ABSTRACT
INTRODUCCIÓN: la calidad de la atención como política sanitaria es considerada una estrategia para el logro de la equidad en salud. OBJETIVOS: Evaluar las características y la calidad de atención de los centros de atención primaria de la salud (CAPS). MÉTODOS: Se realizó un estudio transversal evaluativo, que involucró a 89 CAPS de las provincias de Buenos Aires y Entre Ríos, que se autoevaluaron bajo la supervisión de un equipo docente de la Facultad de Ciencias Médicas de la Universidad Nacional de La Plata. Se evaluaron 200 estándares,agrupados en las siguientes dimensiones: Conducción y gestión (CG), Recursos humanos (RH), Registros e información (RI), Actividades de organización (AO), Normas de atención (N), Actividades del equipo de salud sobre la comunidad (AC), Participación social (PS), ReferenciaContrarreferencia (RF), Planta física (PF), Recursos materiales (RM) e Insumos (I). RESULTADOS: Sólo el 18% de los CAPS cuentan con unequipo de salud básico. El nivel de calidad global fue de 58±14%. Encuanto a las dimensiones, el ranking fue: I 87%, RM 70%, AO 66%, AC63%, PF 61%, CG 55%, RF 55%, N 47%, RH 43%, RI 41%, PS 32%.CONCLUSIONES: Estos resultados permiten establecer un diagnósticode situación en cada CAPS para sustentar planes de mejora específicosy un diagnóstico integral para respaldar la definición de ejes estratégicosen las políticas sanitarias.
INTRODUCTION: the quality of care as health policy is considered a strategy to attain health equity. OBJECTIVES: Toevaluate the characteristics and care quality in primary health care centers (PHCC). METHODS: An evaluative cross-sectional study was conducted. It involved 89 PHCC from the provinces ofBuenos Aires and Entre Ríos. A self-assessment of care quality was performed under supervision of an advisory team from the Faculty of Medical Sciences of the National University of La Plata. Two hundred (200) standards were evaluated according to the following dimensions: Leadership and Management (LM), Human Resources (HR), Records and Information (RI), OrganizationActivities (OA), Norms and Guides (NG), Community Activities (CA), Social Participation (SP), Referral system (RS), Physical plant (PP), Material resources (MR) and Supplies (S). RESULTS: Only 18% of PHCC have a basic health team. The overall qualitylevel was 58±14%. In regard to the dimensions, the ranking was: S 87%, MR 70%, OA 66%, CA 63%, PP 61%, LM 55%, RS 55%, NG 47%, HR 43%, RI 41%, SP 32%. CONCLUSIONS: These results allow to perform a situational diagnosis of each PHCC to support specific improvement plans and a comprehensive diagnosis to define strategic priorities for health policies.
Subject(s)
Humans , Basic Health Services , Primary Health Care , Quality of Health Care , Reference StandardsABSTRACT
OBJECTIVES: To analyze the relationship between maternal and infant health and socioeconomic, cultural, and sanitation factors in Argentina; to evaluate how health program quality affects the primary health indicators for mothers and infants. METHODS: This is a cross-sectional study with multiple variables. The authors studied six indicators for maternal and infant health: rates for maternal, infant, neonatal, and postneonatal mortality; the percentage of newborns with low birthweight; and the percentage of premature newborns. The study was conducted in 79 administrative units in 13 provinces that represent different geographic regions of Argentina. They included (1) the provinces of Salta and Jujuy in northwest Argentina; (2) the provinces of Córdoba, Santa Fe, and Buenos Aires in central Argentina; (3) the provinces of Entre Ríos and Misiones in the Mesopotamia or northeast region; (4) the provinces of San Luis, San Juan, and Mendoza in the Cuyo or northwest, Andean region; and (5) the provinces of Neuquén, Río Negro, and Chubut in the south. The explanatory variable in the study was the quality of health programs, controlled by socioeconomic, cultural, and sanitation factors in 1999 and 2000. The definition of program quality ("poor," "average," "good," and "very good") was based on quantitative and qualitative analysis of selected variables such as policies, organization, and procedures as determined by the investigators. Documentation was obtained from secondary official sources. The investigators interviewed 117 health system managers (including supervisors of provincial and local health programs, administrators of maternal and child health programs, and hospital directors), who provided information on characteristics and indicators of the health programs. RESULTS: There were marked geographic differences in the levels of maternal and infant health, medical care, and socioeconomic, cultural, and sanitation factors. Only 10.0% of health programs were classified as "very good," 35.4% as "good," 31.6% as "average," and 23.0% as "poor." There was a significant correlation (P < 0.05) between rates of infant and postneonatal mortality and adverse socioeconomic circumstances. There was also a significant correlation between the percentage of low birthweight infants and the quality of health programs. CONCLUSIONS: There are clear disparities in the level of maternal and infant health care in different administrative units in Argentina. The infant mortality rate was associated with variations in socioeconomic, cultural, and sanitation factors and with the quality of health programs. Health programs improved infant health when appropriately implemented, even in adverse socioeconomic and sanitation conditions.
Subject(s)
Child Health Services/standards , Maternal Health Services/standards , Argentina , Child Health Services/statistics & numerical data , Cross-Sectional Studies , Female , Humans , Infant , Infant, Newborn , Maternal Health Services/statistics & numerical data , Socioeconomic FactorsABSTRACT
OBJETIVOS: Analizar la relación entre la salud maternoinfantil y los factores determinantes socioeconómicos, culturales y sanitarios y evaluar el efecto de la calidad de los programas de salud sobre los principales indicadores de salud maternoinfantil. MÉTODOS: Estudio analítico de corte transversal con múltiples variables. Se estudiaron seis indicadores maternoinfantiles: las tasas de mortalidad materna, infantil, neonatal y posneonatal y los porcentajes de bajo peso al nacer y de prematuros. El estudio se realizó en 79 unidades administrativas de 13 provincias argentinas distribuidas en las cuatro principales regiones del país: Norte (Salta, Jujuy y Misiones), Centro (Córdoba, Santa Fe y Buenos Aires), Litoral (Entre Ríos), Cuyo (San Luis, San Juan y Mendoza) y Sur (Neuquén, Río Negro y Chubut). Como variable explicativa se utilizó la calidad de los programas de salud, controlada por los factores determinantes socioeconómicos, culturales y sanitarios (período 1999-2000). La calidad de los programas (mala, regular, buena y muy buena) se basó en el análisis cuantitativo y cualitativo de variables seleccionadas de políticas, organización y procesos, según el juicio consensuado de los investigadores. La información documental se obtuvo de fuentes oficiales secundarias y las características e indicadores de los programas de salud se derivaron de las entrevistas a 117 referentes clave. RESULTADOS: Se encontraron marcadas diferencias geográficas en el nivel de salud maternoinfantil, la atención médica y los factores condicionantes de la salud. Solo 10,0 por ciento de los programas de salud fueron calificados como muy buenos, 35,4 por ciento como buenos, 31,6 por ciento como regulares y 23,0 por ciento como malos. Se encontró una correlación significativa (P < 0,05) entre las tasas de mortalidad infantil y posneonatal y la condición socioeconómica desfavorable y entre las tasas de mortalidad infantil y neonatal y el porcentaje de bajo peso...
OBJECTIVES: To analyze the relationship between maternal and infant health and socioeconomic, cultural, and sanitation factors in Argentina; to evaluate how health program quality affects the primary health indicators for mothers and infants. METHODS: This is a cross-sectional study with multiple variables. The authors studied six indicators for maternal and infant health: rates for maternal, infant, neonatal, and postneonatal mortality; the percentage of newborns with low birthweight; and the percentage of premature newborns. The study was conducted in 79 administrative units in 13 provinces that represent different geographic regions of Argentina. They included (1) the provinces of Salta and Jujuy in northwest Argentina; (2) the provinces of Córdoba, Santa Fe, and Buenos Aires in central Argentina; (3) the provinces of Entre Ríos and Misiones in the Mesopotamia or northeast region; (4) the provinces of San Luis, San Juan, and Mendoza in the Cuyo or northwest, Andean region; and (5) the provinces of Neuquén, Río Negro, and Chubut in the south. The explanatory variable in the study was the quality of health programs, controlled by socioeconomic, cultural, and sanitation factors in 1999 and 2000. The definition of program quality ("poor," "average," "good," and "very good") was based on quantitative and qualitative analysis of selected variables such as policies, organization, and procedures as determined by the investigators. Documentation was obtained from secondary official sources. The investigators interviewed 117 health system managers (including supervisors of provincial and local health programs, administrators of maternal and child health programs, and hospital directors), who provided information on characteristics and indicators of the health programs. RESULTS: There were marked geographic differences in the levels of maternal and infant health, medical care, and socioeconomic, cultural, and sanitation factors. Only 10.0 percent...
Subject(s)
Female , Humans , Infant , Infant, Newborn , Child Health Services/standards , Maternal Health Services/standards , Argentina , Child Health Services/statistics & numerical data , Cross-Sectional Studies , Maternal Health Services/statistics & numerical data , Socioeconomic FactorsSubject(s)
Public Health/trends , Health Policy , Delivery of Health Care , Health Services Accessibility , Ethics , PovertySubject(s)
Health Services Accessibility , Delivery of Health Care , Poverty , Health Policy , Public Health/trends , EthicsSubject(s)
Child , Adolescent Health , Breast Feeding , Maternal and Child Health , Local Health Systems/trendsABSTRACT
Since the 1970s the Member States of the World Health Organization have pledged themselves to the goal of "health for all" and to broadening the coverage, quality, and efficiency of the health care services they provide. In spite of that commitment, there has been little progress in the conceptual understanding and development of indicators to help evaluate the characteristics of the populations with and without coverage, as well as in knowing the relationship between coverage and the characteristics of health care services. Most of the countries of Latin America and the Caribbean are in the process of reforming their health care sectors, and they could benefit from new insight in these areas. To help build that knowledge, this study looked at the population without health care services in the countries of Latin America and the Caribbean, using four indicators: vaccination for poliomyelitis, tuberculosis (BCG) vaccination, prenatal care for pregnant women, and childbirths attended by a health professional. In 1995, out of a total population of 474 million in Latin America and the Caribbean, the number without coverage was a minimum of 40 million, calculated using the indicator of BCG vaccination coverage. Using the indicator for prenatal care, the number of persons without health care coverage was 137 million. By analyzing these four indicators in each country, it is possible to develop health services profiles that would suggest different health sector reform policies. The study also analyzed some characteristics of the structure and coverage of the health systems in 46 countries and territories and their correlation with indicators of result or impact. Five indicators of health care resources were used, along with ten indicators of coverage and seven indicators of result or level of health achieved. A statistically significant association (P=0.05) was found between the coverage of prenatal care and professionally attended childbirths and the results as measured by rates of infant mortality and maternal mortality (AU)
Subject(s)
Infant , Humans , Infant, Newborn , Health Services , Latin America , Health Services Accessibility/statistics & numerical data , Caribbean Region , Prenatal Care , Infant MortalityABSTRACT
En los años setenta, los Estados Miembros de la Organización Mundial de la Salud, asumieron la meta de salud para todos y la responsabilidad de mejorar la cobertura, la calidad y la eficiencia de los servicios de salud que ofrecen. A pesar de ese compromiso, se ha avanzado poco en la profundización conceptual y el desarrollo de indicadores que permitan evaluar las características de las poblaciones con y sin cobertura, así como en conocer la relación entre la cobertura y las características de los servicios de salud. La mayoría de los países de América Latina y el Caribe están llevando a cabo reformas del sector de la salud y podrían beneficiarse de una nueva forma de enfocar esas áreas. Para contribuir a ese conocimiento, en este estudio se estimó la población sin cobertura de servicios de salud en los países de América Latina y el Caribe, utilizando cuatro indicadores de cobertura: la vacunación antipoliomielítica, la vacunación antituberculosa (BCG), el control prenatal de la mujer embarazada y la proporción de partos atendidos por profesionales de la salud. De una población total de 474 millones de habitantes, la población sin cobertura en 1995 se estimó en un mínimo de 40 millones según el indicador de cobertura con vacuna BCG y un máximo de 137 millones, según el del control prenatal. El análisis de los cuatro indicadores en cada país también permite identificar diferentes perfiles de desarrollo de los servicios de salud, que podrían sugerir distintos tipos de política en los procesos de reforma del sector. Finalmente, se efectúa un análisis de correlación simple entre indicadores en 46 países y territorios, utilizando cinco indicadores de recursos, 10 de cobertura real y siete de resultados. Se observó una asociación estadísticamente significativa (P= 0,05) entre la cobertura alcanzada en el control prenatal y del parto, y los indicadores de resultados medidos por las tasas de mortalidad infantil y de mortalidad materna
Subject(s)
Health Services Coverage/trends , Health Care Reform , Latin America , Caribbean Region , Poliovirus Vaccine, Inactivated , BCG Vaccine , Prenatal Care , ParturitionABSTRACT
En los años setenta, los Estados Miembros de la Organización Mundial de la Salud, asumieron la meta de salud para todos y la responsabilidad de mejorar la cobertura, la calidad y la eficiencia de los servicios de salud que ofrecen. A pesar de ese compromiso, se ha avanzado poco en la profundización conceptual y el desarrollo de indicadores que permitan evaluar las características de las poblaciones con y sin cobertura, así como en conocer la relación entre la cobertura y las características de los servicios de salud. La mayoría de los países de América Latina y el Caribe están llevando a cabo reformas del sector de la salud y podrían beneficiarse de una nueva forma de enfocar esas áreas. Para contribuir a ese conocimiento, en este estudio se estimó la población sin cobertura de servicios de salud en los países de América Latina y el Caribe, utilizando cuatro indicadores de cobertura: la vacunación antipoliomielítica, la vacunación antituberculosa (BCG), el control prenatal de la mujer embarazada y la proporción de partos atendidos por profesionales de la salud. De una población total de 474 millones de habitantes, la población sin cobertura en 1995 se estimó en un mínimo de 40 millones según el indicador de cobertura con vacuna BCG y un máximo de 137 millones, según el del control prenatal. El análisis de los cuatro indicadores en cada país también permite identificar diferentes perfiles de desarrollo de los servicios de salud, que podrían sugerir distintos tipos de política en los procesos de reforma del sector. Finalmente, se efectúa un análisis de correlación simple entre indicadores en 46 países y territorios, utilizando cinco indicadores de recursos, 10 de cobertura real y siete de resultados. Se observó una asociación estadísticamente significativa (P= 0,05) entre la cobertura alcanzada en el control prenatal y del parto, y los indicadores de resultados medidos por las tasas de mortalidad infantil y de mortalidad materna
Since the 1970s the Member States of the World Health Organization have pledged themselves to the goal of "health for all" and to broadening the coverage, quality, and efficiency of the health care services they provide. In spite of that commitment, there has been little progress in the conceptual understanding and development of indicators to help evaluate the characteristics of the populations with and without coverage, as well as in knowing the relationship between coverage and the characteristics of health care services. Most of the countries of Latin America and the Caribbean are in the process of reforming their health care sectors, and they could benefit from new insight in these areas. To help build that knowledge, this study looked at the population without health care services in the countries of Latin America and the Caribbean, using four indicators: vaccination for poliomyelitis, tuberculosis (BCG) vaccination, prenatal care for pregnant women, and childbirths attended by a health professional. In 1995, out of a total population of 474 million in Latin America and the Caribbean, the number without coverage was a minimum of 40 million, calculated using the indicator of BCG vaccination coverage. Using the indicator for prenatal care, the number of persons without health care coverage was 137 million. By analyzing these four indicators in each country, it is possible to develop health services profiles that would suggest different health sector reform policies. The study also analyzed some characteristics of the structure and coverage of the health systems in 46 countries and territories and their correlation with indicators of result or impact. Five indicators of health care resources were used, along with ten indicators of coverage and seven indicators of result or level of health achieved. A statistically significant association (P = 0.05) was found between the coverage of prenatal care and professionally attended childbirths and the results as measured by rates of infant mortality and maternal mortality
