It was applied in the meetings of the CIRs. For statistical analysis, the data were organized, coded, tabulated in the statistical software IBM SPSS, version 20.0®, using descriptive statistics. Results: It was found that, the trust principle is recognized by 68% of the managers, as well as the elements: Antecedents around 70%; Contractual Governance, 35.5%; Process Governance on average 70%; and Relational Governance approximately 64%. However, it was observed that managers are not clear on identifying them with such importance. Conclusion: The adoption of collaborative management is to appropriate knowledge, providing subsidies to face the obstacles, making it possible to make Specialized Outpatient Care effective, and generate results and meeting the demands of the population.

A path analysis on China’s participation in global health governance: a case study of China Aid of Schistosomiasis Control in Zanzibar / 中国血吸虫病防治杂志

Recently, China’s participation in global health governance has been paid increasing global attention. This paper analyzed the current status and needs of African schistosomiasis control, the participation of China and international organizations in African schistosomiasis control and the progress of China Aid of Schistosomiasis Control in Zanzibar, with China Aid of Schistosomiasis Control in Zanzibar as an example. It is suggested that China may improve the capability of participation in global public health governance and international reputation through strengthening intergovernmental and international collaborations, providing successful disease control experiences and products and improving capability and team building.

Redes sociais e práticas em saúde: influência de uma comunidade online de diabetes na adesão ao tratamento / Social networks and health practices: influence of a diabetes online community on adherence to treatment

Resumo Este estudo visa compreender como as comunidades online podem contribuir, no Brasil, para aumentar a adesão de pacientes crônicos ao tratamento prescrito pelo médico. Para tanto, realizou-se a netnografia da comunidade Diabetes: vivendo e aprendendo - troca de informações, considerando como arcabouço teórico as dimensões da adesão propostas pela Organização Mundial de Saúde - OMS. A análise evidencia os impactos da Cibercultura sobre os processos de saúde e doença, provocando mudanças nas relações médico-paciente, no empoderamento do paciente e na gestão individual de sua condição crônica. Os resultados mostraram também uma influência positiva das interações estabelecidas na comunidade sobre os fatores multidimensionais do modelo de adesão proposto pela OMS, conduzindo ainda à possibilidade de inclusão de uma sexta dimensão referente à conectividade. As principais motivações identificadas para participação na comunidade foram o acesso a informações sobre a doença e o tratamento, o compartilhamento de experiências e o suporte social. Assim, a proposição de políticas de saúde que auxiliem os doentes crônicos a atenderem tais necessidades tende a contribuir para aumentar a adesão ao tratamento.

Abstract This study aims to understand how online communities can contribute to increasing the adherence of chronic patients to the treatment prescribed by the physician in Brazil. For this purpose, we applied the netnography method to analyze the community Diabetes: vivendo e aprendendo - troca de informações (free translation: "Diabetes: living and learning - information exchange"), considering the dimensions of adherence proposed by the World Health Organization (WHO) as a theoretical framework. The analysis shows the influence of cyberculture on health and disease processes, resulting in changes in physician-patient relationships, patient empowerment, and individual management of own chronic condition. The results also showed a positive influence of the interactions established in the community on the multidimensional factors of the adherence model proposed by the WHO1, also leading to the possibility of including a sixth related to connectivity. The primary motivations identified for community participation were access to information on the disease and treatment, the sharing of experiences and social support. Thus, the proposition of health policies that help chronic patients meet these needs tends to contribute to increased adherence to treatment.

How does the world's most efficient healthcare system respond to the challenge? Hong Kong's health governance system, healthcare system reform and implications for mainland China / 中国卫生政策研究

Mainland China's healthcare system reform has achieved remarkable results. As the reform progresses ,more efforts could be made in policy-learning from other Chinese societies with more successful experiences. Hong Kong Special Administrative Region has an internationally renowned healthcare system, ranked at the top in the world's most efficient health systems. This paper reviews Hong Kong's health governance system, the challenges it has faced, its reform initiatives in the recent years, and discusses their implications for the mainland China. Heath governance in Hong Kong has fully realized the separation of regulationswith operation, thus overcoming major institutional barriers. The Hospital Authority of Hong Kong has demonstrated very high efficiency and managerial professionalism. However, Hong Kong's healthcare system is also facing various daunting challenges, and the government has introduced a series of reform initiatives, including the Voluntary Health Insurance Scheme, Public-Private Partnership, and Elderly Health Care Voucher. Many reform ideas and policy instruments can be of reference value for healthcare system reforms in the mainland.

Research on the governance tools of international NGOs participating in global health / 中国卫生政策研究

Non-governmental organizations ( NGOs) are playing an increasingly significant role in global health governance. This study selected ten key NGOs that play an important role in global health affairs and summarized the tools employed by NGOs participating in global health governance, including nine dimensions:“Generating informa-tion and evidence/intelligence”, “Cooperation ( Partnerships )”, “Participation”, “Consultation”, “Transparen-cy”,“Organizational adequacy/system design”, “Formulating policy / strategic direction”, “Responsibility” and“Regulation”. Four types of NGOs including Operational, Supportive, Advocacy and Integrated ones presented com-monness and their priorities in the selection of tools to participate in global health governance. Meanwhile, China should strive to nurture local NGOs, which should pay attention to“Transparency”,“Participation” and“Cooperation ( Partnerships)”.

International experience and reference on NGOs and global health / 中国卫生政策研究

The international Non-governmental Organizations ( NGOs) have been playing an important role in the field of global health, which also represents a channel for countries' international experience. This research fo-cuses on the role of NGOs in global health, their governance tools, global health program management experience, and current status of development for Chinese NGOs. In light of international experiences, we suggest the Chinese government to support a few top NGOs to engage intensely in global health, build management and cooperation mechanism with NGO which will be considered as important complemertary role. The Chinese government shonld implement “major support and comprehensive improvement” strategy.

Analysis of the role and function of professional organizations in health governance in China / 中国卫生政策研究

The characteristics of health care require that health care professional organizations play an impor-tant role in health governance. The role of health care professional organizations in China has not been clearly defined and their functions have not been fully developed. This paper explores the nature, and the functions of health care professional associations in China. Based on the analysis of health governance characteristics in China, the role, and functions of the health care professional organizations in China’s health governance were defined and relevant policy recommendations are were proposed.

From assistance to communitas：Changing of China’s position of global health governance from Ebola outbreak in Africa / 中国卫生政策研究

Health is one of the essential ties between China and Africa. As the Chinese economy is experien-cing rapid development and the strategic transformation, the China-Africa cooperation is entering the era of communi-tas in all directions and the health-related aids and exchanges between China and Africa are experiencing new oppor-tunities and challenges. Previously, the China-Africa health cooperation has experienced three transitional stages from the assistance, collaboration and communitas. During the current global fight against Ebola outbreak period, while the world feared and wondered the Ebola in the beginning, China’s fast action on the fight had showed that not only the relationship between China and Africa is seen from the previous health aid legacy to Africa, but also is coming to the economic development communitas stage. Moreover, there are two essential government and non-government col-laboration established between China and Africa. So, when we analyze the fast action of China towards Ebola out-break, it is clearly shown that the China’s response is based in the perspective of humanitarian, super state accounta-ble responsibilities, and also focused on health system resilience in the epidemic countries. China and Africa are stepping into the economic development communitas stage. Therefore, this change of cooperation reflects the change of China’s position in the global health governance.

The concept and practice of health governance in the international community / 中国卫生政策研究

Based on the formation and development of health governance concept in international community, some representative countries from the two aspects, namely the cooperative governance of both the government and the society as well as the inter-organizational vertical and horizontal governance made the relevant experience of health governance practice. On this basis of the shared values and policy objectives consensus, the health governance con-cept was transformed into common practice with the participation of both the government and the society. It not only reflects the multiple objective value orientation of equality, diversity, trust, cooperation and participation, but also promotes the transformational development of the international community health management system and health serv-ice pattern, which could provide a valuable experience for the construction of health governance model in China.