RESUMO
Peru has applied to six of the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) rounds for funding, achieving success on four occasions. The process of proposal development has, however, been criticised, especially concerning the use of evidence, relevance/consistency and performance indicators. We aimed to analyse the Peruvian Global Fund proposals according to those dimensions, providing feedback to improve future local efforts and inform global discussions around Global Fund procedures. We analysed the content of four HIV-focused proposals (rounds 2, 5, 6 and 8) regarding epidemic context, needs identification and prioritisation and monitoring and evaluation systems. Peruvian proposals submitted after round 1 were described as resulting from collaborative inputs involving formerly unrepresented sectors, principally 'vulnerable populations'. However, difficulties arose regarding the amount and quality of evidence about the epidemiological context; limited consideration of social determinants of the epidemic; lack of theory-driven interventions, and little synergy across projects and the inclusion of weak monitoring and evaluation systems, with poor indicators and measurement procedures. Prioritising the development of analytical and technical skills to generate Global Fund proposals would enhance the country's capacity to produce and utilise evidence, improve the technical-political interface, strengthen information systems and lead to more informed decision making and accountability.
Assuntos
Medicina Baseada em Evidências/normas , Organização do Financiamento/normas , Infecções por HIV/economia , Infecções por HIV/prevenção & controle , Política de Saúde/economia , Promoção da Saúde/normas , Fortalecimento Institucional/economia , Fortalecimento Institucional/métodos , Organização do Financiamento/métodos , Infecções por HIV/epidemiologia , Promoção da Saúde/economia , Promoção da Saúde/métodos , Humanos , Cooperação Internacional , Informática Médica/economia , Informática Médica/métodos , Informática Médica/normas , Avaliação das Necessidades/economia , Peru/epidemiologia , Formulação de Políticas , Política , Comportamento de Redução do Risco , Educação Sexual , Estigma Social , Populações VulneráveisRESUMO
In the face of the worsening health crisis in Africa, educationalists there and beyond are challenged to identify their role in resolving the crisis. The training of doctors has to be re-orientated so that they are well equipped to lead the way towards improving the health situation and effectively participating in improving the general condition of the people. This can be achieved by medical schools having control of their duties and functions and using these powers to train doctors who are community-orientated, able to identify clinical and epidemiological problems and find suitable solutions. Doctors of the future should be comfortable working in the community with other members of health teams and confident in addressing all health-related matters in the community. During their formative years in medical school they should acquire the skills to continue self-education. This paper discusses some of the important steps that should be taken by medical schools, taking into account the present situation in Africa.
Assuntos
Medicina Comunitária/educação , Educação Médica/métodos , Política de Saúde , Adulto , África , Serviços de Saúde Comunitária/economia , Serviços de Saúde Comunitária/organização & administração , Currículo , Educação Médica/ética , Educação Médica/organização & administração , Avaliação Educacional/métodos , Organização do Financiamento/métodos , Política de Saúde/tendências , Humanos , Lactente , Mortalidade Infantil/tendências , Pobreza/prevenção & controle , Faculdades de Medicina/organização & administração , EnsinoRESUMO
El presente artículo presenta una revisión de conceptos en torno a lo público y lo privado en el proceso de modernización y reforma sanitaria actualmente en curso en el país. Para ello se hace una presentación de los conceptos de lo público y lo privado en los diversos planos funcionales de un sistema de salud, es decir en la función de usuario de los servicios, en la función de prestador de los mismos, y en la función del financiador. Se introduce asimismo al concepto de "combinación público-privado", empleando para ello ejeplos tanto de la experiencia internacional como de la experiencia nacional. Finalmente se proponen algunos criterios de evaluación de procesos de reforma en las funciones del sistema de salud a partir de la división de las funciones de compra y producción de servicios, y se examinan brevemente las condiciones para que la introducción de mecanismos de mercado y de mayor participación del sector privado en la prestación se dé mejorando la eficiencia y calidad de las acciones de salud, y presevando el principio de equidad del sistema de salud.
Assuntos
Planos de Sistemas de Saúde/organização & administração , Planos de Sistemas de Saúde/normas , Planos de Sistemas de Saúde/tendências , Organização do Financiamento/métodos , Organização do Financiamento/normas , Organização do Financiamento/organização & administração , Organização do Financiamento/tendências , Planejamento , Setor Privado , Setor Público , Indicadores Econômicos , Modelos Econômicos , Estações de MonitoramentoRESUMO
The income source and the use of assets at the Health Department of a Chilean city hall was studied. A cost control system was created to know the real value of health services, which were compared with the administrative tariffs determined by the authorities. Specific health programs such as complementary feeding, immunizations and responsible paternity programs represented 48.1 percent of the Health Department expenses. Ninety four percent of services had a real cost that exceeded their administrative price. A reformulation of resource distribution for primary health care and the development of control systems that measure the results of experience activities is proposed
Assuntos
Humanos , Atenção Primária à Saúde/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Recursos em Saúde/provisão & distribuição , Hospitais Municipais/economia , Administração em Saúde Pública/economia , Custos e Análise de Custo/estatística & dados numéricos , Organização do Financiamento/métodos , Atenção à Saúde/economiaRESUMO
Financial options for the National Health System in Mexico are discussed in this paper. In the first part the conceptual elements needed to support financing schemes are presented. The second part deals with financing models of the National Health System. Finally, a map of financing proposals are discussed with the aim of enriching the financial options of the health sector.
Assuntos
Atenção à Saúde/economia , Organização do Financiamento/métodos , MéxicoRESUMO
Primary health care (PHC) services are now recognized as a mainstay of development in low-income regions of the world. Yet, in many of these areas, economic conditions that include a burgeoning international debt, precipitous drops in the prices of raw materials, expanding population bases, and faltering currency rates, make the effective financing of PHC services an issue requiring the most immediate attention. A potentially valuable source of assistance in such endeavors is data on consumers' payment patterns for PHC services, and on socioeconomic conditions within their communities. The Centro de Pesquisas de Assistência Integrada à Mulher e à Criança (CPAIMC), the principal private source of PHC in Rio de Janeiro, has collected these type of data for nine low-income communities (LICs) within the Greater Rio de Janeiro Metropolitan Region. The current paper interfaces these data with previously developed solutions to address the problem of financing PHC services within the nine LICs. The solutions were recommended by a methodology developed and implemented by two of the authors. Results indicate that the consumer payment pattern and socioeconomic data support the methodology's recommendations and, more importantly, may be used to improve the effectiveness of those recommendations. Examples are provided and implications discussed.