Conditional cash transfer programs and the health and nutrition of Latin American children / Los programas de transferencias de efectivo condicionadas y la salud y alimentación de los niños latinoamericanos

ABSTRACT Objective To 1) describe the benefits, conditions, coverage, funding, goals, governance, and structure of well-established conditional cash transfer programs (CCTs) in Latin America and 2) identify their health and nutritional impacts among children under 5 years old. Methods A realist review was conducted. CCTs were included if they met the following inclusion criteria: 1) current national-level program; 2) coverage of at least 50% of the target population; 3) continuous operation at scale for 10+ years; 4) clear description of structure, funding sources, and governance; 5) both health/nutrition- and education-related conditions for participation; and 6) available impact evaluation studies with health, development, and/or nutrition indicators among children under 5 years old. Three CCTs (one each in Brazil, Colombia, and Mexico) met the criteria. Results There was consistent evidence that the three CCTs selected for review had positive impacts on child health and nutrition outcomes in their respective countries. In all three countries, the programs were scaled up and positive impacts were documented relatively quickly. All three programs had strong political support and clear and transparent governance structures, including accountability and social participation mechanisms, which might explain their success and sustainability. Conclusions CCTs in Latin America have had a positive impact on child health and nutrition outcomes among the poorest families. A key challenge for the future is to reform these programs to help families move out of not only extreme poverty but all poverty in order to lead healthy and productive lives, as called for in the post-2105 Sustainable Development Goals.

RESUMEN Objetivo (1) Describir los beneficios, requisitos, cobertura, financiamiento, objetivos, gobernanza y estructura de programas bien consolidados de transferencias de efectivo condicionadas (TEC) en América Latina y (2) determinar su efecto en la salud y el estado nutricional de los niños menores de 5 años. Métodos Se llevó a cabo una revisión realista. Se incluyeron en ella los programas de TEC que satisfacían los siguientes criterios de inclusión: (1) programa de alcance nacional en curso; (2) cobertura de 50% de la población destinataria como mínimo; (3) funcionamiento en gran escala sin interrupción durante 10 años o más; (4) descripción explícita de la estructura, fuentes de financiamiento y gobernanza; (5) requisitos para la participación basados en criterios de salud y nutrición, así como de educación; y (6) disponibilidad de estudios de evaluación de efectos con indicadores de salud, desarrollo o estado nutricional en niños menores de 5 años. Tres programas de TEC (uno en el Brasil, uno en Colombia y otro en México) satisficieron estos criterios. Resultados Hay pruebas contundentes de que los tres programas de TEC seleccionados para la revisión tuvieron efectos favorables en la salud y el estado nutricional de los niños en sus respectivos países. En los tres países los programas se ampliaron y los efectos positivos se documentaron con relativa rapidez. Los tres programas gozaron de un sólido apoyo político y tuvieron estructuras de gobernanza explícitas y transparentes con mecanismos de rendición de cuentas y de participación social, lo cual podría explicar sus buenos resultados y sostenibilidad. Conclusiones En América Latina, las TEC han tenido un efecto favorable en la salud de los niños y en el estado nutricional de las familias más pobres. Un reto para el futuro estriba en reformar estos programas para ayudar a las familias a salir no solo de la extrema pobreza, sino de la pobreza en general a fin de que puedan llevar vidas saludables y productivas, en conformidad con los Objetivos de Desarrollo Sostenible para después del 2015.

Programa de tamizaje universal e intervención precoz (PTUIP) en hipoacusia sensorioneural bilateral congénita: Tarea pendiente desde la perspectiva de políticas públicas de salud en Chile / Universal screening program and early intervention (uspei) in congenital bilateral sensorineural hearing loss in Chile

Congenital hearing loss is the total or partial inability to hear sounds through the ears. It is the most common disability in newborns in Chile and worldwide, and is a permanent condition. The direct impact on children who are not adequately diagnosed is the alteration in acquisition of language and cognitive skills and a decline in their social and school insertion, jeopardizing their professional and potentially productive life. Universal screening programs for hearing loss are essential for the diagnosis, since 50% of infants with hearing loss have no known risk factor. Screening before one month of age, confirmation before 3 months, and effective intervention before 6 months, allows the development of these children as if they had normal hearing. In Chile there is a selective program of screening for infants aged less than 32 weeks or 1,500 grams, as part of Explicit Health Guarantees, but it covers only 0.9% of newborns per year. Therefore, a large majority of children remain without diagnosis. The aim of this review is to compare the situation in Chile with other countries, raising the need to move towards a universal neonatal hearing loss screening program, and propose necessary conditions in terms of justification and implementation of a universal screening public policy.

Application of the enterprise management tools Lean Six Sigma and PMBOK in developing a program of research management / Aplicação das ferramentas de gestão empresarial Lean Seis Sigma e PMBOK no desenvolvimento de um programa de gestão da pesquisa científica

OBJECTIVE: Introduce a program for the management of scientific research in a General Hospital employing the business management tools Lean Six Sigma and PMBOK for project management in this area. METHODS: The Lean Six Sigma methodology was used to improve the management of the institution's scientific research through a specific tool (DMAIC) for identification, implementation and posterior analysis based on PMBOK practices of the solutions found. RESULTS: We present our solutions for the management of institutional research projects at the Sociedade Beneficente Israelita Brasileira Albert Einstein. The solutions were classified into four headings: people, processes, systems and organizational culture. A preliminary analysis of these solutions showed them to be completely or partially compliant to the processes described in the PMBOK Guide. CONCLUSION: In this post facto study, we verified that the solutions drawn from a project using Lean Six Sigma methodology and based on PMBOK enabled the improvement of our processes dealing with the management of scientific research carried out in the institution and constitutes a model to contribute to the search of innovative science management solutions by other institutions dealing with scientific research in Brazil.

OBJETIVO: Implementar um programa de gestão da pesquisa científica em um hospital geral aplicando as ferramentas de gestão empresarial Lean Seis Sigma e PMBOK no gerenciamento de projetos nessa área. MÉTODOS: Foi utilizada a metodologia Lean Seis Sigma para melhoria do processo de gestão da pesquisa científica institucional por meio de ferramenta específica (DMAIC) para identificação, implementação e posterior análise das soluções encontradas, tendo como base as boas práticas descritas no PMBOK. RESULTADOS: São apresentadas as soluções implementadas na Sociedade Beneficente Israelita Brasileira Albert Einstein para o gerenciamento dos projetos de pesquisa institucionais. As soluções foram categorizadas em quatro instâncias: pessoas, processos, sistema e cultura organizacional. Uma análise preliminar das soluções implementadas mostra que essas são, total ou parcialmente, aderentes às preconizadas no Guia PMBOK. CONCLUSÃO: Neste estudo de caso post facto, verificou-se que as soluções implementadas a partir do projeto Lean Seis Sigma e baseadas no PMBOK permitiram a melhoria de processo da gestão da pesquisa científica institucional, constituindo um modelo que pretende contribuir com a busca de soluções inovadoras na gestão da pesquisa pelas diferentes instituições com atividade científica no Brasil.

Cost of neonatal intensive care in a tertiary care center.

BACKGROUND: The number of neonatal intensive care units (NICUs) in India has increased substantially over the last decade; yet many more are required. There is limited information on the actual costs of setting up and running an NICU in India. OBJECTIVE: Systematic and comprehensive calculation and analysis of the costs of neonatal intensive care in a tertiary care teaching hospital. METHODS: The costs were compiled by studying the detailed records of various hospital departments and prospectively documenting the costs of drugs, consumables and investigations for a representative group of 30 babies. RESULTS: The total cost of establishing a 16 bed level III tertiary care NICU was Rs 3.78 crore (Rs. 37.8 million, USdollar 860,000) (2003). Equipment cost formed two-thirds of the establishment cost. The running cost of NICU care per patient per day was Rs 5450 (USdollar 125). NICU and ancillary personnel salary comprised the largest proportion of the running costs. The average total cost of care for a baby less than 1000 grams was Rs. 168000 (USdollar 3800), Rs. 88300 (USdollar 2000) for babies 1000 g to 1250 g. and Rs. 41700 (USdollar 950) for those between 1250 to 1500 g. The family had to bear only 25 percent; rest was subsidized. CONCLUSIONS: Equipment and personnel salary form the biggest proportion of establishment and running costs. The costs of treatment for a baby in NICU should be seen in context with costs of other types of health care and the number of useful life years gained.

Introduçäo ao Programa UNI / Introduction for UNI Program

O objetivo geral da programaçäo da Fundaçäo W.K. Kellogg para o setor saúde é contribuir para a organizaçäo de um sistema de saúde comunitário mais coordenado, mais eficiente e eficaz, integrado e integral, acessível a todas as pessoas, e que responda a suas necessidades. O Programa UNI representa um novo degrau no processo de desenvolvimento do setor saúde, sendo uma oportunidade para unir, consolidar e empreender novos esforços para alcançar mudanças concretas em seus três elementos constitutivos: a Universidade, os Sistemas Locais de Saúde, e a Comunidade

Introducción al Programa UNI / Introduction for UNI Program

El objetivo general de la programación de la Fundación Kellogg para el sector salud es contribuir a la organización de un sistema de salud comunitario más coordinado, más eficiente y eficaz, integrado e integral, accesible a todas las personas, en respuesta a sus necesidades. Requiere la aplicación de varias estrategias simultáneas de programación, entre ellas el desarrollo de servicios locales de salud y el de modelos de formación de recursos humanos para operar tales sistemas. Para la implementación e institucionalización de ambos modelos se requieren líderes; sistemas de información para documentar sus procesos, productos e impactos, y de un proceso de difusión para apoyar las decisiones político-institucionales que afectan al aplicarse a toda la sociedad o nación. Representa una nueva etapa en el proceso de desarrollo del sector salud, constituyendo una oportunidad de unir, consolidar y emprender nuevos esfuerzos a fin de lograr cambios concretos en sus tres elementos constitutivos: la Universidad, los Sistemas Locales de Salud y la Comunidad