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BACKGROUND: Haiti and the Dominican Republic (DR) are targeting malaria elimination by 2022. The private health sector has been relatively unengaged in these efforts, even though most primary health care in Haiti is provided by non-state actors, and many people use traditional medicine. Data on private health sector participation in malaria elimination efforts are lacking, as are data on care-seeking behaviour of patients in the private health sector. This study sought to describe the role of private health sector providers, care-seeking behaviour of individuals at high risk of malaria, and possible means of engaging the private health sector in Hispaniola's malaria elimination efforts. METHODS: In-depth interviews with 26 key informants (e.g. government officials), 62 private providers, and 63 patients of private providers, as well as 12 focus group discussions (FGDs) with community members, were conducted within seven study sites in Haiti and the DR. FGDs focused on local definitions of the private health sector and identified private providers for interview recruitment, while interviews focused on private health sector participation in malaria elimination activities and treatment-seeking behaviour of febrile individuals. RESULTS: Interviews revealed that self-medication is the most common first step in the trajectory of care for fevers in both Haiti and the DR. Traditional medicine is more commonly used in Haiti than in the DR, with many patients seeking care from traditional healers before, during, and/or after care in the formal health sector. Private providers were interested in participating in malaria elimination efforts but emphasized the need for ongoing support and training. Key informants agreed that the private health sector needs to be engaged, especially traditional healers in Haiti. The Haitian migrant population was reported to be one of the most at-risk groups by participants from both countries. CONCLUSION: Malaria elimination efforts across Hispaniola could be enhanced by engaging traditional healers in Haiti and other private providers with ongoing support and trainings; directing educational messaging to encourage proper treatment-seeking behaviour; and refining cross-border strategies for surveillance of the high-risk migrant population. Increasing distribution of rapid diagnostic tests (RDTs) and bi-therapy to select private health sector facilities, accompanied by adopting regulatory policies, could help increase numbers of reported and correctly treated malaria cases.

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Introdução: A Constituição Federal de 1988 instituiu o Sistema Único de Saúde (SUS) e mesmo com a sua criação, a assistência à saúde dos trabalhadores no Brasil é predominantemente realizada pelo setor privado suplementar de saúde. A trajetória histórica da assistência médica aos trabalhadores carrega traços herdados da estrutura médica previdenciária. A atual conformação do Sistema de Saúde brasileiro se dicotomiza em dois subsetores: o público e o privado. Este último, ainda estratificado em um segmento suplementar e um segmento liberal/autônomo. De especial interesse é o estudo do setor suplementar constituído por 48,8 milhões de beneficiários em planos de assistência médica e/ou odontológica. Destes, aproximadamente 80% possuem planos de assistência médica coletivo. Tais planos têm sido objeto de negociação nas pautas reivindicatórias de assistência entre sindicatos e empresas, processo que contribui para a privatização do setor saúde no Brasil. Objetivo: Buscou-se compreender a contratação coletiva de planos de saúde para assistência médica a trabalhadores formais, utilizando como análise central os discursos dos atores sociais envolvidos. Metodologia: Trata-se de um estudo de caso exploratório com aporte qualitativo, realizado com um representante sindical e um representante da empresa empregadora, do ramo metalúrgico. Os dados foram coletados por meio de análise documental e de entrevista semiestruturada e analisados na perspectiva da análise de discurso proposta por Michel Foucault. Resultados: Ao longo de 19 anos a categoria metalúrgica pesquisada realizou 26 convenções coletivas de assistência médica, e destas 16 (61%) são cláusulas de planos de assistência à saúde médico-ambulatorial ou hospitalar e odontológica. A empresa empregadora realizou 42 acordos coletivos de assistência médica, sendo 21 (50%) sobre o mesmo tema. A percepção dos entrevistados sobre a assistência à saúde dos trabalhadores serem atualmente responsabilidade dos planos coletivos de saúde deu origem a três temas. O primeiro diz sobre o papel do sindicato e da empresa na contratação coletiva de assistência à saúde, o segundo ressalta o posicionamento dos entrevistados sobre a regulação do setor suplementar exercida pela ANS e o terceiro discorre sobre a utilização pelos trabalhadores dos serviços ofertados pelo SUS. Considerações Finais: Os discursos correlacionados resultam em reflexões sobre o movimento histórico de contratações coletivas de plano de saúde para a classe dos trabalhadores no Brasil. Nos enunciados, vimos emergir inúmeros problemas do passado que ainda se arrastam sem solução, dentre eles, a privatização cada vez mais crescente do sistema de saúde brasileiro.

Introduction: The Federal Constitution of 1988 establishes the Unified Health System (SUS) in 1988 and, even with its creation, health care for workers in Brazil is predominantly performed by the supplementary private health sector. The historical trajectory of medical care to workers carries traits inherited from the social security structure. The current shape of the Brazilian Health System is dichotomized in two sub-sectors: the public and the private. The latter, still stratified in a supplemental segment and a liberal / autonomous segment. Of special interest is the study of the supplementary sector constituted by 48.8 million beneficiaries in medical and / or dental care plans. Of these, approximately 80% have collective health care plans. Such plans have been the subject of negotiation in the demands for assistance between unions and companies, a process that contributes to the privatization of the health sector in Brazil. Objective: To understand the collective contracting of health plans for medical care to formal workers, using as central analysis the speeches of the social actors involved. Methodology: This is an exploratory case study with a qualitative contribution, carried out with a union representative and a representative of the employing company, from the metallurgical branch. The data were collected through documental analysis and semi-structured interview and analyzed from the perspective of discourse analysis proposed by Michel Foucault. Results: Over 19 years, the metallurgical category surveyed carried out 26 collective health care conventions and of these, 16 (61%) are clauses of medical-ambulatory health care or hospital and dental care plans. The employer made 42 collective health care agreements, 21 (50%) on the same subject. The perception of the interviewees about the health care of the workers being currently the responsibility of the collective health plans gave rise to three themes. The first one says about the role of the union and the company in the collective contracting of health care, the second emphasizes the position of the interviewees on the regulation of the supplementary sector exercised by the ANS and the third talks about the use of the services offered by the SUS by the workers. Final Thoughts: The correlated discourses result in reflections on the historical movement of collective contractions of health plan for the class of workers in Brazil. In the enunciated ones, we have seen to emerge innumerable problems of the past that still creep without solution, among them, the increasing privatization of the Brazilian health system.

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Introdução: Este trabalho visa a apresentar um programa de prevenção deinternação hospitalar para idosos na saúde suplementar e descrever as característicasda população sob intervenção do mesmo. Método: o programa realizaa captação de indivíduos de risco, com idade maior ou igual a 65 anos, aplicandoum questionário de risco para internação hospitalar. Indivíduos de riscosão contatados por telefone e convidados a participar do programa. Idosos querecusam o programa permanecem em cuidado usual, e os que o aceitam sãovisitados por enfermeira, em ambiente domiciliar para uma avaliaçãomultidimensional. De acordo com essa avaliação, idosos são distribuídos emgrupos funcionais que vão determinar seu acompanhamento por equipemultidisciplinar. Resultados: 627 indivíduos aceitam o programa e 392 recusam.O sexo feminino é prevalente em ambos os grupos, assim como a idade médiaé semelhante. A maioria é casada, 19% das mulheres vivem sós, em oposiçãoa 9% dos homens. Percentual de analfabetos é menor do que outros estudos;67% dos usuários do programa apresentam têm três ou mais doenças crônicas;49,6% apresentam limitação funcional em ao menos uma atividade de vidadiária, enquanto 20% apresentam dependência total. Conclusão: É marcante adependência funcional nos idosos do programa, o que fala a favor da presença de seleção adversa na adesão ao programa. A diferença para escolaridade sugereuma representação da classe socioeconômica na saúde suplementar. Sugere seque modelos assistenciais de atenção integral à saúde do idoso sejam desenvolvidosna saúde suplementar.

Introduction: This paper aims to present a program on prevention ofhospitalization for the elderly in the health insurance and describe thecharacteristics of the population under the same intervention. Method: theprogram applies a screening questionnaire for those of 65 years old and aboveaiming to identify individuals at risk for hospitalization. Those at risk arecontacted by phone and invited to participate in the program. Elderly whorefuse the program are kept under usual care. Individuals who accepted theprogram are visited by a nurse, at their houses, for a multidimensional healthevaluation. According to the latter, individuals are distributed in functionalgroups which will determine their health care model by the program. Results:627 accepted the program and 392 refused it. Female is prevalent in bothgroups as the average age is similar for both. The majority is married, 19% ofwomen live alone as opposed to 9% of men. The percentage of analphabets issmaller than other studies; 67% of program users have 3 or more chronicdiseases; 49.6% have limited functional activity for at least one activity ofdaily living and 29% have total dependence. Conclusion: There is an importantfunctional dependence in the elderly under the program, suggesting that thereis an advertion selection criteria for those who accept the program. The literacydifference may be justified by the social economical class of the elderly inthe private health care sector. It is suggested that integrated health care modelsfor the elderly should be developed in the private care sector.