Modelo integral de salud con enfoque familiar y comunitario: experiencias en la implementación desde un equipo de atención hospitalaria / Comprehensive healthcare with a family and community focus: experiences from a hospital-based healthcare team

Esta investigación describe las experiencias de un equipo de atención hospitalaria en torno a la implementación del Modelo Integral de Salud Familiar y Comunitario. Estudio exploratorio de carácter cualitativo. Se realizaron 2 entrevistas grupales semi-estructuradas a 17 miembros del Equipo del Hospital Comunitario de Salud Familiar de El Carmen, provincia de Ñuble, los cuales se dividieron en dos grupos de 8 y 9 personas respectivamente. Los resultados señalan la relevancia de considerar en la Implementación del Modelo, Capacidad de organización del equipo, Autonomía en la toma de decisiones, Confianza del equipo en sus capacidades individuales y colectivas, Comprensión del Modelo de Salud Familiar y Convicción en la viabilidad de éste.

This investigation describes the experiences of a hospital-based healthcare team, with the implementation of the Comprehensive Family and Community Healthcare Model. This was an exploratory study of qualitative nature. Two semi-structured group interviews were carried out with a team of 17 workers at the El Carmen Family Health Community Hospital, in the province of Ñuble, divided in two groups of 8 and 9 persons respectively. The results highlight the importance of considering, when implementing such a program, factors to such as the team’s organizational capacities, autonomy in the decision-making process, the team’s confidence in their own individual and collective capacities, comprehension of the Family Healthcare Model and belief in the model’s viability.

Modelo de salud familiar en Chile y mayor resolutividad de la atención primaria de salud: ¿contradictorios o complementarios / Family health model in Chile and greater resoluteness of primary health care: contradictory or complementary

Desde 1978 y por medio de la Declaración de Alma Ata, se describe que la atención primaria de salud (APS) debe entenderse como parte integrante del sistema completo de asistencia sanitaria y del espíritu de justicia social del desarrollo. Se ha demostrado en el tiempo que esta estrategia puede adaptarse a una amplia variedad de contextos políticos, sociales, culturales y económicos. Luego de 25 años la Organización Panamericana de la Salud (OPS) sugirió la revisión y adopción de una estrategia renovada para la APS, que incluyera desafíos epidemiológicos, nuevos conocimientos e instrumentos de mejores prácticas y su contribución en la efectividad de la atención primaria, además del reconocimiento de que la APS es una estrategia para fortalecer la capacidad de la sociedad y reducir las inequidades en salud. En el presente análisis se describe la realidad de Chile, considerando los valores, principios y elementos esenciales en un sistema de salud basado en la atención primaria y las reformas necesarias para reorientar los sistemas sanitarios hacia la salud.

Since 1978 and in accordance with the Alma Ata Declaration, primary care is described as an integral part of the healthcare system and fundamental to achieve social justice together with development. Time has validated this approach, which can be applied to a broad variety of political, social, cultural, and economic realities. After 25 years, the Pan-American Health Organization (PAHO) suggested revising and adopting a renewed strategy for primary care, so as to include epidemiological challenges, new knowledge and better instruments, with the purpose of enhancing effectiveness of primary care and also as a way of acknowledging that it is a strategy that strengthens a society’s capacity to reduce health inequities. This analysis describes the Chilean reality, taking into account values, principles and essential elements of a healthcare system based on primary care. It also looks at the reforms that are needed in order to redirect health systems towards health outcomes.

Health Sector Reform Program in Egypt / 国際保健医療

<B>Introduction</B><BR>Health Sector Reform Program (HSRP) in Egypt started in 1997 to improve equity, efficiency, quality and sustainability of Egyptian health systems. This study aims to review reports and publications regarding HSRP in Egypt and to analyze its achievements and problems.<BR><B>Methods</B><BR>Documents of international organizations and other relevant agencies, such as reports of health sector reform programs and statistics, were reviewed and analyzed.<BR><B>Results</B><BR>HSRP aimed to improve quality of health services and equality of access, and to establish sustainable health financing mechanisms, while focusing on primary health care. Major components of HSRP were: health service delivery, health financing, and evaluation. It started in five pilot governorates. Based on the Family Health Model (FHM), each family registered to a physician or a health facility, and was provided with essential medical services called Basic Benefits Package (BBP). Family Health Fund (FHF), the newly established financing agency of FHM, provided health staff with incentives from a pooled fund. Against the original plan, FHF could not function as a health insurance fund, and was financially unsustainable. Mechanisms of health facility accreditation and health services performance evaluation with incentives were installed to ensure the quality of health services.In addition, health staff training programs were enhanced, health facilities and equipment in rural areas were improved, and referral systems were strengthened.<BR><B>Conclusions</B><BR>HSRP introduced a family health model for the first time in Egypt in pilot governorates. Focusing basic health service provision, HSRP succeeded to improve equity, efficiency and quality of health services. However, sustainable health insurance mechanisms were not established yet, and involvement of private health service providers were very limited. It is needed to bring in commitment of Egyptian government across the sectors and to develop health systems that secure good quality of health services for all Egyptians.