RESUMO
Comprender los aportes que desde los diferentes actores sociales e institucionales se pueden generar alrededor de la respuesta al VIH. Se desarrolló una investigación cualitativa, empleándose como técnica de investigación la entrevista semiestructurada. Se realizaron 15 entrevistas, donde se identificaron cuatro áreas fundamentales para el trabajo en VIH, a saber: educación, promoción y prevención combinada del VIH; diagnóstico temprano y atención integral del VIH; participación social y comunitaria en la respuesta al VIH y disminución del estigma y la discriminación frente al VIH. Se evidenciaron algunas barreras que tienen los ciudadanos para acceder a determinados servicios y las limitaciones que existen en la implementación de proyectos de salud sexual en el municipio, debido a la falta de articulación entre los actores sociales y la administración municipal, lo que restringe el impacto de los programas de VIH.(AU)
Entender as contribuições que diferentes atores sociais e institucionais podem fazer para a resposta ao HIV. A pesquisa qualitativa foi realizada usando uma técnica de entrevista semiestruturada. Foram realizadas 15 entrevistas, identificando quatro áreas principais para o trabalho com o HIV: educação, promoção e prevenção combinada do HIV; diagnóstico precoce e atendimento abrangente do HIV; participação social e comunitária na resposta ao HIV; e redução do estigma e da discriminação do HIV. Foram evidenciadas algumas barreiras que os cidadãos têm para acessar determinados serviços e as limitações existentes na implementação de projetos de saúde sexual no município, devido à falta de articulação entre os atores sociais e a administração municipal, o que restringe o impacto dos programas de HIV.(AU)
To understand the contributions that can be generated from the different social and institutional actors around the response to HIV. A qualitative research was developed, using a semi-structured interview as a research technique. Fifteen interviews were conducted, where four fundamental areas for HIV work were identified, namely: education, promotion and combined HIV prevention; early diagnosis and comprehensive HIV care; social and community participation in the response to HIV; and reduction of HIV stigma and discrimination. Some barriers that citizens have to access certain services and the limitations that exist in the implementation of sexual health projects in the municipality were evidenced, due to the lack of articulation between social actors and the municipal administration, which restricts the impact of HIV programs.(AU)
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RE S U M E N Si bien los lineamientos vigentes para el Ordenamiento Social de la Propiedad Rural-OSPR establecen, entre otros criterios, la transversalización del enfoque diferencial y la verificación de presencia de comunidades étnicas, no se reconoce expresamente el derecho a la tierra del campesinado. Partiendo de las perspectivas teóricas del Estructuralismo Agrario y del Enfoque Socio-Territorial, este trabajo busca proponer lineamientos complementarios para adelantar un proceso de Ordenamiento Social de la Propiedad Rural OSPR que reconozca este derecho, en los corregimientos que actualmente están siendo propuestos para la constitución de una Zona de Reserva Campesina (ZRC) en Pradera, Valle del Cauca. Para tal fin, se hace un acercamiento a la dinámica histórica del poblamiento y apropiación de la tierra por parte del campesinado y se geoespacializan dentro del polígono de la ZRC los predios por rango de tamaño, las coberturas y fertilidad del suelo y la zonificación de la Reserva Forestal, con los cuales se evidencia la existencia de una territorialidad campesina, la necesidad de redistribuir la tierra, de sustraer áreas de la reserva forestal y de acelerar la constitución de la Zona de Reserva Campesina (ZRC).
Embora as diretrizes atuais para a Ordenação Social da Propriedade Rural-OSPR estabeleçam, entre outros critérios, a integração da abordagem diferencial e a verificação da presença de comunidades étnicas, o direito à terra do campesinato não é expressamente reconhecido. Baseado nas perspectivas teóricas do Estruturalismo Agrário e da Abordagem Sócio-Territorial, este documento procura propor diretrizes complementares para avançar um processo de OSPR que reconheça este direito nos municípios que estão sendo propostos atualmente para a constituição de uma Zona de Reserva Camponesa (ZRC) em Pradera, Valle del Cauca. Para este fim, é feita uma abordagem da dinâmica histórica do assentamento e apropriação da terra pelo campesinato e a geo-espatização dentro do polígono da ZRC das propriedades por faixa de tamanho, cobertura e fertilidade do solo e o zoneamento da Reserva Florestal, que mostra a existência de uma territorialidade camponesa, a necessidade de redistribuir a terra, de subtrair áreas da reserva florestal e de acelerar a constituição da ZRC.
A B S T R A C T Although the current guidelines for the Social Planning of Rural Property (OSPR, acronym in Spanish) establish, among other criteria, the mainstreaming of a differential perspective and the inclusion of ethnic communities, land-rights for peasants are not expressly recognized. Drawing from the theoretical perspectives of Agrarian Structuralism and the Socio-Territorial Approach, this paper proposes complementary guidelines to support an OSPR process that recognizes this right, in the districts that are currently being projected for the constitution of a Peasant Reserve Zone (ZRC, acronym in Spanish) in Pradera, Valle del Cauca. To this end, we describe the historical dynamics of the settlement and appropriation of the land by the peasantry and, within the ZRC polygon, we geospatiolize the properties by range of size, soil coverage and fertility and the zoning of the Forest Reserve, through which we provide evidence for the existence of a peasant territoriality, the need to redistribute land, to subtract areas of the Forest Reserve and to accelerate the constitution of the ZRC.
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ABSTRACT OBJECTIVE Propose an Índice de salubridade ambiental (ISARural - environmental salubrity index) that expresses the conditions experienced in rural agglomerations, including indicators and subindicators for its subsequent application in rural communities in the state of Goiás. METHODS We developed the research in three phases: 1) previous analysis for the proposition of an ISARural, with the participation of seven specialists; 2) proposition of the ISARural by means of the Delphi method, starting with 168 specialists from 26 federative units of Brazil and Distrito Federal; and 3) application of the ISARural in 43 rural communities in the state of Goiás. RESULTS The proposed ISARural resulted in the composition of eight indicators, four of which related to basic sanitation, and the others to health, socioeconomic conditions, public services offered, and housing conditions. The weight assigned to each indicator ranged from 22.82% for the water supply indicator to 6.35% for the service indicator, it is possible to apply the ISARural fully or to evaluate each indicator individually. The application of ISARural in communities of Goiás classified 86% of them with low salubrity, highlighting the worst conditions for quilombola communities. The sanitary sewage had the lowest score among the ISARural indicators, requiring greater attention from public authorities. CONCLUSIONS This study contributed to the proposition of an index in line with the concept of environmental salubrity, useful in the scope of public policies as a conditioner for the prioritization of actions needed to improve the salubrity conditions identified. The proposed ISARural can be fully applied or used in the individual evaluation of each indicator of its composition. The results of its application made it possible to identify the communities with the worst environmental salubrity conditions and the indicators that require greater priority attention in the communities studied.
RESUMO OBJETIVO Propor um índice de salubridade ambiental que expresse as condições vividas em aglomerados rurais (ISARural), englobando indicadores e subindicadores para sua posterior aplicação em comunidades rurais do estado de Goiás. MÉTODOS A pesquisa foi desenvolvida em três fases: 1) análise prévia para proposição de um ISARural, contando com a participação de sete especialistas; 2) proposição do ISARuralpor meio do método Delphi, iniciando com 168 especialistas das 26 unidades federativas do Brasil e do Distrito Federal; e 3) aplicação do ISARuralem 43 comunidades rurais do estado de Goiás. RESULTADOS O ISARuralproposto resultou na composição de oito indicadores, sendo quatro relacionados ao saneamento básico, e os demais à saúde, às condições socioeconômicas, aos serviços públicos ofertados e às condições de moradia. O peso atribuído para cada indicador variou de 22,82%, para indicador de abastecimento de água, a 6,35%, para o indicador de serviços, podendo o ISARuralser aplicado na sua totalidade ou para avaliação de cada indicador individualmente. A aplicação do ISARuralem comunidades de Goiás evidenciou que 86% se classificam com baixa salubridade, destacando as piores condições para as comunidades quilombolas. Dentre os indicadores do ISARural, o de esgotamento sanitário foi caracterizado com a menor pontuação, o que demanda uma maior atenção do poder público. CONCLUSÕES Esse estudo cumpriu o papel de contribuir com a proposição de um índice em consonância com o conceito de salubridade ambiental, podendo ser empregado no âmbito das políticas públicas como um condicionante para a priorização das ações necessárias à melhoria das condições de salubridade identificadas. O ISARuralproposto pode ser aplicado na sua totalidade ou ainda na avaliação individual de cada indicador de sua composição. Os resultados da sua aplicação possibilitaram identificar as comunidades com piores condições de salubridade ambiental e os indicadores que requerem maior atenção prioritária nas comunidades estudadas.
Assuntos
Humanos , População Rural , Saneamento/métodos , Abastecimento de Água , BrasilRESUMO
The intestinal parasitic diseases directly affect the quality of life of indigenous populations, because of vulnerabilities they experience. This study aimed to understand the prevalence of intestinal parasites among the Haliti-Paresí and relate with sanitation and ethno-development. It is a quantitative and cross-sectional study on indigenous Utiaritiland where reside the Haliti-Paresí, in the middle region northern Mato Grosso, Brazil. Data collection occurred in 2015, from interview with application of semi-structured form and collection of feces for coprological survey.Forty-three indigenous people participated in the study, of an average age of 30.9 years old, mostly women, and a predominance of basic education. The prevalence of enteroparasitosis was 46.6%, predominantly among men, reaching all adolescents, followed by children, without the influence of schooling in the rate of infection. Nine species were detected, being six pathogenic, Giardia duodenalis, Entamoebahistolytica, Ancilostomídeo, Blastocystishominis, Hymenolepis nana and Rodentolepis nana, in addition to three non-pathogenic, Iodamoebabutschlii, Entamoeba coli and Endolimax nana.The sanitation conditions, associated with cultural habits, point to the need for improvement in sanitation, since we detected a high prevalence of intestinal parasitoses in this study. The ethno-development may be crucial as strategies for the maintenance of culture in balance with health and sanitary development.
As doenças parasitárias intestinais impactam diretamente na qualidade de vida das populações indígenas, em decorrência das vulnerabilidades que vivenciam. Objetivou-se conhecer a prevalência das parasitoses intestinais entre os Haliti-Paresí e relacionar com o saneamento e etnodesenvolvimento. Trata-se de um estudo quantitativo e transversal na terra indígena Utiariti onde residem os Haliti-Paresí, na região médio Norte de Mato Grosso, Brasil. A coleta de dados ocorreu em 2015, a partir de entrevista com aplicação de formulário semiestruturado e coleta de fezes para inquérito coprológico. Participaram do estudo 43 indígenas, com idade média de 30,9 anos, maioria mulheres e predomínio do ensino fundamental. A prevalência de enteroparasitoses foi de 46,6%, predominando entre os homens, atingindo todos os adolescentes, seguido pelas crianças, sem influência da escolaridade na taxa de infecção. Nove espécies foram detectadas, sendo seis patogênicos, Giardiaduodenalis, Entamoebahistolytica, Ancilostomídeo, Blastocystishominis, Hymenolepis nana e Rodentolepis nana, além de três não patogênicas, Iodamoebabutschlii, Entamoeba coli e Endolimax nana. As condições de saneamento associadas aos hábitos culturais apontam para necessidade de melhoria no saneamento, uma vez que detectamos alta prevalência de parasitoses intestinais neste estudo. O etnodesenvolvimento poderá ser fundamental como estratégias de manutenção da cultura em equilíbrio com a saúde e desenvolvimento sanitário.
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Humanos , Masculino , Feminino , Adulto , Doenças Parasitárias , Planejamento Social , Saúde de Populações IndígenasRESUMO
ABSTRACT Objective: to report the experience of research phases on promoting sustainable development based on social technologies with palm fiber artifacts in a vulnerable community. Method: this is an experience report that describes the phases of a multiprofessional project that sought sustainable development, and was conducted with inhabitants from a vulnerable community. Results: the actions were developed in four phases: exploratory, planning, implementation and evaluation. These phases encompassed a situational diagnosis, planning and performing health education workshops, training meetings, production of handcrafted window shutters with insulation and acoustic comfort. The most emphatic result was the possibility of a new source of income. Final Considerations: the project actions favored the individual and collective empowerment of the participants regarding their health, especially considering the recovery of self-esteem, valuation of traditional knowledge and a new source of income.
RESUMO Objetivo: relatar a experiência das fases de uma pesquisa sobre desenvolvimento social, sustentabilidade e promoção da saúde. Método: trata-se de um relato de experiência no qual se discorre a respeito das fases de um projeto de pesquisa desenvolvido por um grupo de profissionais e alunos de enfermagem, engenharia e arquitetura para o desenvolvimento social, a promoção da saúde e da sustentabilidade de uma comunidade vulnerável. Resultados: a pesquisa se deu em quatro fases - exploratória (diagnóstico, aproximação e identificação das potencialidades humanas e ambientais); planejamento (das ações a partir das demandas dos participantes); implementação (construção do espaço para execução das atividades do projeto); e avaliativa (avaliação das três fases citadas a fim de manter ou modificar ações). Considerações finais: as ações do projeto favoreceram o empoderamento individual e coletivo dos participantes do projeto no que tange à saúde, sobretudo em aspectos relacionados ao resgate da autoestima, à valorização do saber tradicional e à fonte de renda.
RESUMEN Objetivo: relatar la experiencia de las fases de una investigación sobre desarrollo social, sostenibilidad y promoción de la salud. Método: se trata de un informe de experiencia en el que discurren las fases de un proyecto de investigación desarrollado por profesionales y estudiantes de Enfermería, Ingeniería y Arquitectura para el desarrollo social, promoción de la salud y la sostenibilidad comunitaria de la comunidad vulnerable. Resultados: la investigación se dio en cuatro fases: exploratoria (diagnóstico, aproximación e identificación del potencial humano y ambiental), planificación (se planeó las acciones a partir de las demandas de los participantes), implantación (construcción del espacio para la ejecución de las actividades del proyecto) y evaluación (evaluación de las tres fases citadas para mantener o modificar acciones). Consideraciones finales: De las acciones del proyecto favoreció el empoderamiento individual y colectivo de los participantes en relación con la salud, especialmente en sus aspectos relacionados con el rescate de la autoestima, la apreciación de los conocimientos tradicionales y la fuente de ingresos.
Assuntos
Humanos , Mudança Social , Avaliação de Programas e Projetos de Saúde/normas , Populações Vulneráveis , Promoção da Saúde/métodos , Participação da Comunidade/métodos , Promoção da Saúde/normasRESUMO
RESUMO O texto procura apresentar a discussão da questão agrária brasileira na perspectiva do conflito entre dois modelos para o campo: um voltado para o agronegócio e outro voltado para a agricultura familiar, reforma agrária e comunidades tradicionais. O presente artigo pretende visitar essa disputa, atualizá-la no contexto do golpe de Estado de 2016 e apresentar possíveis alternativas para o campo no Brasil em busca de novos paradigmas.
ABSTRACT The text seeks to present the discussion of the Brazilian agrarian issue from the perspective of the conflict between two models for the countryside, one focused on the agribusiness, and one another focusing on family farming, agrarian reform, and traditional communities. The present article intends to visit such dispute, to update it in the context of the coup d'etat of 2016, and to present possible alternatives to the countryside in Brazil in search of new paradigms.
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ABSTRACT OBJECTIVE To describe the methodology used in the process of setting health priorities for community intervention in a community of older adults. METHODS Based on the results of a health diagnosis related to active aging, a prioritization process was conceived to select the priority intervention problem. The process comprised four successive phases of problem analysis and classification: (1) grouping by level of similarity, (2) classification according to epidemiological criteria, (3) ordering by experts, and (4) application of the Hanlon method. These stages combined, in an integrated manner, the views of health team professionals, community nursing and gerontology experts, and the actual community. RESULTS The first stage grouped the identified problems by level of similarity, comprising a body of 19 issues for analysis. In the second stage these problems were classified by the health team members by epidemiological criteria (size, vulnerability, and transcendence). The nine most relevant problems resulting from the second stage of the process were submitted to expert analysis and the five most pertinent problems were selected. The last step identified the priority issue for intervention in this specific community with the participation of formal and informal community leaders: Low Social Interaction in Community Participation. CONCLUSIONS The prioritization process is a key step in health planning, enabling the identification of priority problems to intervene in a given community at a given time. There are no default formulas for selecting priority issues. It is up to each community intervention team to define its own process with different methods/techniques that allow the identification of and intervention in needs classified as priority by the community.
RESUMO OBJETIVO Descrever a metodologia utilizada no processo de estabelecimento de prioridades em saúde para intervenção comunitária, numa comunidade idosa. MÉTODOS Partindo dos resultados de um diagnóstico de saúde no âmbito da promoção do envelhecimento ativo, concebeu-se um processo de estabelecimento de prioridades a fim de selecionar o problema prioritário para intervenção. O processo integrou quatro etapas sucessivas de análise e classificação dos problemas: (1) agrupamento por nível de similitude, (2) classificação de acordo com critérios epidemiológicos, (3) ordenação por peritos e (4) aplicação do método de Hanlon. No decurso destas etapas, combinaram-se, de forma integrada, as perspetivas dos profissionais da equipe de saúde, de peritos em enfermagem comunitária e gerontologia e da própria comunidade. RESULTADOS Na primeira etapa, agruparam-se por nível de similitude os problemas identificados, constituindo-se um corpo de 19 problemas para análise. Na segunda, esses problemas foram classificados pelos elementos da equipe de saúde, mediante a aplicação de critérios de cariz epidemiológico (magnitude, vulnerabilidade e transcendência). Os nove problemas mais relevantes resultantes da operacionalização da segunda etapa do processo foram submetidos a análise por peritos, e selecionados os cinco problemas com maior pertinência de atuação. Na última etapa, com recurso à participação de líderes formais e informais da comunidade, identificou-se o problema prioritário para intervenção nessa comunidade específica: a Baixa Interação Social na Participação Comunitária. CONCLUSÕES O processo de estabelecimento de prioridades é uma etapa fundamental do planejamento em saúde, permitindo identificar os problemas prioritários a intervir numa determinada comunidade e num determinado momento. Não existem fórmulas predeterminadas para a seleção de problemas prioritários. Cabe a cada equipe de intervenção comunitária a definição de um processo próprio com diferentes métodos/técnicas que possibilitem a identificação e intervenção em necessidades classificadas como prioritárias pela comunidade.
Assuntos
Humanos , Idoso , Idoso de 80 Anos ou mais , Planejamento em Saúde Comunitária/métodos , Prioridades em Saúde/normas , Avaliação das Necessidades/normas , Estudos de Viabilidade , Serviços de Saúde para Idosos/normas , Portugal , Reprodutibilidade dos Testes , Fatores SocioeconômicosRESUMO
RESUMEN Este artículo, de naturaleza conceptual, discute desde la teoría crítica la lógica programática en el campo sociosanitario como una respuesta técnica sin preguntas, frente a los territorios entendidos como espacios con preguntas a la espera de traducciones. El propósito es poner en discusión la lógica programática, herencia de la planificación y expresión de la razón instrumental, para desde allí discutir la concepción temporo-espacial como eje para pensar y actuar frente a la complejidad de lo social, reconociendo otros saberes y prácticas. Las preguntas, las respuestas, los saberes y el hacer en el campo sociosanitario constituyen los ejes de la reflexión sustentada en conceptos que buscan desarmar el proyecto ideológico que representan los programas mediante el análisis de su base científica (componente epistemológico de la técnica), que es antagónico a cualquier proyecto de emancipación.
ABSTRACT This article, of a conceptual nature, uses critical theory to discuss the programmatic logic within the sociosanitary field as a technical answer without any questions, provided to territories or spaces with questions awaiting translation. The purpose is to put programmatic logic, which is the legacy of public health planning and an expression of instrumental reason, into discussion, and in this way examine the temporal-spatial conception as an axis for thinking and acting within the complexity of the social world, recognizing other knowledge and practices. The questions, answers, knowledge and actions in the sociosanitary field constitute the focus of a reflection rooted in concepts that seek to deconstruct the ideological project represented by health programs through an analysis of their scientific basis (the epistemological component of the technical), which is antagonistic to any emancipatory project.
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Humanos , Saúde Pública , Planejamento em Saúde , ConhecimentoRESUMO
A presente pesquisa investigou como foram desenvolvidas historicamente a sociabilidade e o lazer na cidade de Curitiba, especificamente na sua principal praça, a Tiradentes. Para tanto, a pesquisa foi centrada na análise de fontes históricas secundárias, sobretudo, memorialistas. A conclusão foi a de que com a estruturação dessa praça central como espaço de circulação foi dado o impulso inicial para a vida pública curitibana e um grande salto para o desenvolvimento urbano.
The present research investigated how the sociability and the leisure had been historically developed, in the city of Curitiba, specifically in its main square: the Tiradentes Square. In order to answer this question, the research was centered in the analysis of secondary historical sources, over all, the memoirists ones. Therefore, it can be concluded that, with the construction of this central square as a space of circulation of people, it was given the initial impulse for the Curitiba public life as well as a great jump for the urban development.
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Humanos , Mudança Social/história , Planejamento Social , Urbanização , Área Urbana , Características Culturais/história , Atividades de Lazer , Arquitetura , ReligiãoRESUMO
Objetivos: Este artículo busca mostrar el desarrollo de un Modelo de Interlocución sobre el desempeño local del sistema de salud en La Guajira, entre 2005 y 2007, con el fin de generar condiciones para la participación social y el mejor desempeño del sistema conforme a las condiciones, necesidades y expectativas locales. Métodos: El desarrollo del Modelo se hizo mediante técnicas etnográficas, en la primera y segunda fase de la investigación, y técnicas participativas, en la tercera. La metodología buscaba recoger la información que permitiera escoger las estrategias de intervención para mejorar las habilidades y capacidades para la participación de los usuarios y que sugiriera la creación de espacios de confianza para la interlocución entre los actores y la negociación de acciones de mejoramiento para el sistema. Con base en la etnografía del sistema y del usuario, se diseñaron estrategias de intervención que incluyen materiales impresos pedagógicos y tres módulos en forma de talleres participativos. Se probó el Modelo en cuatro localidades de La Guajira, en donde al final se crearon Mesas de Trabajo en Salud con participación de usuarios y decisores institucionales. Resultados: Se constató que se puede lograr que los usuarios participen como ciudadanos informados y consumidores críticos, fortaleciendo sus habilidades de interlocución, ampliando sus conocimientos, generando léxicos y significados compartidos con los actores institucionales, y utilizando los dispositivos locales y redes sociales de participación. Conclusión: Es indispensable encontrar estrategias efectivas para motivar una mayor participación de las instituciones, especialmente de las Entidades Promotoras de Salud y Aseguradoras del Régimen Subsidiado.
Objectives: This article shows the development of an interlocution model regarding the health system's local performance in La Guajira from 2005 to 2007. It was aimed at producing conditions for social participation and improving the system's performance according to local conditions, needs and expectations. Methods: Such model was developed by using ethnographic techniques during the investigation's first and second phases and participative techniques during its third phase. The methodology sought to collect information leading to choosing intervention strategies for improving user-participation ability and capacity and creating spaces of trust for interlocution between the actors and negotiating action for improving the system. Intervention-strategies were based on system and user ethnography, including printed pedagogical material and three modules in the form of participative workshops. The model was tested in four localities in the Guajira, leading to working tables for health being created, encouraging participation by users and institutional decision-makers. Results: It was noted that users could participate as informed citizens and critical consumers, strengthening their interlocution abilities, broadening their knowledge, producing vocabulary and meaning shared with the institutional actors and using local mechanisms and social participation networks. Conclusion: Effective strategies must be found for motivating greater participation by institutions, especially health promoting entities and subsidised regime insurers.
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Humanos , Participação da Comunidade/estatística & dados numéricos , Atenção à Saúde/organização & administração , Área Programática de Saúde , Colômbia , Regulamentação Governamental , Política de Saúde , Necessidades e Demandas de Serviços de SaúdeRESUMO
PIP: The chronic crisis in Ecuador's health sector is an indication of the general deterioration of the country, whose multiple unmet needs signify a condition of underdevelopment. Theorizing on health problems should not be allowed to substitute for action. Developing a health policy giving priority to the most disadvantaged sectors will require a development model with a participatory character that promotes equity and solidarity and does not benefit the macroeconomy exclusively. The political will of all sectors must be committed to development of a national health system. A well-coordinated regional system of services, comprising integrated levels of care with functioning referral systems, is needed. The existing network of services must be made to function effectively, without strikes or suspension of activities. The government has a constitutional, legal, and moral obligation to provide health care. Ecuador directs about 6% of the gross national product to health, with 1.6% financing the Ministry of Public Health, which attends to at least 60% of the population. A country like Ecuador--with a very poor population--should not require copayment for services. Ecuador needs an environmental policy to guarantee a healthy food supply, treat sewage, and control use of pesticides--measures which will reduce health care costs in the long run. Finally, it is necessary to improve attention to the human values of medical practice.^ieng
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Atenção à Saúde , Estudos de Avaliação como Assunto , Programas Governamentais , Planejamento em Saúde , Administração de Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde , Formulação de Políticas , América , Países em Desenvolvimento , Economia , Equador , Saúde , América Latina , Organização e Administração , Planejamento Social , América do SulRESUMO
PIP: Six Ecuadorian political figures and physicians were interviewed on their opinions concerning the problems of the health sector and possible solutions. Ecuadorians anticipate that installation of the National Assembly will lead to diagnosis and reform of societal ills. Health has not been a high priority of political leaders. Only 10% of the population has access to the social security system. Infant mortality rates are very high in the rural sierra, and nearly 70% of indigenous sierra children suffer from chronic malnutrition. The need for broad reform of the health sector has been recognized. The interview subjects agreed that reforms are needed, especially in regard to the Ecuadorian Institute of Social Security, which all agreed had become weakened by excessive political patronage and presence of unqualified political appointees. They agreed that the nation's health is deteriorating each day, but they did not always agree on how to solve the crisis. Among the themes debated were the need for improved coordination of services, increased investment in health services, redefinition of the role of public and private services, participation of the population in the construction of health policy, the need for professional administration, whether the poor should be charged for services, and whether monopolies should be permitted in the field of health care.^ieng
Assuntos
Governo , Planejamento em Saúde , Serviços de Saúde , Saúde , Liderança , Médicos , Política , Política Pública , Pessoal Administrativo , América , Comunicação , Atenção à Saúde , Países em Desenvolvimento , Economia , Equador , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde , América Latina , Organização e Administração , Planejamento Social , América do SulRESUMO
PIP: Social participation may be understood as a process in which the population itself assumes responsibility for identifying, carrying out, and evaluating actions necessary for solving problems. The Ecuadorian canton of Cotacachi, under the guidance of the mayor, created mechanisms for identifying and resolving problems through collective work. Assemblies were held in September and October 1996 in the canton and zone to discuss problems. Health problems identified by participants included toxic effects of pesticides used by flower plantations, absence of environmental protection, lack of health education, and poor medical attention. The community proposed a series of solutions: educational programs, potable water and sewage services, municipal ordinances, and an inter-institutional committee. The Intersectorial Health Committee of Cotacachi was formed in December 1996 and immediately formed a Diagnostic Commission consisting of representatives of the health and educational sectors, the local peasant syndicate, and other organizations, with technical assistance from Cepar. The representatives made available the information on Cotacachi from their organizations, but the Commission concluded that existing information was incomplete and failed to reflect the viewpoints of the local community. A survey was planned to fill in the gaps. Community members were trained as interviewers for the survey, which was based on the problems identified by community members. The organizations provided logistical assistance and conducted a campaign to explain the survey to the population and request cooperation. The results will serve as the basis for proposing solutions once data processing is complete.^ieng
Assuntos
Participação da Comunidade , Planejamento em Saúde , Desenvolvimento de Programas , Saúde Pública , Características de Residência , América , Demografia , Países em Desenvolvimento , Economia , Equador , Geografia , Saúde , América Latina , Organização e Administração , População , Planejamento Social , América do SulRESUMO
PIP: The relationship between urban projects and planning has received increased attention in the past decade or so, simultaneously with changes in modes of construction and increasingly limited availability of new urban spaces. The discussion has reaffirmed the importance of the interaction between a project and the plan; the plan is valuable as an important element of the project, and the project becomes concrete proof of the value of the plan. This view of project and plan is part of the process underway since the 1970s, in which context emerged as a preeminent part of an architectural project along with the conception of the project itself as a critical dialogue with existing structures and their modification. Greater attention has thus been given to the constructed city and its history. This work traces the debate over aesthetic and practical aspects of the relationship, including commentary on the social implications of reactions to the renewed debate among architects and others.^ieng
Assuntos
Países Desenvolvidos , Filosofia , Planejamento Social , População Urbana , Demografia , Economia , Geografia , PopulaçãoRESUMO
PIP: IDRC is helping to develop the plan for Essential National Health Research (ENHR) for Mexico. Mexico strongly supports this approach to setting public health research priorities in developing countries. The conclusions of an extensive report led to the creation of the Council on Health Research for Development (COHRED) which is made up of national committees entrusted to decide on subjects for ENHR. It is very hard for competent and committed researchers to assign priority to one problem over another, however. Researchers need to know that 90% of health problems originate in developing countries, yet 95% of the human, technical, and financial resources are in developed countries. One needs to cut down the barriers of ignorance at all levels, such as the mistrust and resistance between researchers and decision makers. COHRED is a vehicle to break through the lack of communication. Funding agencies want to clearly understand the public health problems, but researchers do not like setting priorities. The Mexican Committee for Basic Health Research (COMISA) should release its final report on research priorities in mid-1994. The chair says that globalization is occurring in the health field. For example, tourists from developed countries bring tropical diseases back to their countries. The major health problems in urban areas are chronic degenerative diseases, accidents, and cancer. Cancer of the uterus is a major cause of death among poor women in urban areas due to the absence of general screening and of routine doctor's visits. Other committees are determining the disciplines that should be promoted: molecular research, clinical research, epidemiology, health services, and administrative and financial frameworks. There are hopes to achieve an integrated global analysis of all aspects of medicine.^ieng
Assuntos
Comunicação , Tomada de Decisões , Países Desenvolvidos , Países em Desenvolvimento , Planejamento em Saúde , Necessidades e Demandas de Serviços de Saúde , Pesquisa , América , Comportamento , Economia , América Latina , México , América do Norte , Planejamento SocialRESUMO
PIP: This document describes a proposed new health policy for Colombian women. The rationale for the new policy, known as "Health for women, women for health", is discussed, and the general and specific objectives, program description, actions and strategies are presented for each of 5 subprograms. The subprograms cover health promotion and self-care for women, reproductive and sexual health care, prevention of abuse and services for women and children who are victims of violence, mental health, and occupational health Changes in Colombian society and living conditions and in the role of women over the past few decades have been reflected in changing epidemiologic profiles, life expectancy, and demands placed on health services. The Health for women, women for health policy takes into account social discrimination against women and its impact on female health. The subprogram of health promotion and self-care is intended to complement, reinforce, and broaden preventive interventions already offered by the health services. The subprogram will require a mobile interdisciplinary team to conduct educational campaigns and to coordinate activities. Promotional actions include staff training in a gender focus on health and health policy for women, development of a health manual for women, and a mass media campaign on self-care for women. The subprogram for reproductive health and sexuality will reorient existing maternal health services away from their emphasis on increasing coverage of prenatal care, promoting births in health facilities, and actions to reduce infant mortality and toward services appropriate to the different phases of the female reproductive cycle. The subprogram will include provision of family planning services, preventing and managing high risk pregnancies, providing adequate care in maternity centers for labor and delivery, and preventing avoidable maternal deaths. Reviewing and revising existing legislation to protect reproductive health is among proposed activities. The subprogram for prevention of abuse and services for victims of violence will divide its work into 3 interdisciplinary areas focusing on services, prevention, and research into causes and prevention. A pilot project to provide services to victims of violence and to prevent abuse is in the planning stage.^ieng
Assuntos
Planejamento em Saúde , Bem-Estar Materno , Formulação de Políticas , Medicina Reprodutiva , América , Colômbia , Países em Desenvolvimento , Economia , Saúde , América Latina , Organização e Administração , Planejamento Social , América do SulRESUMO
PIP: Infant mortality rate (IMR) is an important indicator of a country's socioeconomic development. While IMR has declined among most developing countries over the past 3 decades, under-registration of infant deaths remains a serious problem. In the case of Jamaica, IMR declined from 102/1000 in 1945 to 32/1000 in 1970 to 13/1000 by 1984. This 1984 rate is comparable to those enjoyed in the US, Austria, UK, Spain, and Australia. Significant under-registration of infant births and deaths, however, render suspect the validity of Jamaica's IMR of 13/1000. One study found 34% of infant deaths to be unregistered, while another found 9.0% of 10,249 live births to be also be unregistered. Under-registration of this magnitude is the result of faulty hospital procedures and recording systems, a lack of standardization of related terminology, and the under-registration of live births. Inaccurate IMR adversely affects development and health planning. Efforts should therefore be made with the active support of the Ministry of Health to strengthen the registration system by increasing the numbers of registrars of births and deaths and training all personnel involved in registration.^ieng
Assuntos
Mortalidade Infantil , Sistema de Registros/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , JamaicaRESUMO
PIP: The potential contribution of census and survey data in understanding health conditions and trends in different geographic areas and population subgroups is assessed in this work. A general consensus exists that health problems transcend the narrow limits of the health sector, and a wide range of social and economic data are required for their analysis. The principal limitations of censuses as a source of data for health analysis result from their inclusiveness and time frame. On the one hand, the cost and effort involved limit censuses to one per decade under the best of circumstances. On the other hand , the questionnaire must be limited to a relatively small number of themes and questions given the difficulty of controlling the selection, training, and motivation of the thousands of census takers who are required to complete the interviewing in a very short time. Census data are basically of five types: sociodemographic characteristics, assessments of migration and changes of residence, educational characteristics, occupational characteristics, and fertility and mortality. The census is the single and indispensable source for determining whether population is growing or declining at the national, regional, subregional, or local level, and for urban and rural localities. The census also provides at least approximate data on the weight of the different components of change: fertility, mortality, and migration. Census data can be compared with other data concerning the social and economic processes affecting different localities, in order to determine their impact on population changes. All information on the components and causes of population change can be used in developing population projections. The census provides information on educational progress; on labor force participation unemployment, and activity sectors; on the proportion of housing units that fail to meet minimum standards; on the characteristics of the population in need of health care; and on infant and early childhood mortality, itself an indicator of social development. Surveys study a relatively small fraction of the population selected to be representative but they may do so over a longer period of time using carefully trained and motivated interviewers. The questions may provide far greater depth. Disadvantages of surveys include cost and the difficulty of studying characteristics that are infrequent. Sociodemographic surveys are conducted on a very wide variety of topics. Some of the principal areas that provide information of use in health analysis are those concerning manpower and employment, income and expenditures, the demographic variables of fertility, mortality, and migration, and health status and services. In practice most surveys address more than one of these topics.^ieng
Assuntos
Censos , Coleta de Dados , Demografia , Planejamento em Saúde , Saúde , América , Região do Caribe , Países em Desenvolvimento , República Dominicana , Economia , América Latina , América do Norte , População , Características da População , Dinâmica Populacional , Pesquisa , Planejamento Social , Ciências SociaisRESUMO
PIP: The determinants of the severity of childhood malnutrition among a low income population in Cali, Colombia in 1974-76 were examined. Sections are devoted to the welfare maximization and household production model and methodology, the data set, the empirical results, the policy implications, and conclusions. The nutritional health of each preschooler is produced within the household with goods and time inputs (food, environmental sanitation, medical care, time invested in child care, and breastfeeding), and is conditioned by the state of household production technology (mother's literacy as a dummy variable -- version 1, and mother's level of schooling -- version 2) as well as by each child's sex, birth order, age, household size, and sociocultural setting. Constraints are total available income and time available (dummy variable). Reinhardt's version of the translog function is used to represent the production process. Household survey data were made available from a pilot study of a maternal and child health program (PRIMOPS) and includes 421 preschool children and 280 households, and food expenditure data for 197 children and 123 households. The main finding is that teaching Third World mothers to read holds the greatest promise of permanently improving the nutritional status of preschool children. The linear regression results show that the determinants of short-term nutritional status as reflected in weight for age (w/a) are the duration of breastfeeding, literacy, 1-3 years of schooling, and the available food in the household. The levels of significance are higher for version 2, but significance is achieved only with the lower levels of schooling. Birth order is statistically significant but weak and negative; i.e., higher birth orders are at higher risk of malnutrition. Long-term nutritional status is statistically significantly influenced by educational level, birth order, and food available, where older preschoolers are likely to experience stunting but not necessarily wasting. The last born suffers the most nutritionally. The proportion of time spent in child rearing vs. employment results needs further clarification. Breastfeeding effects are largely short term. Of the factors affecting children's nutritional status, the data show that food transfer approaches are not the most cost-effective means for solving chronic malnutrition. Implementing literacy programs would be a more successful strategy and lasts a lifetime. Breastfeeding must be for at least 4 months and preferably a year to show a significant improvement in nutrition, and does not eliminate the risk of malnutrition. Smaller families produce healthier children. A mother, who works part time or greater, increases income potential to provide for nutritional need; income and other factors such as literacy are critical determinants of preschool nutritional well being as supported by the findings of Wolfe and Behrman.^ieng