APS

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 APS;  legislación;  

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 APS;  

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 APS;  

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Abstract: Esta investigación hace un resumen narrativo de las evidencias disponibles sobre la experiencia de la política de salud y de la estrategia de Atención Primaria Integral de Salud (APIS) desarrollada por el gobierno local de Bogotá durante el período 2004-2007. El proceso y los resultados de la experiencia indican que a pesar de la racionalidad de mercado de la política nacional de salud de Colombia, es viable implementar a nivel local políticas y estrategias de salud orientadas a garantizar el derecho y la equidad en salud. Sin embargo, las restricciones del contexto nacional son un factor limitante de la potencialidad de tal política y estrategia, lo que sugiere que es necesario propiciar transformaciones de fondo de la política nacional de salud para que los cambios locales buscados sean efectivos y sostenibles.

 APS;  

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Abstract: The community-oriented primary care (COPC) model strives to efficiently distribute, organize, and systematize existing health care resources. In addition to promoting healthy lifestyles within the community, the COPC model enables the health care team and the community to cooperate in identifying and prioritizing health issues. Together they develop and implement prevention and treatment plans for those priority areas. With COPC, the health services assume responsibility for the health of a defined population. The health services not only treat diseases but also develop programs for health promotion, protection, and maintenance. Taking this approach, COPC integrates individual and family clinical care with public health, reflecting the spirit of the International Conference on Primary Health Care held in Alma-Ata in 1978. COPC is a systematic process, with flexible principles and methodologies that can be modified to meet the specific challenges of any health care team and community. An analysis of various countries' experiences with COPC shows that applying the model appropriately can improve the general health status of the community and its members.

 Primary Health Care;  atención primaria de salud;  medicina comunitaria;  capacitación;  community health services;  community medicine;  APS;  

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Abstract: At the 2003 meeting of the Directing Council of the Pan American Health Organization (PAHO), the PAHO Member States issued a mandate to strengthen primary health care (Resolution CD44.R6). The mandate led in 2005 to the document "Renewing Primary Health Care in the Americas. A Position Paper of the Pan American Health Organization/WHO [World Health Organization]," and it culminated in the Declaration of Montevideo, an agreement among the governments of the Region of the Americas to renew their commitment to primary health care (PHC). Scientific data have shown that PHC, regarded as the basis of all the health systems in the Region, is a key component of effective health systems and can be adapted to the range of diverse social, cultural, and economic conditions that exist. The new, global health paradigm has given rise to changes in the population's health care needs. Health services and systems must adapt to address these changes. Building on the legacy of the International Conference on Primary Health Care, held in 1978 in Alma-Ata (Kazakhstan, Union of Soviet Socialist Republics), PAHO proposes a group of strategies critical to adopting PHC-based health care systems based on the principles of equity, solidarity, and the right to the highest possible standard of health. The main objective of the strategies is to develop and/or strengthen PHC-based health systems in the entire Region of the Americas. A substantial effort will be required on the part of health professionals, citizens, governments, associations, and agencies. This document explains the strategies that must be employed at the national, subregional, Regional, and global levels.

 Primary Health Care;  Health policy;  atención primaria de salud;  APS;  políticas públicas de salud;  Américas;  Americas;  

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Abstract: As part of the implementation of the country's Unified Health System (Sistema Único de Saúde), the Brazilian Government created, in the second half of the 1990s, the Family Health Program (FHP) (Programa de Saúde da Família), based on community-oriented, multidisciplinary care serving people organized into small groups. For this study, we evaluated the implementation of the FHP, based on three criteria: (1) the construction of the program as an entry point for most health needs and for access to specialized care, (2) the program's linkages with a comprehensive network of health services, and (3) the incorporation of new care practices into the health system. We found that the implementation of the FHP was far from uniform. In some municipalities the FHP is a focused program that runs in parallel with other primary care efforts. However, in other municipalities the FHP is viewed as a strategy aimed at changing the primary care model, and it partially or completely replaces preexisting primary care health units. Our research confirms a trend toward incremental change in the primary care model in Brazil. However, the expansion of the FHP in large urban areas faces several obstacles to guaranteeing all individuals access to comprehensive care with adequate clinical and collective health services, including secondary and tertiary care. The positive results that we found with some of the experiences with the FHP indicate that, in addition to increased federal financial incentives, the success of the FHP depends on creative local strategies to deal with Brazil's diversity.

 Primary Health Care;  National Health Programs;  Health services accessibility;  Delivery of health care;  APS;  acesso aos serviços de saúde;  cuidados primários;  SUS (BR);  Brazil;  

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Abstract: OBJETIVOS: Los sistemas de salud de todo el mundo se encuentran en un proceso de reestructuración y reforma de sus sistemas de prestación de servicios, reorientándose hacia el modelo de atención primaria de salud (APS) que utiliza equipos de consultorios multidisciplinarios (CMD) para brindar un conjunto de servicios coordinados e integrados. En este estudio se exploran los retos de poner en práctica el enfoque de CMD en una comunidad urbana de Canadá. MÉTODOS:Los datos analizados se tomaron de un proyecto de investigación-acción participativa basada en la comunidad (IAPBC) llevado a cabo en 2004. Su objetivo era perfeccionar un CMD colaborativo en un centro de APS que atiende a una comunidad de 11 000 personas, compuesta por una zona residencial y pequeños negocios, en una ciudad canadiense de aproximadamente 300 000 personas. La IAPBC permite abordar de manera planificada y sistemática problemas importantes para la comunidad en cuestión, requiere la participación de la comunidad, se enfoca hacia la solución de los problemas, se dirige a lograr cambios en la sociedad y hace contribuciones duraderas a la comunidad. Se partió de un aspecto de este complejo proyecto de varios años, para transformar la defensa retórica de la reforma de la APS en una práctica real y sustentable. La comunidad estudiada era diversa en cuanto a la edad, las características socioeconómicas y los estilos de vida. Su equipo multidisciplinario atendía aproximadamente a 3 000 pacientes al año, 30% de los cuales tenían 65 años o más. Gracias a su enfoque multidisciplinario e integrado con respecto a la atención, este centro de APS pasó a formar parte de un selecto grupo dentro del extenso sistema de atención primaria de Canadá. RESULTADOS: El análisis del trabajo de APS puso de manifiesto ideas arraigadas e inconcientes acerca de los límites y las limitaciones de la atención prestada. En el sentido retórico de la APS, el CMD era elogiado por muchos. En la práctica, sin embargo, era difícil lograr el enfoque de equipo colaborativo multidisciplinario. CONCLUSIONES: La exitosa implementación de un enfoque de CMD en la APS exige apartarse del estilo de atención centrada en el médico. Esto sólo puede lograrse cuando cambian las estructuras subyacentes, los valores, las relaciones de poder y los papeles a desempeñar, definidos por los sistemas de salud y la comunidad en general, donde los médicos tienen tradicionalmente una posición por encima de la de otros proveedores de atención sanitaria. La metodología de IAPBC permite a los miembros de la comunidad y a los profesionales relacionados con la salud que los atienden apropiarse de la investigación y reflejarse críticamente en ciclos iterativos de evaluación. Esto ofrece a los médicos una oportunidad de implementar cambios importantes basados en análisis generados internamente.

 canada;  Primary Health Care;  Health care reform;  Reforma en atención de la salud;  research action;  atención primaria de salud;  APS;  Health services research;  interprofessional relations;  patient care team;  Investigación sobre servicios de salud;  relaciones interprofesionales;  grupo de atención al paciente;  Canadá;  

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 OPS;  APS;  

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 APS;  

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Abstract: November 2006 marked the 20-year anniversary of the Ottawa Charter for Health Promotion and Canadas Epp Report. Encapsulating the tenets of health promotion (HP), these publications articulated a vision for reducing health inequities, and described a policy framework for achieving this vision, respectively. These documents also triggered the launch of the population health (PH) field, focused on elucidating the empirical relationships between socioeconomic gradients and population health inequities. Over two decades, a rich HP/PH theoretical and evidentiary base on socioeconomic gradients in health has established. Yet, despite valuable contributions from Canadian researchers, insufficient headway has been made in this country to achieve the Charters vision. There are numerous challenges to reducing population health inequities in Canada. Informational challenges include complexity of HP/PH evidence, and inadequate knowledge translation beyond traditional targets. Institutional challenges include the relative immunity of the healthcare sector to funding reductions, and the organization of policy responsibilities into silos. Concerns from non-healthcare sectors of health imperialism, and inter-governmental tensions are interest-related challenges, while ideological challenges include lack of media discourse on health inequities and a strong neo-liberal political climate. Gains have been made in Canada towards reducing health inequities. The HP/PH discourses are firmly entrenched in academic and policy spheres across the country, while several inter-sectoral policy initiatives are currently underway. HP/PH researchers could be more proactive in the knowledge-translation sphere by engaging other researchers outside of medicine and health, non-healthcare policy-makers, and the general public, vis-\à\-vis the media, on the health inequities knowledge base. Ultimately, significant and sustained progress will only be made if researchers and other champions recognize the inherently political aspect of their work and understand how to overcome ideologically driven resistance.

 Health promotion;  APS;  

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 APS;  

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 APS;  

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 APS;  

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Abstract: Objective: To identify the components of the primary health care (PHC) product defined by health professionals and users in order to establish indicators for evaluation. Methods: Qualitative methodology was used with group techniques: a nominal group (health professionals) and focus groups (users). The study was performed in PHC centers in Catalonia (Spain). There were 7 groups: a) family physicians and pediatricians; b) nurses and social workers; c) staff from admissions units and customer services; d) other medical specialists; e) users; f) managers, pharmacists, pharmacologists, and technicians. Participants responded to the question: «Which features should be evaluated in the services that should be provided by PHC?». A content analysis was performed. Textual data were broken down into units and then grouped into categories, following analogy criteria. The interpretative context of the research team was taken into account. Results: Health professionals and users identified 4 dimensions of the PHC product, coinciding with its basic attributes: a) access to services; b) coordination and continuity of the PHC teams with other levels of healthcare; c) relationship between health professionals and users, and d) scientific-technical quality of the PHC teams and the portfolio of services. Equity, satisfaction and efficiency appeared as keystones in all the components of the product identified. Conclusion: There was broad agreement in the product definition among health professionals and users. The relationship between health professionals and patients was a key element in all groups. The four dimensions should be included in the evaluation of PHC teams.

 qualitative research;  Primary Health Care;  Investigación cualitativa;  atención primaria de salud;  APS;  Producto de la atención primaria de salud;  Técnicas de grupo focales y nominales;  Primary health care outcome;  Focus and nominal group techniques;  

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Abstract: This article analyzes the concepts of primary health care, basic health care, and family health care as used in official documents by the Brazilian Ministry of Health, final reports of the National Conferences on Health and Human Resources, the Basic Operational Ruling on Human Resources, and texts accessed on-line by BIREME. The data analysis, through double-entry matrices, showed a lack of these references in Brazilian health policy formulation and implementation. Basic Operational Ruling 96 (NOB/96) plays a distinct role in this regard; the national conference reports show an important gap in this debate, and most of the published articles present the concepts of primary care and basic care with the meaning of health unit or local service. Articles on the Family Health Program refer to it more as a program than a strategy, and the articles analyzing such concepts show the influence of rationalities underlying the different strategies for organization of health services in the Brazilian scenario, namely Health Surveillance and Programmatic Actions in Health and in Defense of Life.

 Primary Health Care;  Health policy;  APS;  Cuidados Primários de Saúde;  Programa Saúde da Família;  Política de Saúde;  Family Health Program;  

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 APS;  

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 APS;  PHC;  COPC;  

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Abstract: Family physicians in Cuba and the United States operate within very different health systems. Cubas health system is notable for achieving developed country health outcomes despite a developing country economy. The authors of this study traveled to Cuba and reviewed the literature to investigate which practices of Cuban family physicians might be applicable for US family physicians wishing to learn from the Cuban experience. We found that community-oriented primary care (COPC) and complementary and alternative medicine (CAM) are well developed within the Cuban medical system. Because COPC and CAM are already recommended by US family medicine professional bodies, US family physicians may want to learn from the Cuban experience and perhaps incorporate elements into their individual practices.

 APS;  PHC;  COPC;  

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 APS;  

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 APS;  

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Abstract: The principal aim of this article is to discuss the possible senses of humanization in the production of primary health care. For the fulfillment of this aim, the article opens a brief interlocution with the reference literature about humanization of health services identifying those senses that come closer to the approach that will be adopted here. From that point, it performs a discussion that will bring other senses to the proposals of humanization not yet explored in this debate, centralizing in a philosophical questioning of the ways of defining the human. At the end, considering determined characteristics of the production of primary health care, it explores how these new senses could contribute not only on the humanization of services, but how the services can contribute to our own humanization.

 philosophy;  Primary Health Care;  Health Services;  Serviços de Saúde;  APS;  Humanização;  Filosofia;  Atenção primária à saúde;  Humanization;  humanización;  

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 APS;  

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 APS;  

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 APS;  

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 Primary Health Care;  medicine;  WHO;  capacitacionssp;  APS;  Atención Primaria de la Salud;  

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Abstract: I present a historical study of the role played by the World Health Organization and UNICEF in the emergence and diffusion of the concept of primary health care during the late 1970s and early 1980s. I have analyzed these organizations’ political context, their leaders, the methodologies and technologies associated with the primary health care perspective, and the debates on the meaning of primary health care. These debates led to the development of an alternative, more restricted approach, known as selective primary health care. My study examined library and archival sources; I cite examples from Latin America.

 Primary Health Care;  APS;  

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 APS;  

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Abstract: Background: Rapidly occurring changes within the health care systems are creating an opportunity to re-orient the relationships between their different sectors. In order to know the locus of responsibility for various types of preventive activities, we undertook an inquiry on eight areas in six countries from Europe and North America. Methods: An inquiry among experts based on a matrix which arrayed the type of preventive health services against the target population. Eight clinical conditions were identified (childhood immunizations; adult influenza vaccination; mammography screening, tuberculosis screening, hypertension screening, PKU screening, HIV screening, and osteoporosis testing) trying to know their target population and the locus of responsibility for setting of policy, level to contact individuals for testing, follow-up of people with abnormal tests and maintenance of their medical records. Results: This pilot study showed very little results coincidence either within the eight surveyed areas or across them. There was no regular pattern for the preventive activities studied among the different countries, neither according to the type of health system, nor to the primary health care orientation of the different systems. Conclusions: There was a limited consensus in the activities studied concerning the best mode of doing public health interventions for personal health services.

 Primary Health Care;  management;  atención primaria de salud;  APS;  Prevención;  Hospital;  Salud Pública;  Organizaciones de gestión de servicios;  Inmunizaciones;  Hipertensión arterial;  VIH;  Tuberculosis;  Gestión;  Preventive Services;  Public Health;  Health Maintenance organizations;  Immunizations;  Hypetension;  

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 APS;  

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Abstract: This article reports on a primary health care and training center in São Paulo, Brazil, and the organization of its activities based on equity and positive discrimination. Operating in the city center of São Paulo, the policy aims to provide health services access to certain target groups (homeless, sex workers, and slum-dwellers). It also raises discussion on the various forms of social life found in downtown areas, mainly those of vulnerable groups lacking access to public goods and services. The experience demonstrates the feasibility of implementing health policies based on universal access.

 Primary Health Care;  Health Services;  Health policy;  Serviços de Saúde;  APS;  Cuidados Primários de Saúde;  Políticas de Saúde;  

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Abstract: Since its inception in rural, pre-apartheid South Africa, community-oriented primary care (COPC) has intrigued and informed public health and primary care leaders worldwide. COPC has influenced such programs as the US community health center movement, the general practice movement in the United Kingdom, and recent reforms in the public health system of South Africa. We provide a global overview of COPC, tracing its conceptual roots, reviewing its many manifestations, and exploring its future prospects as an organizational paradigm for the democratic organization of community health services. We examine the pitfalls and paradoxes of COPC and suggest its future utility. COPC has important values and methods to offer disparate but powerful movements in public health worldwide.

 APS;  PHC;  COPC;  APOC;  

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 APS;  

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Abstract: O artigo discute a política de reorganização da atenção básica a partir do processo recente de descentralização do SUS no Brasil. Enfatiza-se o papel indutor do governo central, que, através de um conjunto de medidas e programas específicos (PAB e PACS/PSF, principalmente), transfere para os municípios a responsabilidade com a atenção básica. Assim, é no nível municipal que ocorre o processo de implementação dessa política, gerando efeitos de difícil avaliação, dada a diversidade de contextos locais. A argumentação central enfatiza a importância de se avaliarem processos e resultados intermediários voltados para o desempenho institucional, que podem ser traduzidos em vontade política e compromisso público, capacidade de gestão e maior controle e participação social, mais do que exatamente efeitos ou impactos mais diretos sobre a oferta de serviços. A conclusão é de que apesar de todas as dificuldades e obstáculos o processo tem implicado o fortalecimento da capacidade de gestão municipal no que diz respeito à organização da atenção básica em saúde.

 Primary Health Care;  APS;  Decentralization of primary health care;  Evaluation in primary health care;  Atenção básica;  Descentralização da atenção básica;  Avaliação da atenção básica;  

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Abstract: BACKGROUND: Community-oriented primary care (COPC) is a systematic approach to health care based upon principles derived from epidemiology, primary care, preventive medicine, and health promotion. We describe the development of COPC from an historical perspective. A critical assessment of current trends and implication for physician education and practice of COPC will be discussed in a companion article in the next issue of The Journal. METHODS: MEDLINE was searched using the key phrase community-oriented primary care Other sources of information included books and other documents. RESULTS AND CONCLUSIONS: In the 1950s, Sydney Kark showed dramatic positive changes in the health status of the population of Pholela, South Africa, using this approach. Similar approaches showed positive change in the health status of poor and underserved populations in the United States. The results were so impressive that the Institute of Medicine recommended widespread application of COPC in the United States. Successful COPC practices, however, have historically required considerable external funding from private and government sources. Thus, controversy about the feasibility of implementation of COPC in mainstream primary care practices developed. Schools of medicine and the discipline of family medicine have struggled to implement effective training in COPC within traditional medical school and residency structures. Yet, the societal need for recognition of and intervention in community health problems and coordination of community health resources continues.

 APS;  PHC;  COPC;  

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Abstract: Fundamentos y Objetivos: Las conclusiones de Juan César García sobre especialización a fines de los 60s condujeron a describir aspectos actuales de la especialización; ampliarlos y cotejarlos con aquéllas e indagar las expectativas de los alumnos por ejercer o no en niveles de la Atención Primaria de la Salud - APS-) y su porqué. Material y Métodos: Para ello, fueron combinados métodos cualitativos y cuantitativos en ingresantes, alumnos avanzados y médicos. Resultados y Discusión: Entre ambas épocas, aumentó la intención por especializarse para el sistema de atención vigente (de 52 a 74 % en los ingresantes y de 66 a 100 % en los alumnos avanzados). En contraste, disminuyó el interés por ser médico/a general de 26% en los 60s a cerca del 7 % en el 2001. Los ingresantes ignoraban el significado de la APS y sólo 0.5 % de los del ciclo clínico se orientaba hacia ella. La inclinación por especializarse precedía al ingreso, la decisión ocurría en el ciclo clínico (con influencia taxativa de los especialistas) y la elección definitiva acontecía en éste y concluida la carrera, también. Los motivos pueden ser múltiples y cambiantes entre grupos. Las modificaciones contextuales, un sistema de atención anárquico y uno de educación discutible podrían influir. Conclusiones: Valorando a los currículos como coadyuvantes y a las decisiones políticas como determinantes, se infiere que un sistema integral de salud y una formación médica compatible podrían proveer salud para todos en un marco de equidad y hacer de la APS y de la especialización categorías complementarias antes que opuestas, como son percibidas actualmente.

 education;  medicine;  APS;  

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Abstract: Durante los 30 últimos años, las tasas de mortalidad de lactantes y niños han disminuido en casi todos los países. Además, el número de defunciones infantiles ha descendido de unos 15 millones a cerca de 11 millones a pesar del aumento del número de nacimientos, de la resistencia creciente a antibióticos y antipalúdicos comunes y de la propagación relativamente incontrolada del SIDA en gran parte del mundo. Un número limitado de afecciones médicas, como las infecciones respiratorias agudas, las enfermedades diarreicas, el paludismo, el sarampión y la malnutrición, han constituido sistemáticamente las principales causas de mortalidad infantil pese a que existen intervenciones seguras y eficaces contra cada una de ellas. El progreso continuo no está asegurado. Primero, hasta la fecha el éxito no ha sido uniforme. Muchos países pobres, y zonas pobres de muchos países, no han conseguido resultados tan buenos como los más ricos. Además, a medida que disminuyen las tasas de mortalidad, otras afecciones adquieren más importancia; la mortalidad perinatal y neonatal, para la cual todavía no se han desarrollado intervenciones que puedan implantarse de forma generalizada, contribuye aín más que antes al número de defunciones de menores de 5 años. También es necesario abordar las cuestiones relacionadas con la paridad entre los sexos, y la propagación continua del síndrome de inmunodeficiencia adquirida (SIDA), especialmente en el África subsahariana y en Asia Sudoriental, amenaza seriamente la continuidad de los progresos. En este artículo se examinan las tendencias de los programas de promoción de la salud de los niños en los últimos decenios y se formulan sugerencias sobre la mejor manera de diseñar programas en el futuro. Se analizan los diferentes enfoques adoptados en el pasado, a saber: iniciativas a corto plazo y con objetivos muy concretos contra enfermedades específicas, como las primeras iniciativas de erradicación del paludismo (un fracaso) y de la viruela (un éxito), y estrategias amplias, a largo plazo, de desarrollo, orientadas hacia la comunidad, como la de atención primaria de salud. Los programas modernos de erradicación de enfermedades como la poliomielitis y la dracunculosis y las estrategias «selectivas» de atención primaria, como la de lucha integrada contra las enfermedades de la infancia, tratan de combinar diversos elementos de cada uno de esos enfoques. La importante función que han desempeñado tradicionalmente los programas de salud infantil parece estar disminuyendo. Una de las razones podría ser que el impulso hacia la reforma del sector de la salud se ha centrado más en consideraciones administrativas y financieras que en programas o conjuntos de programas técnicos. La descentralización ha dado lugar en muchos países a un deterioro de las funciones de apoyo a los sistemas, como la capacitación, la supervisión y la vigilancia y la evaluación de los programas. Sin embargo, las estrategias técnicas, como las de los programas de vacunación y las iniciativas de gestión de casos, siguen evolucionando para mejorar la prestación de servicios, fortalecer los sistemas de salud y, lo que es más importante, promover la participación comunitaria. Se destaca la relación bidireccional entre la pobreza y la salud. Existen grandes desigualdades desalud entre ricos y pobres, entre los países, dentro de los países y dentro de las comunidades. En el futuro quizá sea importante dirigir los esfuerzos hacia los hogares y familias en los que, debido a la pobreza u otros factores, los niños corren mayor peligro de morir. El mensaje clave de este artículo es que los futuros avances en la reducción de la mortalidad de lactantes y niños bien pueden depender de lo que suceda en las comunidades y los hogares, y no tanto de lo que suceda en el sistema de salud. Se examinan cuatro modelos. El modelo «La Vía de la Supervivencia» y una adaptación del marco de Mosley-Chen muestran la relación entre la comunidad y el sistema de salud, pero de forma diferente. El nuevo enfoque del ciclo de vida ilustra gráficamente la manera en que la salud de los niños depende de los riesgos e intervenciones sanitarios a distintas edades y de influencias intergeneracionales. Por último se menciona la Convención sobre los Derechos del Niño, que reconoce el derecho a la salud y a servicios de salud. Aunque en gran medida se dispone de herramientas tecnológicas para seguir reduciendo la mortalidad infantil, es necesario adaptar las estrategias de aplicación a los contextos locales. Las investigaciones sociológicas encaminadas a identificar maneras de llegar a las comunidades y familias de alto riesgo, especialmente aquellas cuyo acceso a los servicios de salud se halla limitado por la pobreza, están cobrando una importancia creciente.

 Models;  Delivery of health care;  APS;  child welfare;  child health services;  communicable diseases;  infant mortality;  

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 APS;  PHC;  research;  

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Abstract: A methodology is proposed; it allows the assessment of quality using the selection of activities and/or health problems that may be considered as tracers for the process, and participating methods for the selection of criteria, indicators and standards to use in the assessment, in which the staff of the institution subject to assessment takes part, and are referred not only to results in health care, but also to the structure and the process. The opinion of the users of the service is included. Applying this methodology allows a greater compromise of the providers of the services with the results of the process, and with the corrective measures derived from it, and due to this the solutions to the problems detected are more feasible. It is demonstrated how its practical application in a primary health care institution, allowed to know the quality of care for hipertensive patients, by means of the assessment of important dimensions of quality: the scientific-technical quality of care, and the user's satisfaction. This methodology is also used to assess quality in mother-child care, and a project was designed to assess qualityin Hygiene and Epidemiology services in a local health system.

 Quality of health care;  APS;  calidad;  CALIDAD DE LA ATENCION DE SALUD;  

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 APS;  

Abstract: In this book 10 groups of people describe the dramatic changes in the delivery of health care that occurred in their areas or countries. Their starting points were different, as were their methods and the end results, but all are successes. This chapter examines some of the goals, the methods, and the results to determine if their were some general principles that could be used to help other countries and communities to improve their health. In all of the examples described the new system of primary health care was either linked with the indigenous system or attempted to play a role having some of the same qualities that existing systems had. Each country or area also started with the formation, reinforcement, or recognition of a local community organization. This appeared to have 5 relevant functions: it laid down the priorities; it organized community action for problems that could not be resolved by individuals; it controlled the primary health care service by selecting, appointing, or legitimizing the primary health worker; it assisted in financing services; and it linked health actions with wider community goals. Another common element is the use of a primary health care worker who does not fit the expected description of a doctor or nurse. Frequently, this person is a villager selected by the community and trained locally for a period that could be as short as 3-4 months initially, an unpaid volunteer, or a person possibly partially or totally supported by the village people in cash or kind, and with responsibilities for aspects of promotional, preventive, or curative health. The relationship of the primary health worker to the remainder of the health services warrants a separate study. In no example presented is there a separation of the promotional, preventive, and curative health actions at the primary health care level. Arguments for a linkage between financing and service are not so clear. The need for primary health care to be self sufficient has been expressed many times. The examples presented fall into 3 overlapping types: national change (China, Cuba, Tanzania); extensions of the existing system (Iran, Niger, and Venezuela); and local community development (Guatemala, India, and Indonesia). The countries that started the process of national change by a political process have a clear advantage in speed and coherence, but the forces that influence such a change are beyond the scope of this discussion. It is concluded that in most countries health development as a part of rural development is possible if one goes about it in acceptable ways. These ways include the quick evolution of a village based development organization and a primary health care system designed for that country and accompanied by a parallel national effort to build such a peripheral expession into the national scene.

 APS;  PHC;  

Abstract: Sorry no abstract available for this article

 APS;  

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Abstract: Sorry no abstract available for this article

 APS;  

Checkout More Details | Available Online