5 research outputs found
Atenci贸n prenatal en grupo: efectividad y retos de su implementaci贸n
Group prenatal care is an alternative model of care during pregnancy, replacing standard individual prenatal care. The model has shown maternal benefits and has been implemented in different contexts. We conducted a narrative review of the literature in relation to its effectiveness, using databases such as PubMed, EBSCO, Science Direct, Wiley Online and Springer for the period 2002 to 2018. In addition, we discussed the challenges and solutions of its implementation based on our experience in Mexico. Group prenatal care may improve prenatal knowledge and use of family planning services in the postpartum period. The model has been implemented in more than 22 countries and there are challenges to its implementation related to both supply and demand. Supply-side challenges include staff, material resources and organizational issues; demand-side challenges include recruitment and retention of participants, adaptation of material, and perceived privacy. We highlight specific solutions that can be applied in diverse health systems.La atenci贸n prenatal en grupo es un modelo alternativo de atenci贸n durante el embarazo, que sustituye la atenci贸n prenatal individual est谩ndar. El modelo ha mostrado beneficios maternos y se ha implementado en diferentes contextos. Llevamos a cabo una revisi贸n narrativa de la literatura en relaci贸n a su efectividad, utilizando bases de datos como PubMed, EBSCO, Science Direct, Wiley Online y la editorial Springer, para el periodo 2002 a 2018. Adicionalmente, discutimos los retos y soluciones de su implementaci贸n desde nuestra experiencia en M茅xico. La atenci贸n prenatal en grupo puede mejorar el conocimiento prenatal y el uso de servicios de planificaci贸n familiar en el postparto. El modelo se ha implementado en m谩s de 22 pa铆ses y existen retos de su implementaci贸n desde la oferta y la demanda. Los retos desde la oferta incluyen al personal, recursos materiales y cuestiones organizacionales; desde la demanda, el reclutamiento y retenci贸n de participantes, adaptaci贸n del material y privacidad percibida. Resaltamos soluciones concretas que pueden aplicar a diversos sistemas de salud
Group Prenatal Care in Mexico: perspectives and experiences of health personnel
OBJETIVO: Identificar barreras y facilitadores de la implementaci贸n del modelo de Atenci贸n Prenatal en Grupo en M茅xico (APG), desde la perspectiva del personal de salud. M脡TODOS: Estudio cualitativo descriptivo en cuatro cl铆nicas de la Secretar铆a de Salud en dos estados de M茅xico (Morelos e Hidalgo) de junio de 2016 a agosto de 2018. Se realizaron 11 entrevistas semi-estructuradas a prestadores de servicios de salud. Se exploraron sus percepciones y experiencias durante la implementaci贸n del modelo de APG. Se identificaron barreras y facilitadores para su adopci贸n en dos dimensiones: a) estructurales (espacio, recursos, personal de salud, volumen de pacientes, comunidad) y b) actitudinales (motivaci贸n, liderazgo, aceptabilidad, abordaje de problemas, clima y comunicaci贸n). RESULTADOS: Las barreras m谩s relevantes reportadas en el nivel estructural fueron la disponibilidad de espacio f铆sico en las unidades y la sobrecarga de trabajo del personal de salud. Se identific贸 la dificultad para adoptar una relaci贸n menos jer谩rquica durante la atenci贸n a las gestantes en el nivel actitudinal. El principal facilitador a nivel actitudinal fue la aceptabilidad que los prestadores tienen del modelo. Un hallazgo espec铆fico para el contexto de la implementaci贸n en M茅xico fue la resistencia al cambio en la relaci贸n m茅dico-paciente; resulta dif铆cil abandonar el modelo jer谩rquico prevaleciente y cambiar a una relaci贸n m谩s horizontal con las gestantes. CONCLUSIONES: El an谩lisis de la implementaci贸n del modelo de APG en M茅xico, desde la perspectiva del personal de salud, ha evidenciado barreras y facilitadores similares a las experiencias en otros contextos. Esfuerzos futuros para la adopci贸n del modelo deber谩n enfocarse en la atenci贸n oportuna de las barreras identificadas, sobre todo aquellas se帽aladas en la dimensi贸n actitudinal que pueden ser modificadas a trav茅s de capacitaciones continuas al personal de salud.OBJECTIVE: Identify barriers and facilitators to implementing the Group Prenatal Care model in Mexico (GPC) from the health care personnel鈥檚 perspective. METHODS: We carried out a qualitative descriptive study in four clinics of the Ministry of Health in two states of Mexico (Morelos and Hidalgo) from June 2016 to August 2018. We conducted 11 semi-structured interviews with health care service providers, and we examined their perceptions and experiences during the implementation of the GPC model. We identified the barriers and facilitators for its adoption in two dimensions: a) structural (space, resources, health personnel, patient volume, community) and b) attitudinal (motivation, leadership, acceptability, address problems, work atmosphere and communication). RESULTS: The most relevant barriers reported at the structural level were the availability of physical space in health units and the work overload of health personnel. We identified the difficulty in adopting a less hierarchical relationship during the pregnant women鈥檚 care at the attitudinal level. The main facilitator at the attitudinal level was the acceptability that providers had of the model. One specific finding for Mexico鈥檚 implementation context was the resistance to change the doctor-patient relationship; it is difficult to abandon the prevailing hierarchical model and change to a more horizontal relationship with pregnant women. CONCLUSION: Analyzing the GPC model鈥檚 implementation in Mexico, from the health care personnel鈥檚 perspective, has revealed barriers and facilitators similar to the experiences in other contexts. Future efforts to adopt the model should focus on timely attention to identified barriers, especially those identified in the attitudinal dimension that can be modified by regular health care personnel training
COVID-19 vaccine equity and the right to health for displaced Venezuelans in Latin America.
Given the magnitude of Venezuelan displacement in Latin America, there is a need to assess how migrants were, and will continue to be, addressed in COVID-19 vaccination policies. To explore migration status as a dimension of vaccine equity in Latin America and in relation to international human rights, we assessed national vaccination plans, peer-reviewed, and gray literature published between January 2020 and June 2021. Three key rights-related concerns were found to restrict the health rights of migrants in the region: 1) lack of prioritization of migrants in vaccine distribution; 2) onerous documentation requirements to be eligible for COVID-19 vaccination; and (3) how pervasive anti-migrant discrimination limited equitable health care access. While international human rights law prohibits against discrimination based on migration status, few countries analyzed realized their obligations to provide equal access to COVID-19 vaccines to non-citizens, including displaced Venezuelans. Especially for migrants and displaced people, effective and sustainable vaccination strategies for COVID-19 and future pandemics in Latin America must be guided not only by epidemiological risk but also seek to align with human rights obligations. To achieve this, States must also take special measures to facilitate vaccine access for communities facing systemic discrimination, exclusion, and marginalization