Regional-based Integrated Healthcare Network policy in Brazil: from formulation to practice

Background Regional-based Integrated Healthcare Networks (IHNs) have been promoted in Brazil to overcome the fragmentation due to the health system decentralization to the municipal level; however, evaluations are scarce. The aim of this article is to analyse the content of IHN policies in force in Brazil, and the factors that influence policy implementation from the policymakers’ perspective. Methods A two-fold, exploratory and descriptive qualitative study was carried out based on (1) content analysis of policy documents selected to meet the following criteria: legislative documents dealing with regional-based IHNs; enacted by federal government; and in force, (2) semi-structured individual interviews were conducted to a theoretical sample of policymakers at federal (eight), state (five) and municipal levels (four). Final sample size was reached by saturation of information. An inductive thematic analysis was conducted. Results The results show difficulties in the implementation of IHN policies due to weaknesses that arise from the policy design and the performance of the three levels of government. There is a lack of specificity as to the criteria and tools for configuring and financing IHNs that need to be agreed upon between involved governments. For their part, policymakers emphasize the difficulty of establishing agreements in a health system with disincentives for collaboration between municipalities. The allocation of responsibilities that are too complex for the capacity and size of the municipalities, the abandonment of essential functions such as network planning by states and the strategic role by the Ministry, the ‘invasion’ of competences among levels of government and high political turnover are also highlighted. Conclusions The implementation of regional-based IHN policy in Brazil is hampered by the decentralized organization of the health system to the municipal level, suggesting the need to centralize certain functions to regional structures or states and to define better the role of the government levels involved

Introducción a las técnicas cualitativas de investigación aplicadas en salud.

Éste no es un texto teórico sobre métodos cualitativos aplicados en salud, sino un manual autoinstructivo, cuyo propósito es proporcionar a los profesionales de la salud una introducción práctica y sencilla a la investigación cualitativa aplicada en salud. A través de un ejemplo real, se conduce al lector desde los fundamentos teóricos al diseño y desarrollo de un estudio cualitativo en el ámbito de la salud, y se presta especial atención al rigor y al análisis de los datos. Los contenidos teóricos se trabajan mediante el análisis del caso y numerosos ejercicios, y se complementan con una lista de bibliografía comentada. El libro puede ser utilizado de forma individual o bien como base para un curso de investigación cualitativa aplicada en salud.Prólogo a la edición Colombiana -- Introducción al manual -- Introducción al caso -- Introducción a los fundamentos teóricos de la investigación cualitativa -- Diseño de estudios y diseños muestrales en investigación cualitativa -- Técnicas cualitativas aplicadas en salud -- El rigor en la investigación cualitativa -- Análisis de los datos cualitativos -- Divulgación de los resultados de investigaciones cualitativa

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Autonomía de la enfermera que asiste el parto normal en Brasil Autonomia da enfermeira que assiste ao parto normal no Brasil Nurse’s autonomy in the delevery of normal births in Brazil

Objetivo: Identificar los factores que interfieren con la autonomía de la enfermera en la asistencia al parto normal. Metodología: Investigación cualitativa, estudio exploratorio con 9 enfermeras de |4 centros obstétricos de maternidades públicas de São Luís, Maranhão, Brasil, entre abril y mayo de 2002, con utilización de entrevistas grabadas. Resultados: La autonomía de la enfermera en la asistencia al parto normal está influenciada por el poder médico y su propia sumisión, por el desconocimiento sobre el respaldo legal que asegura la actuación del enfermero en esta área del cuidado, por la deficiencia de conocimiento técnico-científico para el manejo del parto y por la sobrecarga en el trabajo cotidiano, que provoca una respuesta de dependencia e inseguridad profesional. Conclusión: Es necesaria la movilización y la unión de esfuerzos de esta categoría para la construcción de su base de autonomía, basada fundamentalmente en la competencia y en la definición de roles.Objetivo: Identificar os fatores que interferem com a autonomia da enfermeira na assistência ao parto normal. Metodologia: Estudo qualitativo, exploratório, realizado com 9 enfermeiras de 4 centros obstétricos de maternidades públicas de São Luís - Maranhão, Brasil, de abril a maio de 2002, com utilização de entrevista gravada. Resultados: A autonomia da enfermeira na assistência ao parto normal é influenciada pelo poder médico e submissão da enfermeira, pelo desconhecimento sobre o respaldo legal que assegura ao enfermeiro atuar nessa área do cuidado, pela deficiência de conhecimento técnico-científico para o manejo do parto e pelo ativismo no cotidiano de trabalho, que provocam uma resposta de dependência e insegurança profissional. Conclusão: É necessária a mobilização e união de esforços dessa categoria para construção de sua base de autonomia, ancorada, fundamentalmente, na competência e na definição de papéis.Objective: To identify factors which interfere on nurse’s autonomy in normal delivery assistance. Methodology: Qualitative and exploratory study, carried through with 9 nurses of 4 obstetric center of public maternities in São Luis, Maranhão, Brazil, from April to May of 2002, through recorded interview. Results: Nurse’s autonomy in normal delivery assistance is influenced by physician’s power and nurse’s submission, by the lack of acquaintance to legal support which assures to the nurse to perform this care taking matter, by the weak technical- scientific knowledge to deal with deliveries and by daily work activism, which motivate a recall of dependence and professional lack of confidence. Conclusion: It is necessary that this category has itself mobilized and gather efforts to raise its autonomy basis, primarily supported by competence and determination of roles

Integrated health care networks in Latin America: toward a conceptual framework for analysis Redes integradas de atención sanitaria en América Latina: hacia un marco conceptual para el análisis

Las inequidades e ineficiencias de los sistemas de salud de América Latina motivaron algunas reformas, concentradas en las últimas dos décadas, particularmente en el financiamiento y el suministro de la atención sanitaria. Este trabajo se enfoca en la introducción de redes integradas de atención sanitaria (RIAS) en varios países de América Latina y los ubica en el contexto internacional. La descripción y el análisis de las RIAS, ya fueran regionales o de afiliación, resaltan el debate actual sobre sus posibles beneficios y riesgos. El impacto de las RIAS -en términos del mejoramiento del acceso a la atención sanitaria o de la promoción de la eficiencia y la equidad en los sistemas de salud- se ha evaluado en muy pocas oportunidades. Para contribuir al tema, se propone un marco conceptual abarcador para el análisis del desempeño de las RIAS, que trata el proceso interno y los factores externos considerados críticos para alcanzar sus objetivos intermedios y finales

Do existing mechanisms contribute to improvements in care coordination across levels of care in health services networks? Opinions of the health personnel in Colombia and Brazil

"Background: The fragmentation of healthcare provision has given rise to a wide range of interventions within organizations to improve coordination across levels of care, primarily in high income countries but also in some middle and low-income countries. The aim is to analyze the use of coordination mechanisms in healthcare networks and its implications for the delivery of health care. This is studied from the perspective of health personnel in two countries with different health systems, Colombia and Brazil. Methods: A qualitative, exploratory and descriptive-interpretative study was conducted, based on a case study of healthcare networks in two municipalities in each country. Individual semi-structured interviews were conducted with a three stage theoretical sample of a) health (112) and administrative (66) professionals of different care levels, and b) managers of providers (42) and insurers (14). A thematic content analysis was conducted, segmented by cases, informant groups and themes. Results: The results show that care coordination mechanisms are poorly implemented in general. However, the results are marginally better in certain segments of the Colombian networks analyzed (ambulatory centres with primary and secondary care co-location owned by or tied to the contributory scheme insurers, and public providers of the subsidized scheme); and in the network of the state capital in Brazil. Professionals point to numerous problems in the use of existing mechanisms, such as the insufficient recording of information in referral forms, low frequency and level of participation in shared clinical sessions, low adherence to the few available clinical guidelines and the lack of or inadequate referral of patients by the patient referral centres, particularly in the Brazilian networks. The absence or limited use of care coordination mechanisms leads, according to informants, to the inadequate follow-up of patients, interruptions in care and duplication of tests. Professionals use informal strategies to try to overcome these limitations. Conclusions: The results indicate not only the limited implementation of mechanisms for coordination across care levels, but also a limited use of existing mechanisms in the healthcare networks analyzed. This has a negative impact on coordination, efficiency and quality of care. Organizational changes are required in the networks and healthcare systems to address these problems. © 2015 Vargas et al.; licensee BioMed Central.

Do existing mechanisms contribute to improvements in care coordination across levels of care in health services networks? Opinions of the health personnel in Colombia and Brazil

Submitted by Adagilson Silva ([email protected]) on 2017-11-16T18:54:17Z No. of bitstreams: 1 26022531 2015 var-doe.oa.pdf: 495740 bytes, checksum: 7955bbfc68088d2a9f8522daa55b32e2 (MD5)Approved for entry into archive by Adagilson Silva ([email protected]) on 2017-11-16T19:35:24Z (GMT) No. of bitstreams: 1 26022531 2015 var-doe.oa.pdf: 495740 bytes, checksum: 7955bbfc68088d2a9f8522daa55b32e2 (MD5)Made available in DSpace on 2017-11-16T19:35:24Z (GMT). No. of bitstreams: 1 26022531 2015 var-doe.oa.pdf: 495740 bytes, checksum: 7955bbfc68088d2a9f8522daa55b32e2 (MD5) Previous issue date: 2015-05-29Fundação Oswaldo Cruz. Instituto Aggeu Magalhães. Recife, PE, BrasilThe fragmentation of healthcare provision has given rise to a wide range of interventions within organizations to improve coordination across levels of care, primarily in high income countries but also in some middle and low-income countries. The aim is to analyze the use of coordination mechanisms in healthcare networks and its implications for the delivery of health care. This is studied from the perspective of health personnel in two countries with different health systems, Colombia and Brazil