Dinámicas de la vulnerabilidad y gestión de la crisis sanitaria por COVID-19 en Cuba / Dynamics of vulnerability and COVID-19 health crisis management in Cuba

Resumen El COVID-19 ha visibilizado las inequidades sistémicas, multiplicado las condiciones de vulnerabilidad y descubierto la incapacidad de numerosas instituciones públicas para responder a la pandemia. El objetivo del presente trabajo fue analizar y contextualizar la gestión de la crisis sanitaria en Cuba, así como la atención a grupos vulnerables durante el primer año de la pandemia. La investigación se sustenta en un enfoque mixto que combina el análisis cualitativo de contenido con el de datos estadísticos procedentes de fuentes primarias y secundarias. Los hallazgos revelaron que más de la mitad de la población cubana es vulnerable ante COVID-19 por factores como edad, género, raza, salud física, condiciones del hogar y limitaciones para acceder a derechos básicos asociados a alimentación de calidad, vivienda digna y servicios de agua potable. Las estadísticas epidemiológicas recabadas entre marzo de 2020 y marzo de 2021 muestran una gestión de la crisis sanitaria adecuada a partir de la articulación gubernamental con la gestión científica y tecnológica y la infraestructura de salud pública y universal. Sin embargo, existen estrategias contradictorias en la atención a la población en riesgo, que profundizan desigualdades previamente existentes y dinamizan y amplían la condición de vulnerabilidad. COVID-19 constituye una ventana de oportunidad para pensar estrategias de desarrollo desde un modelo de política social integral.

Abstract COVID-19 has made visible systemic inequities, multiplied vulnerability conditions, and uncovered the lack of capacity of numerous public institutions to respond to the pandemic. The paper aims to analyze and contextualize the health crisis management, as well as vulnerable groups' care in Cuba during the first year of the pandemic. For this purpose, a mixed approach was selected, which combines qualitative content analysis with statistical data obtained from primary and secondary sources. Findings revealed that more than half of the Cuban population is vulnerable to COVID-19 due to factors such as age, gender, race, physical health, living conditions, and limitations to access to basic rights associated to quality food, dignified housing, and potable water rights. Epidemiological statistics collected between March 2020 and March 2021, show an adequate management of the sanitary contingency based on the coordination of governmental structures with scientific and technological sectors and public and universal health infrastructure. However, there are contradictory strategies in caring for vulnerable populations that deepen previously existing inequalities and dynamize and extend vulnerability conditions. COVID-19 constitutes a window of opportunity to rethink country development strategies from a comprehensive social policy model.

Covid-19 y oportunidades para el bienestar materno-infantil en Cuba / Covid-19 e oportunidades para o bem-estar materno-infantil em Cuba / Covid-19 and opportunities for maternal and child wellbeing in Cuba

El artículo tiene como objetivo analizar los indicadores asociados al bienestar materno-infantil en los protocolos cubanos de actuación para la Covid-19. Con este fin, se realizó un análisis cualitativo de contenido que combinó una lógica deductiva derivada de la revisión bibliográfica de la literatura sobre bienestar materno-infantil y experiencia positiva del parto, y otra inductiva, con base en el procesamiento de la información empírica de los protocolos cubanos, según las recomendaciones de la OMS y la OPS. El análisis reveló que las guías enfatizan en la vida de la madre y el niño y priorizan la atención de las embarazadas como parte del acceso universal y gratuito a la salud; pero descuidan aspectos cualitativos del bienestar y la calidad del servicio, y con ello, los derechos de las gestantes y madres, y sus necesidades físicas, emocionales, psicológicas, sociales y espirituales. (AU)

O artigo tem como objetivo analisar os indicadores associados ao bem-estar materno-infantil nos protocolos de ação cubanos para o Covid-19. Por tanto, foi realizada uma análise de conteúdo qualitativa que combinou uma lógica dedutiva derivada da revisão bibliográfica da literatura sobre bem-estar materno-infantil e uma experiência positiva de parto, e uma indutiva, baseada no processamento de informações empíricas de protocolos cubanos, a luz das recomendações da OMS e da OPAS. A análise revelou que as orientações enfatizam a vida da mãe e do filho e priorizam o cuidado à gestante como parte do acesso universal e gratuito à saúde. Porém, negligenciam os aspectos qualitativos do bem-estar e da qualidade do serviço e, com isso, os direitos da gestante e da mãe, suas necessidades físicas, emocionais, psicológicas, sociais e espirituais. (AU)

The article aims to analyze indicators associated with maternal and child wellbeing in the Cuban Covid-19 action protocols. We carried out a qualitative content analysis that combined a deductive logic derived from a bibliographic review of the literature on maternal and child wellbeing and positive childbirth experiences, and an inductive logic based on the processing of empirical information from Cuban protocols, in light of the recommendations issued by WHO and PAHO. The analysis revealed that the instructions emphasize the mother's and child's life and prioritize care provided for pregnant women as part of free and universal access to health. However, they neglect the qualitative aspects of wellbeing and service quality and, with this, they also neglect the pregnant woman's and mother's rights, as well as their physical, emotional, psychological, social and spiritual needs. (AU)

Vulnerability in health and social capital: a qualitative analysis by levels of marginalization in Mexico.

BACKGROUND: Social capital is employed as an asset when there is a lack of an efficient health-care system. However, this relationship is not homogeneous and can differ according to the characteristics of individuals and their context. In this paper, we aim to analyze the role of social capital in the solution of healthcare problems among individuals with different levels of marginalization and unequal access to health services. METHODS: This qualitative study examines the role of social capital in the demand for healthcare among Mexican individuals with different levels of marginalization. The research draws data from semi-structured interviews (N = 247) that were collected in four Mexican states with different social welfare benefits: Mexico City, Tamaulipas, the State of Mexico, and Oaxaca. The interviewees were selected using the snowball method and other eligibility criteria such as education, age, and gender. RESULTS: Findings suggest that social capital is a relevant factor in solving healthcare problems, depending on the level of marginalization. The role of social capital can be explained by the precariousness of medical service delivery, the poor health infrastructure, and the difficult access to health care in Mexico. Networks are the main resource to deal with health related issues, food, medicine, and out-of-the-pocket medical expenses in contexts of high levels of marginalization. In the middle level of marginalization, networks also help in raising funds for more-specialized medical services and higher quality hospitals. In the least-marginalized levels, social capital is used as companionship for sick individuals, while support networks act as emotional relief. At this level, most individuals have private health insurance, and many of them have major medical healthcare coverage. CONCLUSIONS: Participants reported low levels of trust in the health care system because of the poor infrastructure and quality of medical service delivery. Although the main criticism is focused on public healthcare institutions, there is a lack of trust in private medical services as well. These facts are related to the access and quality of medical service delivery and turn social capital into a significant asset. Despite that social bonds or links are valuable resources that individuals can use to solve healthcare related issues, the use of social capital is not homogenous. Indeed, it can be influenced by several factors that were represented in this study through the municipal marginalization index.