Reforme de los sistemas de salud en America Latin y el Caribe: situacion y tendencias / Health sector reform in Latin America and the Caribbean: situation and trends

In the early 1990s, most Latin American and Caribbean countries were beginning, or planning to begin, health sector reform processes. This paper presents the status and trends of health sector reform at the end of the 1990s. The authors relied on information in 20 health system and services profiles completed by the Pan American Health Organization between August 1998 and October 1999. The analysis, which follows a methodology that had been applied earlier, was organized on two different levels: (1) monitoring the reform processes (dynamics and content) and (2) evaluating their outcomes. In looking at the dynamics of the reform processes, the article examines the content in which they take place and the actors involved in their different phases: inception, design and negotiation, implementation, and evaluation. The description and analysis of the contents of health sector reform inititives are organized into 12 broad thematic areas. Outcomes evaluation was only possible in the eight countries that provided enough pertinent information, and should be viewed as preliminary. Nevertheless, the article does present detailed information on the outcomes of health sector reform in terms of equity, effectiveness and quality, efficiency, sustainability, and societal participation and control. The article also discusses the potential causes and determining factors for the observed outcomes (AU)

La calidad y la reforma del sector de la salud en America Latina y el Caribe / Quality and health sector reform in Latin America and the Caribbean

Improving the quality of basic health services, together with the search for equity, efficiency, sustainability, and social participation, has been one of the guiding principles of health sector reform initiatives ever since thr I Summit of the Americas was held in 1994. This article addresses some basic concepts, examines the status of quality control within health systems and services in Latin America and the Caribbean, and analyzes the most important trends observed in the Region in the establishment of quality assurance programs. Finally, ways of improving and monitoring quality continuously and sustainably are recommended (AU)

Five year health sector plan

Presents a plan aimed at guiding the development of the infrastructure, manpower, management and the delivery and provision of health services on the islands of Grenada, Carriacou and Petit Martinique. Objectives include decreasing mortality and morbidity and strengthening the initiatives of health for all by the year 2000. Details on the current health services; priority programmes for health development; health infrastucture and facilities; and details of legislation pertaining to health are given. Also outlines health policy statements of the Government. The general objectives of the plan are outlined and the strategies that should be used to achieve these goals are included

Caribbean Cooperation in health (CCH); Trinidad and Tobago. Meeting of Donors

Comments on the effect of the world economic crisis on the social sector in the Caribbean and the concern about the potential of long term effect on the health and other social sectors. The limited available resources devoted to services and the rising expectations of the population have emphasised the need to rationalize the use of scarce resources while attempting to satisfy basic health needs. Looks at the institutions within the Caribbean which will make for the success of the initiative. Outlines the seven priority areas around which the CCH was organised such as: environmental protection, human resources development, chronic diseases control and accidents prevention, strengthening of health systems, food and nutrition, maternal and child health and population and AIDS. Presents a brief review of the socio-economic situation in Trinidad and Tobago and gives an epidemiological analysis of the country. Discusses the general health status of the country, the birth and mortality rates, special health problems and communicable and non-communicable diseases. Presents an overview of the priority areas mentioned and outlines the policies, strategies, plans and programmes adopted by Trinidad and Tobago. Presents a project profile of each priority area in which the following are outlined: problem description, project objectives, project components, budget, associated institutions and duration(AU)

Imperatives for community participation in health development: processes, strategies and issues

Limitations faced by governments to provide the resources required for health development has emphasized the critical role of community participation. This document reaffirms the need for individuals, families and community groups to be involved in an organized fashion in a range of decision making processes leading to self-care and self-responsibility. As a strategy, community participation is not being promoted as a separate program. Rather, it is to be integrated as part of all health development programs. Forces that contributed to the adoption of community participation as a strategy for achieving the social goal of Health For All and the factors which affect its promotion are discussed. Brief description is included of measures that had been taken for its promotion, nature of the Caribbean communities, types of participation and recent trends. Reasons for failure of integration and effects on community health development are reviewed. To facilitate the planning and implementation described at community level, certain requirements for organization and management of community health education and participation at national level are discussed. These pertain to: policy guidelines, development,. of human resources; provisions of needed logistic support; broad programming and mechanism to achieve intrasectoral collaboration. The maintaining phase is concerned with sustaining people's involvement. Monitoring and evaluation of program implementation ensures that required skills and behaviroal changes leading to self care and self reliance are in place by the time program inputs are completed. Indicators are needed that are community related and health system related. Implications for areas of research and related issues of technical, adminstrative and political nature are included. (Summary)