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Resumo Objetivos Analisar desenhos de avaliação econômica em Práticas Integrativas e Complementares em Saúde (PICS). Métodos O estudo é uma revisão integrativa de estudos disponíveis na Biblioteca Virtual em Saúde, de 2009 a 2021. Resultados Vinte e um estudos foram selecionados para análise final, apresentando importante conformidade com as recomendações dos especialistas. Em geral, a população foi composta por mulheres adultas com distúrbios osteomusculares, que receberam terapias manipulativas, acupuntura/acupressão e homeopatia. Para avaliar essas intervenções, foram utilizadas as perspectivas da sociedade ou do provedor, a partir de análises de custo-efetividade e de custo-consequência, concentrando-se em estimar os custos diretos de saúde, e por vezes, os custos indiretos. Quanto aos desfechos, a maioria dos estudos coletou mais de uma medida, principalmente relacionadas a manifestações sintomáticas, bem-estar global e/ou fatores psicossociais. Conclusões A avaliação econômica está evoluindo para considerar perspectivas mais amplas, com maior variedade de custos e resultados, adaptando-se a diversos cenários de intervenção, atendendo às especificidades das PICS. Conciliar o desenho metodológico ao contexto de inserção das PICS no Brasil é possível e necessário, dada a carência de avaliações nacionais, aos vieses gerados por comparações internacionais e às disputas pela sustentabilidade desse conjunto de práticas no Sistema Único de Saúde.
Abstract Objectives To analyze economic evaluation designs in Integrative and Complementary Health Practices (PICS). Methods This study is an integrative review of available studies in the Virtual Health Library, from 2009 to 2021. Results Twenty-one studies were selected for final analysis, showing significant compliance with the experts' recommendations. In general, the population consisted of adult women with musculoskeletal disorders, who received manipulative therapies, acupuncture/acupressure and homeopathy. To evaluate these interventions, society's or provider's perspectives were used, based on cost-effectiveness and cost-consequence analyses, focusing on estimating direct health costs, and sometimes indirect costs. As for outcomes, most studies collected more than one measure, mainly related to symptomatic manifestations, overall well-being and/or psychosocial factors. Conclusions The economic evaluation is evolving to consider broader perspectives, with a greater variety of costs and results, adapting to different intervention scenarios, meeting the specificities of PICS. Reconciling methodological design and PICS' context of insertion in Brazil is possible and necessary, given the lack of national assessments, the biases generated by international comparisons, and the disputes over the sustainability of this set of practices in the Brazilian Unified Healht System.
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ABSTRACT OBJECTIVE To recognize elements that facilitated or hindered the PlanificaSUS implementation stages. METHODS A multiple case study was carried out in four pre-selected health regions in Brazil—Belo Jardim (PE), Fronteira Oeste (RS), Sul-Mato-Grossense (MT) and Valença (BA) using systemic arterial hypertension and maternal and child care as tracer conditions. Participant observation (in regional interagency commissions) and in-depth interviews with key informants from state and municipal management and primary health care and specialized outpatient care service professionals within the project were carried out in these four regions. Analysis was built according to political, technical-operational, and contextual dimensions. RESULTS The political dimension evinced that the regions found the project an opportunity to articulate states and municipalities and an important political bet to build networks and lines of care but that there remained much to be faced in the disputes related to building the Unified Health System (SUS). In the technical operational dimension, it is important to consider that primary health care stimulated a culture of local planning and favored traditional tools to organize and improve it, such as organizing registrations, agendas, and demands. However, centralized training and planning-inducing processes fail to always respond to local needs and can produce barriers to implementation. CONCLUSIONS It is worth considering the central and regional role of state managers in the commitment related to the project and the effect of mobilizing primary health care and expanding its power. There remains much to be faced in the disputes at stake in bullring SUS.
RESUMO OBJETIVO Reconhecer elementos que facilitaram ou dificultaram as etapas do processo de implementação do PlanificaSUS. MÉTODOS Foi realizado um estudo de casos múltiplos em quatro regiões de saúde pré-selecionadas - Belo Jardim (PE), Fronteira Oeste (RS), Sul-Mato-Grossense (MT), Valença (BA) -, utilizando como condições traçadoras a hipertensão arterial sistêmica e a atenção materno infantil. Foi realizada observação participante na Comissão Intergestora Regional (CIR), bem como entrevistas em profundidade nas quatro regiões estudadas, com informantes-chave da gestão estadual e municipal e com profissionais dos serviços da atenção primária à saúde e atenção ambulatorial especializada envolvidos no projeto. Construiu-se análise em três dimensões: política, técnico operacional e contexto. RESULTADOS Na dimensão política, ficou evidenciado que, de alguma forma, as regiões identificaram no projeto uma oportunidade de articulação entre estados e municípios e uma aposta política importante para a construção de redes e linhas de cuidado, mas ainda com muitos caminhos a percorrer para enfrentar as barreiras identificadas nas disputas em jogo na construção do Sistema Único de Saúde (SUS). Na dimensão técnico operacional, é importante considerar que foi estimulada uma cultura de planejamento local na APS, além do favorecimento do uso de ferramentas tradicionais, no sentido de organizá-la e qualificá-la, como a organização dos cadastros, da agenda e da demanda. No entanto, os processos centralizados formativos e indutores da planificação nem sempre respondem às necessidades singulares dos territórios e podem produzir barreiras à implementação. CONCLUSÕES Cabe considerar o papel do gestor estadual na aposta relacionada ao projeto, tanto no nível central quanto no nível regional, e o efeito de processos de mobilização da atenção primária à saúde e amplificação de sua potência, mas ainda com muitos caminhos a percorrer para enfrentar as barreiras identificadas nas disputas em jogo na construção do SUS.
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BACKGROUND: Cancer is a public health priority in Chile. AIM: To estimate the expected annual cost of cancer in Chile, due to direct costs of health services, working allowances and indirect costs for productivity losses. MATERIAL AND METHODS: We undertook an ascendent costing methodology to calculate direct costs. We built diagnostic, treatment and follow-up cost baskets for each cancer type. Further, we estimated the expenditure due to sick leave subsidies. Both estimates were performed either for the public or private sector. Costs related to productivity loss were estimated using the human capital approach, incorporating disease related absenteeism premature deaths. The time frame for all estimates was one year. RESULTS: The annual expected costs attributed to cancer was $1,557 billion of Chilean pesos. The health services expected annual costs were $1,436 billion, 67% of which are spent on five cancer groups (digestive, hematologic, respiratory, breast and urinary tract). The expected costs of sick leave subsidies and productivity loss were $48 and $71 billion, respectively. CONCLUSIONS: Cancer generates costs to the health system, which obliges health planners to allocate a significant proportion of the health budget to this disease. The expected costs estimated in this study are equivalent to 8.9% of all health expenditures and 0.69% of the Gross Domestic Product. This study provides an updated reference for future research, such as those aimed at evaluating the current health policies in cancer.
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Humans , Health Care Costs , Neoplasms/therapy , Chile/epidemiology , Health Expenditures , Cost of Illness , AbsenteeismABSTRACT
RESUMEN Introducción: el internet de las cosas ofrece nuevas oportunidades de acceso a datos, servicios específicos en la educación, seguridad y asistencia sanitaria, entre otros campos. Objetivo: realizar una revisión de la literatura existente sobre aspectos que definen el internet de las cosas en el ámbito de la salud pública. Métodos: se realizó una investigación documental de la literatura en diversas bases de datos académicas y motores de búsqueda; (MEDLINE, Scopus, IEEE Xplore, PubMed, Science Direct, Google Scholar y Google Books) y sitios web corporativos e institucionales (Cisco, Naciones Unidas y Organización Mundial de la Salud). Se utilizaron los siguientes descriptores: internet de las cosas, conectividad, salud pública, salud móvil, epidemiología, aprendizaje automático, aprendizaje profundo e inteligencia artificial. Se revisaron documentos siguiendo el método que incluye la identificación de la pregunta de investigación (con base en el objetivo) y los estudios relevantes, seguido de la selección de los escritos y el cotejo, resumen y presentación de los resultados. Desarrollo: los conceptos y opiniones se estructuraron en tres capítulos donde se exponen las ideas esenciales relacionadas con el tema objeto de estudio: origen del internet de las cosas, el internet de las cosas en salud pública y conclusiones. Conclusiones: el internet de las cosas representa para el área de salud pública una posibilidad innovadora para entender y atender el fenómeno salud-enfermedad de las poblaciones, y proporcionar una red de colaboración entre individuos sustentado en la conformación de una arquitectura de la participación desde un enfoque inteligente.
ABSTRACT Introduction: the internet of things offers new opportunities for access to data, specific services in education, security and health care, among other fields. Objective: to carry out a review of the existing literature on aspects that define the internet of things in the field of public health. Methods: a documentary research of the literature was carried out in various academic databases and search engines; (MEDLINE, Scopus, IEEE Xplore, PubMed, Science Direct, Google Scholar and Google Books) and corporation and institutional websites (Cisco, United Nations and World Health Organization). The following descriptors were used: internet of things, connectivity, public health, mobile health, epidemiology, machine learning, deep learning, and artificial intelligence. Documents were reviewed following the method that includes the identification of the research question (based on the objective) and the relevant studies, followed by the selection of the writings and the comparison, summary and presentation of the results. Development: the concepts and opinions were structured in three chapters where the essential ideas related to the subject under study are presented: origin of the internet of things, the internet of things in public health and conclusions. Conclusions: the internet of things represents an innovative possibility for the area of public health to understand and attend to the health-disease phenomenon of populations, and to provide a network of collaboration between individuals based on the creation of an architecture of participation from a smart approach.
Subject(s)
Internet of Things , Education, Medical , Internet-Based Intervention , Health Planning SupportABSTRACT
ntrodução:A previsão da demanda por serviços de saúde possibilita melhorias no processo de tomada de decisões gerenciais nas organizações de saúde.Objetivo:O estudo buscou identificar, na literatura, as metodologias utilizadas para prevera demanda por serviçosodontológicos. Metodologia:Trata-se de uma revisão integrativa conduzida de acordo com o método PRISMA. A expressão de busca (((forecast* OR "prediction" OR "prevision") AND ("demand" OR trend*) AND ("dental services"))) foi aplicada em campos determinados para os repositórios Scopus Elsevier, Pubmed, BVS e IEEE Xplore.As metodologias empregadas foram categorizadas conforme a temporalidade e o instrumento empregado nosestudos. Resultados:Após aplicação do processo de seleção-exclusão baseado na recomendação PRISMA, foram selecionados 34 documentos, classificados conforme a dependência da colaboração do paciente, a procedência de auto avaliações, o direcionamento a um grupo populacional ou demanda específica, e a relação com o setor público, privado ou ambos. As metodologias identificadas foram: estudos de temporalidade transversal em que o instrumento foi a aplicação de questionário; estudos de temporalidade transversal nos quais o instrumento foi a observação; e estudo de temporalidade longitudinal onde o instrumento foi a aplicação de questionário. Conclusões:A partir dos resultados dessa revisão, foi gerado conhecimento capaz de apoiar o delineamento de estudos com potencial para aprimorar a previsibilidade da demanda por serviços odontológicos (AU).
Introduction:Forecasting the demand for health services enables improvements in the decision-makingprocess in healthcareorganizations.Objective:The present study aimed to identify in the literature the methodologies used to predict the demand for dental services.Methodology:This was an integrative review conducted in accordance with the PRISMA method. The search expression (((forecast* OR "prediction" OR "prevision") AND ("demand" OR trend*) AND ("dental services"))) was applied to fields determined for the Scopus Elsevier, PubMed, VHL, and IEEE Xplore databases.The identified methodologies were categorized according to temporality and instrument used in the studies.Results:After applying the selection-exclusion process based on Prisma, 34documents were selected, classifiedaccording to patient's collaboration dependence, self-assessments, the targeting of a specific group or demand and the relationship with public, private or both sectors. The methodologies identified were transversal temporality in which the instrument was the application of a questionnaire or observation and longitudinal temporality where the instrument was the application of a questionnaire. Conclusions:From the results of this review, insights were generatedcapable of supporting studies with potential to improve the forecast of dental services (AU).
Introducción: La predicción de la demanda de servicios de salud permite mejorar el procesode decisiones em organizaciones de salud.Objetivo: El estudio buscó identificar, en la literatura, las estrategias utilizadas para predecirla demanda deserviciosdentales.Metodología: Esta es una revisión integradora realizada de acuerdo con el método PRISMA. La expresión de búsqueda (((pronóstico * O "predicción" O "previsión") Y ("demanda" O tendencia *) Y ("servicios dentales"))) se aplicó a los campos determinados para repositorios Scopus Elsevier, Pubmed, BVS y IEEE Xplore.Las metodologías identificadas se categorizaron según la temporalidady el instrumento utilizado em los estudios.Resultados:Tras aplicar el procesode selección-exclusión basado emPrisma, se seleccionaron 34documentos, clasificadossegún la dependencia de colaboración del paciente, las autoevaluaciones a, la focalización de un grupo o demanda específica y la relación con el sector público, privado o ambos. Las metodologíasidentificadas fueron: latemporalidad transversal en los cuales el instrumento era la aplicación de un cuestionario; estudios de temporalidad transversal en los cuales la observación era el instrumento; y estudio de temporalidad longitudinal donde el instrumento fue la aplicación de un cuestionario. Conclusiones: A partir de los resultados de esta revisión se generó conocimiento capaz de sustentar el diseño de estudios con potencial para mejorar la predictibilidad de la demanda de servicios odontológicos (AU).
Subject(s)
Delivery of Health Care , Dental Health Services , Health Planning Support , Health Services Needs and Demand , BrazilABSTRACT
ABSTRACT Objective: to describe the stages of construction and content validation of an instrument to assess Primary Health Care Planning workshops. Methods: this methodological study focused on validating the instrument's content. The instrument developed was assessed by a committee of experts using the Delphi Technique, in two rounds. For the degree of agreement, percentage agreement and Content Validity Index (CVI) were used. Results: in the first round, six experts participated, and the degree of agreement was 87% for clarity and 94% for representativeness. In the second round, five experts participated, the CVI was 0.95 for clarity, 0.97 for representativeness and 0.96 total CVI. The final instrument had 42 items divided into three chunks. Conclusion: the instrument has content validity to assess Primary Health Care Planning workshops, being a tool for the use of state and municipal administrations.
RESUMEN Objetivo: describir las etapas de construcción y validación de contenido del instrumento para evaluar los talleres de Planificación de la Atención Primaria de Salud. Métodos: estudio metodológico, enfocado en validar el contenido del instrumento. El instrumento desarrollado fue evaluado por un comité de expertos utilizando la técnica Delphi, en dos rondas. Para el grado de acuerdo, se utilizaron el Porcentaje de Acuerdo y el Índice de Validez del Contenido (IVC). Resultados: en la primera ronda, participaron seis expertos, y la tasa de acuerdo fue del 87% para mayor claridad y del 94% para la representatividad. En la segunda ronda, participaron cinco expertos, el IVC fue de 0.95 por claridad, 0.97 por representatividad y 0.96 IVC total. El instrumento final tiene 42 ítems divididos en tres bloques. Conclusión: el instrumento de evaluación incorporado tiene validez de contenido para evaluar los talleres de Planificación de Atención Primaria de Salud, siendo una herramienta para el uso de las administraciones estatales y municipales.
RESUMO Objetivo: descrever as etapas de construção e validação de conteúdo do instrumento para avaliação das oficinas de Planificação da Atenção Primária à Saúde. Métodos: estudo metodológico, com foco na validação de conteúdo do instrumento. O instrumento elaborado foi avaliado por um comitê de especialistas utilizando a Técnica Delphi, em duas rodadas. Para o grau de concordância, foram utilizados o Percentual de Concordância e o Índice de Validade de Conteúdo (IVC). Resultados: na primeira rodada, participaram seis especialistas, e a taxa de concordância foi 87% para clareza e 94% para representatividade. Na segunda rodada, participaram cinco especialistas, o IVC foi 0,95 para clareza, 0,97 para representatividade e 0,96 IVC total. O instrumento final possui 42 itens divididos em três blocos. Conclusão: o instrumento de avaliação construído possui validade de conteúdo para avaliar as oficinas de Planificação da Atenção Primária à Saúde, sendo uma ferramenta para utilização das gestões estadual e municipal.
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Successful pregnancy and delivery of a healthy offspring largely rely on a well-developed placenta. Defects in placental development may lead to various pregnancy complications. However, placenta has been one of the least understood organs. The mechanism of its development and function, as well as the molecular association between placental disorders and pregnancy complications remain unclear, thus become the least known area in the exploration of pregnancy and life. Along with the advances in modern techniques, the understanding of the placenta has been deepened from tissue structure to cellular and molecular level, and gradually toward the omics and systematic biology. In recent years, a number of groundbreaking achievements have been made in the field of placental development, which were summarized in this article. Some relevant international funding programs and future prospects in this area were also discussed.
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Successful pregnancy and delivery of a healthy offspring largely rely on a well-developed placenta. Defects in placental development may lead to various pregnancy complications. However, placenta has been one of the least understood organs. The mechanism of its development and function, as well as the molecular association between placental disorders and pregnancy complications remain unclear, thus become the least known area in the exploration of pregnancy and life. Along with the advances in modern techniques, the understanding of the placenta has been deepened from tissue structure to cellular and molecular level, and gradually toward the omics and systematic biology. In recent years, a number of groundbreaking achievements have been made in the field of placental development, which were summarized in this article. Some relevant international funding programs and future prospects in this area were also discussed.
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RESUMO Este artigo investiga práticas de apoio na rede de saúde ao problematizar o cuidado à população em situação de rua. Apoiado pelo conceito de biopoder, o estudo analisa as formações disciplinares e a regulamentação da vida que atravessam a rede de cuidados, que, normalmente, espera receber usuários já padronizados, o que traz como efeito a marginalização de determinadas populações. A pesquisa-intervenção cartográfica norteia o método ao desenhar uma trajetória de cuidado em uma situação experienciada entre Consultório na Rua, Unidade Básica de Saúde e usuário morador de rua. Como resultado, o texto aponta para a necessidade de se multiplicar, cada vez mais, trocas de experiências de apoio na rede de atenção para se abrir espaços de "desaprendizagem" permanente, provocadora de atos de cuidados inventivos, desviantes do padrão excludente de diversas singularidades que se apresentam no cotidiano do trabalho em saúde.
RESUMEN Este trabajo investiga prácticas de apoyo en la red de salud al problematizar el cuidado a la población en situación de calle. Apoyado por el concepto de biopoder, el estudio analiza las formaciones disciplinares y la reglamentación de la vida que atraviesan la red de cuidados, que, normalmente, espera recibir usuarios ya estandarizados, lo que trae como efecto la marginación de determinadas poblaciones. La investigación e intervención cartográfica orienta el método al dibujar una trayectoria de cuidado en una situación experimentada entre Consultorio en la Calle, Unidad Básica de Salud y usuario que vive en la calle. Como resultado, el texto señala la necesidad de multiplicar, cada vez más, cambios de experiencias de apoyo en la red de atención para abrir espacios de "desaprendizaje" permanente, provocador de acciones de cuidados inventivas, desviadas del estándar excluyente de diversas singularidades que se presentan en el cotidiano del trabajo en salud.
ABSTRACT This paper aims to investigate the support practices to the network of healthcare for homeless people. Based on the concept of biopower this study analyzes how the disciplinary formations and life regulamentation impact healthcare, marginalizing certain populations. Through the research methodology of cartographic intervention the trajectory that intertwine Consultation office in the Street, Basic Health Care services and the homeless population is mapped. The results points towards the necessity to continuously increase experience exchange throughout the healthcare network, opening oportunities to permanently "unlearn" misconceptions brought by a standardized care. To be able to welcome the singularity of diverse and marginalized populations, the health care routes need to be inventive and deviant.
Subject(s)
Ill-Housed Persons , Delivery of Health Care , Health Policy , Psychosocial Support Systems , Health ServicesABSTRACT
OBJECTIVE To analyze whether the level of institutional and matrix support is associated with better certification of primary healthcare teams.METHODS In this cross-sectional study, we evaluated two kinds of primary healthcare support - 14,489 teams received institutional support and 14,306 teams received matrix support. Logistic regression models were applied. In the institutional support model, the independent variable was "level of support" (as calculated by the sum of supporting activities for both modalities). In the matrix support model, in turn, the independent variables were the supporting activities. The multivariate analysis has considered variables with p < 0.20. The model was adjusted by the Hosmer-Lemeshow test.RESULTS The teams had institutional and matrix supporting activities (84.0% and 85.0%), respectively, with 55.0% of them performing between six and eight activities. For the institutional support, we have observed 1.96 and 3.77 chances for teams who had medium and high levels of support to have very good or good certification, respectively. For the matrix support, the chances of their having very good or good certification were 1.79 and 3.29, respectively. Regarding to the association between institutional support activities and the certification, the very good or good certification was positively associated with self-assessment (OR = 1.95), permanent education (OR = 1.43), shared evaluation (OR = 1.40), and supervision and evaluation of indicators (OR = 1.37). In regards to the matrix support, the very good or good certification was positively associated with permanent education (OR = 1.50), interventions in the territory (OR = 1.30), and discussion in the work processes (OR = 1.23).CONCLUSIONS In Brazil, supporting activities are being incorporated in primary healthcare, and there is an association between the level of support, both matrix and institutional, and the certification result.
OBJETIVO Analisar se o grau de apoio institucional e matricial está associado à melhor certificação das equipes da atenção básica à saúde.MÉTODOS Neste estudo transversal analisamos dois tipos de apoio na atenção básica, sendo que 14.489 equipes receberam apoio institucional e 14.306 equipes receberam apoio matricial. Foram aplicados modelos de regressão logística. No de apoio institucional, a variável independente foi grau de apoio (calculado pelo somatório de atividades de apoio das duas modalidades), enquanto no de apoio matricial, as variáveis independentes foram as atividades de apoio. A análise multivariada considerou variáveis que apresentaram p < 0,20. O ajuste do modelo foi realizado pelo teste de Hosmer-Lemeshow.RESULTADOS As equipes contavam com atividades de apoio institucional e matricial em 84,0% e 85,0%, respectivamente, sendo que 55,0% realizavam entre seis e oito atividades. Para o apoio institucional, observamos chances de 1,96 e 3,77 de possuir certificação ótima ou boa quando as equipes possuíam médio e alto grau de apoio, respectivamente. Para o apoio matricial, as chances de possuir certificação ótima ou boa foram de 1,79 e 3,29, respectivamente. Quanto à associação entre atividades de apoio institucional e a certificação, a certificação ótima ou boa associou-se positivamente com autoavaliação (OR = 1,95), educação permanente (OR = 1,43), avaliação compartilhada (OR = 1,40) e monitoramento e avaliação de indicadores (OR = 1,37). Quanto ao apoio matricial, a certificação ótima ou boa associou-se positivamente com educação permanente (OR = 1,50), intervenções no território (OR = 1,30) e discussão nos processos de trabalho (OR = 1,23).CONCLUSÕES No Brasil, as atividades de apoio estão sendo incorporadas na atenção básica, existindo associação entre o grau de apoio tanto matricial quanto institucional e o resultado da certificação.
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Humans , Primary Health Care/standards , Quality Assurance, Health Care , Efficiency, Organizational , Institutional Management Teams , Primary Health Care/organization & administration , Brazil , Cross-Sectional Studies , Inservice Training/statistics & numerical dataABSTRACT
O presente trabalho discute o apoio matricial como ferramenta de transformação dos modos de organização na saúde, especificamente na atenção primária. Para isso, conceitua o tema e reflete sobre a crescente atuação do terapeuta ocupacional nas equipes de matriciamento desde a criação dos Núcleos de Apoio à Saúde da Família (NASF) pelo Ministério da Saúde. Busca-se problematizar as questões levantadas durante o grupo ?Trabalho em Equipe e Matriciamento na Atenção Primária à Saúde? realizado em outubro de 2011, no I Simpósio de Atenção Primária do XII Congresso Brasileiro e IX Congresso Latino Americano de Terapia Ocupacional. Apresenta reflexões acerca de desafios encontrados na prática do apoio matricial no cotidiano de trabalho no NASF. Observou-se que os obstáculos encontrados na atuação têm paralisado os profissionais, porém valoriza-se, neste artigo, a importância de sua identificação como o primeiro passo para superá-los, bem como o papel do terapeuta ocupacional como um dos atores das transformações necessárias.
This paper discusses matrix support as a tool for transforming the ways of organizing health care, particularly concerning primary care. To this end, it conceptualizes the subject and reflects on the growing role of the Occupational Therapist in matrix teams since the creation of the Centers of Support for Family Health Care (NASF) by the Brazilian Health Agency. Moreover, it discusses the issues raised during the workshop on ?Teamwork and matrix support in Primary Health Care? held in October 2011, at the Primary Health Care Symposium of the XII Brazilian Congress and IX Latin American Congress of Occupational Therapy. It introducesreflections on the challenges encountered in the practice of matrix support in the everyday work in the NASFs. It was possible to observe that the obstacles found have been impairing workers' activities; nevertheless, what isvalued in this article is the importance of the identification of these obstacles as the first step to overcome them,as well as the occupational therapist's role as one of the actors of the transformations needed
Subject(s)
Primary Health Care , Unified Health System , Occupational Therapy , Health Planning SupportABSTRACT
El presente estudio tuvo como objetivos a) conocer en qué medida América Latina y el Caribe (ALC) se vio beneficiada por los aumentos de la asistencia internacional para el desarrollo de la salud (ADS) a nivel mundial y si la tendencia observada después de la Cumbre del Milenio, también fue una tendencia observada en la Región, b) determinar si existen diferencias en la distribución de esta asistencia, según el ingreso bruto per cápita de los países, c) identificar el posible efecto de la crisis financiera internacional de 2008 en la ayuda oficial bilateral y d) comparar las tendencias que tuvo el gasto público salud con respecto a la ADS antes y después de la Cumbre del Milenio Se encontró que la ADS en ALC sigue un curso muy diferente al de otras regiones del mundo. A partir de 1997 se entra en un período de estancamiento fluctuante que se extiende hasta 2008, con desembolsos promedios anuales de US$ 1 200 millones. La banca multilateral tuvo una participación de 79 por ciento de los desembolsos promedios entre 2002 y 2008 en los países de ingreso medio alto, mientras que la ayuda oficial bilateral registró la mayor participación (61 por ciento) en los países de ingresos medios bajos y bajos. En este período la ayuda bilateral tiene un crecimiento anual de 13 por ciento, pero en el año posterior a la crisis los desembolsos caen en US$ 20 millones. El 64 por ciento de la ayuda bilateral provino de Estados Unidos, España y Canadá, y el 29 por ciento de la misma se destinó a VIH/Sida y enfermedades de transmisión sexual. Después de la Cumbre del Milenio la ADS canalizada hacia los gobiernos disminuyó en un 30 por ciento entre 2001-2006 y su participación con respecto al gasto público en salud regional fue de 0,30 por ciento en el mismo período, con una proporción igualmente marginal con respecto al gasto total en salud para 2008 (0,37 por ciento; US$ 2 per cápita). Se concluye que después de la Cumbre del Milenio la ADS en ALC no creció ni logró igualar las tendencias antes del 2000 y el gasto público en salud siguió su tendencia de crecimiento histórico, sin mayores incrementos con respecto al producto interno bruto regional. Frente a este panorama y por ser ALC la región más desigual pero no la más pobre del mundo, resulta imperativo replantearse las formas de pensar, conducir y entregar la cooperación para el desarrollo de la salud con enfoques innovadores y mecanismos alternativos de financiamiento que respondan más y mejor a las realidades de la región.
The purpose of this study is (a) to examine the ways in which Latin America and the Caribbean (LAC) have benefited from increases in international development assistance for health (DAH) at the global level and whether the trend observed after the Millennium Summit has also applied to the Region; (b) to determine whether there are differences in the distribution of this assistance, based on the gross per capita income of each country; (c) to identify the possible effects of the 2008 international financial crisis on official bilateral assistance; and (d) to compare trends in public health expenditure in relation to DAH before and after the Millennium Summit. The study has found that DAH in LAC follows a very different pattern than in other regions of the world. The period from 1997 to 2008 was one of fluctuating stagnation, with average annual disbursements of US$ 1 200 million. Multilateral financial institutions accounted for 79 percent of the average disbursements in the upper-middle income countries between 2002 and 2008, while official bilateral assistance held the greatest share (61 percent) in the low- and lower-middle income countries. Bilateral assistance grew at an annual rate of 13 percent during this period, but in the year after the crisis, disbursements fell to US$ 20 million. Sixty-four percent of bilateral assistance came from the United States, Spain, and Canada, with 29 percent of it being directed to HIV/AIDS and sexually transmitted diseases. After the Millennium Summit DAH channeled to governments decreased 30 percent in the period 2001-2006, and its share of public health expenditure in the region was 0.3 percent for the same period, with an equally marginal proportion in relation to total health expenditure for 2008 (0.37 percent; US$ 2 per capita). The study concludes that after the Millennium Summit, DAH in LAC did not grow nor did it equal the trends prior to 2000, and public health expenditure followed its historical growth trend, without further increases in relation to the regional gross domestic product. Given these realities and the fact that LAC is the world's most unequal region, but not its poorest, it is imperative to reconsider the concepts, management, and delivery of cooperation in the development of health, using innovative approaches and alternative financing mechanisms that respond more effectively to the realities of the region.
Subject(s)
Humans , Financing, Organized/organization & administration , International Cooperation , Public Health/economics , Global Health/economics , Caribbean Region , Developing Countries/economics , Goals , Health Expenditures/statistics & numerical data , Health Planning Support , Health Promotion/economics , Health Promotion/organization & administration , Health Services Needs and Demand , Latin America , Pan American Health Organization/economics , Pan American Health Organization/organization & administration , World Health Organization/economics , World Health Organization/organization & administrationABSTRACT
OBJETIVO: Adaptar y evaluar una herramienta de autodiagnóstico de la capacidad de los equipos de gestión de salud para utilizar la investigación, con énfasis en su adquisición, análisis, adaptación y aplicación. MATERIAL Y MÉTODOS: La herramienta se tradujo al español y se elaboró un manual sometido a la autorización de la Comisión de Ética del Instituto Nacional de Salud Pública, antes de su aplicación durante el periodo de abril a noviembre del 2007 en 122 unidades (tasa de respuesta de 84.4 por ciento) para cubrir una amplia gama de instituciones en seis entidades contrastantes de México, según el índice de desarrollo humano (IDH). Se validó la herramienta de manera interna y externa con métodos estadísticos. RESULTADOS: Se observaron diferencias en la capacidad de los equipos para cada fase de utilización, sin importar cuáles fueran su composición por género, experiencia o estudios, pero sí la participación en la atención a los pacientes, de acuerdo con el IDH de los estados. CONCLUSIONES: La herramienta se validó de modo interno y externo para su aplicación en diversas condiciones de México. Puede aplicarse en cualquier país de habla hispana.
OBJECTIVE: A tool was adapted and evaluated for the self-assessment by health management teams of their capacity to utilize research, distinguishing between its acquisition, analysis, adaptation and application. MATERIAL AND METHODS: The tool was translated into Spanish and a manual was created. The manual was submitted for authorization to the Ethics Committee of the National Public Health Institute of Mexico. The kit was sent to 122 units (response rate of 84.4 percent), covering a wide range of institutions in six contrasting states of Mexico according to the Human Development Index (HDI). The tool was validated internally and externally using statistical methods. RESULTS: Differences were observed in the teams' research utilization capacity within each phase, regardless of their composition by gender, experience or academic level but with differences according to the extent of involvement in patient care and to the states' HDI. CONCLUSIONS: The tool was validated both internally and externally for its application under widely varying conditions in Mexico. The tool can be applied in any Spanish speaking country.