RESUMO
BACKGROUND: Increasing prioritization of quality primary health care (PHC) includes community engagement as a key element to improve PHC performance. We assessed the correlation of good regional management practices with PHC performance in Peru in community-comanaged PHC that is designed with multiple accountability mechanisms. METHODS: We conducted a secondary analysis of a survey of Dirección Regional de Salud (regional health directorates, DIRESAs) regarding their management of public PHC services with collaborative community involvement by a Comunidad Local de Administración de Salud (Local Community for Health Administration, CLAS). CLAS-run facilities have previously shown evidence of superior performance over standard PHC services. We classified survey questions on 5 management functions of the Primary Health Care Performance Initiative: leadership, information system, financial control, transfer of management and leadership skills to health facilities, and supervision. An expert panel designated management practices as "good" or "less effective." The outcome, PHC service performance, was the percentage of CLAS comanaged facilities in each DIRESA achieving coverage and utilization goals. We correlated frequency of good management practices with PHC service performance. DIRESAs were divided into Group 1, "higher performance," and Group 2, "lower performance," to identify specific practices linked to better performance. RESULTS: We identified 32 good management practices among 52 response options to 17 questions. Correlation between good management practice and good service performance was significant (r=.7266; 12 df; P<.01). An average of 91.1% and 37.6% of CLAS facilities achieved service goals in Groups 1 and 2, respectively. Of all good management practices identified, an average of 40.6% and 24.0% were used by Groups 1 and 2, respectively. Group 1 used 11 specific good practices more frequently than Group 2. CONCLUSIONS: Regional management and community-comanaged PHC services designed with accountability mechanisms should be intentionally aligned, incorporating these into policies, budgets, processes, and capacities to strengthen PHC services.
Assuntos
Atenção Primária à Saúde , Peru , Atenção Primária à Saúde/organização & administração , Atenção Primária à Saúde/normas , Humanos , Liderança , Serviços de Saúde Comunitária/organização & administração , Qualidade da Assistência à Saúde , Participação da Comunidade , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Community health workers (CHWs) are increasingly deployed to support mothers' adoption of healthy home practices in low- and middle-income countries. However, little is known regarding how best to train them for the capabilities and cultural competencies needed to support maternal health behavior change. We tested a CHW training method, Sharing Histories (SH), in which CHWs recount their own childbearing and childrearing experiences on which to build new learning. METHODS: We conducted an embedded cluster-randomized trial in rural Peru in 18 matched clusters. Each cluster was a primary health facility catchment area. Government health staff trained female CHWs using SH (experimental clusters) or standard training methods (control clusters). All other training and system-strengthening interventions were equal between study arms. All CHWs conducted home visits with pregnant women and children aged 0-23 months to teach, monitor health practices and danger signs, and refer. The primary outcome was height-for-age (HAZ)<-2 Z-scores (stunting) in children aged 0-23 months. Household surveys were conducted at baseline (606 cases) and 4-year follow-up (606 cases). RESULTS: Maternal and child characteristics were similar in both study arms at baseline and follow-up. Difference-in-differences analysis showed mean HAZ changes were not significantly different in experimental versus control clusters from baseline to endline (P=.469). However, in the subgroup of literate mothers, mean HAZ improved by 1.03 on the Z-score scale in experimental clusters compared to control clusters from baseline to endline (P=.059). Using generalized estimating equations, we demonstrated that stunting in children of mothers who were literate was significantly reduced (Beta=0.77; 95% confidence interval=0.23, 1.31; P<.01), adjusting for covariates. CONCLUSION: Compared with standard training methods, SH may have improved the effectiveness of CHWs as change agents among literate mothers to reduce child stunting. Stunting experienced by the children of illiterate mothers may have involved unaddressed determinants of stunting.
Assuntos
Agentes Comunitários de Saúde , Mães , Criança , Feminino , Visita Domiciliar , Humanos , Lactente , Peru , Gravidez , População RuralRESUMO
Enfoca la necesidad de cambios institucionales significativos, incluyendo la consolidación de los programas de nutrición dentro de una sola entidad administrativa y la descentralización de la responsabilidad en torno a la implementación del programa. Propone un conjunto integrado de programas que aborden las múltiples causas del enanismo, retardo del crecimiento o desnutrición crónica
Assuntos
Humanos , Masculino , Feminino , Distúrbios Nutricionais , Peru , Estratégias de Saúde Nacionais , Programas e Políticas de Nutrição e Alimentação , Nanismo NutricionalRESUMO
Con el objetivo de averiguar la equidad en salud ("Salud para Todos") se hizo un análisis del tipo y costo del tratamiento usado para niños con diarrea, según los datos de la Encuesta Nacional de Nutrición y Salud (ENNSA) del Perú de 1984. En este análisis, la equidad en salud se refiere a la presunción de que todos los grupos poblacionales tienen el derecho de obtener atención de la misma calidad y tantas veces como sea necesario para sus problemas de salud. La utilización de servicios de salud es sólo un componente de "equidad" en salud, porque además del acceso físico a los servicios y el gasto que se impone, la "equidad" incluye otros factores como por ejemplo el riesgo de enfermarse y tipo de enfermedad que se contrae