Determination of public and private primary birthing centers service delivery network functionality in Albay, Philippines

Background@#One of the strategies adopted by the Department of Health (DOH) to improve maternal outcomes is the systems approach which means understanding extensively how the system operates to determine factors affecting the delivery of services. In 2014, Albay province responded by adapting and implementing the Maternal, Newborn and Child Health, and Nutrition (MNCHN) Service Delivery Network Guidelines. However, no external monitoring and evaluation have been done to assess the compliance of birthing facilities to these guidelines. @*Objectives@#To determine Legazpi city’s obstetric service delivery network functionality and to compare government and private primary level birthing facilities in terms of 1) governance; 2) human resources; 3) protocols; 4) transportation and communication; and 5) emergency drugs and equipment. @*Materials and Methods@#A cross-sectional study using the referral system assessment (RSA) questionnaire translated into a scorecard with a review of secondary data on high-risk pregnancies, referral rates, and maternal mortalities was done on eight facilities in Legazpi City. @*Results@#Overall, none of the health facilities assessed were fully-functional. Privately owned facilities scored highest in emergency drugs and equipment (83.3%) and lowest in human resources (38.9%). Government facilities scored highest in emergency drugs and equipment (88.9%) but lowest in transportation and communication (44.4%). Statistically significant differences were observed for human resources (p-value=0.0180), wherein public facilities garnered higher scores, and in transportation and communication (p-value=0.0294), private facilities showed better scores. Only one maternal death in 418 referrals was reported.@*Conclusion@#Overall, the health facilities varied in the level of functionality in terms of SDN guidelines.

Utilização do monitoramento da Política de Prevenção à Criminalidade de Minas Gerais / Utilización del monitoreo de la Política de Prevención a la Criminalidad de Minas Gerais / Monitoring the crime prevention policy in Minas Gerais

Resumo As sistemáticas de monitoramento de políticas públicas ganharam relevância no âmbito governamental a partir das reformas gerenciais da administração pública. A despeito disso, a utilização das informações pelos gestores persiste como desafio iminente. O objetivo do artigo é identificar e categorizar, à luz da literatura de referência, o uso dado às informações geradas pelas estratégias de monitoramento da Política de Prevenção Social à Criminalidade (PPSC) do Estado de Minas Gerais. São utilizados dados qualitativos coletados em pesquisa realizada com atores que atuam em diferentes áreas de execução da política. Constatou-se que os gestores fazem uso direto e político das informações, de tipo instrumental, processual, persuasiva e imposta. Apesar disso, observou-se que a PPSC não dispõe de um sistema de monitoramento estruturado. Assim, a produção de registros e dados fica concentrada nas unidades locais de implementação dos programas que compõem a política. Notou-se ainda que a publicização destes dados é insuficiente e que as atividades de monitoramento são percebidas como instrumentos de controle e fiscalização.

Resumen Las sistemáticas de monitoreo de políticas públicas adquirieron relevancia en el ámbito gubernamental a partir de las reformas gerenciales de la administración pública. Sin embargo, la utilización de la información por los gestores persiste como un desafío inminente. El artículo identifica y categoriza, a la luz de la literatura de referencia, el uso de las informaciones generadas por las estrategias de monitoreo de la Política de Prevención Social a la Criminalidad (PPSC) del estado de Minas Gerais. Se utilizan dados cualitativos de investigación realizada con actores involucrados en la gestión de la política. Se notó que los gestores hacen uso directo y político de la información, en la forma instrumental, procesual, persuasiva e impuesta. Sin embargo, la política no tiene un sistema de monitoreo estructurado, la producción de información se concentra en las unidades locales de implementación de los programas que componen la política, la divulgación de estos datos es insuficiente y las actividades de monitoreo se ven como instrumentos de control y fiscalización.

Abstract Methods of public policy monitoring have gained relevance with the emergence of managerial reforms of the public administration. However, the use of information by managers persists as an imminent challenge. The objective of this study is to identify and categorize, based on the literature, the use of the information collected from the monitoring strategies adopted in the Crime Prevention Policy in the Brazilian state of Minas Gerais, based on qualitative research. The study observed that managers make direct and political use of information in an instrumental, procedural, persuasive, and imposed form. However, the policy does not have a structured monitoring system. The production of information is concentrated in the local units of implementation, the publicity of the data is insufficient, and the activities are seen as instruments of control and inspection.

A review of national plans of action for nutrition in Southeast Asian countries

@#This review describes national plans of action for nutrition (NPANs) in six Southeast Asia countries (Indonesia, Malaysia, Myanmar, Philippines, Thailand and Vietnam) in order to provide an understanding of the approach and framework undertaken by these countries in the formulation and implementation of NPANs, as well as the similarities and differences in various NPAN components. The six countries recognised the persistent undernutrition and escalating rates of obesity and other diet-related chronic diseases as the key drivers for nutrition action plan implementation. The prioritisation of nutrition interventions outlined in these NPANs are based on respective country context and needs. Although differing in strategies and targets set, these countries show similarities in several components including objectives, stakeholder involvement, nutritional issues to be addressed, implementation, monitoring and evaluation mechanism, programme/ activities identified and challenges in implementing NPANs. Countries have recognised that effective implementation, monitoring and evaluation are essential to successfully address both extremes of the challenging nutrition situation. Several important similarities in the NPANs studied suggest that closer collaboration among countries and stakeholders on NPANs would be beneficial. Opportunities should be created for periodic exchanges to enable sharing of experiences in the development and implementation of NPANs among the countries. Recommendations and conclusions drawn from this review could serve as useful reference for nutrition policy and planning in the future.

Avances en el desarrollo infantil temprano: desde neuronas hasta programas a gran escala / Advances in early childhood development: from neurons to big scale programs

Resumen: El desarrollo infantil temprano (DIT) es la base del desarrollo económico y social de los países y de su capacidad de cumplir con los Objetivos de Desarrollo Sostenible (ODS). La gestación y los primeros 3 años de vida son fundamentales para que los niños tengan un desarrollo físico, psicosocial, emocional y cognitivo adecuado para el resto de sus vidas. La crianza y el cuidado cariñoso y sensible a las necesidades de los niños durante la gestación y la primera infancia son esenciales para el desarrollo de los billones de neuronas y trillones de sinapsis necesarias. El DIT requiere de acceso a buena nutrición y servicios de salud desde la gestación, crianza sensible de acuerdo a la etapa de desarrollo del niño, protección social y del bienestar del niño, y oportunidades de estimulación y aprendizaje temprano. Para mejorar el DIT a nivel nacional se recomiendan seis acciones con fuerte participación de la sociedad civil: expandir la voluntad política y financiamiento, crear un entorno de políticas favorables basadas en evidencia, construir capacidad con coordinación intersectorial, asegurar una gobernanza justa y transparente de los programas y servicios, aumentar apoyo a la investigación multidisciplinaria y promover el desarrollo de líderes. México ha logrado avances importantes en DIT bajo el liderazgo del Sector Salud, pero enfrenta retos significativos para implementar estas recomendaciones. La reciente creación de un marco nacional intersectorial favorable al DIT con apoyo de los organismos internacionales y la participación de la sociedad civil pueden ayudar a sobreponer estos retos.

Abstract: Early childhood development (ECD) is the basis of countries' economic and social development and their ability to meet the Sustainable Development Goals (SDGs). Gestation and the first three years of life are critical for children to have adequate physical, psychosocial, emotional and cognitive development for the rest of their lives. Nurturing care and protection of children during gestation and early childhood are necessary for the development of trillions of neurons and trillions of synapses necessary for development. ECD requires access to good nutrition and health services from gestation, responsive caregiving according to the child's developmental stage, social protection and child welfare, and early stimulation and learning opportunities. Six actions are recommended to improve national ECD programs: expand political will and funding; create a supportive, evidence-based policy environment; build capacity through intersectoral coordination; ensure fair and transparent governance of programs and services; increase support for multidisciplinary research; and promote the development of leaders. Mexico has made significant progress under the leadership of the Health Ministry, but still faces significant challenges. The recent creation of a national intersectoral framework to enable ECD with support of international organizations and the participation of civil society organizations can help overcome these challenges.

Continuous monitoring and evaluation on clean area for pharmacy intravenous admixture service / 医疗卫生装备

Objective To analyze the factors affecting the cleanliness level and infection control in the clean area for pharmacy intravenous admixture service (PIVAS) based on continuous monitoring.Methods The cleanliness indexes such as suspended particle and settling bacteria,infection control indexes such as the hygiene of object surface and hand as well as the noise in the clean area for PIVAS from 2013 to 2016 were monitored continuously according to GB 50457-2008 Clean factory building design specifications of medical industry and Intravenous admixture quality control specification.Results All the indexes accorded with the requirements for cleanliness and infection control except some odd cases unqualified in hand hygiene.Suspended particles increased as the time went by,and decreased along with noise after replacing high-performance filter.Conclusion It's of great significance to qualify the clean area of PIVAS to maintain air conditioning purification system periodically,implement anti-infection measure strictly and standardize continuous monitoring and evaluation.

Continuous monitoring and evaluation on clean area for pharmacy intravenous admixture service / 医疗卫生装备

Objective To analyze the factors affecting the cleanliness level and infection control in the clean area for pharmacy intravenous admixture service (PIVAS) based on continuous monitoring.Methods The cleanliness indexes such as suspended particle and settling bacteria,infection control indexes such as the hygiene of object surface and hand as well as the noise in the clean area for PIVAS from 2013 to 2016 were monitored continuously according to GB 50457-2008 Clean factory building design specifications of medical industry and Intravenous admixture quality control specification.Results All the indexes accorded with the requirements for cleanliness and infection control except some odd cases unqualified in hand hygiene.Suspended particles increased as the time went by,and decreased along with noise after replacing high-performance filter.Conclusion It's of great significance to qualify the clean area of PIVAS to maintain air conditioning purification system periodically,implement anti-infection measure strictly and standardize continuous monitoring and evaluation.

Analysis of monitoring results of Keshan disease from 2007 to 2011 in Baoji City of Shaanxi Province / 中国地方病学杂志

Objective To learn the existing state of Keshan disease and its trend in Baoji City,and to provide a scientific basis for control of the disease.Methods Feng,Qianyang,Linyou and Long Counties,the Keshan disease affected areas were selected to carry out the case study,and Keshan cases were searched from all registered cases of myocardial patients of the past three years at county-level medical institutions and hospitals of townships(towns).Thirteen villages affected by Keshan disease in Qianyang,Fengxiang,Feng,Linyou and Long Counties were selected as monitoring points to carry out a intensified monitoring.All subjects were surveyed by comprehensive clinical physical examination and 12-lead ECG tracings,and they were diagnosed according to the Keshan disease diagnostic criteria.Ten households were selected randomly in each monitoring point(village),and self-produced wheat samples and adult subject's occipital hair samples were collected for detecting selenium levels.Results Seven hundred and forty-six cardiac cases which containing 17 cases of chronic Keshan disease were discovered in 32 medical institutions,and there were no acute and subacute type of Keshan disease patients.Five thousand seven hundred and twenty-three subjects were examined in the 13 monitoring sites,and 65 cases of Keshan disease were diagnosed which including 17 cases of slow and 48 cases of potential Keshan disease,and no acute or subacute case was found.The total detection rate was 1.14％,and the detection rate ranged from 0 to 2.86％.Hair selenium mean was 0.420 mg/kg; wheat selenium mean was 0.079 mg/kg.Conclusions The Keshan disease detection rate of Baoji City is at a low level.The selenium level of local residents has reached the level of non-endemic area.Constant detection of patient with Keshan disease means various control measures should be reinforced.The comprehensive monitoring program,such as monitoring people's in vivo and in vitro selenium level and others,should be established as soon as possible.

Avaliação da capacidade de governo de uma secretaria estadual de saúde para o monitoramento e avaliação da Atenção Básica: lições relevantes / Evaluation of the capacity for governance of a State Health Department in monitoring and evaluation of basic health care provision: lessons learned

A descentralização do SUS exige que as secretarias estaduais de saúde assumam novas competências como o monitoramento e avaliação da Atenção Básica. Este artigo busca avaliar a "capacidade de governo" de uma secretaria estadual de saúde do Nordeste brasileiro para o monitoramento e avaliação da Atenção Básica. A partir da colaboração técnica realizada via componente III do Programa de Expansão e Consolidação da Saúde da Família (Proesf), foram entrevistados gestores estratégicos, analisados documentos de gestão e realizada observação participativa das atividades do centro formador junto à secretaria, com "análise de conteúdo" do material disponível. Como resultados, destacam-se: ausência de "projeto de governo"; problemas de estrutura física, recursos humanos e materiais; profissionais com baixa qualificação no uso de sistemas de informação, monitoramento e avaliação, e planejamento estratégico, promovendo trabalhos burocráticos e frágil uso de dados epidemiológicos. Em 2006, a secretaria usou recursos federais para fortalecer o monitoramento e avaliação da Atenção Básica, ampliando sua estrutura física, adquirindo equipamentos e capacitando pessoal, sem investir recurso próprio. Conclui-se que esta secretaria tem dificuldades em se adequar à descentralização, com a institucionalização de novos processos de trabalho.

The decentralization of the SUS requires state health departments to assume new powers as the monitoring and evaluation of Basic Care. This article aims to evaluate the "capacity for governance" of a State Health Northeastern Brazilian Department in monitoring and evaluation of Basic Care. From the technical cooperation held via component III of Proesf, key health care managers were interviewed, strategical documents were analyzed, and participatory observation of activities was carried out at a training centre, with a "contend analysis" procedure. Among the results, are: absence of "government project", problems of physical infrastructure, human resources and material, with low professional qualification in the use of information systems, monitoring and evaluation, and strategic planning, promoting and fragile bureaucratic work use of epidemiological data. In 2006, the Department used federal resources to strengthen the monitoring and evaluation of primary care by expanding its physical infrastructure, acquiring equipment and training for staff, without investing its own resource. To conclude, the Health Department has experienced difficulties in adjusting to decentralization, with the introduction of new working procedures into the institution.

Contratualização na saúde: proposta de um contrato único para os programas no Estado de Minas Gerais / Contracting in health: proposal of contrato único for programs in the State of Minas Gerais

O processo de contratualização na gestão pública nasce da perspectiva de que o Estado, por meio de instrumentos contratuais, repassa às entidades não-estatais a execução de determinados serviços. No entanto, o Estado permanece como responsável pelas políticas públicas, exercendo o papel de financiador, indutor e regulador, para que os serviços sejam prestados adequadamente,com qualidade e eficiência. Visando prestar assistência à população, a Secretaria de Estado de Saúde de Minas Gerais (SES/MG) caracteriza-se como grande compradora de serviços e ações de saúde, fazendo uso de uma variedade excessiva de instrumentos contratuais, sem padronização, para a formalização dessas transações. Nesse contexto, viu-se a necessidade de reformular os contratos dos programas estaduais, como adotar instrumento jurídico único que centralize a formalização do conteúdo. O objetivo deste trabalho foi apresentar o Contrato Único como uma proposta de inovação e qualidade na gestão pública, visando desenvolver no Sistema Único de Saúde em Minas Gerais (SUS/MG) a cultura de resultados. Essa mudança da lógica contratual torna o processo mais objetivo, organizado e transparente, propiciando uma gestão mais eficiente e que efetiva uma relação de parceria. O modelo proposto contribuirá para o aprimoramento da gestão dos contratos assistenciais no Estado de Minas Gerais, além de viabilizar a existência de um processo de acompanhamento e avaliação, até então não-efetivo nos processos de contratação da SES/MG.

The contracting process in public management derives from the perspective that the State, bycontractual arrangements, passes to non-state entities the implementation of certain services. However, the State remains responsible for the public policies, playing the role of financier, regulator and inductor, so the services are rendered with proper quality and efficiency. Aiming to assistthe population, the Secretaria de Estado de Saúde of Minas Gerais (SES/MG) is characterized as a large buyer of health services and actions, using a variety of contractual arrangements, withoutstandardization, for the transactional formalization. In this context, it is necessary to restructure thecontracts of the State programs, with the adoption of a single legal instrument, which centralizes the formalization of the content. The aim of this paper was to present Contrato Único as a proposal for innovation and quality in public administration, in order to develop results-oriented culture inthe National Health System of Minas Gerais (SUS/MG). This change in contractual logic makes the process more objective, organized and transparent, and provides a more efficient management which effects a partnership. The proposed model will contribute to the improvement of assistance contract management in Minas Gerais and will provide the existence of a monitoring and evaluationprocess which is not effective yet in SES/MG hiring procedures.

For better MCH training on French speaking African countries-Monitoring and evaluation based on daily trainee's voice / 国際保健医療

<b>Purpose</b><br> Every year, a lot of training programs by Japan International Cooperation Agency (JICA) are conducted in Japan. However, the method of monitoring and evaluation of those trainings are not always conducted other than simple questionnaire survey. The purpose of this research is to demonstrate the significance of daily recording and analysis of the trainee’s voice as a way of the improvement of the quality of training.<br> Bureau of International Cooperation in National Center for Global Health and Medicine (NCGM) conducted detailed monitoring and evaluation for “JICA training for Maternal and Child Health in French speaking African countries in 2009” which NCGM itself had planned training curriculum and implemented the training. The key word of this training was “Continuum of care”. At the end of the 5 weeks training, NCGM expected the trainees to obtain comprehensive understanding of continuum of care, especially two different perspectives, which were “the health system” and “the dignity of individual client”.<br><b>Method</b><br> NCGM training team kept recording the trainee’s voice, then analyzed them every day during five weeks’ training. At the end of the training course, the team divided trainee’s voice into several categories, and then analyzed their time-dependent change.<br><b>Results</b><br> The everyday recording and analysis of the trainee’s voice made NCGM training team possible to differentiate the trainee’s fundamental interest and understanding from simple guesses or curiosity. Based on the result of daily analysis, the training team could introduce unscheduled discussion or fine-tuned the contents of lectures for better understanding of trainees. The trainees’ interpretation about “continuum of care” showed obvious change before and after the training. The active learning program by using Laboratory method gave deeper impact on trainees than the expectation of training team. At the end of training course, the trainees formulated concrete and detailed action plans. The purpose of their action plans was to establish the continuum of care from aspects of both “the health system” and “the dignity of individual client” by analyzing the existing stakeholders and institutions, and ensuring a collaborative linkage among them, which were exactly the expected outcome.<br><b>Conclusion</b><br> Daily recording and analysis of the trainee’s voice was effective and useful to monitor the training. The comprehensive analysis at the end of training course revealed the short impact of the training on trainees, which could be used as a self evaluation tool for the training team.<br> NCGM plans to visit the trainees’ workplace in their home countries for middle and long term monitoring and evaluation. The results will be feed backed into the training curriculum of next year.

Get back to where you once belonged: monitoring the AIDS pandemic in the 21st century / Volte para o lugar de onde saiu: monitorando a pandemia da aids no século XXI

This paper reviews the concepts and methodological strategies that have shaped the monitoring of the AIDS pandemic, today in its third decade. A deliberate effort was made to highlight aspects usually forgotten by the canon. The paper aims to track the footsteps of the evolving strategies in the field of surveillance & monitoring, with the help of disciplines such as epidemiology, molecular biology, social, and behavioral sciences. The deep divide that opposes societies severely affected by the epidemic and affluent societies much less affected by the epidemic is contrasted with the scarce human and financial resources of the societies facing harshest epidemic vis-à-vis the comprehensiveness of the response to the epidemic in their affluent counterparts in terms of the scope and high standards of their initiatives on monitoring, prevention, management & care. The pressing need to implement feasible alternatives to the current sophisticated and expensive ones is briefly discussed. Beyond the renewed challenge posed to the creativity of scientists and health professionals, the AIDS pandemic is described as a major public health crisis, compromising the social fabric in some contexts, and as a never fulfilled calling for an ethics of solidarity between different societies and different social strata of each given society.

O artigo procede a uma retrospectiva histórica dos conceitos e estratégias metodológicas que informaram e informam o monitoramento da pandemia de aids, hoje na sua terceira década. Procurou-se iluminar aspectos raramente abordados pela história canônica da epidemia, buscando traçar as raízes e desdobramentos das atuais alternativas de vigilância e monitoramento, no campo da epidemiologia, da biologia molecular e das ciências sociais e comportamentais. O profundo cisma que opõe sociedades duramente afetadas pela epidemia e que contam com recursos humanos e financeiros escassos a serem empregados tanto no monitoramento, como na implementação ampla e adequada de estratégias de prevenção e tratamento às pessoas vivendo com HIV/aids nas sociedades afluentes e substancialmente menos afetadas pela epidemia é criticamente revisado, em prol de soluções factíveis e prementes, dado o alto custo e a complexidade de boa parte das alternativas-padrão em curso nos países mais ricos. Mais do que um desafio à engenhosidade de cientistas e profissionais de saúde, a pandemia de aids é revista como uma crise de grandes proporções da saúde pública, da vida social e um chamamento renovado à frustrada ética solidária entre as diferentes sociedades e segmentos sociais.

Monitoramento e avaliação do Programa de Erradicação do Trabalho Escravo / Monitoring and evaluation practices in the Program for the Eradication of Slave Labor

A avaliação formal é poderosa ferramenta de transparência da ação pública e de gestão de políticas e programas, apontando as medidas necessárias para sua sustentabilidade, otimização dos recursos e controle social. Este artigo trabalha a avaliação além da simples abstração teórica, agregando o foco no Programa de Erradicação do Trabalho Escravo, que visa eliminar essa grave violação aos direitos humanos que ainda persiste no Brasil. Com o intuito de investigar quais as características da sistemática de monitoramento e avaliação atualmente adotada pelos gestores do programa, partiu-se de pesquisa aplicada exploratória, utilizando-se dados secundários. Verificou-se que a sistemática adotada pelos gestores do programa possui características que se aproximam mais de um acompanhamento do que de um monitoramento e uma avaliação do programa. Os dados disponíveis, abundantes, necessitam de tratamento prático para se transformarem em instrumentos de monitoramento e avaliação. Com esse objetivo, o artigo utiliza-se da metodologia de avaliação formal constante nas referências teóricas, com vistas a propor uma sistemática de monitoramento e avaliação que possa ser utilizada para a melhoria da gestão do programa.

Formal evaluation is a powerful tool for ensuring the transparency of public action and in the management of policies and programs, pinpointing necessary measures for a policy's sustainability, for resource optimization and social control. This paper utilizes evaluation far beyond simple theoretical abstraction, applying it to the Program for the Eradication of Slave Labor, which functions to eliminate this grave violation of human rights, still being practiced in Brazil. In order to investigate the characteristics of the present monitoring and evaluation system adopted at by the program's managers, an applied-exploratory research approach was instigated using secondary data. It was verified that the characteristics of the monitoring system adopted by the program managers are closer to a performance follow-up than to a de facto monitoring or evaluation of the program as pointed out in the literature. Although abundant, the available data needs practical handling to be transformed into a tool of monitoring and evaluation. With that objective, this study uses the methodology of formal evaluation from various theoretical references aimed at the development of a system of monitoring and evaluation that can be used to improve the program's management.

The role of monitoring and evaluation in the implementation of international collaboration programs on disease control and prevention / 中国艾滋病性病

Program monitoring and evaluation (M & E) is the major method used in the international collaboration programs on disease control and prevention in China in recent years. It functions in the progress overseeing,problem finding and solving in terms of enhancing the program quality,managing the work plan,summing up the experiences,auditing the performance and finally achieving the expected goal. The indicators and implementation progress based on M & E serve as a scientific tool to measure the program implementation outcome periodically.

Analysis of current status and problems existing in monitoring and evaluation of HIV/AIDS prevention and control in China / 中国艾滋病性病

Objective To identify main problems and related factors existing in monitoring and evaluation(M&E)of HIV/AIDS prevention and control in China through status quo investigation and problem analysis.Methods Data collected from the existing information and field investigations were analyzed with horizontal,longitudinal comparison and GAP analysis to identify current situation and problems.Results 1)Basic situation in the seven aspects,including;institution,staff,funding,use of indicators,data management,result feedback and operation of M&E was defined;2)Problems in the five aspects,including coordination mechanism,staff ability,use of indicator system,data analysis and use and level of M&E were identified.Conclusions In order to improve the overall quality of M&E of HIV/AIDS prevention and control in this country,a unified nationwide M&E system of HIV/AIDS prevention and control should be established.