Expansion Of Health Services Research Articles

Global Speech-Language Health: Belize

This independent field experience in global health explores the application of health promotion and service delivery models from the field of public health to speech-language services through descriptive research of the case in southern Belize. This project explores first steps in global speech-language health outreach for children living in very limited resource settings. Global speech-language health outreach includes community-wide interventions, fostering collaboration in the community and internationally, health education, building on local resources to expand health services, and special education program development. This project makes the assumption that a rich language environment may be a determinant of speech-language health. Speech-language interventions that enrich the linguistic environment may be a strong starting point for regions with very limited access to speech-language services. Therefore, this project looks at targeting social and environmental factors that influence language and literacy skills. The aim is to raise awareness of pediatric speech-language disability in southern Belize, with the ultimate goal of increasing school and community participation of children with speech-language disabilities. The purpose of this project is to explore points of entry for population-wide, environment-enriching, and culturally relevant intervention targeting communication and academic growth, in a limited resource setting. Furthermore, this project describes barriers to speech-language services and interventions in southern Belize.

Participação social e gestão pública no Sistema Único de Saúde

The article examines the question of social participation in public health policies from 1988 onwards. It seeks to problematize the State-society relation through an examination of the creation of management councils with decision-making powers in Brazil's National Health Service (SUS). The text sets out from the premise that achieving more democratic healthcare is not limited to expanding health services and coverage: such a process also involves building awareness of health as a public asset, rather than conceiving health simply as a marketable item or an individual consumer commodity. The text explores the nature of social participation in healthcare, the public and private spheres of social life involved in this dynamic, and the extent to which these social demands are representative given the diversity of the social actors and identities involved.

Effectively engaging the private sector through vouchers and contracting – A case for analysing health governance and context

Health systems of low and middle income countries in the Asia Pacific have been described as mixed, where public and private sector operate in parallel. Gaps in the provision of primary health care (PHC) services have been picked up by the private sector and led to its growth; as can an enabling regulatory environment. The question whether governments should purchase services from the private sector to address gaps in service provision has been fiercely debated. This purposive review draws evidence from systematic reviews, and additional published and grey literature, for input into a policy brief on purchasing PHC-services from the private sector for underserved areas in the Asia Pacific region. Additional published and grey literature on vouchers and contracting as mechanisms to engage the private sector was used to supplement the conclusions from systematic reviews. We analysed the literature through a policy lens, or alternatively, a 'bottom-up' approach which incorporates components of a realist review. Evidence indicates that both vouchers and contracting can improve health service outcomes in underserved areas. These outcomes however are strongly influenced by (1) contextual factors, such as roles and functions attributable to a shared set of key actors (2) the type of delivered services and community demand (3) design of the intervention, notably provider autonomy and trust (4) governance capacity and provision of stewardship. Examining the experience of vouchers and contracting to expand health services through engagement with private sector providers in the Asia Pacific found positive effects with regards to access and utilisation of health services, but more importantly, highlighted the significance of contextual factors, appropriate selection of mechanism for services provided, and governance arrangements and stewardship capacity. In fact, for governments seeking to engage the private sector, analysis of context and capacities are potentially a more useful frame than generalizable outcomes of effectiveness.

A population-based cross-sectional study comparing depression and health service deficits between rural and nonrural U.S. military veterans.

With involvement in two wars over the past decade, there has been a documented increase in depression prevalence and suicide incidence among U.S. military veterans. Because higher proportions of veterans come from rural communities, access to care may be an issue when behavioral health care is needed. Although the Veterans Administration has expanded health services in rural areas, this has not always resulted in increased service utilization. This study examined the prevalence of depression and associated health service deficits (HSDs) for rural versus nonrural U.S. military veterans. Using bivariate and multivariate techniques, 2006 Behavioral Risk Factor Surveillance System data were analyzed. Bivariate analysis revealed that rural veterans had greater odds of having at least one HSD, being currently depressed as measured by the Personal Health Questionnaire-8, and having lifetime depression. Logistic regression analysis confirmed that rural veterans had higher odds of both current and lifetime depression than nonrural veterans when controlling for socioeconomic status and race/ethnicity. Additionally, logistic regression analysis also revealed that rural veterans with current depression had higher odds of being Hispanic or Other/Multiracial than Caucasian, not employed for wages than employed for wages, <65 years of age, and reported having at least one HSD.

La temprana descentralización de los servicios de salud en la Argentina: la construcción del sistema sanitario en Córdoba, 1930-1955

Este trabajo analiza el proceso de construcción del sistema público de salud argentino, poniendo en evidencia las limitaciones que se produjeron en el proyecto de nacionalización de las políticas sanitarias en la postguerra y el papel central que tuvieron las jurisdicciones subnacionales, provincializando la provisión de los servicios. Más precisamente se visibiliza cómo, en el segundo cuarto del siglo XX, la ampliación de los servicios de salud en algunas provincias fue principalmente el resultado de la acción de las reparticiones locales antes que nacionales. Con el propósito de dilucidar mejor ese proceso, estudiamos la trayectoria de los dispositivos sanitarios públicos en la provincia de Córdoba entre 1930 y 1955.

Trans-national scale-up of services in global health.

BackgroundScaling up innovative healthcare programs offers a means to improve access, quality, and health equity across multiple health areas. Despite large numbers of promising projects, little is known about successful efforts to scale up. This study examines trans-national scale, whereby a program operates in two or more countries. Trans-national scale is a distinct measure that reflects opportunities to replicate healthcare programs in multiple countries, thereby providing services to broader populations.MethodsBased on the Center for Health Market Innovations (CHMI) database of nearly 1200 health programs, the study contrasts 116 programs that have achieved trans-national scale with 1,068 single-country programs. Data was collected on the programs' health focus, service activity, legal status, and funding sources, as well as the programs' locations (rural v. urban emphasis), and founding year; differences are reported with statistical significance.FindingsThis analysis examines 116 programs that have achieved trans-national scale (TNS) across multiple disease areas and activity types. Compared to 1,068 single-country programs, we find that trans-nationally scaled programs are more donor-reliant; more likely to focus on targeted health needs such as HIV/AIDS, TB, malaria, or family planning rather than provide more comprehensive general care; and more likely to engage in activities that support healthcare services rather than provide direct clinical care.ConclusionThis work, based on a large data set of health programs, reports on trans-national scale with comparison to single-country programs. The work is a step towards understanding when programs are able to replicate their services as they attempt to expand health services for the poor across countries and health areas. A subset of these programs should be the subject of case studies to understand factors that affect the scaling process, particularly seeking to identify mechanisms that lead to improved health outcomes.

Opening Access for Burmese and Karen Immigrant and Refugee Populations in California: A Blueprint for Integrated Health Service Expansion to Emerging Asian Communities

This article describes: 1) internal and external factors enabling the expansion of health care access to Burmese and Karen refugees, 2) operational processes required to expand integrated primary health care services to this emerging community, 3) the importance of culturally and linguistically competent services that incorporate prior experiences of forced immigration, and 4) lessons learned and what to expect when expanding health care access to new populations within a federally qualified health center (FQHC). This case study may provide a blueprint for other FQHCs seeking to respond to emerging immigrant and refugee populations. Such expansion gains relevance as the nation grows more diverse and continues to rely on FQHCs to respond to the health needs of medically underserved populations.

Inadequate prenatal care utilization and associated factors in São Luís, Brazil.

BackgroundOver the last decades there has been a reduction of social inequalities in Brazil, as well as a strong expansion of health services, including prenatal care. The objective of the present study was to estimate the rate of inadequate prenatal care utilization and its associated factors in São Luís, Brazil, in 2010 and to determine whether there was a reduction of inequity in prenatal care use by comparing the present data to those obtained from a previous cohort started in 1997/98.MethodsData from the BRISA (Brazilian birth cohort studies of Ribeirão Preto and São Luís) population-based cohort, which started in 2010 (5067 women), were used. The outcome variable was the inadequate utilization of prenatal care, classified according to the recommendations of the Brazilian Ministry of Health. The explanatory variables were organized into three hierarchical levels based on the Andersen’s behavioral model of the use of health services: predisposing, enabling and need factors.ResultsOnly 2.0% of the women did not attend at least one prenatal care visit. The rate of inadequate prenatal care utilization was 36.7%. Despite an improved adequacy of prenatal care use from 47.3% in 1997/98 to 58.2% in 2010, social inequality persisted: both low maternal schooling (prevalence ratio (PR) = 2.78; 95% confidence interval (95% CI) 2.23-3.47 for 0 to 4 years of study) and low family income, less than 0.5 monthly minimum wage per capita (PR = 1.37; 95% CI 1.22-1. 54), continued to be associated with higher rates of inadequate prenatal care utilization. Racial disparity regarding adequate utilization of prenatal services was detected, with black (PR = 1.19; 95% CI 1.04-1.36) and mulatto (PR = 1.14; 95% CI 1.02-1.26) women showing higher rates of inadequate use. On the other hand, women covered by the FHP - Family Health Program (PR = 0.92; 95% CI 0.85-0.98) showed a lower rate of inadequate prenatal care utilization.ConclusionsDespite strong expansion of health services and expressive improvements in adequate prenatal care use and social indicators, inequalities in prenatal care use still persist. The FHP seems to be effective in reducing inadequate prenatal care utilization.

Factors associated with safe delivery service utilization among women in Sheka zone, southwest Ethiopia.

Attempts to predict pregnancy and childbirth complications before they occur have not been successful. Provision of safe delivery service for all births is considered to be a critical intervention for ensuring safe motherhood. Hence the aim of the study was to assess factors associated with safe delivery service utilization among women in Sheka Zone South West Ethiopia. A community based comparative cross sectional survey was conducted among 554 women in Sheka Zone from February to March 2008. Data were collected through structured pre-tested questionnaire and entered into Epinfo version 3.3. Analyses were done with SPSS version 13 computer software with which bivariate and multiple logistic regressions were carried out. Mothers who completed at least secondary school were more likely to give birth at health facility than those uneducated (AOR=3.26, 95% CI 1.51-7.06). Women with birth order above four were less likely to give birth in a health facility than those with first order births (AOR=0.21, 95%CI 0.10-0.43). Women who had encountered problems in their immediate birth and received prenatal care were more likely to give birth at health facilities AOR=33.78 95% CI 16.44-69.39) and (AOR=2.55, 95% CI 1.05-6.21) respectively. Factors associated with safe delivery service utilization are related to the women's socioeconomic status and obstetric experiences. Consequently promotion of maternal education, prenatal care utilization, information education and communication on obstetric risks and general health service expansion are needed to ensure safe delivery service.

Pharmacies as providers of expanded health services for people who inject drugs: a review of laws, policies, and barriers in six countries.

BackgroundPeople who inject drugs (PWID) are underserved by health providers but pharmacies may be their most accessible care settings.MethodsStudies in the U.S., Russia, Vietnam, China, Canada and Mexico employed a three-level (macro-, meso-, and micro-) model to assess feasibility of expanded pharmacy services for PWID. Studies employed qualitative and quantitative interviews, review of legal and policy documents, and information on the knowledge, attitudes, and practices of key stakeholders.ResultsStudies produced a mixed assessment of feasibility. Provision of information and referrals by pharmacies is permissible in all study sites and sale and safe disposal of needles/syringes by pharmacies is legal in almost all sites, although needle/syringe sales face challenges related to attitudes and practices of pharmacists, police, and other actors. Pharmacy provision of HIV testing, hepatitis vaccination, opioid substitution treatment, provision of naloxone for drug overdose, and abscess treatment, face more serious legal and policy barriers.DiscussionChallenges to expanded services for drug users in pharmacies exist at all three levels, especially the macro-level characterized by legal barriers and persistent stigmatization of PWID. Where deficiencies in laws, policies, and community attitudes block implementation, stakeholders should advocate for needed legal and policy changes and work to address community stigma and resistance. Laws and policies are only as good as their implementation, so attention is also needed to meso- and micro- levels. Policies, attitudes, and practices of police departments and pharmacy chains as well as knowledge, attitudes, and practices of individual PWID, individual pharmacies, and police officers should support rather than undermine positive laws and expanded services. Despite the challenges, pharmacies remain potentially important venues for delivering health services to PWID.

A mobile phone-based, community health worker program for referral, follow-up, and service outreach in rural Zambia: outcomes and overview.

Mobile health (m-health) utilizes widespread access to mobile phone technologies to expand health services. Community health workers (CHWs) provide first-level contact with health facilities; combining CHW efforts with m-health may be an avenue for improving primary care services. As part of a primary care improvement project, a pilot CHW program was developed using a mobile phone-based application for outreach, referral, and follow-up between the clinic and community in rural Zambia. The program was implemented at six primary care sites. Computers were installed at clinics for data entry, and data were transmitted to central servers. In the field, using a mobile phone to send data and receive follow-up requests, CHWs conducted household health surveillance visits, referred individuals to clinic, and followed up clinic patients. From January to April 2011, 24 CHWs surveyed 6,197 households with 33,304 inhabitants. Of 15,539 clinic visits, 1,173 (8%) had a follow-up visit indicated and transmitted via a mobile phone to designated CHWs. CHWs performed one or more follow-ups on 74% (n=871) of active requests and obtained outcomes on 63% (n=741). From all community visits combined, CHWs referred 840 individuals to a clinic. CHWs completed all planned aspects of surveillance and outreach, demonstrating feasibility. Components of this pilot project may aid clinical care in rural settings and have potential for epidemiologic and health system applications. Thus, m-health has the potential to improve service outreach, guide activities, and facilitate data collection in Zambia.

Making the post-MDG global health goals relevant for highly inequitable societies: findings from a consultation with marginalized populations in Guatemala.

IntroductionThe United Nations presented a set of Millennium Development Goals that aimed to improve social and economic development and eradicate poverty by 2015. Most low and middle-income countries will not meet these goals and today there is a need to set new development agenda, especially when it comes to health. The paper presents the findings from a community consultation process carried out within the Goals and Governance for Global Health (GO4Health) research consortium in Guatemala, which aims to identify community needs and expectations around public policies and health services.MethodsThrough a participative and open consultation process with experts, civil society organizations and members of the research team, the municipalities of Tectitan and Santa Maria Nebaj were selected. A community consultation process was undertaken with community members and community leaders. Group discussions and in-depth interviews were conducted and later analyzed using thematic analysis, a qualitative method that can be used to analyze data in a way that allows for the identification of recurrent patterns that can be grouped into categories and themes, was used.FindingsFollowing the Go4Health framework’s domains for understanding health-related needs, the five themes identified were health, social determinants of health, essential health needs and their provision, roles and responsibilities of relevant stakeholders and community participation in decision-making. Participants reported high levels of discrimination related to ethnicity, to being poor and to living in rural areas. Ethnicity played a major role in how community members feel they are cared for in the health system.ConclusionAchieving health goals in a context of deep-rooted inequality and marginalization requires going beyond the simple expansion of health services and working with developing trusting relationships between health service providers and community members. Involving community members in decision-making processes that shape policies will contribute to a larger process of community empowerment and democratization. Still, findings from the region show that tackling these issues may prove complicated and require going beyond the health system, as this lack of trust and discrimination has permeated to all public policies that deal with indigenous and rural populations.

Innovative Community-Based Approaches Doubled Tuberculosis Case Notification and Improve Treatment Outcome in Southern Ethiopia

BackgroundTB Control Programmes rely on passive case-finding to detect cases. TB notification remains low in Ethiopia despite major expansion of health services. Poor rural communities face many barriers to service access.Methods and FindingsA community-based intervention package was implemented in Sidama zone, Ethiopia. The package included advocacy, training, engaging stakeholders and communities and active case-finding by female Health Extension Workers (HEWs) at village level. HEWs conducted house-to-house visits, identified individuals with a cough for two or more weeks, with or without other symptoms, collected sputum, prepared smears and supervised treatment. Supervisors transported smears for microscopy, started treatment, screened contacts and initiated Isoniazid preventive therapy (IPT) for children. Outcomes were compared with the pre-implementation period and a control zone. Qualitative research was conducted to understand community and provider perceptions and experiences.HEWs screened 49,857 symptomatic individuals (60% women) from October 2010 to December 2011. 2,262 (4·5%) had smear-positive TB (53% women). Case notification increased from 64 to 127/100,000 population/year resulting in 5,090 PTB+ and 7,071 cases of all forms of TB. Of 8,005 contacts visited, 1,949 were symptomatic, 1,290 symptomatic were tested and 69 diagnosed with TB. 1,080 children received IPT. Treatment success for smear-positive TB increased from 77% to 93% and treatment default decreased from 11% to 3%. Service users and providers found the intervention package highly acceptable.ConclusionsCommunity-based interventions made TB diagnostic and treatment services more accessible to the poor, women, elderly and children, doubling the notification rate and improving treatment outcome. This approach could improve TB diagnosis and treatment in other high burden settings.

Measles Epidemiology in Sistan and Baluchistan Province During April 2006-March 2011

Background: Measles is one of the main causes of death among children, especially in developing countries. Although over 30 years have passed since the availability of measles vaccine; it is still uncontrolled in many countries.In Iran the highest incidence of confirmed measles cases have occurred in Sistan and Baluchistan province. Objectives: This study was conducted to determine demographic and epidemiological characteristics of measles cases in order to improve strategies to eliminate measles in this province. Patients and Method: All suspected and confirmed measles cases from April 2006 until March 2011 were evaluated in this province. Results: Overall 456 suspected cases of measles were reported. 19.7% of cases were reported clinically positive, and positive test ratio was 56%. During our study measles incidence rate had increasing trend. The most incidence cases have occurred in spring and summer and the most cases have occurred in 1-4 years age group. Chabahar city has had the most confirmed cases. About measles vaccination history, 56.4% of all reported cases never vaccinated before. Conclusions: Improving vaccination coverage and more accurate control of the cold chain can reduce probable outbreaks of measles and also it is proposed to expand health services in the eastern border to health control of immigrants.

Measles Epidemiology in Sistan and Baluchistan Province During April 2006-March 2011

Background: Measles is one of the main causes of death among children, especially in developing countries. Although over 30 years have passed since the availability of measles vaccine; it is still uncontrolled in many countries.In Iran the highest incidence of confirmed measles cases have occurred in Sistan and Baluchistan province. Objectives: This study was conducted to determine demographic and epidemiological characteristics of measles cases in order to improve strategies to eliminate measles in this province. Patients and Method: All suspected and confirmed measles cases from April 2006 until March 2011 were evaluated in this province. Results: Overall 456 suspected cases of measles were reported. 19.7% of cases were reported clinically positive, and positive test ratio was 56%. During our study measles incidence rate had increasing trend. The most incidence cases have occurred in spring and summer and the most cases have occurred in 1-4 years age group. Chabahar city has had the most confirmed cases. About measles vaccination history, 56.4% of all reported cases never vaccinated before. Conclusions: Improving vaccination coverage and more accurate control of the cold chain can reduce probable outbreaks of measles and also it is proposed to expand health services in the eastern border to health control of immigrants.

Livelihood experiences and adherence to HIV antiretroviral therapy among participants in a food assistance pilot in Bolivia: a qualitative study.

IntroductionHealth and development organizations increasingly promote livelihood interventions to improve health and economic outcomes for people living with HIV (PLHIV) receiving treatment with antiretroviral therapy (ART). In-depth understanding about how PLHIV make labor decisions in the context of treatment for HIV – and treatment decisions in the context of their livelihoods – is essential to guiding intervention design and developing hypotheses for future research on livelihoods and ART. However, few studies have explored the perspectives of PLHIV regarding integration of livelihoods and ART in urban, resource-limited settings.MethodsQualitative interviews explored the livelihood experiences of food insecure ART patients in four Bolivian cities (n = 211). Topics included work-related barriers to ART adherence, HIV-related barriers to work, and economic coping mechanisms. Themes were identified using content coding procedures, with two coders to maximize reliability.ResultsParticipants reported complex economic lives often characterized by multiple economic activities, including both formal and informal labor. They struggled to manage ART treatment and livelihoods simultaneously, and faced a range of interpersonal and structural barriers. In particular, lack of HIV status disclosure, stigma, and discrimination were highly salient issues for study participants and likely to be unique to people with HIV, leading to conflict around requesting time off for clinic visits, resentment from co-workers about time off, and difficulties adhering to medication schedules. In addition, health system issues such as limited clinic hours or drug shortages exacerbated the struggle to balance economic activities with HIV treatment adherence.ConclusionsImproved policy-level efforts to enforce existing anti-discrimination laws, reduce HIV-related stigma, and expand health services accessibility could mitigate many of the barriers discussed by our participants, improve adherence, and reduce the need for livelihoods interventions.

History of Blood Transfusion in Sub-Saharan Africa

The adequacy and safety of blood transfusion in sub-Saharan Africa is the subject of much concern, yet there have been very few studies of its history. An overview of that record finds that transfusions were first reported in Africa (sub-Saharan and excluding South Africa) in the early 1920s, and organized transfusion practices were established before the Second World War. Blood transfusion grew rapidly after 1945, along with the construction of new hospitals and expanded health services in Africa. Significant differences existed between colonial powers in the organization of transfusion services, but these converged after independence as their use continued to grow and decentralized and hospital-based practices were adopted. It was only after the oil crisis in the mid-1970s that health spending declined and the collection, testing, and transfusion of blood began to level off. Thus, when the AIDS crisis hit transfusion services, they were already struggling to meet the needs of patients. At this time, foreign assistance as well as the World Health Organization and the League of Red Cross Societies helped respond to both the immediate problem of testing blood, and for some countries, support existed for the broader reorganization of transfusion. Overall, the history shows that transfusion was adopted widely and quickly, limited mainly by the availability of knowledgeable doctors and hospital facilities. There was less resistance than expected by Africans to receive transfusions, and the record shows a remarkable flexibility in obtaining blood. The dangers of disease transmission were recognized from an early date but were balanced against the potential lifesaving benefits of transfusion.

Lamster and Formicola Respond

Giddon et al. suggest that as midlevel dental providers (MLPs) are introduced, confusion can occur regarding who is a dentist and who is an MLP. They suggest that a name change is in order and that “oral physician” be used to differentiate doctoral-trained providers (dentists) from others who do not receive this level of education. The authors reference our recent editorial,1 which introduced reports from the 2010 Dunning Symposium, a meeting held every few years at the Columbia University College of Dental Medicine with a focus on the role of dentistry in society. In fact, an article by Lamster and Eaves,2 also from this symposium, included a discussion of the arguments for and against the name change from “dentist” to “oral physician” and reviewed the case made by others regarding a name change. This subject was specifically included because it relates to the topic being discussed—expansion of health services in the dental office. In the United States, MLPs are a new class of dental providers that have been proposed to address access to oral health care concerns. They will provide a limited range of basic but nonreversible procedures. MLPs receive considerably less training than dentists and would provide services in areas and locations where dental care services are not readily available. These providers would work under the indirect supervision of a dentist. In the United States, MLPs have been introduced on a very limited basis.3,4 Although Lamster and Eaves2 do not draw any conclusions regarding the desirability of using the term “oral physicians,” let us address the argument made by Giddon et al. First, the introduction of MLPs in the United States has encountered considerable resistance, and widespread introduction is not imminent. Second, the name change question would likely complicate the more substantive issue raised,2 which is the desirability of expanding the scope of dental practice to include primary health care activities. Third, as midlevel providers have been introduced in medicine with appropriate identification, patients have not been confused by the role filled by midlevel providers (e.g., physician assistants and midwives) versus the role filled by physicians. Giddon et al. feel passionately about the importance of this name change.5 Perhaps a more prudent approach would be to implement changes in clinical care and determine how these changes impact the health of patients and the mix of services provided by dentists. If benefits to patients’ health are realized and interaction between dentists and other health care providers increases, perhaps a name change would be indicated. Then the debate could be reexamined with a focus on the substantive issue of improving health, not on avoiding confusion.

El vivir de las mujeres en el climaterio: revisión sistemática de la literatura

Life expectancy of over 60 years for 2020 reveals that an important nunber of women will experience the menopause, and this requires appropriate health measures. Therefore, this systematic review is to characterize the scientific literature on the experience of women in the climacteric. The search was conducted through the Virtual Health Library (VHL) with descriptors climacteric and women's health in a period from 2004 to 2010 and 13 field research papers in LILACS were subsequently selected, on account of their presenting experiences in the climacteric. The analysis found the folowing categories: climacteric as a psycho-physiological stage of life, for a healthy life in climacteric and health actions aimed at menopausal women. We conclude that there is a need to effectively link the phenomenon of menopause in public health policy in Brazil and the expansion of health services to meet the demand and comprehensive care to women undergoing menopause.

El vivir de las mujeres en el climaterio: revisión sistemática de la literatura

Life expectancy of over 60 years for 2020 reveals that an important nunber of women will experience the menopause, and this requires appropriate health measures. Therefore, this systematic review is to characterize the scientific literature on the experience of women in the climacteric. The search was conducted through the Virtual Health Library (VHL) with descriptors climacteric and women's health in a period from 2004 to 2010 and 13 field research papers in LILACS were subsequently selected, on account of their presenting experiences in the climacteric. The analysis found the folowing categories: climacteric as a psycho-physiological stage of life, for a healthy life in climacteric and health actions aimed at menopausal women. We conclude that there is a need to effectively link the phenomenon of menopause in public health policy in Brazil and the expansion of health services to meet the demand and comprehensive care to women undergoing menopause.