Abordagem da doença de Chagas na Atenção Primária: pesquisa qualitativa em uma Área Endêmica da Argentina

El objetivo de este estudio fue evaluar la percepción de equipos de salud de atención en primer nivel y público objetivo acerca de facilitadores y barreras para el abordaje de Chagas a partir de una intervención multifacética, en una zona endémica. Se realizaron 12 entrevistas semiestructuradas y grupos focales en Centros de Atención Primaria en Resistencia, Chaco. El estudio fue guiado por el Marco Consolidado para la Investigación de la Implementación. Los profesionales tuvieron una impresión positiva de la intervención pero mostraron preocupación acerca de la factibilidad. Los profesionales perciben un número excesivo de programas, pocos insumos y recursos humanos, insuficiente capacitación, material informativo desactualizado, trabas burocrática para pedido de insumos y medicación; asimismo perciben falta de vinculación en niveles de atención y fragmentación de registros. Esta investigación contribuiría a la adaptación de intervenciones según barreras y facilitadores existentes.The objective of this study was to evaluate the perception of the healthcare teams and target population about the facilitators and barriers to address Chagas disease in primary level in an endemic area in Argentina. Twelve semi-structured interviews and focus groups were conducted in Primary Health Care Centres in Resistencia, Chaco. The study was guided by the Consolidated Framework for Implementation Research. While professionals had a positive perception of the proposed intervention to address Chagas, they showed concern about complexity and feasibility. Professionals perceive an excessive number of programs, limited material and resources, a lack of training in Chagas, outdated information material, bureaucratic obstacles to requesting supplies and medication, unrelated levels of care and fragmented records on Chagas. This research would contribute to the design of interventions that can be adapted to the existing barriers and facilitators.O objetivo deste estudo foi avaliar a percepção das equipes de saúde e da população alvo sobre os facilitadores e as barreiras para enfrentar a doença de Chagas ao nível primário em uma área endêmica na Argentina. Foram realizadas 12 entrevistas semiestruturadas e grupos focais em Centros de Saúde Primários em Resistencia, Chaco. O estudo foi orientado pelo Quadro Consolidado de Pesquisa para Implementação. Os profissionais tiveram uma percepção positiva da intervenção proposta para abordar o Chagas, mas mostraram preocupação com a sua complexidade e viabilidade. Os profissionais percebem um número excessivo de programas, material e recursos limitados, falta de treinamento em Chagas, material informativo desatualizado, obstáculos burocráticos para solicitar suprimentos e medicamentos, níveis de cuidados não relacionados e registros fragmentados sobre Chagas. Esta investigação contribuiria para a concepção de intervenções que possam ser adaptadas às barreiras e facilitadores existentes.Fil: Roberti, Javier Eugenio. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Alonso, Juan Pedro. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Rouvier, Mariel Vanesa. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Belizán, María Melina Eleonora. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Klein, Karen. Instituto de Efectividad Clínica y Sanitaria; Argentin

Mapping of health system functions to strengthen priority programs. The case of maternal health in Mexico

<p>Abstract</p> <p>Background</p> <p>Health system strengthening is critical to ensure the integration and scaling-up of priority health promotion, disease prevention and control programs. Normative guidelines are available to address health system function imbalances while strategic and analytical frameworks address critical functions in complex systems. Tacit knowledge-based health system constructs can help identify actors' perspectives, contributing to improve strengthening strategies. Using maternal health as an example, this paper maps and analyses the health system functions that critical actors charged with formulating and delivering priority health programs consider important for their success.</p> <p>Methods</p> <p>Using concept mapping qualitative and statistical methods, health system functions were mapped for different categories of actors in high maternal mortality states of Mexico and at the federal level. Functions within and across maps were analyzed for degree of classification, importance, feasibility and coding.</p> <p>Results</p> <p>Hospital infrastructure and human resource training are the most prominent functions in the maternal health system, associated to federal efforts to support emergency obstetric care. Health policy is a highly diffuse function while program development, intercultural and community participation and social networks are clearly stated although less focused and with lower perceived importance. The importance of functions is less correlated between federal and state decision makers, between federal decision makers and reproductive health/local health area program officers and between state decision makers and system-wide support officers. Two sets of oppositions can be observed in coding across functions: health sector vs. social context; and given structures vs. manageable processes.</p> <p>Conclusions</p> <p>Concept mapping enabled the identification of critical functions constituting adaptive maternal health systems, including aspects of actor perspectives that are seldom included in normative and analytical frameworks. Important areas of divergence across actors' perceptions were identified to target capacity strengthening efforts towards better integrated, performing health systems.</p

Problemas del sistema de salud en estados de México con alta incidencia de mortalidad materna Problems of the health system in Mexican states with high incidence of maternal mortality

OBJETIVO: Identificar y priorizar problemas de los sistemas estatales de salud que limitan la eficacia de las intervenciones para prevenir la mortalidad materna. MATERIAL Y MÉTODOS: Se realizó un mapeo conceptual de los problemas prioritarios percibidos por comunidades de práctica (Cop) en estados con alta incidencia de mortalidad materna. Posteriormente, las Cop revisaron la literatura médica para contrastar los problemas identificados. RESULTADOS: Los problemas priorizados por las Cop se enfocaron en la atención de la emergencia obstétrica (AEO), específicamente en recursos financieros y desabasto de insumos (Guerrero), falta de capacitación del personal para atender la EO (Estado de México), ineficiencia de las redes obstétricas (Oaxaca) y desconocimiento y falta de adherencia a protocolos de AEO (Veracruz). La revisión de literatura médica confirmó la pertinencia de los problemas identificados mediante el mapeo conceptual. CONCLUSIÓN: Las Cop pusieron en evidencia un alto grado de congruencia entre la percepción de los problemas de los sistemas estatales de salud y la evidencia científica internacional. Los problemas identificados y reformulados con base en la evidencia facilitan la identificación de soluciones apropiadas.<br>OBJECTIVE: To identify and prioritize problems in states' health systems which limit the efficacy of interventions to prevent maternal mortality. MATERIALS AND METHODS: We made a conceptual mapping of priority problems perceived as such by communities of practice (COP) in four states with high ratios of maternal mortality in Mexico. Then, the four COP reviewed the literature and refined their formulation of previously identified problems. RESULTS: Priority problems focused on emergency obstetric care (EmOC), specifically: inadequate financial resources (Guerrero), substandard training among available EmOC providers (State of Mexico), inefficiencies in existing EmOC networks (Oaxaca) and inadequate knowledge of, and/or compliance to, standard EmOC protocols (Veracruz). The literature review confirmed the pertinence of problems previously identified by COP through conceptual mapping. CONCLUSIONS. The four COP showed a high level of congruency between their original perception of problems in the states' health systems and international scientific evidence. Identified problems and their reformulation based on evidence help identify solutions adaptable to local contexts

Mapeo de problemas para la atención a la salud materna por actores estatales y federales

&lt;p&gt;&lt;strong&gt;Objetivo&lt;/strong&gt;. Analizar las características de problemas del sistema de salud que obstaculizan la atención materna, según los representan y califican funcionarios en diversos puestos y contextos sociales. &lt;strong&gt;Material y métodos&lt;/strong&gt;. Se realizaron talleres con funcionarios de estados de alta mortalidad materna en México (México, Guerrero, Oaxaca y Veracruz) y a nivel federal. Se identificaron 99 problemas en los sistemas de salud. Utilizando mapeo conceptual, 94 funcionarios calificaron los problemas según importancia y factibilidad y se agruparon en regiones. Se analizaron los datos según estado/federación y responsabilidades de los participantes. Se midió la asociación entre perfil/contexto y la priorización de las regiones. &lt;strong&gt;Resultados&lt;/strong&gt;. Las regiones de alta prioridad para la atención materna son infraestructura, contratación de personal y recursos financieros. La importancia de algunas regiones depende del contexto social, aunque también en parte del perfil de responsabilidades de los actores. &lt;strong&gt;Conclusione&lt;/strong&gt;s. Existe consenso entre actores para enfrentar los principales problemas de salud materna en México. Diferencias importantes se deben a diversos contextos. Se demostró la utilidad del mapeo conceptual para el análisis de problemas.&lt;/p&gt

Additional file 3 of Design and feasibility of an implementation strategy to address Chagas guidelines engagement focused on attending women of childbearing age and children at the primary healthcare level in Argentina: a pilot study

Additional file 3. Flowchart for the management of Chagas in women of childbearing age, Spanish version (original version). Information for gynecologists, obstetricians, midwives and general and family practitioners, for the management of Chagas in women of childbearing age

Additional file 10 of Design and feasibility of an implementation strategy to address Chagas guidelines engagement focused on attending women of childbearing age and children at the primary healthcare level in Argentina: a pilot study

Additional file 10. English language translation of the additional files 7, 8 and 9

Additional file 8 of Design and feasibility of an implementation strategy to address Chagas guidelines engagement focused on attending women of childbearing age and children at the primary healthcare level in Argentina: a pilot study

Additional file 8. Reminder for the management of Chagas in children and adolescents, Spanish version (original version). Poster remaining on how to manage Chagas in children and adolescents

Additional file 4 of Design and feasibility of an implementation strategy to address Chagas guidelines engagement focused on attending women of childbearing age and children at the primary healthcare level in Argentina: a pilot study

Additional file 4. Flowchart for the management of Chagas in women of childbearing age, English version

Additional file 9 of Design and feasibility of an implementation strategy to address Chagas guidelines engagement focused on attending women of childbearing age and children at the primary healthcare level in Argentina: a pilot study

Additional file 9. Reminder for Chagas, Spanish version (original version). Stickers to remind the relevance of Chagas. Legend for Additional files 1-9: These materials were developed after extensive formative research, working with designers and researchers from different disciplines, and are the fundamental components of the implementation strategy. It was all produced by the research team based on the information and recommendations of the national Chagas guide, which is similar to Chagas guidelines from other regions of Latin America. Appropriate copyright permission to use images of the company logos was obtained

Additional file 1 of Design and feasibility of an implementation strategy to address Chagas guidelines engagement focused on attending women of childbearing age and children at the primary healthcare level in Argentina: a pilot study

Additional file 1. Flowchart for the management of Chagas in pregnant women, Spanish version (original version). Information for gynecologists, obstetricians, midwives and general and family practitioners for the management of Chagas in pregnant women