Avances en el desarrollo de los recursos humanos en salud en el Perú y su importancia en la calidad de atención / Progress in the development of healthcare human resources in Peru and their importance in the quality of care

RESUMEN Los Recursos Humanos en Salud (RHUS) son pilar clave en el éxito de todo sistema de salud, su desarrollo y desempeño son fundamental para garantizar una atención de calidad. A pesar de esta realidad, los RHUS suelen estar ausentes en procesos de reforma sanitaria. En el Perú, en los últimos 30 años, se han dado diversas reformas que han incluido en mayor o menor medida, mejoras en las políticas de RHUS con la finalidad de brindar una mejor calidad de atención a la población. Este artículo busca hacer un breve análisis de los avances en el campo de la gestión y desarrollo de los Recursos humanos en el Sector Salud en los últimos años, destacando su importancia en la calidad de atención. De hacer esfuerzos suficientes en este campo, lograríamos RHUS competentes, distribuidos de forma equitativa y comprometidos con entregar atención de calidad a todos los individuos.

ABSTRACT Healthcare Human Resources (HHR) are key for the success of any health system; its development and performance are fundamental to ensure quality care. Despite this reality, HHR are often absent from health reform processes. In Peru, in the last 30 years, there have been several reforms that have included, to a greater or lesser extent, improvements in HHR policies aimed at providing a better quality of care to the population. This article seeks to make a brief analysis of the advances in the field of management and development of human resources in the healthcare sector in recent years, highlighting their importance in the quality of care. Through considerable effort, we would achieve competent, equitably-distributed HHR committed to delivering quality care to all individuals.

Repercusiones de "ObamaCare" para la reforma sanitaria en Chile / "ObamaCare": effects for the health reform in Chile

Health care raises structural issues in a democratic society, such as the role assigned to the central government in the management of health risk and the redistributive consequences generated by the implementation of social insurance. These are often cause of strong political controversy. This paper examines the United States of America health reform, popularly known as "ObamaCare". Its three main elements, namely individual mandate, creation of new health insurance exchanges, and the expansion of Medicaid, generated a redistribution of health risks in the insurance market of that country after almost a century of frustrated legislative efforts to guarantee minimum universal coverage. The article proposes that a change of this magnitude in the United States will produce effects in a forthcoming parliamentary discussion on the health reform in Chile, which still maintains a highly deregulated private health system.

Dos clamores das ruas aos rumores no Congresso: uma análise da conjuntura recente da saúde no Brasil / The popular claim and Congress rumors: a recent conjuncture analysis of health in Brazil / De las voces de las calles a los rumores en el Congreso: un análisis de lacoyuntura reciente de salud en Brasil

O processo da Reforma Sanitária Brasileira requer acompanhamento da Política de Saúde. Assim, objetivou-se analisar a conjuntura e as políticas de saúde no Brasil no período de junho/2013 a março/2015. A investigação utilizou pesquisa documental por meio da mídia, programas de candidaturas à presidência e publicações de entidades de saúde para identificar fatos e acontecimentos relevantes a serem categorizados e analisados. Em junho de 2013, a saúde foi apontada como prioridade pelas manifestações de rua, obtendo como resposta institucional o Programa Mais Médicos. Entretanto, a Reforma Sanitária e o SUS não prevaleceram no debate eleitoral das campanhas à presidência, enquanto predominava a influência do setor privado. Aprovações de leis recentes no Congresso Nacional podem indicar assimilação da lógica de Cobertura Universal. Mudanças na política econômica e prioridades governamentais sugerem desmonte das conquistas sociais e apontam a necessidade de rearticulação da sociedade civil em defesa do direito universal à saúde...

The Brazilian Health Reform’s process needs the continuous monitoring of the Health Policy. So, theobjective was to analyze the conjuncture and health policies in Brazil from June/2013 to March/2015. Thestudy used documental research through the media, government programs of the presidential candidatesand health associations’ documents to identify the relevant facts and events for analysis. In June/2013,health was identified as a priority by protests, getting as government response the More Doctors Program.However, the Brazilian Health Reform and the SUS did not preponderate in the electoral debate of thepresidency running, while the private sector had predominant influence. Laws recently passed in Congressmay indicate assimilation of Universal Coverage logic. Changes in economic policy and governmentpriorities suggest regression of social rights and the need for re-articulation of civil society in defense of theuniversal right to health...

El proceso de la Reforma de Salud Brasileña requiere un seguimiento de la política de salud. El objetivofue analizar la coyuntura y las políticas de salud en Brasil, de junio/2013 a marzo/2015. Fue utilizadala investigación documental a través de los medios de comunicación, programas de los candidatos a laPresidencia y publicaciones de las entidades de salud para identificar acontecimientos relevantes paraanálisis. En junio de 2013 la salud fue una prioridad para las manifestaciones, obteniendo como respuestadel gobierno lo Programa Más Médicos. Pero, la Reforma de Salud Brasileña y el SUS no prevalecieron en eldebate electoral de la campaña presidencial, donde el sector privado consiguió la influencia predominante.Recientes leyes aprobadas en el Congreso pueden indicar asimilación de la lógica de la Cobertura Universal.Los cambios en la política económica y prioridades del gobierno sugieren desmantelamiento de lasconquistas sociales y destacan la necesidad de re-articulación de la sociedad civil en defensa del derechouniversal a la salud...

A institucionalização de um aparelho formador: o caso da Secretaria de Saúde do Estado da Bahia, 1971-2006 / The institutionalization of an educational apparatus: the case of the Health Department of the State of Bahia, 1971-2006

O presente estudo procura analisar o processo de institucionalização dos espaços para formação e desenvolvimento de Recursos Humanos em Saúde ­ RHS na Secretaria de Saúde do Estado da Bahia - SESAB, entre 1971 e 2006. Observando as modificações no campo da saúde e a evolução histórica e política brasileira e baiana, a pesquisa buscou compreender a criação, desenvolvimento e (re)estruturação do Aparelho para Formação e Desenvolvimento de RHS (AFD-RHS) na SESAB, em três períodos históricos (1971 - 1986, 1987 - 1990 e 1991 - 2006). No primeiro período, sob a face do governo militar, se organizam movimentos para o surgimento de um espaço de formação dentro dessa instituição. No segundo período observa-se certa ruptura com a linha política e ideológica que dominava a Bahia, com repercussões para o setor saúde e para o AFD-RHS. No terceiro período, houve o retorno e continuidade de aliados que se revezavam no poder no chamado Carlismo. O desenho desse estudo de caso histórico privilegiou a investigação qualitativa de caráter exploratório, com pesquisa documental e entrevistas, voltadas para ex-dirigentes dos órgãos de RHS da SESAB. Na fundamentação teórica utilizou-se o referencial elaborado por Mario Testa para análise de instituições, considerando os diferentes tipos de poder setorial (técnico, administrativo, político) e as estratégias de hegemonia. Os resultados apresentados indicam a trajetória de expansão do AFD-RHS, destacando a ação dos sujeitos na conformação dessa estrutura. Condiz com algumas reflexões no sentido de interpretar as razões quanto a criação, surgimento ou (re)estruturação (motivo-porque) desse aparelho e quanto à necessidade ou demanda social (motivo-para) que tem buscado atender.

El plan AUGE: 2005 al 2009 / Health care reform in Chile: 2005 to 2009

Five years ago Chile implemented a Health Care Reform to reduce the great inequalities in health care provision that affects the low- income, high-risk segment of its population. A universal care plan ("AUGE") was designed to make medical coverage available to all Chilean citizens suffering from one of a specifed, growing list of diseases (66 at present time). The diseases are prioritized by the Ministry of Health and its inclusion in the plan is revised periodically by an Advisory Committee according to four cardinal criteria: burden of disease, effectiveness of treatment, specific capacity of the health system and financial costs. The plan is funded by the state and enforced by law through a set of four specific guarantees: access, opportunity, quality and financial protection. This paper reviews the origin and development of the reform, the benefits and drawbacks of the application of the specific guarantees and the perception of the public regarding its strengths and weaknesses.

Democracia sem equidade: um balanço da reforma sanitária e dos dezenove anos de implantação do Sistema Único de Saúde no Brasil / Democracy without equity: analysis of health reform and nineteen years of National Health System in Brazil

Este artigo procura avaliar os dezenove anos da implementação do Sistema Único de Saúde (SUS) no Brasil sob o prisma da equidade. Toma como ponto de partida um contexto de expectativas vigentes nos anos oitenta do século XX de que a democratização do país e do setor saúde pudesse, por si, levar a uma situação mais equitativa em relação ao acesso a serviços de saúde. Discute os conceitos de democracia e equidade, analisando que situações podem facilitar ou dificultar sua associação no plano teórico, aplicando-os ao contexto brasileiro de forma mais geral e aos movimentos pela reforma sanitária e implementação do SUS em particular. Procura também evidenciar os limites e as possibilidades destes movimentos no que tange à redução das desigualdades no acesso a serviços de saúde que ainda persistem. A conclusão aponta a necessidade de que se estabeleçam outros movimentos que busquem a redução destas e de outras desigualdades, como o acesso á educação, moradia, etc., chamando a atenção, em especial, para o papel do Estado, que é questionado em sua pretensa debilidade para promover justiça social, uma vez que se mostra muito potente quando aborda outras questões.

This paper aims to evaluate the nineteen years of the National Health System in Brazil, under the prism of equity. It takes into account the current political context in Brazil in the 80s, that the democratization of the country and the health sector could, per se, lead to a more equitable situation regarding the access to health services. Democracy and equity concepts are here discussed; analyzing which situations may facilitate or make it difficult its association in a theoretical plan, applying them to the Brazilian context in a more general form and, to emphasizing practical implications to the National Health System and to groups of activism related to health reforms. It also seeks to show the limits and possibilities of these groups with regards to the reduction of inequality, in relation to the access to health services, which still remain. To conclude, the author points out the need for other movements to be established which seek the reduction of such and other inequalities, such as access to education, housing, etc, drawing special attention to the role played by the State, which is questioned regarding its incapacity of promoting equity, once it presents itself as being powerful when approaching other matters.

Deficiencias en los diagnósticos de las reformas sanitarias de los años noventa en América Latina / Deficiencies in evaluating health care reforms in the 1990s in Latin America

Some of the recurring themes seen on health-sector reform agendas of Western countries (those at the center as well as those on the periphery) over the last decade have been: the debate over new ways of organizing health systems, with sights set on achieving greater efficiency and quality; redefining health care benefit packages and services to better distribute health resources; and incorporating market mechanisms into the health care environment to better respond to expectations of health care consumers. The fundamental purpose of this article is to analyze certain concepts that define and explain the origin of the 1990s health care reforms in Latin America and to refute some of the more important principles, such as: the belief that improving the functional efficiency of the health care system alone would improve the health of the population; the excessive concern with the administrative and structural aspects of health systems without a discussion of the underlying theoretical models; the idea that access, in and of itself, can guarantee "equity in health"; and lastly, the undo emphasis that was placed on individual "risk factors" as the cause of all illness.

Evaluación social del proyecto reforma del sector salud: resultado de la consulta social a municipios y comunidades indígenas: región oriental de Bolivia / sss

La Evaluación Social del Proyecto de Reforma de Salud en Terreno, fue realizada a solicitud de la Coordinación del PRS. La parte central del informe constituye todas las percepciones y opiniones de la población de las comunidades indígenas, incluidas sus autoridades sobre temas relacionados con el servicio de salud. Se optó por presentar de manera separada los informes de la región occidental y de la región oriental...

Reforma integral para mejorar el desempeño del sistema de salud en México / Comprehensive reform to improve health system performance in Mexico

A pesar de haber alcanzado una esperanza de vida promedio de 75 años, similar a la de países más desarrollados, México ingresó al siglo XXI con un sistema de salud marcado por su incapacidad para ofrecer protección financiera en salud a más de la mitad de su población. Esto es resultado y causa de las desigualdades sociales que han caracterizado el proceso de desarrollo en México. Varias limitaciones estructurales han dificultado el funcionamiento y limitado el avance de su sistema de salud. Consciente de que la falta de protección financiera era su principal debilidad, México ha emprendido una reforma estructural para mejorar el desempeño del sistema de salud mediante el establecimiento del Sistema de Protección Social en Salud (SPSS), el cual ha introducido nuevas reglas de financiamiento e incentivos. La principal innovación de la reforma ha sido el Seguro Popular de Salud, el componente de aseguramiento del SPSS dirigido al financiamiento de la atención médica para todas aquellas familias, en su mayoría pobres, que históricamente habían sido excluidas de la seguridad social. La reforma ha permitido un incremento significativo en la inversión pública en salud, al tiempo que realinea los incentivos para garantizar una atención de mayor calidad técnica e interpersonal. En este trabajo se describen las principales características y los resultados iniciales de este esfuerzo de reforma de México, y se derivan algunas lecciones para otros países que consideren llevar a cabo transformaciones a su sistema de salud en circunstancias de desafío similares.

Despite having achieved an average life expectancy of 75 years, much the same as that of more developed countries, Mexico entered the 21st century with a health system mared by its failure to offer financial protection in health to more than half of its citizens; this was both a result and a cause of the social inequalities that have marked the development process in Mexico. Several structural limitations have hampered performance and limited the progress of the health system. Conscious that the lack of financial protection was the major bottleneck, Mexico has embarked on a structural reform to improve health system performance by establishing the System of Social Protection in Health (SSPH), which has introduced new financial rules and incentives. The main innovation of the reform has been the Seguro Popular (Popular Health Insurance), the insurance-based component of the SSPH, aimed at funding health care for all those families, most of them poor, who had been previously excluded from social health insurance. The reform has allowed for a substantial increase in public investment in health while realigning incentives towards better technical and interpersonal quality. This paper describes the main features and initial results of the Mexican reform effort, and derives lessons for other countries considering health-system transformations under similarly challenging circumstances.

Benchmarks of Fairness for health care reform in Thailand--combining evidence with opinion of the civic group.

The concept of the Benchmarks of Fairness was tried in Thailand before the big reform of universal coverage policy in 2001. The first phase of the Benchmarks in 1999 involved the analysis of the national health reform proposal as well as the analysis of ongoing field trials of health reforms in two provinces. Though the participants were predominately health personnel, the results suggested the power of combining qualitative viewpoints of participants with the quantitative indicators within the province to move health reforms to more equitable, more efficient and more democratic directions. The second phase of the Benchmarks of Fairness, therefore, tested the possibility of involving wider participation of the civic groups related, and not-related to health, in assessing their provincial health system. The health achievements of the provinces a measured by 81 indicators, in the 9 benchmarks, were provided to the civic groups before focus group discussions in 10 selected provinces to facilitate discussions based on evidence. More qualitative data were obtained from the discussions as well as their judgements on the fairness of their provincial health system. Having completed this second phase, it was recommended that the benchmarks tool could be further endorsed as the basis for monitoring the progress of health reform by province and the effect of health care decentralization. To accomplish this monitoring, the civic groups should have continuous access to evidence, in line with the benchmarks, and they should be provided with the opportunity to express their views, which is helpful in monitoring fairness in the long run.

Los valores vinculados a equidad en la reforma de la atención médica en Argentina / Equity issues in health care reform in Argentina

This article analyzes the historical and contemporary development of the Argentine health care system from the viewpoint of equity, a principle which is not explicitly mentioned in the system's founding documents. However, other values can be identified such as universal care, accessibility, and solidarity, which are closely related to equity. Nevertheless, the political dynamics characterizing the development of the country's health care system led to the suppression of more universalistic approaches, with group solidarity the only remaining principle providing structure to the system. The 1980s financial crisis highlighted the relative value of this principle as the basis for an equitable system. The authors illustrate the current situation with data on coverage under the medical social security system.

Impacto de la reforma del sistema de seguridad social sobre la equidad en los servicios de salud en Colombia / The impact of social security system reform on health services equity in Colombia

To evaluate the impact on access to, and use of, health services in Colombia's new national health insurance system, the authors compared two cross sections of the population: before (1993) and after (1997), with the approval of Act 100, creating the General System for Social Security in Health (SGSSS). Two equity indicators were assessed: concentration curves (CC) and concentration indices (CI), summarizing the distribution of access to health care and utilization of health care services provided by the SGSSS according to income deciles. Between 1993 and 1997, the CI for access to insurance halved from 0.34 to 0.17; simultaneously, coverage increased from 23 to 57, especially among the poorest segments of the population, where it increased from 3.7 to 43.7 as a result of subsidies provided by local governments. The CI for utilization of health care services did not vary significantly. Increased disease prevalence and utilization of services among the insured, due to biased selection of risks and moral hazards, were also documented. These findings suggest a positive impact by the Reform on inequalities in access to health care insurance; however, a similar effect on inequities in utilization of health services is not clear.

Consensus and conflicts in health sector reforms in India: a Delphi study.

BACKGROUND: Health sector reforms have generated much debate in India, especially in the context of economic liberalization. The World Bank intensified this debate in 1993 when it tried to redefine the role of the public and private sectors in healthcare. The Government of India has recently announced the National Health Policy. We are not aware of any formal exercise by which a consensus has been reached or conflicts in the issues related to health policy have been assessed. We present the results of such an exercise conducted in the format of a Delphi study. METHODS: Based on a review of the current literature, a 9-domain, 56-item questionnaire was prepared. This was sent to a panel of 132 respondents with diverse backgrounds, from the grassroots workers to policymakers by surface or electronic mall. They were asked to identify the three top priorities and to give their degree of agreement to the statements. The results of the first round were analysed and sent back to the respondents for reconsideration. Consensus was defined as the presence of > or = 75% of the respondents in agreement whereas conflict was said to be present if > 35% of the respondents were on either side of the divide. During the subsequent round, the respondents were also asked to give three suggestions on how to approach the previously identified top three priorities. RESULTS: Half (66) of the original list of panelists replied to the questionnaire. The three priorities identified and later ratified were: improving the quality of care of the primary healthcare system, improvements in medical education and setting up a disease surveillance system. Other areas of consensus identified were: setting up a formal channel of interaction with the private health sector, instituting cost recovery systems in the government sector, setting up a technology assessment commission and bringing accountability into the system. Conflicts were in continuation of subsidy in medical education, the role of and need for health insurance and the role of health professionals vis-a-vis Panchayati Raj institutions. CONCLUSION: We have demonstrated, on a small scale, the feasibility of assessing consensus on a wide range of issues. The approach is replicable, cost-effective and ensures that the scope of involvement is widened. Also, there is likely to be a greater feeling of self-involvement in the decisions made which would therefore meet with less resistance from the system during implementation.

Compendio de normas / Norms compendium

Contiene: Ley General de Salud; 2. Reglamento de la Ley de Modernización de la Seguridad Social en Salud; 3. Estatutos de la SEPS; 4. Resoluciones