Nicaragua: A Health System Developing under Conditions of War

1987 ◽  
Vol 17 (1) ◽  
pp. 169-178 ◽  
Author(s):  
Paula Braveman ◽  
David Siegel
Keyword(s):  
Health Care ◽  
Health System ◽  
Latin American ◽  
Rural Areas ◽  
National Health System ◽  
Universal Coverage ◽  
Health Programs ◽  
Community Based ◽  
Military Conflict ◽  
Preventive Health Programs

Since its inception in 1979, the Nicaraguan National Health System has dramatically improved health care in Nicaragua through the provision of universal coverage, emphasis on preventive community-based primary care, and community participation in health activities. Of major importance in the development of the health system has been the decentralization of the administration, planning, and implementation of health programs. The war in Nicaragua has had a major impact on the development of the health system. Nicaraguan health personnel and facilities have been the objects of attack by the contras and scarce resources have been diverted from the development of social programs to military activities. A large refugee population has been created which further strains existing resources. Community-based preventive health programs have been adversely affected, particularly in rural areas where military activity is the most intense. Because of the war, efforts to optimize regionalization of the health system have been retarded. Economic pressures both within Nicaragua resulting from the war and within the entire Latin American area have further hampered efforts for development. Continued major improvements in health care in Nicaragua will depend on a settlement of the present military conflict which is draining resources in all sectors of development, including health.

Learning from health system reform trajectories in seven Canadian provinces

2020 ◽  
pp. 1-17
Author(s):  
Susan Usher ◽  
Jean-Louis Denis ◽  
Johanne Préval ◽  
Ross Baker ◽  
Samia Chreim ◽  
...  
Keyword(s):  
Health System ◽  
Grey Literature ◽  
Universal Coverage ◽  
System Reform ◽  
Turn Of The Millennium ◽  
Publicly Funded ◽  
Community Based ◽  
Multiple Strategies ◽  
Canadian Provinces ◽  
Longitudinal Case Studies

Abstract In publicly funded health systems, reform efforts have proliferated to adapt to increasingly complex demands. In Canada, prior research (Lazar et al., 2013, Paradigm Freeze: Why is it so Hard to Reform Health Care in Canada?, McGill-Queen's Press) found that reforms at the end of the 20th century failed to change the fundamentals of the Canadian system based on physician independence and assured universal coverage only for medical and hospital services. This paper focuses on reforms since the turn of the millennium to explore the transformative capacities developed in seven provinces within this system architecture. Longitudinal case studies, based on scientific and grey literature, and interviews with key informants, trace the patterns of reform in each province and reveal five objectives that, to varying degrees, preoccupied reformers: (1) address chronic disease, (2) align health system actors with provincial objectives, (3) shift from hospital to community-based care, (4) integrate physicians, and (5) develop improvement capacities. The range of strategies adopted to achieve these objectives in different provinces is compared to identify emerging pathways of reform and extract lessons for future reformers. We find significant cross-learning between provinces, but also note an emergent dimension to reforms, where multiple strategies aggregate through time to create unique patterns, presenting their own set of possibilities and limitations for the future.

scholarly journals Community-based health care is an essential component of a resilient health system: evidence from Ebola outbreak in Liberia

2017 ◽  
Vol 17 (1) ◽  
Author(s):  
Kendra Siekmans ◽  
Salim Sohani ◽  
Tamba Boima ◽  
Florence Koffa ◽  
Luay Basil ◽  
...  
Keyword(s):  
Health Care ◽  
Health System ◽  
Community Based ◽  
Essential Component

scholarly journals IMPACT OF RESOURCE MANAGEMENT QUALITY ON ACCESS TO HEALTH CARE

2020 ◽  
Vol 15 (3) ◽  
pp. 88-93
Author(s):  
Sergey Budarin ◽  
Yuliya El'bek
Keyword(s):  
Health Care ◽  
Resource Management ◽  
Health System ◽  
Medical Care ◽  
Rural Areas ◽  
Financial Management ◽  
Access To Health Care ◽  
Importance Value ◽  
Management Quality

The potential for improving the efficiency of medical organizations that provide medical care to the population in conditions of limited resources largely depends on an objective and comprehensive assessment of their use. In this regard, the research of methodological and practical approaches to assessing the efficiency and rational use of resource potential, which are important for different levels of the organization of the health system, including the provision of medical care to citizens living in rural areas, is of particular relevance. The purpose of the study was to determine the relationship between indicators for assessing the quality of resource management and indicators of access to medical care of medical organizations of the state health system in Moscow that provide primary health care to adults in 2019. The quality of resource management was assessed using 27 indicators selected for the purpose of the study in 4 areas of resource management (financial management, procurement management, property management, personnel management), provided by the methodology of the resource management quality standard (RMQS). For each indicator, the calculated score based on the importance value (weight value) a normative criterion of evaluation and the degree of difficulty, and by summing up of scores obtained a composite score. The assessment of the availability of medical care is also calculated using the method of point estimates based on 7 indicators developed through the use of the methodology of performance audit. The article presents the results of a study based on data from 9 Moscow city polyclinics, which confirmed the existence of a correlation between the selected indicators of the quality of resource management and the availability of medical care. The total score for 2019 for the selected indicators of resource management quality varies from 9.62 points to 13.92 points, availability-from 5.54 to 11.63 points, and the correlation coefficient was 0.612

scholarly journals Możliwości kształtowania postaw zdrowotnych dzieci i młodzieży w Polsce

2012 ◽  
pp. 147-157
Author(s):  
Aleksandra Czerw
Keyword(s):  
Health Care ◽  
Healthy Lifestyle ◽  
Health Behaviours ◽  
Holistic Approach ◽  
Preventive Health ◽  
Health Programs ◽  
Health Determinants ◽  
Personal Health ◽  
Preventive Actions ◽  
Preventive Health Programs

Lifestyle, environment, genetics and usage of health care are the classical health determinants. Each of these factors influences personal health to certain degree. Lifestyle has the biggest impact (50–52%), followed by environment (18–20%), genes (15–20%) and finally usage of health care (10–15%). Acknowledgement of negative health behaviours as key reason for diseases of modern civilization formed the basis for many preventive actions. Implementation of preventive health programs is aimed at shaping healthy lifestyle and healthy behaviours in society. The objective of this article is to present links between social marketing and possibilities to influence healthy behaviours of kids and youth. Necessity for holistic approach to health and examples of healthy behaviours of kids and young people in Poland are discussed.

scholarly journals Advanced Practice Nursing in Primary Health Care in the Spanish National Health System

2020 ◽  
Vol 25 (1) ◽  
pp. 303-314 ◽  
Author(s):  
Kerstin Hämel ◽  
Beatriz Rosana Gonçalves de Oliveira Toso ◽  
Angela Casanova ◽  
Ligia Giovanella
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health System ◽  
National Health ◽  
National Health System ◽  
Shared Responsibility ◽  
Primary Health ◽  
Spanish National Health System ◽  
Health Centres ◽  
Doctors And Nurses

Abstract The primary health care in the Spanish National Health System is organised in health centres with multi-professional teams, composed of doctors and nurses specialised in family and community health, in addition to other professionals. This article analyses the role of primary health care nurses in the Spanish National Health System. In the last decade, new concepts of task sharing between doctors and nurses as well as advanced nursing roles have been evolved in the health centres that focus on improving care for chronically ill patients and access to primary care. With shared responsibility, nurses are responsible for chronic patients in stable conditions, health prevention and promotion. The scaling up of advanced nursing tasks is limited by uncertainties of roles, disparities between states, and legislations that do not cover the full extent of advanced nursing tasks. The case study of Spain indicates that a strong multi-professional model of primary health care teams is a crucial basis for the evolvement of advanced nursing practice and its acceptance in daily routines. However, advantageous education structures and legislations are needed to allow nurses to develop their contribution in the full potential.

Assessing the state of lean and six sigma practices in healthcare in Mexico

2019 ◽  
Vol 32 (4) ◽  
pp. 644-662 ◽  
Author(s):  
Rodrigo E. Peimbert-García ◽  
Timothy Matis ◽  
Jaime H. Beltran-Godoy ◽  
Claudia L. Garay-Rondero ◽  
Julio C. Vicencio-Ortiz ◽  
...  
Keyword(s):  
Health System ◽  
Latin American ◽  
National Health ◽  
Six Sigma ◽  
Management Practices ◽  
Research Work ◽  
National Health System ◽  
The State ◽  
Content Type ◽  
Sampling Procedures

Purpose The purpose of this study is to assess the state at which lean and six sigma (LSS) are used as a management system to improve the national health system national health system of Mexico. Design/methodology/approach Cross-sectional survey-research. The survey was administered at 30 different hospitals across six states in Mexico. These were selected using convenience sampling and participants (N = 258) were selected through random/snowball sampling procedures, including from top managers down to front-line staff. Findings Only 16 per cent of respondents reported participation in LSS projects. Still, these implementations are limited to using isolated tools, mainly 5s, failure mode and effects analysis (FMEA) and Fishbone diagram, with the lack of training/knowledge and financial resources as the top disabling factors. Overall, LSS has not become systematic in daily management and operations. Research limitations/implications The sampling procedure was by convenience; however, every attempt was made to ensure a lack of bias in the individual responses. If still there was a bias, it is conjectured that this would likely be in overestimating the penetration of LSS. Practical implications The penetration of LSS management practices into the Mexican health system is in its infancy, and the sustainability of current projects is jeopardized given the lack of systematic integration. Hence, LSS should be better spread and communicated across healthcare organizations in Mexico. Originality/value This is the first research work that evaluates the use of LSS management practices in a Latin American country, and the first journal paper that focuses on LSS in healthcare in Mexico.

Toward National Health System Guidelines in Canada: Reflections of a Comprehensive Audit

1993 ◽  
Vol 6 (2) ◽  
pp. 13-22
Author(s):  
Denis H.J. Caro
Keyword(s):  
Health Care ◽  
Health System ◽  
Health Program ◽  
Response Rate ◽  
National Health System ◽  
Perceived Effectiveness ◽  
Perceived Needs ◽  
Key Informant ◽  
Canadian Health ◽  
Effectiveness And Efficiency

A comprehensive assessment of the Health Program Guidelines (HPG) in Canada was undertaken between January and September 1992. This review examined the strategic effectiveness and operational efficiency of the guidelines under the auspices of the Federal, Provincial and Territorial Committee on Institutional and Medical Services. To assess the perceived needs for the guidelines, over 185 structured mail questionnaires were sent to a sample of health care agencies, institutions and organizations across Canada; the response rate was over 80.5%. A key informant approach was also used to assess the perceived effectiveness and efficiency of the guidelines. Based on the results of the questionnaires, over 45 interviews and an extensive content analysis of key documents, recommendations were made that may be relevant to the Canadian health system community.

scholarly journals How do community health actors explain their roles? Exploring the roles of community health actors in promoting maternal health services in rural Ethiopia

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Abebe Mamo ◽  
Sudhakar Morankar ◽  
Shifera Asfaw ◽  
Nicole Bergen ◽  
Manisha A. Kulkarni ◽  
...  
Keyword(s):  
Child Health ◽  
Health System ◽  
Community Health ◽  
Rural Areas ◽  
Maternal Child Health ◽  
Community Members ◽  
Health Extension Workers ◽  
Community Based ◽  
Rural Ethiopia ◽  
Rural Settings

Abstract Background Maternal and child morbidity and mortality remains one of the most important public health challenges in developing countries. In rural settings, the promotion of household and community health practices through health extension workers in collaboration with other community members is among the key strategies to improve maternal and child health. Little has been studied on the actual roles and contributions of various individuals and groups to date, especially in the rural areas of Ethiopia. In this study, we explored the role played by different actors in promoting ANC, childbirth and early PNC services, and mainly designed to inform a community based Information, Education & Communication intervention in rural Ethiopia. Methods An exploratory qualitative study was conducted on 24 in-depth interviews with health extension workers, religious leaders, women developmental army leaders, and selected community members; and 12 focus group discussions, six with female and six with male community members. Data was captured using voice recorders and field notes and transcribed verbatim in English, and analyzed using Atlas.ti software. Ethical approval for the fieldwork was obtained from Jimma University and the University of Ottawa. Results Participants described different roles and responsibilities that individuals and groups have in promoting maternal/child health, as well as the perceived roles of family members/husband. Commonly identified roles included promotion of health care services; provision of continuous support during pregnancy, labour and postnatal care; and serving as a link between the community and the health system. Participants also felt unable to fully engage in their identified roles, describing several challenges existing within both the health system and the community. Conclusions Involvement of different actors based on their areas of focus could contribute to community members receiving health information from people they trust more, which in turn is likely to increase use of services. Therefore, if our IEC interventions focus on overcoming challenges that limit actors’ abilities to engage effectively in promoting use of MCH services, it will be feasible and effective in rural settings, and these actors can become an epicenter in providing community based intervention in using ANC, childbirth and early PNC services.

scholarly journals Right to health: (in) congruence between the legal framework and the health system

2016 ◽  
Vol 24 (0) ◽  
Author(s):  
Fernando Mitano ◽  
Carla Aparecida Arena Ventura ◽  
Mônica Cristina Ribeiro Alexandre d'Auria de Lima ◽  
Juvenal Bazilashe Balegamire ◽  
Pedro Fredemir Palha
Keyword(s):  
Health System ◽  
National Health ◽  
National Health System ◽  
Universal Coverage ◽  
Legal Framework ◽  
Right To Health ◽  
Theory And Practice ◽  
Levels Of Care ◽  
Management Actions ◽  
The Right

Objective to discuss the right to health, incorporation into the legal instruments and the deployment in practice in the National Health System in Mozambique. Method this is a documentary analysis of a qualitative nature, which after thorough and interpretative reading of the legal instruments and articles that deal with the right to health, access and universal coverage, resulted in the construction of three empirical categories: instruments of humans rights and their interrelationship with the development of the right to health; the national health system in Mozambique; gaps between theory and practice in the consolidation of the right to health in the country. Results Mozambique ratified several international and regional legal instruments (of Africa) that deal with the right to health and which are ensured in its Constitution. However, their incorporation into the National Health Service have been limited because it can not provide access and universal coverage to health services in an equitable manner throughout its territorial extension and in the different levels of care. Conclusions the implementation of the right to health is complex and will require mobilization of the state and political financial, educational, technological, housing, sanitation and management actions, as well as ensuring access to health, and universal coverage.

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