RESUMO
Purpose This research analyzes the cases of five women living along the U.S.-Mexico border who overcame challenges during pregnancy or parenting with the support of a federally funded Healthy Start program, designed to eliminate disparities in perinatal health in disadvantaged communities with the poorest birth outcomes. Study objectives were to: (1) identify common factors that affect healthy maternal and child outcomes for Healthy Start participants; and (2) identify a shared definition of what success looks like for Healthy Start participants and opportunities for further study. Description Five border Healthy Start sites (CA, AZ, NM, and TX) contributed case stories from participants who had overcome access barriers to achieve positive pregnancy, birth or parenting outcomes. Case studies were collected using review of successful participant cases and non-structured interviews by Healthy Start staff, and analyzed using participatory methods and thematic analysis. Assessment Common barriers were: lack of insurance; isolation or unsupportive family relationships; timidness and lack of self-advocacy. Healthy Start programs have been successful in securing supportive relationships through the community health worker model; reducing isolation; obtaining insurance access and a medical home; building self-advocacy skills; and supporting participants to pursue their goals. Conclusion Identified barriers are in line with available literature on health care access and provide a U.S.-Mexico border-specific view. The Healthy Start model is effective at helping women to overcome barriers. Learning from this research may contribute to development of shared measures for more impactful evaluation of Healthy Start and similar programs.
Assuntos
Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Programas Gente Saudável/organização & administração , Mães , Assistência Centrada no Paciente , Determinantes Sociais da Saúde , Adulto , Criança , Agentes Comunitários de Saúde , Feminino , Humanos , Entrevistas como Assunto , México , Avaliação de Resultados em Cuidados de Saúde , Poder Familiar , Parto , Assistência Perinatal , Período Pós-Parto , Pobreza , Gravidez , Avaliação de Programas e Projetos de Saúde , Pesquisa Qualitativa , Estados UnidosRESUMO
The University of New Mexico Health Sciences Center (UNMHSC) adopted a new Vision to work with community partners to help New Mexico make more progress in health and health equity than any other state by 2020. UNMHSC recognized it would be more successful in meeting communities' health priorities if it better aligned its own educational, research, and clinical missions with their needs. National measures that compare states on the basis of health determinants and outcomes were adopted in 2013 as part of Vision 2020 target measures for gauging progress toward improved health and health care in New Mexico. The Vision focused the institution's resources on strengthening community capacity and responding to community priorities via pipeline education, workforce development programs, community-driven and community-focused research, and community-based clinical service innovations, such as telehealth and "health extension." Initiatives with the greatest impact often cut across institutional silos in colleges, departments, and programs, yielding measurable community health benefits. Community leaders also facilitated collaboration by enlisting University of New Mexico educational and clinical resources to better respond to their local priorities. Early progress in New Mexico's health outcomes measures and state health ranking is a promising sign of movement toward Vision 2020.
Assuntos
Relações Comunidade-Instituição , Prioridades em Saúde , Programas Gente Saudável/organização & administração , Determinantes Sociais da Saúde , Fortalecimento Institucional/métodos , Fortalecimento Institucional/organização & administração , Fortalecimento Institucional/normas , Programas Gente Saudável/métodos , Programas Gente Saudável/normas , Humanos , New Mexico , Estudos de Casos Organizacionais , UniversidadesRESUMO
Dirigida a médicos, enfermeras, profesionales, auxiliares de enfermería, nutricionistas, psicólogos y técnicos en salud rural, que realizan acciones de promoción, prevención, atención clínica y orientación a adolescentes y jóvenes, familias y comunidad en la red de servicios de salud del primero y segundo nivel de atención, esta guía de atención integral, pretende que el personal de salud esté actualizado con los conocimientos, capacidades y prácticas que le permitan brindar un servicio de calidad. Es un complemento de las Normas de Atención, que contiene los lineamientos técnico-normativos basados en evidencia científica para que sean aplicados por el personal de salud en los servicios del primero y segundo nivel de atención. Su objetivo principal es el de proporcionar lineamientos para que el personal de salud del primero y segundo nivel brinde a la población adolescente y joven, atención y orientación integral de calidad, basada en evidencia científica, con enfoque de género, pertinencia cultural y de derechos humanos. Contiene glosario e ilustraciones de desarrollo del adolescente y joven.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Suicídio , Comportamentos Relacionados com a Saúde , Psicologia do Adolescente/educação , Programas Gente Saudável/organização & administração , Nutrição do Adolescente , Adulto Jovem , Estilo de Vida Saudável , Promoção da Saúde/organização & administração , Desenvolvimento Humano , Obesidade/prevenção & controle , Gravidez na Adolescência/prevenção & controle , Peso Corporal , Síndrome Pré-Menstrual , Índice de Massa Corporal , Comportamento Alimentar , Dieta Saudável/tendências , Guatemala , Ciclo MenstrualRESUMO
This article examines the experience of a frontier-based community health center when it utilized the Tool for Health and Resilience in Vulnerable Environments (THRIVE) for assessing social determinants of health with a local health consortium. Community members (N = 357) rated safety, jobs, housing, and education among the top health issues. Community leaders integrated these health priorities in a countywide strategic planning process. This example of a frontier county in New Mexico demonstrates the critical role that community health centers play when engaging with local residents to assess community health needs for strategic planning and policy development.
Assuntos
Centros Comunitários de Saúde/organização & administração , Pesquisa Participativa Baseada na Comunidade/organização & administração , Programas Gente Saudável/organização & administração , Assistência Centrada no Paciente/organização & administração , Determinantes Sociais da Saúde , Pesquisa Participativa Baseada na Comunidade/economia , Pesquisa Participativa Baseada na Comunidade/métodos , Planejamento em Saúde/economia , Planejamento em Saúde/métodos , Planejamento em Saúde/organização & administração , Política de Saúde , Prioridades em Saúde , Programas Gente Saudável/economia , Programas Gente Saudável/métodos , Humanos , New Mexico , Estudos de Casos Organizacionais , Assistência Centrada no Paciente/economia , Assistência Centrada no Paciente/normasAssuntos
Educação em Saúde/organização & administração , Programas Gente Saudável/organização & administração , Programas Nacionais de Saúde/organização & administração , Controle de Doenças Transmissíveis/economia , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/organização & administração , Planejamento em Saúde Comunitária/organização & administração , Participação da Comunidade/métodos , Educação em Saúde/métodos , Humanos , Área Carente de Assistência Médica , México , Programas Nacionais de Saúde/economia , Apoio à Pesquisa como Assunto , Gerenciamento de Resíduos/economia , Gerenciamento de Resíduos/métodosRESUMO
Mexico is undergoing profound health reform, extending health insurance to previously uninsured populations and changing the way health care services are delivered. Legislation enacted in 2003 and implemented in 2004 mandated funding and infrastructure that will allow 52% of Mexico's population to access medical care at no cost by 2010. This ambitious social reform has not been without challenges, particularly financial sustainability. Health promotion, because of its potential to prevent or delay chronic diseases and injuries and their associated costs, is a key component of health care reform. In 2006, the Ministry of Health's General Directorate of Health Promotion developed the Health Promotion Operational Model. Based on Ottawa Charter functions, the model integrates health promotion activities within the overall health care system. The main goal of this model is to build strong human capital and to improve organizational capacity for health promotion starting at the local level by training health care personnel to implement health promotion activities. Organizational development workshops started in 2006, and implementation plans in all 32 Mexican states were in place by end of 2008.
Assuntos
Programas Gente Saudável/organização & administração , Programas Nacionais de Saúde/organização & administração , Adolescente , Adulto , Criança , Pré-Escolar , Redes Comunitárias , Participação da Comunidade , Defesa do Consumidor , Feminino , Reforma dos Serviços de Saúde/métodos , Reforma dos Serviços de Saúde/organização & administração , Política de Saúde , Promoção da Saúde , Pesquisa sobre Serviços de Saúde , Humanos , Lactente , Recém-Nascido , Masculino , México , Pessoa de Meia-Idade , Saúde Pública/educaçãoRESUMO
This paper presents the first published report of a national-level effort to implement the Integrated Management of Childhood Illness (IMCI) strategy at scale. IMCI was introduced in Peru in late 1996, the early implementation phase started in 1997, with the expansion phase starting in 1998. Here we report on a retrospective evaluation designed to describe and analyze the process of taking IMCI to scale in Peru, conducted as one of five studies within the Multi-Country Evaluation of IMCI Effectiveness, Cost and Impact (MCE) coordinated by the World Health Organization. Trained surveyors visited each of Peru's 34 districts, interviewed district health staff and reviewed district records. Findings show that IMCI was not institutionalized in Peru: it was implemented parallel to existing programmes to address acute respiratory infections and diarrhoea, sharing budget lines and management staff. The number of health workers trained in IMCI case management increased until 1999 and then decreased in 2000 and 2001, with overall coverage levels among doctors and nurses calculated to be 10.3%. Efforts to implement the community component of IMCI began with the training of community health workers in 2000, but expected synergies between health facility and community interventions were not realized because districts where clinical training was most intense were not those where community IMCI training was strongest. We summarize the constraints to scaling up IMCI, and examine both the methodological and policy implications of the findings. Few monitoring data were available to document IMCI implementation in Peru, limiting the potential of retrospective evaluations to contribute to programme improvement. Even basic indicators recommended for national monitoring could not be calculated at either district or national levels. The findings document weaknesses in the policy and programme supports for IMCI that would cripple any intervention delivered through the health service delivery system. The Ministry of Health in Peru is now working to address these weaknesses; other countries working to achieve high and equitable coverage with essential child survival interventions can learn from their experience.
Assuntos
Serviços de Saúde da Criança/organização & administração , Prestação Integrada de Cuidados de Saúde/organização & administração , Programas Gente Saudável/organização & administração , Desenvolvimento de Programas , Administração em Saúde Pública , Serviços de Saúde da Criança/economia , Mortalidade da Criança , Pré-Escolar , Agentes Comunitários de Saúde/educação , Agentes Comunitários de Saúde/provisão & distribuição , Comportamento Cooperativo , Prestação Integrada de Cuidados de Saúde/economia , Implementação de Plano de Saúde , Política de Saúde , Pesquisa sobre Serviços de Saúde , Programas Gente Saudável/economia , Humanos , Lactente , Recém-Nascido , Peru/epidemiologiaRESUMO
Over the last twenty years the international community-realizing that the tragedy of women dying during pregnancy and in childbirth could no longer be tolerated-launched a series of initiatives aimed at making safe motherhood a cornerstone of health services in all countries. Making pregnancy and delivery safe events is particularly complex, as it involves infrastructural and logistic, as well as technical, issues. Women die because they have no access to skilled personnel during pregnancy and at the time of delivery and because--if an emergency situation arises--they cannot reach a facility where emergency obstetric services are available. FIGO, the International Federation of Obstetrics and Gynecology-as the only global organization representing the Obstetricians of the world-decided some time ago that it could not limit its activities to proposing technical guidelines and debating scientific issues. It had to move into the field and, through its affiliated societies, help change the ability of the multitude of women in the developing world to obtain skilled attendance at birth. In 1997, plans were made to launch activities in five areas where maternal mortality was particularly high: Central America (Guatemala, Honduras, Nicaragua and El Salvador), Ethiopia, Mozambique, Pakistan, and Uganda. Five member societies from the developed world (the American College of Obstetricians and Gynecologists, the Society of Obstetricians and Gynecologists of Canada, the Italian Society of Obstetrics and Gynecology, the Royal College of Obstetricians and Gynecologists of the United Kingdom; and the Swedish Society of Obstetrics and Gynecology) agreed to provide support to their counterparts in these five selected areas. The project is now in its final stage. Results are, by and large, positive, demonstrating that, by motivating health professionals in the field and for a relatively modest financial outlay, more efficient use of existing services could be made in a sustainable fashion to save lives.