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Climate change adaptation in South Africa: a case study on the role of the health sector

Abstract Background

Globally, the response to climate change is gradually gaining momentum as the impacts of climate change unfold. In South Africa, it is increasingly apparent that delays in responding to climate change over the past decades have jeopardized human life and livelihoods. While slow progress with mitigation, especially in the energy sector, has garnered much attention, focus is now shifting to developing plans and systems to adapt to the impacts of climate change.

Methods

We applied systematic review methods to assess progress with climate change adaptation in the health sector in South Africa. This case study provides useful lessons which could be applied in other countries in the African region, or globally. We reviewed the literature indexed in PubMed and Web of Science, together with relevant grey literature. We included articles describing adaptation interventions to reduce the impact of climate change on health in South Africa. All study designs were eligible. Data from included articles and grey literature were summed thematically.

Results

Of the 820 publications screened, 21 were included, together with an additional xx papers. Very few studies presented findings of an intervention or used high-quality research designs. Several policy frameworks for climate change have been developed at national and local government levels. These, however, pay little attention to health concerns and the specific needs of vulnerable groups. Systems for forecasting extreme weather, and tracking malaria and other infections appear well established. Yet, there is little evidence about the country’s preparedness for extreme weather events, or the ability of the already strained health system to respond to these events. Seemingly, few adaptation measures have taken place in occupational and other settings. To date, little attention has been given to climate change in training curricula for health workers.

Conclusions

Overall, the volume and quality of research is disappointing, and disproportionate to the threat posed by climate change in South Africa. This is surprising given that the requisite expertise for policy advocacy, identifying effective interventions and implementing systems-based approaches rests within the health sector. More effective use of data, a traditional strength of health professionals, could support adaptation and promote accountability of the state. With increased health-sector leadership, climate change could be reframed as predominately a health issue, one necessitating an urgent, adequately-resourced response. Such a shift in South Africa, but also beyond the country, may play a key role in accelerating climate change adaptation and mitigation.

Categorías: Investigaciones

Resolución CSP29. R4: plan de acción para el fortalecimiento de las estadísticas vitales 2017-2022

BIREME - Repositorio RHS - Lun, 18/03/2019 - 20:00
La 29.a Conferencia Sanitaria Panamericana, habiendo examinado el Plan de acción para el fortalecimiento de las estadísticas vitales 2017-2022 (documento CSP29/9); Reconociendo la importancia de mejorar la cobertura y la calidad de las estadísticas vitales para disponer de información más confiable y válida para el diseño, la ejecución, el seguimiento y la evaluación de políticas de salud en los países, siguiendo las recomendaciones internacionales; Reconociendo la necesidad de contar con datos válidos, oportunos y al mayor nivel de desglose posible a nivel subnacional, nacional, subregional y regional para el diagnóstico y la formulación de políticas de salud y el seguimiento de indicadores como los establecidos para los Objetivos de Desarrollo Sostenible, la Agenda de Salud Sostenible para las Américas 2018-2030 y el Plan Estratégico de la OPS 2014-2019; Consciente de los esfuerzos realizados y los logros obtenidos hasta el presente mediante el anterior plan de acción para el fortalecimiento de las estadísticas vitales y de salud (2008-2012), y de las recomendaciones de los Estados Miembros para continuarlo y ampliarlo, haciendo énfasis en el nivel subnacional y la capacidad de análisis de las estadísticas. […] (AU)

The impact of the health care workforce on under-five mortality in rural China

Abstract Background

Previous studies have focused on the relationship between increases in the health care workforce and child health outcomes, but little is known about how this relationship differs in contexts where economic growth differs by initial level and pace. This study evaluates the association between increased health professionals and the under-five mortality rate (U5MR) in rural Chinese counties from 2008 to 2014 and examines whether this relationship differs among counties with different patterns of economic growth over this period.

Methods

We estimated fixed effects models with rural counties as the unit of analysis to evaluate the association between health professional density and U5MR. Covariates included county-level gross domestic product (GDP) per capita, female illiteracy rate, value of medical equipment per bed, and province-level health expenditures (measured as a proportion of provincial GDP). To explore modification effects, we assessed interactions between health professionals and county types defined by county poverty status and county-level trajectories of growth in GDP per capita. U5MR data have been adjusted for county-level underreporting, and all other data were obtained from administrative and official sources.

Results

The U5MR dropped by 36.19% during the study period. One additional health professional per 1000 population was associated with a 2.6% reduction in U5MR, after controlling for other covariates. County poverty status and GDP trajectories moderated this relationship: the U5MR reductions attributed to a one-unit increase in health professionals were 6.8% among poor counties, but only 1.1% among non-poor ones. These reductions were, respectively, 6.7%, 0.7%, and 4.3% in counties with initially low GDP that slowly increased, medium-level GDP that rose at a moderate pace, and high GDP that rose rapidly.

Conclusions

This study demonstrates that increased health professionals were associated with reductions in U5MR. The largest association was seen in poor counties and those with low and slowly increasing GDP per capita, which justifies further expansion of the health care workforce in these areas. This study could be instructive for other developing countries to achieve Sustainable Development Goal 3 by helping them identify where additional health professionals would make the greatest contribution.

Categorías: Investigaciones

Necesidades de especialistas médicos para la Caja Costarricense de Seguro Social: proyección 2006-2017

BIREME - Repositorio RHS - Sáb, 16/03/2019 - 20:00
En el estudio de las necesidades de dotación de Médicos Especialistas en la Caja Costarricense de Seguro Social, confluyen una cantidad considerable de variables que se provienen tanto de la oferta y de la demanda de servicios de salud de la población costarricense. Si se estudiase las necesidades de Especialistas Médicos, únicamente desde el punto de la demanda, seguramente los resultados serían mucho mayores a los valores indicados en el presente medición En tal interacción las variables de la demanda están limitadas por las variables de la oferta, debido a la infraestructura instalada para hacer frente a la demanda de servicios de salud. Una vez trianguladas todas las fuentes y sujetos de información según Hospital y Red de Servicios de Salud, se presenta el presente informe de investigación que ofrece datos sobre los principales requerimientos de recurso humano en las Especialidades Médicas que ofrece la CCSS a la población Costarricense. Debe indicarse que, aunque confluyen una cantidad importante de factores, sujetos y fuentes de información, aproximadamente el 30% de los datos, corresponden a necesidades de recurso humano según la jubilación proyectada. Aproximadamente 40% responde a brechas actuales de recurso humano, principalmente en Centros de Atención Integral en Salud, Hospitales Periféricos y Hospitales Regionales. (AU)

Informe: consultoría residencias médicas. El Salvador

BIREME - Repositorio RHS - Vie, 15/03/2019 - 20:00
El análisis referente a los antecedentes y determinantes sociopolíticos, científicos, legales y académicos de la formación de Médicos Especialistas en América Latina, la cual se inicia en la década del 50, permite apreciar una consistente tendencia que pone de manifiesto una serie de premisas para el estudio, explicación de las modalidades de especialización médica hospitalaria conocida como Residencias Médicas. A la luz de los señalamientos planteados, resulta comprensible el accidentado discurrir que ha caracterizado los esfuerzos emprendidos por los distintos países para dotar a los Sistemas de Salud de Médicos Especialistas con sólidos conocimientos, habilidades, destrezas profesionales y técnicas y de los valores necesarios para contribuir a hacer efectivo el derecho a la salud de la población a una atención equitativa y de calidad acorde con los avances científicos y tecnológicos de la medicina contemporánea. Como rasgo distintivo de la experiencia de El Salvador, en la formación de Médicos Especialistas, iniciada en la década del 60, se destaca que a diferencia de la mayoría de los países de la región, que mostraron un dilatado pero sostenido proceso de organización y normatización de la formación médica, en El Salvador, por razones sociales y políticas, el proceso formativo permaneció limitado de forma exclusiva al entorno hospitalario, quedando todas las fases de la formación especializada en las unidades de enseñanza bajo la responsabilidad del staff médico. (AU)

Health Plan for Central America and the Dominican Republic 2010 - 2015

BIREME - Repositorio RHS - Jue, 14/03/2019 - 20:00
This Health Plan complements the Health Agenda, agreed in the XXIII Forum of the Health Sector of Central America and Dominican Republic Sector (RESSCAD) and approved by the XXIX Meeting of the Council of Ministers of Health of Central America (COMISCA) of the System for Central American Integration (SICA), held in Tegucigalpa in January 31st, 2009. The Subregional Technical Commission for Elaboration of the Agenda and Health Plan (COTESAS) led the process of formulation and dissemination of the Health Agenda for Central America and the Dominican Republic (Subregion). Subsequently, the Technical Commission developed the Health Plan itself, in an intense and extensive process of consultations with the countries and subregional entities. Countless ordinary meetings and virtual sessions of the Commission led to the definition of a conceptual framework for the Health Plan, as well as the identification and definition of expected results, lines of action, indicators, management modalities and monitoring. The Health Plan was designed with inputs from organizations that are part of the family of specialized agencies participating in the SICA. These specialized agencies include the Nutrition Institute for Central America and Panama (INCAP), the Forum for Health, Potable Water and Sanitation of the Dominican Republic (FOCARD-APS), the Council of Institutions of Social Security in Central America and the Dominican Republic (CISSCAD), and the Center for Coordination of Prevention and Natural Disasters in Central America (CEPREDENAC). The Health Plan was designed to benefit from potential inter institutional synergies, and was guided by agreement documents issued by the different entities that are involved in integration efforts in Central America. Some of these agreement documents include the Strategic Social Agenda of the System for Central American Integration (SISCA), the Meso-american Public Health Plan, the Plan for Care of Indigenous Communities, the Subregional Program for Food Security in Central America (PRESANCA), and the Subregional Strategy for Health and the Agro-environment for Central America (ERAS). (AU)

Ley del Consejo Superior de Salud Pública y de las juntas de vigilancia de las profesiones en salud

BIREME - Repositorio RHS - Jue, 14/03/2019 - 20:00
Esta ley tiene por objeto regular el ejercicio de las profesiones médicas relacionadas con la salud del pueblo.

A cross-sectional study on workplace experience: a survey of nurses in Quebec, Canada

Abstract Background

Nurses play a significant role in healthcare systems. Their workplace experience can have an impact not only on nurses themselves, but also on patients and organizations, particularly in terms of quality of care and performance. Despite the importance of this experience, it remains an ambiguous concept with varying interpretations. Current studies do not fully capture its complexity, as its multiple dimensions are often considered in isolation. As such, developing a portrait of nurses’ workplace experience that integrates its multiple dimensions can provide decision-makers with better indications regarding what levers can be mobilized to generate positive results for nurses, patients, and organizations.

Aim

To identify profiles of nurses’ workplace experience in Quebec, Canada.

Design

Cross sectional.

Methods

In April 2017, 891 nurses participated in this study by completing a self-administered questionnaire. Four dimensions of nurses’ workplace experience were measured: resources available to them in their workplace, personal resources, demands (psychological and physical) placed on them, and outcomes associated with their work. Descriptive and factorial analyses were performed.

Results

Three profiles of nurses’ workplace experience emerged from the factorial analyses: nurses in distress, nurses in moderately positive situations, and nurses in positive situations.

Conclusion

The study identified profiles of nurses’ workplace experience that were differentiated based on nurses’ access to workplace resources, the demands of their work, and outcomes. Healthcare managers can use the results to improve the quality of nurses’ workplace experience by improving access to structural work resources and alleviating psychological demands.

Categorías: Investigaciones

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