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Source publication
Objective:
This article describes the experience of the aval ciudadano "Citizens' Representative" (CR) in improving the Mexican health care system.
Methods:
This is a qualitative study which took place in eight Mexican states in 2008. It evaluates different aspects of a nationwide program to increase the quality of health care services (National...
Context in source publication
Context 1
... the main challenges to better functioning faced by the health care units were: shortages of medications in both accredited and non-accredited units, resistance to change on the part of the staff (particularly doctors), defi ciencies in infrastructure and distrust towards health care personnel (Table 3). ...
Citations
... 6 Similarly, other studies show that some community leaders are perceived as agents capable of change in health services, research also makes evident that family and community networks foster participation. [25][26][27] In Colombia, there have been more barriers to participation than facilitators. This include the asymmetry of power generated by the lack of technical knowledge about the health system and the legislation that regulates said participation among social leaders. ...
... (Field diary, leader, older people's association, El Dorado, man, 64 years old) Promoting Social Participation in Colombia against social participation in health was found, results that coincide with other Latin American studies. 22,25,28,31 In this sense, community leaders perceived that they had insufficient arguments and tools to deal with the situations that violated their rights. This was associated with their urgency to understand the participation mechanisms to transform their realities. ...
Background:
In Latin America, community participation in health issues is subject to corrupt and self-serving interest. Research recommends strengthening communities' abilities to develop actions that involve them in the coproduction of their health.
Objectives:
This study aims (1) to understand social participation in health based on the discourse of community leaders and institutional representatives and (2) to design and implement an educational strategy for capacity building within two communities in Colombia.
Methods:
The study used a community-based participatory research partnership between researchers, community leaders, and institutional representatives. To understand social participation in health, 17 interviews were conducted with leaders and institutional representatives. Based on this assessment, an educational strategy was designed and implemented with residents of two communities, which resulted in 28 people taking part in 14 pedagogical workshops. The strategy was evaluated through focus groups and the results of the project were validated by all the interested parties.
Results:
Interviewees' perception of participation is reduced to access to health care services. They identified that the agencies and institutions promote participation only to comply with the law. The communities stated that they had few tools to resolve situations that violate their right to health. Therefore, leaders and researchers developed an educational strategy custom tailored, so the community could acquire the capacities to confront injustices and bureaucracy in the health system and public services.
Conclusions:
This participatory research empowered communities to defend their right to health. The findings are a reference for social participation in health initiatives in similar contexts.
... Un aspecto adicional que resulta relevante en la formación de un directivo sobre todo el rector universitario, es que debe tener una actitud de líder para tomar acción y conducir a la institución que representa por buen camino en el alcance de los objetivos. En relación a ello, López (2013) sitúa al líder como la persona que tiene la responsabilidad de motivar a la gente que trabaja con él para que sigan su visión y alcances los objetivos. Debe tener capacidad para ser creativo y consolidar su posición. ...
... Como aproximación temática se tienen reportes en donde se proponen mejoras interesantes en la gestión de la calidad (Bartolomé et al., 2019;Giménez et al., 2017;Olmedo et al., 2015;Taylor et al., 2014;Abuosi & Atinga, 2013;, que incluso van hasta la formación profesional para garantizar un desempeño integral del personal directivo y asistencial (Saturno-Hernández et al., 2015). Asimismo, se encontraron propuestas en donde se dan pautas para el éxito de transferencia de resultados de investigaciones en salud hacia las entidades encargadas de administrar los servicios hacia la comunidad (Macías-Chapula, 2012) y otros donde se proveen modelos participativos para la mayor efectividad de la calidad de los servicios de salud (Nigenda- López et al., 2013), con participación de las escuelas de posgrado de las universidades (Quispe-Juli et al., 2019;Medina, 2018;Perdomo et al., 2017) en base a las tendencias de gestión de las entidades de salud previstas desde inicio del siglo XXI Caballero et al., 2010;Martín, 2003;Infante et al., 2000). Es rescatable también la advertencia de algunos investigadores que precisan la necesidad de construir una agenda nacional de investigación en el recurso humano para el sector salud (Curisinche et al., 2011) y que, sin embargo, pocos decisores tomaron en cuenta a pesar de la determinación del probable colapso del modelo del sistema de salud imperante en Latinoamérica y, por supuesto, en el Perú (Atun et al., 2015;Jaime, 2016;Hernández-Quevedo et al., 2016;Repullo & Freire, 2016). ...
... En el análisis temático de los documentos seleccionados, en las tesis con una orientación de diagnóstico debe indicarse que el nivel de criticidad y descripción de la realidad observada es de buena calidad, proporcionando, incluso, detalles documentarios que respaldan las afirmaciones. Esto brinda un detalle muy cercano a lo verdadera situación en este sector, por lo que, si se tienen un buen diagnóstico, es de esperarse que la proyección de las soluciones tendría mayor probabilidad de ejecutarse; no obstante, para que esto ocurra debería articularse a los decisores en el marco de un modelo participativo Hernández-Quevedo et al., 2016;Nigenda-López et al., 2013) para la optimización de la gestión. ...
El objetivo de investigación es exponer la forma en que la concesión de los peajes de
Lima afectan el interés público. El análisis se sustenta en documentos oficiales de
la Contraloría General de la República y de la Municipalidad Metropolitana de Lima.
El diseño de los contratos de concesión de peajes no evidencia haber respetado
los principios de proporcionalidad y reciprocidad que exige la función de garante
de los funcionarios públicos. La falta de transparencia en la información pública y
la indiferencia ciudadana, contribuyen al empoderamiento de la corrupción y a la
consolidación de organizaciones criminales. El interés público se ve avasallado y la
sociedad percibe como normal lo que les afecta gravemente. Mas aún, si los actos
realizados gozan de protección jurídica y constitucional. El tipo de investigación
realizada es exploratoria y cualitativa. El método es inductivo y se muestra, además,
el estudio de casos a partir de la observación sistemática de la realidad, con una
visión holística. Se expone, claramente, el mal uso del poder gubernamental y
la discrecionalidad con que los funcionarios públicos municipales, disponen del
patrimonio público municipal, en aparente concertación con intereses privados para
obtener ventajas económicas, en perjuicio de la ciudad y la ciudadanía.
... These efforts should include a determined and proactive search (with frequent home visits) for women in need of care; the introduction of transportation subsidies; the elimination of copays; the incorporation of professional midwives in the provision of maternal care services; and the reinforcement of community participation in the area of maternal health (for example, by means of educational and publicity campaigns). It will also be crucial to reclaim the importance of key community actors including citizen endorsement 51 and to promote health units networks, performing, among other functions, the role of facilitators for identifying obstetric complications. Contact with, and frequent use of, health services, 52 while respecting social norms and cultural adaptation of services, will also be essential. ...
Objective
To analyze the formation of spatial clusters of technical efficiency (TE) in the production of outpatient maternal health services in México for the period 2008 to 2015.
Methods
We performed a longitudinal analysis of administrative and structural data related to the 243 Mexican health jurisdictions. We use window data envelopment analysis and spatial and econometric techniques. Structural correlates of each TE cluster obtained were identified estimating a pooled multinomial logit model.
Results
We observed an increase in the overall TE, accompanied by a reduction in its standard deviation. Furthermore, we identified positive TE spatial dependence both globally and locally. Multiple regression analysis showed that the maximum‐performance TE cluster was composed of health jurisdictions located in the North of México and characterized by social marginalization, a reduced indigenous population, and a low demand for maternal health services.
Conclusions
The identification of TE clusters can provide elements to induce decision makers to innovative in ways of allocating resources and manage their utilization. In México as other low‐ and middle‐income countries, it is key to develop targeting strategies to implement specific health services innovations putting to the population to be served at the front of the strategy. This implies testing new modalities to strengthen primary health services, the empowerment of community participation, the training and allocation of health personnel that could respond adequately to population's demand, and the active involvement of competent state and local authorities in the assessment of the results of these innovations.
... A number of key constructs linked to community participation were highlighted across the various frameworks and models used. These include leadership (Ryan, 2016 Ryan, 2016); enabling community voices, perspectives and values (Wenz-Gross et al., 2012;López, 2013) to shape attitudes and behaviors (Weiner et al., 2002); using local, technical and experiential knowledge of the community (Gomez et al., 2005;Baur et al., 2010); and having effective resources for sustainable interventions (Art et al., 2007;Anderson-Lewis et al., 2012;Gomez et al., 2005). Through many of these constructs, the concept of power emerges as a basic tenet in driving forward genuine and effective community participation. ...
... From the papers that cited the use of a theoretical framework, model, guiding principle or approach for community participation, we identified a number of key constructs underpinning successful community participation in general health interventions. These include effective leadership and communication (Ryan, 2016;Ansari, 2012); the enabling of community voices, perspectives and values (Wenz-Gross et al., 2012;López, 2013); the utilization of local, technical and experiential knowledge of the community (Gomez et al., 2005;Baur et al., 2010); and having effective resources for sustainable interventions (Art et al., 2007;Anderson-Lewis et al., 2012;Gomez et al., 2005). Central to these constructs is the issue of 'power' and 'control', which is a key element in conceptualizing and enabling genuine community participation (Arnstein, 1969). ...
Community participation is commonly regarded as pivotal in enabling the success of many health initiatives. However, the theoretical constructs, and evidence about the contextual drivers and relational issues that shape participation is lacking. The aim of this systematic review was to examine the evidence for published academic literature on community participation in relation to general, non-disease specific health initiatives, including the use of theories to inform community participation, and the study of contextual drivers and relational issues that influence community participation, with a focus on high and upper-middle income countries. We searched multiple databases including Medline, Embase, Scopus, LILACs and Global Health from January 2000 to September 2016. We screened papers for inclusion, then conducted data extraction and a narrative synthesis of the data. Only papers that focused on general health were included. Disease-specific literature was excluded. 27,232 records were identified, with 23,468 after duplicate removal. 79 papers met our final inclusion criteria. Overall, our findings show that strategies to encourage community participation in health initiatives can be categorized along a continuum that varies from less to more participation and control among the community. Our analysis of reported outcomes demonstrates that community participation in general health initiatives can contribute to positive process, social and health outcomes. Social outcomes are more often associated with increasing community participation in our selection of papers. Overall, our findings reaffirm the understanding that community participation is a complex process that is strongly influenced by the context in which it occurs, and that social factors such as power relations must be carefully considered. There is a need for more robustly designed studies to improve the theorization of community participation, and to draw out a better understanding of how tangible and intangible elements such as power, influence community participation and its outcomes.
The government's direct administration of public health facilities has proved to be bureaucratic and of low quality. Therefore, governments are trying new management models for some healthcare facilities using public-private partnerships (PPP). One kind of PPP is deployment of social organizations. Social organizations are nongovernmental nonprofit organizations created in Brazil, in the 1990s, engaged in such activities as teaching, research, technological development, or protection and conservation of the environment. Nonprofits enter PPPs created specifically for the purpose of running health facilities, and the state department of health monitors and evaluates contracts with them. This chapter's objective is to analyze the implementation process of the social organizations management program, focusing on the role played by factors such as administrative and financial autonomy, direction, innovative management practices, and gains in efficiency of the health facility. The chapter discusses differences between direct government management and administration by social organizations.
Resumen
Objetivo
Explorar las perspectivas de tomadores de decisiones y miembros de la comunidad en atención primaria en salud (APS) en torno a la conceptualización de la participación social (PS).
Diseño
Estudio transversal de carácter exploratorio con metodología cualitativas.
Emplazamiento
Centros de Salud de la Región Metropolitana (RM), Santiago, Chile.
Participantes
Ocho informantes del nivel directivo (grupo 1), 13 del nivel de ejecución en APS (grupo 2) y 28 miembros de la comunidad y cuatro agentes comunitarios de salud (grupo 3).
Método
Se realizaron entrevistas y grupos de discusión, que fueron grabados y transcritos. La organización y análisis se realizó con Atlas.ti 8.1. Las narrativas fueron sistematizadas mediante un análisis temático. Se codificó la totalidad de los documentos a través de reuniones periódicas para revisar los códigos existentes y para discutir la inclusión de nuevos códigos.
Resultados
El grupo 1 remite concepciones más teóricas acerca de la PS. El grupo 2 expresa dimensiones más concretas y operativas. El grupo 3 indica que la PS se encarna en experiencias particulares, vividas cercanamente por quienes las relatan. Los grupos 1 y 3 poseen más de una noción de la participación social en salud.
Conclusiones
Predomina transversalmente una concepción institucional de la participación, arraigada desde la década de 1990. En el nivel de la comunidad, las narrativas adquieren la forma de prácticas colectivas vividas en torno al mejoramiento de la calidad de vida comunitaria mediadas por el nivel de ejecución.
Objetivo. Analizar la implementación del programa Sistema Integral de Calidad en Salud (Sicalidad) en México, en 2011. Material y métodos. Estudio transversal, cualicuantitativo, con una muestra probabilística de conglomerados y dos etapas de selección. Se realizaron 3 034 entrevistas en 13 entidades federativas para evaluar ocho componentes del programa. Se formularon índices generales de desempeño (IGD) para evaluar la implementación en términos de estructura, proceso y satisfacción de los usuarios, médicos y enfermeras con el programa. Resultados. El IGD peor evaluado fue acreditación, con 25.4 y con 28% de unidades evaluadas; el mejor fue prevención y reducción de la infección nosocomial, con IGD de 78.3 y con 92% de implementación. Conclusiones. Los componentes de Sicalidad evaluados evidencian problemas en su implementación relacionados con la estructura y los procesos críticos de los servicios.
Objective:
To analize the implementation of the Sistema Integral de Calidad en Salud (Sicalidad) program of the Ministry of Health in the 2011.
Materials and methods:
The study follows a cross sectional design, hybrid, with a qualitative and quantitative components. A cluster probabilístic sample was used with two stages. A total of 3 034 interviews were carried out in 13 states to evaluate the implementation of the eight components of the Sicalidad program. General indexes of performance (GIP) were formulated for structure process and satisfaction of users, physicians and nurses with the program.
Results:
The GIP with the lower score was accreditation of health facilities with a range of scores between 25.4 and 28% in the medical units evaluated; The highest range of scores was in the component of nosocomial infection prevention between 78.3 and 92%.
Conclusion:
In brief the Sicalidad components evaluated suggest problems with both structure and critical process elements in the implementation of the quality initiatives.
