[Recruitment, selection and retention of health professionals in indirect management and private management entities]. / Captación, selección y retención de profesionales sanitarios en entidades de gestión indirecta y de gestión privada. Informe SESPAS 2024.

The recruitment and retention of professionals in indirectly managed and privately managed health care institutions is governed by a different regulatory framework than in directly managed institutions. That legal framework is the Workers' Statute, which contains its own regulatory elements in terms of bargaining power and general basic conditions, among others. The regulatory framework of the Workers' Statute allows for a broad capacity for management, negotiation and agreement in the field of human resources management, and specifically in the processes of recruitment, selection and retention, but for some years now basic legislation and interventions by public control bodies have been incorporated which have modified this discretionarily for indirect management entities, bringing them closer and closer to the system of administrative management for civil servants/statutory employees, and consequently limiting the capacity for decision making and adaptation typical of business/private management. This article attempts to explain the similarities and differences between the different areas of management and to explore the weaknesses and opportunities of each of them in terms of recruitment, selection, and retention policies, offering a specific reflection on the selection of executives and managers, as well as an analysis and assessment of the retention of professionals in healthcare institutions.

Catalyzing alignment and systems transformation through cross-sector partnerships: Findings from the California Accountable Communities for Health Initiative.

OBJECTIVES: To describe the impact of Accountable Communities of Health (ACHs) on organizational and community partnerships and explore how ACHs contribute to systems change. DATA SOURCES AND STUDY SETTING: The California Accountable Communities of Health Initiative (CACHI) was a 5-year, $17 M investment in community health transformation in 13 ACH sites. Data sources include two surveys, key informant interviews, small group conversations, and ACH meeting observations and document review. STUDY DESIGN: This was a mixed-methods, observational study. Surveys conducted in 2021 and 2022 focused on ACH progress in building organizational and community partnerships and ACH impact on partners and systems, respectively. Interviews and small group conversations were conducted toward the end of the CACHI grant period and designed to complement the surveys. DATA COLLECTION: Survey respondents included ACH backbone agency staff and partner organization representatives (n = 141 in 2021 and 88 in 2022). Semistructured individual interviews and group conversations were conducted with 40 ACH backbone staff and partners. Documents were collected via grant reporting and directly from ACH staff. Data were analyzed descriptively and thematically. PRINCIPAL FINDINGS: ACHs appear to have supported organizational partnerships and collaboration. Seventy-six percent of survey respondents reported that their ACH had strengthened organizations' ability to work together and 65% reported developing new or deepened connections. While ACH participants reported a better understanding of community needs and priorities, progress on community relationships, and greater attention to equity and racial justice, many saw room for improvement on meaningful community engagement. Systems changes and precursors of systems change observed across ACH sites included strengthened partnerships, enhanced knowledge, increased capacity, more collaborative ways of working, and new funding streams. CONCLUSIONS: The ACH model is effective at strengthening organizational partnerships and catalyzing other systems changes and precursors including enhanced knowledge, increased capacity, more collaborative ways of working, and new funding.

Oferta de leitos exclusivos para Covid-19 no estado do Espírito Santo / Offer of exclusive beds for COVID-19 in the state of Espírito Santo

RESUMO A pandemia trouxe vários desafios a toda estrutura social, requisitando a organização e desenvolvimento de políticas públicas para conduzir o quadro sanitário. Com relação à saúde, as ações inicialmente envolveram medidas não farmacológicas e preparação do sistema de saúde. No caso do Brasil, em março de 2020 foram deliberadas portarias específicas sobre a oferta de leitos UTI Covid-19. Em abril de 2020, o estado do Espírito Santo iniciou a estruturação dos hospitais referência para Covid-19 habilitando leitos em hospitais públicos de gestão direta e indireta, e em hospitais privados e filantrópicos. Assim sendo, o objetivo deste estudo é analisar a relação de compra e oferta de leitos exclusivos para Covid-19 pela rede SUS no estado do Espírito Santo. Os dados revelam uma rede com diferentes formatos jurídicos, com forte presença de setor filantrópico, seja por Organizações Sociais de Saúde (OSS) ou hospitais. Por fim, o estudo concluiu que a condução da rede hospitalar para leitos UTI Covid-19 ocorreu pela heterogeneidade de formatos jurídicos, com a participação da gestão pública direta substituída por diferentes tipos de gestão, condicionando o estado a reafirmar as contratualizações conforme lógica do mercado.

ABSTRACT The pandemic brought several challenges to the entire social structure, demanding the organization and development of public policies to guide the health situation. With regard to health, actions so far have involved non-pharmacological measures and preparation of the health system. In the case of Brazil, in March 2020, specific ordinances were deliberated on the offer of COVID-19 ICU beds. In April 2020, the state of Espírito Santo began structuring reference hospitals for COVID-19, enabling beds in public hospitals under direct and indirect management, and in private and philanthropic hospitals. Therefore, the objective of this study is to analyze the relationship of purchase and supply of exclusive beds for COVID-19 by the SUS network in the State of Espírito Santo. The data reveal a network with different legal formats, with a strong presence of the philanthropic sector, whether by Social Health Organizations (OSS) or hospitals. Finally, the study concluded that the conduction of the hospital network for COVID-19 ICU beds occurred due to the heterogeneity of legal formats, with the participation of direct public management replaced by different types of management, conditioning the state to reaffirm the contractualizations according to market logic.

Public-private partnership in care provision for ageing-in-place: A comparative study in Guangdong, China.

OBJECTIVE: This paper investigates how the public-private partnership (PPP) functions in the care provision for older people in Guangdong, China, particularly for ageing-in-place programs. METHODS: Three cities with diversified PPP forms of care provision for older people were chosen as case studies. Focus groups were conducted in these cities for the local authorities and care homes involved in the partnerships. RESULTS: Three forms of PPP, including private sector involvement for the ownership, construction, and operation of the facilities delivering care services, were identified. The public-private co-constructed and privately run model with greater private sector involvement may lead to higher quality care in one specific program. The publicly constructed and privately run program is widely used in many cities, advancing the expansion of ageing-in-place programs in more communities. These PPPs reflect flexible and practical collaboration between the public and private sectors at the local level in the Chinese context. CONCLUSIONS: PPP have accelerated the development of a better care system for older people, mainly in terms of more affordable and higher-quality care options for the public. They are also a feasible solution for the local government due to more cost-effective and sustainable care provisions than previous publicly provided programs. The specific forms adopted are primarily associated with the scale of home care provision for ageing-in-place and the local government's financial capacity. Despite increasing private sector involvement, the public sector retains its crucial role in delivering care services targeting ageing in China.

O Fundo de Saúde e sua apropriação pelas Organizações Sociais no município de São Paulo / The Health Fund and its appropriation by Social Organizations in the municipality of São Paulo

RESUMO Discute-se o Fundo de Saúde do município de São Paulo, destacando a apropriação dos seus recursos pelo setor privado, especialmente pelas Organizações Sociais (OS). Para tanto, a primeira parte apresenta os fundamentos mais gerais do Fundo Público. A segunda parte analisa a trajetória histórica do Fundo Municipal de Saúde e a utilização de seus recursos, em grande medida, para o financiamento da atenção básica, via Programa de Saúde da Família, executado pelas OS. A terceira apresenta as características das OS, analisando a evolução da apropriação dos recursos do Fundo de Saúde entre 2011 e 2021. Percebe-se que os recursos do Fundo de Saúde passam a ser cada vez mais apropriados por essas entidades de caráter privado, apresentando uma tendência de crescimento, alcançando um patamar de 89,2% do total dos recursos em 2021. Desse modo, constata-se o movimento de mercantilização implícita, marcado pela lógica de ampliação dos mecanismos de mercado no Sistema Único de Saúde municipal.

ABSTRACT The Health Fund of the municipality of São Paulo has been discussed, highlighting the appropriation of its resources by the private sector, especially by Social Organizations (OS). To this end, the first part presents the more general foundations of the Public Fund. The second part analyzes the historical trajectory of the Municipal Health Fund and the use of its resources, to a large extent, to finance primary care, via the Family Health Program executed by the OS. The third part presents the characteristics of the OS, analyzing the evolution of the appropriation of resources of the Health Fund between 2011 and 2021. It can be seen that the Health Fund resources are increasingly appropriated by these private entities, with a growing trend, reaching a level of 89.2% of total resources in 2021. Thus, the movement of implicit mercantilization is verified, marked by the logic of expansion of market mechanisms in the municipal Unified Health System.

Incentivising public transport use for physical activity gain: process evaluation of the COVID-19 disrupted trips4health randomised controlled trial.

BACKGROUND: Partnering with a public transport (PT) provider, state government, and local government, the single-blinded randomised controlled trial, trips4health, investigated the impact of PT use incentives on transport-related physical activity (PA) in Tasmania, Australia. The intervention involved 16-weeks of incentives (bus trip credits) for achieving weekly PT use targets, supported by weekly text messages. This study objective was to conduct a process evaluation of the COVID-19 disrupted trips4health study. METHODS: The Medical Research Council UK's framework for complex public health interventions guided the process evaluation. Participant reach, acceptability, fidelity and feasibility were evaluated. Administrative and post-intervention survey data were analysed descriptively. Semi-structured interviews with intervention participants (n = 7) and PT provider staff (n = 4) were analysed thematically. RESULTS: Due to COVID-19, trips4health was placed on hold (March 2020) then stopped (May 2020) as social restrictions impacted PT use. At study cessation, 116 participants (approximately one third of target sample) had completed baseline measures, 110 were randomised, and 64 (n = 29 in the intervention group; n = 35 in the control group) completed post-intervention measures. Participants were 18 - 80 years (average 44.5 years) with females (69%) and those with tertiary education (55%) over-represented. The intervention was delivered with high fidelity with 96% of bus trip credits and 99% of behavioural text messages sent as intended. Interviewed PT staff said implementation was highly feasible. Intervention participant acceptability was high with 90% reporting bus trip incentives were helpful and 59% reporting the incentives motivated them to use PT more. From a total of 666 possible bus trip targets, 56% were met with 38% of intervention participants agreeing and 41% disagreeing that 'Meeting the bus trip targets was easy'. Interviews and open-ended survey responses from intervention participants revealed incentives motivated bus use but social (e.g., household member commitments) and systemic (e.g., bus availability) factors made meeting bus trip targets challenging. CONCLUSIONS: trips4health demonstrated good acceptability and strong fidelity and feasibility. Future intervention studies incentivising PT use will need to ensure a broader demographic is reached and include more supports to meet PT targets. TRIAL REGISTRATION: ACTRN12619001136190 .

Desafios e soluções na gestão do Núcleo de Inovação Tecnológica do Instituto Adolfo Lutz (NIT-IAL) / Challenges and solutions in the management in the Technological Innovation Center of the Adolfo Lutz Institute, NIT-IAL

O Núcleo de Inovação Tecnológica do Instituto Adolfo Lutz (NIT-IAL), foi criado em dezembro de 2013 com o objetivo de estimular a inovação dentro do instituto, bem como administrar a propriedade intelectual gerada na instituição e providenciar meios para promover a transferência de conhecimento científico, tecnológico e cultural ao setor produtivo público e privado. Após o mapeamento das áreas técnicas, foram identificados obstáculos não previstos na Lei de Inovação, os quais o NIT-IAL conseguiu superar, permitindo parcerias técnico-científicas com instituições públicas e privadas, e gerenciamento dos recursos financeiros (AU).

The Technological Innovation Center of the Adolfo Lutz Institute (NIT-IAL) was created in December 2013 with the objective of stimulating innovation within the IAL, as well as managing the intellectual property generated at the institute and providing means to promote the transfer of scientific, technological and cultural knowledge to the public and private productive sector. After mapping the technical areas, situations not covered by the Innovation Law were identified. The NIT-IAL managed to overcome these challenges and allowing technical-scientific partnerships with public and private institutions and financial resources management (AU).

Census of Brazilian social health organizations: survey and characterization

Objective: To identify and characterize the Brazilians' establishments managed by the Social Health Organizations (OSS). Methods: The identification of these establishments was carried out through primary research on four search procedures on the websites of the health departments of the states and municipalities, and consultation on the websites of the OSS and in the Survey of Basic Municipal Information of the Brazilian Institute of Geography and Statistics (IBGE) in 2018. A descriptive analysis of the establishments managed by OSS was carried out comparing with the AD according to hospital indicators. Results: The OSS are concentrated mainly in the Southeast and South of the country, with 69% of these establishments are being managed by 20 social responsibility organizations. The establishments managed by OSS are concentrated mainly in the Southeast and South of the country, with 69% of these establishments managed by 20 OSS. The characterization of the hospitals shows that the OSS has a better performance than DA; however, the difference decreases as the size increases. Larger hospitals performed better than other sizes, and this is where the highest proportion of OSS is concentrated among hospitals. Conclusion: This is the first work that surveys the OSS at the national level. This list of OSS is an important tool for planning, monitoring, and organizing the structure of service provision in public health in Brazil. The results found demonstrate the need to organize an administrative database that allows a temporal monitoring of the establishments.

Censo das organizações sociais de saúde brasileiras: levantamento e caracterização / Census of Brazilian social health organizations: survey and characterization

Objetivo: Identificar e caracterizar os estabelecimentos geridos por Organizações Sociais de Saúde (OSSs) no Brasil. Métodos: A identificação desses estabelecimentos foi realizada mediante quatro procedimentos de busca por meio de pesquisa primária nos sítios das secretarias de saúde dos estados e dos municípios e consulta nos sítios das OSS e na Pesquisa de Informações Básicas Municipais do Instituto Brasileiro de Geografia e Estatística (IBGE), em 2018. Foi realizada uma análise descritiva dos estabelecimentos geridos por OSS comparando com as Administrações Diretas (ADs) segundo indicadores hospitalares. Resultados: Os estabelecimentos geridos por OSSs estão concentrados principalmente no Sudeste e no Sul do país, e 69% desses estabelecimentos são geridos por 20 OSSs. As OSSs estão mais presentes em hospitais-dia, seguidos de prontos atendimentos e de hospitais. A caracterização dos hospitais mostrou que aqueles administrados por OSSs apresentam melhor desempenho; contudo as diferenças diminuem à medida que se aumenta o porte do serviço. Os hospitais de maior porte apresentaram melhor desempenho em relação aos demais e é onde está concentrada a maior proporção de OSSs entre os hospitais. Conclusão: Este é o primeiro trabalho que faz uma identificação das OSSs em nível nacional. Essa listagem das OSSs é um instrumento importante de planejamento, monitoramento e organização da estrutura de oferta de serviços no Sistema Único de Saúde (SUS). Os resultados encontrados demonstram a necessidade de organização de uma base de dados administrativa que permita um acompanhamento do desempenho dos estabelecimentos no tempo.

Objective: To identify and characterize the Brazilians' establishments managed by the Social Health Organizations (OSS). Methods: The identification of these establishments was carried out through primary research on four search procedures on the websites of the health departments of the states and municipalities, and consultation on the websites of the OSS and in the Survey of Basic Municipal Information of the Brazilian Institute of Geography and Statistics (IBGE) in 2018. A descriptive analysis of the establishments managed by OSS was carried out comparing with the AD according to hospital indicators. Results: The OSS are concentrated mainly in the Southeast and South of the country, with 69% of these establishments are being managed by 20 social responsibility organizations. The establishments managed by OSS are concentrated mainly in the Southeast and South of the country, with 69% of these establishments managed by 20 OSS. The characterization of the hospitals shows that the OSS has a better performance than DA; however, the difference decreases as the size increases. Larger hospitals performed better than other sizes, and this is where the highest proportion of OSS is concentrated among hospitals. Conclusion: This is the first work that surveys the OSS at the national level. This list of OSS is an important tool for planning, monitoring, and organizing the structure of service provision in public health in Brazil. The results found demonstrate the need to organize an administrative database that allows a temporal monitoring of the establishments.

Improving access to diabetes care for children: An evaluation of the changing diabetes in children project in Kenya and Bangladesh.

BACKGROUND: The changing diabetes in children (CDiC) project is a public-private partnership implemented by Novo Nordisk, to improve access to diabetes care for children with type 1 diabetes. This paper outlines the findings from an evaluation of CDiC in Bangladesh and Kenya, assessing whether CDiC has achieved its objectives in each of six core program components. RESEARCH DESIGN AND METHODS: The Rapid Assessment Protocol for Insulin Access (RAPIA) framework was used to analyze the path of insulin provision and the healthcare infrastructure in place for diagnosis and treatment of diabetes. The RAPIA facilitates a mixed-methods approach to multiple levels of data collection and systems analysis. Information is collected through questionnaires, in-depth interviews and focus group discussions, site visits, and document reviews, engaging a wide range of stakeholders (N = 127). All transcripts were analyzed thematically. RESULTS: The CDiC scheme provides a stable supply of free insulin to children in implementing facilities in Kenya and Bangladesh, and offers a comprehensive package of pediatric diabetes care. However, some elements of the CDiC program were not functioning as originally intended. Transitions away from donor funding and toward government ownership are a particular concern, as patients may incur additional treatment costs, while services offered may be reduced. Additionally, despite subsidized treatment costs, indirect costs remain a substantial barrier to care. CONCLUSION: Public-private partnerships such as the CDiC program can improve access to life-saving medicines. However, our analysis found several limitations, including concerns over the sustainability of the project in both countries. Any program reliant on external funding and delivered in a high-turnover staffing environment will be vulnerable to sustainability concerns.

"It depends:" a qualitative study on digital health academic-industry collaboration.

BACKGROUND: Academic-industry collaborations (AICs) are endorsed to alleviate challenges in digital health, but partnership experiences remain understudied. The qualitative study's objective investigated collaboration experiences between academic institutions and digital health companies. METHODS: A phenomenology methodology captured experiences of AICs, eliciting perspectives from academic researchers and industry affiliates (e.g., leadership, company investigators). Semi-structured interviews probed eligible collaborators about their experiences in digital health. Analysts coded and organized data into significant statements reaching thematic saturation. RESULTS: Participants (N=20) were interviewed from 6 academic institutions and 14 unique industry partners. Seven themes emerged: (I) Collaboration evolves with time, relationships, funding, and evidence; (II) Collaboration demands strong relationships and interpersonal dynamics; (III) Operational processes vary across collaborations; (IV) Collaboration climate and context matters; (V) Shared expectations lead to a better understanding of success; (VI) Overcoming challenges with recommendations; (VII) Collaboration may help navigate the global pandemic. CONCLUSIONS: Digital health academic industry collaboration demands strong relationships, requiring flexible mechanisms of collaboration and cultural fit. Diverse models of collaboration exist and remain dependent on contextual factors. While no collaboration conquers all challenges in digital health, AICs may serve as a facilitator for improved digital health products, thus advancing science, promoting public health, and benefiting the economy.

Transparência nas relações público-privadas para prestação de serviços de saúde no estado de São Paulo / Transparency in public-private relations for the provision of health services in the state of São Paulo / Transparencia en las relaciones público-privadas para la prestación de servicios de salud en el estado de São Paulo

Objetivos: verificar se os instrumentos e mecanismos de inclusão e transparência disponíveis ao cidadão no estado de São Paulo permitem o exercício da democracia sanitária e o controle social das metas e resultados da contratualização da prestação de serviços de saúde. Metodologia: pesquisa documental, realizada em sistemas oficiais de informação, sobre a contratualização de entidades públicas e/ou privadas para prestação de serviços públicos de saúde pelo estado de São Paulo/ e pesquisa documental em Portais da Transparência e financeiros, de âmbito estadual, para aferição de metas e resultados dessas contratações. Resultados: as iniciativas privadas complementares ao papel do Estado atuam sob nítida dependência financeira da esfera governamental. Há um déficit significativo de informações para a construção ou padronização dos dados de performance, inviabilizando a fiscalização das políticas públicas em saúde e a aferição do custo/efetividade dos serviços de saúde prestados diretamente pela Administração Pública e pelo setor privado. Conclusão: os dados encontrados na pesquisa não aferiram uma maior eficiência dessas novas formas de coalizões e alianças com a sociedade civil, em que pese o fato do Poder Público não ter capacidade de absorver diretamente toda a assistência hoje prestada por intermédio dos entes privados e do terceiro setor. A falta de instrumentos de accountability governamental ocasiona falta de transparência no controle de metas e resultados das contratualizações.

Objectives: to verify whether the instruments and mechanisms for inclusion and transparency available to citizens in the state of São Paulo allow for the exercise of sanitary democracy and social control of the goals and results of the contractualization of the provision of health services. Methods: documentary research, conducted in official information systems, on the contracting of public and/or private entities for the provision of public health services by the state of São Paulo/ and documentary research on Transparency and financial Portals, at the state level, for measurement of goals and results of these contracts. Results: private initiatives that complement the role of the State act under a clear financial dependence on the government sphere. There is a significant deficit of information for the construction or standardization of performance data, making it impossible to monitor public health policies and to measure the cost/effectiveness of health services provided directly by the Public Administration and by private sector. Conclusion: the data found in the research did not show a greater efficiency of these new forms of coalitions and alliances with civil society, even though the Government is not able to directly absorb all the assistance currently provided through private entities and the third sector. The lack of governmental accountability instruments causes a lack of transparency in the control of contractual targets and results.

Objetivos: verificar si los instrumentos y mecanismos de inclusión y transparencia a disposición de los ciudadanos en el estado de São Paulo permiten el ejercicio de la democracia sanitaria y el control social de las metas y resultados de la contratación de la prestación de servicios de salud. Metodología: investigación documental realizada en sistemas de información oficiales sobre contratos con entidades públicas y/o privadas para la prestación de servicios de salud pública en el estado de São Paulo e investigación documental en Portales de Transparencia y financieros, a nivel estatal, para medir metas y resultados de estas contrataciones. Resultados: las iniciativas privadas que complementan el rol del Estado actúan bajo una clara dependencia financiera del ámbito gubernamental. Existe un importante déficitde información capaz de conducir a la construcción o estandarización de datos de desempeño, imposibilitando el seguimiento de las políticas de salud pública y la medición del costo/efectividad entre los servicios de salud brindados directamente por la Administración Pública y los brindados por el sector privado. Conclusión: No existe evidencia científica o empírica que asegure una mayor eficiencia en estas nuevas formas de coaliciones y alianzas con la sociedad civil, a pesar de que el Gobierno no puede absorber directamente toda la asistencia que actualmente se brinda a través de las entidades privadas y del tercer sector. Además, la falta de instrumentos gubernamentales de rendición de cuentas terminaprovocando poca transparencia en el control de metas y resultados colimados en los contratos establecidos.

Management of the COVID-19 Pandemic in the Republic of Korea from the Perspective of Governance and Public-Private Partnership.

The government of the Republic of Korea (ROK) has established relevant laws and a master plan for infectious disease control and prevention based on their experiences with past epidemics. In addition, the Ministry of Health and Welfare has designed a standard manual for risk management that involves pan-governmental crisis management systems. This national infectious disease management system is constantly being supplemented and developed in face of infectious disease-related crises. In this study, we set out to present directions for infectious disease prevention and flow of management and governance between central and local governments to ensure systematic quarantine activities in the ROK. During the coronavirus disease 2019 (COVID-19) pandemic, public-private partnerships have been established to collect, provide, process, and disseminate information for effective quarantine. This has enabled the development and rapid approval of test kits, the tracking of cases, and the allocation of appropriate resources for patient treatment. Additionally, the Infectious Disease Control Agency has actively utilized information and communication technology platforms to disclose information necessary in real-time for COVID-19 quarantine and management. Overall, these efforts have played an important role in epidemiological investigations, patient management, and quarantine in the early stages of the COVID-19 pandemic.

Quality Evaluation of Health Services Using the Kano Model in Two Hospitals in Peru.

Public-private partnerships (PPP) represent an alternative model of health management focused on improving the quality of health services, particularly in emerging countries. To date, a systematic method to improve the perceived quality of health services by healthcare users in Peru has not been established. The purpose of this study was to evaluate the quality of health services in two PPP hospitals in Peru using the Kano model. A prospective cross-sectional descriptive observational study was carried out through a health service satisfaction survey using the Kano model methodology, measuring six categories of attributes. A total of 250 users of the health services were surveyed in the two PPP hospitals, located in Lima and Callao, using non-probability convenience sampling. Of the 31 attributes evaluated by the patients, 27 (81%) were classified as having a one-dimensional-type attribute, 3 (10%) were reported as mandatory, and 1 (3%) was considered as inverse. These results suggest that the presence of most of the attributes evaluated was relevant to maintaining the level of user satisfaction and that the absence of these attributes generated dissatisfaction in the users. The results showed that the users' evaluation of health services was multidimensional-namely, their evaluation was focused not only on the interaction space between the patient and medical personnel but also addressed other interaction services.

Exploring the capacity of community-based organisations to absorb health system patient referrals for unmet social needs.

This study examines the perspectives, resources, role and services provided by community-based organisations (CBOs) in response to the integration of health and social services to address individual unmet social needs, as well as the impact on organisational carrying capacity related to the ability to receive referrals from health system partners. Mixed methods combining qualitative interviews with 24 organisations and Social Network Analysis with 75 organisations were completed in 2018 in two communities (Denton, TX and Sarasota, FL) with robust examples of health and social systems alignment. Findings suggest that while community organisations are embedded in robust cross-sector networks, the potential increase in referrals from clinical settings is not something they are fully aware of, or prepared for, as evidenced by inadequate funding models, misalignment between capacity and capability, and a lack of coordination on screening and referral activities. Misalignment between clinical and CBO understanding of demand, needs and capacity present a potential risk in building strategies that integrate health and social services to address unmet social need. Failing to build a strong cross-sector screening and referral infrastructure that considers CBO capacity from the start could undermine the goal of improving population health through the integration of clinical and social care.

Avaliação da economicidade e da vantajosidade nas Parcerias para o Desenvolvimento Produtivo / Assessment of the economic savings and advantages of Productive Development Partnerships / Evaluación de la economicidad y las ventajas de las Asociaciones para el Desarrollo Productivo

A política das Parcerias para o Desenvolvimento Produtivo surgiu como uma estratégia do Governo Federal brasileiro em prol do fortalecimento do Complexo Econômico-Industrial da Saúde. Apesar de a primeira parceria datar do ano de 2009, o seu marco regulatório foi consolidado apenas em 2014, quando foram descritos oito objetivos da política. Desses, o presente artigo se propôs a avaliar especificamente o quarto objetivo: "proteger os interesses da Administração Pública e da sociedade ao buscar a economicidade e a vantajosidade, considerando-se preços, qualidade, tecnologia e benefícios sociais". Para tal, foi realizada uma avaliação dos resultados da política, por meio de uma abordagem metodológica mista, com a proposição de quatro indicadores de avaliação de resultados. Os resultados da análise quantitativa permitiram confirmar que houve redução nos custos de aquisição em 37 dos 39 medicamentos avaliados após o início da política, ao mesmo tempo em que houve aumento na quantidade adquirida em 38 dos 39 medicamentos. Por sua vez, a análise qualitativa permitiu observar uma falta de planejamento dos gestores públicos e de observância às normativas da política no que concerne ao princípio da vantajosidade. Aproximadamente 40% dos medicamentos estudados não passaram por uma avaliação de tecnologias em saúde pela Comissão Nacional de Incorporação de Tecnologias no Sistema Único de Saúde, o que gera dúvidas em relação à sua vantajosidade para a Administração Pública, que é medida pelo custo-efetividade dos medicamentos incorporados na política.

The policy for Productive Development Partnerships emerged in Brazil as a Federal Government strategy to strengthen the Health Economic-Industrial Complex. Although the first partnership dates back to 2009, the regulatory framework was only consolidated in 2014, when eight policy objectives were described. Of these, this article is intended to specifically evaluate the fourth objective: "to protect the interests of the Public Administration and society by seeking economic savings and advantage, considering prices, quality, technology, and social benefits". An assessment of the policy results was performed through a mixed methodological approach, by proposing four assessment indicators. The quantative analysis results confirmed a reduction in the purchase price for 37 of the 39 drugs assessed after the policy implementation, while there was an increase in the amounts purchased in 38 of the 39 drugs. On the other hand, the qualitative analysis revealed a lack of planning by public administrators and lack of compliance with the policy guidelines related to the principle of advantageousness. Approximately 40% of the drugs studied did not undergo a health technology assessment by the Brazilian National Commission for the Incorporation of Technologies in the Unified Health System, raising doubts with regards to the advantage for the Public Administration, which is measured by the cost-effectiveness of the drugs incorporated by the policy.

La política de las Asociaciones para el Desarrollo Productivo surgió como estrategia del Gobierno Federal brasileño a favor del fortalecimiento del Complejo Económico-Industrial de la Salud. En que pese a la primera colaboración haber ocurrido en 2009, su marco regulatorio se consolidó solamente en 2014, cuando se describieron ocho objetivos de la política. De estos, el presente artículo se propuso a evaluar específicamente el cuarto objetivo: "proteger los intereses de la Administración Pública y de la sociedad, al buscar la economicidad y sus ventajas, considerándose precios, calidad, tecnología y beneficios sociales". Para ello, se realizó una evaluación de los resultados de la política, mediante un abordaje metodológico mixto, con la propuesta de cuatro indicadores de evaluación de resultados. Los resultados del análisis cuantitativo permitieron confirmar que hubo reducción en los costes de adquisición en 37 de los 39 medicamentos evaluados tras el inicio de la política, al mismo tiempo que hubo un aumento en la cantidad adquirida en 38 de los 39 medicamentos. A su vez, el análisis cualitativo permitió observar una falta de planificación de los gestores públicos y de observancia de las normativas de la política, en lo que concierne al principio de ventajas. Aproximadamente un 40% de los medicamentos estudiados no pasaron por una evaluación de tecnologías en salud por la Comisión Nacional de Incorporación de Tecnologías en el Sistema Único de Salud, lo que genera dudas en relación a sus ventajas para la Administración Pública, que es medida por el coste-efectividad de los medicamentos incorporados en su política.

Relação entre cumprimento das metas dos contratos de gestão e qualidade da atenção à saúde: uma revisão integrativa / Relationship between goals achievement of management contracts and quality of health care: an integrative review

RESUMO Trata-se de uma revisão sistemática integrativa da literatura realizada no portal da Biblioteca Virtual em Saúde com o objetivo de compreender se existe relação entre o cumprimento de metas e a qualidade da atenção à saúde. A estratégia de busca foi construída pelos polos: metas (fenômeno); contrato de gestão (população); e qualidade (contexto). A seleção foi feita através do protocolo Prisma por dois revisores, e a análise de dados realizada na modalidade temática, com foco na relação entre o cumprimento das metas e a qualidade. Dos 22 artigos incluídos na revisão, apenas 4 respondiam diretamente ao objeto desta pesquisa. 7 temas foram alvo de discussão nos artigos revisados: metodologia dos artigos; metas e seus cumprimentos nos contratos de gestão; tipos de contratualização; ideia de qualidade; aspectos do cumprimento do contrato de gestão; metas do contrato de gestão; e, por fim, a relação entre cumprimento das metas e qualidade. A maioria dos artigos revisados encontra-se no nível 4 de qualidade das evidências disponíveis. Com as evidências encontradas, foi possível concluir que as metas dos contratos de gestão não se relacionam com a qualidade da atenção à saúde e que faltam estudos que abordem o contexto brasileiro e do Sistema Único de Saúde (SUS).

ABSTRACT This study is a systematic integrative review was carried out on the Virtual Health Library portal to understand whether there is a relationship between the achievement of goals and the quality of health care. The search strategy was built by the poles: goals (phenomenon); management contract (population); and quality (context). The selection of publications was made through the Prisma protocol by two independent reviewers, and data analysis was carried out in the thematic mode, with focus on theme of the relationship between the achievement of goals and quality. Of the 22 articles included in the review, only 4 responded directly to the object of this research. 7 themes were discussed in the reviewed articles: methodology; goals and compliance with management contracts; types of contracting; quality idea; aspects of compliance with the management contract; management contract goals; and, finally, the relationship between achievement of goals and quality. Most of the articles reviewed refer to level 4 of quality evidence. With the evidence found, it was possible to conclude that the goals of management contracts are not related to the quality of health care and that there is a lack of studies that address the Brazilian context and the Unified Health System (SUS).

Private Health Sector in India-Ready and Willing, Yet Underutilized in the Covid-19 Pandemic: A Cross-Sectional Study.

Background: The private medical sector is a resource that must be estimated for efficient inclusion into public healthcare during pandemics. Methods: A survey was conducted among private healthcare workers to ascertain their views on the potential resources that can be accessed from the private sector and methods to do the same. Results: There were 213 respondents, 80% of them being doctors. Nearly half (47.4%) felt that the contribution from the private medical sector has been suboptimal. Areas suggested for improved contributions by the private sector related to patient care (71.8%) and provision of equipment (62.4%), with fewer expectations (39.9%) on the research front. Another area of deemed support was maintaining continuity of care for non-COVID patients using virtual consultation services (77.4%), tele-consultation being the preferred option (60%). 58.2% felt that the Government had not involved the private sector adequately; and 45.1% felt they should be part of policy-making. Conclusion: A streamlined pathway to facilitate the private sector to join hands with the public sector for a national cause is the need of the hour. Through our study, we have identified gaps in the current contribution by the private sector and identified areas in which they could contribute, by their own admission.

Impact of COVID-19 Pandemic on the National PPM Tuberculosis Control Project in Korea: the Korean PPM Monitoring Database between July 2019 and June 2020.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic caused disruptions to healthcare systems and endangered the control and prevention of tuberculosis (TB). We investigated the nationwide effects of COVID-19 on the national Public-Private Mix (PPM) TB control project in Korea, using monitoring indicators from the Korean PPM monitoring database. METHODS: The Korean PPM monitoring database includes data from patients registered at PPM hospitals throughout the country. Data of six monitoring indicators for active TB cases updated between July 2019 and June 2020 were collected. The data of each cohort throughout the country and in Daegu-Gyeongbuk, Seoul Metropolitan Area, and Jeonnam-Jeonbuk were collated to provide nationwide data. The data were compared using the χ² test for trend to evaluate quarterly trends of each monitoring indicator at the national level and in the prespecified regions. RESULTS: Test coverages of sputum smear (P = 0.622) and culture (P = 0.815), drug susceptibility test (P = 0.750), and adherence rate to initial standard treatment (P = 0.901) at the national level were not significantly different during the study period. The rate of loss to follow-up among TB cases at the national level was not significantly different (P = 0.088); however, the treatment success rate among the smear-positive drug-susceptible pulmonary TB cohort at the national level significantly decreased, from 90.6% to 84.1% (P < 0.001). Treatment success rate in the Seoul metropolitan area also significantly decreased during the study period, from 89.4% to 84.5% (P = 0.006). CONCLUSION: Our study showed that initial TB management during the COVID-19 pandemic was properly administered under the PPM project in Korea. However, our study cannot confirm or conclude a decreased treatment success rate after the COVID-19 pandemic due to limited data.