En busca de los resultados de la cooperación técnica / In search of the results of technical cooperation

RESUMO

For the Pan American Health Organization (PAHO), technical cooperation (TC) is the process by which teh PAHO Member States work with the Organization, as equal partners, to identify and reach their own health goals and to promote self-sufficiency in health development, through programs that respond to those countries' needs and national priorities. Since 1978, PAHO has used the American Regional Planning, Programming, Monitoring, and Evaluation System (AMPES) to establish management procedures and to facilitate decision-making in health TC. As part of AMPES, PAHO uses a "logical approach to project management" to structure the work program of the Organization and to identify the expected results from TC activities and TC resource investments. This project management approach, which replaces the "functional approaches" system used to date, also helps establish a causative relationship between the programmed activities and the results that PAHO expects, and between the activities and the hoped-for outcomes in the countries. As part of an ongoing process of rethinking international health TC, several years ago PAHO began a four-phase study on the usefulness and validity of functional approaches and on the need to propose new ones or to modify existing ones. The results of the initial phase showed it was difficult to classify the activities because the functional approaches categories were not mutually exclusive and the TC activities were complex. Further, the expected results did not specify the product for which the PAHO Secretariat was accountable within a certain time frame nor the Secretariat's level of responsibililty. Thus, a new and more flexible classification of expected results was proposed, with the following categories cooperation networks and alliances; surveillance and information systems; standards and guidelines; research and evaluation studies; plans, projects, and policies; methods, models, and technologies; training programs; promotional campaigns and advocacy; and direct support. In the second phase of the study, it was concluded that the proposed classification system made it possible to more precisely identify the products of PAHO technical cooperation projects, the Organization's degree of responsibility, and the bases for estimating needed resources. The new system could also facilitate monitoring and evaluation. In addition, the third pahse of analyzing the functional approaches has begun. Its objective is to evaluate the effect of technical cooperation based on the changes incorporated in the programming of activities

RESUMEN

El presente estudio tuvo por objetivo evaluar la calidad de los servicios de anticoncepción en la ciudad de El Alto, Bolivia. En su diseño se han contemplado cuatro elementos 1) las relaciones entre los proveedores de servicios y sus clientes, 2) la disponibilidad de métodos anticonceptivos, 3) las condiciones de los servicios, y 4) la satisfacción de las usuarias. También se han tenido en cuenta las opiniones de los proveedores y de las usuarias y no usuarias de estos servicios, quienes se clasificaron como gubernamentales o no gubernamentales, de acuerdo con la administración de la institución a la que pertenecían. Los datos provinieron de un análisis de la situación de dichos servicios y de testimonios obtenidos de las participantes durante 1995. En cuanto a las relaciones interpersonales, se encontró que los proveedores percibían el trato del médico más favorablemente que las clientas, en tanto que las no usuarias lo percibían desfavorablemente. La percepción de un trato igualitario se correlacionó positivamente con la vestimenta que usaban las clientas. En cuanto a la disponibilidad de los métodos anticonceptivos, 15 de las 36 instituciones encuestadas no disponían de métodos modernos, a pesar de la existencia de una política nacional para proveerlos a la población. La oferta de estos servicios a parejas y a adolescentes es escasa, principalmente en las instituciones gubernamentales. El análisis de las condiciones de los servicios demostró que en algunas instituciones había problemas graves en la provisión de una atención de mínima calidad. Finalmente, este trabajo describe cómo la mayoría de estas limitaciones en la prestación de servicios de anticoncepción en El Alto pueden subsanarse mediante estrategias de costo moderado.