Recomendação nº 036, de 15 de dezembro de 2022: recomenda providências orçamentárias urgentes para evitar o colapso no atendimento da saúde indígena / Recommendation nº 036, of December 15, 2022: recommends urgent budgetary measures to avoid the collapse of indigenous health care

Recomenda ao Ministério da Saúde, especialmente à Secretaria Especial de Saúde Indígena, à Coordenação Geral de Planejamento e Orçamento e ao Fundo Nacional de Saúde, bem como ao Grupo de Trabalho da Saúde - Equipe de Transição do Governo, que: Reconheça o caráter emergencial da falta de recursos orçamentários para o pagamento dos salários dos trabalhadores e trabalhadoras de saúde indígena e tome as providências orçamentárias necessárias para a regularização dos pagamentos, evitando, assim, um colapso na rede de atendimento.

Establishing voluntary certification of community health workers in Arizona: a policy case study of building a unified workforce.

BACKGROUND: Community health workers (CHWs) are widely recognized as essential to addressing disparities in health care delivery and outcomes in US vulnerable populations. In the state of Arizona, the sustainability of the workforce is threatened by low wages, poor job security, and limited opportunities for training and advancement within the profession. CHW voluntary certification offers an avenue to increase the recognition, compensation, training, and standardization of the workforce. However, passing voluntary certification legislation in an anti-regulatory state such as Arizona posed a major challenge that required a robust advocacy effort. CASE PRESENTATION: In this article, we describe the process of unifying the two major CHW workforces in Arizona, promotoras de salud in US-Mexico border communities and community health representatives (CHRs) serving American Indian communities. Differences in the origins, financing, and even language of the population-served contributed to historically divergent interests between CHRs and promotoras. In order to move forward as a collective workforce, it was imperative to integrate the perspectives of CHRs, who have a regular funding stream and work closely through the Indian Health Services, with those of promotoras, who are more likely to be grant-funded in community-based efforts. As a unified workforce, CHWs were better positioned to gain advocacy support from key health care providers and health insurance companies with policy influence. We seek to elucidate the lessons learned in our process that may be relevant to CHWs representing diverse communities across the US and internationally. CONCLUSIONS: Legislated voluntary certification provides a pathway for further professionalization of the CHW workforce by establishing a standard definition and set of core competencies. Voluntary certification also provides guidance to organizations in developing appropriate training and job activities, as well as ongoing professional development opportunities. In developing certification with CHWs representing different populations, and in particular Tribal Nations, it is essential to assure that the CHW definition is in alignment with all groups and that the scope of practice reflects CHW roles in both clinic and community-based settings. The Arizona experience underscores the benefits of a flexible approach that leverages existing strengths in organizations and the population served.

A cost comparison of travel models and behavioural telemedicine for rural, Native American populations in New Mexico.

OBJECTIVE: The purpose of this study was to model the cost of delivering behavioural health services to rural Native American populations using telecommunications and compare these costs with the travel costs associated with providing equivalent care. METHODS: Behavioural telehealth costs were modelled using equipment, transmission, administrative and IT costs from an established telecommunications centre. Two types of travel models were estimated: a patient travel model and a physician travel model. These costs were modelled using the New Mexico resource geographic information system program (RGIS) and ArcGIS software and unit costs (e.g. fuel prices, vehicle depreciation, lodging, physician wages, and patient wages) that were obtained from the literature and US government agencies. RESULTS: The average per-patient cost of providing behavioural healthcare via telehealth was US$138.34, and the average per-patient travel cost was US$169.76 for physicians and US$333.52 for patients. Sensitivity analysis found these results to be rather robust to changes in imputed parameters and preliminary evidence of economies of scale was found. CONCLUSION: Besides the obvious benefits of increased access to healthcare and reduced health disparities, providing behavioural telehealth for rural Native American populations was estimated to be less costly than modelled equivalent care provided by travelling. Additionally, as administrative and coordination costs are a major component of telehealth costs, as programmes grow to serve more patients, the relative costs of these initial infrastructure as well as overall per-patient costs should decrease.

La migración interdepartamental en honduras / Interdepartmental Migration In Honduras

Antecedentes: En el marco del diseño de estudios biomédicos, dilucidar las migraciones y su impacto en un territorio es esencial, ya que éstas constituyen un componente importante en la determinación de la estructura genética de las poblaciones humanas. Estudios anteriores utilizando los registros censales muestran una fuerte migración desde los departamentos rurales a los urbanos en Honduras. Objetivo: Confirmar la tasa migratoria rural-urbana, determinando los valores de parámetros que revelan las relaciones migratorias interdepartamentales y su posible consecuente en la salud. Población y Métodos: Estudio descriptivo, en el cual se incluyeron el universo de votantes 4,331,204 en los 18 departamentos de Honduras, que aparecen registrados en la base de datos del Tribunal Supremo Electoral. Con la información de los departamentos de nacimiento y de residencia de los votantes se construyeron matrices migratorias. Se dilucidaron las rutas migratorias más importantes, los saldos migratorios calculados como el número de inmigrantes menos el de emigrantes, y se estimaron las relaciones migratorias y el nivel de aislamiento de los departamentos mediante la construcción de una matriz de distancias.Resultados: Se encontró un gran flujo migratorio desde las áreas rurales a las urbanas. El departamento con la mayor inmigración y el mayor saldo migratorio fue Cortés, seguido de Francisco Morazán. El departamento más aislado de Honduras resultó ser Gracias a Dios. Discusión: El alto flujo migratorio rural-urbano, referido como proceso de urbanización, amenaza con diezmar la riqueza étnica en Honduras por lo que urgen estudios destinados a aumentar el conocimiento de este acervo genético, especialmente a través de los estudios genómicos de enfermedades multifactoriales...

The quest for equity in Latin America: a comparative analysis of the health care reforms in Brazil and Colombia.

INTRODUCTION: Brazil and Colombia have pursued extensive reforms of their health care systems in the last couple of decades. The purported goals of such reforms were to improve access, increase efficiency and reduce health inequities. Notwithstanding their common goals, each country sought a very different pathway to achieve them. While Brazil attempted to reestablish a greater level of State control through a public national health system, Colombia embraced market competition under an employer-based social insurance scheme. This work thus aims to shed some light onto why they pursued divergent strategies and what that has meant in terms of health outcomes. METHODS: A critical review of the literature concerning equity frameworks, as well as the health care reforms in Brazil and Colombia was conducted. Then, the shortfall inequality values of crude mortality rate, infant mortality rate, under-five mortality rate, and life expectancy for the period 1960-2005 were calculated for both countries. Subsequently, bivariate and multivariate linear regression analyses were performed and controlled for possibly confounding factors. RESULTS: When controlling for the underlying historical time trend, both countries appear to have experienced a deceleration of the pace of improvements in the years following the reforms, for all the variables analyzed. In the case of Colombia, some of the previous gains in under-five mortality rate and crude mortality rate were, in fact, reversed. CONCLUSIONS: Neither reform seems to have had a decisive positive impact on the health outcomes analyzed for the defined time period of this research. This, in turn, may be a consequence of both internal characteristics of the respective reforms and external factors beyond the direct control of health reformers. Among the internal characteristics: underfunding, unbridled decentralization and inequitable access to care seem to have been the main constraints. Conversely, international economic adversities, high levels of rural and urban violence, along with entrenched income inequalities seem to have accounted for the highest burden among external factors.

The quest for equity in Latin America: a comparative analysis of the health care reforms in Brazil and Colombia

Introduction: Brazil and Colombia have pursued extensive reforms of their health care systems in the last couple of decades. The purported goals of such reforms were to improve access, increase efficiency and reduce health inequities. Notwithstanding their common goals, each country sought a very different pathway to achieve them. While Brazil attempted to reestablish a greater level of State control through a public national health system, Colombia embraced market competition under an employer-based social insurance scheme. This work thus aims to shed some light onto why they pursued divergent strategies and what that has meant in terms of health outcomes. Methods: A critical review of the literature concerning equity frameworks, as well as the health care reforms in Brazil and Colombia was conducted. Then, the shortfall inequality values of crude mortality rate, infant mortality rate, under-five mortality rate, and life expectancy for the period 1960-2005 were calculated for both countries. Subsequently, bivariate and multivariate linear regression analyses were performed and controlled for possibly confounding factors. Results: When controlling for the underlying historical time trend, both countries appear to have experienced a deceleration of the pace of improvements in the years following the reforms, for all the variables analyzed. In the case of Colombia, some of the previous gains in under-five mortality rate and crude mortality rate were, in fact, reversed. Conclusions: Neither reform seems to have had a decisive positive impact on the health outcomes analyzed for the defined time period of this research. This, in turn, may be a consequence of both internal characteristics of the respective reforms and external factors beyond the direct control of health reformers. Among the internal characteristics: underfunding, unbridled decentralization and ...

Family support and parenting education in the home: an effective extension of clinic-based preventive health care services for poor children.

A study was designed to assess the effect and cost of providing parenting and child care education in the home to inner-city mothers of poor infants receiving comprehensive health care in a large federal Children and Youth Program. Randomly selected, healthy neonates weighing more than 2000 gm and born to black women aged 18 years and older (n = 131) and to comparable control subjects (n = 132) were followed for a mean of 23.4 and 22.9 months, respectively. A community woman, with educational, social service, and medical backup support from the Children and Youth Program, made home visits 7 to 10 days after the birth and between regularly scheduled well-child-care visits. Improved compliance with well-child care, fewer illness visits, and sharp reductions in hospitalization and in neglect or abuse were found in the visited group compared with the control group, and substantial cost was averted. Prerequisite and concomitant to focusing the mother's attention on the infant was the resolution of the numerous crises and survival problems experienced by these poor women. Only then was parenting education accepted by the mother.

[Integration of health development cooperation into the cultural and socioeconomic context of the operational area: work of the Putina medical team in Peru]. / Erwägungen zur Integration medizinischer Entwicklungszusammenarbeit in den kulturellen und sozioökonomischen Kontext des Einsatzgebietes: Zum Beispiel der Arbeit des Putina-Arzteteams in Peru.

Contrasting with what happened with the indio traditional medicine and with the Western medical knowledge the Spaniards imported, industrialized nations' medicine, through its growing ability to fight infectious diseases, has sharpened in Peru in the 20th century the social disparity between the well-to-do upper classes and the poor masses. In order to alleviate this situation, efforts have been undertaken since the 1940's in the Department of Puno, the poorest of the country, in order to bring to the rural population the benefits of modern medicine. Since 1971, a team of Swiss physicians, integrated into the Peruvian Ministry of Health, works in the Putina area in several State health centers. There are presently five doctors for a 130,000 inhabitants population, collaborating in the setting up of basic health services. The most important pillars of the programme, which should be able to function without physicians, if need be, are voluntary health auxiliaries, chosen by their own community (1 per 500 people). State employed auxiliary nurses (1 per 5000 people), and Peruvian State Registered nurses, entrusted with training and supervisory tasks. The progress of the programme, in terms of the growing independence of the basic health system, is described, as are potentialities and limits in bringing it closer to the indigenous traditional medicine. Through the example of the supply of basic drugs, it is pointed out how setbacks suffered in the last two years, are illustrative of the country political crisis and of its growing dependency on industrialized nations.