COVID-19 Disruption To Routine Health Care Services: How 8 Latin American And Caribbean Countries Responded.

Latin America and the Caribbean was one of the regions hardest hit globally by SARS-CoV-2. This qualitative exploratory study examined how the COVID-19 pandemic disrupted the delivery of routine health services from the perspective of health care system decision makers and managers. Between May and December 2022, we conducted forty-two semistructured interviews with decision makers from ministries of health and health care managers with responsibilities during the COVID-19 pandemic in eight countries in Latin America and the Caribbean. On the basis of these interviews, we identified themes in three domains: impacts on the provision of routine health services, including postponed and forgone primary care and hospital services; barriers to maintaining routine health services due to preexisting structural health care system weaknesses and difficulties attributed to the pandemic; and innovative strategies to sustain and recover services such as public-private financing and coordination, telemedicine, and new roles for primary care. In the short term, policy efforts should focus on recovering postponed services, including those for noncommunicable diseases. Medium- and long-term health care system reforms should strengthen primary care and address structural issues, such as fragmentation, to promote more resilient health care systems.

Condiciones de trabajo en consultorios adyacentes a farmacias privadas en Ciudad de México: perspectiva del personal médico / Working conditions in outpatient clinics adjacent to private pharmacies in Mexico City: perspective of physicians

Objetivo: Analizar, desde la perspectiva del personal médico, las condiciones laborales de los consultorios adyacentes a farmacias privadas (CAF), así como sus elementos organizativos. Método: Estudio cualitativo exploratorio consistente en entrevistas semiestructuradas a 32 médicos/as de los CAF en Ciudad de México. Se utilizó la técnica de análisis de contenido dirigido basado en códigos previamente construidos y emergentes, relacionados con la experiencia vivida de los sujetos en su campo laboral. Resultados: El personal médico percibió que trabajar en los CAF no cumple con sus expectativas profesionales por la baja remuneración, la informalidad en la contratación y la ausencia de garantías laborales establecidas en la ley. Esto les impide disfrutar de los beneficios asociados con el empleo formal y sustenta el deseo de laborar en los CAF solo de manera temporal. Consideraron que los incentivos económicos por número de consultas, procedimientos y ventas alcanzadas por la farmacia les permiten aumentar su ingreso sin influir en su conducta prescriptiva. Señalaron que los sistemas de supervisión y presión en los CAF buscan afectar su autonomía para activar la venta de medicamentos en la farmacia. Conclusiones: El personal médico que labora en CAF enfrenta una difícil situación laboral. Los elementos gerenciales usados para inducir la prescripción y activar las ventas de las farmacias conforman un entorno laboral que genera retos en materia de regulación, y subraya la necesidad de monitorear la calidad de los servicios brindados en estos consultorios y los posibles riesgos a los usuarios (AU)

Objective: To analyse the working conditions of physicians in outpatient clinics adjacent to pharmacies (CAFs) and their organizational elements from their own perspective. Methods: We carried out an exploratory qualitative study. Semi-structured interviews were conducted with 32 CAF physicians in Mexico City. A directed content analysis technique was used based on previously built and emerging codes which were related to the experience of the subjects in their work. Results: Respondents perceive that work in CAFs does not meet professional expectations due to low pay, informality in the recruitment process and the absence of minimum labour guarantees. This prevents them from enjoying the benefits associated with formal employment, and sustains their desire to work in CAF only temporarily. They believe that economic incentives related to number of consultations, procedures and sales attained by the pharmacy allow them to increase their income without influencing their prescriptive behaviour. They express that the monitoring systems and pressure exerted on CAFs seek to affect their autonomy, pushing them to enhance the sales of medicines in the pharmacy. Conclusions: Physicians working in CAFs face a difficult employment situation. The managerial elements used to induce prescription and enhance pharmacy sales create a work environment that generates challenges for regulation and underlines the need to monitor the services provided at these clinics and the possible risk for users (AU)

[Working conditions in outpatient clinics adjacent to private pharmacies in Mexico City: perspective of physicians]. / Condiciones de trabajo en consultorios adyacentes a farmacias privadas en Ciudad de México: perspectiva del personal médico.

OBJECTIVE: To analyse the working conditions of physicians in outpatient clinics adjacent to pharmacies (CAFs) and their organizational elements from their own perspective. METHODS: We carried out an exploratory qualitative study. Semi-structured interviews were conducted with 32 CAF physicians in Mexico City. A directed content analysis technique was used based on previously built and emerging codes which were related to the experience of the subjects in their work. RESULTS: Respondents perceive that work in CAFs does not meet professional expectations due to low pay, informality in the recruitment process and the absence of minimum labour guarantees. This prevents them from enjoying the benefits associated with formal employment, and sustains their desire to work in CAF only temporarily. They believe that economic incentives related to number of consultations, procedures and sales attained by the pharmacy allow them to increase their income without influencing their prescriptive behaviour. They express that the monitoring systems and pressure exerted on CAFs seek to affect their autonomy, pushing them to enhance the sales of medicines in the pharmacy. CONCLUSIONS: Physicians working in CAFs face a difficult employment situation. The managerial elements used to induce prescription and enhance pharmacy sales create a work environment that generates challenges for regulation and underlines the need to monitor the services provided at these clinics and the possible risk for users.

[Clinics adjacent to private pharmacies in Mexico: infrastructure and characteristics of the physicians and their remuneration]. / Consultorios adyacentes a farmacias privadas en México: infraestructura y características del personal médico y su remuneración.

OBJECTIVE: To analyze and compare the physicians' characteristics, their remuneration, the compliance with regulation and the services offered between clinics adjacent to pharmacies (CAF) and independent medical clinics (CMI). MATERIALS AND METHODS: Questionnaire applied to 239 physicians in 18 states including the Federal District, in Mexico in 2012. RESULTS: Physicians in CAF had less professional experience (5 versus 12 years), less postgraduate studies (61.2 versus 81.8%) and lower average monthly salaries (USD 418 versus USD 672) than their peers in CMI. In CAF there was less compliance in relation to medical record keeping and prescribing. CONCLUSIONS: The employment situation of physicians in CAF is more precarious than in CMI. It is necessary to strengthen the enforcement of existing regulations and develop policies according to the monitoring of its performance, particularly, but not exclusively, in CAF.

Consultorios adyacentes a farmacias privadas en México: infraestructura y características del personal médico y su remuneración / Clinics adjacent to private pharmacies in Mexico: infrastructure and characteristics of the physicians and their remuneration

Objetivo. Analizar las características del personal médico y su remuneración, así como la infraestructura, apego a la regulación y servicios ofrecidos en consultorios adyacentes a farmacias (CAF), y compararlos con consultorios médicos independientes (CMI). Material y métodos. Cuestionario aplicado a 239 médicos generales en 18 entidades federativas, incluido el Distrito Federal, en México en 2012. Resultados. Los médicos en CAF tenían menor experiencia profesional (5 vs 12 años), menos estudios de posgrado (61.2% vs 81.8%) y menor salario base promedio mensual (MXN 5500 vs MXN 8500) que en CMI. En CAF hubo menor cumplimiento de la regulación en relación con la historia clínica y la receta médica. Conclusiones. Los aspectos laborales explorados de médicos en CAF son más precarios que en CMI. Es necesario fortalecer la aplicación de la regulación vigente para consultorios y generar políticas a partir del monitoreo de su funcionamiento, particularmente, pero no de forma exclusiva, en CAF.

Objective. To analyze and compare the physicians' characteristics, their remuneration, the compliance with regulation and the services offered between clinics adjacent to pharmacies (CAF) and independent medical clinics (CMI). Materials and methods. Questionnaire applied to 239 physicians in 18 states including the Federal District, in Mexico in 2012. Results. Physicians in CAF had less professional experience (5 versus 12 years), less postgraduate studies (61.2 versus 81.8%) and lower average monthly salaries (USD 418 versus USD 672) than their peers in CMI. In CAF there was less compliance in relation to medical record keeping and prescribing. Conclusions. The employment situation of physicians in CAF is more precarious than in CMI. It is necessary to strengthen the enforcement of existing regulations and develop policies according to the monitoring of its performance, particularly, but not exclusively, in CAF.