Haciendo, planeando, "planhaciendo": una experiencia de pragmatismo municipal en la pandemia del Covid-19 en cooperación con la universidad / Doing, planning, "planning-doing": a case of municipal pragmatism in collaboration with a university during the COVID-19 pandemic

RESUMEN Este artículo problematiza las posibilidades municipales de hacer frente a la pandemia de COVID-19, a partir de la cooperación técnico-científica entre un municipio y una universidad del norte del estado de Rio de Janeiro, a partir de abril de 2020, que involucró la implementación de una sala de situación, procesamiento y análisis de datos para la toma de decisiones y de información para la población, centro de televigilancia, educación permanente con equipos territoriales de atención y estudio epidemiológico de COVID-19 en el municipio, entre otras acciones. En este análisis se utilizó como soporte conceptual una visión micropolítica de los conceptos de experiencia, pragmatismo, trabajo vivo en acto y deseo. La noción de "planhaciendo" se retomó como una planificación inventiva que solo puede ser narrada a posteriori, un acto imperativo, un gobierno vivo en acto que depende de un movimiento anhelante orientado por la vida, y que solo se da en espacios colectivos de prácticas de gestión y de atención a la salud.

ABSTRACT This article critically analyzes local governments' abilities to face the COVID-19 pandemic by examining an instance of technical-scientific cooperation between a municipality and a university located in the northern Rio de Janeiro (state) beginning in April 2020. This collaboration included: the implementation of a situation room, data processing and analysis for decision making and for public communication, a telemonitoring center, ongoing training with territorial healthcare teams, and an epidemiological study of COVID-19 in the municipality, among other actions. We situate our analysis within a conceptual framework that adopts a micropolitical view of concepts such as experience, pragmatism, "live work in action," and desire. The notion of "planning-doing" is deployed as an inventive form of planning that is only narrated a posteriori, as an imperative act, a live government in action that depends on the movement of desire oriented by life, and that only takes place in collective spaces of management practices and health care.

Guía de conteo poblacional / Population counting guide

Conteo poblacional se comprenderá como la serie de acciones y procedimientos de recolección de datos de personas, identificación de viviendas y familias, comunidades, sectores y territorios con fines eminentemente sanitarios, relacionando las condiciones de vida, los problemas de salud, sus determinantes sociales y factores de riesgo presentes en ellas. Debido a que las características de la población de una comunidad son dinámicas, se hace necesario realizar cada año una actualización de la información que es de uso necesario para las acciones de salud, lo cual lo diferencia del censo de población que es estático, de cohorte, con otro tipo de indicadores dado por el ente rector el Instituto Nacional de Estadística ­INE-. Además permite el contacto directo entre los equipos de salud del Ministerio de Salud y la población a su cargo Este documento además, forma parte de las herramientas para la implementación del Modelo de Atención y Gestión, junto a la "Guía para la elaboración de un croquis" y a la "Guía de acercamiento y negociación", que forman parte de los documentos que hay en esta App. Este documento contiene los lineamientos y ruta a seguir para el desarrollo del conteo poblacional, describe conceptos básicos, sus características, la secuencia de fases y pasos que incluyen preparación y organización de los equipos de trabajo, herramientas y registro de datos, revisión, análisis y certificación de la información recolectada. Los principales usuarios son el personal que conforman los equipos de salud ­ES- responsables de cada sector y territorio de los distritos de salud.

Governança, sustentabilidade e equidade no plano de saúde de São José dos Pinhais, Brasil / Governance, sustainability, and equity in the health program for the municipality of São José dos Pinhais, Brazil

OBJETIVO: Analisar o Relatório Final da VIII Conferência de Saúde e o Plano Municipal de Saúde de São José dos Pinhais 2010-2013 e verificar se esses documentos contemplaram os temas sustentabilidade, governança e equidade e as interfaces entre esses temas - políticas de governo e estado, balanço de poder e processo inclusivo e resultados impactantes -, que compõem um Modelo Conceitual para Desenvolvimento Humano e Promoção da Saúde proposto pelos autores. MÉTODOS: Neste estudo de caso, foram analisadas as 331 propostas aprovadas para incorporação no Plano Municipal de Saúde. Foram analisadas as seis categorias temáticas do Modelo Conceitual para Desenvolvimento Humano e Promoção da Saúde pelo programa ATLAS Ti 5.0. As propostas foram classificadas pelo número de temas e interfaces do Modelo Conceitual: propostas plenas de promoção de saúde continham as seis categorias de conceitos e interfaces; propostas de promoção parcial continham três categorias; e propostas incipientes continham uma categoria. RESULTADOS: Das 331 propostas aprovadas, 162 (49%) contemplaram as seis categorias temáticas, sendo classificadas como propostas plenas de promoção da saúde. Noventa e cinco (29%) contemplaram três categorias, sendo classificadas como de parcial promoção da saúde. Dessas, 38 (12%) contemplaram as categorias governança, sustentabilidade e políticas de governo/estado, 33 (10%) contemplaram governança, balanço de poder e equidade e 24 (7%) contemplaram equidade, processo inclusivo/resultados impactantes e sustentabilidade. Finalmente, 74 (22%) propostas contemplaram uma categoria, sendo classificadas como proposta de incipiente promoção da saúde: 36 (11%) contemplaram governança, 27 (8%) contemplaram sustentabilidade e 11 (3%) contemplaram equidade. CONCLUSÕES: Tendo em vista que 49% das propostas foram classificadas como de promoção plena da saúde, o controle social, a partir da participação popular na construção do plano de saúde, contribuiu para a promoção da saúde no município.

OBJECTIVE: To analyze the Final Report of the VIII Health Conference and the São José dos Pinhais City Health Program for 2010-2013 and investigate whether these documents addressed the themes of sustainability, governance, and equity and the interfaces between these themes-government policies, power balance, and inclusive processes/impacting results-that make up the Concept Model for Human Development and Health Promotion developed by the authors. METHOD: This case study analyzed 331 proposals approved for incorporation in the City Health Program. The six thematical categories of the Concept Model were analyzed using ATLAS Ti 5.0 software. The proposals were classified according to the number of themes and interfaces of the Concept Model: full health proposals contained all six categories; partial proposals contained three categories; and incipient proposals contained one category. RESULTS: Of 331 proposals approved, 162 (49%) contemplated the six thematical categories and were classified as full health promotion proposals. Ninety-five (29%) contemplated three categories (partial health promotion). Of these, 38 (12%) addressed Governance, Sustainability, and Government Policies, 33 (10%) addressed Governance, Power Balance, and Equity and 24 (7%) addressed Equity, Inclusive Processes/Impact Results, and Sustainability. Finally, 74 (22%) proposals contemplated only one category and were classified as incipient: 36 (11%) addressed Governance, 27 (8%) addressed sustainability, and 11 (3%) addressed equity. CONCLUSIONS: Based on the fact that 49% of the proposals approved were classified as full health promotion, it is considered that the effectiveness of social control and popular participation in the construction of health policies at the local level contritute to the promotion of health in the city.

Política de práticas integrativas em Recife: análise da participação dos atores / Integrative practice policy in Recife, northeastern Brazil: an analysis of stakeholder involvement / Política de prácticas integradoras en Recife (Noreste de Brasil): análisis de la participación de los actores

OBJETIVO: Analisar a participação dos atores envolvidos na evolução de política municipal de práticas integrativas. PROCEDIMENTOS METODOLÓGICOS: Estudo com abordagem qualitativa em Recife, PE. A coleta dos dados foi realizada por meio de consultas às atas do conselho municipal de saúde, entre 2004 e 2009, entrevistas com informantes-chave e gestores, e grupos focais com profissionais e usuários. Os dados foram analisados segundo o modelo de condensação de significados. Para apresentação dos resultados, quatro categorias de atores foram formadas, segundo seu poder e interesse, a saber: sujeitos, população, líderes e jogadores. RESULTADOS: Após cinco anos da implantação da política em Recife, só um serviço oferecia práticas integrativas. A população ou os usuários não tiveram participação efetiva e não contribuíram com a política; os profissionais de saúde, apesar do interesse em participar do processo, não foram incluídos. Os líderes encontrados foram o Conselho Municipal de Saúde, os gestores e as entidades médicas, sendo os dois últimos também considerados jogadores, pois participaram efetivamente da elaboração da política. CONCLUSÕES: A participação de poucos atores na construção de uma política de práticas integrativas dificulta sua consolidação e amplia a distância entre formulação e implementação, prejudicando o alcance dos resultados esperados.

OBJECTIVE: To examine the involvement of stakeholders in the implementation of a local policy of integrative practices. METHODOLOGICAL PROCEDURES: Qualitative study conducted in the city of Recife, Northeastern Brazil. Data was collected from local health board records between 2004 and 2009, interviews with managers and key informants and focus groups with providers and users. The analysis was performed using the condensation of meaning model. The results were grouped into four categories of stakeholders according to their influence and interest, namely: subjects; population; leaders; and players. ANALYSIS OF RESULTS: Five years after the policy was implemented in Recife, only a single service offered integrative practices. The population, or users, did not have any effective involvement and did not make any contributions to the policy, and health providers, despite their willingness to participate in the process, were not involved. The leaders included the local health board, managers and medical organizations; the latter two were also players as they were effectively involved in the formulation of the policy. CONCLUSIONS: The involvement of few stakeholders in the formulation of an integrative practice policy makes it difficult its implementation and widens the gap between formulation and implementation, hindering the achievement of expected results.

OBJETIVO: Analizar la participación de los actores envueltos en la evolución de la política municipal de prácticas integradoras. PROCEDIMIENTOS METODOLÓGICOS: Estudio con abordaje cualitativo en Recife, Noreste de Brasil. La colecta de los datos fue realizada por medio de consultas de las actas del consejo municipal de salud, entre 2004 y 2009, entrevistas con informantes-clave y gestores, y grupos focales con profesionales y usuarios. Los datos fueron analizados según el modelo de condensación de significados. Para presentación de los resultados, cuatro categorías de actores fueron formadas, según su poder e interés, a saber: sujetos, población, líderes y jugadores. RESULTADOS: Posterior a cinco años de la implantación de la política en Recife, solo un servicio ofrecía prácticas integradoras. La población o los usuarios no tuvieron participación efectiva y no contribuyeron con la política; los profesionales de salud, a pesar del interés en participar del proceso, no fueron incluidos. Los líderes encontrados fueron el consejo municipal de salud, los gestores y las entidades médicas, siendo los dos últimos también considerados jugadores, pues participaron efectivamente de la elaboración de la política. CONCLUSIONES: La participación de pocos actores en la construcción de una política de prácticas integradoras dificulta su consolidación y amplia la distancia entre formulación e implementación, perjudicando el alcance de los resultados esperados.

Diagnóstico de situación y evaluación de un programa de educación comunitaria para la prevención del Síndrome Urémico Hemolítico / Situation Diagnosis and Evaluation of a Community Education Program for the Prevention of Hemolytic Uremic Syndrome

Se conocen los puntos precisos de intervención en la cadena epidemiológica para prevenir el Síndrome Urémico Hemolítico, pero las condiciones pueden variar entre distintas localidades. OBJETIVOS: Con este estudio se pretende mostrar la utilidad de un modelo de diagnóstico de situación que permite optimizar la implementación de un programa preventivo de educación comunitaria de tipo “formación de formadores” en dos municipios de la provincia de Buenos Aires, y una evaluación de procesos. MÉTODO: El diagnóstico incluyó el relevamiento de la situación socio-sanitaria, hábitos y costumbres alimentarios y detección de los problemas en la cadena de producción, comercialización y consumo de alimentos. La evaluación del proceso fue cuali-cuantitativa: número de talleres y de participantes, e indagación de fortalezas y debilidades del proceso. RESULTADOS: Los principales problemas encontrados fueron la carencia de agua potable y de manejo de las excretas en un gran porcentaje de la población y los deficientes controles bromatológicos y de mantenimiento de la cadena de frío en la provisión de carne y leche. Este diagnóstico permitió adaptar el programa a las condiciones específicas locales, elemento necesario para lograr una intervención eficaz. Se realizaron en total 26 talleres con la participación de 588 agentes. El material gráfico fue de gran utilidad para la comprensión de los contenidos docentes y todos los participantes de los talleres respondieron con gran motivación. Se logró el apoyo de las autoridades locales, lo que facilitó la ejecución del programa

The precise points of intervention in the epidemiological chain to prevent Hemolytic Uremic Syndromeare well known, although conditions may vary between different localities. OBJECTIVES: This study aims to show the usefulness of a situation diagnostic model to optimize the implementation of a preventive community education program type “training the trainers” in two municipalities in the province of Buenos Aires, and the evaluation of the process. METHODS: The diagnosis included a survey of the socio-sanitary conditions, food habits and identifying problem sin the chain of production, marketing and consumption of food. Process assessment was qualitative and quantitative: number of workshops and participants, and determination of strengths and weaknesses of the process. RESULTS: The main concerns were: lack of safe water and excreta management in a large percentage of the population, weak bromatological controls and maintenance of cold chainin providing meat and milk. This diagnosis allowed to adaptthe program to specific local conditions, which is necessary to achieve effective intervention. A total of 26 workshops involving 588 agents were carried out. The artwork was useful for the understanding of educational contents and all workshop participants responded with great motivation. The support from local authorities facilitated the implementation of the program

Prevención de la transmisión vertical del VIH: gestión pública en la Ciudad de Buenos Aires / Prevention of vertical HIV transmission: governance in the City of Buenos Aires

La Coordinación Sida, desde su creación ha basado su gestión en la construcción de un modelo participativo con un horizonte estratégico político en todas sus acciones. El fortalecimiento de las capacidades autónomas del equipo así como la de los efectores, ha sido la estrategia principal en la prevención de la transmisión vertical del VIH (TV) dentro del sistema público de salud en la CABA. El propósito del presente artículo es describir esta trayectoria, tomando tres ejes principales: un modelo de gestión basado en el acompañamiento de los equipos, los aportes de la vigilancia epidemiológica y la investigación aplicada. El análisis de estas líneas de trabajo permitió identificar aciertos y obstáculos que permiten fortalecer las estrategias implementadas para reducir la tasa de TV.

Since its creation, Coordinación Sida has based its management on the creation of a participative model with a political strategic horizon in all of its actions. Strengthening the has been the main strategy aimed at preventing HIV vertical transmission within the public healthcare system in the City of Buenos Aires. The objective of this article is describing Coordinación Sida's background with special emphasis on three axes: a management model based on team follow-up, its contribution to epidemiological surveillance and applied research. The analysis of these work lines allowed to identify both success and obstacles, both of them allow to strengthen the strategies applied for reducing the vertical transmission rate.

Integrated Diseases Surveillance Project (IDSP) through a consultant's lens.

India has long experienced one of the highest burdens of infectious diseases in the world, fueled by factors including a large population, high poverty levels, poor sanitation, and problems with access to health care and preventive services. It has traditionally been difficult to monitor disease burden and trends in India, even more difficult to detect, diagnose, and control outbreaks until they had become quite large. In an effort to improve the surveillance and response infrastructure in the country, in November 2004 the Integrated Disease Surveillance Project (IDSP) was initiated with funding from the World Bank. Given the surveillance challenges in India, the project seeks to accomplish its goals through, having a small list of priority conditions, many of which are syndrome-based at community and sub center level and easily recognizable at the out patients and inpatients care of facilities at lowest levels of the health care system, a simplified battery of laboratory tests and rapid test kits, and reporting of largely aggregate data rather than individual case reporting. The project also includes activities that are relatively high technology, such as computerization, electronic data transmission, and video conferencing links for communication and training. The project is planned to be implemented all over the country in a phased manner with a stress on 14 focus states for intensive follow-up to demonstrate successful implementation of IDSP. The National Institute of Communicable Diseases chosen to provide national leadership may have to immediately address five issues. First, promote surveillance through major hospitals (both in public and private sector) and active surveillance through health system staff and community, second, build capacity for data collation, analysis, interpretation to recognize warning signal of outbreak, and institute public health action, third, develop a system which allows availability of quality test kits at district and state laboratories and/or culture facilities at identified laboratories and a national training program to build capacities for performing testing and obtaining high quality results, fourth, there must be a process established by which an appropriate quality assurance program can be implemented and fifth, encourage use of IT infrastructure for data transmission, analysis, routine communication (E-mail etc) and videoconferencing for troubleshooting, consultations and epidemiological investigations. These five activities must be addressed at the national level and cannot be left up to individual states/districts.

Variabilidad de la práctica médica: a casi 70 años del efecto Glover / Variability of the medical practice: almost 70 years of the Glover's effect

Knowledge about the financing efficiency and organization of health services requires continual updating.Clinical epidemiology is the science of making predictions that can guide the management of individual patients by the careful study of groups. It is clear at the present that the application of the logical epidemiology to the health administration should permit the identification of which diseases have importance to determinate populations to identify people in risk situation. These situations are considered in detail in the article

Sanitation: a call on resources for promoting urban child health.

Poor sanitation is known to increase the risk of morbidity and mortality from diarrhea among children. Several studies have found a high correlation between childhood morbidity and availability of sanitation services. It has been estimated that 1.7 million deaths each year, or 3.1 percent of all deaths are attributable to inadequate access to water, sanitation and hygiene. The urgency for sanitation in the urban environment stems from the fact that the urban poor live in crowded slums and informal settlements where sanitation facilities are particularly important for children's health and personal dignity. Demand for sanitation services has remained low, as livelihood priorities have been more pressing. There is a pressing need to get Governments and society to recognize the appalling toll created by poor sanitary conditions in urban poor settlements. Serious efforts should be made to develop local, national and international campaigns which promote convergence among programs aimed at urban health infrastructure, community development and education; motivate people to demand and maintain better sanitation; and place sanitation to the forefront of development and political dialogue.

School health in rural Nepal: why and how?

School health has been regarded as a high priority intervention in developing countries from the perspective of donor organizations. This paper aims to show why school health is important from the community perspective as well, and how school health programs should be implemented based on a case study by the School and Community Health Project (SCHP) in Nepal. SCHP conducted a needs assessment using a participatory rural appraisal in 28 rural communities (mean household number: 51; mean population: 352) in rural Nepal. As a result, SCHP found 70% of the target communities regarded schools as the most important institutions in their communities. Then, SCHP initiated two school health programs to meet their needs, a Supportive Healthy Environment Program and Child Initiative Program. The community members welcomed them, and all the schools successfully built toilets and water supply systems, and initiated child club activities, even though the school teachers' commitment was limited.

Gender, mosquitos and malaria: implications for community development programs in Laputta, Myanmar.

This paper examines the gender roles linked to division of labor and potential exposure to mosquitos and malaria prevention activities. A "Human Development Initiative" (HDI) Project has been launched in Laputta, a mangrove delta region of Myanmar assisted by United Nations Development Program since 1994. The project aims to improve rural community access to primary health care and provide micro-credit programs, income generation schemes, and educational opportunities as a basis for community empowerment. Women and children of low-income households are the target beneficiaries. Prior to self-care training program and distribution of self-care manuals, altogether 20 focus group discussions (separately assigned to men and women) were conducted in eight study villages between January to February 2000. The primary vector for malaria in study area is Anopheles sundaicus. Rural women were prone to malaria due to exposure to mosquitos within the peak biting period at night because of their gender assigned roles. Both men and women perceived that mosquitos commonly bite before midnight, more at dusk. Lack of awareness of correlation between mosquitos and malaria together with lack of affordability enhance either non-use or shared use of bed-nets at home. Rural women did not consider destruction of breeding places of mosquitos as their major concern. Thus, it is essential for program planners to motivate local women for more active participation in vector control measures within and beyond their households in the context of community development programs.

Management model of community participative rabies vaccine fund.

The objective of this study was to set up a management model of a Rabies Vaccine Fund by using community participation. It was a Participatory Action Research-PAR (Research and Development) during January-December 1999. The target population were the Local Administrative Organization (LAO) committee, community leaders and village health volunteers. The research instrument was the focus group discussion purposively set. The result showed that the Rabies Vaccine Fund was successful, sustainable with no rabies case and the fund increased. The management model of Rabies Vaccine Fund consists of the fund committee, community participation in fund raising, delegation of work, fund regulation, animal vector registration and immunization, and provision of health education through village cable line. The recommendation is that promotion of this type of Rabies Vaccine Fund should be one alternative of a rabies protection and control program.

Planificación estratégica en salud; acompañando la democratización de un sector en crisis / Strategic planification in health accompaniment the democrations of one sector in crisis

El presente trabajo intenta analizar la planificación como una práctica que está siendo revisada y readecuada en su apliocación al campo de la salud, un campo cada vez más dinámico y cambiante. El persosnal de salud experimentado recordará épocas de fuerte presencia de la planificación, épocas que, miradas desde el presente, podríamos describir como de valoración y prestigio de los planes, de sus mecanismos de formulación y de los mismos planificadores. Confialidad, objetividad, ordenamiento, racionalidad parecian emanar de su presencia y su circulación por las organizaciones. Sin embargo, el ejercicio entró en ciclos de rendimiento decreciente, que volvió ritual y periférico respecto a las prácticas en salud, sin lograr involucrar al personal en sus distintos niveles, en una reflexión sistemática sobre su quehacer ; terminó privilegiando la optimización de los procesos conocidos sin conseguir despertar el interes y la capacidad innovativa de los diferentes niveles e instancias de las grandes organizaciones de salud. La planificación le llegó desde afuera al sector salud y cuando desde ese "afuera" se redujo la demanda, la presión o el interés, los procesos de planificación comenzaron a languidecer hasta encontrar un piso. Ese piso, consideramos, fue el que posibilitó la detección de las necesidades propias del sector y que permitió a través de un cierto efecto " vacio" desencadenar nuevos procesos, menos pomposos, ordenados o abrcativos que los anteriores, pero en ocaciones más efectivos. Fueron surgiendo casi espontaneamente allí donde el sector tuviera una instancia innovadora, donde se desarrollara un programa creativo, donde se organizara un distrito, donde una unidad evidenciara un liderazgo emprendedor, donde las comunidades se organizaran, donde las instituciones formadoras se propusieran cambiar sus curricula, etc. Alli se detecta la insuficiencia de las herramientas y de las formas de pensar los cambios en las instituciones y quienes se involucran comienzan a buscar, a adaptar, a adecuar métodos y técnicas y, en ocaciones producen innovaciones significativas en la creación de metodología. En medio de estos procesos es que el pensamiento estratégico se vuelve una perspectiva aliada. Resistido por las organizaciones más jarárgicas o burocráticas, el pensamiento estratégico comenzó a fluir por aquellos espacios que empezaban a liberarse de este ordenamiento...

Introduçäo do programa de Medicina de Família no Posto de Saúde da Vila Municipal, Pelotas, RS / Introducing Family Health Planning in a Community Health Station in a slum of Pelotas, RS

Este estudo objetivou identificar alguns dos principais problemas de saúde na Vila Santos Dumont, Pelotas, RS. Realizou-se um censo nos 749 domicílios da Vila Santos Dumont, aplicando-se questionários com informaçöes sobre aspectos demográficos, sociais, ambientais e clínicos. Entre as 2.652 pessoas residentes na Vila, encontramos mais de 50 por cento das familias com renda inferior a dois salários mínimos...