La última reforma del sistema general de seguridad social en salud Colombiano / The latest reform of the Colombian healthcare-related social security system

Objetivo El propósito de este ensayo es explorar y analizar los cambios y oportunidades generados con la reforma del sistema de salud colombiano, a partir de la ley 1438 del 2011. Métodos Para lograrlo se revisan documentalmente algunos temas pendientes desde la reforma introducida por la ley 100 de 1993 y los compara con la norma del 2011; también se contrastan con algunas estrategias de la salud pública inoperantes en la etapa de la reforma, bajo condiciones del modelo de mercado. Resultados Se discute esta segunda fase de la reforma en relación con el alcance del derecho a la salud, el acceso y la equidad global. Se reconoce el avance en temas importantes, como la igualación de los paquetes de beneficios, la atención primaria en salud, las redes integradas de servicios de salud, pero se discute su inoperancia para modificar aspectos medulares del sistema, como la sostenibilidad financiera y la lógica económica que se imponen sobre las estrategias mencionadas las cuales ven cercenada su capacidad de respuesta, en aras de mantener incólume el modelo de la ley 100 de 1993. Conclusión Finalmente, se esbozan los puntos cruciales necesarios a una gran reforma estructural del sistema de salud colombiano que se base en el derecho a la salud y en la equidad.

Objective This essay was aimed at exploring and analysing the challenges and opportunities arising from reforming Colombian law 1438/2011 dealing with the healthcare-related social security system. Methods Some outstanding issues from the reform introduced by Law 100/1993 were reviewed and then compared to the 2011 regulations; they were also contrasted (in market model conditions) with some public health strategies which were inoperative during the reform stage. Results This second reform phase was discussed in relation to the scope of the right to health, access and overall equity. Progress regarding important issues such as benefit package equalisation, primary healthcare attention, integrated healthcare service networks was recognised; however, its failure to change core aspects of the system was discussed, i.e. financial sustainability and the economic rationale imposed on the aforementioned strategies which curtailed its responsiveness to keep the model introduced by law 100/1993 intact. Conclusion The crucial points necessary for major structural reform of the Colombian healthcare system based on the right to health and equity were then outlined.

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.

Gerenciamento do risco ocupacional no Exército Brasileiro: aspectos normativos e práticos / Occupational risk management in the Brazilian army: normative and practical aspects

Neste estudo procurou-se descrever o método de gerenciamento do risco que o Exército Brasileiro utiliza em suas atividades, desde a parte normativo-documental até a execução das atividades nos quartéis de tropa e confrontá-lo, de maneira sucinta, com alguns aspectos de segurança ocupacional previstos pelo Ministério do Trabalho e Emprego. Foi utilizada uma abordagem qualitativa, com base em uma triangulação de técnicas de coleta de dados, a saber: coleta documental; observação sistemática e entrevista semi-estruturada, na qual selecionou-se 24 informantes militares, os quais foram divididos em três grupos, visando a coletar informações dos grandes círculos hierárquicos: oficiais, sargentos, cabos e soldados. Constatou-se que o método de gerenciamento do risco do Exército Brasileiro apóia-se em três documentos principais: o Caderno de Instrução 32/1, o Caderno de Instrução 32/2 e o Programa de Instrução Militar. Observou-se, ainda, que esse método faz referência apenas aos riscos de acidentes, desconsiderando alguns aspectos importantes previstos nas Normas Regulamentadoras do Ministério do Trabalho e Emprego e os demais tipos de riscos.

This study aims to describe the risk management method used by the Brazilian Army, ranging from the guidelines, norms, and standards to the implementation of activities in the barracks, providing a brief comparison with key occupational safety provisions by the Ministry of Labor and Employment. A qualitative approach was used, based on triangulation of data collection techniques: document collection; systematic observation; and a semi-structured interview with 24 key informants among the military, divided into three groups, aimed at collecting information on the main hierarchical levels: officers, sergeants, corporals, and privates. We found that the Brazilian Army's risk management method is based on three main documents: Instruction Booklet 32/1, Instruction Booklet 32/2, and the Military Instruction Program. The method only refers to accident risks, overlooking other important aspects covered in the Regulatory Standards of the Ministry of Labor and Employment and other types of risks.

Effectiveness in the implantation of law 155 of 2002 ordering the designation of spaces for breastfeeding in government agencies

As part of an effort to promote and protect breastfeeding among working mothers in Puerto Rico, Public Law 427 was passed in December 2000. This law grants a paid breastfeeding daily break for milk extraction in the workplace. In support of this initiative Public Law 155 was passed in 2002 ordering Secretaries, Directors, Presidents and Public Administrators of the government of Puerto Rico to designate breastfeeding spaces in the workplaces. OBJECTIVE: Describe the level of compliance with the dispositions of Law 155 in government agencies. METHODOLOGY: A cross sectional descriptive study was carried out. A sample of 28 government agencies was randomly selected, representing 25of the total number of agencies, and a structured telephone interview was administered using an instrument made up of 6 premises. RSEULTS: All (100) of the agencies had knowledge about the existence of this law, but only 50had set up and equipped the spaces. Of these, all had a table, a chair, and an electric outlet, 43had available running water, and 71provided a refrigerator for milk storage. Fifty three percent of the agencies reported having received followup communications to verify whether they were complying with the law, and 61reported having a written public policy in support of breastfeeding for working mothers. Only 54of the agencies stated they had offered some type of orientation to their women employees regarding their breastfeeding rights. CONCLUSIONS: In spite of over two years since the passing of Law 155, the majority of government agencies in Puerto Rico have not complied with its legal dispositions. It is necessary that the responsible entities watch for the satisfactory compliance with this law since working mothers need a secure and accesible place for milk extraction during the working day.