Manual de organización y funciones de la Unidad de Cumplimiento / Organization and functions manual of the Compliance Unit

El presente manual describe los objetivos, misión, visión, funciones, organigrama, así como las relaciones de trabajo internas y externas, de la Unidad de Cumplimiento, el cual tiene como propósito desarrollar de forma eficiente, eficaz, efectiva y transparente la gestión administrativa

This manual describes the objectives, mission, vision, functions, organizational chart, as well as internal and external work relationships, of the Compliance Unit, which aims to develop administrative management efficiently, efficiently, effectively and transparently

Manual de organización y funciones de la Dirección del Sistema de Emergencias Médicas / Organization and functions manual of the Management System Medical Emergencies

El presente manual de organización y funciones, fue adecuado como un instrumento técnico que permita agilizar los procesos institucionales, evitando la duplicidad de funciones, delimitando las responsabilidades y estableciendo los canales de comunicación e información, contribuyendo además a la transparencia en la rendición de cuentas. Así como también, detalla la dependencia jerárquica, objetivos, estructura interna, funciones y relaciones de trabajo, asignadas a cada una de las unidades organizativas que conforman la Dirección del Sistema de Emergencias Médicas. Además, el manual permite el eficiente y oportuno desarrollo de todas las actividades que realizan las unidades que conforman la Dirección, así como el desarrollo de sus funciones de manera integrada, eficiente y oportuna

This organization and functions manual was suitable as a technical instrument that allows streamlining institutional processes, avoiding duplication of functions, delimiting responsibilities and establishing communication and information channels, also contributing to transparency in accountability. As well as, it details the hierarchical dependency, objectives, internal structure, functions and work relationships, assigned to each of the organizational units that make up the Directorate of the Medical Emergency System. Furthermore, the manual allows the efficient and timely development of all the activities carried out by the units that make up the Directorate, as well as the development of their functions in an integrated, efficient and timely manner

Ruta de trabajo para adecuación de la normativa técnica, Ley Crecer Juntos / Work route for adaptation of the technical regulations, Grow Together Law

El objetivo de la ruta es establecer las pautas formales, respecto a la atención integral en salud en las niñas, niños y adolescentes, ayudando a optimizar las acciones, disminuir costos, incrementar la satisfacción de los usuarios, así como mejorar la productividad y competitividad del personal de salud. En razón de lo anterior presentamos la ruta de trabajo, para la adecuación de la normativa técnica, producto del trabajo de las diferentes dependencias vinculadas directa e indirectamente a la atención en salud a niñas, niños y adolescentes

The objective of the route is to establish formal guidelines regarding comprehensive health care in the girls, boys and adolescents, helping to optimize actions, reduce costs, increase user satisfaction, as well as improving the productivity and competitiveness of health personnel. Due to the above, we present the work route, for the adaptation of the technical regulations, product of the work of the different agencies linked directly and indirectly to care in health for girls, boys and adolescents

Norma técnica de terapia respiratoria / Respiratory therapy technical standard

La presente norma técnica tiene por objeto establecer las disposiciones técnicas para regular las actividades relacionadas a la prestación de servicios de terapia respiratoria en los distintos establecimientos del Sistema Nacional Integrado de Salud

The purpose of this technical standard is to establish the technical provisions to regulate activities related to the provision of respiratory therapy services in the different establishments of the National Integrated Health System.

Lineamientos técnicos para el proceso de ingreso al internado rotatorio y año social 2025 / Technical guidelines for the admission process to the rotating boarding school and social year 2025

Los presentes Lineamientos detallan las pautas necesarias para realizar el proceso de ingreso al internado rotativo y año social para el 2025

These Guidelines detail the necessary guidelines to carry out the admission process to the rotating boarding school and social year for 2025

Lineamientos técnicos de vigilancia centinela / Technical guidelines for sentinel surveillance

La vigilancia centinela incluye una amplia gama de actividades, dirigidas a conocer la evolución de determinados problemas de salud en la población general o en grupos específicos, para ello, intenta obtener una medida de la frecuencia de los eventos en el país, sin tener que acudir a encuestas amplias y costosas. El propósito fundamental de este tipo de vigilancia es obtener información puntual y de interés para la salud pública con un menor costo. El presente documento establece las actividades y roles de los equipos de vigilancia centinela, además los objetivos, sitios centinela, definición de caso, pasos para la vigilancia, datos necesarios para el análisis, flujograma, análisis de datos y procedimiento de laboratorio para la vigilancia centinela de rotavirus, neumonías y meningitis bacteriana, virus influenza y otros virus respiratorios

Sentinel surveillance includes a wide range of activities, aimed at knowing the evolution of certain health problems in the general population or in specific groups; to do so, it attempts to obtain a measure of the frequency of events in the country, without having to go to extensive and expensive surveys. The fundamental purpose of this type of surveillance is to obtain timely information of interest to public health at a lower cost. This document establishes the activities and roles of the sentinel surveillance teams, as well as the objectives, sentinel sites, case definition, steps for surveillance, data necessary for analysis, flowchart, data analysis and laboratory procedure for sentinel surveillance. rotavirus, pneumonia and bacterial meningitis, influenza virus and other respiratory viruses

Manual de organización y funciones de la Dirección de Monitoreo Estratégico de Servicios de Salud / Manual of organization and functions of the Directorate of Strategic Monitoring of Health Services

Las funciones de monitoreo a los servicios de salud, se ven fortalecidas por los sistemas de información en salud, en ese sentido el exitoso avance y consolidación del Sistema Integrado de Salud, la conectividad y funcionalidad del 98% de los establecimientos de salud del Ministerio, permiten ahora continuar con las siguientes etapas del proceso buscando la edificación, expansión, mantenimiento y mejora con el objeto de consolidar la gestión de la información como pieza clave en los procesos de evaluación, monitoreo y toma de decisiones. La Dirección de Monitoreo Estratégico de Servicios de Salud, es partícipe directa en el proceso de planificación, implementación, monitoreo, evaluación y seguimiento del Sistema Integrado de Salud y apuesta por su fortalecimiento como una herramienta efectiva y ágil para la ejecución del monitoreo estratégico

The monitoring functions of health services are strengthened by health information systems, in that sense the successful advancement and consolidation of the Integrated Health System, the connectivity and functionality of 98% of the Ministry's health facilities, They now allow us to continue with the next stages of the process seeking construction, expansion, maintenance and improvement in order to consolidate information management as a key piece in the evaluation, monitoring and decision-making processes. The Directorate of Strategic Monitoring of Health Services is a direct participant in the process of planning, implementation, monitoring, evaluation and follow-up of the Integrated Health System and is committed to its strengthening as an effective and agile tool for the execution of strategic monitoring

Replication guide. Applying the human security approach to advance an integrated response to health and migration in El Salvador, Guatemala, Honduras, and Mexico

In 2022, the program on Applying the Human Security Approach to Advance an integrated response to Health and Migration in the Northern Triangle of Central America and Mexico was jointly launched by the Pan American Health Organization/World Health Organization (PAHO/WHO) and the International Organization for Migration (IOM). The program grant was sponsored by the United Nations Trust Fund for Human Security (UNTFHS). Among its main goals was the intention of raising awareness of the human security approach and how it can be used as a successful operational tool to advance universal access to health and universal health coverage, as well as the Sustainable Development Goals (SDGs), by contextualizing the added value of human security to health and migration in the four countries in which it was implemented: El Salvador, Guatemala, Honduras, and Mexico. Sustainability and replicability of the program were specifically integrated in the program’s design to promote continuity and scale-up of the activities, ensuring that knowledge obtained on the ground be disseminated and used to mainstream the human security approach throughout the region and beyond. This guide is part of those activities to facilitate the process of further replicating the program and its outcomes, taking into consideration lessons learned through its implementation also this publication is crucial in promoting the human security approach as an operational tool in health and migration, demonstrating its effectiveness in improving universal health access and advancing the SDGs. It also provides a practical guide for replicating the program in other regions, ensuring the sustainability and expansion of its benefits.

Edentulism and quality of life in the Salvadoran population: a cross-sectional study.

INTRODUCTION: Edentulism is the partial or total loss of teeth, it is irreversible and disabling due to its sequelae in the masticatory, phonetic and aesthetic function that affect the quality of life. OBJECTIVE: To establish the impact of edentulism and sociodemographic factors on the quality of life of the Salvadoran population. MATERIALS AND METHODS: Secondary cross-sectional analysis of data in 3322 users of the Public Health System of El Salvador, aged 15 to > 60 years. The variables under study were sociodemographic, edentulismo and quality of life. Edentulism was determined by clinical examination using the Oral Impact on Daily Performance scale. The statistical analysis was performed using χ2, OR, multiple regression analysis and set the significance threshold at p < 0.05. RESULTS: Partial edentulism in the upper jaw was present in 68.24% people, partial edentulism in the lower jaw was present in 72.42% people and complete edentulism was observed in 2.02% people. There were significant sex differences and a relationship between sex and quality of life (p < 0.004); the self-perception of severe/very severe impacts was greater in women. People without education or with primary or secondary education only were the most affected (p < 0.05). Tooth loss increases with age, affecting quality of life in a severe/very severe manner. Complete edentulism had greater impacts on quality of life in terms of eating (25.64%), speaking (21.15%), and socializing/enjoying contact with people (10.90%). A severe/very severe impact on quality of life of teeth lost was reported mainly by those over 60 years of age, with an average of 11 missing posterior teeth, 6 missing anterior teeth and 13 missing teeth per patient. Those missing up to 6 anterior teeth were times more likely to perceive severe/very severe impacts on quality of life than those without any missing teeth (OR:5.788). Edentulism affected the quality of life of those examined, especially the loss of upper anterior teeth.

Do behavioral drivers matter for healthcare decision-making during crises? A study of low-income women in El Salvador during the COVID-19 pandemic.

Understanding health-seeking behaviors and their drivers is key for governments to manage health policies. A growing body of research explores the role of cognitive biases and heuristics in health and care-seeking behaviors, but little is known about how a context of heightened anxiety and uncertainty might influence these behavioral drivers. This study analyzes the association between four behavioral predictors-internal locus of control, impatience, optimism bias, and aspirations-and healthcare decisions among low-income women in El Salvador, controlling for other factors. We find positive associations between internal locus of control and preventive health behaviors during the COVID-19 pandemic. For instance, a one standard deviation increase in locus of control is associated with a 10% increase in an index measuring the use of masks, distancing, hand washing, and vaccination. Locus of control was also associated with women's use of preventive health services (one standard deviation improves the likelihood of having a hypertension test in the last six months by 5.8 percentage points). In a sub-sample of mothers, we find significant relationships between the four behavioral drivers and the decisions the mothers make for their children. However, we find these associations are less robust compared to the decisions they make for themselves. Some associations were stronger during the pandemic, suggesting that feelings of uncertainty and stress could amplify behavioral drivers' influence on health-related behaviors. This novel finding is relevant for designing policy responses for future shocks. JEL CODES: I12, D10, D91, I30.

Lineamientos técnicos de radiología e imágenes en el Primer Nivel de Atención / Technical guidelines for radiology and images in the First Level of Care

Los presentes lineamientos técnicos contienen las directrices para la regulación y estandarización de los procesos de atención en la realización de estudios radiológicos con base en las especificaciones técnicas de los equipos de rayos X portátiles, adquiridos para los establecimientos del Primer Nivel de Atención, incluye además los aspectos relacionados con la calidad, seguridad y eficacia, indicaciones, contraindicaciones y el flujograma de atención para la toma de imágenes

These technical guidelines contain the guidelines for the regulation and standardization of care processes in the performance of radiological studies based on the technical specifications of portable X-ray equipment, acquired for First Level Care establishments, and also includes the aspects related to quality, safety and efficacy, indications, contraindications and the care flow chart for image taking

Protocolos para la interpretación de pruebas de bienestar fetal ante parto e intraparto / Protocols for the interpretation of fetal well-being tests before delivery and intrapartum

Los presentes protocolos contiene las disposiciones para la realización de las pruebas de bienestar fetal ante e intraparto con el objetivo de prevenir la hipoxia fetal aguda en los establecimientos de atención del Sistema Nacional Integrado de Salud (SNIS) tanto en el Primer Nivel de Atención, como a nivel hospitalario, cuenta además con las disposiciones para realizar el monitoreo, supervisión y evaluación en los diferentes niveles de atención y de esta forma ayudar a disminuir la mortalidad infantil

These protocols contain the provisions for carrying out prenatal and intrapartum fetal well-being tests with the objective of preventing acute fetal hypoxia in the care facilities of the National Integrated Health System (SNIS) both at the First Level of Care and At the hospital level, it also has the provisions to carry out monitoring, supervision and evaluation at different levels of care and in this way help reduce infant mortality

Manual de procedimientos básicos de enfermería / Basic Nursing Procedures Manual

El presente manual de procedimientos, documenta las principales actividades de atención integral que ofrece el personal de enfermería, como parte del proceso de atención en salud, describe el cuidado y atenciones que se ofrecen a la persona en los establecimientos de salud, mediante el enfoque por procesos institucional. Este enfoque fomenta el desarrollo organizacional y el mejoramiento continuo para cumplir la misión del Ministerio de Salud

This manual of procedures documents the main activities of comprehensive care offered by nursing staff as part of the health care process. It describes the care and attention offered to people in health facilities, using the institutional process approach. This approach promotes organizational development and continuous improvement to fulfill the mission of the Ministry of Health

Degradation as salvation: Reflections on El Salvador's punitive prison model.

The pictures of shaven men with naked upper bodies, sitting in rows back-to-back with fellow prisoners in close proximity, sur-rounded by heavily armed guards, encapsulates the essence of El Salvador's ongoing "war on gangs".

A Case of Chagas Disease in South Dakota: Diagnosis and Treatment.

Chagas disease is a chronic, systemic parasitic infection caused by the protozoan Trypanosoma cruzi. The primary mode of transmission to humans is by the Reduviid insect, endemic to South America. Recent migration of the vector has led to increased cases in the southern United States and has prompted increased surveillance and blood donation screening. It is unusual to diagnose and treat individuals with Chagas disease in the northern United States. This case describes an immigrant female from El Salvador that was informed she had Chagas disease from a blood bank screening. Confirmation and treatment of the disease were performed by her South Dakota primary care provider thus demonstrating the importance of identifying Chagas disease in the immigrant population in regions where Chagas disease infection is uncommon.

Surgical outreach for the Americas: a self-sustainable model for partnership and education.

INTRODUCTION: It is estimated that up to 28% of global disease burden is surgical with hernias representing a unique challenge as the only definitive treatment is surgery. Surgical Outreach for the Americas (SOfA) is a nongovernmental organization focused primarily on alleviating the disease burden of inguinal and umbilical hernias in Central America. We present the experience of SOfA, a model focused on partnership and education. METHODS: SOfA was established in 2009 to help individuals recover from ailments that are obstacles to working and independent living. Over the past 15 years, SOfA has partnered with local healthcare providers in the Dominican Republic, El Salvador, Honduras, and Belize. The SOfA team consists of surgeons, surgery residents, triage physicians, an anesthesiologist, anesthetists, operating room nurses, recovery nurses, a pediatric critical care physician, sterile processing technicians, interpreters, and a team coordinator. Critical partnerships required include the CMO, internal medicine, general surgery, nursing, rural health coordinators and surgical training programs at public hospitals. RESULTS: SOfA has completed 24 trips, performing 2074 procedures on 1792 patients. 71.4% of procedures were hernia repairs. To enhance sustainability of healthcare delivery, SOfA has partnered with the local facilities through capital improvements to include OR tables, OR lights, anesthesia machines, monitors, hospital beds, stretchers, sterilizers, air conditioning units, and electrosurgical generators. A lecture series and curriculum on perioperative care, anesthesia, anatomy, and operative technique is delivered. Local surgery residents and medical students participated in patient care, learning alongside SOfA teammates. Recently, SOfA has partnered with SAGES Global Affairs Committee to implement a virtual Global Laparoscopic Advancement Program, a simulation-based laparoscopic training curriculum for surgeons in El Salvador. CONCLUSION: A sustainable partnership to facilitate surgical care in low resource settings requires longitudinal, collaborative relationships, and investments in capital improvements, education, and partnership with local healthcare providers, institutions, and training programs.

Lineamientos técnicos para la prevención y control de las enfermedades inmunoprevenibles / Technical guidelines for the prevention and control of vaccine-preventable diseases

En los presentes lineamientos técnicos se describen cada una de las enfermedades definidas, los aspectos epidemiológicos, la respuesta de los servicios, apoyo del laboratorio, coordinaciones, flujo de la información, análisis de la misma, medidas de control a implementar, indicadores y la evaluación del sistema de vigilancia, así como toda la información referente a las vacunas específicas incluidas en el Esquema Nacional de Vacunación del Sistema Nacional Integrado de Salud (SNIS), para que se constituya en la herramienta que apoye al personal de los servicios en la prevención y control de las enfermedades inmunoprevenibles

These technical guidelines describe each of the defined diseases, the epidemiological aspects, the response of the services, laboratory support, coordination, flow of information, analysis of the same, control measures to be implemented, indicators and evaluation. of the surveillance system, as well as all the information regarding the specific vaccines included in the National Vaccination Scheme of the National Integrated Health System (SNIS), so that it becomes the tool that supports service personnel in prevention and control of vaccine-preventable diseases

Un caso de Chagas agudo en edad pediátrica / Acute Vector-transmitted Chagas in Pediatric Age. A Case Reportt

Presentación del caso. Se trata una niña de siete años de edad, originaria de una zona rural del departamento de San Miguel, quién consultó por presentar fiebre y edema bipalpebral derecho indoloro, de seis semanas de evolución, sin otros síntomas acompañantes. El estudio para el diagnóstico de enfermedad de Chagas fue realizado en una clínica privada; la Inmunoglobulina M para Chagas tuvo un resultado positivo, luego, se realizó la microscopía directa mediante gota al fresco y técnica de Strout con resultado negativo. En las intervenciones comunitarias se identificó la presencia del vector y la positividad del mismo, así como el diagnóstico de un caso crónico en otro miembro de la familia. Intervención terapéutica. Se indicó tratamiento con nifurtimox 150 mg cada ocho horas por 60 días y se realizó el seguimiento clínico de la evolución y control de efectos secundarios del tratamiento y exámenes de laboratorio. Evolución clínica. Evolucionó con leve disminución del apetito, se manejó con protectores gástricos. El concentrado de Strout y la gota al fresco resultaron negativos y los demás exámenes de laboratorio se mantenían en los rangos normales.

Case presentation. A seven-year-old female patient, with no previous medical history, originally from a rural area of the department of San Miguel, who presented febrile process plus long-term right bipalpebral edema of six weeks of evolution, without accompanying symptoms. Immunoglobulin M for Chagas was positive, direct microscopy by fresh drop and Strout technique was performed with negative results. In community interventions, the presence of the vector and its positivity were identified, as well as the diagnosis of a chronic case in another family member. Treatment. The patient was treated with nifurtimox 150 mg every eight hours for 60 days, subsequent controls were performed to investigate side effects of the treatment, and control tests. Outcome. With the treatment, the patient evolved with a slight decrease in appetite, and was managed with gastric protectors. Strout's concentrate and fresh gout were negative and the other laboratory tests were within normal ranges.

Metástasis hepática metacrónica de un tumor sólido pseudopapilar de páncreas / Metachronous liver metastasis from a solid pseudopapillary pancreas tumor

Presentación del caso. Se trata de una mujer de 32 años quien consultó por dolor abdominal en el epigastrio no asociado a las comidas, tenía el antecedente de una pancreatectomía distal con preservación de bazo debido a un tumor en la cola del páncreas, cinco años previos. En el examen físico no presentó ninguna anormalidad y durante su abordaje se realizaron estudios de imagen. Intervención terapéutica. La tomografía axial computarizada evidenció una lesión en el segmento lateral izquierdo del hígado con características sugestivas de metástasis debido a su antecedente quirúrgico. Los exámenes de laboratorio y marcadores tumorales se encontraron dentro de límites normales. Se evaluó en conferencia multidisciplinaria y se recomendó un abordaje quirúrgico. Se realizó una hepatectomía izquierda con una evolución posquirúrgica sin complicaciones. Evolución clínica. Luego de seis meses posoperatorios, se encontraba sin evidencia de enfermedad activa o residual

Case presentation. A 32-year-old woman consulted for abdominal pain in the epigastrium not associated with meals. She had a history of distal pancreatectomy with spleen preservation due to a tumor in the tail of the pancreas five years earlier. Physical examination showed no abnormalities and imaging studies were performed during his approach. Treatment. Computed axial tomography revealed a lesion in the left lateral segment of the liver with characteristics suggestive of metastasis due to his surgical history. Laboratory tests and tumor markers were within normal limits. It was evaluated in a multidisciplinary conference, and a surgical approach was recommended. A left hepatectomy was performed with an uncomplicated postoperative evolution. Outcome. Six months postoperatively, there was no evidence of active or residual disease

Fístula carótido-cavernosa con hipertensión ocular secundaria: reporte de caso / Carotid-cavernous fistula with secondary ocular hypertension. A case report

Presentación del caso. Paciente femenina de 62 años con una historia de diez meses de dolor ocular pulsátil, proptosis e inyección conjuntival en el ojo izquierdo; posteriormente presentó un edema palpebral superior izquierdo. Se evaluó con mejor agudeza visual corregida de 20/30 en dicho ojo y presión intraocular de 30 mmHg. Intervención terapéutica.Resonancia magnética nuclear de órbitas evidencia proptosis y dilatación de vena oftálmica superior izquierda, por lo que se diagnosticó como defecto del drenaje venoso e hipertensión ocular del ojo izquierdo. Inició tratamiento hipotensor tópico de ojo izquierdo; estudios de imagen angiotomografía de órbitas y ultrasonido doppler de ojo izquierdo, con énfasis en párpado superior, evidencian fístula carótido-cavernosa izquierda de alto gasto. Se realizó angiografía cerebral diagnóstica y terapéutica con embolización de fístula en arterias meníngea media y faríngea ascendente con ausencia de flujo por dichas ramas después de la intervención. Evolución clínica. Presentó una evaluación clínica favorable, conservando agudeza visual y presión intraocular dentro de valores normales en ojo izquierdo, con evidente disminución de congestión venosa epiescleral, edema de párpado superior y ausencia de proptosis izquierda. Ultrasonido doppler control de párpado superior izquierdo con disminución de flujo venoso a valores normales

Case presentation. 62 years old female with ten months history of ocular pain, proptosis, and conjunctival hyperemia in left eye, developing swollen upper eyelid. Best corrected visual acuity was 20/30 in her left eye, with and intraocular pressure of 30 mmHg. Treatment. Nuclear magnetic resonance of the orbits showed proptosis and dilated superior ophthalmic vein. Initial diagnosis. Abnormal venous drainage and ocular hypertension in the left eye. Topical hypotensive treatment of the left eye was initiated with ocular hypotensive eyedrops. Angiotomography of the orbit and left eye Doppler ultrasound, with upper eyelid emphasis, gave visualization of high flow carotid-cavernous fistula. Cerebral diagnostic and therapeutic angiography with embolization of the fistula in middle meningeal and ascending pharyngeal arteries showed no vascular flow after the procedure. Outcome. Positive clinical outcome, with corrected visual acuity conserved and normal eye pressure. Notable relief of ocular congestion and swollen upper eyelid with no proptosis in the left eye. Doppler ultrasound in the upper eyelid showed normal flow rate measurement.