Aspects that facilitate access to care for viral hepatitis: An evaluative research

ABSTRACT BACKGROUND: Viral hepatitis is a major public health concern worldwide. OBJECTIVES: This study aimed to analyze the factors that facilitate access to care for viral hepatitis. DESIGN AND SETTING: Using a sequential mixed method, this evaluation research was conducted in the state of Mato Grosso, Brazil. METHODS: Mapping of references and selection of regions were made based on the quantity and heterogeneity of services. The stakeholders, including the managers of the State Department of Health and professionals from reference services, were identified. Nine semi-structured interviews were conducted using content analysis and discussions guided by the dimensions of the analysis model of universal access to health services. RESULTS: In the political dimension, decentralizing services and adhering to the Intermunicipal Health Consortium are highly encouraged. In the economic-social dimension, a commitment exists to allocate public funds for the expansion of referral services and subsidies to support users in their travel for appointments, medications, and examinations. In the organizational dimension, the availability of inputs for testing, definition of user flow, ease of scheduling appointments, coordination by primary care in testing, collaboration following the guidelines and protocols, and engagement in extramural activities are guaranteed. In the technical dimension, professionals actively commit to the service and offer different opening hours, guarantee the presence of an infectious physician, expand training opportunities, and establish intersectoral partnerships. In the symbolic dimension, professionals actively listen to the experiences of users throughout their care trajectory and demonstrate empathy. CONCLUSIONS: The results are crucial for improving comprehensiveness, but necessitate managerial efforts to enhance regional governance.

Reflections on Moral Governance Path of Public Health Emergencies / 中国医学伦理学

Moral governance is an important social practice activity to improve social norms, cultivate citizens’ moral character, and cultivate citizens’ legal literacy. The changes of the social environment under public health emergencies have brought new changes and challenges to the work of moral governance. Under the background of normalization epidemic prevention and control, it is necessary to accurately understand and deeply grasp the risks of social and environmental changes caused by public health emergencies, fully combine the needs of public health emergency management, and be targeted in the content and requirements of moral governance. At the same time, it is significant to actively transform governance ideas, and improve the effectiveness of moral governance through multi-dimensional path innovation such as value and orientation, resources and methods, technology and carrier, strategies and means.

Supervision Strategy and Implementation Key Points of Scientific and Technological Ethical Governance in Health and Medical Field / 中国医学伦理学

The ethical governance of science and technology is a kind of practical ethics, which develops in the process of continuously solving the ethical problems and ethical conflicts arising from scientific and technological activities. Ethical governance has common requirements and professional standards. Health-related science and technology activities, including the application of life science and artificial intelligence in health and medical field, make the medical ethical governance face common and unique challenges. The supervision and ethical review should consider the speciality of life science and medical research, and bring the existing ethical review system into full play. However, the focus, emphasis and standards of ethical governance have changed with the application of some technologies (ex. the next-generation sequencing, gene editing, and artificial intelligence). Actions should be taken to strengthen the ethical governance and promote ethics in advance with science and technological implementation in health and medical field. Here in this article, the classified, hierarchical supervision and ethical review strategies are discussed; then some potential effective organization and mechanisms for regional ethics committees are introduced. Promoting the medical education and continuing education of ethical governance of science and technology is also recommended.

Science and Technology Ethics Governance, How to Put Ethics First? / 中国医学伦理学

Science and technology ethics governance, how to put ethics first? The purpose of "technological innovation, ethics first" is to build an ethical soft landing mechanism for scientific and technological innovation. Researchers of science and technology ethics should start from the practice of international and domestic science and technology ethics governance, and explore the realistic way of science and technology ethics governance on the basis of understanding and thinking about the innovative culture, value orientation and operation mechanism. First of all, it should be noted that seeking technical, management and institutional solutions in the current ethical governance of science and technology may not be perfect and thorough, but operable management measures can be explored and continuously improved under the framework of mainstream scientific and technological innovation. Secondly, the co-governance of science and technology ethics needs to further explore the corresponding group co-governance epistemology facing pluralistic co-governance. Finally, the ethical governance of science and technology should pay attention to the principle of proportionality, and avoid both lax and being too strict.

Discrimination of the Governance Principles of Science and Technology Ethics and Dissemination of Ideas / 中国医学伦理学

Ethical governance is inherent in responsible research and innovation. The Opinions on Strengthening Ethical Governance of Science and Technology puts forward five ethical principles: promoting human well-being, respecting the right to life, adhering to fairness and justice, reasonably controlling risks and maintaining openness and transparency. This paper interpreted the ideas, key points and difficulties of these five ethical principles. Three suggestions were put forward to strengthen the ethics education of science and technology: first, optimize the curriculum of science and technology ethics for related majors in colleges and universities, and help young students understand ethical principles and establish the correct ethics view of science and technology; second, colleges and universities should carry out education and training for teachers, researchers, managers and members of ethics committees, and actively explore scientific research ethics training and effect evaluation; third, the professional courses offered by college teachers should be organically integrated with the ideological and political content of the courses to play a warning role.

The Ethical Principles of Science and Technology Need Concrete Research to Guide / 中国医学伦理学

On March 20, 2022, the General Office of the CPC Central Committee and the General Office of the State Council issued The Opinions on Strengthening Ethical Governance of Science and Technology, which put forward five ethical principles of science and technology: promoting human well-being, respecting the right to life, adhering to fairness and justice, reasonably controlling risks and maintaining openness and transparency. Ethical principles require to be studied and interpreted concretely by ethical scholars, that is, first, they need to be refined in order to be truly guided; second, the principle of balance is needed to truly guide; third, it is necessary to study ethical theory in order to truly guide; fourth, it is significant to explore Chinese civilization in order to truly guide. In this way, the ethical principles of science and technology can be practically applied and guide the concrete practice of science and technology.

Ethical Governance of Human Health Related Research / 中国医学伦理学

The frequent several ethical events in recent years suggested carry out the construction of ethical governance system involving human health-related research under the background of national governance. The subjects of ethical governance include the government, medical institutions, universities, scientific research institutes, enterprise, ethics committees, researchers, the public, etc., the multiple subjects are interrelated and interact with each other to restrict and standardize ethics through different governance tools. However, there are some problems in China’s ethical governance, such as the relative lag in the construction of ethical governance concept and system, insufficient multi-party participation, the difficulty in sole legislation to solve risk and ethical problems, the specification cannot be met, inadequate supervision, insufficient accountability for violations, researchers lack ethical awareness, ethical education lags behind and insufficient information disclosure to the public. It should be taken such as countermeasures as paying attention to the theoretical research of ethical governance system, strengthening the construction of ethical governance system, pluralistic co governance, agile governance, strengthening legislation, improving norms, implementing supervision, strengthening the construction of ethics committee, talent training, training researchers, ethical education, popular science public, academic self-discipline, information disclosure and public participation, so as to build a scientific and technological ethics governance system in line with China’s national conditions and in line with international standards, and contribute China’s wisdom for world ethical governance.

Estilos de liderazgo en profesionales sanitarios peruanos

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

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

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

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

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

Salud: Dignidad, Derechos y Ética

La salud y la atención de las personas enfermas implican no solo aspectos de diagnósticos y tratamientos médicos; por el contrario, encierran un conjunto de aspectos que están intrínsecamente vinculados (o deberían estarlo) aun cuando aparentemente no sean visibilizados con facilidad. La salud de las personas involucra las perspectivas de respeto a la dignidad de las personas, el ejercicio de sus derechos, y el desempeño ético de los protagonistas (los que atienden y los atendidos), que no deben ser dejadas de lado en el momento real que sucede cada atención de salud.

SUMMARY Health and care for sick people involve not only aspects of medical diagnosis and treatment; on the contrary, it contains a set of aspects that are intrinsically linked (or should be) even though they are apparently not easily visible. The health of the people involves the perspectives of respect for the dignity of the people, the exercise of their rights, and the ethical performance of the protagonists (those who attend and those attended), which should not be left aside in the real moment. that happens every health care.

ASSESSING PUBLIC SERVICE QUALITY & SERVICE SATISFACTION:WITH REFERENCE TO GOVERNANCE IN KARNATAKA, INDIA

Being a democratic country India has brought in various acts and reforms to uphold citizen centricity. Right to service act has been one of such initiatives. As on 2023, the state of Karnataka has been able to provide highest number of services under this act. This study explores and investigates citizen's perspective of service quality & service satisfaction attained by availing the public services. A questionnaire survey was formulated and study found that the ve factors 'Reliability' 'Assurance', 'Empathy', 'Valence', and 'Waiting Time' are determinants of the quality of citizen/government services. The outcome indicate that overall service quality has signicantly positive impact on service satisfaction. This research is of greater value to scholars who are interested in the area of governance, administration, and service delivery.

Applying the SES Framework to coral reef restoration projects on the Pacific coast of Costa Rica

Introduction: Global and local stressors have led to rapid declines in coral reef health. The high rates of coral degradation have motivated restoration initiatives worldwide. Evaluation of these initiatives has provided valuable information regarding coral restoration techniques and limitations faced by projects. However, most of the literature is focused on evaluating metrics related to fragment survival rate and growth, leaving a gap in understanding how social aspects such as governance structure affect project outcomes. Objective: The present research applies the Social-Ecological Systems Framework to identify social and ecological factors contributing to the success of three coral reef restoration projects in Costa Rica. Methods: Data was gathered from 50 semi-structured interviews with project members, volunteers, tour operators, fishers, and related community and government organizations that were analyzed using the categories determined by the Social-Ecological Systems Framework. Results: Despite each case's specific ecological and governance characteristics, research results show that three main steps have contributed to project success. First, the importance of locals having a positive perception of coral reef and project benefits; second, the use of network structure to obtain adequate financial and human resources and third, the importance of compliance with a regulatory framework to create enabling environments for reef restoration. Conclusions: Results show no universal solutions for coral reef restoration projects. Project managers must understand the ecological and social context of the restoration site to boost the benefits that reef restoration projects can provide, such as an increase in local stewardship, income generation, and the creation of more resilient communities.

Introducción: Los factores de estrés globales y locales han llevado a una rápida disminución de la salud de los arrecifes de coral. Las altas tasas de degradación de los corales han motivado iniciativas de restauración en todo el mundo. La evaluación de estas iniciativas ha proporcionado información valiosa sobre las técnicas de restauración de coral y las limitaciones que enfrentan los proyectos. Sin embargo, la mayor parte de la literatura se centra en la evaluación de métricas relacionadas con la tasa de supervivencia y el crecimiento de fragmentos, lo que deja un vacío en la comprensión de cómo los aspectos sociales y estructura de gobernanza, afectan los resultados del proyecto. Objetivo: La presente investigación aplica el Marco Conceptual de Sistemas Socio-Ecológicos para identificar los factores sociales y ecológicos que contribuyen al éxito de tres proyectos de restauración de arrecifes de coral en Costa Rica. Métodos: Los datos se recopilaron a partir de 50 entrevistas semiestructuradas con miembros del proyecto, voluntarios, operadores turísticos, pescadores y organizaciones comunitarias y gubernamentales relacionadas que se analizaron utilizando las categorías determinadas por el Marco Conceptual de Sistemas Socio- Ecológicos. Results: A pesar de las características ecológicas y de gobernanza específicas de cada caso, los resultados de la investigación muestran que tres pasos principales han contribuido al éxito del proyecto. Primero, la importancia de que los locales tengan una percepción positiva de los arrecifes de coral y los beneficios del proyecto; segundo, el uso de la estructura de la red para obtener recursos financieros y humanos adecuados y tercero, la importancia del cumplimiento de un marco regulatorio para crear entornos propicios para la restauración de arrecifes. Conclusiones: A pesar de las características ecológicas y de gobernanza específicas de cada caso, los resultados de la investigación muestran que tres puntos principales han contribuido al éxito del proyecto. Primero, la importancia de que los locales tengan una percepción positiva de los arrecifes de coral y los beneficios del proyecto; segundo, el uso de la estructura de la red para obtener recursos financieros y humanos y tercero, la importancia del cumplimiento de un marco regulatorio para crear entornos propicios para la restauración de arrecifes.

Participatory construction of the food security agenda in Brazil: Interests and priorities from re-democratization to institutional dismantling

This study analyzed the trajectory of interests and priorities related to food security expressed in the reports of the five National Food and Nutritional Security Conferences (Conferências Nacionais de Segurança Alimentar e Nutricional - CNSAN) held in Brazil between 1994 and 2015. The documentary research was systematized through content analysis with a quantitative and qualitative focus. Food security dimensions were identified in the 1,181 action proposals assessed through an analysis model consisting of 3 cross-sectional categories, 8 thematic categories, and 10 subcategories. The temporal content analysis revealed: continuous reduction in demands for "universal access to adequate food", especially in the subcategory "employment and income"; constant predominance of the category "structuring sustainable food production and supply systems" with a progressive increase in the subcategory "incentive to agroecology-based production"; and increased demands for "prioritization of traditional peoples and communities". The timeline suggests different contributions of the Conferences to the evolution of the debate on food security in Brazil. However, the insertion of social actors in the process of formulating the Brazilian National Food and Nutritional Security Policy did not guarantee the incorporation of the problems into the public agenda, which should be re-established and deepened in the decision-making processes. The findings attest to the importance of social participation for the theoretical and political qualification of food security in Brazil.

Este estudio analizó la trayectoria de los intereses y prioridades relacionados con la seguridad alimentaria expresados en los informes de las cinco Conferencias Nacionales de Seguridad Alimentaria y Nutricional (Conferências Nacionais de Segurança Alimentar e Nutricional - CNSAN) realizadas en Brasil entre 1994 y 2015. La investigación fue sistematizada a través del análisis de contenido con un enfoque cuantitativo y cualitativo. Las dimensiones de la seguridad alimentaria se identificaron en las 1.181 propuestas de acción evaluadas a través de un modelo de análisis que consta de 3 categorías transversales, 8 categorías temáticas y 10 subcategorías. El análisis de contenido temporal reveló: continua reducción de las demandas de "acceso universal a una alimentación adecuada", especialmente en la subcategoría "empleo e ingresos"; predominio de la categoría "estructuración de sistemas sostenibles de producción y abastecimiento de alimentos" con un aumento progresivo de la subcategoría "incentivo a la producción basada en la agroecología"; y mayores demandas de "priorización de los pueblos y comunidades tradicionales". La línea de tiempo sugiere diferentes contribuciones de las Conferencias a la evolución del debate sobre la seguridad alimentaria en Brasil. Sin embargo, la inserción de los actores sociales en el proceso de formulación de la Política Nacional de Seguridad Alimentaria y Nutricional de Brasil no garantizó la incorporación de los problemas en la agenda pública, que debe ser reconquistada y profundizada en los procesos de toma de decisiones. Los hallazgos atestiguan la importancia de la participación social para la calificación teórica y política de la seguridad alimentaria en Brasil.

Redes de gobernanza intermunicipal: aplicación de modelos de grafos aleatorios exponenciales en la región de Los Lagos, Chile / Redes de governança intermunicipal: aplicação de modelos de gráficos aleatórios exponenciais em Los Lagos, Chile / Inter-municipal governance networks: application of exponential random graph models in Los Lagos, Chile

Resumen Desde los noventa, la idea de gobernanza ha permeado los debates acerca de la transformación del Estado a escala regional, sin embargo, las dificultades de su operacionalización han limitado nuestro conocimiento. Este artículo busca contribuir con esta brecha, examinando la dimensión interjurisdiccional de la gobernanza regional. Aplicando la perspectiva de análisis de redes, se estudia la formación de las redes intermunicipales que se configuran a partir de diferentes mecanismos de colaboración. Con base en el marco de acción colectiva institucional, el artículo analiza la prevalencia de estructuras de relacionamiento asociadas a diferentes tipos de capital social (bonding - capital social vínculo ‒ y bridging - capital social puente ‒) en tres redes intermunicipales de la región de Los Lagos, en Chile. Por medio de la aplicación de modelos de grafos aleatorios exponenciales (ERGM), se obtiene evidencia para sustentar la consistente prevalencia de bonding en las tres redes estudiadas y su coexistencia con estructuras descentralizadas en las redes de mayor complejidad regional.

Resumo Desde a década de noventa, a ideia de governança permeou os debates sobre a transformação do Estado no âmbito regional, não obstante, as dificuldades de sua operacionalização têm limitado nosso conhecimento. Este artigo busca contribuir para essa lacuna, examinando a dimensão interjurisdicional da governança regional. Aplicando a perspectiva da análise de redes, estuda-se a formação de redes intermunicipais que se configuram a partir de diferentes mecanismos de colaboração. Com base no marco institucional da ação coletiva, o artigo analisa a prevalência de estruturas de relacionamento associadas a diferentes tipos de capital social (bonding/bridging) em três redes intermunicipais da região de Los Lagos, no Chile. Através da aplicação de modelos de gráficos aleatórios exponenciais (ERGM), obtêm-se evidências que suportam a prevalência consistente de bonding nas três redes estudadas e sua coexistência com estruturas descentralizadas em redes de maior complexidade regional.

Abstract The idea of governance has permeated the debates on the state's transformation at the regional level since the 1990s. However, operationalization difficulties have limited our knowledge of the phenomenon. This article contributes to filling this gap by examining the inter-jurisdictional dimension of regional governance. From a network perspective, the article studies the emergence of inter-municipal networks from different local collaborative mechanisms. Based on the institutional collective action framework, the study analyzes the prevalence of network structures associated with different types of social capital (bonding/bridging) in three inter-municipal networks in the Los Lagos Region in Chile. The application of exponential random graph models (ERGM) revealed evidence supporting the consistent prevalence of bonding in the three networks studied. The findings also showed the networks' coexistence with structures decentralized in more complex regional networks.

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

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

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

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

Validación de instrumentos para estudio de referenciación en enfermería oftalmológica / Validation of Instruments for the Study of Benchmarking in Ophthalmology Nursing

Introducción: El estudio de procesos que inciden en la calidad de enfermería en oftalmología con la utilización de la referenciación competitiva requiere la validación de instrumentos para el alcance de los resultados esperados. Objetivo: Describir el proceso de construcción y validación de instrumentos para el estudio de procesos relacionados con la calidad de enfermería en oftalmología. Métodos: Estudio instrumental realizado en el Instituto Cubano de Oftalmología "Ramón Pando Ferrer", en el período de enero-julio 2020, que contó con dos fases, la construcción de los instrumentos y la validación de comprensión o de apariencia y de contenido. Para el diseño se tuvieron en cuenta las tareas que cada proceso estudiado incluye en su ficha y para la validación de comprensión y de contenido se utilizó la consulta a profesionales y expertos, así como el método Barraza que integra la valoración cuantitativa de los ítems que integran los instrumentos. Resultados: En la validación de comprensión o apariencia más del 94 % de los ítems no sufrieron cambios desde su primera ronda de consulta, en tanto solo cuatro ítems requirieron modificaciones en la forma de enfocar las preguntas propuestas. Los instrumentos recibieron en la valoración de los expertos una evaluación mayor a 2,6, lo que les confiere una fuerte validez de contenido. Conclusión: La validación realizada permitió constatar la pertinencia de los instrumentos diseñados para el estudio en la referencia de buenas prácticas, en la Clínica Central "Cira García", de los procesos de hospitalización, atención a urgencias y esterilización(AU)

Introduction: The use of competitive benchmarking for the study of processes that influence on ophthalmology nursing quality requires the validation of instruments for the achievement of the expected results. Objective: To describe the construction and validation of instruments for the study of processes related to nursing quality in ophthalmology. Methods: A instrumental study was carried out at Instituto Cubano de Oftalmología "Ramón Pando Ferrer" in the period January-July 2020. It had two phases: the construction of the instruments, and the validation of comprehension or appearance and content. For the design, the tasks that each studied process includes in their respective files were taken into account, while the validation of comprehension and content was performed by means of consultation with professionals and experts, as well as the Barraza method, which integrates the quantitative evaluation of the items making up the instruments. Results: In the validation of comprehension or appearance, more than 94% of the items did not have any changes since the first consultation round, while only four items required modifications in the way of approaching the proposed questions; the instruments received an evaluation of more than 2.6 according to the experts' assessment, which provides them with strong content validity. Conclusion: The performed validation allowed to confirm the relevance of the instruments designed for the study in reference to good practices, as well as the hospitalization, emergency care and sterilization processes, at Clínica Central "Cira García"(AU)

Financiamento climático: eficácia institucional do Fundo Nacional sobre Mudança do Clima / Financiación climática: eficacia institucional del fondo nacional para el cambio climático / Climate financing: institutional effectiveness of the national fund on climate change

Resumo Atualmente há amplo consenso científico sobre a emergência climática. As organizações públicas têm intensificado ações de mitigação e adaptação, conduzindo financiamentos climáticos por meio de fundos nacionais do clima. Em 2009, foi instituído no Brasil o Fundo Nacional sobre Mudança do Clima (FNMC). As análises sobre financiamento climático se intensificaram a partir de 2020, mas ainda há poucos estudos empíricos documentando as experiências sobre esses fundos. Este artigo contribui para essa lacuna, analisando a eficácia institucional do FNMC mediante pesquisa documental, no período de 2009 a 2020, considerando 21 indicadores distribuídos em cinco dimensões. Identificar quais são os principais desafios para a eficácia institucional do FNMC é importante, pois a sua capacidade e continuidade colaboram com as metas internacionais assumidas pelo Brasil para redução de Gases de Efeito Estufa (GEE) e fortalecem os estudos e investimentos em projetos sobre mudança do clima. Os resultados revelam grande fragilidade na eficácia institucional do FNMC, visto que, nenhuma dimensão tem atendimento satisfatório em todos os seus indicadores, sendo a mobilização de recursos e sustentabilidade o principal desafio para o FNMC.

Resumen Actualmente existe un amplio consenso científico sobre la emergencia climática. Las organizaciones públicas han intensificado las acciones de mitigación y adaptación llevando a cabo la financiación climática a través de fondos nacionales del clima. En 2009, fue instituido en el Brasil el Fondo Nacional sobre el Cambio Climático (FNMC). La investigación sobre financiación climática se ha intensificado desde 2020, pero todavía hay pocos estudios empíricos sobre estos fondos. Este artículo contribuye a este vacío analizando la eficacia institucional del FNMC a través de la investigación documental, en el período de 2009 a 2020, considerando 21 indicadores distribuidos en cinco dimensiones. Identificar los principales desafíos a la eficacia institucional del FNMC es importante, ya que su capacidad y continuidad colaboran con las metas internacionales asumidas por Brasil para la reducción de Gases de Efecto Invernadero (GEI) y fortalecen los estudios e inversiones en proyectos de cambio climático. Los resultados revelan una gran fragilidad en la eficacia institucional del FNMC, ya que ninguna dimensión tiene una asistencia satisfactoria en todos sus indicadores, constituyendo la movilización de recursos y la sostenibilidad los principales desafíos para el FNMC.

Abstract There is broad scientific consensus about the climate emergency. Governments have intensified mitigation and adaptation actions by conducting climate finance through national climate funds. In 2009, the National Fund on Climate Change (FNMC) was established in Brazil. Analyzes on climate finance have intensified after 2020, and there are few empirical studies on these funds. This article contributes to this gap by analyzing the institutional effectiveness of the FNMC through desk research in the period from 2009 to 2020, considering 21 indicators distributed in five dimensions. This study identifies the main challenges to the FNMC's institutional effectiveness, recognizing its importance in helping Brazil meet its commitment to international climate goals by reducing greenhouse gases (GHG), strengthening research, and increasing investments in climate change projects. The results reveal great fragility in the FNMC's institutional effectiveness. None of the five dimensions analyzed had all indicators satisfied, and resource mobilization and sustainability were identified as the main challenges to the FNMC's institutional effectiveness.

Transparência, accountability e governance: revisão sistemática da literatura nos hospitais públicos / Transparencia, rendición de cuentas y gobernanza: una revisión de la literatura en el contexto de los hospitales públicos / Transparency, accountability, and governance: a literature review in the context of public hospitals

Resumo Neste estudo busca-se desenvolver uma revisão da literatura baseada na análise bibliométrica sobre o tema da transparência e da accountability no contexto da governance dos hospitais públicos, procurando identificar linhas de investigação, teoria, método de investigação e lacunas existentes por intermédio da análise das publicações científicas datadas até 2020. A investigação seguiu o referencial teórico da transparência e da accountability no setor público com o intuito de compreender o seu enquadramento no contexto da governance dos hospitais. Com recurso ao software Bibliometrix e terminado o processo de consulta dos artigos nas bases de dados Scopus e WoS, foram selecionados 118 artigos para este estudo. Constatou-se que, no período entre 2017-2020, cerca de 85% das publicações são de base qualitativa e há uma tendência crescente no estudo da transparência e da accountability na governança dos hospitais públicos. A transparência surge frequentemente interligada à responsabilização dos agentes (accountability), às políticas de comunicação externa (relatórios públicos) e interna, assim como à sua compreensibilidade. Verificou-se a ainda predominância das publicações de origem norte-americana e chinesa. O estudo identifica também a escassez de investigação baseada em modelos quantitativos que explorem relações de dependência entre as dimensões estudadas, limitando a compreensão da interdependência entre as práticas de transparência e os atributos internos e externos das organizações. O estudo contribui para o conhecimento sobre interações entre transparência, accountability e prestação de contas na governança dos hospitais públicos.

Resumen El objetivo de este estudio es desarrollar una revisión bibliográfica basada en el análisis bibliométrico sobre el tema de la transparencia y la rendición de cuentas en el ámbito de la gobernanza de los hospitales públicos, buscando identificar líneas de investigación, teorías, métodos de investigación y lagunas existentes a través del análisis de las publicaciones científicas fechadas hasta 2020. La investigación siguió el referencial teórico de la transparencia y la rendición de cuentas en el sector público para comprender su marco en el ámbito de la gobernanza de los hospitales. Recurriendo al software Bibliometrix, y tras el proceso de consulta de los artículos en las bases de datos Scopus y WoS, se seleccionaron 118 artículos de interés para este estudio. Se constató que, en el periodo comprendido entre 2017 y 2020, aproximadamente el 85% de las publicaciones son de base cualitativa y existe una tendencia creciente en el estudio de la transparencia y la rendición de cuentas en el ámbito de la gobernanza de los hospitales públicos. La transparencia aparece a menudo interconectada con la responsabilidad de los agentes (rendición de cuentas), las políticas de comunicación externa (informes públicos) e interna, así como su comprensibilidad. También se observó el predominio de publicaciones de origen norteamericano y chino. El estudio también identifica la escasez de investigaciones que utilicen modelos cuantitativos que exploren las relaciones de dependencia entre las dimensiones estudiadas, lo que limita la comprensión de la interdependencia entre las prácticas de transparencia y los atributos internos y externos de las organizaciones. El estudio contribuye al conocimiento de las interacciones entre transparencia, rendición de cuentas y reporte en el ámbito de la gobernanza de los hospitales públicos.

Abstract This study develops a literature review based on bibliometric analysis on the theme of transparency and accountability within the scope of governance of public hospitals, seeking to identify research lines, theories, research methods, and existing gaps through the analysis of scientific publications until 2020. The investigation followed the theoretical lens of transparency and accountability in the public sector to understand its framework within the scope of the governance of hospitals. Using the Bibliometrix software, and after the consultation process of the articles published in the Scopus and WoS databases, a sample with 118 articles was selected. It was found that, in the period between 2017-2020, approximately 85% of the publications were qualitative, and there is a growing trend in the study of transparency and accountability within the scope of governance of public hospitals. Transparency often appears interconnected with the accountability of agents (accountability), external communication policies (public reports), internal communication policies, and their comprehensibility. The predominance of publications of North American and Chinese origin was also noted. The study also identifies the scarcity of research using quantitative models that explore dependency relationships between the dimensions studied, limiting the comprehensibility of the interdependence between transparency practices and organizations' internal and external attributes. The study contributes to the knowledge about the interactions between transparency, accountability, and reporting within the scope of governance of public hospitals.

Gobernanza en Enfermería durante la pandemia de COVID-19 / Nursing Governance during the COVID-19 Pandemic

Introducción: La gobernanza en Enfermería consiste en la toma de decisiones de acuerdo con el liderazgo del profesional de Enfermería en la organización, y responde a las necesidades de los grupos de interés. El gremio de enfermería tiene una participación clave en la gestión de los servicios y cuidados proporcionados en el plan de emergencia de la pandemia COVID-19. Sin embargo, hasta estos momentos no se tiene una idea clara sobre su gobernanza y el desarrollo profesional durante este período de crisis. Objetivo: Describir la gobernanza del profesional de enfermería y su relación con la gerencia durante la pandemia de COVID-19. Métodos: Revisión integradora, desarrollada en el período de mayo a julio del 2022, con una construcción de artículos científicos completos disponibles en los idiomas español, inglés y portugués, publicados entre los años del 2018 al 2022, procedentes de las bases de datos PubMed, CINAHL, Scopus, Cuiden, SciELO, Lilacs y Latindex, y con un adecuado rigor metodológico de acuerdo con el diseño del estudio. La búsqueda inicial arrojó un total de 4267 referencias bibliográficas; tras la revisión se filtraron y analizaron 20 artículos que respondían a los criterios de inclusión, para su posterior categorización. Conclusiones: Ante la pandemia de COVID-19, Enfermería persistirá y desafiará su capacidad para pensar, aprender, adaptar y actuar como fuerza laboral sanitaria, y el éxito dependerá del empoderamiento de gobernanza en el equipo de salud. Los modelos de Enfermería no solo deben ir orientados a la formación y preparación de enfermeras de atención directa, se debe potenciar la confianza, autoeficacia y habilidades en gestión y liderazgo en Enfermería(AU)

Introduction: Governance in nursing consists in decision making in accordance with the nursing professional's leadership regarding the organization, as well as it responds to the needs of the stakeholders. The nursing profession has a key role in the management of the services and care provided as part of the emergency plan during the COVID-19 pandemic. However, until now, there is no clear picture of their governance or professional development during this crisis period. Objective: To describe the nursing professional's governance and their relationship with management during the COVID-19 pandemic. Methods: This integrative review was developed in the period from May to July 2022, with a compilation of full scientific articles available in Spanish, English and Portuguese and published between 2018 and 2022. The scientific articles came from the PubMed, CINAHL, Scopus, Cuiden, SciELO, Lilacs and Latindex databases and their adequate methodological rigor was in accordance with the study design. The initial search yielded a total of 4267 bibliographic references. After the review, 20 articles that met the inclusion criteria were filtered and analyzed for subsequent categorization. Conclusions: In the face of the COVID-19 pandemic, nursing will boldly persist with its ability for thinking, learning, adaptation and action as a healthcare workforce, and success will depend on empowering governance in the healthcare team. Nursing models should not only be oriented to the training and preparation of direct care nurses. In this respect, confidence, self-efficacy and skills in nursing management and leadership should be enhanced(AU)

Governança federal na construção da política de enfrentamento à COVID-19 na atenção primária à saúde brasileira / Federal governance in building the policy to combat the COVID-19 pandemic in Brazilian primary health care

Resumo Este artigo objetiva descrever e analisar o processo de pactuação federal da política de enfrentamento à pandemia de COVID-19 no âmbito da atenção primária à saúde (APS). Trata-se de um estudo de análise de políticas para o qual se realizou pesquisa documental exploratória buscando identificar os registros dos debates e publicações oficiais do Ministério da Saúde acerca das políticas/orientações relacionadas à gestão e ao trabalho na APS ao longo da pandemia. À luz do referencial de governança em políticas públicas, procedeu-se à análise de conteúdo dos achados. O debate sobre o tema foi identificado em 23 reuniões/encontros oficiais, em sua maioria no âmbito da gestão, sendo menores os espaços científicos e de participação popular. No que se refere ao conteúdo das 34 publicações ministeriais, apenas 15 haviam sido discutidas previamente com outras representações institucionais. Não apenas pela pouca propensão aos debates, mas pelas contradições e ausências percebidas ao se concatenar o conteúdo das discussões e das publicações oficiais, percebeu-se evidente descoordenação central, rompimento do pacto federativo e hierarquização do modelo histórico de governança em redes no Sistema Único de Saúde, induzidos pela agenda autoritária e negacionista da Presidência da República.

Abstract This article aims to describe and analyze the process of federal agreement of the policy to combat the COVID-19 pandemic within the scope of primary health care (PHC). This is a policy analysis study for which exploratory documentary research was conducted seeking to identify the records of debates and official publications of the Ministry of Health on policies/guidelines related to management and work in PHC throughout the pandemic. In the light of the governance framework in public policies, content analysis of the findings was carried out. The debate on the topic was identified in 23 official meetings, mostly in the management sphere, with fewer scientific and popular participation spaces. With respect to the contents of the 34 ministerial publications, only 15 had been previously discussed with other institutional representations. Not only due the lack of propensity for debates, but also because of the contradictions and absences perceived when integrating the content of discussions and official publications, there was a clear lack of central coordination, as well as the rupture of the federative pact and hierarchization of the historical model of governance in networks in the Unified Health System, induced by the authoritarian and denialist agenda of the Presidency of the Republic.