‘Makkalai Thedi Maruthuvam’ scheme in Tamil Nadu: an intersectionality-based analysis of access to NCD care.

There are gross inequities in access to non-communicable disease (NCD) care in India. The Indian state of Tamil Nadu recently launched the “Medicine at people’s doorstep” (Makkalai Thedi Maruthuvam — MTM) scheme in which screening and medications for NCDs are delivered at people’s doorsteps. This is likely to improve geographical access to NCD services in the community. The objective of this study is to analyse the MTM scheme and recommend policy interventions for improved and equitable access to NCD services in the community. We analysed the MTM policy document using the intersectionality-based policy analysis framework. This analysis was supplemented further with literature review to enhance understanding of the various intersecting axes of inequities, such as gender discrimination, caste oppression, poverty, disabilities and geographical access barriers. The MTM policy document, while it removes the physical access barrier, does not frame the problem of NCDs from an intersectionality perspective. This can increase the chances of inequities in access to NCD services persisting despite this scheme. We also recommend interventions for the short, intermediate and long term to make NCD care more accessible. Creation of a gender, caste, class, geographical access, and disabilities disaggregated database of patients with NCDs, using this database for monitoring the delivery of MTM services, dynamic mapping of vulnerability of the target populations for delivery of MTM services and long term ongoing digital surveillance of factors inducing inequities to access of NCD services can all help reduce inequities in access to NCD care.

Um modelo teórico-metodológico para análises de políticas com longas trajetórias e ação de atores em prol da mudança e da estabilidade / Un modelo teórico-metodológico para el análisis de políticas con largas trayectorias y acción de actores en pro del cambio y de la estabilidad / A theoretical and methodological framework for analyzing long-term policy and the role played by actors in promoting change and stability

Políticas públicas, frequentemente, estão associadas a legados históricos constituídos em processos políticos nos quais atores agem em prol da mudança ou da estabilidade institucional. Este artigo apresenta uma proposta teórico-metodológica que usa o process tracing na identificação dos processos mais relevantes para o estudo da trajetória de políticas, por intermédio das lentes teóricas oferecidas pelos estudos sobre processo político e Teoria da Mudança Institucional Gradual. Essa abordagem teórico-metodológica possibilitou a identificação e a compreensão da influência de diferentes atores, de arranjos institucionais e mudanças na política para a força de trabalho médica (PFTM) da década de 1960 a 2010, bem como propiciou que se apreendesse na análise a importância da ação de atores que dirigiram o Ministério da Saúde, a partir de 2003, interessados em direcionar a PFTM às necessidades do Sistema Único de Saúde (SUS).(AU)

Con frecuencia, las políticas públicas están asociadas a legados históricos constituidos en procesos políticos en los cuales los actores actúan en pro del cambio o de la estabilidad institucional. Este artículo presenta una propuesta teórico-metodológica que usa el process tracing en la identificación de los procesos más relevantes para el estudio de la trayectoria de políticas por intermedio de las lentes teóricas ofrecidas por los estudios sobre proceso político y Teoría del Cambio Institucional Gradual. Ese abordaje teórico-metodológico posibilitó la identificación y la comprensión de la influencia de diferentes actores, de arreglos institucionales y cambios en la política para la fuerza de trabajo médica (PFTM) de la década de 1960 a 2010, así como propició que se captase en el análisis la importancia de la acción de actores que dirigieron el Ministerio de la Salud, a partir de 2003, interesados en dirigir la PFTM hacia las necesidades del Sistema Único de Salud.(AU)

Public policies are often associated with historical legacies constituted by political processes in which actors seek to promote institutional change or maintain stability. This article presents a theoretical and methodological framework that uses process tracing to identify the most relevant processes for the study of the trajectory of policy through a theoretical lens that draws on studies of the public policy process and the theory of gradual institutional change. The framework enabled us to identify changes in medical workforce policy (MWP) between the 1960s and 2010s and understand the influence of different actors and institutional arrangements. Our findings also reveal the importance of the role of ministry of health executives interested in tailoring MWP to the needs of Brazil's public health system from 2003.(AU)

Current Situation on Clinical Comprehensive Evaluation of Chinese Patent Medicines in China / 中国实验方剂学杂志

ObjectiveTo clarify the development and methodological research status of clinical comprehensive evaluation of Chinese patent medicines in China and identify the problems and difficulties in the evaluation， so as to provide a reference for promoting the subsequent evaluation. MethodFirstly， we analyzed the current situation of clinical comprehensive evaluation in China by reviewing the articles about the process of clinical comprehensive evaluation of drugs and the process of clinical comprehensive evaluation of Chinese patent medicines. Secondly， we comprehensively summarized the formulation background and key points of policies related to clinical comprehensive evaluation of Chinese patent medicines and then show the development status in this field at the national and provincial levels. ResultThe comprehensive clinical evaluation of Chinese patent medicines is still in its infancy in China， and 32 articles of specific evaluation of Chinese patent medicines were included in the study. The dosage forms were mainly capsules （15 articles， 46.88%） and injections （28.13%）. The evaluation mainly involved diseases such as the nervous system （10 articles， 31.25%）， digestive system （5 articles， 15.63%）， and respiratory system （5 articles， 15.63%）. The research results of clinical comprehensive evaluation of Chinese patent medicines were mainly from relevant societies and research institutions. Different research teams have developed technical guidelines or specifications for the evaluation， while the government-leading evaluation guidelines remained to be formulated at the national and provincial levels. In addition， the research articles in this field mainly concentrated on the application of evaluation methods， the building of evaluation index systems， and completed evaluation reports. ConclusionTo reflect the unique value and advantages of Chinese patent medicines， the government needs to build technical guidelines for the clinical comprehensive evaluation of Chinese patent medicines on the basis of the clinical comprehensive evaluation of drugs and create a favorable policy environment for the evaluation work.

Implementation status and suggestions of centralized volume-based procurement policy for drugs and medical consumables in China / 中国药房

OBJECTIVE To provid e reference and sugge stions for improving the volume-based procurement of drugs and medical consumables （hereinafter referred to as “consumables”）in China. METHODS The relevant policy documents of centralized volume-based procurement of drugs and consumables published from November 2018 to November 2021 were retrieved ； the implementation status and problems of centralized volume-based procurement of drugs and consumables in China were analyzed by using the policy analysis method and referring to relevant research literatures. RESULTS & CONCLUSIONS National health department and healthcare security administration guaranted the rational use of selected products in medical institutions through incentive and supervision measures ；healthcare security administration should optimize the way of medical insurance payment ， promote the medical institutions to control the fees by themselves ，and conduct the credit evaluation of bidding and procurement ； medical products administration should evaluate the consistency of drugs and supervise the quality of selected products. With the normalization of centralized volume-based procurement of drugs and consumables organized by the state and trans-regional alliance ， the drug varieties and dosage forms included in centralized procurement were increasingly in line with the demand of Chinese pharmaceutical market. The price of most selected drugs decreased by more than 50％，and the decrease of consumables was significantly higher than that of drugs. The selected enterprises were mainly domestic generic drug enterprises ，and domestic consumables had gradually become the competitors and substitute of imported consumables. However ，there were still some problems such as repeated bidding and procurement in various alliances and provinces （autonomous regions and municipalities ）， unclear construction of compensation mechanism in medical institutions ，inconsistent bidding and procurement rules and quality evaluation standards for consumables ，low localization rate of some consumables ，low innovation level and profitability of pharmaceutical enterprises and consumables manufacturers. Local centralized volume-based procurement should be encouraged ，and the bidding and procurement rules and quality evaluation standards of “one product ，one policy ”should be gradually established. Great importance should be paid to the construction of compensation mechanism of medical institutions ，standardize zhangqiuyu739632@126.com the dynamic adjustment of medical serv ice prices ；pharma- ceutical enterprises and consumables manufacturers should increase research and development investment to transform into innovative and diversified enterprises ，so as to improve the competitiveness of domestic drugs and consumables.

CHINA PH ARMACY Volume 33，Number 14，July 30，2022 Semimonthly Table of Contents Analysis of pediatric drug policies in China on the basis of policy tools / 中国药房

OBJECTIVE To provide refere nce for the optimization and adjustment of the relevant policies in the field of pediatric drug in China. METHODS“Children”“pediatrics”and“drugs”were taken as the keywords to search the official websites of the State Council ，the National Health Commission ，the National Healthcare Security Administration ，the State Administration of Market Regulation and other relevant ministries and commissions ，and collect the relevant pediatric drug policies issued at the national level from January 1，2010 to December 31，2021. Content analysis method was used to summarize ，code and statistically analyze the policy tools used in the policy research documents. RESULTS A total of 39 policy documents and 327 policy tools were included in this study. According to statistics ，from 2011 to 2021，China issued national policy documents on pediatric drug use every year ，and in recent years ，the issuance of documents was relatively intensive. The main body of issuing pediatric drugs policy was the national health department and drug supervision and administration department （71.79％，28/39），and the number of documents issued by relevant ministries and commissions alone （76.92％，30/39）was significantly more than the number of documents jointly issued by multiple ministries and commissions （23.08％，9/39）. The environmental policy tools were the most widely used （64.83％，212/327），followed by s upply-oriented policy tools （30.28％，99/327），and demand-oriented policy tools were the least used （4.89％，16/327）. CONCLUSIONS The development of pediatric drug use in China is in its infancy. It is suggested that China should optimize supply-oriented policy tools，increase capital investment and the use of public health service tools ；adjust environmental policy tools ，accelerate the legislation of pediatric drugs ，and increase the proportion of incentive policy tool ；attach importance to demand-oriented policy tools ，strengthen international exchanges and the application of service outsourcing in the field of pediatric medication ；plan the use of various policy tools as a whole ，and coordinate the use proportion of three types of policy tool and their sub policy tools，so as to enhance the initiative of policy tools ，form policy synergy ，and jointly promote the development of pediatric drug use.

Analysis of the implementation of health impact assessment of public policies in Zhejiang province / 中华医院管理杂志

The policy implementation model of G. C. Edwards was used to analyze the public policy health impact assessment in Zhejiang province, and summarize its practice and existing problems in four aspects of policy implementation standards, policy resources, policy executors′ intention and management organization structure, so as to provide reference for promoting the national health impact assessment pilot work. The analysis results showed that Zhejiang province has initially established the public policy health impact assessment mechanism and achieved phased results, but there were still some problems, including the imperfection of policy content and implementation strategy, the inadequacy of leadership decision-making and top-level design, the difference in attitude, understanding and implementation preference of policy implementation subjects, and the ambiguity of the authority and responsibility system of each department in cooperation. In order to further promote the smooth development of public policy health impact assessment, Zhejiang province should actively promote the top-level design to strengthen policy support, integrate and optimize policy resources, gradually establish and improve the health governance mechanism of multiple and overall coordination, and promote the high-quality development of public policy health impact assessment by taking cross departmental cooperation as the path of health co-construction.

Analysis of " Internet plus healthcare" related policies in the eastern, central and western regions of China before and after the COVID-19 pandemic / 中华医院管理杂志

Objective:To analyze the commonalities and differences of " Internet plus healthcare" related policies in the eastern, central and western regions of China before and after the COVID-19 pandemic and to provide references for further improving China′s " Internet plus healthcare" policy.Methods:Collecting the policies of " Internet plus healthcare" promulgated by 31 provinces(autonomous regions, municipalities)in China from April 2018 to December 2020 on the websites of various government departments, extracting keywords based on content analysis methods, and calculating degree centralities using UCINET 6 software. A comparison of the policies of the eastern, central and western regions between the pre epidemic stage(April 2018 to December 2019)and the COVID-19 pandemic stage(January 2020 to December 2020)was carried out.Results:In the pre epidemic stage, Internet diagnosis and treatment, " Internet plus medical service price" and quality supervision were the focus of attention in all regions. But the eastern region paid more attention to the policy planning of Internet hospital operation and Internet medical application, the central region focused on the transformation and efficiency improvement of medical service process by Internet technology, and the western region paid more attention to encourage the application of telemedicine to solve the difficulty of seeing a doctor. In the pandemic stage, the " Internet plus service price" was the policy focus in all regions, mostly in medical insurance payment, and the policy difference was not obvious among the eastern, central and western regions.Conclusions:Before and after the COVID-19 pandemic, the policy of " Internet plus healthcare " promulgated by the local governments in eastern, central and western regions had different emphasis and different characteristics. Our suggestion was to improve the policy system, standardize industry supervision, strengthen information security, orderly interconnect medical insurance, and actively promote the exchange of policy experiences among the provinces.

Políticas, crianças e segurança no trânsito: contribuições da abordagem WPR à análise de políticas / Políticas, niños y seguridad vial: contribuciones del enfoque de WPR al análisis de políticas / Policies, Children, and Road Safety: contributions from the WPR approach to policy analysis

Resumo: Consideramos a atenção pública voltada à segurança da criança no trânsito tendo por base a abordagem, de inspiração foucaultiana, What's the Problem Represented to Be?, (WPR) de Carol Bacchi. A premissa, neste estudo, reside em utilizar textos de políticas e propostas de políticas visando acessar problematizações por meio das quais somos governados. Seu potencial é relevante para que repensemos ênfases convencionais na definição de agenda e em processos de elaboração de políticas. A WPR sugere que, na internalização do discurso da segurança da criança, o 'problema' do trânsito não é dado a priori, mas produzido também discursivamente no contexto das políticas e propostas de políticas, com efeitos práticos sobre o cotidiano de crianças em aglomerados urbanos.

Resumen: Consideramos la atención pública a la seguridad infantil en el tránsito desde el enfoque inspirado en Foucault ¿Cuál es el problema que representa ser? (WPR) de Carol Bacchi, cuya premisa radica en el uso de textos de políticas y propuestas de políticas para acceder a las problematizaciones a través de las cuales estamos gobernados. Su potencial es relevante para repensar los énfasis convencionales en el establecimiento de la agenda y en los procesos de formulación de políticas. El WPR sugiere que en la internalización del discurso de seguridad de los niños, el "problema" del tránsito no se da a priori, sino que también se produce de manera discursiva en el contexto de políticas y propuestas de políticas con efectos prácticos en la vida cotidiana de los niños en las zonas urbanas.

Abstract We consider public attention to child safety in traffic from the Foucault-inspired approach What's The Problem Represented to Be? (WPR) by Carol Bacchi, whose premise lies in using policy texts and policy proposals to access problematizations through which we are governed. It highlights a potential to rethink conventional emphases in agenda setting and in policy-making processes. The WPR approach suggests that in the internalization of children's safety discourse, the 'problem' of traffic is not given a priori, but is also produced discursively in the context of policies and policy proposals with practical effects on the daily lives of children in urban areas.

Stories in the agenda: a Narrative Policy Framework study / Historias en la agenda: un estudio del Narrative Policy Framework / Histórias na agenda: uma aplicação do "Narrative Policy Framework"

Abstract This study applies the "Narrative Policy Framework" (NPF) to the affirmative action policy process of the Federal University of Pelotas (UFPEL) and proposes theoretical intersection between the NPF and agenda setting literature, seeking to find out the role of policy narratives in policy processes. NPF is an empiric-oriented framework that posits that the policy-makers' stories have generalizable components and are built and crafted in accordance to their ideas. These are policy narratives, and are at the center of the policy process. By analyzing formulation stages of public policy and referring to ideas and narratives, the NPF refers to the agenda setting literature and provides means for empirical research of agenda setting concepts. The study undertook analysis of regulatory outputs and semi-structured interviews. Findings indicate that policy narratives have affected institutional regulatory outputs regarding UFPel's affirmative action policies.

Resumen: Este artículo aplica el Narrative Policy Framework (NPF) al proceso de producción de políticas de acciones afirmativas de la Universidad Federal de Pelotas (UFPEL) y propone avances teóricos que exploran la intersección entre el NPF y la literatura sobre formación de agenda. El NPF es un enfoque orientado empíricamente que propone que las historias que utilizan los actores en el proceso de formulación de políticas tienen componentes generalizables y se crean estratégicamente de acuerdo con sus ideas y sistemas de creencias. Estas historias se llaman "narrativas de política" y se consideran una parte central de los procesos de políticas públicas. Al analizar la formulación de políticas públicas y abordar el papel de las ideas y narrativas, el NPF dialoga directamente con la literatura sobre la formación de la agenda y proporciona medios para la investigación empírica de conceptos desarrollados en este enfoque. La metodología para este estudio utiliza análisis de documentos reglamentarios y entrevistas semiestructuradas. Los resultados indican que se utilizaron narrativas de políticas e influyeron en la regulación de las políticas de acciones afirmativas de la UFPEL.

Resumo Este artigo aplica o "Narrative Policy Framework" (NPF) ao processo de produção das políticas de ações afirmativas da Universidade Federal de Pelotas (UFPEL) e propõe especificação de intersecção teórica entre o NPF e a literatura sobre formação de agenda, visando responder questões sobre o papel das narrativas em processos de produção de políticas públicas. O NPF é uma abordagem de orientação empírica que propõe que as histórias que os atores do processo de produção de políticas públicas utilizam têm componentes generalizáveis e são criadas estrategicamente, de acordo com suas ideias e sistemas de crença. Essas histórias são chamadas "narrativas de política" e são consideradas parte central dos processos de políticas públicas. Ao analisar a formulação de políticas públicas e abordar o papel das ideias e das narrativas, o NPF dialoga diretamente com a abordagem da formação de agenda e provê meios para a pesquisa empírica de conceitos desenvolvidos nesta literatura. A metodologia para este estudo utiliza análise de documentos regulatórios oficiais e entrevistas semiestruturadas. Resultados indicam que narrativas de política foram utilizadas e influenciaram a regulamentação das políticas de ações afirmativas da UFPel.

Análise de políticas esportivas: compartilhando uma proposta teórico-metodológica / Analysis of sports policies: sharing a theoretical-methodological proposal / Análisis de las políticas deportivas: compartir una propuesta teórico-metodológica

Este artigo de revisão apresenta uma proposta teórico-metodológico vinculada ao materialismo dialético para análise de políticas esportivas. Após revisão sistemática sobre a produção de conhecimento no tema da política pública na Educação Física, os autores apresentam os pressupostos teóricos que fundamentam sua proposta. Posteriormente, realizam descrição dos aspectos e indicadores do modelo de análise aplicados ao contexto da política esportiva. Por fim, destaca-se a impossibilidade de emprego universal e homogêneo do modelo, apontando para a necessidade de coteja-lo com o contexto histórico e social da realidade concreta observada, além das múltiplas determinações do objeto investigado.

This review article presents a theoretical-methodological proposal linked to dialectical materialism for the analysis of sports policies. After a systematic review on the production of knowledge in the subject of public policy in Physical Education, the authors present the theoretical assumptions that underlie their proposal. Subsequently, they describe the aspects and indicators of the analysis model applied to the context of sports policy. Finally, it is important to highlight the impossibility of universal and homogeneous use of the model, pointing to the need to compare it with the historical and social context of the concrete reality observed, besides the multiple determinations of the investigated object.

Este artículo de revisión presenta una propuesta teórico-metodológica vinculada al materialismo dialéctico para el análisis de políticas deportivas. Después de una revisión sistemática sobre la producción de conocimiento en el tema de la política pública en la Educación Física, los autores presentan los presupuestos teóricos que fundamentan su propuesta. Posteriormente, describen los aspectos e indicadores del modelo de análisis aplicados al contexto de la política deportiva. Por último, se destaca la imposibilidad de empleo universal y homogéneo del modelo, apuntando a la necesidad de cotejarlo con el contexto histórico y social de la realidad concreta observada, además de las múltiples determinaciones del objeto investigado.

Serviços Farmacêuticos na Atenção Primária em Saúde à luz do modelo ambiguidade-conflito / Pharmaceutical Services in Primary Health Care in light on the ambiguity-conflict model

Resumo Este artigo tem por objetivo analisar os níveis de ambiguidade e conflito em relação aos objetivos e meios necessários à implementação dos Serviços Farmacêuticos (SeFar) no âmbito da Atenção Primária à Saúde no município do Rio de Janeiro. Os dados foram coletados por meio de entrevistas-semiestruturadas com 14 atores-chave, realizadas em 2018. Os resultados foram interpretados com base na análise temática de conteúdo e à luz do modelo ambiguidade-conflito de análise de implementação. Quanto aos objetivos dos SeFar, houve alto consenso intracategorias, porém baixo intercategorias. Quanto aos meios, foram identificadas divergências importantes intercategorias e consenso quanto a aspectos relevantes como a insuficiência de recursos financeiros e humanos. Os conflitos identificados resultam especialmente da falta de clareza de outros atores mais afastados do nível local ou de outras categorias profissionais, sobre o papel dos SeFar. Assim, considera-se que houve predomínio de características de "implementação experimental", apresentando alta ambiguidade quanto aos objetivos e meios dos SeFar num ambiente de médio conflito e fortemente dependente dos recursos disponíveis no nível local. Também apresentou alguns atributos de "implementação política", uma vez que em determinadas circunstâncias os resultados sofreram influência do contexto político, condicionados por conflitos em relação aos meios para a consecução dos SeFar.

Abstract This article aims to analyze the levels of ambiguity and conflict regarding the objectives and means required for the Pharmaceutical Services (PharmSer) implementation within the Primary Health Care in the city of Rio de Janeiro. Data were collected through semi-structured interviews applied in 2018 with 14 key actors. The results were interpreted based on thematic content analysis and in the light of the ambiguity-conflict model of implementation analysis. Related to the PharmSer aims, we found high consensus intra key actors categories and low inter categories. Related to the means, we found important inter-categories divergences and consensus regarding relevant aspects as insufficient financial and human resources. The conflicts identified result mainly from low clarity of other actors more distant from the local level or other professionals, about role of PharmSer. We conclude for the predominance of "experimental implementation" characteristics, with high ambiguity regarding the objectives and means of the PharmSer, in a medium conflict environment and being strongly dependent on the resources available at the local level. It also presented some attributes of "political implementation", since in certain circumstances the results were influenced by the political context, conditioned by conflicts over the means for achieving the PharmSer.

Policy analysis for countywide medical communities in the policy model of G. C. Edwards / 中华医院管理杂志

The policy model of G. C. Edwards was used to study the policies on building a countywide medical community ( CMC), and identify problems in such aspects as policy communication, resources, disposition and bureaucratic structure. The analysis found that enriching health resources at primary level and powerful government support are creating ideal environment for the construction of CMC. But due to its preliminary development, rooms of improvement of its policy design, and unclear enforcement standards, there appear behavioral polarizations at local health authorities. For example, some are proactive to explore and accumulate rich experiences, while the most take a wait and see stand, or even take administrative means to cope with their authorities by forming medical communities in form only. A small part of county hospitals, thanks to support from the government and inherent conditions, take active measures in this direction as policy frontrunners. On the other hand, most county hospitals prefer to be policy followers in order to avoid cost and risks of the reform. In the worst cases, a few county hospitals have become free riders of the policy, and attempt to take advantages of their primary health institutions. Primary health institutions warmly embrace CMC, but their limited service capability constitutes roadblocks in CMC construction. What is more, poor communication and collaboration mechanisms among systems and authorities hinder the effective policy synergy and health service integration of CMS.

Analysis of policy making process of family physicians contracted service from the perspective of multiple streams theory / 中华医院管理杂志

The family physicians contracted service is an important means to promote hierarchical diagnosis and treatment and realize healthy Chinese strategy. With the continuous introduction of family physicians contracted service policy, it is very important to raise awareness, effectively promote and put into place.This study analyzed the family physicians contracted service policy from the perspective of public policy, and used the multiple streams theory framework to analyze the driving factors of the policy proposed. In addition, it explored the influence of problem stream, policy stream, and political stream on the policy launch process.These efforts can help improvement the policy awareness in the process, and help ensure sustainable progress of the policy.

A formulação e implementação do Programa Mais Médicos e a cooperação com a Organização Pan-Americana da Saúde e Cuba / The formulation e implementation of the More Doctors Program and the cooperation with the Pan American Health Organization and Cuba / La formulacion e implementación del Progama más Médicos y la cooperacion con la Organización Panamericana de la Salud y Cuba

A escassez de profissionais de saúde em áreas remotas é um problema mundial, dificultando o acesso principalmente de populações vulneráveis aos serviços de saúde. Como uma resposta a essa situação no Brasil foi criado em 2013 o Programa Mais Médicos, tendo como um de seus pontos mais debatidos a cooperação para a vinda de médicos cubanos. Realizou-se um estudo qualitativo com análise documental para analisar a influência de política anterior similar ao Programa Mais Médicos, dos diálogos internacionais com países e organismos internacionais e da cooperação entre Brasil, Organização Pan-Americana da Saúde e Cuba na formulação desta política pública. Evidenciou-se a importância da cooperação na formulação, viabilização da implementação e resultados do Programa Mais Médicos e a necessidade da mesma para garantir o número de médicos demandados pelos municípios, em especial nas cidades e áreas mais vulneráveis, e os efeitos em saúde dessa atuação. (AU)

The shortage of health professionals in remote areas is a global problem, dificult making difficult for vulnerable populations to access health services. As a response to this situation in Brazil was created in 2013 the More Doctors Program, with one of its most discussed points being the cooperation for the arrival of Cuban doctors. A qualitative study was carried out with documentary analysis to analyze the influence of previous policy similar to the More Doctors Program, the international dialogues with countries and international organizations, and the cooperation between Brazil, Pan American Health Organization and Cuba in the formulation of this public policy. It was evidenced the importance of cooperation in formulating, making feasible the implementation and results of the More Doctors Program and the need for it to guarantee the number of physicians demanded by the municipalities, especially in the most vulnerable cities and areas, and the health effects of this action. (AU)

La escasez de profesionales de la salud en áreas remotas es un problema mundial, dificultando el acceso principalmente a poblaciones vulnerables a los servicios de salud. Como una respuesta a esa situación en Brasil fue creado en 2013 el Programa Más Médicos, teniendo como uno de sus puntos más debatidos la cooperación para la llegada de médicos cubanos. Se realizó un estudio cualitativo con análisis documental para analizar la influencia de política anterior similar al Programa Más Médicos, de los diálogos internacionales con países y organismos internacionales y de la cooperación entre Brasil, Organización Panamericana de la Salud y Cuba en la formulación de esta política pública. Se evidenció la importancia de la cooperación en la formulación, viabilización de la implementación y resultados del Programa Más Médicos y la necesidad de la misma para garantizar el número de médicos demandados por los municipios, en especial en las ciudades y áreas más vulnerables, y los efectos en salud de esa actuación. (AU)

Comparative Analysis on the New Round Provincial Medicines Centralized Bidding Procurement Policies in China / 中国卫生经济

Objective:To study the new round provincial medicines centralized bidding procurement policies,and to provide reference for the improvement of provincial centralized bidding procurement work.Methods:It collected the latest provincial centralized procurement documents after the publication of Guidance on Implementing Drug Centralized Purchasing in Public Hopitols and Announcement on the Guidance on Implementing Drug Centralized Purchasing in Public Hospitals.By using literature review,comparative analysis and experts consulting,it analyzed the content of centralized bidding procurement,summaried the differences of provincial medicines centralized bidding procurement work.Results:Progress of provincial centralized bidding procurement work was not the same.There were differences in quantity purchasing,price fixing regulations,the double envelope evaluation,and other aspects.Conclusion:It needed to implement layering price fixing regulation to reflect the quality difference of medicines.The price fixing range was determined based on the average of reference prices.It needed to set reasonable economic and technical indexes,determine winning medicines by cross-referencing the economic and technical score and price,increase the number of winning medicines to ensure supply of medicines.

Políticas públicas de zoonosis en Colombia, 1975-2014: un abordaje desde la ciencia política y la salud pública / Public policies of zoonoses in Colombia, 1975-2014: an approach from Political Science and Public Health

RESUMEN Objetivo Analizar las políticas públicas de zoonosis en Colombia, en términos de capacidad de respuesta, decisiones, procesos y resultados, aproximándose a los impactos de las mismas, en el período de 1975 a 2014. Métodos Se realizó un estudio de análisis y evaluación de políticas públicas, con un diseño mixto. Se seleccionaron algunas zoonosis con base en su importancia en salud pública, epidemiología, ubicación en la política y disponibilidad de información consecutiva. Se utilizaron fuentes secundarias de tipo documental y fuentes primarias por medio de una encuesta comentada. Se construyó un marco interpretativo, histórico y estructural, desde el punto de vista económico, epidemiológico y político. Para el análisis de las políticas se utilizó el enfoque secuencial y, de manera complementaria, el enfoque de desarrollo institucional. Se llevó a cabo un análisis de tendencias de las zoonosis seleccionadas. Resultados El marco interpretativo abordó el contexto macro y los procesos clave en dos períodos: 1975-1990 y 1990-2014. El análisis de las políticas públicas en zoonosis se adelantó según su nivel de decisión y relaciones verticales y horizontales entre las mismas. Se obtuvo un análisis de tendencias de las zoonosis en el largo plazo, aproximándose a una valoración del impacto de las políticas. Conclusiones La diversificación y profundización instrumental de las políticas sugieren que las mismas se han acercado a la comprensión y capacidad de manejo de las problemáticas complejas de las zoonosis. Sin embargo, el análisis de tendencias sugiere que el impacto de las políticas públicas en zoonosis sigue siendo limitado.(AU)

ABSTRACT Objective To analyze public policies regarding zoonoses in Colombia, in terms of responsiveness, decision-making, processes and results, approaching their impact in the period between 1975 and 2014. Methods An analysis and assessment of public policies were carried out using a mixed design. Some zoonoses were selected based on their importance for public health, epidemiology, policy and availability of consecutive information. Secondary documentary sources and primary sources were used through an annotated survey. An interpretive, historical and structural framework was built from an economic, epidemiological and political point of view. For policy analysis, the sequential approach was used and, in a complementary manner, the institutional development approach. A trend analysis of selected zoonoses was carried out. Results The interpretive framework addressed the macro context and the key processes in two periods: 1975-1990 and 1990-2014. The analysis of public policies in zoonoses was conducted according to their decision level and the vertical and horizontal relationships between them. A trend analysis of zoonoses in the long term, as well as an assessment of the impact of the policies, was obtained. Conclusions Policy diversification and instrumental depth suggest that they have approached the understanding and management capacity of the complex problems of zoonoses. However, the trend analysis suggests that the impact of public policies on zoonoses is still limited.(AU)

Arena política do Parque Canela de Ema em Sobradinho II, Distrito Federal / Political arena of the Canela of Ema Park in Sobradinho II, Federal District

Trata-se de um artigo, cujo objetivo foi analisar a arena política da recriação do Parque Canela de Ema, em Sobradinho II, no Distrito Federal, com enfoque na influência da participação comunitária na formação da agenda, para formulação de políticas públicas saudáveis, tendo como base teórica o modelo dos múltiplos fluxos. As estratégias utilizadas para a busca de evidências empíricas foram a análise documental e a observação participante. A arena política analisada revelou uma janela de oportunidade, que permitiu a inclusão do tema na agenda do governo local. O papel dos atores da comunidade local foi decisivo para a agregação de diferentes atores na arena, e a incorporação de seus interesses nas alternativas para política do parque. Eles formularam a proposta de um Mosaico de Unidades de Conservação para a região, que induziu a realização de estudos ambientais para a viabilidade da proposta. Essa participação foi facilitada pela mobilização prévia e preparo técnico dos atores da comunidade. A participação comunitária na arena política mostrou-se frágil frente a influencia de outros atores com maior poder econômico, cultural e político, e pela dificuldade dos órgãos governamentais trabalharem de forma cooperativa com a comunidade. O estudo sugere a necessidade de qualificar a participação política da comunidade, para que ela seja efetiva, permitindo a construção de políticas públicas saudáveis.

It is an article, whose objective was to analyze the political arena for the re-creation of the Canela de Ema Park, in Sobradinho II, in the Federal District, focusing on the influence of community participation in the formation of the agenda, for the formulation of healthy public policies, based on the multiple streams model. The strategies used to search for empirical evidence were documentary analysis and participant observation. The political arena analyzed revealed a police window, which allowed the inclusion of the theme in the local government agenda. The role of the local community actors was decisive for the aggregation of different actors in the arena, and the incorporation of their interests in the alternatives for park policy. They formulated a proposal for a Mosaic of Conservation Units for the region, which led to environmental studies for the feasibility of the proposal. This participation was facilitated by the prior mobilization and technical preparation of the community actors. Community participation in the political arena has proved fragile in the face of the influence of other actors with greater economic, cultural and political power and the difficulty of government agencies working cooperatively with the community. The study suggests the need to qualify the political participation of the community, so that it is effective, allowing the development of healthy public policies.

Obstáculos políticos à regionalização do SUS: percepções dos secretários municipais de Saúde com assento nas Comissões Intergestores Bipartites / Political Obstacles to Regionalization of the SUS: perceptions of Municipal Health Secretaries with seat in the Bipartite Interagency Commissions

Resumo O artigo tem como objetivo identificar e analisar os obstáculos políticos à implementação do Contrato Organizativo da Ação Pública (COAP) a partir das percepções dos secretários municipais de saúde das Comissões Intergestores Bipartites (CIB). Para isso, foram entrevistados, de outubro de 2015 a agosto de 2016, 195 secretários (92% do total). A partir da abordagem da 'análise de políticas', os principais obstáculos identificados foram, em síntese: um obstáculo tradicional (a falta de recursos), um que vem ganhando força nos últimos anos (a judicialização da política) e outro, talvez inédito: o sistema político-partidário e o Poder Executivo Estadual são os grandes ausentes nas coalizões de apoio às políticas de regionalização do Sistema Único de Saúde (SUS). Conclui-se que tais obstáculos indicam um cenário extremamente negativo para a implementação do COAP e de outras políticas que busquem a regionalização do SUS. Diante disto, cabe aos envolvidos refletir, negociar, construir consenso em torno da melhoria da saúde da população e superar tais obstáculos caso, logicamente, desposem da concepção dos autores de que a regionalização é fundamental para o SUS.

Abstract This paper aims to identify and analyze the political obstacles to the implementation of Organizational Contract of Public Action (COAP) based on the perceptions of municipal health secretaries of Bipartite Interagency Commissions (CIB). For this purpose, we interviewed 195 secretaries (92% of the total) from October 2015 to August 2016. Based on the approach of policy analysis, the main hurdles identified were, in short, a traditional obstacle (lack of resources), one that has been gaining strength in recent years (judicialization of politics) and another, perhaps unheard of: the party-political system and the State Executive Branch are the great absentees in the coalitions in support of SUS regionalization policies. We can conclude that such obstacles indicate an extremely negative setting for the implementation of the COAP and other SUS regionalization policies. Thus, it is incumbent upon those involved to reflect, negotiate and build consensus on improving the health of the population and overcome such obstacles if, of course, they embrace the authors' concept that regionalization is fundamental for the SUS.

Economic and accounting evaluation of rice milled production chains in Rio Grande do Sul (Brazil) and Uruguay with application of the Policy Analysis Matrix / Avaliação econômica e contábil das cadeias produtivas do arroz beneficiado no Rio Grande do Sul (Brasil) e Uruguai com aplicação da Matriz de Análise de Políticas

ABSTRACT: Rice is the basis of diet for almost half of the world population, and its culture is one of the strategic agroindustrial production chains in the agribusiness environment, in both economic and social levels. Thus, the comparative analysis between the production chains of rice milled in Rio Grande do Sul (RS), Brazil, and Uruguay was mainly motivated by the interest in knowing the differences in the business environment and public policies that impact the competitiveness of this chain in both study regions. Therefore, the objective of this study was to assess the economic efficiency, competitiveness, and effects of public policies of the rice production chain of milled rice in RS (Brazil) relative to Uruguay. The data collected in this study are from the 2011-2012 harvests and indicators were calculated by applying the concepts of the policy analysis matrix (PAM). Results showed that the chains in both study regions were competitive under the existing market and policy conditions, revealed comparative advantage, transferred a high load of resources to other sectors of the economy, and satisfactorily remuneration of the domestic production factors. However, the competitiveness and comparative advantage shown in this study were not due to the encouraging intervention policies, as both production systems pay high taxes.

RESUMO: O arroz é a base da alimentação para quase metade da população mundial, e sua cultura se situa como uma das cadeias produtivas agroindustriais estratégicas no ambiente do agronegócio, tanto no nível econômico como no social. Assim, a análise comparativa entre as cadeias produtivas do arroz beneficiado no Rio Grande do Sul (RS), Brasil e no Uruguai foi motivada, principalmente, pelo interesse em conhecer as diferenças no ambiente de negócios e nas políticas públicas que afetam a competitividade desta cadeia nas respectivas regiões. Portanto, o objetivo deste estudo foi avaliar a eficiência econômica, competitividade, e efeitos de políticas públicas da cadeia produtiva de arroz beneficiado no RS (Brasil) em relação ao Uruguai. Os dados coletados neste estudo são das safras de 2011-2012 e, os indicadores foram calculados aplicando os conceitos da matriz de análise de políticas (MAP). Os resultados mostraram que as cadeias em ambas as regiões de estudo foram competitivas sob as condições de mercado e políticas existentes, evidenciaram vantagem comparativa, transferiram alto volume de recursos para outros setores da economia, remunerando satisfatoriamente os fatores domésticos de produção. Entretanto, tal competitividade e vantagem comparativa demonstrada não se deveram às intervenções políticas de incentivo, pois ambos sistemas de produção pagam elevados tributos.

Policy analysis on targeted admission medical education program in rural areas / 中国卫生政策研究

This paper analyzes the document contents of targeted admission medical students in 16 provinces of China in 2016.Through analyses of the characteristics of the program, this study found that, 1) the number of admissions is determined by the national level and issued to the provincial level, where rural students are the main source of students, undergraduate program is the main enrollment category, and clinical medicine and traditional Chinese medicine are the main majors of admission;2) the number of admissions and the actual demand of health professionals of primary health care institutions do not match, the incubation period is too long, there is a shortage of targeted training model, contract signing is difficult to implement, and other problems.Therefore, in accordance with the problems, this paper suggests that, 1) the government should increase the number of admissions to match with the demands;2) a three-year bachelor's degree should be set up in order to shorten the incubation period;3) the training model of targeted admission medical students should be changed;and 4) various powerful measures should be carried out to attract and keep excellent health care professionals.