[The health system of Honduras]. / Sistema de salud de Honduras.

This paper describes the health system of Honduras, including its challenges, structure coverage, sources of financing, resources and stewardship activities. This system counts with a public and a private sector. The public sector includes the Ministry of Health (MH) and the Honduran Social Security Institute (HSSI). The private sector is dominated by a set of providers offering services payed mostly out-of-pocket. The National Health Plan 2010-2014 includes a set of reforms oriented towards the creation of an integrated and plural system headed by the MH in its stewardship role. It also anticipates the creation of a public health insurance for the poor population and the transformation of the HSSI into a public insurance agency which contracts services for its affiliates with public and private providers under a family medicine model.

A double-blind study of the efficacy and safety of multiple daily doses of amikacin versus one daily dose for children with perforated appendicitis in Costa Rica.

BACKGROUND: There is evidence that aminoglycosides given in a single daily dose (once daily dose, ODD) are as effective and safe as multiple daily doses (MDD). However, the published pharmacokinetic and pharmacodynamic data are overly representative of pediatric populations in Europe and the USA, and not representative of low or middle-income countries such as Costa Rica, in which the patient population might differ from those in higher income settings. METHODS: A double-blind, randomized clinical trial of the efficacy and safety of ODD vs. MDD amikacin therapy was conducted for children aged 2-12 years with an intraoperative diagnosis of perforated appendicitis. One hundred patients were randomized following a one-to-one randomization to receive either amikacin 7.5 mg/kg every 8 h (MDD) or 22.5 mg/kg as a single dose (ODD). Patients in both groups were given clindamycin 10 mg/kg every 6 h. Efficacy was evaluated by the occurrence of intra-abdominal abscesses, documented by abdominal ultrasound, and therapeutic failure. Safety was determined by the presence of renal or cochlear toxicity. RESULTS: Fifty patients were enrolled in each group. There were no statistically significant differences in the incidence of intra-abdominal abscesses or therapeutic failures, or in the occurrence of cochlear or renal toxicity, between the MDD and ODD treatment groups. CONCLUSIONS: In this patient population of Costa Rican children with perforated appendicitis, we found that amikacin ODD is as safe and effective as the MDD regimen. This could have implications for national health systems such as that in Costa Rica, as ODD is presumably a more economic option and may reduce the cost of antibiotic treatment in patients with perforated appendicitis. This would need to be confirmed through an economic analysis, which is outside the purview of this paper.

Sistema de salud de Honduras / The health system of Honduras

En este trabajo se describe el sistema de salud de Honduras, incluyendo los retos que enfrenta, su estructura y cobertura, su financiamiento, los recursos con los que cuenta y las actividades de rectoría que en él se desarrollan. Este sistema cuenta con un sector público constituido por la Secretaría de Salud (SS) y el Instituto Hondureño de Seguridad Social (IHSS), y un sector privado en el que predomina el uso de servicios con pago de bolsillo. El Plan Nacional de Salud 2010-2014 se plantea una ambiciosa reforma del sistema que contempla la universalización del aseguramiento mediante un sistema de salud integrado y plural, en el que la SS funcionaría como una institución rectora y reguladora, y que contaría con un seguro público nacional de salud para la población pobre y un IHSS que funcionaría exclusivamente como aseguradora al contratar servicios para sus afiliados con proveedores públicos y privados, que operarían bajo un modelo de salud familiar y comunitaria.

This paper describes the health system of Honduras, including its challenges, structure coverage, sources of financing, resources and stewardship activities. This system counts with a public and a private sector. The public sector includes the Ministry of Health (MH) and the Honduran Social Security Institute (HSSI). The private sector is dominated by a set of providers offering services payed mostly out-of-pocket. The National Health Plan 2010-2014 includes a set of reforms oriented towards the creation of an integrated and plural system headed by the MH in its stewardship role. It also anticipates the creation of a public health insurance for the poor population and the transformation of the HSSI into a public insurance agency which contracts services for its affiliates with public and private providers under a family medicine model.