Evaluation of Brazil's public health surveillance system within the context of the International Health Regulations (2005) / Evaluación del sistema de vigilancia de salud pública del Brasil dentro del contexto del Reglamento Sanitario Internacional (2005)

OBJECTIVE: To evaluate Brazil's public health surveillance system (HSS), identifying its core capacities, shortcomings, and limitations in dealing with public health emergencies, within the context of the International Health Regulations (IHR 2005). METHODS: In 2008-2009 an evaluative cross-sectional study was conducted using semistructured questionnaires administered to key informants (municipal, state, and national government officials) to assess Brazilian HSS structure (legal framework and resources) and surveillance and response procedures vis-à-vis compliance with the IHR (2005) requirements for management of public health emergencies of national and international concern. Evaluation criteria included the capacity to detect, assess, notify, investigate, intervene, and communicate. Responses were analyzed separately by level of government (municipal health departments, state health departments, and national Ministry of Health). RESULTS: Overall, at all three levels of government, Brazil's HSS has a well-established legal framework (including the essential technical regulations) and the infrastructure, supplies, materials, and mechanisms required for liaison and coordination. However, there are still some weaknesses at the state level, especially in land border areas and small towns. Professionals in the field need to be more familiar with the IHR 2005 Annex 2 decision tool (designed to increase sensitivity and consistency in the notification process). At the state and municipal level, the capacity to detect, assess, and notify is better than the capacity to investigate, intervene, and communicate. Surveillance activities are conducted 24 hours a day, 7 days a week in 40.7% of states and 35.5% of municipalities. There are shortcomings in organizational activities and methods, and in the process of hiring and training personnel. CONCLUSIONS: In general, the core capacities of Brazil's HSS are well established and fulfill most of the requisites listed in the IHR 2005 with respect to both structure and surveillance and response procedures, particularly at the national and state levels.

OBJETIVO: Evaluar el sistema de vigilancia de salud pública del Brasil, identificando sus capacidades básicas, deficiencias y limitaciones para manejar emergencias de salud pública, dentro del contexto del Reglamento Sanitario Internacional (RSI 2005). MÉTODOS: En el período 2008-2009 se llevó a cabo un estudio transversal de evaluación utilizando cuestionarios semiestructurados administrados a informantes clave (funcionarios del gobierno municipal, estatal y nacional) a fin de evaluar la estructura del sistema de vigilancia de salud pública del Brasil (marco jurídico y recursos), y la vigilancia y los procedimientos de respuesta, con relación al cumplimiento de los requisitos del RSI 2005 para el manejo de emergencias de salud pública de importancia nacional e internacional. Los criterios de evaluación incluyeron la capacidad de detectar, evaluar, notificar, investigar, intervenir y comunicar. Las respuestas se analizaron por separado según el nivel gubernamental (departamentos de salud municipales y estatales y ministerio de salud nacional). RESULTADOS: En general, en los tres niveles del gobierno, el sistema de vigilancia de salud pública del Brasil tiene un marco jurídico bien establecido (incluidas las reglamentaciones técnicas esenciales) y la infraestructura, los suministros los materiales y los mecanismos requeridos para el enlace y la coordinación. Sin embargo, todavía hay algunos puntos débiles a nivel estatal, especialmente en las zonas fronterizas y los pueblos pequeños. Los profesionales de campo deben conocer más la herramienta de decisión del anexo 2 del RSI 2005 (diseñada para aumentar la sensibilidad y la consistencia del proceso de notificación). En el nivel estatal y municipal, la capacidad para detectar, evaluar y notificar es mejor que la capacidad para investigar, intervenir y comunicar. Las actividades de vigilancia se llevan a cabo 24 horas al día, 7 días a la semana, en 40,7% de los estados y 35,5% de los municipios. Existen deficiencias en las actividades de organización y los métodos, y en el proceso de contratación y capacitación del personal. CONCLUSIONES: En general, las capacidades básicas del sistema de vigilancia de salud pública del Brasil están bien establecidas y cumplen la mayoría de los requisitos enumerados en el RSI 2005, tanto con respecto a la estructura como a la vigilancia y los procedimientos de respuesta, en particular en los niveles nacional y estatal.

Relatório de gestão CNS/MS: exercício 2011 / CNS/MS management report: financial year 2011

O Relatório de Gestão do Conselho Nacional de Saúde ­ CNS é uma ferramenta de controle e avaliação, que busca a transparência das ações realizadas. Assim, a apresentação desse Relatório é uma forma de prestação de contas com a sociedade, mostrando a ela como o Conselho utilizou os recursos públicos, o planejamento em médio prazo e principalmente as ações e os objetivos alcançados em 2011. Os resultados apresentados são decorrentes das atividades realizadas pelo Conselho Nacional como um todo, e pelas suas subdivisões. Serão apresentadas as reuniões e deliberações do Plenário e da Mesa Diretora. No tocante a presidência, foram elencadas as reuniões em que o presidente esteve representando o Conselho. Quanto a Secretaria-Executiva, foram reunidas as suas principais atividades, juntamente com as da área de Comunicação. Na parte destinada as Comissões e aos Grupos de Trabalho, destacou-se as reuniões e eventos realizados. É importante frisar que 2011 foi um ano diferenciado para o Controle Social e para o Conselho. Em virtude do Decreto Nº 7.446 de 1 de março que reduziu os limites para o empenho de diárias e passagens, alguns eventos e o número de reuniões foram reduzidas. Mesmo com essa redução a Secretaria-Executiva conseguiu se organizar para realizar as principais atividades programas. Foram realizados 6 eventos, 10 reuniões da Mesa Diretora, 12 Reuniões Ordinárias, 69 reuniões de Comissões, além das reuniões dos Grupos de Trabalho e outras atividades.

A utilização das informações de custos na gestão da saúde pública: um estudo preliminar em secretarias municipais de saúde do estado de Santa Catarina / The use of costs information in public health: a preliminary study in local health departments in the state of Santa Catarina

Este artigo analisa o uso das informações de custos pelos gestores de 20 grandes secretarias municipais da saúde do estado de Santa Catarina. Para isso, foi avaliado o perfil dos gestores entrevistados; foi verificada a existência ou não de sistemas de custos implantados nessas secretarias; foi feita uma avaliação da percepção desses gestores sobre a utilização das informações de custos no processo de tomada de decisão e foram identificadas quais informações de custos são utilizadas atualmente na gestão desses órgãos. Os entrevistados foram os ocupantes de cargos administrativos nas secretarias municipais da saúde pesquisadas. Conseguiu-se avaliar o uso das informações de custos na gestão de 18 secretarias municipais da saúde do estado de Santa Catarina. Os resultados indicam que apenas duas secretarias municipais da saúde possuem esse processo um pouco mais avançado; nas demais, o que se verifica é que existem algumas tentativas de se obter informações mais detalhadas sobre custos. Entretanto, na opinião dos entrevistados, as informações de custos são bastante importantes na gestão das secretarias.

Desdiagnosticando o gênero / Undiagnosing gender

A autora analisa o debate atual sobre a questão da despatologização da transexualidade nos Estados Unidos. Afirma que, se por um lado o diagnóstico de transtorno de identidade de gênero continua a ser valorizado por facilitar um percurso economicamente viável para a transformação corporal, por outro, a oposição ao diagnóstico se faz necessária, dado que ele insiste em considerar como doença mental o que deveria ser entendido como uma possibilidade, entre outras, de autodeterminação do gênero. Finalmente, a autora argumenta que estas posições não são necessariamente antagônicas - indicando a complexidade e o paradoxo deste debate -, já que, no seu ponto de vista, a "transautonomia" não será alcançada sem a construção de uma rede jurídica, assistencial e social que lhe dê suporte e permita que a transexualidade possa ser vivida.

The paper takes stock of the current debate on the undoing of the pathologization process of transsexuality in the United States. The author asserts that, if, on one hand, the diagnosis of Gender Identity Disorder is still considered worthwhile to be maintained as to ease the financial means to the transition, on the other hand, opposing the diagnosis is also needed in that the diagnosis presumes as a mental illness what should rather be understood as a possibility among many of gender self-determination. Bringing to light how complex and paradoxal this debate is, she contends that these two stands should, however, not be considered fully contradictory since, in her viewpoint, transautonomy will not be achieved as long as a legal, medical and social supportive net is not brought about, which only will really make it possible that one lives a transsexual life.

Efecto del ajuste estructural sobre la situación de salud en América Latina y el Caribe, 1980-2000 / The effect of structural adjustment on health conditions in Latin America and the Caribbean, 1980-2000

OBJETIVO: Evaluar el impacto del ajuste estructural sobre los indicadores de salud en América Latina y el Caribe durante el período de 1980-2000. MÉTODOS: Se trata de un estudio ecológico. Los datos del gasto público y del producto interno bruto per cápita (PIBpc) se tomaron del Banco Mundial y los de la esperanza de vida (EV) y mortalidad infantil (MI), de la Organización Mundial de la Salud. El ajuste estructural (adelgazamiento del Estado) se evaluó mediante el cambio en el consumo de gobierno (la reducción del gasto público) en los países de América Latina y el Caribe en la década de 1980-1990. El cambio en los indicadores de salud se midió por la variación porcentual de la EV y la MI. Se compararon estas variaciones en América Latina y el Caribe con las observadas en diferentes grupos de países de otras regiones del mundo durante el período de 1980-2000. Se determinaron las asociaciones entre la reducción del gasto público y los indicadores de salud mediante la prueba de Pearson. Para estimar el efecto de los cambios sobre la salud se construyó un modelo de regresión lineal multifactorial ajustado según el PIBpc. RESULTADOS: Se observó una ralentización del incremento de la EV y del descenso de la MI en América Latina y el Caribe, especialmente en la década de 1980-1990. Se encontraron asociaciones significativas entre la variación de los indicadores de salud y el cambio del gasto público en todos los grupos de países analizados. Al ajustar el modelo de regresión múltiple, las asociaciones solo se mantuvieron en América Latina y el Caribe. CONCLUSIONES: En la década de 1980, el ajuste de las políticas macroeconómicas tuvo un efecto negativo sobre los indicadores sociales, específicamente sobre los relacionados con la situación de salud en América Latina y el Caribe. Estos efectos se siguieron observando durante la década siguiente.

Blood culture in India: a proposal for a national programme for early detection of sepsis.

Septicaemia is a major contributor of mortality. Blood culture is the essential investigation for the management of sepsis. Due to lack of resources blood culture is an irregularly used investigation in India. A three-tier level of development is being proposed to develop the blood culture based national programme for early detection of sepsis. The plan envisages the establishment of manual blood culture based elementary system in the health centre and district hospital level (Level 1), direct Gram stain and direct antibiotic sensitivity testing from the "positive" blood culture broths at the medical college hospital level (Level 2) and development of automated methods, enhancement of quality control and safety measures, clinical liaison and re-orientation of microbiology training at the tertiary care centre level (Level 3).

Indicadores de gestión de servicios de salud públicos y asignación de recursos desde el Ministerio de Salud de Chile / Indices of public health services and resource allocation from the Health Ministry of Chile

Background: Chile has a National Health Services System, formed by 29 Health Services. An efficient resource distribution among this services is crucial for an efficient health care delivery. Aim: To obtain indices from the Chilean Public Health Services, that could improve allocation of resources. Material and methods: Information from the Chilean Public Health Services, corresponding to activities during 2001 budgetary period, was collected. This is the latest complete and official information for the totality of Health Services in the country. Seventeen variables generated or monitored by the Instituto Nacional de Estadísticas (INE), the Ministerio de Salud (MINSAL), the Ministerio de Hacienda, the Ministerio de Planificación y Cooperación (MIDEPLAN) and the Fondo Nacional de Salud (FONASA) were studied. The Main Components Analysis (ACP) was used, obtained from the R correlation matrix. Results: The first two main components were selected, with an accumulated percentage of explained variability of 63.05 percent. The first component is related to the population assigned to each Health Service. This corresponds to the number of people needed to treat in the hospitals of these Services and their answer to this demand, justified by the expenses in which each Health Service incurs. There is an inverse relation of the first component with health indicators, measured by burden of disease and death. The second main component would represent the social and economic characteristics of the population, poor and ery poor populations and public health insurance beneficiaries, to take care of in each Health Service. Conclusions: Health indicators in each Health Service are not considered a priority for resource distribution among Health Services in the country. The transference is done considering the indices contained in the two main components defined.

Challenges of managing patients with inherited metabolic disorders in a developing country.

The main problems encountered in managing patients with inherited metabolic disorders (IMDs) are inadequate numbers of clinicians and scientists with experience in IMDs, ill-equipped laboratory facilities, lack of funding, and lack of a well-organized plan. Other challenges that must be faced in developing countries include basic health care, birthing centers, and funding. The community environment including a clean water supply and appropriate waste disposal may also be problems. A stable communication system is necessary, as well as the means of paying for these systems. Analyses of local foods, at least for protein and energy, are required to utilize local materials in the diet. The home environment must also be considered. Adequate housing, clothing, and fuel are essential to help prevent frequent infections that may lead to serious illness or death of patients with IMDs. Adequate parental education is necessary along with adequate finances to purchase equipment to measure a prescribed diet and any necessary foods. Specialized medical, public health, community and home environments all contribute challenges of managing patients with IMDs in developing countries.

La economía del la salud: ¿debe ser de interés para el campo sanitario? / Health economics: should it concern the health sector?

This paper addresses the most important features of health economics, especially its scope and applications within the sphere of health. Health economics is a field of study which allows countries to gear their health policies toward making more rational use of their resources and expanding and improving their health care services. Such policies should, on the other hand, aim to generate strategies for adequately managing human, technical, economic, and financial resources so as to reap the finest health benefits possible. A knowledge of how economics can be applied to health will enable health professionals to introduce an economics culture into their daily work. In other words, it will allow them to keep in mind the scope of their various working tools¾health planning, national health accounts and accounting, and economic assessment methods, which include health and pharmaceutical technology assessment and pharmacoeconomics¾as well as the place that economics has in health research. Hopefully, a knowledge of these aspects of economic analysis will provide decision-makers with one more tool they can apply in selecting more efficient options and attaining the highest health benefits at the lowest possible cost for the national health system

Reporte final del subcomponente alternativas de financiamiento

Describe las actividades llevadas a cabo con el fin de evaluar las opciones del mejoramiento de la base financiera para fortalecer los servicios de salud y mejorar la calidad de la atención en salud, permitiendo hacer un uso más eficiente de los recurso asignados. En tal sentido, se han preparado estudios y análisis que permitan identificar las estrategias que pueden desarrollarrse para el cumplimiento de los objetivos de la Política Nacional de salud, definida por el Ministerio de Salud de Nicaragua.

Costo de las prestaciones de salud / Cost of health deliveries

The income source and the use of assets at the Health Department of a Chilean city hall was studied. A cost control system was created to know the real value of health services, which were compared with the administrative tariffs determined by the authorities. Specific health programs such as complementary feeding, immunizations and responsible paternity programs represented 48.1 percent of the Health Department expenses. Ninety four percent of services had a real cost that exceeded their administrative price. A reformulation of resource distribution for primary health care and the development of control systems that measure the results of experience activities is proposed