Construcción de un marco de monitoreo para la salud universal / Construction of a monitoring framework for universal health / Construção de um quadro de monitoramento para saúde universal

RESUMEN El objetivo del trabajo es construir un marco conceptual de monitoreo sobre los avances de políticas y acciones orientadas a alcanzar la salud universal. Se revisaron modelos conceptuales y propuestas metodológicas relacionados con el monitoreo del acceso y la cobertura universal de salud. Se realizó también una revisión de la literatura para seleccionar indicadores relevantes. Esta revisión fue complementada con un proceso de consulta con expertos en sistemas de salud de la Región de las Américas. Se desarrolló un marco integral para el monitoreo de políticas y acciones para el acceso y la cobertura universal de salud. El marco de monitoreo contiene cuatro componentes (acciones estratégicas, resultados inmediatos, resultados intermedios y resultados de impacto) e identifica un conjunto de opciones políticas para guiar la transformación de los sistemas de salud hacia el acceso y la cobertura universal de salud. Se eligieron 64 indicadores entre un total de 500 indicadores para la evaluación de los componentes del marco de monitoreo. El abordaje propuesto para la utilización del marco se basa en la medición de inequidades en las condiciones de acceso y cobertura, así como en la recolección de evidencia cualitativa sobre el grado de ejecución de políticas y acciones. El marco propuesto podría contribuir a fortalecer los procesos de transformación de los sistemas de salud para avanzar hacia el acceso y la cobertura universal de salud.

ABSTRACT The objective of the study is to construct a conceptual framework for monitoring progress on policies and actions aimed at reaching universal health. Conceptual models and proposed methodologies for monitoring universal health coverage and access were reviewed. A literature review was also done to select relevant indicators. This review was supplemented with a process of consultation with health systems experts from the Region of the Americas. A comprehensive framework was developed for monitoring policies and actions for universal health coverage and access. This monitoring framework contains four components (strategic actions, outputs, outcomes, and impacts) and identifies a set of policy options to guide the transformation of health systems toward universal access to health and universal health coverage. Sixty-four out of 500 indicators were chosen for evaluation of the monitoring framework components. The proposed approach for use of the framework is based on measuring inequities in access and coverage, and on collecting qualitative evidence on the degree to which policies and actions have been implemented. The proposed framework could help strengthen health system in processes of transformation toward universal access to health and universal health coverage.

RESUMO Construir um quadro conceitual de monitoramento do progresso de políticas e ações voltadas à saúde universal. Foram examinados modelos conceituais e propostas metodológicas de monitoramento do acesso universal à saúde e cobertura universal de saúde. Foi realizada também uma revisão da literatura para selecionar os indicadores relevantes, complementada com um processo de consulta com especialistas em sistemas de saúde da Região das Américas. Foi elaborado um quadro completo para o monitoramento de políticas e ações para o acesso universal à saúde e a cobertura universal de saúde. O quadro de monitoramento contém quatro componentes (ações estratégicas, resultados imediatos, resultados intermediários e resultados de impacto) e expõe uma série de opções políticas para direcionar a transformação dos sistemas de saúde para o acesso universal à saúde e cobertura universal de saúde. Foram selecionados 64 de um total de 500 indicadores para avaliar os componentes do quadro de monitoramento. A abordagem proposta para a aplicação do quadro se baseia na mensuração das iniquidades das condições de acesso e cobertura e na coleta de evidências qualitativas do nível de implementação de políticas e ações. O quadro proposto pode contribuir para consolidar os processos de transformação dos sistemas de saúde rumo ao acesso universal à saúde e cobertura universal de saúde.

The development of situation assessment and trend monitoring model of cancers in Thailand.

This study is aimed to develop appropriate models for situation assessment and trend monitoring of cancers in Thailand. This study used system approach and was carried out during 1991-1993. It is composed of two parts : Part I was a review of cancer surveillance systems of Thailand and other countries. Results of the first part were used as direct inputs for Part-II study. Pats II was solicitation of experts’ opinions. Experts included public health specialists, cancer specialists, and to solicit their ideas on how the cancer surveillance system should look like. The questionnaire survey was followed by a brain-storming session where the results of the survey were presented and shaped to reach a consensus of opinion that past experiences of cancer surveillance systems faced several difficulties including duplicate reporting, inaccurate/insufficient diagnoses, unknown or unfamiliar abbreviations used in writing the surveillance report cards, and clinical diagnoses inconsistent with and/or lacking supports of pathological findings. Experts’ conclusion was that cancer registry. In particular, cancer registry should start as hospital-based to be later expanded to population-based registry. In addition, development and research activities are needed to obtain supplementary information on risk factors and risk groups for cancers and to develop appropriate indicators for evaluation.