Integra Project: strengthening social participation in the agenda of health policies, services, and technologies. / Projeto Integra: fortalecimento da participação social na agenda das políticas, serviços e tecnologias em saúde.

The 16th National Health Conference illustrated the interest of health councils to intervene in public policies in order to guarantee the right to health technologies. The INTEGRA project (Integration of policies for Health Surveillance, Pharmaceutical Care, Science, Technology, and Innovation in Health) is a partnership among the National Health Council, the National School of Pharmacists, and the Oswaldo Cruz Foundation (Fiocruz), with support from the Pan American Health Organization (PAHO), with the goal of strengthening participation and social engagement in the theme, as well as the integration of health policies and practices within different sectors of society (social movements, health councils, and health professionals), with the various stages related to the access to medicines (research, incorporation, national production, and services) being the main theme in the context of the COVID-19 pandemic. It seeks to offer training for leadership groups in the health regions and activities with a broad national and political scope, and it hopes to establish an intersectorial and integrated network of leaders capable of acting collaboratively to defend the development of science, public policies, national sovereignty, and social control of health.

A 16ª Conferência Nacional de Saúde demonstrou o interesse do controle social em intervir sobre as políticas públicas a fim de garantir o direito às tecnologias de saúde. O projeto Integra - Integração das Políticas de Vigilância em Saúde, Assistência Farmacêutica, Ciência, Tecnologia e Inovação em Saúde -, nasce da parceria entre o Conselho Nacional de Saúde, a Escola Nacional dos Farmacêuticos e a Fundação Oswaldo Cruz (Fiocruz), com apoio da Organização Pan-Americana de Saúde (OPAS) com objetivo de fortalecimento da participação e engajamento social na temática e a integração das políticas e práticas de saúde em diferentes setores da sociedade (movimentos sociais, controle social e profissionais de saúde), tendo as diversas etapas relacionadas ao acesso aos medicamentos (pesquisa, incorporação, produção nacional e serviços) como mote principal, no cenário da pandemia de COVID-19. Oferta-se, neste projeto, capacitação para grupos de lideranças nas regiões de saúde e atividades de grande abrangência nacional e política. Espera-se alcançar o estabelecimento de uma rede intersetorial, integrada de lideranças capazes de atuar colaborativamente para a defesa do desenvolvimento da ciência, das políticas públicas, da soberania nacional e do controle social da saúde.

Health Science, Technology and Innovation Policy (ST&I/H): an update for debate. / Política de Ciência, Tecnologia e Inovação em Saúde (CT&I/S): uma atualização para debate.

The text presents an updated proposal for a Health Science, Technology and Innovation Policy in Brazil, following the huge political turmoil in the country since 2019 and the COVID-19 pandemic since 2020. The proposal is presented in five sections: Scientific Research; Productive Innovation; Health Technology Assessment and Incorporation; Intellectual Property in Health; New challenges posed by the Pandemic. The authors take part in the Advisory Committee in Science, Technology and Innovation of the Brazilian Association of Collective Health.

O texto contém uma proposta atualizada de política de Ciência, Tecnologia e Inovação em Saúde no Brasil e a pertinência da atualização decorre do desastre nas atividades nesse terreno verificadas no país desde o início do atual governo federal em 2019, bem como dos desafios colocados pela emergência da pandemia COVID-19 desde 2020. Ele está organizado em cinco seções, a saber: Pesquisa em Saúde; Inovação Produtiva; Avaliação e Incorporação de Tecnologias em Saúde; Propriedade Intelectual em Saúde; Novos desafios colocados pela Pandemia. Os autores fazem parte do Comitê de Assessoramento em Ciência, Tecnologia e Inovação da Abrasco.

Unintended consequences of communicating rapid COVID-19 vaccine policy changes- a qualitative study of health policy communication in Ontario, Canada.

BACKGROUND: The success of the COVID-19 vaccination roll-out depended on clear policy communication and guidance to promote and facilitate vaccine uptake. The rapidly evolving pandemic circumstances led to many vaccine policy amendments. The impact of changing policy on effective vaccine communication and its influence in terms of societal response to vaccine promotion are underexplored; this qualitative research addresses that gap within the extant literature. METHODS: Policy communicators and community leaders from urban and rural Ontario participated in semi-structured interviews (N = 29) to explore their experiences of COVID-19 vaccine policy communication. Thematic analysis was used to produce representative themes. RESULTS: Analysis showed rapidly changing policy was a barrier to smooth communication and COVID-19 vaccine roll-out. Continual amendments had unintended consequences, stimulating confusion, disrupting community outreach efforts and interrupting vaccine implementation. Policy changes were most disruptive to logistical planning and community engagement work, including community outreach, communicating eligibility criteria, and providing translated vaccine information to diverse communities. CONCLUSIONS: Vaccine policy changes that allow for prioritized access can have the unintended consequence of limiting communities' access to information that supports decision making. Rapidly evolving circumstances require a balance between adjusting policy and maintaining simple, consistent public health messages that can readily be translated into action. Information access is a factor in health inequality that needs addressing alongside access to vaccines.

Embedding rapid reviews in health policy and systems decision-making: Impacts and lessons learned from four low- and middle-income countries.

BACKGROUND: Demand for rapid evidence-based syntheses to inform health policy and systems decision-making has increased worldwide, including in low- and middle-income countries (LMICs). To promote use of rapid syntheses in LMICs, the WHO's Alliance for Health Policy and Systems Research (AHPSR) created the Embedding Rapid Reviews in Health Systems Decision-Making (ERA) Initiative. Following a call for proposals, four LMICs were selected (Georgia, India, Malaysia and Zimbabwe) and supported for 1 year to embed rapid response platforms within a public institution with a health policy or systems decision-making mandate. METHODS: While the selected platforms had experience in health policy and systems research and evidence syntheses, platforms were less confident conducting rapid evidence syntheses. A technical assistance centre (TAC) was created from the outset to develop and lead a capacity-strengthening program for rapid syntheses, tailored to the platforms based on their original proposals and needs as assessed in a baseline questionnaire. The program included training in rapid synthesis methods, as well as generating synthesis demand, engaging knowledge users and ensuring knowledge uptake. Modalities included live training webinars, in-country workshops and support through phone, email and an online platform. LMICs provided regular updates on policy-makers' requests and the rapid products provided, as well as barriers, facilitators and impacts. Post-initiative, platforms were surveyed. RESULTS: Platforms provided rapid syntheses across a range of AHPSR themes, and successfully engaged national- and state-level policy-makers. Examples of substantial policy impact were observed, including for COVID-19. Although the post-initiative survey response rate was low, three quarters of those responding felt confident in their ability to conduct a rapid evidence synthesis. Lessons learned coalesced around three themes - the importance of context-specific expertise in conducting reviews, facilitating cross-platform learning, and planning for platform sustainability. CONCLUSIONS: The ERA initiative successfully established rapid response platforms in four LMICs. The short timeframe limited the number of rapid products produced, but there were examples of substantial impact and growing demand. We emphasize that LMICs can and should be involved not only in identifying and articulating needs but as co-designers in their own capacity-strengthening programs. More time is required to assess whether these platforms will be sustained for the long-term.

[Privacy and health data management.] / Privacy e gestione del dato sanitario.

The effective use of data in healthcare, and the use of information to support decision-making processes is a key issue. Experiencing the Covid-19 pandemic drove to important developments in a relatively short time. In this context, Cittadinanzattiva, which has been dealing with citizens' rights in the health field for years, is really interested in exploring the boundaries between citizens' right to privacy and the promotion of health as a fundamental human right. New strategies to protect the individual and his dignity should be identified, without hindering the use of data to support health policy. The relationship between health and privacy is a pivotal issue because it involves two of the fundamental rights that are most exposed to the evolution of technology and innovation.

Oral Health Policy in Brazil: changes and ruptures during the period 2018-2021. / Política de Saúde Bucal no Brasil: transformações e rupturas entre 2018-2021.

This study analyzed the implementation of Brazil's National Oral Health Policy during the period 2018-2021, covering institutional actions, implementation of public dental services, results achieved, and federal funding. We conducted a retrospective descriptive study using documentary analysis and secondary data obtained from institutional websites, government information systems, and reports published by dental organizations. The findings show a significant reduction in funding between 2020 and 2021 and declining performance against indicators since 2018, such as coverage of first dental appointments and group supervised tooth brushing, which stood at 1.8% and 0.02%, respectively, in 2021. Federal funding dropped in 2018 and 2019 (8.45%), followed by an increase in 2020 (59.53%) and decrease in 2021 (-5.18%). The study period was marked by economic and political crises aggravated by the COVID-19 pandemic. This context influenced the functioning of health services in Brazil. There was a sharp reduction in performance against oral health indicators, while performance in primary health care and specialized care services remained stable.

Analisou-se a implementação da Política de Saúde Bucal no Brasil no período 2018-2021, através das ações institucionais, implantação dos serviços, resultados alcançados e financiamento federal. Estudo de monitoramento, a partir da análise documental e de dados secundários, obtidos em sites institucionais, sistemas de informações governamentais e notícias publicadas por entidades odontológicas. Todos os indicadores de resultados monitorados apresentaram expressiva redução dos valores entre 2020-2021, com agravamento desde 2018, como a cobertura da primeira consulta odontológica e ação coletiva de escovação dental supervisionada, que chegou a 1,8% e 0,02% em 2021, respectivamente. Observa-se uma queda do financiamento federal nos anos 2018-2019 (8,45%), com crescimento em 2020 (59,53%) e nova diminuição em 2021 (5,18%). O período analisado foi marcado por crise econômica e política, agravadas pela crise sanitária, decorrente da pandemia do COVID-19. Contexto que influenciou o funcionamento dos serviços de saúde no Brasil. No caso particular da saúde bucal, verificou-se progressiva e acentuada redução dos resultados, ainda que a implantação dos serviços de atenção básica e especializada tenha se mantido estável.

Organization of primary health care and surveillance in response to COVID-19 in municipalities in the Northeast of Brazil. / Organização da atenção e vigilância em saúde na atenção primária frente à COVID-19 em municípios do Nordeste brasileiro.

The aim of this study was to analyze the organization and development of primary health care and surveillance, including normative frameworks and the implementation of local health actions. Qualitative descriptive multiple-case study involving three municipalities in the state of Bahia. We conducted 75 interviews and a document analysis. The results were categorized into the following two dimensions: approach to the organization of the pandemic response; and development of care and surveillance actions at local level. Municipality 1 was found to have a well-defined concept of the integration of health and surveillance with a view to organizing team work processes. However, the municipality did not strengthen the technical capacity of health districts to support surveillance actions. In M2 and M3, delays in defining PHC as the entry point for the health system and the prioritization of a central telemonitoring service run by the municipal health surveillance department compounded the fragmentation of actions and meant that PHC services played only a limited role in the pandemic response. Clear policy and technical guidelines and adequate structural conditions are vital to ensure the effective reorganization of work processes and foster the development of permanent arrangements that strengthen intersectoral collaboration.

O estudo objetivou analisar a organização e o desenvolvimento das ações de vigilância e atenção na APS, desde o arcabouço normativo até a execução das ações sanitárias nos territórios de abrangência das equipes de saúde. Estudo exploratório, analítico-descritivo, de natureza qualitativa, de casos múltiplos em três municípios-sede de região de saúde na Bahia. Foram feitas 75 entrevistas e análise documental. Os resultados consideraram a lógica de organização tecnológica e o desenvolvimento das ações de atenção e vigilância em saúde pelas equipes no nível local. No caso do M1, constatou-se uma concepção bem definida sobre a integração das ações, com vistas à organização do processo de trabalho das equipes. Contudo, não houve aumento da capacidade técnica dos distritos sanitários para apoiar as ações de vigilância junto às equipes. Em M2 e M3, a demora na definição da APS como porta de entrada e a priorização de serviço central de telemonitoramento realizado pela vigilância municipal reforçou a fragmentação das ações, revelando um baixo protagonismo da APS nas respostas. Diretrizes políticas e técnicas e condições estruturais mostraram-se fundamentais para a reorganização do trabalho, de modo a fomentar arranjos permanentes que promovam condições e incentivem a colaboração intersetorial.