Interesses públicos e privados na rede SUS de Petrópolis / Public and private interests in the SUS network at Petrópolis

Essa dissertação tem como objetivo analisar a rede SUS de Petrópolis e a proposta de sua reorganização, sugerida pelo Diagnóstico executado pela equipe CEPESC/IMS/UERJ no ano de 2019. considerando os interesses em jogo que interferem nas chances de efetivação da proposta no Plano Municipal de Saúde para o período 2022-2025. O estudo consistiu principalmente em uma abordagem qualitativa por meio de entrevistas com atores-chave envolvidos no processo de tomada de decisão, além, de procedimentos quantitativos utilizando cálculos estatísticos simples. Os resultados demonstraram que as principais propostas sugeridas e aprovadas na 1ª Conferência Extraordinária de Saúde no ano de 2019 e no Fórum de Saúde em 2021, foram colocadas de forma secundária e tangencial no Plano Municipal de Saúde. Foi ponderada ainda, a dinâmica da relação público/privado e os meios de incentivo que facilitam a proliferação do setor privado a partir da falta de planejamento e organização da rede pública de saúde, de modo a discutir a quem interessa? Ou cui bono ?

The aim of this dissertation aims is the analysis of the SUS network at Petrópolis and the proposal for reorganization, suggested in the Diagnosis executed by the CEPESC/IMS/UERJ team in the year 2019, considering the interests at stake that interferes in the chances of implementation of the proposal in the Municipal Health Plan for the period 2022-2025. The study consisted mainly of qualitative approach through interviews with key actors involved in the decision-making process, in addition to quantitative procedures using simple statistical calculations. The results showed that the main proposals suggested and approved at the 1st Extraordinary Health Conference in 2019 and at the Health Forum in 2021 were placed in a secondary and tangential way in the Municipal Health Plan. It also considered the dynamics of the public/private relation and the means of incentive that facilitate the proliferation of the private sector from the lack of planning and organization of the public health network, in order to discuss who is interested? Or cui bono?.

Lessons learnt from UNAIDS virtual technical support to countries applying for funding from the Global Fund COVID-19 Response Mechanism

In 2020 the Global Fund for AIDS, Tuberculosis and Malaria initiated a new funding modality, the COVID-19 Response Mechanism, to mitigate the pandemic's effects on HIV, TB and malaria programmes and health systems in implementer countries. In 2021 UNAIDS introduced an innovative technical virtual support mechanism for COVID-19 Response Mechanism proposal development to help countries quickly implement COVID-19 interventions while at the same time adapting HIV and related services to the pandemic's circumstances and mitigate its impact while maintaining hard-won gains. It also intended to ensure more attention was paid to communities, human rights and gender considerations in proposal development, resulting in successful proposals to mitigate COVID-19's impact, bring human rights-based and people-centred HIV programmes back on track and even expand their reach through using new delivery platforms. In 2021, applications from 18 sub-Saharan African and Asian countries received in-depth remote peer reviews. We discuss the reviews' key findings and recommendations to improve proposal quality and identify future opportunities for virtual technical support. The model was successful and contributed to better quality funding applications, but also highlighted challenges in pandemic mitigation, adaptations and innovations of HIV programmes. Countries still fell short on comprehensive community, human rights and gender interventions, as well as innovations in HIV service delivery, especially in prevention and gender-based violence. Several other weaknesses meant that some countries would have to refine their programme design and implementation model in the final version of their funding application. There are implications for future assistance to countries trying to mitigate the impact of COVID-19 on their health programmes and innovative ways to deliver technical support using new technologies and local expertise.

Experience of a technical assistance project on strengthening a local national tuberculosis programme, Lusaka, Zambia: 2012-2015 / 国際保健医療

Objectives  The authors conducted a technical assistance project on tuberculosis (TB) control in Bauleni, Chelston, and Chilenje, Lusaka, Zambia in 2012-2015. Herein we describe the project activities and achievements. Methods  We trained community health volunteers (CHVs) and organized their activities. We evaluated the project considering the trends of TB cases, particularly the percent of bacteriologically confirmed TB cases among the presumptive (suspected) TB cases, and treatment outcomes.Results  We organized training for the CHVs of three areas. The CHVs conducted a total of 160 community sensitizations attended by over 50 000 community members. They visited their assigned patients 23 716 times. At Bauleni, the number of bacteriologically positive (bac+) cases exhibited a decreasing trend (r = −0.55, p=0.03), whereas that of the presumptive TB cases exhibited an increasing trend (r = 0.70, p = 0.004). At Chelston, both the numbers of bac+ cases and the presumptive TB cases exhibited increasing trends (r = 0.52, p = 0.046 and r = 0.68, p = 0.005, respectively). At Chilenje, the number of bac+ TB cases exhibited a decreasing trend (r = −0.84, p < 0.001), whereas that of the presumptive TB cases did not change (r = 0.09, p = 0.76). In all three areas, the proportions of the bac+ cases among the presumptive TB cases exhibited decreasing trends (p < 0.0001 at all three clinics). The treatment success rates improved in Chelston and Chilenje from 50.7% and 61.9%, respectively, in early 2011 to 78.3% and 97.0%, respectively, in late 2014 (both p < 0.001). The treatment success rates of Bauleni maintained at over 85% in most quarters. Conclusion  The activities of the project contributed to the strengthened local national TB programme, resulting in the decreased burden of TB in the areas.

Cancer registration for cancer control in Latin America: a status and progress report / Registros de cáncer para el control de la enfermedad en América Latina: informe de situación y progreso

ABSTRACT Cancer incidence by type has been included as a core indicator in the World Health Organization (WHO) Global Monitoring Framework for the Prevention and Control of Noncommunicable Diseases. The Global Initiative for Cancer Registry Development (GICR), coordinated by the International Agency for Research on Cancer (IARC), supports low- and middle-income countries to reduce disparities in cancer information for cancer control by increasing the coverage and quality of cancer registration. A baseline assessment has been performed at the IARC Regional Hub for Latin America using secondary and public information sources. Countries have been categorized according to the following criteria for population-based cancer registries (PBCRs): 1) "has no established PBCR (but some registration activity)," 2) "has established PBCR(s) but none of high-quality," and 3) "has established, high-quality PBCR(s) (regional or national)." Currently, in Latin America, most countries have cancer control plans in place; PBCRs cover approximately 20% of the region's population, though only 7% are deemed as having high-quality information. No information is available on the extent of use of the information generated by PBCRs for cancer control purposes. Though there are important advances in cancer registration in the region, there is still much to be done. This report also outlines key elements for improving cancer surveillance in the region, including 1) involvement of local stakeholders and experts, 2) integration of cancer registries into existing surveillance systems (accounting for the complexities and particularities of cancer surveillance), 3) improvement in data availability and quality, 4) enhanced communication and dissemination, and 5) better linkages between cancer registries and cancer planning and cancer research.(AU)

RESUMEN La incidencia del cáncer por tipo se ha incluido como indicador central del Marco mundial de vigilancia integral para la prevención y el control de las enfermedades no transmisibles de la Organización Mundial de la Salud (OMS). La Iniciativa Mundial para el Desarrollo de Registros de Cáncer (GICR por su sigla en inglés), bajo la coordinación del Centro Internacional de Investigaciones sobre el Cáncer (CIIC), brinda apoyo a los países de ingresos bajos y medianos para reducir las disparidades de información sobre el cáncer para el control de esta enfermedad mediante el aumento de la cobertura y la calidad de los registros de cáncer. El Núcleo Regional del CIIC para América Latina (Buenos Aires) realizó una evaluación de valores de referencia y comparación usando fuentes secundarias y de información pública. Los países se han clasificado según los siguientes criterios relativos a los registros de cáncer basados en la población: 1) "no tiene ningún registro"; 2) "ha establecido uno o varios registros, pero ninguno es de alta calidad"; y 3) "tiene un registro de alta calidad (regional o nacional)". En América Latina, la mayor parte de los países ya han implantado planes de control del cáncer; los registros cubren aproximadamente 20% de la población de la región, aunque se considera que solo 7% tiene información de alta calidad. No hay ninguna información disponible sobre el grado de utilización de la información generada por estos registros para fines de control del cáncer. Si bien se observan adelantos importantes en cuanto a los registros de cáncer en la región, hay todavía mucho por hacer. En este informe también se describen los elementos principales para mejorar la vigilancia del cáncer en la región como: 1) la participación de interesados directos y expertos locales; 2) la integración de los registros de cáncer a los sistemas de vigilancia existentes (para tomar en cuenta las complejidades y particularidades de la vigilancia del cáncer); 3) el mejoramiento de la disponibilidad y la calidad de los datos; 4) el mejoramiento de la comunicación y la difusión; y 5) mejores vínculos entre los registros de cáncer y la planificación e investigación en materia de cáncer.(AU)

Efecto de la asistencia técnica en el desempeño profesional

La presente investigación tuvo la finalidad de identificar las ventajas de la asistencia técnica en los procesos de formación continua y sus efectos en el desempeño de profesionales de salud que atienden a niños y niñas menores de 3 años en el Control de Crecimiento y Desarrollo (CRED). La investigación evidenció que al incorporar la variable Asistencia Técnica (AT), los programas de formación continua son más eficientes, es decir, cuando se fortalecen capacidades en el campo de la acción profesional. El diseño del estudio fue cuantitativo, según su profundidad es explicativo de tipo cuasiexperimental, orientado a identificar la relación de causalidad o efecto de la asistencia técnica en el desempeño profesional, comparando un grupo experimental y un grupo control. Los resultados generales muestran diferencias significativas, el grupo experimental, alcanzó una media del 51.67, mientras que el grupo control solo llegó a 26.53, aplicando la prueba no paramétrica U Mann Whitney: p≤.01. Si bien la formación continua genera avances en ambos grupos, al incorporar la variable AT se evidencia un salto significativo respecto al grupo control, concluyendo que la asistencia técnica mejora el desempeño del personal de salud que atienden en el Control de CRED, fortaleciendo e incrementando sus capacidades.

The purpose of this research was to identify the advantages of technical assistance in continuous training processes and its effects on the performance of health professionals who care for children under 3 years of age in the Growth and Development Control (CRED). The research showed that by incorporating the Technical Assistance (TA) variable, continuous training programs are more efficient, that is, when capacities are strengthened in the field of professional action. The study design was quantitative, according to its depth it is explanatory of a quasi-experimental type, aimed at identifying the causal relationship or effect of technical assistance on professional performance, comparing an experimental group and a control group. The general results show significant differences, the experimental group, reaching an average of 51.67, while the control group only reached 26.53, applying the non-parametric Mann Whitney U test: p≤.01. Although continuous training generates progress in both groups, when incorporating the AT variable, a significant jump is evidenced compared to the control group, concluding that technical assistance improves the performance of the health personnel who attend to the CRED Control, strengthening and increasing their capabilities.

O objetivo desta pesquisa foi identificar as vantagens da assistência técnica nos processos de formação contínua e seus reflexos na atuação dos profissionais de saúde que cuidam de crianças menores de 3 anos no Controle de Crescimento e Desenvolvimento (CRED). A pesquisa mostrou que, ao incorporar a variável Assistência Técnica (AT), os programas de formação contínua são mais eficientes, isto é, quando se fortalecem as capacidades no campo da atuação profissional. O delineamento do estudo foi quantitativo, pois pela sua profundidade é explicativo do tipo quase experimental, visando identificar a relação causal ou efeito da assistência técnica no desempenho profissional, comparando um grupo experimental e um grupo controle. Os resultados gerais mostram diferenças significativas, o grupo experimental, atingindo a média de 51,67, enquanto o grupo controle atingiu apenas 26,53, aplicando-se o teste não paramétrico U de Mann Whitney: p≤,01. Embora o treinamento contínuo gere avanços em ambos os grupos, ao incorporar a variável TA, evidencia-se um salto significativo em relação ao grupo controle, concluindo que a assistência técnica melhora o desempenho dos profissionais de saúde que atendem ao Controle CRED, fortalecendo e aumentando sua capacidades.

Utilization of Nursing Career Ladder / 国際保健医療

  In this article, the author presents experience of JICA’s project, “The Project for Enhancement of Nursing Competency through In-Service Training” (hereinafter referred to as “the Project”) that is under implementation with the Ministry of Health, Republic of Indonesia, five universities and nine hospitals in Indonesia (hereinafter referred to as “counterparts”) based on the author’s experience as an expert for the Project from December 2012 to December 2015. In the Project, Indonesian counterparts improved their Nursing Career Ladder (hereinafter referred to as “the Ladder”) and modified/developed several training curricula in line with the Ladder. <BR>  As a result, through improvement/development of the Ladder and several curricula in the Project, several results were found such as utilization of the Ladder for curriculum development; training planning and management; allocation of nursing authorities to nurses; effective allocation of human resources. It was also found that the Ladder could be utilized as the internal control in line with the Ladder of the Project and literature study.<BR>  Presently, the Ladder is utilized for human resource development and human resource allocation and defined as a tool for nursing human resource development and career management, however the author concluded that the Ladder can be utilized for nursing management in consistent manner; communication between hospital (management) and nurse; fair evaluation; designated training contents and effective training planning; communication between hospital and stakeholders; allocation of authority; internal control by discussing the Ladder based on literature study, project activities and project results that were reported in the reports such as the Project’s mind-term review reports, experts reports to JICA and Indonesian counterparts and so on.