Basic Health System Research Articles

Challenges of women health in Baixada Santista: access to HIV diagnostic and to the treatment of sexually transmitted diseases

AIDS in Brazil is no doubt a women’s disease, a fact described from the 19901s, and it continues to be one of the main tendencies of the epidemicin Baixada Santista. Due to this, the universal access to HIV tests, together with preventive actions directed to the various population groups are seen as theprincipal strategies for combating the epidemic. The question of access to diagnosis, as well as to STD treatment must be understood as a challenge for theseveral levels of management of SUS (unified health system), especially in metropolitan regions. The present article analyzed access conditions to HIV test andto STD treatment of women from the Metropolitan Region of Baixada Santista-SP, from primary data collected by a survey developed by local authorities ofthe region with a population of more than 100.000 inhabitants. As for HIV diagnosis, results show that 79.6% of women from 25 to 39 years of age told theydid it in the basic health system in 37.6% of cases. But there are problems related to the quality of the services, especially as regards instructions and advice onpreventive actions: 51.5% of the women had had no instruction. Regarding STD, it was possible to realize that women ask for treatment especially in the basichealth system (47.3%), followed by private doctors (37.4%). However, the treatment of partners, an important strategy for breaking the chain of transmission,happened in only 33.4% of cases.

Administração em enfermagem: desvelando as bases conceituais, metodológicas e pedagógicas de seu ensino em João Pessoa - PB

In the present article it is discussed the conceptual, methodological and pedagogical aspects regarding teaching planning on the subjects of Applied Nursing Administration, taking into account the contradictions viewed in their education process in undergraduate courses of three schools of Nursing of Joao Pessoa, Paraiba State. It was assumed that the teaching of these subjects is in inconsistency with the requirements of the new professional practice in view of the needs of the Public Healthcare System. The Resolution CNE / CES 03/2001 was taken as the interpretative category of search. The empirical material was obtained through examination of teaching plans of the subjects taught in schools in confrontation with the testimony of teachers responsible for its work. The technique used for the analysis of evidence obtained through semi-structured interviews was discourse analysis. It was concluded that the conceptual, methodological and pedagogical foundations that underlie the teaching plans on the subjects are not in agreement with the Guidelines of National Curriculum for the formation of Nursing Human Resources, undermining the administrative function in the context of managing staff and services for the Basic Health System.

Developing Geostatistical Space–Time Models to Predict Outpatient Treatment Burdens from Incomplete National Data

Basic health system data such as the number of patients utilising different health facilities and the types of illness for which they are being treated are critical for managing service provision. These data requirements are generally addressed with some form of national Health Management Information System (HMIS) which coordinates the routine collection and compilation of data from national health facilities. HMIS in most developing countries are characterised by widespread under-reporting. Here we present a method to adjust incomplete data to allow prediction of national outpatient treatment burdens. We demonstrate this method with the example of outpatient treatments for malaria within the Kenyan HMIS. Three alternative modelling frameworks were developed and tested in which space-time geostatistical prediction algorithms were used to predict the monthly tally of treatments for presumed malaria cases (MC) at facilities where such records were missing. Models were compared by a cross-validation exercise and the model found to most accurately predict MC incorporated available data on the total number of patients visiting each facility each month. A space-time stochastic simulation framework to accompany this model was developed and tested in order to provide estimates of both local and regional prediction uncertainty. The level of accuracy provided by the predictive model, and the accompanying estimates of uncertainty around the predictions, demonstrate how this tool can mitigate the uncertainties caused by missing data, substantially enhancing the utility of existing HMIS data to health-service decision-makers.

From Alma-Ata to the Global Fund: the history of international health policy

'Verticalization' of health care delivery, in one form or another, is the common theme pervading the history of international health policy over the last sixty years. It is often accompanied by radical policies of privatization of health services, everywhere resulting in people being forced to pay for all services. The failure of the vertical approach, of which the global public-private partnership initiatives are a modernized version, has been well recognized and its reasons are clear: actions on the distal determinants of disease (income, education, housing, the environment and infrastructure, etc) are overlooked; distribution of services dedicated to specific diseases and interventions (such as AIDS, malaria, tuberculosis, etc.) are artificially and temporarily reinforced, creating absurd and harmful forms of competition between services and making even more precarious and inefficient the work of already fragile basic health systems. This article describes the role played in this disturbing historical development by the prevailing economic ideology and its operational arm, the World Bank, with the view to reclaim international policy making processes and actors that really respond to people's health needs.

Cancer in children: the diagnostic itinerary

This study aims to describe the trajectory children and adolescents experience from the beginning of cancer signs and symptoms until the confirmation of the diagnosis, based on their parents' report. A total of eight mothers and two fathers participated in the study. Data were collected through semi structured interviews, and data were subject to qualitative analysis. We found that this period is significant for parents, who are capable of recognizing that something wrong started to happen to their children, expressed through signs and symptoms. They precisely reported the chronological time of this trajectory. The challenges they mentioned refer to the different diagnostic hypotheses, the difficulty to performing specific diagnostic exams and to be referred to specialized care services. This search for health service care revealed to be a difficult journey, which permits to identify that the Brazilian Basic Health System's principles of accessibility and problem-solving capacity are jeopardized.

A divisão do trabalho no setor de saúde e a relação social de tensão entre trabalhadores e gestores

Este estudo estrutura-se partir da análise crítica da gestão do trabalho no setor público de saúde no município de Joinville (SC), em relação à situação do trabalho no cotidiano dos trabalhadores de saúde nas unidades básicas do Sistema Único de Saúde (SUS). Nele são identificados alguns princípios de funcionamento dos serviços de saúde empreendidos pela gestão como mecanismos de dominação no trabalho, e que decorrem de sua divisão, a saber: o caráter fragmentar da organização do trabalho no setor de saúde, o domínio do conflito pela gestão, o controle dos trabalhadores pelas metas de produção e a resistência dos trabalhadores de saúde ao trabalho imposto. O estudo utiliza, como forma de evidenciar a existência da divisão do trabalho, as técnicas de pesquisa: entrevista e observação direta do trabalho.

Responding to the crisis in sub-Saharan Africa: the role of nutrition

In the chapter dealing with education and health, the report of the influential Commission for Africa prioritises basic health systems, HIV/AIDS, malaria and tuberculosis. In contrast, nutrition is given less than half a page and is reduced to parasite control and micronutrient support. Such neglect of nutrition is hard to understand in the context of increasing hunger and malnutrition across the continent. Sub-Saharan Africa is the only region in the world where the proportion of underweight children has stagnated and the absolute numbers have actually increased in the last decade. It has been pointed out that if current trends continue sub-Saharan Africa will achieve the Millennium Development Goal for child mortality around 2115 - one century after the target date. Quite clearly those concerned with nutrition need to more powerfully advocate the role of nutrition in lifting Africa out of the spiral of poverty. The present paper argues that to achieve this requires an understanding not just of the critical role of nutrition for health and development (both individual and national), but also of how recent global changes are interacting with changes in food production and supply, other determinants of maternal and child health, and the role and capacity of the state to tackle malnutrition in Africa. It concludes by suggesting some responses that nutritionists could now be making.

Bioética y precarización del trabajo del enfermero del programa de salud de la familia.

The objective of this study is to discuss the precariousness of the job of the Family Health Program (PSF) teams in the discipline Nursing and Bioethics of The Masters Course from Universidade Federal do Estado do Rio de Janeiro, class 2004, put into context from the practical experience of the program’s implementation in Petropolis district as well as Nurses and Physicians capacitating during introductory course. The subjects of the study were health professionals analyzed in the Family health Program (PSF) National Evaluation 2001/2002. The research shows that such professionals are unstably employed and, while visiting bioethics principles, it is found district managers’contradictory speeches in the development of the “Unique Health System”-SUS presenting opposing practices, peculiar to neoliberalism. The study is relevant once PSF is the strategy chosen to reorganize the basic health system and consolidate the “Unique Health System” - SUS. It is concluded that health professionals from the PSF strategy urge to adopt speeches based on bioethics and promote action and mobilization together with the Decision making forum in order to guarantee a definite employment settlement as a strategic maneuver to consolidate the democratization of the SUS.

The inception and development of basic animal health systems: examples of German development co-operation

About thirty years ago the financial, logistic and manpower resources of veterinary and animal production services in the developing world were stretched to the limit. Epizootic disease control was their main and often only field activity, which left livestock owners to manage their daily production and health problems alone. To meet their requirements, Veterinary Services in these countries came under increasing public and political pressure to modify and adjust their approaches. This gave rise to a series of workshops in Africa (e.g. Bujumbura in Burundi and Blantyre in Malawi) and South-East Asia (e.g. Singapore, and Khon Kaen in Thailand), most of which were organised and facilitated by the German Agency for Technical Co-operation (GTZ) in close collaboration with French and British development co-operation agencies and universities. These workshops stimulated discussion with the key stakeholders and, thus, were most beneficial in supporting the process of developing alternative approaches. This paper reports in particular on the outcomes of the regional workshops held in Bujumbura, Burundi, in 1984, Blantyre, Malawi, in 1985, Bangui, Central African Republic, in 1988, Khon Kaen, Thailand, in 1989, Schmitten, Germany, in 1991, and Mzuzu, Malawi, in 1996 and 2000. For more than two decades, concepts of community-based livestock services in general, and primary animal health activities (PAHAs) in particular, have been developed and established in various developing countries. Over the years the PAHA concept has proved to be effective and has shown that livestock-keeping communities clearly benefit from such programmes. In presenting key features from some prominent and successful project examples (GTZ-supported projects in Thailand, Malawi and Somalia) it can be demonstrated that such approaches are not static but rather dynamic, requiring open minded innovative partners on both sides. Over the last few years, the delivery of PAHA has become the domain of non-governmental organisations. The propagation and application of this approach in various developing countries with limited veterinary infrastructure is supporting a privatisation process within the existing governmental veterinary structures, thus, allowing veterinary departments more freedom to focus on their core functions.

Canada. New virtual institutes for biomed research.

OTTAWA-- A prominent Canadian cancer researcher has taken on the job of leading a new biomedical research institution that is modeled after the U.S. National Institutes of Health--but which reflects 21st century practices and priorities. Last week Alan Bernstein, 52, was named president of the Canadian Institutes of Health Research. The new entity replaces the Medical Research Council as the country9s primary source of extramural grants for basic biomedical, clinical, population-based, and health systems research.

Diabetes Mellitus and Asthma:: “Twin” Challenges for Public Health and Managed Care Systems

Many changes are rapidly occurring in and to health care systems in the United States. These changes reflect fundamental concerns about issues of access, quality of care, and cost of health services. The emergence of chronic diseases, the importance of economic considerations in health decisions; and the proper role of managed care organizations (MCOs) are of particular significance. Diabetes mellitus (DM) and asthma are two conditions that are frequently used as “model diseases” to study the impact of these changes. In spite of apparent differences between asthma and DM, there are, in fact, many important commonalities that explain the attention being directed to these diseases. In considering basic tenets, objectives, and approaches, MCOs and public health systems also have very common interests and characteristics. In understanding the impact of the many emerging health care concepts and approaches on DM and asthma, public health and MCOs can be better positioned not only to understand each other, but also to subsequently address other important chronic diseases, injury-related disorders, and behavioral/emotional conditions in an effective and efficient manner.

Community-based health workers: Head start or false start towards health for all?

Health service delivery programs using minimally-trained community-based health workers (CHWs) have been established in many developing countries in recent years. These programs are expected to improve the cost-effectiveness of health care systems by reaching large numbers of previously underserved people with high-impact basic services at low cost. The reported experience with these programs has been mixed, raising questions about whether the community health worker is an optimal vehicle for extending primary health care. This review of six large-scale community-based worker programs suggests that they have succeeded in some of their objectives but not in others. CHWs increase the coverage and equity of service delivery at low cost compared with alternative modes of service organization. However, they do not consistently provide services likely to have substantial health impact and the quality of services they provide is sometimes poor. Large-scale CHW systems require substantial increases in support for training, management, supervision, and logistics. The evidence suggests that, in general, their potential has not been achieved in large routine programs. Further development of these programs is needed to reinforce their successes and assure that they are adequately supported as an integral component of the basic health system.