RESUMEN
Resumo Este estudo tem como objetivo avaliar a qualidade da ação do Governo Português no sector da saúde, no período de intervenção da Troika (2011-2015), tomando como critério a preocupação com a aplicação dos princípios de Boa Governança, em termos de grau e diversidade. Pretende-se perceber em que medida a ação pública promovida pelo Ministério da Saúde se desenvolveu procurando contribuir para o fortalecimento das práticas de Boa Governança. Com base em análise documental, suportada nos diplomas legais e em outros documentos oficiais, foram analisadas 50 medidas de ação do Ministério da Saúde, que se distribuem por nove áreas de intervenção. Os princípios de Boa Governança que representam uma preocupação mais transversal são claramente o da "transparência" e o da "eficácia/eficiência", presentes em oito das nove áreas de intervenção. A preocupação com a "orientação para consensos" está essencialmente presente nas medidas tipificadas como Acordos, a "independência" na área Ética, o "reforço do Estado de direito" na área Controlo e a "equidade/inclusão" na área Cidadão no Centro do SNS.
Abstract This study aims to evaluate the quality of the Portuguese Government's action in the health sector during Troika's intervention period (2011-2015), taking as criterion the concern with the application of Good Governance principles, in terms of degree and diversity. The intention is to understand the extent to which the public action promoted by the Ministry of Health has developed seeking to contribute to the strengthening of Good Governance practices. Fifty measures of the Ministry of Health, distributed by nine intervention areas, were analyzed, based on documental analysis, supported on the law and on other official documents. The principles of Good Governance that demonstrate a more transversal concern are clearly that of "transparency" and of "effectiveness/efficiency", present in eight of the nine intervention areas. The concern with "orientation to consensus" is essentially present in the measures classified as Agreements, "independence" in the Ethics area, the "strengthening of the rule of Law" in the Control area and "equity/inclusion" in the area of the Citizen in the Centre of the NHS.
Asunto(s)
Humanos , Calidad de la Atención de Salud , PortugalRESUMEN
@#ntroduction: Governance affects nutrition improvement. This study aimed to determine the association between nutrition governance (NG), nutritional status (NS) of children under five years (CU5) and good governance for nutrition (GGN) in Laguna, where malnutrition is a chronic problem. Methods: This crosssectional study obtained data from thirty cities and municipalities (C/M) using desk review and face-to-face interviews. A developed scorecard generated NG and GGN data using 3-point scale with "0" as lowest/absence to "1" indicating partial to "2" as highest/full compliance. Total NG scores was 26 while 38 for GGN. NS was determined using Operation Timbang Plus data. Spearman's rank analysis statistically determined the associations between NG, NS, and GGN. Results: Underweight and wasting prevalence were low (6.1% and 3.4%) while stunting was high (17.7%). The median percentage scores of C/M on NG and GGN were 73.0%±14.0% and 82.0%±24.0%, respectively. Rosa City and Kalayaan had the highest NG score and the lowest underweight prevalence in urban and rural areas, respectively. Significant but negative associations were found between NG and underweight (r=-0.729, p<0.001), and stunting (r=-0.753, p<0.001). Likewise, GGN and underweight (r=-0.488, p=0.006), and stunting (r=-0.380, p=0.046) showed negative associations. Conclusion: C/M in Laguna with higher NG and GGN scores have lower CU5 underweight and stunting prevalence. The study recommended to local governments to invest in establishing separate nutrition unit, hiring technical and administrative staffs, formulating vision and mission, and building capacity on nutrition programme management.
RESUMEN
The good performance of publicly-produced health services is of vital importance, well beyond the health sector. Taking into account the great complexity of the health services in the public sector due both to their public and professional nature, we identify seven Gordian Knots as being responsible for the most frequent problems of publicly produced health services in Spain and Latin America. From the concept of good governance we take its character as a normative and ethical benchmark and its potential to renew and invigorate the government of the public sector. From comparative analysis of publicly-produced health services in the best performing countries, we extract eight characteristics which contribute significantly to good performance. A final reflection is on the relevance of the importance of offsetting the potential hostility to a reformist impulse of the status-quo with alliances that strengthen public trust and the social contract between health professionals and citizens based on the values of public health systems.
El buen desempeño de servicios de salud de producción pública tiene importancia vital, más allá del sector salud. Se aborda su buen gobierno y gestión a partir del marco conceptual de los valores e ideas del buen gobierno y de la experiencia de países más ejemplares, como referente práctico de buen desempeño. Se parte de la gran complejidad de los servicios públicos de salud, por su carácter público y su naturaleza profesional, y se identifican siete nudos gordianos de los servicios públicos de salud en España e Iberoamérica. Del concepto de buen gobierno se toma su carácter de referente ético y normativo y su potencial para renovar y dinamizar el gobierno de lo público. Del análisis comparado de los servicios de salud de producción pública se extraen ocho características que contribuyen a su buen desempeño. Se concluye con una reflexión sobre la importancia de compensar la posible hostilidad corporativa y gremial a un impulso reformista del statu-quo con alianzas que refuercen la confianza pública y el contrato social entre profesionales y ciudadanos en torno a los valores de los sistemas públicos de salud.