Health impact assessment and inequalities - Ruth Barnes 1 and Alex Scott-Samuel
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Resumen:
La evaluación del impacto sanitario (EIS) trata de investigar los efectos de los programas, políticas y proyectos en la salud de la población y cómo se distribuyen dichos efectos en ella. Uno de los principios subyacentes de la EIS es su enfoque hacia la equidad y la justicia social. La EIS se ha aplicado en el Reino Unido a varias iniciativas de regeneración (renovación) urbana, entre ellas las denominadas Single Regeneration Budget (SRB), New Deal for Communities (NDC) y Healthy Living Centers. Aunque estas iniciativas se centran en las poblaciones desfavorecidas, a veces no se tiene en cuenta el objetivo de reducir las desigualdades en la población destinataria, en oposición a reducir las desigualdades entre dicha población y otros grupos. Este artículo cita ejemplos de las iniciativas SRB y NDC en zonas de Londres, destinadas a mejorar las condiciones económicas proporcionando formación y educación con
el fin de crear mejores oportunidades de empleo.
Aunque se podría lograr el objetivo de mejorar las condiciones económicas generales de las zonas de intervención, algunos segmentos de la población
podrían no beneficiarse tanto como otros, o verse incluso forzados a mudarse a otras zonas desfavorecidas a medida que fueran escaseando los alojamientos de precio asequible, con lo cual el problema tan solo cambiaría de lugar. Estas
situaciones alternativas destacan la necesidad de que las EIS tengan un ámbito claramente definido (por ejemplo, el de los residentes actuales, en vez de la zona en sí misma), así como la necesidad de identificar los aspectos relevantes de la distribución equitativa de las repercusiones sanitarias. A medida que se vayan desarrollando más los métodos y procedimientos para llevar a cabo las EIS, este enfoque podría desempeñar un importante papel en la reducción de las desigualdades sanitarias, ayudando a los planificadores a optimizar las repercusiones sanitarias positivas de las políticas públicas.
Reforma de sistemas de servicios de salud y equidad en América Latina y el Caribe: algunas lecciones de los años 80 y 90 - Celia Almeida - Departamento de Administração e Planejamento em Saúde, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz. Brasil.
Resumen
Este ensayo propone una revisión de la cuestión equidad y reformas en América Latina y el Caribe en el contexto de cambios de las dos últimas décadas, dando énfasis a la discusión de la reforma de los sistemas de servicios de salud. La coyuntura económica, política y social de los críticos años 70 fue ampliamente favorable a los cortes en el gasto público, sobre todo en el ámbito social, y a la reorganización de servicios de salud bajo una perspectiva economicista, pragmática y restrictiva. El balance de la situación económica y social latinoamericana es impactantemente negativo, e incluso los esfuerzos para recuperar los estragos de los años 80 no tuvieron mucho éxito en los 90. Las reformas implementadas en algunos países confirman la difusión de una agenda común, adaptada a las condiciones nacionales, siendo las opciones más radicales de adhesión al nuevo modelo reformista las que presentan peor impacto en términos de equidad. Algunos resultados positivos de estos procesos se diluyen en los nuevos problemas suscitados por las propias reformas. La superación de las desigualdades, sin embargo, todavía es una meta distante.
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Health systems reform and equity in Latin America and the Caribbean: lessons from the 1980s and 1990s - Celia Almeida - Departamento de Administração e Planejamento em Saúde, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz. Brasil.
Abstract
This essay proposes a review of the issues of equity and reform in Latin America and the Caribbean in the context of changes in recent decades, emphasizing the discussion of health systems reform. The economic, political, and social context prevailing in the critical 1970s extensively favored budget cuts for public expenditures, cost containment, changes in the health sector power structure, and health services reorganization from an 'economicist', pragmatic, and restrictive perspective. An inventory of the Latin American economic and social situation is markedly negative, and efforts to recover from the damage done in the 1980s were largely unsuccessful in the 1990s. The reforms implemented in some paradigmatic countries (Chile, Colombia, Costa Rica, Argentina, and Brazil), in light of their specific characteristics, demonstrate the dissemination of a common agenda, adapted to the various national conditions. Some positive results of these processes were diluted in new problems caused by the reforms themselves, especially in countries with more radical adherence to the new reformist model; meanwhile, in the country where the public, universal system based on solidarity was most consolidated, the management changes have obtained the best results. However, overcoming inequalities is still a distant goal.
"Equidad de Género en Salud" - Hoja informativa Programa Mujer Salud y Desarrollo - Organización Panamericana de la Salud
Este artículo aborda la equidad de género en salud, en tanto disparidades injustas en los niveles del bienestar físico, psicológico y emocional que están presentes en los diferentes grupos sociales.
Estas disparidades, definidas como inequidades, resultan de las diferencias de sexo, nivel socio-económico, étnicidad, edad, región geográfica e orientación sexual. El intercambio de dos o más de estas características también puede exacerbar las inequidades de la salud entre grupos.
La equidad de género en salud significa la ausencia de disparidades innecesarias, evitables e injustas entre mujeres y hombres. Significa que las mujeres y los hombres tienen la misma oportunidad de gozar de las condiciones de vida y servicios que les permiten estar en buena salud, sin enfermar, discapacitar o morir por causas que son injustos y evitables.
La perspectiva de género en salud implica vincular la distribución del poder y el trabajo entre las mujeres y los hombres a sus perfiles epidemiológicos. Con esto, podemos explicar cómo y por qué difieren los perfiles de salud de los hombres y la mujeres.
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"Effects of health decentralization, financing and governance in Mexico"- Armando Arredondo and Emanuel Orozco(*)
Rev. de Saúde Pública 2006;40(1): 152-60
(*)Centro de Investigación en Sistemas de Salud. Instituto Nacional de Salud Pública. Cuernavaca, Morelos, México
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The Objective of this study is to identify the effects of decentralization on health financing and governance policies in Mexico from the perspective of users and providers.
The Methodolgy used by the authors is a cross-sectional study carried out in four states that were selected according to geopolitical and administrative criteria. Four indicators were assessed: changes and effects on governance, financing sources and funds, the final destination of resources, and fund allocation mechanisms. Data collection was performed using in-depth interviews with health system key personnel and community leaders, consensus techniques and document analyses. The interviews were transcribed and analyzed by thematic segmentation.
The Results show different effectiveness levels for the four states regarding changes in financing policies and community participation. Effects on health financing after decentralization were identified in each state, including: greater participation of municipal and state governments in health expenditure, increased financial participation of households, greater community participation in low-income states, duality and confusion in the new mechanisms for coordination among the three government levels, absence of an accountability system, lack of human resources and technical skills to implement, monitor and evaluate changes in financing.
Governance and Corruption in Public Health Care Systems- By Maureen Lewis - Working Paper Number 78. January 2006 - Center for Global Development
Abstract
What factors affect health care delivery in the developing world? Anecdotal
evidence of lives cut tragically short and the loss of productivity due to avoidable diseases is an area of salient concern in global health and international development.
This working paper looks at factual evidence to describe the main challenges facing health care delivery in developing countries, including absenteeism, corruption, informal payments, and mismanagement. The author concludes that good governance is important in ensuring effective health care delivery, and that returns to investments in health are low where governance issues are not addressed.
A continuación se presenta un conjunto de ponencias presentadas en el marco de la Conferencia Internacional sobre Seguro Social de Salud en países en desarrollo, realizada en Berlín del 5 al 7 de diciembre de 2005.
Opening of the International GTZ-ILO-WHO Conference on Social Health Insurance in Developing CountriesDescargar archivo pdf (46 kb)
Seguro médico social y su papel en desarrollo económico y
reducción de pobreza - Discurso Inaugural del Sr. David Fuentes Montero, Ministro de Hacienda de la República de Costa Rica, América Central
Implementation of Health Insurance in Developing Countries: Lessons from International Experience - Bong-min YANG, PhD. Professor, Seoul National University, South KoreaDescargar archivo formato pdf (38 kb)
Universalidad con Solidaridad. Protección Social y financiamiento de salud en América Latina. Jens Holsts & Nicola Wiebe - Editores Cooperación Internacional Alemana (GTZ), por encargo del Ministerio Federal de Cooperación Económica y Desarrollo. Eschborn, Frankfurt. 2004
Principales contenidos
Retos de la protección social sustentable en América Latina.
Experiencia y desafíos de reforma en Sistemas de Salud en América Latina
Financiamiento de salud y su impacto en la equidad
Sistemas de aseguramiento de salud
La exclusión social en América Latina: una visión de conjunto
El desafío de las nuevas reformas en el sector salud
Income Generation and Social Protection for the Poor The International Bank for Reconstruction and Development / World Bank, August, 2005
This report presents the results of an assessment of the Mexican government strategies to reduce rural and urban poverty, and of the country’s social protection system and its impact on the poor.
“…August 24, 2005 – Even though its 2002 to 2004 poverty-reduction trends are encouraging – particularly as far as rural poverty is concerned – Mexico still faces challenges such as reducing urban poverty, which has fallen into a rut of sorts, as well as the challenge of making its social protection system less regressive and more equitable so as to provide coverage for more of its poor….”
English version at:
http://web.worldbank.org/WBSITE/EXTERNAL/NEWS/0,,contentMDK:20626144~pagePK:34370~piPK:34424~theSitePK:4607,00.html
Spanish version at:
http://web.worldbank.org/WBSITE/EXTERNAL/NEWS/0,,contentMDK:20626144~pagePK:34370~piPK:34424~theSitePK:4607,00.html
Governance and the City: An Empirical Exploration into Global Determinants of Urban Performance - Daniel Kaufmann, Frannie Léautier, and Massimo Mastruzzi World Bank Policy Research Working Paper 3712, September 2005
The authors contribute to the field of urban governance and globalization through an empirically-based exploration of determinants of performance of cities. They construct a preliminary worldwide database for cities, containing variables and indicators of globalization (at the country and city level), city governance, city performance (access and quality of infrastructure service delivery), as well as other relevant city characteristics. This city database, encompassing hundreds of cities worldwide, integrates existing data with new data gathered for this research project. They present a very simple conceptual framework and a set of hypotheses, and then test them econometrically.
The findings suggest that good governance and globalization (at both the country as well as at the city level) do matter for city-level performance in terms of access and quality of delivery of infrastructure services. The authors also find that globalization and good city governance are significantly
related with each other. There appear to be dynamic pressures from globalization and accountability that result in better performance at the city level. Furthermore, the evidence suggests that there are particular and complex interactions between technology choices, governance and city performance, as well as evidence of a non-linear (u-shaped) relationship between city size and
performance, challenging the view that very large cities necessarily exhibit lower performance and pointing to potential agglomeration economies. Their framework also suggests a way of bridging two seemingly competing strands of the literature, namely viewing the city as a place or as an outcome. They conclude pointing to the need for expanding the database and the econometric
framework, as well as to more general future research directions and policy implications emerging from this initial empirical investigation in the field of governance and the city.
Strategies for Assessing Health Plan Performance on Chronic Diseases: Selecting Performance Indicators and Applying Health-Based Risk Adjustment Ann Volpel, John O’Brien, Center for Health Program Development and ManagementUniversity of Maryland, Baltimore County
Jonathan Weiner, Health Services Research and Development Center, Johns Hopkins Bloomberg School of Public Health Johns Hopkins University
Funded by the Center for Health Care Strategies, Inc. under
The Robert Wood Johnson Foundation’s Medicaid Managed Care Program, March 2005
Developing a performance measurement program requires states to consider a number of factors. The process can be divided into five steps:
Selecting the data
Selecting Diseases for analysis
Defining disease cohorts
Selecting performance measures
Involving the Health Plans
Pathways to “Evidence-Informed” Policy and Practice: A Framework for Action Shelley Bowen*, Anthony B. Zwi PLoS Med 2(7): e166. Volume 2 | Issue 7 | JULY 2005
The authors of this article propose that an “evidence-informed policy and practice pathway” can help both researchers and policy actors navigate the use of evidence. The pathway illustrates different types of evidence and their uses in health policymaking, and proposes that specific capacities, such as an individual's skills, experience, and participation in networks, influence the adoption and adaptation of evidence in practice.
Full-text article available at: http://dx.doi.org/10.1371/journal.pmed.0020166
“Interacción” y usos de la investigación en las políticas y programas de salud: funciona? - Anita Kothari, Stephen Birch and Cathy Charles - Volume 71, Issue 1, Pages 117-125, January 2005
The objective of this study was to assess if interaction between users and producers of research is associated with a greater level of adoption of research findings in the design and delivery of health care programs. Responses to the dissemination of a research report on breast cancer prevention were compared between two groups of public health units in Ontario, Canada. Although all public health units received the report, only a subset of units was involved in the development of the report, while others were not. Research utilisation was conceptualized in terms of stages, including reading the report, information processing, and application of findings for public health units’ policies and programs. Using a multi-case study design, three units that contributed to the report's production (the interacting units) were compared with three units were not involved in producing the report (the comparison units) on the basis of research utilisation. Data collection involved group interviews and document review. Results demonstrated that interacting units had a greater understanding of the report's analysis and attached greater value to the report. However, interaction was not associated with greater levels of utilisation in terms of application. Both interacting and comparison units used the research findings to confirm that their on-going program activities were consistent with the research findings, and to compare their program performance relative to other units. In conclusion, interaction influenced the understanding of the research, and intent to use the research findings, but applied use was independent of interaction between producers and users of research.
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"Assessing the impact of social science research:conceptual, methodological and practical issues"- Huw Davies, Sandra Nutley, Isabel Walter - Research Unit for Research Utilisation School of Management, University of St Andrews - May 2005
This paper lays out the reasons why it is necessary to examine the difference that research can make. It then explores different ways of approaching this problem, outlining the core issues and choices that arise when seeking to assess research impact. A wide range of key questions are raised in the paper, and consideration of these should help those wishing to develop work in this area.
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PANORAMA DE LA LUCHA CONTRA LA EXCLUSIÓN SOCIAL Conceptos y estrategias- Jordi Estivill - Ginebra, Oficina Internacional del Trabajo, 2003.
La exclusión social es a la vez un fenómeno del pasado y del presente y si no se le remedia, del futuro. Afecta a millones de personas que tratan de sobrevivir, en las más duras condiciones de vida y de trabajo. A lo largo de la historia, las formas de la exclusión han ido evolucionando tanto en sus características como en la concepción que se tiene de ellas. En la actualidad, la exclusión presenta rostros distintos en los diversos continentes, y aun dentro de ellos, en las regiones y países. Los programas y las medidas para afrontar sus diferentes aspectos han cambiado y no son los mismos en todos los rincones del mundo. El conjunto de los actores no juega el mismo papel en el afán de paliarla y de erradicarla. Por todo ello era y es importante conocer mejor la exclusión social.
La presente publicación la OIT pretende hacer una aportación que, coordinada con las iniciativas de las otras agencias internacionales, los gobiernos, las organizaciones de empleadores y de trabajadores y otros, espera que contribuya a construir un mundo menos excluyente y más justo.
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MODELOS DE PROTECCION SOCIAL - Sonia Fleury y Carlos Gerardo Molina. Octubre, 2000.
En el artículo se abordan dos temas principales: el desarrollo de los sistemas de protección social y la caracterización de los modelos a que dan lugar, particularmente los de seguridad social, que predominaron en América Latina hasta finales de los años ochenta. En este último punto, se revisan algunos intentos de caracterización de los modelos de protección social en América Latina y particularmente de la institucionalización de la protección social como sistemas de seguridad social. A diferencia de lo que sucede en los países industrializados, para América Latina los modelos de protección se abren en dos vertientes, que existen paralelamente y que interactúan entre sí: la una concentrada en la seguridad social, la otra en sectores como la educación y la salud pública. Ambas vertientes se nutren de las consideraciones téoricas y desarrollos del primer tema, pero tienen diferencias importantes en la forma como terminan institucionalizándose.
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AMÉRICA LATINA: POBREZA Y DESIGUALDAD DURANTE 50 AÑOS DE REFORMAS ECONÓMICAS Y SOCIALES. Nohra Rey de Marulanda. Banco Interamericano de Desarrollo, Instituto Interamericano para el Desarrollo Social (INDES). Junio, 1999
América Latina es la región del mundo con la distribución del ingreso más desigual, fenómeno que es muy anterior a los problemas de la crisis de los años 80 y los consiguientes ajustes. Es conveniente recalcar que la situación de desigualdad y pobreza es anterior a la crisis pues de lo contrario es muy fácil llegar a conclusiones equivocadas: si los causantes de tales males fueron la crisis y los ajustes, el restablecimiento de equilibrios macroeconómicos debería automáticamente acabar con esos fenómenos. La evidencia empírica no soporta esa afirmación. Por una parte, el mero restablecimiento de los equilibrios macroeconómicos no garantiza eliminación de la pobreza y reducción de la desigualdad; por otra, la región, a pesar de contar con largos períodos de alto crecimiento económico (1950-1970), no logró eliminar la pobreza y ciertamente no se modificó la situación de pobreza y desigualdad. Por tanto, si bien debemos buscar tener una situación de crecimiento económico sostenido y ciertos balances macroeconómicos, la búsqueda de mayor igualdad requiere acciones adicionales, tanto en la conformación de la política económica como de la social.
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Governance, Microgovernance and Health - Scott Burris
In this article the author develops a theory of “nodal governance”. In this theory, governance is a social adaptation accomplished in significant part through the creation and operation of “nodes.” Nodes, as the name suggests, are commonly points on a network, so that nodes can be understood as participating in the type of information-based governance described by Manuel Castells. In Castells’ work, social systems are seen as comprised of networks that govern through control of information, capital, production, and other basic functions and resources. Governing entities like states and firms are understood to be networks themselves, comprised of many subsidiary nodes, rather than as monolithic entities.
The theory of nodal governance is intended to enrich network theory by focusing attention on and bringing more clarity to the internal characteristics of nodes and thus to the analysis of how power is actually created and exercised within a social system. While power is transmitted across networks, the actual point where knowledge and capacity are mobilized for transmission is the node. Given networks, nodal governance asks how local participation is organized and effectuated.
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"Governance Matters IV: Governance Indicators for 1996-2004" Daniel Kaufmann, Aart Kraay, and Massimo Mastruzzi - The World Bank, May 2005
Este artículo presenta indicadores actualizados de gobernanza y un análisis de varios temas relacionados con el uso de estas medidas. Los indicadores de gobernanza miden las siguientes seis dimensiones de gobernanza: i) Democracia y responsabilidad; ii) Inestabilidad política y violencia; iii) Eficiencia del gobierno; iv) Calidad reguladora; v) Normas y leyes; vi) Control de corrupción. Estas medidas cubren 209 países y territorios para 1996, 1998, 2000, 2002 y 2004. Están basados en una centena de variables individuales que miden la percepción de gobernanza, tomados de 37 bases de datos independientes, contruidos por 31 organizaciones diferentes. Los autores presentan estimaciones de las seis dimensiones de gobernanza para cada período, así como márgenes de error que capturan el rango de valores para cada país.
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(For the english version click on "Read More")
This paper presents the latest update of aggregate governance indicators, together with new analysis of several issues related to the use of these measures. The governance indicators measure the following six dimensions of governance: i) Voice and Accountability; ii) Political Instability and Violence; iii) Government Effectiveness; iv) Regulatory Quality; v) Rule of Law, and, vi) Control of Corruption. They cover 209 countries and territories for 1996, 1998, 2000, 2002, and 2004. They are based on several hundred individual variables measuring perceptions of governance, drawn from 37 separate data sources constructed by 31 different organizations. The authors present estimates of the six dimensions of governance for each period, as well as margins of error capturing the range of likely values for each country.
"Ethical Guidelines for Managing Conflicts of Interest in Health Services Research" - Academy Health Report - December 2004
Summary: The primary interest of health services researchers is to generate and disseminate valid and reliable research that informs policy and practice and to ensure integrity in the process. A conflict of interest occurs when secondary interests—such as teaching, administration, political advocacy, or financial or avocational pursuits—distort the integrity of judgments regarding the primary interest. AcademyHealth convened an Ethical Guidelines Committee comprising individuals reflecting a range of organizations and disciplines to provide practical guidance to individuals and organizations who struggle with the potential for conflicts of interest in health services research and health policy analysis.
Disponible en /Available atwww.academyhealth.org/ethics/introduction.htm
"Health Financing Innovations in the Caribbean:EHPO© and the National Health Fund of Jamaica" Raphael D. Barrett Stanley Lalta
This paper examines the desirable features of national health financing systems, the Jamaica public policy context and the role of EHPO© (Evaluating Health Policy Options) in analyzing health benefits and coverage, financial risk and liability. It suggests lessons to other countries for the design of healthcare benefits coverage, financing, provider payment mechanisms and public policy implementation. Descargar archivo/Download file (443 KB PDF Format)
"India’s Public Health System. How Well Does It Function at the National Level?" Monica Das Gupta - Manju Rani
This paper focuses on the Federal Health System in India and reports strengths and weaknesses in carrying out Essential Public Health Functions. After the analysis the authors conclude that with some re-assessment of priorities and better management practices, health outcomes could be substantially improved.
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"Equity, capabilities and health" edited by Paul Anand and Paul DolanThis paper provides an introduction to a collection of articles concerning the relevance of Amartya Sen’s work, the capability approach and related ethical claims, to health-care rationing. 2004 Elsevier Ltd. Descargar archivo / Download file (164 KB PDF Format)
"Equidad y reforma del Sector Salud" - Dr. Jorge Luis Prosperi - OPSDescargar archivo/Download file (186 KB PDF Format)
"Governance and the City: An Empirical Exploration into Global Determinants of Urban Performance" - Daniel Kaufmann, Frannie Léautier, and Massimo Mastruzzi
The article contributes to the field of urban governance and globalization through an empirically-based exploration of determinants of performance of cities. It constructs a preliminary worldwide database for cities, containing variables and indicators of globalization (at the country and city level), city governance, city performance (access and quality of infrastructure service delivery), as well as other relevant city characteristics. The paper presents a very simple conceptual framework and a set of hypotheses, and then test them econometrically.
The findings suggest that good governance and globalization (at both the country as well as at the city level) do matter for city-level performance in terms of access and quality of delivery of infrastructure services. Also, globalization and good city governance are significantly related with each other. As a conclusion the authors point to the need for expanding the database and the econometric framework, as well as to more general future research directions and policy implications emerging from this initial empirical investigation in the field of governance and the city.
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"Impacts of participation and governance on equity in health systems:Report of a research meeting"- Report produced by Regional Network for Equity in Health in Southern Africa
(EQUINET) and Training and Research Support Centre (TARSC). In collaboration with IDRC (Canada) Lusaka, January 18 and 19 2002
Contents of the Report:
1.Background
2.Opening and workshop objectives
3.Research issues in the impact of Governance on Equity in health Systems
4.Country Situations and proposals on Governance and Equity in Health Systems
5.Research Methods
6.Follow up actions on the Research
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"The other face of research governance" - Alysun M Jones,Bryony Bamford
After inadvertently making an unauthorised protocol deviation,two researchers were left with a weakened study and feeling disillusioned.
Research governance is designed to ensure that “health and social care research is conducted to high scientific and ethical standards.” Currently the same process is applied to all breaches,regardless of their
severity or likely implications.Although we do not deny the importance and relevance of research governance,our experience leads us to question how it is applied.
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"United Kingdom research governance strategy" - Susan Kerrison,Nick McNally,Allyson M Pollock
The new research governance strategy marks a radical overhaul of the arrangements for medical research in the NHS and academic institutions with far reaching implications for all those taking part in research.The days of registrars and consultants singlehandedly doing research projects are over.
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"Convergent evolution:The academic and policy roots of collaborative research" Editorial. Journal Health Services Research and Policy, Vol 8 Suppl 2. October 2003
In the editorial the authors argue that the current popularity of collaborative research is a convergence between emerging forces and traditions within academia and changing rules and norms within policy and management, particularly the public management of health and social policy. First, they discuss briefly the converging streams of academic work behind collaborative research. Then they describe how the field of policy-making and management, through a commitment to evidence-based decision-making, has developed an interest in collaboration with researchers to produce knowledge. Then they position the papers in this supplement: three introductory case studies from the perspective of the collaborating investigators; three articles that evaluate, from the perspective of the research funding agency, the impact of grant programmes that encourage collaborative research; two papers analysing the impact of collaboration on research domains; and, finally, a review of lessons for
collaborative research from outside health care. Finally, they extract a few lessons that emerge from the collection of papers.
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"Diffusion and Innovations in Service Organizations: Systematic Review and Recommendations" - Trisha Greenhalgh, Glenn Robert et al. - The Milbank Quarterly, Vol.82, No 4, 2004 (pp.581-629)
The article summarizes an extensive literature review addressing the questions, How can we spread and sustain innovations in health service delivery and organization? It considers both content (defining and measuring the diffusion of innovation in organizations) and process (reviewing the literature in a systematic and reproducible way). This article discusses 1) a parsimoniousus and evidence-based model for considering the diffusion of innovations in health service organizations, 2) clear knowledge gaps where further research should be focused, and 3) a robust and transferable methodology for systematically reviewing health service policy and management. Both the model and the method should be tested more widely in a range of contexts.
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"Knowledge translation in health and development. Research to Policy Strategies" International Development Research Centre (IDRC),Coalition for Global Health Research Canada, Institute of Population Health, University of Ottawa. October 2003
There are three notable models that include one or more elements of knowledge
translation: Research utilization model in policy (Hanney, 2003), Knowledge Transfer (Lavis et al., 2003) and Ottawa Model of Research Use (OMRU) (Logan and Graham,1998). The OMRU framework provides a way to organise the potential challenges or barriers to research use and the recommendations for overcoming those barriers. One of the principle recommendations for overcoming the barriers to the use of research by policy makers is to create networks. Networks work to facilitate knowledge sharing, creation and dissemination, build relationships to link and involve researchers and policy makers in the research and policy process and train people in research and policy making skills, as well as knowledge translation skills.
This review showed that a number of networks in both industrialised and Low and Middle Income Countries (LMICs), are active in developing and applying innovations that have important KT potential. However, there are few examples of knowledge translation activities linking researchers and research users to work together in priority setting and research planning. The interviews support the great potential for KT and identify a number of key issues critical
to the success of an initiative focussing upon LMICs.
"Exclusión en Salud en países de América Latina y el Caribe" - Organización Panamericana de la Salud (OPS) - Agencia Sueca para el Desarrollo Internacional (ASDI)
Este trabajo presenta el resultado de los estudios realizados entre 2001 y 2003 en seis países de Latinoamérica (Ecuador, Guatemala, Honduras, Perú, Paraguay y República Dominicana) con el objetivo de caracterizar y medir la exclusión en salud. Con el objetivo de intentar superar las dificultades que ofrece la caracterización de la exclusión en salud, se elaboró una guía metodológica que contiene técnicas cualitativas y cuantitativas de recolección de información.
Los resultados del estudio muestran que los factores más importantes de exclusión en salud difieren para cada país. La medición de la exclusión realizada de esta manera, puede constituir un instrumento importante para la definición de políticas sociales en los países.
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"Elementos para la formulación de estrategias de extensión de la protección social en salud" - Dossier - Eduardo Levcovitz y Cecilia Acuña
Este trabajo analiza las causas de la situación de exclusión en salud hoy en día en la región y propone un marco analítico para abordar la formulación de estrategias destinadas a extender la protección a partir de dichas causas, entendiendo la extensión de la protección social en salud como la garantía que la sociedad otorga, a través de los poderes públicos para que un individuo
o grupo de individuos, pueda satisfacer sus necesidades de salud a través del acceso a bienes y servicios de manera adecuada, sin que la capacidad de pago sea un factor restrictivo.
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