Descentralización de los sistemas de salud: revisión sistemática de la literatura y estudio de caso en Guinea Ecuatorial

Las intervenciones dirigidas a fortalecer los sistemas de salud, en sus distintas tipologías y formas, han demostrado ser una herramienta esencial para mejorar y mantener la salud de la población. A pesar de esto, no está claro qué modelo de sistema de salud es más efectivo o qué organización estructural mejora la gobernanza global del sistema. Las reformas del sector salud basadas en atención primaria de salud (APS) han sido posiblemente las más extendidas de los últimos 30 años. La estrategia de APS se reconoció como el pilar fundamental para la consecución del objetivo de salud para todos en el año 2000, y se centró en dos elementos principales que se añadían al modelo de cuidados: la promoción de la salud basada en la lucha contra los determinantes sociales de la salud, y la descentralización de los servicios de salud asociado a participación comunitaria. Mientras la eficacia de las estrategias basadas en atención primaria ha sido ampliamente demostrada tanto en países de renta alta como en países de bajos recursos, no existe consenso entre los investigadores sobre si la descentralización, de forma aislada, es una reforma que mejora el desempeño de los sistemas de salud o si es una estrategia adecuada para países con bajos recursos. A pesar de ello, la mayor parte de los países africanos se embarcaron en los años 80 en procesos de descentralización a diferentes escalas con el aumentar la sostenibilidad del sistema y mejorar su eficiencia. Aunque las reformas han variado en la magnitud de la reforma, todas ellas han compartido dos elementos: descentralización del sistema de salud y utilización de fondos rotatorios para medicamentos esenciales..

Development of an economic case for civil registration and vital statistics : final technical report

This report describes how the IDRC-Centre of Excellence (CoE) on Civil Registration and Vital Statistics (CRVS) Systems administrative and technical team, together with the Swiss Tropical and Public Health Institute (SwissTPH) responded to challenges and difficulties, including the COVID-19 pandemic. The research identified a framework that can be used by countries to make an economic case for increased investments in CRVS systems. An online CRVS Economic Analysis Tool (CEAT) [vatools.net] was created in order to systematically collect data useful for the CRVS community including governments, development agencies and other CRVS stakeholders. CRVS-produced data can be used in support of sustainable development goals (SDG) indicators

The 'Ten CRVS Milestones' framework for understanding civil registration and vital statistics systems

Civil registration and vital statistics (CRVS) systems are complex adaptive systems involving multiple stakeholders in different government agencies (at a minimum, ministry of health, civil registration authority and national statistics office). CRVS systems not only generate data, but also offer a gateway to services that people need, such as identity, legal entitlements, access to essential services and social protection. To date most attempts to strengthen CRVS systems have been ad hoc and reductionist, focused on single components of the system and introducing short-term technical fixes such as assessment, digitization of administrative tasks, advocacy and training. The potential of new technologies to bring CRVS systems to acceptable levels of coverage and quality can be realised only if structural bottlenecks are dealt with and system-wide actions are taken to ensure scale up and sustainability. The "Ten CRVS Milestones" framework is designed to help CRVS stakeholders—policy-makers, managers and development partners—better understand how CRVS systems function as a whole, from end-to-end, by describing the key processes that must be accomplished in any CRVS system. The "Ten CRVS Milestones" framework, used as part of the CRVS assessment and during the design and integration of new interventions, encourages CRVS stakeholders to have a systemic approach to all the essential steps needed for the system to be fully operational

Las vacunas de la malaria y su potencial aportación para el control y eliminación de la enfermedad

A pesarde que la malaria se puede prevenir y tratar, sigue ejerciendo efectos devastadores en la salud y el modo de vida de las personas a nivel mundial. La comunidad internacional lleva décadas realizando esfuerzos conjuntos para la eliminación del paludismo, lo que ha supuesto importantes cambios en las estrategias de salud pública adoptadas por los países en la lucha contra esta enfermedad.La vacunación es una de las estrategias fundamentales para el control de las enfermedades infecciosas, sin embargo, no siempre se puede lograr de manera sencilla. Por suerte la vacunología es uno de los campos donde más se ha avanzado en las últimas décadas y existen varios ensayos clínicos en desarrollo de los que se esperan buenos resultados. La disponibilidad de vacunas seguras que proporcionen una protección duradera contra la malaria puede suponer un importante avance en la lucha contra la enfermedad, y debe ser estudiada en el contexto de la aplicación de otras intervenciones efectivas, como son el uso de mosquiteros tratados con insecticida y el acceso a diagnóstico y tratamientos combinados con artemisinina.Despite the fact that malaria can be prevented and treated, it still produces devastating effects on health and wellbeing of millions worldwide. Due to global, national and local efforts towards malaria control and elimination, the landscape of public health strategies in the endemic countries is changing rapidly.Malaria vaccines are being developed and has reached a stage where they have been taken to phase III and phase IV trials. Vaccination is an essential strategyfor infectious disease control. However, the integration of new vaccines in an existing vaccination plan is not an easy endeavour. The availability of safe vaccines that produce long-lasting protection can be a considerable move in the fight against malaria worldwide. This should be studied in context where other effective public health interventions, such as long-lasting insecticide nets and access to rapid diagnosis and malaria combined treatment, are being applied

Evaluation of the feasibility and sustainability of the joint human and animal vaccination and its integration to the public health system in the Danamadji health district, Chad

Background:One Health approaches such as the Joint human and animal vaccination programmes (JHAVP) are shown to be feasible and to increase health care access to hard-to-reach communities such as mobile pastoralists. However, the financial sustainability and the integration into the public health systems at the district level of such programmes are still challenging. The main objective of the present study was to give insight to the feasibility and financial sustainability of JHAVP integrated as part of the public health system in Chad.Methods:We conducted a mixed methods study using semi-structured key informant interviews, focus group discussions and budget impact analysis. Strengths, weaknesses, opportunities, and threats were analysed regarding the feasibility and sustainability of the implementation of JHAVP in Danamadji health district in Chad. Feasibility was further analysed using three dimensions: acceptability, implementation, and adaptation. Financial sustainability of JHAVP was analysed through budget impact analysis of implementation of the programme at district level.Results:The acceptability of this approach was regularly assessed by immunization campaign teams through evalua-tion meetings which included pastoralists. The presence of authorities in the meetings and workshops of the pro-gramme had an incentive effect since they represent a mark of consideration these populations generally declared to be lacking. The coordination between the public health and veterinary services at central and decentralized level seemed to be a key element in the success of the implementation of the programme. Regarding financial sustainabil-ity, the total incremental budget impact was 27% slightly decreasing to 26% after five years, which accounts for up to one third of the total budget of the district health office. Also, given that most of the costs for each round are recur-rent costs, efficiency gains from scale effects over time are limited.Conclusion:Based on these findings, we conclude that for JHAVP to be routinely delivered at the district health level, a considerable increase in financial resources would be required. The district could benefit from joint immunization to maintain contact with mobile pastoralists to promote the use of available immunization services at district level

En l’absence de systèmes ESEC, comment recenser et enregistrer les décès dans les contextes de conflit ou d’urgence ou dans les milieux fragiles?

Affaires mondiales Canad

Where there is no CRVS : counting and registering deaths in conflict, emergencies, and fragile settings

The paper examines the role of civil registration and vital statistics (CRVS) systems during crises associated with conflict, migration, disasters, and health emergencies, and in particular on counting and registering deaths and determining causes of death. It identifies gaps in the international response to registration of deaths and discusses how capturing this information and providing surviving family members with information and certificates helps to support institutional and societal resilience. These capacities pave the way for stability in the post-disaster and post-conflict future.Global Affairs Canada (GAC

Synthèses de connaissances sur le genre et les systèmes ESEC

English version in the LibraryAffaires mondiales Canad

Matching comprehensive health insurance reimbursements to their real costs: the case of antenatal care visits in a region of Peru.

BACKGROUND: Prepaid contributory systems are increasingly being recognized as key mechanisms in achieving universal health coverage in low and middle-income countries. Peru created the Seguro Integral de Salud (SIS) to increase health service use amongst the poor by removing financial barriers. The SIS transfers funds on a fee-for-service basis to the regional health offices to cover recurrent cost (excluding salaries) of pre-specified packages of interventions. We aim to estimate the full cost of antenatal care (ANC) provision in the Ventanilla District (Callao-Peru) and to compare the actual cost to the reimbursement rates provided by SIS. METHODS: The economic costs of ANC provision in 2011 in 8 of the 15 health centres in Ventanilla District were estimated from a provider perspective and the actual costs of those services covered by the SIS fee of $3.8 for each ANC visit were calculated. A combination of step-down and bottom-up costing methodologies was used. Sensitivity analysis was conducted to test the uncertainty around estimated parameters and model assumptions. Results are reported in 2011 US$. RESULTS: The total economic cost of ANC provision in all 8 health centres was $569,933 with an average cost per ANC visit of$31.3 (95 % CI $29.7-$33.5). Salaries comprised 74.4 % of the total cost. The average cost of the services covered by the SIS fee was $3.4 (95$3.0-$3.8) per ANC visit. Sensitivity analysis showed that the probability of the cost of an ANC visit being above the SIS reimbursed fee is 1.4 %. CONCLUSION: Our analysis suggests that the fee reimbursed by the SIS will cover the cost that it supposed to cover. However, there are significant threats to medium and longer term sustainability of this system as fee transfers represent a small fraction of the total cost of providing ANC. Increasing ANC coverage requires the other funding sources of the Regional Health Office (DIRESA) to adapt to increasing demand