ABSTRACT
BACKGROUND: Non-communicable Diseases (NCDs) are the leading cause of global mortality and disability with a rising burden in low- and middle-income countries. Their multifactorial aetiology, and their requirement of long-term care, implies the need for comprehensive approaches. From 2009, the Ministry of Health (MoH) in El Salvador has developed a national public health system based on comprehensive primary health care. This study aims to describe the different stakeholders' perceptions about the management of NCDs along the pathways of care in this health system. METHODS: During three fieldwork periods in 2018, three complementary qualitative data collection methods were deployed and conducted in settings with high prevalence of NCDs within El Salvador. First, illness narrative methodology was used to document the life histories of people living with a chronic disease and being treated in second and third level health facilities. Second, through social mapping, support resources that NCD patients used throughout the process of their illness within the same settings were analysed. Third, semi-structured interviews were conducted in the same locations, with both chronic patients and health personnel working at different levels of the primary health care setting. Participants were recruited through purposive and snowball sampling, and a deductive approach was implemented for coding during the analysis phase. After grouping codes into potential themes, a thematic framework was developed using a reflexive approach and following triangulation of the data. RESULTS: This innovative approach of combining three well-defined qualitative methods identified key implications for the implementation of a comprehensive approach to NCD management in resource-poor settings. The following elements are identified: 1) social risk factors and barriers to care; 2) patient pathways to NCD care; 3) available resources identified through social connections mapping; 4) trust in social connections; and 5) community health promotion and NCD prevention management. CONCLUSIONS: The Salvadoran public health system has been able to strengthen its comprehensive approach to NCDs, combining a clinical approach - including long-term follow-up - with a preventive community-based strategy. The structural collaboration between the health system and the (self-) organised community has been essential for identifying failings, discuss tensions and work out adapted solutions.
Subject(s)
Delivery of Health Care , Disease Management , Medical Staff/psychology , Noncommunicable Diseases/therapy , El Salvador , Female , Health Knowledge, Attitudes, Practice , Humans , Interviews as Topic , Male , Medical Assistance , Primary Health Care , Qualitative ResearchABSTRACT
BACKGROUND: One of today's greatest challenges in public health worldwide - and especially its key management from Primary Health Care (PHC) - is the growing burden of non-communicable diseases (NCDs). In El Salvador, since 2009 the Minister of Health (MoH) has scaled up a national public health system based on a comprehensive PHC approach. A national multi-sectorial strategic plan for a comprehensive approach to NCDs has also been developed. This analysis explores stakeholders' perceptions related to the management of NCDs in PHC and, in particular, the role of social participation. METHODS: A case-study was developed consisting of semi structured interviews and official document reviews. Semi-structured interviews were developed with chronic patients (14) and PHC professionals working in different levels within PHC (12). Purposive sampling was used to recruit participants. A non-pure, deductive approach was implemented for coding. After grouping codes into potential themes, a thematic framework was elaborated through a reflexive approach and the triangulation of the data. The research was conducted between March and August of 2018 in three different departments of El Salvador. RESULTS: The structure and the functioning of the Salvadoran PHC system and its intersectoral approach is firstly described. The interdisciplinary PHC-team brings holistic health care closer to the communities in which health promoters play a key role. The findings reflect the generally positive perception of the PHC system in terms of accessibility, quality and continuity of care by chronic patients. Community engagement and the National Health Forum are ensuring accountability through social controllership mechanisms. However, certain challenges were also noted during the interviews related to the shortage of medication and workforce; coordination between the levels of care and the importance of prevention and health promotion programmes for NCDs. CONCLUSIONS: The Salvadoran PHC and its comprehensive approach to NCDs with an emphasis on intersectoral participation has been positively perceived by the range of stakeholders interviewed. Social engagement and the NHF works as a driving force to ensure accountability as well as in the promotion of a preventive culture. The challenges identified provide keys to amplify knowledge for addressing inequalities in health by strengthening PHC and its NCDs management.
Subject(s)
Noncommunicable Diseases/epidemiology , Noncommunicable Diseases/therapy , Primary Health Care/organization & administration , Adult , Aged , Chronic Disease , Continuity of Patient Care , El Salvador/epidemiology , Female , Global Health , Health Services Accessibility , Health Workforce , Humans , Interviews as Topic , Male , Middle Aged , Organizational Case Studies , Primary Health Care/standards , Quality of Health CareABSTRACT
BACKGROUND: To determine the prevalence of hypertension treatment and control among hypertensive patients in the Cuban municipalities of Cardenas and Santiago and to explore the main associated predictors. METHODS: Cross-sectional study, with multistage cluster sampling, conducted between February 2012 and January 2013 in two Cuban municipalities. We interviewed and measured blood pressure in 1333 hypertensive patients aged 18 years or older. Hypertension control was defined as blood pressure lower than 140/90 mmHg. RESULTS: The mean age ± standard deviation (SD) of participants was 59.8 ± 14 years, the mean systolic and diastolic blood pressure ± SD was 130.0 ± 14.4 and 83.1 ± 9.0 mmHg respectively. The majority of patients (91, 95%CI 90-93) were on pharmacological treatment, 49% with a combination of 2 or more classes of drugs. Among diagnosed hypertensive patients 58% (95%CI 55-61) had controlled hypertension. There was no association between hypertension control and gender, age and socio-economic condition. Levels of hypertension control depended on health area and control furthermore was positively associated with post-primary education, not being obese and white ethnicity: adjusted Odds Ratio (95% CI) 1.71 (1.26-2.34), 1.43 (1.09-1.88) and 1.41 (1.09-1.81) respectively. CONCLUSIONS: The observed figures are outstanding at the international level and illustrate that hypertension treatment and control are achievable in a resource-constrained setting such as Cuba. The country's primary health care approach and social equity in access to health care can be seen as key determinants of this success. Nevertheless, there is still room for improvement, as over a third of patients did not have controlled hypertension.
Subject(s)
Antihypertensive Agents/therapeutic use , Blood Pressure/drug effects , Hypertension/drug therapy , Aged , Antihypertensive Agents/adverse effects , Cross-Sectional Studies , Cuba/epidemiology , Drug Therapy, Combination , Female , Humans , Hypertension/diagnosis , Hypertension/epidemiology , Hypertension/physiopathology , Male , Middle Aged , Prevalence , Registries , Time Factors , Treatment OutcomeABSTRACT
After 40 years of the Alma Ata Declaration on primary health care, the Pan American Journal of Public Health published an actualized overview of Cuban policies on health and well-being. It describes the longstanding and successful experience of this socialist country, developed in adverse and complex circumstances. The Cuban case remains one of the leading examples of a comprehensive governmental approach toward population health and well-being. The analysis underscores the essential role of continued political will toward population health.
Subject(s)
Delivery of Health Care/organization & administration , Politics , Universal Health Care , Cuba , Humans , Internationality , Noncommunicable Diseases/epidemiology , Primary Health Care/organization & administration , Research/organization & administrationABSTRACT
For decades, two opposing logics have dominated the health policy debate: a comprehensive health care approach, with the 1978 Alma Ata Declaration as its cornerstone, and a private competition logic, emphasizing the role of the private sector. We present this debate and its influence on international health policies in the context of changing global economic and sociopolitical power relations in the second half of the last century. The neoliberal approach is illustrated with Chile's health sector reform in the 1980s and the Colombian reform since 1993. The comprehensive "public logic" is shown through the social insurance models in Costa Rica and in Brazil and through the national public health systems in Cuba since 1959 and in Nicaragua during the 1980s. These experiences emphasize that health care systems do not naturally gravitate toward greater fairness and efficiency, but require deliberate policy decisions.
Subject(s)
Health Policy , Politics , Public Health , State Medicine/organization & administration , Health Care Reform , Humans , Internationality , Socioeconomic Factors , State Medicine/economics , State Medicine/legislation & jurisprudenceABSTRACT
Quantitative evaluations might be insufficient for measuring the impact of interventions promoting the right to health, particularly in their ability to contribute to a greater understanding of processes at the individual, community, and larger population level through which certain results are obtained. This paper discusses the application of a qualitative approach, the "most significant change" (MSC) methodology, in the Philippines, Palestine, the Democratic Republic of the Congo, and El Salvador between 2010 and 2013 by Third World Health Aid and its partner organizations. MSC is based on storytelling through which the central question--what changes occurred?--is developed in terms of, "who did what, when, why, and why was it important?" The approach focuses on personal stories that reflect on experiences of change for individuals over time. MSC implementation over several years allowed the organizations to observe significant change, as well as evolving types of change. Participants shifted their stories from "how the programs helped them" and "what they could do to help others benefit from the programs" to "what they could do to help their organizations." The MSC technique is useful as a complement to quantitative methods, as it is a slow, participatory, and intensive endeavor that builds capacity while being applied. This makes MSC a useful monitoring tool for programs with participatory and empowering objectives.
Subject(s)
Community Health Services , Health Promotion , Human Rights , Power, Psychological , Democratic Republic of the Congo , El Salvador , Humans , PhilippinesABSTRACT
Los determinantes sociales de la salud son las condiciones sociales en las cuales las personas que conforman una población determinada nacen, viven y trabajan. El presente artículo tiene el objetivo de documentar las evidencias actuales sobre las propuestas de intervención local para el estudio y manejo de los determinantes sociales de la salud de la población cubana. Desde una perspectiva estructural las variables de servicios de salud muestran diferencias entre territorios, asociadas básicamente a la existencia de un sistema de salud único con cobertura y acceso universal para toda la población. Se observan mayores diferenciales en el comportamiento de los llamados determinantes no médicos, como densidad poblacional, producción y circulación económica, mostrando estas diferencias un patrón geográfico. También se observan diferenciales en el comportamiento de la mortalidad materna y la hipertensión arterial entre territorios y en el tiempo. La productividad económica y las condiciones de vida están poco relacionadas con otros indicadores de resultados. Ante lo anteriormente expuesto se presenta una propuesta metodológica para el estudio y manejo de los determinantes sociales de la salud. Se requieren espacios de estudio de los determinantes sociales a nivel local, mediante técnicas multivariadas cuyos resultados aporten insumos para el diseño de intervenciones integrales basadas en los enfoques de planificación estratégica, acción intersectorial y participación social. Se impone insertar en la práctica del sistema de salud cubano un enfoque dirigido a trabajar más con los determinantes sociales de la salud, para lo cual se propone un modelo para el estudio e intervención local(AU)
Social determinants of health are the social conditions where members of a particular population are born, live and work. This article was aimed at documenting the current evidence on the proposed local intervention for the study and management of social determinants of health of the Cuban population. From a structural perspective, the health service variables show differences among the regions, mainly associated to the existence of a single health system with universal coverage and access for the entire population. Greatest differences are observed in the behavior of non-medical determinants such as population density, economic production and circulation, these differences showing a geographical pattern. Differentials are also observed in the behavior of maternal mortality and hypertension among regions and in the course of time. Economic productivity and living conditions are poorly related to other result indicators. Given the above-mentioned, a methodological proposal for the study and management of social determinants of health was presented. Some study spaces of local social determinants are required at local level through multivariate techniques whose results provide inputs for the design of integrated interventions, based on strategic planning approaches, intersectoral action and social involvement. Therefore, an approach to work more with the social determinants of health is required to be integrated into the Cuban health system. A model for local study and intervention were suggested in this paper in order to attain this goal(AU)
Subject(s)
Humans , Social Determinants of Health/ethics , CubaABSTRACT
Los determinantes sociales de la salud son las condiciones sociales en las cuales las personas que conforman una población determinada nacen, viven y trabajan. El presente artículo tiene el objetivo de documentar las evidencias actuales sobre las propuestas de intervención local para el estudio y manejo de los determinantes sociales de la salud de la población cubana. Desde una perspectiva estructural las variables de servicios de salud muestran diferencias entre territorios, asociadas básicamente a la existencia de un sistema de salud único con cobertura y acceso universal para toda la población. Se observan mayores diferenciales en el comportamiento de los llamados;determinantes no médicos, como densidad poblacional, producción y circulación económica, mostrando estas diferencias un patrón geográfico. También se observan diferenciales en el comportamiento de la mortalidad materna y la hipertensión arterial entre territorios y en el tiempo. La productividad económica y las condiciones de vida están poco relacionadas con otros indicadores de resultados. Ante lo anteriormente expuesto se presenta una propuesta metodológica para el estudio y manejo de los determinantes sociales de la salud. Se requieren espacios de estudio de los determinantes sociales a nivel local, mediante técnicas multivariadas cuyos resultados aporten insumos para el diseño de intervenciones integrales basadas en los enfoques de planificación estratégica, acción intersectorial y participación social. Se impone insertar en la práctica del sistema de salud cubano un enfoque dirigido a trabajar más con los determinantes sociales de la salud, para lo cual se propone un modelo para el estudio e intervención local(AU)
Social determinants of health are the social conditions where members of a particular population are born, live and work. This article was aimed at documenting the current evidence on the proposed local intervention for the study and management of social determinants of health of the Cuban population. From a structural perspective, the health service variables show differences among the regions, mainly associated to the existence of a single health system with universal coverage and access for the entire population. Greatest differences are observed in the behavior of non-medical determinants such as population density, economic production and circulation, these differences showing a geographical pattern. Differentials are also observed in the behavior of maternal mortality and hypertension among regions and in the course of time. Economic productivity and living conditions are poorly related to other result indicators. Given the above-mentioned, a methodological proposal for the study and management of social determinants of health was presented. Some study spaces of local social determinants are required at local level through multivariate techniques whose results provide inputs for the design of integrated interventions, based on strategic planning approaches, intersectoral action and social involvement. Therefore, an approach to work more with the social determinants of health is required to be integrated into the Cuban health system. A model for local study and intervention were suggested in this paper in order to attain this goal(AU)
Subject(s)
Humans , Health Status Disparities , Social Determinants of Health/ethics , Health Policy , Clinical Trial , CubaABSTRACT
Introducción: las categorías de sexo y género permiten analizar sus desigualdades sociales, influencia sobre la salud e inequidades derivadas de ellas. En Cuba, desde hace varios años, se aplica el modelo de medicina familiar en el nivel primario de atención con el fin de lograr equidad en los servicios de salud y el cual periódicamente se ha ido evaluando. Sin embargo, se desconocen las particularidades y la equidad en la utilización de lo servicios según el género, lo cual motivó la realización de este estudio. Objetivo: identificar inequidades de género en la utilización de los servicios del nivel primario de atención. Métodos: se hizo un estudio descriptivo de la utilización de las consultas ofertadas para las personas entre 20 y 59 años, residentes en los territorios atendidos por algunos consultorios de los policlínicos Felipe I. Rodríguez, Marcio Manduley y Enrique Barnet. Se calcularon números absolutos, porcentajes y tasas anuales por habitantes/personas/año por sexo, para el total y en cada policlínico. Resultados: las hembras tuvieron tasas mayores que los varones en todos los aspectos analizados, respectivamente, con cifras de aproximadamente 2,65 y 1,05 para las consultas; 0,90 y 0,40 para los terrenos; 0,88 y 0,39 para las consultas programadas; 1,42 y 0,58 para las actividades preventivas y 3,40 contra 1,38 para las prescripciones médicas. Sin embargo, en varios servicios las hembras tuvieron menores o iguales porcentajes de asignación o utilización que los varones, a pesar de tener mayores necesidades de dichos servicios. Consideraciones finales: las formas de utilización y la no asignación proporcional de los servicios, según las necesidades de cada sexo, originan inequidades de género. El sexo femenino está en desventaja por estas inequidades(AU)
Introduction: the categories of sex and gender make it possible to analyze their social inequalities, their influence upon health, and the inequities stemming from them. For several years now, the family medicine model has been applied in primary care in Cuba, with the purpose of achieving equity in health services. The model has been evaluated periodically. However, little is known about specific equity features in the use of services according to gender. This is the reason why the present study was undertaken. Objective: identify gender inequities in the use of primary health care services. Methods: a descriptive study was conducted of the use of consultations offered to persons aged 20-59 living in areas covered by consultation offices from the polyclinics Felipe I. Rodríguez, Marcio Manduley and Enrique Barnet. An estimation was made of absolute numbers, percentages and annual rates per inhabitant / person / year by sex, for the total sample and at each polyclinic. Results: females showed higher rates than males in all the aspects analyzed, with figures of approximately 2.65 and 1.05 respectively for consultations; 0.90 and 0.40 for field visits; 0.88 and 0.39 for scheduled consultations; 1.42 and 0.58 for prevention activities and 3.40 and 1.38 for medical prescriptions. However, in several services females had a lower or equal percentage of allotment or use, even though their need to use those services was greater. Final considerations: imbalance in the forms of use and the allotment of services between the sexes resulted in gender inequities. The female sex was at a disadvantage due to these inequities(AU)
Subject(s)
Health Status Disparities , Gender and Health , Sexism , Health Services Accessibility , Equity in Access to Health ServicesABSTRACT
Introducción: las categorías de sexo y género permiten analizar sus desigualdades sociales, influencia sobre la salud e inequidades derivadas de ellas. En Cuba, desde hace varios años, se aplica el modelo de medicina familiar en el nivel primario de atención con el fin de lograr equidad en los servicios de salud y el cual periódicamente se ha ido evaluando. Sin embargo, se desconocen las particularidades y la equidad en la utilización de lo servicios según el género, lo cual motivó la realización de este estudio. Objetivo: identificar inequidades de género en la utilización de los servicios del nivel primario de atención. Métodos: se hizo un estudio descriptivo de la utilización de las consultas ofertadas para las personas entre 20 y 59 años, residentes en los territorios atendidos por algunos consultorios de los policlínicos Felipe I. Rodríguez, Marcio Manduley y Enrique Barnet. Se calcularon números absolutos, porcentajes y tasas anuales por habitantes/personas/año por sexo, para el total y en cada policlínico. Resultados: las hembras tuvieron tasas mayores que los varones en todos los aspectos analizados, respectivamente, con cifras de aproximadamente 2,65 y 1,05 para las consultas; 0,90 y 0,40 para los terrenos; 0,88 y 0,39 para las consultas programadas; 1,42 y 0,58 para las actividades preventivas y 3,40 contra 1,38 para las prescripciones médicas. Sin embargo, en varios servicios las hembras tuvieron menores o iguales porcentajes de asignación o utilización que los varones, a pesar de tener mayores necesidades de dichos servicios. Consideraciones finales: las formas de utilización y la no asignación proporcional de los servicios, según las necesidades de cada sexo, originan inequidades de género. El sexo femenino está en desventaja por estas inequidades
Introduction: the categories of sex and gender make it possible to analyze their social inequalities, their influence upon health, and the inequities stemming from them. For several years now, the family medicine model has been applied in primary care in Cuba, with the purpose of achieving equity in health services. The model has been evaluated periodically. However, little is known about specific equity features in the use of services according to gender. This is the reason why the present study was undertaken. Objective: identify gender inequities in the use of primary health care services. Methods: a descriptive study was conducted of the use of consultations offered to persons aged 20-59 living in areas covered by consultation offices from the polyclinics Felipe I. Rodríguez, Marcio Manduley and Enrique Barnet. An estimation was made of absolute numbers, percentages and annual rates per inhabitant / person / year by sex, for the total sample and at each polyclinic. Results: females showed higher rates than males in all the aspects analyzed, with figures of approximately 2.65 and 1.05 respectively for consultations; 0.90 and 0.40 for field visits; 0.88 and 0.39 for scheduled consultations; 1.42 and 0.58 for prevention activities and 3.40 and 1.38 for medical prescriptions. However, in several services females had a lower or equal percentage of allotment or use, even though their need to use those services was greater. Final considerations: imbalance in the forms of use and the allotment of services between the sexes resulted in gender inequities. The female sex was at a disadvantage due to these inequities
Subject(s)
Gender and Health , Health Inequities , Health Services Accessibility , Sexism , Equity in Access to Health ServicesABSTRACT
For decades, two opposing logics dominate the health policy debate: A comprehensive health care approach, with the 1978 Alma Ata Declaration as its cornerstone, and private competition logic, emphasizing the role of the private sector. We present this debate and its influence on international health policies in the context of changing global economic and sociopolitical power relations. The neoliberal approach is illustrated with Chile's health sector reform in the 1980s and the Colombian reform since 1993. The comprehensive 'public logic' is shown through the social insurance models in Costa Rica and in Brazil, and through the national public health systems in Cuba since 1959, and in Nicaragua -during the 1980s. These experiences emphasize that health (care) systems do not naturally gravitate towards greater fairness and efficiency, but that they require deliberate policy decisions.
Subject(s)
Health Policy , Global Health , Health Policy/trends , Humans , Politics , Sociology , Time FactorsABSTRACT
Introducción: la participación comunitaria es un componente clave para mejorar la salud y permanentemente ha sido un pilar dentro del Sistema de Salud cubano, sin embargo no se ha garantizado totalmente la participación de líderes formales e informales comunitarios dentro de la planificación de salud y específicamente en la elaboración del Análisis de Situación de Salud (ASIS), lo cual limita el potencial de empoderamiento comunitario. Objetivo: proponer una metodología de planificación-implementación-evaluación de salud para incrementar la participación comunitaria y el empoderamiento a nivel local. Método: se propone la aplicación de la Metodología Integral Participativa de Planificación y Evaluación en Salud por sus siglas en Inglés CPPE (Comprehensive Participatory Planning and Evaluation) de uso internacional en proyectos de desarrollo, y adaptada al contexto cubano, para ser utilizada en los servicios de salud, partiendo de una fase piloto dentro de un proyecto de investigación-acción.Conclusiones: se propuso una metodología de planificación-implementación-evaluación de salud para incrementar la participación comunitaria y el empoderamiento a nivel local, donde se analizó el potencial que encierra para lograr sus propósitos. Si la implementación de la metodología fuera exitosa nosotros podríamos proponer su introducción y generalización dentro del sistema de salud, como una alternativa para la planificación en el trabajo conjunto de áreas de salud-consejos populares(AU)
Background: community participation is a key component to improve health and has permanently been a mainstay within the Cuban Health System; however, the participation of community formal and informal leaders within health planning, specifically, in the development of Health Situation Analysis (ASIS) was not guaranteed, which limits the potential of community empowerment. Objective: to propose a methodology for health planning, implementation and evaluation to increase community participation and local empowerment. Method: the application of the methodology of the Comprehensive Participatory Planning and Evaluation (CPEE), internationally used for development projects, is proposed and adapted to the Cuban context to be used in the health services, starting from a pilot phase within an action research project.Conclusions: a methodology for health planning, implementation and evaluation to increase community participation and local empowerment was proposed, which analyzed the potential for the achievement of its goals. If the implementation of the methodology were successful, we could propose its introduction and generalization within the health system as an alternative for the planning of group work in health areas and popular councils(AU)
Subject(s)
Community Health Planning , Community ParticipationABSTRACT
Introducción: la participación comunitaria y el empoderamiento son vistos como elementos importantes para mejorar la salud e incrementar la calidad de vida de las comunidades.Objetivos: presentar una dinámica participativa dentro de la planificación-implementación-evaluación en salud en contextos intervenidos y mostrar su potencial para incrementar la participación comunitaria y el empoderamiento a nivel local.Métodos: presentamos una investigación-acción participativa donde se utilizó la metodología participativa CPPE (Comprehensive Participatory Planning and Evaluation), adaptada al contexto cubano para la planificación-implementación-evaluación de intervenciones de salud. Durante el proceso participaron líderes de salud, líderes formales (intersectorialidad) y líderes informales de áreas de salud_consejos populares. Se realizaron talleres de planificación y/o evaluación_planificación y se implementaron intervenciones. Las fuentes de información fueron: la observación participante en los talleres, las relatorías y la evaluación de los talleres, algunas entrevistas a profundidad, los Reportes Estandarizados de los Estudios de Casos de la Metodología y los Reportes Estandarizados de los Estudios de Casos de la Implementación.Resultados: la implementación metodológica permitió mejorar el proceso de la toma de decisiones, tuvo gran aceptación y hubo un interés creciente por la sostenibilidad del proceso.Conclusiones: se evidenció el potencial de esta metodología para reforzar los procesos de participación-empoderamiento comunitarios en las comunidades intervenidas. En todas las localidades los diferentes tipos de líderes y gran parte de las comunidades pasaron de ser colaboradores en las intervenciones de salud, a constituirse en actores fundamentales en la toma de decisiones(AU)
Introduction: community participation and empowerment are seen as important elements to improve health and enhance the quality of life of communities.Objectives: submit a participatory in planning-implementation-evaluation in health contexts intervened and show its potential to increase community participation and local empowerment.Methods: present a participatory action research where the participatory methodology was used CPPE (Comprehensive Participatory Planning and Evaluation) adapted to the Cuban context for planning-implementation-evaluation of health interventions. During the process involved health leaders, formal leaders (intersectoral) and informal leaders of health areas - Councils. Planning workshops were held and / or assessment - planning and interventions were implemented. The sources of information were: participant observation in workshops, rapporteurs and evaluation of the workshops, in-depth interviews, the Case Studies of the methodology report and the Case Studies of the implementation reports.Results: the methodology implementation improved the decision-making process, the methodology was widely accepted, there was a growing interest in the sustainability of the process. Conclusions: the implementation methodology, favored the process of participation and empowerment within the target communities.In all locations the different types of leaders and much of the communities went from being partners in health interventions, to become key players in the decision-making(AU)
Subject(s)
Humans , Community-Based Participatory Research/methods , Evaluation of the Efficacy-Effectiveness of Interventions , CubaABSTRACT
La participación comunitaria es un componente clave para mejorar la salud y permanentemente ha sido un pilar dentro del Sistema de Salud cubano, sin embargo no se ha garantizado totalmente la participación de líderes formales e informales comunitarios dentro de la planificación de salud y específicamente en la elaboración del Análisis de Situación de Salud (ASIS), lo cual limita el potencial de empoderamiento comunitario. Objetivo: proponer una metodología de planificación-implementación-evaluación de salud para incrementar la participación comunitaria y el empoderamiento a nivel local. Método: se propone la aplicación de la Metodología Integral Participativa de Planificación y Evaluación en Salud por sus siglas en Inglés CPPE (Comprehensive Participatory Planning and Evaluation) de uso internacional en proyectos de desarrollo, y adaptada al contexto cubano, para ser utilizada en los servicios de salud, partiendo de una fase piloto dentro de un proyecto de investigación-acción.Conclusiones: se propuso una metodología de planificación-implementación-evaluación de salud para incrementar la participación comunitaria y el empoderamiento a nivel local, donde se analizó el potencial que encierra para lograr sus propósitos. Si la implementación de la metodología fuera exitosa nosotros podríamos proponer su introducción y generalización dentro del sistema de salud, como una alternativa para la planificación en el trabajo conjunto de áreas de salud-consejos populares...
Community participation is a key component to improve health and has permanently been a mainstay within the Cuban Health System; however, the participation of community formal and informal leaders within health planning, specifically, in the development of Health Situation Analysis (ASIS) was not guaranteed, which limits the potential of community empowerment. Objective: to propose a methodology for health planning, implementation and evaluation to increase community participation and local empowerment. Method: the application of the methodology of the Comprehensive Participatory Planning and Evaluation (CPEE), internationally used for development projects, is proposed and adapted to the Cuban context to be used in the health services, starting from a pilot phase within an action research project.Conclusions: a methodology for health planning, implementation and evaluation to increase community participation and local empowerment was proposed, which analyzed the potential for the achievement of its goals. If the implementation of the methodology were successful, we could propose its introduction and generalization within the health system as an alternative for the planning of group work in health areas and popular councils...
Subject(s)
Humans , Community Health Planning , Community ParticipationABSTRACT
La participación comunitaria y el empoderamiento son vistos como elementos importantes para mejorar la salud e incrementar la calidad de vida de las comunidades.Objetivos: presentar una dinámica participativa dentro de la planificación-implementación-evaluación en salud en contextos intervenidos y mostrar su potencial para incrementar la participación comunitaria y el empoderamiento a nivel local.Métodos: presentamos una investigación-acción participativa donde se utilizó la metodología participativa CPPE (Comprehensive Participatory Planning and Evaluation), adaptada al contexto cubano para la planificación-implementación-evaluación de intervenciones de salud. Durante el proceso participaron líderes de salud, líderes formales (intersectorialidad) y líderes informales de áreas de salud_consejos populares. Se realizaron talleres de planificación y/o evaluación_planificación y se implementaron intervenciones. Las fuentes de información fueron: la observación participante en los talleres, las relatorías y la evaluación de los talleres, algunas entrevistas a profundidad, los Reportes Estandarizados de los Estudios de Casos de la Metodología y los Reportes Estandarizados de los Estudios de Casos de la Implementación.Resultados: la implementación metodológica permitió mejorar el proceso de la toma de decisiones, tuvo gran aceptación y hubo un interés creciente por la sostenibilidad del proceso.Conclusiones: se evidenció el potencial de esta metodología para reforzar los procesos de participación-empoderamiento comunitarios en las comunidades intervenidas. En todas las localidades los diferentes tipos de líderes y gran parte de las comunidades pasaron de ser colaboradores en las intervenciones de salud, a constituirse en actores fundamentales en la toma de decisiones...
Community participation and empowerment are seen as important elements to improve health and enhance the quality of life of communities.Objectives: submit a participatory in planning-implementation-evaluation in health contexts intervened and show its potential to increase community participation and local empowerment.Methods: present a participatory action research where the participatory methodology was used CPPE (Comprehensive Participatory Planning and Evaluation) adapted to the Cuban context for planning-implementation-evaluation of health interventions. During the process involved health leaders, formal leaders (intersectoral) and informal leaders of health areas - Councils. Planning workshops were held and / or assessment - planning and interventions were implemented. The sources of information were: participant observation in workshops, rapporteurs and evaluation of the workshops, in-depth interviews, the Case Studies of the methodology report and the Case Studies of the implementation reports.Results: the methodology implementation improved the decision-making process, the methodology was widely accepted, there was a growing interest in the sustainability of the process. Conclusions: the implementation methodology, favored the process of participation and empowerment within the target communities.In all locations the different types of leaders and much of the communities went from being partners in health interventions, to become key players in the decision-making...
Subject(s)
Humans , Evaluation of the Efficacy-Effectiveness of Interventions , Community-Based Participatory Research/methods , CubaABSTRACT
Desde hace décadas, dos lógicas opuestas dominan el debate político de la salud: el enfoque de atención integral de salud, con la Declaración de Alma Ata de 1978 como piedra angular, y la lógica de la competencia privada, haciendo hincapié en el papel del sector privado. Presentamos este debate y su influencia en las políticas internacionales de salud en el contexto de las relaciones de poder económicas y sociopolíticas globales. Se ilustra el enfoque neoliberal de la reforma del sector salud de Chile en la década de 1980 y de la reforma colombiana desde 1993. La lógica pública integral se ilustra a través de los modelos de seguridad social en Costa Rica y en Brasil, y a través de los sistemas nacionales de salud pública en Cuba vigentes desde 1959, y en Nicaragua, durante la década de 1980. Estas experiencias ponen de relieve que los sistemas de salud no gravitan naturalmente hacia una mayor equidad y eficiencia, sino que requieren de decisiones políticas explícitas.
For decades, two opposing logics dominate the health policy debate: A comprehensive health care approach, with the 1978 Alma Ata Declaration as its cornerstone, and private competition logic, emphasizing the role of the private sector. We present this debate and its influence on international health policies in the context of changing global economic and sociopolitical power relations. The neoliberal approach is illustrated with Chile’s health sector reform in the 1980s and the Colombian reform since 1993. The comprehensive ‘public logic’ is shown through the social insurance models in Costa Rica and in Brazil, and through the national public health systems in Cuba since 1959, and in Nicaragua -during the 1980s. These experiences emphasize that health (care) systems do not naturally gravitate towards greater fairness and efficiency, but that they require deliberate policy decisions.
Subject(s)
Humans , Health Policy , Health Policy/trends , Politics , Sociology , Time Factors , Global HealthABSTRACT
La revolución científico-técnica ha contribuido al envejecimiento poblacional (mayor proporción de ancianos en la población), y ha impactado al sistema de salud con la utilización más frecuente de servicios, como los del nivel primario de atención, que a su vez no tienen el desarrollo necesario para enfrentar la demanda creciente y especializada de este grupo de edad. Para describir la utilización de los servicios del nivel primario de atención por los ancianos residentes en algunos de los consultorios de tres policlínicos del país durante el año 2006 se hizo un estudio descriptivo. Se calcularon números absolutos, razones de tasas y tasas anuales por habitantes/personas/año por sexo y para el total del grupo en estudio de cada policlínico. Las tasas de utilización fueron 1,22 y 3,53 respectivamente para terrenos y consultas. Los indicadores mostraron diferencias en la organización, calidad y tipo de los servicios brindados entre uno y otro policlínico. El policlínico Marcio Manduley tuvo las mayores tasas de utilización (6,00 contra 2,27, respectivamente) para consultas y terrenos; 2,54 contra 6,22 para consultas programadas/no programadas; 8,46 contra 0,31 para prescripciones médicas hechas Sí/No y 4,48 contra 4,49 para actividades preventivas indicadas Sí/No. El Policlínico Felipe J. Rodríguez tuvo los indicadores más bajos. Se concluye que la organización del trabajo en los policlínicos repercutió sobre la utilización de los servicios en el nivel primario de atención, como la calidad y el tipo de servicios brindados, y estas diferencias entre policlínicos podrían constituir inequidades en el acceso a estos servicios por los ancianos
The scientific and technological revolution has contributed to population aging (higher proportion of elderly in the population), and it has impact on the health system since it is more frequent the use of primary health care services, which, in turn, does not have the necessary development to meet this growing and specialized demand for this age group. A descriptive study was conducted to describe the use of primary health care services by the elderly residents in some of Cuban medical practices in 2006. Absolute numbers, rate ratios and annual rates per capita/person/year by sex were calculated for the total study group at each clinic. Utilization rates were 1.22 and 3.53 respectively for territory and medical practices. The indicators showed differences in organization, quality, and type of services provided between these medical practices. Marcio Manduley clinic had the highest rates of use -6.00 versus 2.27, respectively, for medical practices and territory; 2.54 versus 6.22 for consultations scheduled/unscheduled, 8.46 versus 0.31 for Yes/No medical prescriptions performed and 4.48 versus 4.49 for Yes/No indicated prevention activities. On the other hand, Felipe J. Rodríguez Polyclinic had the lowest indicators. We conclude that the work organization in polyclinics has impact on the use of primary health care services, quality and type of services provided, and these differences could between polyclinics could be inequities in the access to these services by elderly
