La migración en cuarentena: una aproximación a la noción de sujeto político en tiempos del bienestar digital / Quarantine migration: an approach to the notion of a political subject in times of digital well-being

A partir de la primera pandemia experimentada en simultáneo a nivel global, se postula una reflexión sobre el sentido de las respuestas en el contexto de la sociedad global del 2020. Dos reflexiones se entretejen en este escrito. La primera tiene que ver con el proceso de despolitización y des-ciudadanización que se puede experimentar en momentos como los actuales en los cuales una crisis de legitimidad se cruza con una situación que demanda un estado de excepción. La segunda reflexión tiene que ver con el establecimiento de la manifestación tecnológica del ser humano como signo vital para su cuidado control. Se concluye conjugando ambas reflexiones en torno a la constitución de un nuevo dispositivo social humano en el aparato productivo y de seguridad en el presente.

At the emergence of a first contagious disease experimented almost simultaneously around the globe, a reflection on the meaning of the responses from the national states and the global society in 2020 is presented. There are two threads intertwined. The first one is a process of de-politization and loss of citizenship that can occur at the time that state of exception are considered as the appropriate answer in societues facing legitimacy crisis. The second one is referred to the establishment of a technological-driven approach of human being as subject of care and control. Both reflections are merfed around the appearance of a new social-human device in the productive and policy making at the present.

Trabajo, miserias y recompensas: Asistentes sociales, enfermeras y matronas en la construcción de la política sanitaria chilena a mediados del siglo XX / Work, miseries and rewards: Social workers, nurses and midwives in the construction of Chilean health policy in the mid-twentieth century

RESUMEN El artículo busca mostrar el aporte realizado por asistentes sociales, enfermeras y matronas a la exitosa política de salud pública de mediados del siglo XX en Chile, llevada a cabo por el Servicio Nacional de Salud en el marco de un modelo de desarrollo estatista y benefactor. Se han utilizado fuentes documentales de diverso tipo y testimonios de asistentes, enfermeras y matronas entrevistadas para la investigación. Las profesionales, encargadas fundamentalmente de tareas operativas y en contacto directo con la población usuaria del Servicio Nacional de Salud, fueron artífices de la instalación de una verdadera pedagogía sanitaria que cambió el patrón epidemiológico y trastocó la cultura de la población chilena, incidiendo en la valoración del autocuidado y la prevención. Como ejecutoras, sortearon las dificultades inherentes al trabajo burocratizado de los programas sociales pero, a la vez, recibieron gratificaciones diversas de tipo afectivo y altruista, que las hizo sentirse protagonistas de una construcción histórica.

ABSTRACT The article seeks to show the contribution made by social workers, nurses and midwives to the successful public health policy implemented in the mid-twentieth century in Chile by the National Health Service in the context of a statist and welfare development model. Documentary sources of different types and testimonies of social workers, nurses and midwives who were interviewed for this research were used. These professionals, mainly responsible for operational tasks and in close contact with the users of the National Health Service, were responsible for the establishment of a true health pedagogy that changed the epidemiological pattern and touched the culture of the Chilean population, influencing its estimation of self-care and prevention. As executors of the policy, they avoided the difficulties inherent to the bureaucratized work of social programs, gaining, at the same time, satisfaction at the affective and altruistic level, which made them feel like the protagonists of a historical process.

Gênese da atenção domiciliária no Brasil no início do século XX / Génesis de la atención domiciliaria en Brasil al inicio del siglo XX / Genesis of home care in Brazil at the start of the twentieth century

RESUMO Objetivo problematizar as condições de possibilidade para o aparecimento da atenção domiciliária no início do século XX no Brasil. Método estudo de inspiração genealógica sobre a atenção domiciliária. O material empírico foi constituído por dois documentos legais sobre o tema publicados no Diário Oficial. A análise documental utilizou as ferramentas analíticas poder, poder disciplinar e biopolítica, inspiradas em Foucault. Resultados foram elaboradas duas categorias: “Vigilância no domicílio: as enfermeiras visitadoras e a tuberculose” e “Registros: o aparelho político e econômico”. Considerações finais A tuberculose, a nova profissão das enfermeiras visitadoras, os registros produzidos pela vigilância e a análise minuciosa das cidades conferiram à atenção domiciliária um caráter de vigilância, inspeção e controle voltado a conduzir as condutas dos indivíduos.

RESUMEN Objetivo problematizar las condiciones de posibilidad para el aparecimiento de la atención domiciliaria al inicio del siglo XX. Método se trata de un estudio de inspiración genealógica sobre atención domiciliaria. El material empírico fue constituido por documentos legales sobre el tema, publicados en el Diario Oficial. El análisis documental utilizó las herramientas analíticas poder, poder disciplinar y biopolítica, inspiradas en Foucault. Resultados fueron elaboradas dos categorías analíticas, “vigilancia en el domicilio: enfermeras visitadoras y la tuberculosis” y “registros: aparato político y económico”. Consideraciones finales la tuberculosis, la nueva profesión de las enfermeras visitadoras, los registros producidos por la vigilancia, y el análisis minucioso de las ciudades configuran la atención domiciliaria con carácter de vigilancia, inspección y control para mejor conducir las conductas de individuos.

ABSTRACT Objective to discuss the conditions that enabled home care at the beginning of the twentieth century. Method study of the genealogic inspiration on home care. The empirical material consisted of legal documents on the subject that were published in the Official Journal. The documents were studied using analytical tools, such as Power, Discipline and Biopolitics, which were inspired in Foucault. Results two analytical categories were established, “home inspection: visiting nurses and tuberculosis” and “records: political and economic apparatus”. Final considerations tuberculosis, the new profession of visiting nurses, inspection records and the detailed analysis of the cities grant home care a nature of surveillance, inspection and control to conduct the behaviour of individuals.

Cuba: healthcare and the revolution / Cuba: la atención a la salud y la revolución

This paper depicts Cuba as a relic of the Cold War. Its coverage of healthcare demonstrates steadfastness and success in surmounting hurdles of complacency and disregard to socialized medicine - an extension of Soviet patronage and third world alliances. The literature relays a mission of inclusivity underpinned by political ideology and a conviction to humanity. With the aid of endorsements, it speaks to contrasts and critiques in service and results by reflecting on the delivery of free healthcare for all Cuban citizens and its impression on the eradication of numerous diseases, reduced mortality rate and increased life expectancy. Punished by the longest trade embargo in modern history, the regime is in possession of limited resources to expedite remedy to its subjects. Such, much to the dislike of the authorities, elevates elements of distinction in association with the dispensation of service and drugs demonstrated by an evolving twotier system for the disenfranchised and privileged clientele while simultaneously impacting the maintenance of facilities and equipment. Consequently, it recognizes harsh ramifications attributed to compliance with ideology and subtle adjustments to withstand external exertion. The Cuban replica is currently a tale of sorts awaiting a comprehensible definition for future generations.

Este trabajo describe a Cuba como una reliquia de la guerra fría. Su discusión en torno a la atención de la salud demuestra firmeza y éxito en la superación de los obstáculos provenientes de la autocomplacencia e indiferencia frente a la "medicina socializada" - una extensión del apoyo soviético y las alianzas del tercer mundo. La literatura transmite una misión de inclusión apuntalada por ideología política y una convicción de humanidad. Con documentación de apoyo, el trabajo se refiere a los contrastes y críticas del servicio y los resultados, reflexionando sobre los servicios de atención médica gratuita para todos los ciudadanos cubanos. Asimismo expone su impresión sobre la erradicación de numerosas enfermedades, la disminución de la tasa de mortalidad, y el aumento de la esperanza de vida. Castigado por el embargo comercial más largo de la historia moderna, el régimen se halla en posesión de limitados recursos para ofrecer soluciones a los ciudadanos. Para pesar de las autoridades, estas cosas aumentan los elementos de diferenciación asociados con el ofrecimiento de servicios y medicamentos, demostrada por un sistema que se va desarrollando en dos planos - los carentes de privilegios frente a una clientela privilegiada - en tanto que a su vez se hace sentir el impacto sobre el mantenimiento de las instalaciones y los equipos. Por consiguiente, el trabajo reconoce las duras ramificaciones que se atribuyen al cumplimiento con la ideología y los sutiles ajustes para resistir la presión externa. El modelo cubano es actualmente una suerte de historia en espera de una definición comprensible para las generaciones futuras.

Implementación del Reglamento Sanitario Internacional en Cuba: evaluación de capacidades básicas del sector salud en provincias seleccionadas / Implementation of the International Health Regulations in Cuba: evaluation of basic capacities of the health sector in selected provinces

Objetivo. Obtener información de línea base sobre el estado de las capacidades básicas delsector salud a nivel local, municipal y provincial, a fin de facilitar la identificación de prioridadesy orientar las políticas públicas dirigidas a garantizar los requisitos y capacidades establecidosen el Anexo 1A del Reglamento Sanitario Internacional de 2005 (RSI-2005).Métodos. Se realizó un estudio descriptivo de corte transversal mediante la aplicación de uninstrumento de evaluación de capacidades básicas referidas a la autonomía legal e institucional,el proceso de vigilancia e investigación y la respuesta frente a emergencias sanitarias en36 entidades involucradas en el control sanitario internacional de los niveles local, municipaly provincial en las provincias de La Habana, Cienfuegos y Santiago de Cuba.Resultados. Los policlínicos y centros provinciales de higiene y epidemiología de las tres provinciascontaban con más del 75% de las capacidades básicas requeridas. Doce de 36 unidadesdisponían del 50% del marco legal e institucional implementado. La vigilancia e investigaciónde rutina presentaron una disponibilidad variable, mientras que las entidades de La Habanacontaron con más del 40% de capacidades básicas en el campo de la respuesta ante eventos.Conclusiones. Las provincias evaluadas cuentan con capacidades básicas instaladas quepermitirán la implementación del RSI-2005 según el plazo previsto por la Organización Mundialde la Salud. Es necesario establecer y desarrollar planes de acción eficaces para consolidara la vigilancia como una actividad esencial de seguridad nacional e internacional en términosde salud pública.

Objective. Obtain baseline information on the status of the basic capacities ofthe health sector at the local, municipal, and provincial levels in order to facilitateidentification of priorities and guide public policies that aim to comply with therequirements and capacities established in Annex 1A of the International HealthRegulations 2005 (IHR-2005).Methods. A descriptive cross-sectional study was conducted by application ofan instrument of evaluation of basic capacities referring to legal and institutionalautonomy, the surveillance and research process, and the response to healthemergencies in 36 entities involved in international sanitary control at the local,municipal, and provincial levels in the provinces of Havana, Cienfuegos, andSantiago de Cuba.Results. The polyclinics and provincial centers of health and epidemiology in thethree provinces had more than 75% of the basic capacities required. Twelve out of36 units had implemented 50% of the legal and institutional framework. There wasvariable availability of routine surveillance and research, whereas the entities inHavana had more than 40% of the basic capacities in the area of events response.Conclusions. The provinces evaluated have integrated the basic capacities thatwill allow implementation of IHR-2005 within the period established by the WorldHealth Organization. It is necessary to develop and establish effective action plans toconsolidate surveillance as an essential activity of national and international securityin terms of public health.

Sistema de salud de Cuba / The health system of Cuba

En este trabajo se describen las condiciones de salud de Cuba y el sistema cubano de salud, incluyendo su estructura y cobertura, sus fuentes de financiamiento, su gasto en salud, los recursos físicos, materiales y humanos de los que dispone, y las actividades de rectoría e investigación que desarrolla. También se discute la importancia de sus instituciones de investigación y se describe el papel de los usuarios de los servicios en la operación y evaluación del sistema, así como las actividades que en este sentido desarrollan la Federación de Mujeres Cubanas y los Comités de Defensa de la Revolución. La parte final de este trabajo se dedica a discutir las innovaciones más recientes dentro de las que destacan las redes de cardiología, la Misión Milagro y la Batalla de Ideas.

This paper describes the health conditions in Cuba and the general characteristics of the Cuban health system, including its structure and coverage, its financial sources, its health expenditure, its physical, material and human resources, and its stewardship functions. It also discusses the increasing importance of its research institutions and the role played by its users in the operation and evaluation of the system. Salient among the social actors involved in the health sector are the Cuban Women Federation and the Committees for the Defense of the Revolution. The paper concludes with the discussion of the most recent innovations implemented in the Cuban health system, including the cardiology networks, the Miracle Mission (Misión Milagro) and the Battle of Ideas (Batalla de Ideas).

Governança local no sistema descentralizado de saúde no Brasil / Local governance in the decentralized health care system in Brazil

OBJETIVO: Analisar as mudanças decorrentes do processo de descentralização do Sistema Único de Saúde na governança do setor saúde no âmbito do poder local entre 1996 e 2006. MÉTODOS: Um questionário foi aplicado aos gestores municipais de saúde de todo o Brasil em 1996 e novamente em 2006. Foram coletadas informações sobre as características de inovação da gestão em três dimensões: social, gerencial e assistencial. O presente artigo analisa resultados referentes à dimensão social da gestão (relação entre a gestão municipal e os diferentes atores da sociedade) a partir de quatro atributos: elaboração do orçamento (qual o grau de influência de atores variados), estabelecimento de prioridades, prestação de contas e fluxo de informações para a sociedade. RESULTADOS: Aumentou a influência dos secretários e dos conselhos municipais de saúde na elaboração do orçamento, em detrimento da influência dos políticos locais. Na definição de prioridades em saúde, reduziu-se a solicitação dos políticos locais e a demanda espontânea e fortaleceram-se o parecer do corpo técnico e as propostas dos conselhos e das conferências de saúde. Observa-se a institucionalização da prática de prestação de contas em virtude da diversificação do conjunto de atores a que se direciona (especialmente câmara de vereadores e conselho de saúde) e dos mecanismos utilizados, embora continue prevalecendo o uso de balancete periódico (que implica em conhecimento técnico para interpretação dos resultados). Por fim, as informações oferecidas à população ainda se referem acima de tudo às ações e campanhas de saúde e ao funcionamento de serviços, embora tenha crescido a divulgação de informações inovadoras à sociedade. Esse padrão se observa em todas as regiões e portes populacionais, com tendências mais progressivas na região Sul. CONCLUSÕES: A relação entre estado e sociedade modificou-se em direção a um padrão mais democrático de governança local, embora tenham sido mantidas práticas governamentais concentradoras de poder na tomada de decisão. O processo de descentralização ainda encontra obstáculos importantes para a concretização de um modelo de maior participação, controle social, responsabilização e interação entre Estado e sociedade.

OBJECTIVE: To analyze the changes in local health care governance resulting from the decentralization process associated with the Unified Health System (SUS) in Brazil between 1996 and 2006. METHODS: A questionnaire was answered in 1996 and again in 2006 by all city officials involved in health care management in Brazil. Information was collected on the innovative characteristics of administrative practices in terms of three dimensions: social, management, and care. The present article analyzes the results relating to the social dimension (relationship between municipal officials and the various community actors) according to four attributes: preparing the budget (degree of influence of various actors), establishing priorities, accountability, and flow of information to the community. RESULTS: The influence of municipal secretaries of health and health councils on budget preparation has increased, with a decrease of local politician influence. In prioritizing health issues, local politicians and spontaneous demands have also become less influential, with strengthening of the influence of technical opinions and proposals by health councils and conferences. Public disclosure of results has become institutionalized as a result of the diversification of stakeholders (especially municipal secretaries and health councils) and of the methods available for disclosure, even though balance sheets are still the most common type of information disclosed (which imply technical knowledge for interpretation of results). Finally, the information conveyed to the community still mainly refers to health actions and campaigns and functioning of health services, even though a larger amount of innovative information is being communicated. This was observed in all regions and in cities of all sizes, with a more progressive trend in the South of Brazil. CONCLUSIONS: The relationship between government and society has changed toward a more democratic standard of local governance, despite the maintenance of centralized government decision-making practices. The process of decentralization still faces important obstacles to the establishment of a more participative model, with enhanced social control, accountability and interaction between government and society.

Commitment among state health officials & its implications for health sector reform: lessons from Gujarat.

BACKGROUND & OBJECTIVE: Commitment, competencies and skills of people working in the health sector can significantly impact the performance and its reform process. In this study we attempted to analyse the commitment of state health officials and its implications for human resource practices in Gujarat. METHODS: A self-administered questionnaire was used to measure commitment and its relationship with human resource (HR) variables. Employee's organizational commitment (OC) and professional commitment (PC) were measured using OC and PC scale. Fifty five medical officers from Gujarat participated in the study. RESULTS: Professional commitment of doctors (3.21 to 4.01) was found to be higher than their commitment to the organization (3.01 to 3.61). Doctors did not perceive greater fairness in the system on promotion (on the scale of 5, score: 2.55) and were of the view that the system still followed seniority based promotion (score: 3.42). Medical officers were upset about low autonomy in the department with regard to reward and recognition, accounting procedure, prioritization and synchronization of health programme and other administrative activities. INTERPRETATION & CONCLUSION: Our study provided some support for positive effects of progressive HR practices on OC, specifically on affective and normative OC. Following initiatives were identified to foster a development climate among the health officials: providing opportunities for training, professional competency development, developing healthy relationship between superiors and subordinates, providing useful performance feedback, and recognising and rewarding performance. For reform process in the health sector to succeed, there is a need to promote high involvement of medical officers. There is a need to invest in developing leadership quality, supervision skills and developing autonomy in its public health institutions.

Surtimiento de recetas a los afiliados al Seguro Popular de Salud de México / Dispensing prescriptions to persons affiliated with Popular Health Insurance in Mexico

OBJETIVO: Medir y comparar el porcentaje de recetas surtidas completamente a los usuarios de servicios ambulatorios y de los hospitales generales de los Servicios Estatales de Salud de México (SESA) afiliados y no afiliados al Seguro Popular de Salud (SPS) según condición de aseguramiento, además de medir la satisfacción de los usuarios de los SESA con el acceso a los medicamentos. MATERIAL Y MÉTODOS: La información del estudio procede de cuatro encuestas de unidades ambulatorias y hospitalarias de los SESA que contaron con muestras probabilísticas de representatividad estatal. Las muestras de las unidades ambulatorias se seleccionaron mediante estratificación por nivel de atención y por condición de pertenencia a la red de servicios del SPS. RESULTADOS: Los hallazgos indican que el porcentaje de recetas completamente surtidas ha mejorado en las unidades ambulatorias de los SESA, sobre todo en aquellas que ofrecen servicios a los afiliados al SPS y que alcanzan porcentajes de casi 90 por ciento. Estos porcentajes, sin embargo, siguen siendo inferiores a los de las unidades ambulatorias de las instituciones de seguridad social. Los porcentajes de recetas surtidas en las unidades hospitalarias de los SESA también han mejorado, pero siguen siendo relativamente bajos. En casi todas las entidades federativas, conforme se ha incrementado el porcentaje de surtimiento completo de recetas, ha aumentado la satisfacción de los usuarios con el acceso a los medicamentos. CONCLUSIONES: En 2006, más de 50 por ciento de las entidades federativas presentaron altos niveles de surtimiento completo de recetas entre los afiliados al SPS (>90 por ciento). El mayor problema en este sentido se encuentra en los hospitales, ya que sólo 44 por ciento de los usuarios que recibieron una prescripción en los hospitales de los SESA en 2006 obtuvieron el surtimiento completo de sus recetas. Este hallazgo obliga a revisar la política de medicamentos del SPS, que ha privilegiado...

OBJECTIVE: Measure and compare the percentage of prescriptions fully dispensed to persons with and without Popular Health Insurance (SPS in Spanish) who use ambulatory and general hospital services associated with the Mexico State Health Services (SESA in Spanish), and taking into account insurance status. SESA user satisfaction was also measured with respect to access to medication. MATERIAL AND METHODS: Information for the study was taken from four surveys of SESA ambulatory and hospital units that included probabilistic samples with state representativity. Samples of ambulatory units were selected by stratification according to level of care and association to the SPS service network. RESULTS: The findings indicate that the percentage of prescriptions fully dispensed in SESA ambulatory units has improved, reaching approximately 90 percent, especially among those units offering services to persons affiliated with SPS. Nevertheless, these percentages continue to be lower than those of ambulatory units associated with social security institutions. Percentages of prescriptions fully dispensed have also improved in SESA hospital units, but continue to be relatively low. In nearly all states, as the percentage of prescriptions fully dispensed has increased, user satisfaction with access to medication has also improved. CONCLUSIONS: In 2006 more than 50 percent of the states had high levels of fully dispensed prescriptions among persons with SPS (>90 percent). The more significant problem exists among hospitals, since only 44 percent of users who received a prescription in SESA hospitals in 2006 had their prescriptions fully dispensed. This finding requires a review of SPS medication policies, which have favored highly prescribed low-cost medications at ambulatory services at the expense of higher cost and more therapeutically effective medications for hospital care, the latter having a greater impact on household budgets.

National Leprosy Eradication Programme and progress towards elimination of leprosy in India.

The World Health Assembly in May 1991 made the declaration to eliminate leprosy at global level by the year 2000. Complete coverage of all the districts with MDT was possible in the year 1996. Very good results were obtained and the case lead came down to 0.51 million by December 2000. A new goal has been set to reach leprosy elimination at national level in India by December 2005. The challenges to eliminate leprosy and to bring prevalence rate 0.9/10,000 by December 2005 are to be taken at epidemiological, operational and at administrative levels.

Do public inquiries for noise control serve a useful purpose?--An acoustic consultant's view.

In the United Kingdom, before the introduction of the various town and country planning acts and associated regulations, landowners were free to use their land in any way they wished, subject only to limitations imposed by lease or covenant and the avoidance of nuisance or trespass against neighbours. Any disputes arising would be resolved by negotiation or via a court of law. Under current planning laws and regulations, local authorities are empowered to impose special conditions or even to refuse development to prevent excessive nuisance, but the resulting noise management solutions are not always optimum from either the noise maker's or the noise exposed's points of view. In addition, the planning system has almost no effect on existing noise. Public inquiries provide a useful mechanism for the investigation of appeals against local authority decisions, or where the government has decided that issues of strategic or national importance need to be fully explored in a public forum. In practice, and largely because of individual disagreement, public inquiries can result in excessive delays while all interested parties are allowed to have their say. There seems to be an increasing consensus that the general inadequacy of existing methods of assessing noise impact is at least partly to blame. The new European Environmental Noise Directive represents a step change towards the imposition of one-size-fits-all regulatory or administrative procedures which should eventually contribute towards the reduction of public inquiry delays, but on the other hand, any weakening of the general principle of basing decisions on 'informed flexibility' will probably have significant negative consequences over the longer term.

Ambient noise strategy: a solution for noise control?

The British Government earlier this year undertook a consultation on its proposal, announced in the Rural White Paper, to develop an Ambient Noise Strategy in England. The proposals envisage a three phase approach: In phase 1 we would aim to establish three key sets of information: information on the ambient noise climate in the country--i.e. the number of people affected by different levels of noise, the source of that noise (road, rail, airports and industry) and the location of the people affected, by producing noise maps of the main sources of noise; methods which the Government might use to assess the effects of noise--particularly regarding people's quality of life and tranquility; the techniques available to take action to improve the situation where bad or preserve it where good. In phase 2 we would aim to evaluate and identify options for prioritising the various alternatives from phase 1 in terms not only of costs and benefits but also time-scales and synergies and conflicts with other Government priorities including economic and social issues. An optimal policy reduces noise at lowest net cost, whilst capturing as many synergistic benefits, and minimising any potentially adverse impacts. Decision makers need to ensure that the impacts of the noise policies do not cost society more than the benefits expected. A recent study undertaken by the Government, looked at how a cost-benefit type framework could be used, with noise maps, to help inform such decisions. Finally, in phase 3, the Government would need to agree on the necessary policies to move towards the desired outcome--i.e. the National Ambient Noise Strategy itself. The results of the consultation are expected to be published later this year.