Decision-making and strategic planning in a public research organisation: The case of Fiocruz

Abstract The study was drawn to investigate an unusual form of 'industrial democracy', in Fiocruz, the Brazilian public research organisation in the health field, linked to the Ministry of Health. It is a single case study research making use of two contrasting cases: Embrapa and Pasteur Institute. The former is the Brazilian public research organisation in the agriculture field, similar to Fiocruz in space; and the latter is the French public research organisation for health, similar to Fiocruz in the field. The investigation works with the triangulation of methods approach, combining the analysis of quantitative and qualitative methods aiming at an in-depth analysis of the decision-making and the strategic planning processes of these research-led organisations. For this purpose, two exclusive tools were created and applied to their management boards and key actors. The first tool, an online questionnaire, was applied to the management boards; the second tool, a face-to-face interview, was made with the key actors. The findings were examined considering the literature, whose results supported the analysis of the context of each organisation and their strategic plans. The research revealed an original approach to industrial democracy by Fiocruz, based on a concept postulated by Arouca, which underpinned the creation of SUS, the Brazilian National Unified Health System: 'Democracy is health'. It represents a paradigm shift in the way the health concept is addressed, by adding a political dimension to it, which includes the citizenship, the free self-determination, the capacity of mastering the future. This unique approach to industrial democracy underpins the decision-making and the strategic planning of Fiocruz, revealing that it is, in fact, a new type of public research organisation; thus, questioning the validity of the existing framework concerning such entities. Key messages Democracy is Health is an original conceptual approach postulated by Arouca, which underpinned the creation of the Brazilian National Unified Health System. Fiocruz is the Brazilian Public Research Organisation in the Health field, whose unique administration approach questions the literature in the field.

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PP495 Addressing The Interactions Between Health Regulation And Health Technology Assessment In Brazil

International Journal of Technology Assessment in Health Care ◽

10.1017/s026646232000183x ◽

2020 ◽

Vol 36 (S1) ◽

pp. 38-38

Author(s):

Maíra Catharina Ramos ◽

Margarete Martins de Oliveira ◽

Erica Tatiane da Silva ◽

Daniella Cristina Rodrigues Pereira ◽

Flávia Tavares da Silva Elias

Keyword(s):

Decision Making ◽

Health Technology Assessment ◽

Health System ◽

Technology Assessment ◽

Low Cost ◽

Health Technology ◽

Essential Medicines ◽

Regulatory Interaction ◽

Unified Health System ◽

Post Marketing

IntroductionThe interaction of health technology assessment (HTA) and health regulatory agencies has been widespread, especially for decision-making in health system coverage. The objective of this paper is to report the HTA-regulatory interaction in Brazil.MethodsThis is a case study on the interaction between HTA and regulation in Brazil. Technical documents and Brazilian legislation on health regulation and HTA were analyzed. The study was conducted in July 2019.ResultsHTA-Regulatory Interaction in Brazil is still incipient. There is no responsible agency for interaction between agencies, as there is in Europe and Canada, for example. In the last 4 years, cooperation has started between the Brazilian Health Surveillance Agency (Anvisa) and the Oswaldo Cruz Foundation (Fiocruz) for post-registration monitoring of medicines. During this partnership, 170 post-marketing drug opinions were prepared, assisting the regulatory agency in decision-making.ConclusionsBrazil legislation guarantees essential medicines at low cost or free. The interaction between HTA and regulation has the potential to reduce the time taken to incorporate technology to the patient, in addition to ensuring greater safety for users of the Unified Health System. In this sense, it was observed that the interaction between health regulation and science and technology institutions has innovative potential in this approach.

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Planejamento estratégico na promoção à saúde do idoso: uma experiência integradora academia-serviço-comunidade

International Journal of Health Education ◽

10.17267/2594-7907ijhe.v3i1.2139 ◽

2019 ◽

Vol 3 (1) ◽

pp. 36

Author(s):

Carla Maria Lima Santos ◽

Suélem Maria Santana Pinheiro Ferreira ◽

Carla Santos Almeida ◽

Igor Brasil de Araújo ◽

Ana Caroline de Marino ◽

...

Keyword(s):

Strategic Planning ◽

Health System ◽

Health Planning ◽

The Elderly ◽

Community Interventions ◽

Work Processes ◽

Social Actors ◽

Unified Health System ◽

Evaluation And Monitoring ◽

Collective Construction

INTRODUCTION: Health planning can be understood as a device for systematizing actions and facilitating the elaboration of work processes, as well as for the training of health professionals engaged in the organization of the Unified Health System. OBJECTIVE: To discuss the involvement of several social actors in the collective construction of Situational Strategic Planning in a curricular component of health graduation courses and to highlight potential benefits of this process. MATERIALS AND METHODS: The students had theoretical basis about the Unified Health System, Health Promotion, Epidemiology, Health Planning and Popular Education during the three semesters of the above mentioned curricular component. In the second semester, a situational diagnosis was made of a group of elderly people of USF. Based on this diagnosis, in the third semester, along with the USF team, teachers and the elderly from the group, Situational Strategic Planning (PES), according to Carlos Matus, of community interventions based on Popular Health Education was carried out. RESULTS: The PES, with the participation of all the actors, made possible the horizontality of the relations during the process, from the planning to the execution of the activities. Five community interventions were carried out with the elderly, with subsequent evaluation and monitoring. CONCLUSION: The results point to the potential role of this integrative practice and the importance of experiencing SUS since the beginning of the academic course.

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OP103 CONITEC's Rapid Reports As Technical Support In The Litigation

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462317001726 ◽

2017 ◽

Vol 33 (S1) ◽

pp. 46-47

Author(s):

Eliete Simabuku ◽

Carla Biella ◽

Izamara Catanheide ◽

Sarah Silva ◽

Vania Canuto

Keyword(s):

Decision Making ◽

Health System ◽

Technical Assistance ◽

Treatment Options ◽

Technical Information ◽

National Committee ◽

Evidence Based ◽

Health Technologies ◽

Unified Health System ◽

State Defense

INTRODUCTION:The Unified Health System (SUS) is based on the principle of health as a citizen's right and the state's duty, which must be guaranteed based on public policies. Although there are several legislations, lists of medicines and clinical guidelines, Brazilians who have been prescribed expensive technologies that are not part of the essential drug lists ask judges to issue court orders obliging public health managers to purchase these drugs or to provide elective medical procedures immediately. Due to the health technical inexperience from judges, prosecutors and public lawyers, a partnership has arisen for the National Committee for Health Technology Incorporation (CONITEC) to provide technical assistance to help their decision-making process. Thus the purpose of this study is to describe CONITEC's experiences in communicating with stakeholders in this process.METHODS:A case study method was used and information about the rapid reports developed by CONITEC's Executive Secretariat in response to the applicants in the period of 2012 to 2016, was retrieved from CONITEC database.RESULTS:Rapid reports (2,773) about health technologies incorporation such as medicines, procedures or medical devices were produced by CONITEC during this period. Most requests covering topics as treatments for diabetes, arterial hypertension, osteoporosis, oncology and epilepsy; diseases for which there are several treatment options in SUS. The data analysis indicated that CONITEC contributed to the evidence based decision-making. On one hand, the Prosecutor's Office has been increasingly requesting information before starting lawsuits and Judiciary Power has increasingly used evidence-based technical information before deciding on the concession of injunctions; on the other hand, from 2012 to 2016 the number of requests decreased for information to State defense in lawsuits that has been already established.CONCLUSIONS:There is a growing interest in technical knowledge for fair decision making that respects the current organization of the evidence-based health system.

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Designing animated pictorial instructions: A methodology proposed for the Open University of the Unified Health System in Brazil (UNA-SUS/UFMA)

European Journal of Teaching and Education ◽

10.33422/ejte.v2i4.525 ◽

2020 ◽

Vol 2 (4) ◽

pp. 42-51

Author(s):

Carla Galvão Spinillo ◽

Ana Emília Figueiredo de Oliveira ◽

Katherine Marjorie ◽

Camila Lima ◽

Larissa Ugaya Mazza ◽

...

Keyword(s):

Decision Making ◽

Health System ◽

Health Professionals ◽

Open University ◽

Online Questionnaire ◽

Context Analysis ◽

Unified Health System ◽

Usability Tests ◽

Educational Production ◽

Pictorial Instructions

Animated pictorial instructions are effective resources for learning medical content (e.g., surgical procedures). Considering this, the Open University of the Unified Health System of the Federal University of Maranhão (UNA-SUS/UFMA) in Brazil employs animation in their distance learning courses. From 2009 to the present the UNA-SUS/UFMA has offered 48 e-courses to health professionals, reaching around 470,000 enrolments. The development of animated instructions at UNA-SUS/UFMA considers medical and pedagogical knowledge only, lacking information design expertise to reach communication effectiveness. Thus, a design methodology was proposed based on: (a) the results of an analytical study of 100 medical animations; (b) the outcomes of a context analysis of the UNA-SUS/UFMA design process through interviews with the heads of the educational production departments; and (c) the results of an online questionnaire with 1,735 health professionals. The methodology consists of three phases: (1) Structuring: identification and arrangement of different contents (introductory content, inventory information, steps, warnings), resulting in an animation script; (2) Representation: definition of the animation graphic appearance and technological resources (e.g., pictorial style, camera framing, interaction cues), resulting in a visual storyboard or mock-up/prototype that can be tested with users (e.g., comprehension, usability tests); and (3) Finalization: programming and production of the animation. For each phase, instruments/protocols were developed to aid decision-making (form, guidelines and checklist). To evaluate the methodology, a focus group was conducted with the animation stakeholders/developers of the UNA-SUS/UFMA. The results were positive, but suggestions were made to improve the decision-making instruments, which were considered in the methodology final design.

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Management Strategies of Recovery Centers for Coronavirus Patients in Iran

Quarterly Journal of Management Strategies in Health System ◽

10.18502/mshsj.v6i1.6502 ◽

2021 ◽

Author(s):

Adel Eftekhari ◽

Najmeh Baghian

Keyword(s):

Decision Making ◽

Health System ◽

Management Strategies ◽

Health It ◽

Set Up ◽

And Function ◽

Role And Function ◽

Different Levels

The global and Iranian pandemic crisis of the coronavirus caused the health system to face the problem of insufficient resources. Outpatient convalescence for coronavirus disease is one of the most effective ways to reduce hospital load and costs. In order to set up any position related to the issue of health, it is necessary to formulate the necessary laws, regulations, and standards, in which different levels of decision-making and implementation must play a role. Formulation of goals, laws, coordination, provision of equipment and space, manpower, and cost coverage should be considered in highlighting the role and function of convalescents by the authorities. This study aimed to review the management strategies of coronavirus patients.

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Making the COVID-19 pandemic a driver for digital health: the Brazilian strategies (Preprint)

10.2196/preprints.28643 ◽

2021 ◽

Author(s):

Bruna Donida ◽

Cristiano André da Costa ◽

Juliana Nichterwitz Scherer

Keyword(s):

Health System ◽

Digital Health ◽

Clinical Care ◽

Health Data ◽

Notification System ◽

The Public ◽

Unified Health System ◽

First Results ◽

The Creation ◽

Medical Teams

UNSTRUCTURED The COVID-19 outbreak exposed a number of problems faced by health systems around the world, especially with regard to generation and sharing health data, in a quickly and safely manner. However, this pandemic scenario also facilitates the rapid implementation and monitoring of technologies in the health field. In view of the occurrence of the public calamity state caused by the virus SARS-CoV-2 in Brazil, the Department of Informatics from Brazilian Unified Health System created a contingency plan. This paper aims to report the Brazilian digital health strategies and the first results obtained during the fight against COVID-19. ConecteSUS, a platform created to store all the health data of an individual throughout their life is the center point of the Brazilian digital strategy. Access can be made through an application by the patient and the health professionals involved in the case. The health data sharing became possible due to the creation of the National Health Data Network (RNDS). A mobile application was developed to guide citizens about the need or not to go to a health facility and to assist in the dissemination of official news about the virus. The app is also able to alert the user if he had contact with someone infected. The official numbers of cases and beds available in hospitals are being updated and published daily, on a website containing interactive graphics. These data are obtained due to the creation of an online notification system that uses RNDS to share information about the cases. Pre-clinical care through telemedicine has become essential to prevent the overload in health facilities. The exchange of experiences between medical teams from great centers and small hospitals was possible by the use of telehealth. Brazil took a giant step towards digital health, creating and implementing important initiatives, which do not yet cover the entire health system. It is expected that, in the near future, the sharing of health data kept up and authorized by the patient becomes a reality. The intention is to obtain a better clinical outcome, cost reduction, and faster and better services in the public health network.

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A Human Centred-Design Approach to a Serious Game in Health Training for the Open University of the Unified Health System (UNA-SUS/UFMA) in Brazil

European Journal of Teaching and Education ◽

10.33422/ejte.v2i3.493 ◽

2020 ◽

Vol 2 (3) ◽

pp. 24-34

Author(s):

Daniela Rosito Michella Munhoz ◽

Luciane Maria Fadel ◽

Carla Galvão Spinillo ◽

Ana Emília Figueiredo de Oliveira ◽

Katherine Marjorie Mendonça de Assis ◽

...

Keyword(s):

Health System ◽

Serious Games ◽

Educational Process ◽

Serious Game ◽

Design Approach ◽

Open University ◽

It Professionals ◽

Unified Health System ◽

Health Field ◽

Human Centred Design

A serious game is a media based on the narrative of a game focused on learning. The narrative of a game brings elements and mechanics that motivate the participation and engagement of the players. This is because games are a constant in human development as they formalize cultural activities with social function, being full of meanings. Moreover, the possibilities found in the game narratives contribute to the construction of more participatory plots, since the player can act actively in the course of the story. The narrative and engagement of serious games are of prime importance to distance learning in the health field. In Brazil, the Open University of the Unified Health System (UNA-SUS/UFMA) develops serious games as educational resources to train health professionals. This paper presents the design process of the Clinical Case Game, a serious game for diagnosis and treatment of medical conditions, addressed to doctors in Brazil. A multidisciplinary and human-centred design approach was adopted to develop the game. It involved medical doctors, educators, IT professionals, information designers and game designers, who coordinated the team and acted on the balance of the dynamics involved, that is, the narrative and playful pleasure. The methodology employed consisted of a workshop; content and prototype production; prototype testing with users; and refinements for the final version of the game. The results suggested that narrative unity must be coherent for serious games on health and highlight the relevance of serious games as high potential resources in the educational process.

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Children with special needs in health: challenges of the single health system in the 21st century

Revista Brasileira de Enfermagem ◽

10.1590/0034-7167-2019-0037 ◽

2020 ◽

Vol 73 (suppl 4) ◽

Author(s):

Camilla Ferreira Catarino Barreiros ◽

Maria Auxiliadora de Souza Mendes Gomes ◽

Saint Clair do Santos Mendes Júnior

Keyword(s):

Health System ◽

Special Needs ◽

Clinical Care ◽

Medical Knowledge ◽

Children With Special Needs ◽

Health It ◽

Access To Health Services ◽

Technological Support ◽

Unified Health System ◽

Access To Health

ABSTRACT Objective: Reflect on the gaps in the care of Children with Special Needs in Health that demand complex clinical care with dependence on technological support for the maintenance of life, in the Unified Health System. Methods: This is a reflection study based on recent policies and literature related to the theme. Discussion: Despite the advances achieved with the Unified Health System with regard to access to health services and the expansion of Primary Care, with the aim of reorienting health, it can be said that the health care model for CSHCN in Brazil is still centered on the hospital and medical knowledge. Final considerations: There are gaps in the policies for children aimed at the new paediatric profile, and little is discussed about its implications for the Unified Health System.

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Effects and utility of an online forward triage tool during the SARS-CoV-2 pandemic: patient perspectives (Preprint)

10.2196/preprints.26553 ◽

2020 ◽

Author(s):

Janet Michel

Keyword(s):

Decision Making ◽

Health System ◽

Information Source ◽

Patient Perspectives ◽

User Friendliness ◽

Fear And Anxiety ◽

Mail Address ◽

Second Wave ◽

E Mail

BACKGROUND Background: Online forward triage tools (OFTT) or symptom checkers are being widely used during this COVID-19 pandemic. The effects and utility of such tools however, have not been widely assessed. OBJECTIVE Objective: To assess the effects (quantitatively) and the utility (qualitatively) of a COVID-19 OFTT in a pandemic context, exploring patient perspectives as well as eliciting recommendations for tool improvement. METHODS Methods: We employed a mixed-method sequential explanatory study design. Quantitative data of all users of the OFTT between March 2nd, 2020 and May 12th, 2020 were collected. A follow-up survey of people who consented to participation was conducted. Secondly, qualitative data was collected through key informant interviews (n=19) to explain the quantitative findings, as well as explore tool utility, user experience and elicit recommendations. RESULTS Results: An estimate of the effects, (quantitatively) and the utility (qualitatively) of a COVID-19 OFTT in a pandemic context, and recommendations for tool improvement. In the study period, 6,272 users consulted our OFTT; 560 participants consented to a follow-up survey and provided a valid e-mail address. 176 (31.4%) participants returned a complete follow-up questionnaire. 85.2% followed the recommendations given. 41.5% reported that their fear was allayed after using tool and 41.1% would have contacted the GP or visited a hospital had the tool not existed. Qualitatively, seven overarching themes emerged namely i) accessibility of tool, ii) user-friendliness of tool, iii) utility of tool as an information source, iv) utility of tool in allaying fear and anxiety, v) utility of tool in decision making (test or not to test), vi) utility of tool in reducing the potential for onward transmissions (preventing cross infection) and vii) utility of tool in reducing health system burden. CONCLUSIONS Conclusion: Our findings demonstrated that a COVID-19 OFTT does not only reduce the health system burden, but can also serve as an information source, reduce anxiety and fear, reduce cross infections and facilitate decision making (to test or not to test). Further studies are needed to assess the transferability of these COVID-19 OFTT findings to other contexts as the second wave sweeps across Europe.

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