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Os grupos na atenção básica de saúde de Porto Alegre : usos e modos de intervenção terapêutica; Groups in basic health attention in Porto Alegre : uses and forms of therapeutic intervention

Maffacciolli, Rosana; Lopes, Marta Júlia Marques
Fonte: Universidade Federal do Rio Grande do Sul Publicador: Universidade Federal do Rio Grande do Sul
Tipo: Artigo de Revista Científica Formato: application/pdf
Português
Relevância na Pesquisa
75.98%
Esse artigo trata dos grupos como modalidade assistencial utilizada pelos serviços de atenção básica de saúde. Oficinas, grupos de educação em saúde e palestras constituem atividades diferenciadas em relação aos demais atendimentos tradicionais. O estudo que subsidia essa discussão teve como objetivo conhecer o perfil da assistência, sob a forma de grupos, prestada nas unidades que compõem a rede básica de saúde de Porto Alegre. Foram abordados 116 profissionais, de um total de 124 serviços de saúde, entre os quais 96 desenvolviam grupos. Evidenciou-se que os mesmos têm relevância terapêutica por favorecerem a troca de informações e o aprendizado sobre aspectos relacionados à saúde/doença. Constituem práticas inclusivas, capazes de vincular os usuários aos serviços e de reformular o modelo assistencial vigente. Assim, constatou-se que a compreensão dessas práticas remete a sua dimensão de qualificação da assistência coletiva e também a uma dimensão estratégica de compensação de atendimento às crescentes demandas de saúde.; This article deals with groups as an assistential modality used by the services of basic health attention. Workshops, health education groups, as well as, lectures are different activities done in relation to other traditional attendances. The study that is behind this discussion had as its main aim to know the profile of assistance...

Estratégias metodológicas de educação e assistência na atenção básica de saúde; Estratégias metodológicas de educación y asistencia en la Atención básica de salud; Methodological education and care strategies in basic health care

Lopes, Marta Júlia Marques; Silva, João Luis Almeida da
Fonte: Universidade Federal do Rio Grande do Sul Publicador: Universidade Federal do Rio Grande do Sul
Tipo: Artigo de Revista Científica Formato: application/pdf
Português
Relevância na Pesquisa
75.97%
Trata-se de discussão sobre estratégias ou ferramentas metodológico-assistenciais utilizadas na prática em atenção básica de saúde. Baseia-se no diálogo estabelecido entre o que se pensa e o que se desenvolve nos Ambulatórios de Promoção da Qualidade de Vida-APQVs. Esses ambulatórios estão sediados em dois serviços de atenção básica do município de Porto Alegre-RS e seus usuários são, em sua maioria, pacientes adultos e idosos, portadores de doenças de longa duração. A proposta desta discussão é oriunda de um projeto de pesquisa financiado pelo CNPq e integrante da rede temática intitulada: Metodologias de Educação e Assistência na Promoção da Qualidade de Vida. A partir dessa base empírica e conceitual, construíram-se ferramentas metodológicas para o desenvolvimento de consultoria em enfermagem na atenção ambulatorial a indivíduos e grupos. Este artigo propõe-se a apresentar os pressupostos relacionais e operacionais utilizados na assistência nesses serviços.; Se trata de una discusión sobre las estrategias o herramientas metodológicas-asistenciales utilizadas en la práctica de atención básica de salud, basada en el diálogo establecido entre lo que pensamos y lo que desarrollamos en los Ambulatorios de Promoción de Calidad de Vida - APQVs. Esos ambulatorios están localizados en dos servicios de atención básica en Porto Alegre/RS...

Key Issues in Central America Health Reforms : Diagnosis and Strategic Implications, Volume 1. Synthesis of Findings

World Bank
Fonte: Washington, DC Publicador: Washington, DC
Português
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76.11%
The main objective of this report is to identify and analyze the most pressing health sector issues in the sub region of El Salvador, Guatemala, Honduras, and Nicaragua (referred to as CA4) while building on the successes already attained, in order to lay the groundwork for discussing and refining strategies and policies in CA4. It will focus on analyzing (a) CA4 health sector performance, measured by financial protection and a subset of health indicators; and (b) health system functions of financing and service delivery. The report also addresses three topics that CA4 stakeholders selected as their main areas of interest: (a) decentralization processes initiated in these countries; (b) the design and implementation of alternative strategies to improve access to basic maternal and child health care services: and (c) the high prevalence of malnutrition. The synthesis of findings can be found in volume 1 of the report. In volume 2, aside from the introduction, the report comprises five chapters: Chapter 2 discusses the different aspects that characterize the health sector of these countries: health care financing...

Key Issues in Central America Health Reforms : Diagnosis and Strategic Implications, Volume 2. Main Report

World Bank
Fonte: Washington, DC Publicador: Washington, DC
Português
Relevância na Pesquisa
76.09%
The main objective of this report is to identify and analyze the most pressing health sector issues in the sub region of El Salvador, Guatemala, Honduras, and Nicaragua (referred to as CA4) while building on the successes already attained, in order to lay the groundwork for discussing and refining strategies and policies in CA4. It will focus on analyzing (a) CA4 health sector performance, measured by financial protection and a subset of health indicators; and (b) health system functions of financing and service delivery. The report also addresses three topics that CA4 stakeholders selected as their main areas of interest: (a) decentralization processes initiated in these countries; (b) the design and implementation of alternative strategies to improve access to basic maternal and child health care services: and (c) the high prevalence of malnutrition. The synthesis of findings can be found in volume 1 of the report. In volume 2, aside from the introduction, the report comprises five chapters: Chapter 2 discusses the different aspects that characterize the health sector of these countries: health care financing...

Guinea - Health and Nutrition

Mohan, P.C.
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Português
Relevância na Pesquisa
76%
This project was implemented over the period 1994-2002 with a World Bank credit of $24.6 million. The objective was to improve the health status of the population of Middle and Lower Guinea (the prefectures of Boke, Kindia, Mamou and Labe regions), especially the most vulnerable groups of the population, by increasing quality and access to low-cost basic health services. This was to be accomplished through (1) expansion of service coverage and quality improvement of health, nutrition and family planning services; and (2) strengthening sector organization, management and resource mobilization and community participation in order to build a sustainable program.

Chad - The Safe Motherhood Project : Strengthening the Health System

World Bank
Fonte: Washington, DC Publicador: Washington, DC
Português
Relevância na Pesquisa
76.01%
In this largely Muslim population, only about a third of women have any schooling, most marry young (nearly 80 percent by the age of 19) and by the age of 18, more than half have had their first child. Nearly 1 in every 5 women joins in a polygamous marriage. As both women and men state they want 8 and 16 children, respectively, the use of modern contraception remains strikingly low at 1 percent among women and fertility is high. The objectives of this project are to: (a) enhance capability at the central level to support regional health services (16 percent); (b) ensure accessibility of the population to low-cost essential drugs (21 percent); and (c) improve access to basic health services in the regions of Guera and Tandjile (63 percent). While the scope of (a) and (b) are nationwide and support capacity building for health generally, (c) targets two regions for the implementation of these efforts with an emphasis on Safe Motherhood. This project builds on a prior Bank project that included support for the general health sector...

Mexico : Reaching the Poor with Basic Health Services

Marquez, Patricio; de Geyndt, Willy
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Português
Relevância na Pesquisa
86.13%
In the mid-1990s, many Mexicans lived in poverty without adequate access to health and social services. Of a total population of 84 million, 25 percent were considered poor and 16 percent, extremely poor. Urban areas had health indicators similar to OECD countries, with an increasing burden of non-communicable diseases and injuries, while many people in rural areas and the southern states still suffered from common infectious diseases and malnutrition. Life expectancy in rural areas was 55 versus 71 in urban areas and 53 among the poor. The Mexican government realized that inequitable access to basic health care for poor and indigenous people hampered economic development, jeopardized investments in basic education and deprived citizens of their constitutional right to attain good health. So it devised a strategy to reduce inequities, improve health care, and modernize the Federal Health Secretariat (SSA). A 1994 presidential decree created a Health Cabinet (Gabinete de Salud) headed by the President with representatives from social security...

Buying Votes vs. Supplying Public Services : Political Incentives to Under-invest in Pro-poor Policies

Khemani, Stuti
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Português
Relevância na Pesquisa
76.08%
This paper uses unique survey data to provide, for the first time in the literature, direct evidence that vote buying in poor economies is associated with lower provision of public services that disproportionately benefit the poor. Various features of the data and the institutional context allow the interpretation of this correlation as the equilibrium policy consequence of clientelist politics, ruling out alternate explanations (such as, for example, poverty driving both vote buying and health outcomes). The data come from the Philippines, a country context that allows for measuring vote buying during elections and services delivered by the administrative unit controlled by winners of those elections. The data reveal a significant, robust negative correlation between vote buying and the delivery of primary health services. In places where households report more vote buying, government records show that municipalities invest less in basic health services for mothers and children; and, quite strikingly, as a summary measure of weak service delivery performance...

Contracting for the Delivery of Community Health Services : A Review of Global Experience

Loevinsohn, Benjamin; Harding, April
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Português
Relevância na Pesquisa
76.04%
To achieve the health-related Millennium Development Goals, it will be necessary to improve the delivery of health services, particularly to poor people. One proposed approach to improving both coverage and quality of care is to contract with NGOs or other non-state entities to deliver health services. This paper reviews experiences with contracting in which some coherent form of evaluation was carried out, using at least before and after, or controlled evaluation designs. Ten examples of contracting with NGOs were found and from these studies, it appears that in developing countries, contracting with non-state providers to deliver primary health or nutrition services can be very effective and that improvements can be rapid. These results were found in a variety of services and settings. Six of the ten studies compared contractor performance to government provision of the same services and all six found that the contractors achieved better results. There are a number of concerns about contracting that have been raised...

Assessment of Systems for Paying Health Care Providers in Mongolia; Implications for Equity, Efficiency and Universal Health Coverage

Joint Learning Network; Mongolia Ministry of Health; World Bank; World Health Organization
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Tipo: Report; Economic & Sector Work :: Policy Note; Economic & Sector Work
Português
Relevância na Pesquisa
86.02%
Achieving access to basic health services for the entire population without risk of financial hardship or impoverishment from out-of-pocket expenditures (‘universal health coverage’ or UHC) is a challenge that continues to confront most low- and middle-income countries. As coverage expands in these countries, issues of financial sustainability, efficiency, and quality of care quickly rise to the surface. Strategic health purchasing is an important lever to efficiently manage funds for UHC through the definition of what is purchased (which services and benefits the covered population is entitled to receive), from whom services are purchase (which providers are contracted to deliver the covered services), and how and how much the providers are paid. The assessment was conducted to help inform the design and implementation of Mongolia’s provider payment systems going forward. Health care provider payment systems, the way providers are paid to deliver the covered package of services, are an important part of strategic purchasing to balance system revenues and costs in a way that creates incentives for providers to improve quality and deliver services more efficiently. This ultimately makes it possible to expand coverage within limited funds (Langenbrunner...

Health Insurance Handbook : How to Make It Work

Wang, Hong; Switlick, Kimberly; Ortiz, Christine; Zurita, Beatriz; Connor, Catherine
Fonte: World Bank Publicador: World Bank
Tipo: Publications & Research :: Publication; Publications & Research :: Publication
Português
Relevância na Pesquisa
76.05%
Many countries that subscribe to the Millennium Development Goals (MDGs) have committed to ensuring access to basic health services for their citizens. Health insurance has been considered and promoted as the major financing mechanism to improve access to health services, as well as to provide financial risk protection. In Africa, several countries have already spent scarce time, money, and effort on health insurance initiatives. Ethiopia, Ghana, Kenya, Nigeria, Rwanda, and Tanzania are just a few of them. However, many of these schemes, both public and private, cover only a small proportion of the population, with the poor less likely to be covered. In fact, unless carefully designed to be pro-poor, health insurance can widen inequity as higher income groups are more likely to be insured and use health care services, taking advantage of their insurance coverage. The purpose of this handbook is to provide policy makers and health insurance designers with practical, action-oriented support that will deepen their understanding of health insurance concepts...

Contracting and Providing Basic Health Care Services in Honduras : A Comparison of Traditional and Alternative Service Delivery Models

Garcia Prado, Ariadna; Lao Peña, Christine
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Tipo: Publications & Research :: Working Paper; Publications & Research
Português
Relevância na Pesquisa
76.1%
This study uses data from health facility and patient exit surveys carried out in 2006 in Honduras to examine the characteristics of two basic health care provision models: a traditional Ministry of Health (MOH) public health care one versus a community based one also known as 'alternative' or 'public-social'. The author compare these models based on access, quality, costs, productivity, and management autonomy. While the alternative model has higher unit costs for drugs, it also has higher labor productivity. The fact that alternative providers are held accountable through performance-based contracts and that their personnel are hired on a contractual basis and can be demoted or even fired may account for their stronger performance relative to traditional providers whose personnel are centrally hired civil service staff. The findings support the alternative model as a viable option to expand services to other areas of Honduras that lack health services, compensating for the MOH's insufficient capacity to deliver and manage health care services in poor and remote areas. Some elements of this model such as performance-based agreements and other incentives can be also incorporated in the management and implementation of the traditional MOH health units in order to improve their performance. As the alternative models increase in number...

Islamic Republic of Iran - Health Sector Review : Volume 1. Main Report

World Bank
Fonte: Washington, DC Publicador: Washington, DC
Tipo: Economic & Sector Work :: Health Sector Review; Economic & Sector Work
Português
Relevância na Pesquisa
76.05%
The Government of the Islamic Republic of Iran has stated its commitment to improving the health and nutritional status of the population as articulated in the Interim Country Assistance Strategy (CAS), which lists as priorities addressing nutritional deficiencies, expanding coverage of basic health services, and improving efficiency of the health system and the quality of service at all levels. This health sector review is consistent with this in that it provides the platform and evidence base for such reform. It is also in-line with part three of the current Fourth Five-Year Plan, which includes health development, human security and social justice priority, the reduction of illness from malnutrition, increasing public health service coverage, and increasing access to quality health services while reducing the financial burden on the families. The objective of this study is to provide a comprehensive review and diagnostic of the performance of the health sector in the Islamic Republic of Iran. The government is quite advanced in the type of analysis it already undertakes on various aspects of the sector (e.g....

Output-Based Health Care : Paying for Performance in Haiti

Eichler, Rena; Auxila, Paul; Pollock, John
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Tipo: Publications & Research :: Viewpoint; Publications & Research
Português
Relevância na Pesquisa
76%
In 1999 the U.S. Agency for International Development introduced performance-based contracting in an effort to improve the effectiveness of some of Haiti's nongovernmental organizations in providing basic health services, such as immunization and prenatal and maternal care. These providers has been operating under a payment system that reimbursed their expenses up to a ceiling. The new systems set performance targets and withheld a portion of their historical budget, allowing them to earn back the withheld payment plus a bonus if they met the targets. A one-year pilot involving three providers showed some marked improvements in performance.

Stakeholder Participation Targets the Rural Poor : China Basic Health Project

Kuehnast, Kathleen
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Tipo: Publications & Research :: Brief; Publications & Research
Português
Relevância na Pesquisa
76.04%
The past 20 years have witnessed a growing disparity in health status indicators between urban and rural populations in China. The economic and social reforms that have accelerated the growth in GDP and personal income levels of the urban population have not trickled down to the rural areas. Declining government support of public health programs and the collapse of community financing of health services have meant that health services in poor rural areas have deteriorated in general. Services have declined in coverage, quality, efficiency, utilization, and financial viability. To address this disparity, the World Bank-supported Basic Health Project in China introduced a systematic but rapid process of consultation and feedback among selected beneficiary communities. The project was prepared using guidelines prepared by national and international experts. The social assessment confirmed impressions gained from less structured consultations and provided additional support for project design. Stakeholder involvement was extensive...

Tanzania - The Health and Nutrition Project; Tanzanie - Projet Sante et Nutrition

Mohan, P.C.
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Tipo: Publications & Research :: Brief; Publications & Research
Português
Relevância na Pesquisa
75.94%
The objectives of the Health and Nutrition Project were to raise the quality, coverage, and effectiveness of family planning, nutrition, and basic health services through the provision of support to critical and strategic elements of the Health, Nutrition and Population (HNP) sector. This was the first International Development Association (IDA)-financed health project in Tanzania. The project suffered from poor quality at entry, with ambitious objectives, complex design, and implementation arrangements, and ill-considered covenants and cross-conditionality's between different implementing agencies. Combined with the government's weak ownership at the outset and poor project management, project performance during the first three years was very poor. A mid-term review in 1994, and subsequent project restructuring in 1996, resulted in clearer project direction, more feasible work plans and more streamlined implementation. By the end of the project, the government assumed full ownership, and planned activities were completed with project objectives largely achieved. Moreover...

Brazil - Innovative Approaches to Extending Family Health Services; Brasil - Abordagens inovadoras para a ampliacao dos servicos de saude da familia

La Forgia, Gerard
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Tipo: Publications & Research :: Brief; Publications & Research
Português
Relevância na Pesquisa
86.02%
The recently completed Family Health Extension Project (FHEP) has provided support to Brazil's Family Health Program (Programa de Saude da Familia, or PSF) and allowed dramatic improvements in the coverage of basic health services. The project aimed to improve utilization and quality of publicly-financed health services by: (a) expanding coverage of the PSF in about 100 large municipalities, establishing well-articulated referral and counter-referral systems, and introducing performance-based financing and management arrangements; (b) establishing family health as a core element of health professional and para-professional training; and (c) strengthening the Ministry of Health's (MOH or Ministerio da Saude) capacity to monitor and evaluate PSF health services, policies, and training activities on a systematic basis.

Acesso aos serviços básicos de saúde e fatores associados : estudo de base populacional; Access to basic health services and associated factors : a population based study

Andréia Aparecida de Luca Moore Bonello
Fonte: Biblioteca Digital da Unicamp Publicador: Biblioteca Digital da Unicamp
Tipo: Dissertação de Mestrado Formato: application/pdf
Publicado em 27/02/2012 Português
Relevância na Pesquisa
75.93%
Este trabalho teve como objetivo estudar o acesso aos serviços básicos de saúde, identificando fatores associados a essa dimensão a partir das manifestações da população. Trata-se de um estudo transversal, de base populacional, envolvendo 101 famílias residentes na área de abrangência da Unidade de Saúde Américo Bertão, Jardim Eldorado, Cordeirópolis, selecionadas por amostragem aleatória simples, a partir do Sistema de Informação da Atenção Básica. O trabalho foi desenvolvido por meio de entrevista individual, utilizando um questionário semiestruturado. Foi incluído na pesquisa um morador com 18 anos ou mais de cada família que compôs a amostra. A variável resposta foi a informação do entrevistado referente à procura da unidade de saúde como primeira opção, quando alguém na família precisa de atendimento de saúde. As variáveis independentes investigadas foram aspectos da oferta de serviços (sócio-organizacional e geográfico) e características demográficas; socioeconômicas; morbidades; uso da unidade de saúde nos últimos seis meses e comportamento dos indivíduos e da população com influência no acesso e no uso dos serviços de saúde. Além da análise descritiva, a análise univariada foi realizada por meio da razão de Chances...

Estratégias metodológicas de educação e assistência na atenção básica de saúde; Estratégias metodológicas de educación y asistencia en la atención básica de la salud; Methodological education and care strategies in basic health care

Lopes, Marta Julia Marques; Silva, João Luis Almeida da
Fonte: Universidade de São Paulo. Escola de Enfermagem de Ribeirão Preto Publicador: Universidade de São Paulo. Escola de Enfermagem de Ribeirão Preto
Tipo: info:eu-repo/semantics/article; info:eu-repo/semantics/publishedVersion; Formato: application/pdf
Publicado em 01/08/2004 Português
Relevância na Pesquisa
75.97%
Trata-se de discussão sobre estratégias ou ferramentas metodológico-assistenciais utilizadas na prática em atenção básica de saúde. Baseia-se no diálogo estabelecido entre o que se pensa e o que se desenvolve nos Ambulatórios de Promoção da Qualidade de Vida-APQVs. Esses ambulatórios estão sediados em dois serviços de atenção básica do município de Porto Alegre-RS e seus usuários são, em sua maioria, pacientes adultos e idosos, portadores de doenças de longa duração. A proposta desta discussão é oriunda de um projeto de pesquisa financiado pelo CNPq e integrante da rede temática intitulada: Metodologias de Educação e Assistência na Promoção da Qualidade de Vida. A partir dessa base empírica e conceitual, construíram-se ferramentas metodológicas para o desenvolvimento de consultoria em enfermagem na atenção ambulatorial a indivíduos e grupos. Este artigo propõe-se a apresentar os pressupostos relacionais e operacionais utilizados na assistência nesses serviços.; Se trata de una discusión sobre las estrategias o herramientas metodológicas-asistenciales utilizadas en la práctica de atención básica de salud, basada en el diálogo establecido entre lo que pensamos y lo que desarrollamos en los Ambulatorios de Promoción de Calidad de Vida - APQVs. Esos ambulatorios están localizados en dos servicios de atención básica en Porto Alegre/RS...

Health services under the General Agreement on Trade in Services

Adlung,Rudolf; Carzaniga,Antonia
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2001 Português
Relevância na Pesquisa
76.04%
The potential for trade in health services has expanded rapidly in recent decades. More efficient communication systems have helped to reduce distance-related barriers to trade; rising incomes and enhanced information have increased the mobility of patients; and internal cost pressures have led various governments to consider possibilities for increased private participation. As yet, however, health services have played only a modest role in the General Agreement on Trade in Services (GATS). It is possible that Members of the World Trade Organization have been discouraged from undertaking access commitments by the novelty of the Agreement, coordination problems between relevant agencies, widespread inexperience in concepts of services trade, a traditionally strong degree of government involvement in the health sector, and concerns about basic quality and social objectives. However, more than five years have passed since GATS entered into force, allowing hesitant administrations to familiarize themselves with its main elements and its operation in practice. The present paper is intended to contribute to this process. It provides an overview of the basic structure of GATS and of the patterns of current commitments in health services and of limitations frequently used in this context. The concluding section discusses possibilities of pursuing basic policy objectives in a more open environment and indicates issues that may have to be dealt with in current negotiations on services.