La importancia de las Barreras de acceso y equidad en la atención de los servicios de salud

Objective: To explain how "access barriers" in medical services influence the state of population health in different realities. Material and methods: Research with a deductive method, a basic study, with a non-experimental and cross-sectional design, through a bibliographic review with a descriptive and retrospective emphasis; categorizing the variables of interest, under the deductive method from related research. The review was carried out during the months of June to July of the year 2022. Results: Access to care services presents multiple barriers such as financial, social, cultural, among others; which must be identified early and are not always the same or have the same magnitude in the different realities; but it is common to find that this limitation in access is usual in places far from large cities due to lack of infrastructure and specialized health professionals, it also affects vulnerable populations and the poorest. Conclusions: It was evidenced that the reduction of "access barriers" improves equity in medical services and the population's health status, there are multiple "access barriers" such as geographic, financial, social, cultural, ethnic, sexual, among others; There are multiple public management models, all implemented in accordance with their public policies in order to reduce the gaps with respect to health that exist in the different realities.Objetivo: Explicar cómo las “barreras de accesibilidad” a los servicios médicos influye sobre el estado de la salud poblacional en las diferentes realidades. Material y métodos: Investigación con método deductivo, estudio básico, de diseño no experimental y transversal, mediante la realización de una revisión bibliográfica con énfasis descriptivo y retrospectivo; categorizando las variables de interés, bajo el método deductivo desde investigaciones afines. La revisión fue realizada durante los meses de junio a Julio del año 2022.Resultados: El Acceso a servicios de atención presenta múltiples barreras como las financieras, sociales, culturales, entre otras; las cuales deben ser identificados precozmente y no siempre son las mismas ni tienen la misma magnitud en las diferentes realidades; pero es frecuente hallar que esta limitación en el acceso es usual en los lugares alejados a las grandes urbes por falta de infraestructura y profesionales especializados en salud, asimismo afecta a poblaciones vulnerables y a los más pobres. Conclusiones: Se evidenció que la disminución de las “barreras de acceso”, mejoran la equidad en los servicios médicos y el estado de salud poblacional, existen múltiples “barreras de acceso” como los geográficos, los financieros, sociales, culturales, étnicos, sexuales, entre otros; existen múltiples modelos públicos de gestión, todos implantados de acuerdos a sus políticas públicas para disminuir las brechas con respeto a la salud que existen en las diferentes realidade

Igualdad de oportunidades de la mujer para fomentar su desarrollo profesional en la institución pública: sector agrario Chachapoyas

This research article aims to evaluate the equal opportunities of women to promote their professional development in the public institution - Chachapoyas agricultural sector. The research was applied, non-experimental design, and correlational descriptive level. In this way it was possible to analyze the reality and observe the progress over the years on the equal opportunity of women in the field of their professional development at a national and international level, it is seen that there is an increase in the norms to achieve labor gender equality; Likewise, thanks to empowerment and the constant struggle to have opportunities, a greater number of jobs for women can be seen in the different sectors. Women today are occupying a place in the social stratum with which equality is being achieved thanks to the fact that the state has created help centers such as the Ministry of Women and Vulnerable Populations, Women's Emergency Centers and others; Government devices also allow the development of equality and inclusion between women and men, being essential to achieve gender equity.Este artículo de investigación tiene como objetivo evaluar la igualdad de oportunidades de la mujer para fomentar su desarrollo profesional en la institución pública - sector agrario Chachapoyas. La investigación fue de tipo aplicada , el diseño no experimental, y de nivel descriptivo correlacional. De esta manera se pudo analizar la realidad y observar el avance a lo largo de los años sobre la igualdad de oportunidad de la mujer en el ámbito de su desarrollo profesional a nivel nacional e internacional, lo cual nos permite concluir que existen avances positivos, ya que se ve que hay un incremento de las normas para lograr la igualdad laboral de género; así mismo gracias al empoderamiento y la lucha constante por tener oportunidades se puede apreciar un mayor número de puestos de trabajo para las mujeres en los diferentes sectores. La mujer hoy en día va ocupando un lugar en el estrato social con el cual se está logrando una igualdad gracias a que el estado ha creado centros de ayuda como el Ministerio de la Mujer y Poblaciones Vulnerables, Centros de Emergencia Mujer y otros; también los dispositivos gubernamentales permiten desarrollar la igualdad e inclusión entre las mujeres y hombres siendo esencial para lograr la equidad de género

Revisión sistemática de literatura del sistema de control interno y gestión institucional en las entidades públicas

This article seeks from the systematic review of literature, the theoretical foundation of the internal control system and the institutional management of public entities; this research is based on a quantitative approach on the key words of the study, which allowed through the inductive method to perform the exhaustive verification of the related articles through the use of different reliable sources for its compilation and the analytical-synthetic processing of bibliographies; The problematic situation of which allows us to establish the reflection on the lack of a permanent and adequate management tool in public and private entities that allows regulating the procedures and establishing adequate provisions that contribute to the achievement of the objectives, resulting in a good management for results. The results and discussions are based on contributions from different sources that support and complement this article and refer to international, national and local texts.El presente artículo busca a partir de la revisión sistemática de literatura, la fundamentación teórica del sistema de control interno y la gestión institucional de las entidades públicas; la presente investigación se inclina por un enfoque cuantitativo sobre las palabras claves del estudio, que permitió a través del método inductivo realizar la verificación exhaustiva de los artículos relacionados mediante el uso de diferentes fuentes confiables para su recopilación y el procesamiento analítico – sintético de las bibliografías; la situación problemática del cual nos permite establecer la reflexión sobre la falta de una herramienta de gestión permanente y adecuada en las entidades públicas y privadas que permita regular los procedimientos y establecer disposiciones adecuadas que contribuyan al logro de los objetivos que se traduzca en una buena gestión por resultados. En los resultados y discusiones, se establece a partir de aportes de diferentes fuentes que fundamente y complementan este artículo y refiere a textos internacionales, nacionales y locales

Eficacia de la gestión pública, impacto y percepción del usuario de los programas de alimentación escolar de latinoamérica: una revisión sistemática

The objective of this article was to conduct a systematic review of the effectiveness of public management, impact and user perception of School Feeding Programmes in Latin America. The study was qualitative in approach, phenomenological in design and the sample studied consisted of 25 articles, selected through a documentary analysis. The results were diverse, ranging from an effectiveness of public management with weaknesses for some countries that do not involve family farming in their policies, nor do they consider the opinion of users, or there are problems in food management. On the other hand, the rapid action of some countries in the face of the COVID-19 pandemic, readapting the food service mechanism, stands out. With regard to impact, most authors affirm that the impacts generated by school feeding programmes are not as expected, which is why it is urgent to take the necessary measures to improve them; moreover, in terms of perception, users value the programme as essential for the development of schoolchildren. It is concluded that school feeding programmes in Latin America are important and despite their weaknesses, the social management and the interest they have for their low-income population is highlightedEl objetivo de este artículo fue realizar una revisión sistemática sobre la eficacia de la gestión pública, impacto y percepción del usuario de los Programas de Alimentación Escolar de Latinoamérica. El estudio fue de enfoque cualitativo, de diseño fenomenológico y la muestra estudiada de 25 artículos, seleccionados mediante un análisis documental. Los resultados fueron diversos, desde una efectividad de la gestión pública con debilidades para algunos países que no involucran en sus políticas a la agricultura familiar, ni consideran la opinión de los usuarios, o existen problemas en la gestión alimentaria. Por otro lado, se destaca el rápido accionar de algunos países ante la pandemia por COVID-19, readaptando el mecanismo de servicio alimentario. Respecto al impacto, la mayoría de autores afirman que los impactos generados por los programas de alimentación escolar no son los esperados, por lo que urge tomar las medidas de mejora necesarias, además en cuanto a la percepción, los usuarios valoran al programa por considerarlo esencial en el desarrollo de los escolares. Se concluye que en Latinoamérica los programas de alimentación escolar son importantes y pese a sus debilidades, se resalta la gestión social y el interés que tienen por su población de escasos recursos. &nbsp

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030