RESUMEN
Drawing on six months of ethnographic fieldwork in the main welfare office of the city of Buenos Aires, this article dissects poor people's lived experiences of waiting. The article examines the welfare office as a site of intense sociability amidst pervasive uncertainty. Poor people's waiting experiences persuade the destitute of the need to be patient, thus conveying the implicit state request to be compliant clients. An analysis of the sociocultural dynamics of waiting helps us understand how (and why) welfare clients become not citizens but patients of the state.
Asunto(s)
Pobreza , Asistencia Pública , Clase Social , Servicios Urbanos de Salud , Salud Urbana , Población Urbana , Argentina/etnología , Atención a la Salud/economía , Atención a la Salud/etnología , Atención a la Salud/historia , Atención a la Salud/legislación & jurisprudencia , Historia del Siglo XX , Historia del Siglo XXI , Hospitales Públicos/economía , Hospitales Públicos/historia , Hospitales Públicos/legislación & jurisprudencia , Pacientes/historia , Pacientes/legislación & jurisprudencia , Pacientes/psicología , Pobreza/economía , Pobreza/etnología , Pobreza/historia , Pobreza/legislación & jurisprudencia , Pobreza/psicología , Asistencia Pública/economía , Asistencia Pública/historia , Asistencia Pública/legislación & jurisprudencia , Clase Social/historia , Bienestar Social/economía , Bienestar Social/etnología , Bienestar Social/historia , Bienestar Social/legislación & jurisprudencia , Bienestar Social/psicología , Salud Urbana/historia , Servicios Urbanos de Salud/economía , Servicios Urbanos de Salud/historia , Servicios Urbanos de Salud/legislación & jurisprudencia , Población Urbana/historiaRESUMEN
The purpose of this article is two-fold: (i) to lay out conceptual frameworks for programming in the fields of maternal and neonatal health for the reduction of maternal and peri/neonatal mortality; (ii) to describe selected MotherCare demonstration projects in the first 5 years between 1989 and 1993 in Bolivia, Guatemala, Indonesia and Nigeria. In Inquisivi, Bolivia, Save the Children/Bolivia, worked with 50 women's groups in remote rural villages in the Andean mountains. Through a participatory research process, the 'autodiagnosis', actions identified by women's groups included among others: provision of family planning through a local non-governmental organization (NGO), training of community birth attendants, income generating projects. In Quetzaltenango, Guatemala, access was improved through training of traditional birth attendants (TBAs) in timely recognition and referral of pregnancy/delivery/neonatal complications, while quality of care in health facilities was improved through modifying health professionals' attitude towards TBAs and clients, and implementation of management protocols. In Indonesia, the University of Padjadjaran addressed issues of referral and emergency obstetric care in the West-Java subdistrict of Tanjunsari. Birthing homes with radios were established in ten of the 27 villages in the district, where trained nurse/midwives provided maternity care on a regular basis. In Nigeria professional midwives were trained in interpersonal communication and lifesaving obstetric skills, while referral hospitals were refurbished and equipped. While reduction in maternal mortality after such a short implementation period is difficult to demonstrate, all projects showed improvements in referral and in reduction in perinatal mortality.
PIP: This article presents an analysis of baseline data from four Mothercare projects that provided community-based maternal and child health services in rural Inquisivi, Bolivia; rural Quetzaltenango, Guatemala; rural Tanjungsari in West Java, Indonesia; and Bauchi state, Nigeria. Each project relied on different interventions. All women faced economic, psychological, sociocultural, technical, and administrative barriers in accessing services. The Safe Motherhood Initiative found that people's medical decisions were often based on nonmedical reasons and cultural appropriateness, and that the medical community needs to recognize their competitors in alternative health systems. Maternal and child survival are dependent upon recognition of the problem, decision making about care, access to care, and quality of care. A well-functioning program includes policy formulation, training, IEC, management and supervision, logistics and supplies, and research, monitoring, and evaluation. Study surveys were conducted during the early 1990s. In Bolivia, findings indicate that perinatal mortality declined during 1990-93 to 38/1000 births and fewer mothers died due to pregnancy or childbirth. Family planning use increased from 0 to 27%. The Bolivian project worked to strengthen women's groups. Findings from the Guatemalan project indicate that referrals from traditional birth attendants (TBAs) increased in both the implementation and the comparison areas, but significantly more so in the implementation area. Perinatal mortality among referred women decreased in both areas (from 22.2% to 11.8% in the intervention area). Indonesian results indicate that referrals to birthing centers by TBAs increased from 19% to 62%. Maternal mortality was halved; perinatal mortality declined to 35.8/1000. In Nigeria, maternal mortality declined among all causes.
Asunto(s)
Mortalidad Infantil , Mortalidad Materna , Servicios de Salud Rural/normas , Servicios Urbanos de Salud/normas , Bolivia/epidemiología , Femenino , Guatemala/epidemiología , Humanos , Indonesia/epidemiología , Recién Nacido , Partería , Nigeria/epidemiología , Embarazo , Complicaciones del Embarazo/epidemiología , Servicios de Salud Rural/legislación & jurisprudencia , Servicios Urbanos de Salud/legislación & jurisprudencia , Salud de la MujerRESUMEN
El contenido del informe, intenta dar una visión de los referentes conceptuales en cuanto a políticas de salud que influyeron en el desarrollo del trabajo del equipo de la Consultoría y las actividades planteadas para la consecución de los objetivos. El programa integrado de servicios básicos y fortalecimiento institucional del sector P.S.F. es un Programa especial de la Secretaría Nacional de Salud. Conformado por cuatro componentes: Fortalecimiento de los programas de salud prioritarios de la secretaría nacional de salud. Fortalecimiento institucional. Fortalecimietno de la red de servicios. Componente de estudios