4 ． Research Use of Public Health and Medical Data Using the “Healthcare Data Integration System” Promoted by Kobe City Government / 薬剤疫学

Kobe City has developed a new “Healthcare Data Integration System” that links and anonymizes health care data such as medical and nursing care claims data and medical checkup data, and started its operationin November 2020. Kobe City aims to improve healthcare services through the promotion of data-driven evidence-based policymaking using the same system. This system contains consolidated data on an individual basis for about 600,000 citizens, such as medical claims data, nursing care claims data, health checkup data, nursing care certification records, and immunization data. These consolidated data can be used free of charge for research purposes, but only by academic institutions. The use of the data must be approved by the Institutional Review Board of Kobe City. The minimum necessary data set is created according to the content of the research and is anonymized so that individuals cannot be identified. Kobe City uses the data stored in the “Healthcare Data Integration System” for two purposes： first, to understand and keep track of the health status and health issues of citizens, and second, to accelerate the use of data for research purposes. When the research of high public value is conducted based on Kobe City's data, new findings from the results can be reflected in health services by the government. Byaccelerating the use of the “Healthcare Data Integration System”, Kobe City is expecting to further improve health services for all citizens.

Apoio contínuo na assistência ao parto para redução das cirurgias cesarianas: síntese de evidências para políticas / Continuous support during childbirth to reduce cesarean sections: evidence brief for policy

Resumo As taxas mundiais de cirurgia cesariana têm crescido há 30 anos, correspondendo a mais de 56% dos nascimentos no Brasil. Considerando os agravos ocasionados por cesáreas eletivas na saúde materna e infantil, esta revisão buscou apresentar uma estratégia para a redução dessas taxas. Para realizar a síntese das melhores evidências, adotou-se a metodologia SUPPORT. Foram incluídas revisões sistemáticas publicadas em inglês, português ou espanhol sobre intervenções não clínicas. As buscas resultaram em quatro estudos, que em metanálise associaram o apoio contínuo durante o parto à redução de 25% a 51% nas taxas de cesárea. Igualmente, o apoio contínuo reduziu a duração e as intervenções clínicas desnecessárias durante o trabalho de parto e a probabilidade de bebê com baixo escore de Apgar aos cinco minutos. Além disso, proporcionou melhoria na amamentação e na recuperação da mulher, aumento da satisfação com o processo de nascimento e maiores chances de parto vaginal espontâneo. O apoio contínuo foi benéfico para a gestante e o recém-nascido. A intervenção garante respeito, segurança e qualidade durante o parto, bem como reduz custos hospitalares. Portanto, é uma estratégia efetiva que deve ser adotada nos serviços de saúde para ampliar o acesso das mulheres aos seus direitos.

Abstract Cesarean section rates have increased globally in the last 30 years, representing more than 56% of total births in Brazil. Considering the impacts of elective cesarean sections in maternal and child health, this review aimed to present an option to reduce these rates. We used the SUPPORT tools to summarize the best evidence. We included systematic reviews published in English, Portuguese, or Spanish, which focused on non-clinical interventions. Continuous support during labor and birth was described in four systematic reviews as an option to reduce cesarean rates (down to -51%). It also decreased unnecessary clinical interventions during labor, the duration of labor, and the likelihood of delivering a baby with a low Apgar score at five minutes. Moreover, continuous support improved breastfeeding, postpartum recovery of women during the puerperium period, and increased women's satisfaction with the birth experience and the possibility of spontaneous vaginal deliveries. The continuous support was beneficial for women and newborns. The intervention fosters respect, safety, and quality during birth, besides reducing hospital costs. Therefore, it is an effective strategy that should be adopted in hospitals and other health services to improve women's access to their rights.

O uso de múltiplas fontes de informação nas políticas públicas: um olhar sobre a burocracia federal brasileira / El uso de múltiples fuentes de información en las políticas públicas: una mirada a la burocracia federal brasileña / The use of multiple sources of information in public policy: the Brazilian federal bureaucracy

Resumo A produção de políticas públicas é um processo complexo que envolve um conjunto de estímulos e condicionantes. Compreender o que, de fato, tem informado os burocratas e as organizações públicas é um elemento essencial para caracterizar a produção de políticas públicas, assim como para a discussão das potencialidades e dos limites das Políticas Públicas Baseadas em Evidências (PPBE) no contexto brasileiro. Neste estudo, investigamos as diferentes fontes de informação disponíveis aos burocratas brasileiros; dentre as quais, não somente as científicas, mas também as experienciais, as internas e as externas ao Estado. Esta pesquisa traz resultados de um survey respondido por 2.180 servidores da Administração Federal Direta no final de 2019. Os resultados indicam que há variação na utilização de fontes de informação a serem mobilizadas pelos burocratas de acordo com o tipo de trabalho desempenhado e, também, com a área de política pública na qual atuam.

Resumen La elaboración de políticas públicas es un proceso complejo que implica un conjunto de estímulos y limitaciones. Comprender lo que de hecho ha informado a los burócratas y las organizaciones públicas es un elemento esencial para caracterizar la elaboración de políticas, así como para discutir las potencialidades y los límites de las políticas públicas basadas en la evidencia (PPBE) en el contexto brasileño. Se investigan las diferentes fuentes de información de que disponen los burócratas brasileños, incluyendo las científicas, pero también las experienciales, internas y externas al Estado. Esta investigación trae los resultados de una encuesta contestada por 2.180 funcionarios de la administración federal directa a finales de 2019. Los resultados indican que hay variaciones en la elección de los tipos de información que deben movilizar los burócratas en función del tipo de trabajo realizado, así como del ámbito de la política pública en el que operan.

Abstract Policy-making is a complex process involving stimuli and conditioning. Understanding the sources of information bureaucrats and public organizations use is essential to characterize policy-making and discuss the opportunities and limits of Evidence-Based Public Policies (EBPP) in the Brazilian context. The different sources of information available to bureaucrats in the country are investigated, such as the state's internal and external sources and scientific and experiential sources. This paper presents the results of a survey with 2,180 officials of the direct federal administration conducted at the end of 2019. The findings indicate variation in the types of information bureaucrats mobilized depending on policy area and the type of policy work they perform.

Assessment of the context for eHealth Development in the Philippines: A work in progress from 1997 to 2020

Introduction@#eHealth is described by the World Health Organization (WHO) as the use of information and communication technologies (ICT) for health. The use of eHealth closes the gaps in terms of geographical barriers, time constraints, lack of healthcare professionals in healthcare and service delivery. This study is important as it provides the current landscape and status of eHealth in the Philippines. Hence, policymakers, program implementors as well as other stakeholders, including the public, will be able to know which eHealth and telemedicine services and products are available in various sectors of society, either private or government, what are the existing gaps in eHealth, and the trajectory in the future based on the guide of the World Health Organization - International Telecommunication Union (WHO-ITU). @*Objectives@#The objectives of the study are 1) to provide a landscape of eHealth in the Philippines since its start in the country; 2) to identify programs, services, and technology innovations implemented in the country on eHealth and telemedicine; and 3) to identify Philippine systems that correspond to the eHealth components laid out by WHO-ITU for a successful implementation of eHealth at a national level. @*Methods@#We conducted an extensive review of the literature and key informant interviews with eHealth experts in the Philippines. The literature review covered research and studies, gray literature, peer-reviewed journals, databases, and government statistics. The years covered in this study span a total of 24 years from 1997, which is the beginning of the information management system as an institutional approach in the country, to 2020. The assessment tool was based on the framework provided by the WHO-ITU on the context for eHealth development. @*Results@#The National Telehealth Center (NTHC) of the Philippines began with projects for 1) eLearning, 2) eMedicine, 3) eRecords, 4) eHealth Policy and Advocacy, and 5) eSurveillance. Telemedicine services are now being offered by hospitals in the country. This shows eHealth services, in general, and telemedicine are being utilized in not only targeting the poor, but also in giving faster, more efficient, and equally effective virtual health services to the general public, even the private-pay patients. @*Conclusion@#The sustainability of eHealth in the Philippines still depends on the national effort to institutionalize an eHealth structure and eHealth system where the various components are interrelated.

Análise da participação popular na política de atenção à saúde da pessoa com deficiência em Aracaju, Sergipe, Brasil / Analysis of popular participation in healthcare policy for people with disabilities in Aracaju, Sergipe, Brazil / Análisis de la participación popular en la política de atención a la salud de la persona discapacitada en Aracaju, estado de Sergipe, Brasil

Este artigo objetiva analisar o papel da sociedade civil na política de saúde da pessoa com deficiência no município de Aracaju-SE. Foi realizado um estudo qualitativo com entrevistas semiestruturadas com representantes do Conselho de Defesa dos Direitos da Pessoas com Deficiência. Os dados foram analisados de acordo com a análise temática de conteúdo. Os resultados demonstram que o entendimento da concepção da deficiência, por parte dos representantes da sociedade civil, é difuso, transitando entre os paradigmas existentes. Foi notável a dificuldade dos representantes em propor temas para a agenda política no âmbito local e participar na formulação e implementação da política pública de saúde, criando um distanciamento entre os órgãos de controle social e gestão.(AU)

The aim of the present article is to analyze the role of civil society in healthcare policymaking for persons with disabilities in the municipality of Aracaju, Sergipe, Brazil. This was a qualitative study with semi-structured interviews with representatives of the Council for the Defense of the Rights of People with Disabilities. The data were analyzed according to thematic content analysis. The results show that the representatives held diffuse understandings of the concept of disability, shifting among existing paradigms. Special mention goes to the difficulty presented by the representatives to propose issues for the local political agenda and participate in the creation and implementation of public health policy, creating a gap between social control organizations and public management.(AU)

El objetivo de este artículo es analizar el papel de la sociedad civil en la política de salud de las personas con discapacidad en el municipio de Aracaju-Estado de Sergipe. Se realizó un estudio cualitativo con entrevistas semi-estructuradas con representantes del Consejo de Defensa de los Derechos de las Personas con Discapacidad. Los datos se analizaron de acuerdo con el análisis temático de contenido. Los resultados demuestran que el entendimiento de la concepción de la discapacidad por parte de los representantes de la sociedad civil es difuso, transitando entre los paradigmas existentes. Fue notable la dificultad de los representantes en proponer temas para la agenda política en el ámbito local y participar en la formulación e implementación de la política pública de salud, creando un distanciamiento entre los órganos de control social y gestión.(AU)

La Agenda 2030 como herramienta de desarrollo para los jóvenes en Argentina / The 2030 Agenda as a development tool for young people in Argentina

Resumen La población de jóvenes y adolescentes representa un conjunto crítico de la población global. Su importancia para una agenda de desarrollo no se debe a la cantidad, sino a otro tipo de problemas que favorecen la reproducción intergeneracional de la pobreza y consolidan brechas de desigualdad que acentúan los procesos de "desinstitucionalización" y "desocialización", entre otros: sistemas educativos insuficientemente adaptados al mundo del trabajo actual o a la escolarización masiva de jóvenes provenientes de hogares vulnerables, mercados de trabajo precarios a los que muchos jóvenes se incorporan con baja calificación, o condiciones socioambientales que afectan gravemente las condiciones de salud de jóvenes de barrios marginales. Los 17 Objetivos de Desarrollo Sostenible marcan con claridad el sendero a transitar en los próximos años, así como también resaltan la necesidad de innovación y fortalecimiento de las políticas públicas para asegurar "que ningún joven será dejado atrás". La Agenda 2030 representa una oportunidad única para que el Estado, el sector privado, la sociedad civil y el sistema de cooperación internacional aprovechen sinergias positivas para mejorar la calidad de vida de la población joven.

Abstract Youth and adolescent populations constitute a critical set in global population. They are important to development agendas not for their quantity, but for other types of problem that favour the intergenerational reproduction of poverty and establish inequality gaps that accentuate processes of "de-institutionalisation" and "de-socialisation" of these populations and others: education systems insufficiently adapted to the current world of work or to the mass schooling of young people from vulnerable households; precarious labour markets, which many young people enter with poor qualifications; or socioenvironmental conditions that severely affect the health conditions of youth in marginal neighbourhoods. The 17 Sustainable Development Goals clearly signal the path forward for coming years, as well as highlighting the need for stronger, more innovative public policies to ensure "that no young people will be left behind". The 2030 Agenda represents a unique opportunity for the State, private sector, civil society and the international cooperation system to harness positive synergies to improve young people's quality of life.

Scale development of transformation from health technology assessment to policy-making / 中国卫生政策研究

Through literature review and theoretical analysis,an initial scale was designed with five dimensions namely"evidence influence","organizational support","channel connectivity","communication and collabora-tion"and"decision-makers impetus". The reliability and validity of the scale were evaluated through questionnaire survey on HTA researchers. It is reported that the overall Cronbach's α coefficient of the questionnaire was 0.904, meanwhile the Cronbach's α coefficient of each dimension was more than 0.80 except the dimension of"decision-makers impetus". The average variance extraction of each dimension was more than 0.50. The maximum of correla-tion coefficients between each dimension was 0.571,which was less than the threshold value of 0.85. Additionally, for certain dimensions,the standardized correlation coefficients to each other dimensions was less than regarding arith-metic square root of average variance extraction.

Current situation of Health Policy and System Research and personnel training focuses in Chi-nese universities / 中国卫生政策研究

Objectives:This study aims to provide a full picture of how Health Policy and Systems Research ( HPSR) in Chinese universities. Based on the current situation, analysis of problems and challenges of the HPSR capacity has been conducted and suggestions on personnel training have been proposed. Methods: Quantitative sur-veys and qualitative interviews have been conducted among personnel engaged in HPSR from 8 representative univer-sities. Results:Most HPSR researchers in the universities are young, of which 75. 26% have doctorates and the ma-jority is trained in health care management and public health sciences. Among the current HPSR projects, health in-formation and evidence is the main research direction in this field, and both the capital investment and attention of re-searchers are high. However, research resources and funding are still currently focused on senior researchers, with limited efforts to support young scholars. HPSR has interdisciplinary and multidisciplinary characteristics, but cur-rently the collaboration among institutions and individuals is relatively limited. In addition, only 5. 81% of undertak-en HPSR projects have been translated into health policy. Discussion and Suggestions:HPSR researchers in Chinese universities are not sufficient and have similar backgrounds, resulting in limited collaboration. Investment in HPSR projects is still shallow and young researchers are vulnerable in acquiring funding resources. The ability to translate research results into policy is weak. Therefore, this paper suggests to mainstream undergraduate and postgraduate teaching, enhance the training, funding and technical support for young researchers, and to establish the mechanism of dissemination of research findings and their translation into policy.

Os sentidos e disputas na construção da Política Nacional de Promoção da Saúde / The senses and disputes in the construction of the National Health Promotion Policy

Este estudo teve como objetivo analisar a definição da Política Nacional de Promoção da Saúde de 2006 no Brasil, buscando explicitar os sentidos e disputas no processo de formulação e suas implicações para o campo da saúde. Para tanto, foram feitas revisão bibliográfica, análise de documentos e entrevistas com participantes da rede de discussão sobre promoção da saúde no Brasil. Partimos de uma visão de ciência construcionista, compreendendo a política como um processo dinâmico que se constitui a partir de diferentes fatores que influenciam as escolhas e posicionamentos dos atores e grupos. Identificamos no processo alguns tensionamentos que podem ser entendidos como dilemas que o debate da promoção suscita. Um primeiro dilema apresentou-se no debate propriamente dito em torno do modelo de promoção, que decorre da polarização historicamente construída entre a perspectiva regulatória e a perspectiva emancipatória. Um segundo dilema refere-se à apropriação desta polarização se desdobrando na discussão entre o amplo e o restrito, onde as propostas voltadas para o coletivo são tidas como comprometidas com um projeto emancipatório e as propostas voltadas para o individual são entendidas numa perspectiva de controle. O terceiro dilema se traduziu no emprego do conceito de empowerment sem uma discussão aprofundada de seus efeitos no processo de construção desta política em nosso âmbito...

This study aimed to examine the definition of the National Health Promotion Policy in 2006 in Brazil, trying to explain the meanings and disputes in the formulation and its implications for the field of healthcare process. For this purpose, literature review, analysis of documents and interviews with participants in the discussion of health promotion network in Brazil were made. We start from a constructionist view of science, including the policy as a dynamic process that is different from the factors that influence the choices and positions of actors and groups. We identify some tensions in the process can be understood as dilemmas that the debate raises. A first dilemma presented itself in the debate around the promotion model, which stems from the polarization historically constructed between the regulatory perspective and emancipatory perspective. A second dilemma concerns the ownership of this discussion unfolding in bias between the broad and narrow, where the proposals impacting the collective are seen as committed to an emancipatory project and proposals geared to the individual are understood from the perspective of control. The third dilemma has resulted in the employment of the concept of empowerment without a thorough discussion of its effect on the construction process of this policy in our framework...

Rol de la evidencia científica en las decisiones políticas relacionadas con los sistemas de salud / The role of research-based evidence in health system policy decision-making

RESUMEN Existen diferentes modelos para explicar cómo la evidencia de la investigación se utiliza en los procesos de formulación de políticas sobre los sistemas de salud. En este artículo argumentamos que los modelos que se desarrollaron desde el contexto clínico, como el de políticas basadas en la evidencia, pueden ser útiles en algunas decisiones políticas. Sin embargo, debido a su "silencio" sobre el contexto político, estos modelos son incompatibles con las decisiones relacionadas con la modificación de los arreglos de los sistemas de salud. Otros modelos, generados desde las ciencias políticas, son más útiles para entender que la investigación es uno solo de los factores que afecta la toma de decisiones y que diferentes tipos de evidencia científica pueden ser utilizados de manera instrumental, conceptual o estratégica en diferentes etapas del proceso de formulación de políticas.

ABSTRACT Different models may be used for explaining how research-based evidence is used in healthcare system policy-making. It is argued that models arising from a clinical setting (i.e. evidence-based policy-making model) could be useful regarding some types of healthcare system decision-making. However, such models are "silent" concerning the influence of political contextual factors on healthcare policy-making and are thus inconsistent with decision-making regarding the modification of healthcare system arrangements. Other political science-based models would seem to be more useful for understanding that research is just one factor affecting decision-making and that different types of research-based evidence can be used instrumentally, conceptual or strategically during different policy-making stages.

Policy making considerations for abolishing drug price plus policy at county hospitals in Hubei Province / 中华医院管理杂志

Drug price plus policy had been in place at public hospitals since 1954 and began to phase out since 2009.Hubei province studied the profile and reform progress of 20 pilot county public hospitals before June 2012,and measured the drug income loss incurred by abolishment of this policy since 2012.It is recommended that the reform to abolish drug price plus policy in the province be made based on investigation,evaluation and academic research,prioritizing medical service pricing adjustment aided by government compensation.The authors proposed a new approach of medical service pricing to make up for the revenue gap caused by the abolishment.

A implantação do Programa de Saúde da Família (PSF) no Estado de São Paulo (1995-2002) / The implementation of the Family Health Program (PSF) in the State of São Paulo (1995-2002)

Este artigo relata a implantação do Programa de Saúde da Família no Estado de São Paulo desde seu início até o ano de 2002. São mencionados como antecedentes importantes outros programas do Ministério da Saúde, como o PIASS (1976-1979), o PACS (1991) e o Projeto do Vale do Ribeira da SES-SP (1980-1987). Destaca-se também a importância do Programa metropolitano de Saúde na década de 1980 e do Movimento Popular de Saúde na Cidade de São Paulo desde a década de 1970. São descritas as principais características do modelo, a composição inicial da equipe mínima e a incorporação de novos atores no programa. São destacados três mecanismos de ação do Governo Estadual em relação ao desenvolvimento do PSF, sendo um de apoio técnico, outro de apoio técnico e financeiro e o terceiro de contratação direta de entidades filantrópicas para a implantação do programa no Município de São Paulo. A avaliação de todas as equipes de saúde da família implantadas no Estado de São Paulo, realizada em 2002, demonstrou grande aceitação da população em relação à atenção desenvolvida e identificou os problemas nos mecanismos de contratação dos profissionais da equipe. Este artigo descreve a preparação das equipes de trabalho e o papel dos Polos de Capacitação e todo o movimento envolvendo Cosems e gestores municipais, universidades e entidades da comunidade.

El debate parlamentario sobre inmigración y salud en España / The Parliamentary debate on immigration and health in Spain

Objetivo Describir y analizar el debate parlamentario español sobre inmigración y salud. Métodos Búsqueda sistemática de las iniciativas parlamentarias (IP) sobre inmigración e inmigración y salud desde el inicio del periodo democrático español en 1979 hasta 2007. Se aplicó un protocolo de recogida de información para identificar las características del debate parlamentario y los principales temas en las IP relacionadas con inmigración y salud. Se calcularon la proporción de IP de inmigración sobre el total de iniciativas y la proporción de población inmigrante sobre la población española por cada año de estudio. Resultados Se identificaron 4 022 IP sobre inmigración en el periodo estudiado. Se destaca la generación de datos estadísticos sobre aspectos que afectan a la población inmigrante (57,2 por ciento). En 116 IP sobre inmigración y salud, destaca la discusión sobre estrategias de atención sanitaria (25 por ciento) y el acceso a servicios de salud (24,1 por ciento). El 94 por ciento de estas IP fueron preguntas correspondientes a la función de control del gobierno. En 113 IP (97,4 por ciento) sobre inmigración y salud no se tomaron decisiones. Junto a la presencia cada vez mayor de población inmigrante por año, no se observan cambios notorios en las IP sobre inmigración hasta el año 1996 y en inmigración y salud hasta 1999. Conclusión El debate sobre inmigración y salud es heterogéneo. Seria conveniente fomentar la discusión sobre estrategias para el fomento de la salud basadas en las necesidades de la población inmigrante.

Objective Describing and analysing the Spanish Parliamentary debate on immigration and health. Methods A systematic search regarding parliamentary initiatives (PI) on immigration and immigration and health was conducted from the beginning of the Spanish democratic period (1979 to 2007). A protocol for collecting information was used to identify the parliamentary debate’s main characteristics and the main topics related to PI concerning immigration and health. The PI immigration rate was calculated regarding the total rate of PI about the immigrant population based on the Spanish population per year. Results 4,022 PI concerning “immigration” were identified. The main content concerned statistical information about the immigrant population (57.2 percent). 116 PI about “immigration and health” were analysed. The most frequently recurring topics were health-care strategies (25 percent), health-service access (24.1 percent) and epidemiological information (19.8 percent). Most PI concerned questions related to the function of government control (94 percent). No decisions were taken in 113 PI (97.4 percent). Immigrant population rates increased per year; however, notable changes in PI regarding immigration were not observed until 1996 and PI about immigration and health until 1999. Conclusion The immigration and health debate on the parliamentary agenda is heterogeneous. It would seem necessary to increase parliamentary debate about strategies and action for promoting immigrant-based needs in health.

Network analysis of Korean health insurance policy-making process

This study examines how the decision-making process evolved in Korea during the initial phases of introduction and implementation of National Health Insurance. This study analyses the official documents and interviews views made with government officials and related personnel. We used the method of network analysis and multidimensional scaling in order to demonstrate how the major participants in the decision-making process developed and changed under the contemporary political situations. In the pre-implementation stage around 1976, major concerns were concentrated around the issues of financial support for social insurance, the fee schedule and who ought to be covered first. The total number of participants of the health or health-related organization was 61, which included the President, the Minister of Health and Social Affairs, representatives of special interest groups, etc. In the actual implementation period of 1982, different issues were brought up by the major participants. The number of participants in this period declined to 44 with the deletion of 19 and with the addition of two newly formed health insurance organizations. By 1988, as the implementation reached its final decision period, disagreements were centered on progressive premium rating and the administration of National Health Insurance. The number of participants increased to 60 after the addition of 16 participants. The analysis of this paper may provide some insight for other countries which wish to establish National Health Insurance; as reference to the policy-making process, it may provide some suggestions for when to initiate and how to formulate National Health Insurance policies.