[Factors influencing Central America's civil society organization's capacity to provide AIDS related care]. / Contexto de las organizaciones civiles centroamericanas en la atención al sida en poblaciones móviles.

OBJECTIVE: To analyze the capacities of Central American civil society organizations (CSOs) to implement HIV prevention and care strategies in mobile groups within the HIV Mesoamerican Project. MATERIALS AND METHODS: During the year 2008, 14 key actors of nine Central American civil society organizations participating in the Mesoamerican Project were interviewed. The information collected was systematized using Atlas-TI software, and content analysis was performed according to its categories and dimensions. RESULTS: These items were a contribution to capacity: the previous work of CSOs allowed the sensibilization of population and authorities to STD-HIV and to the implemented program; the coordination with government and other involved actors. LIMITATIONS: a good but informal coordination with the government; the worsening economic situation reduced available resources; attended communities are isolated and unsecure. CONCLUSION: To improve the capacities of CSOs in developing this type of project, it is recommended: that an initial community diagnosis be performed in order to better adapt the proposed interventions; to improve administrative efficiency; to formalize collaborative links with the government; and to seek counseling in the development of HIV prevention strategies that consider population mobility.

Contexto de las organizaciones civiles centroamericanas en la atención al sida en poblaciones móviles / Factors influencing Central America's civil society organization's capacity to provide AIDS related care

OBJETIVO: Analizar los factores contextuales que influyen en la capacidad de las organizaciones de la sociedad civil (OSC) centroamericanas en acciones de prevención y atención al síndrome de inmunodeficiencia adquirida (sida) en poblaciones móviles (PM). MATERIAL Y MÉTODOS: En 2008 se realizaron 14 entrevistas a directivos y operativos de nueve OSC centro-americanas que participaron en el Proyecto Mesoamericano. La información se sistematizó con el software Atlas-TI, y el tipo de análisis fue de contenido de acuerdo con categorías y dimensiones. RESULTADOS: Contribuyeron a la capacidad: el trabajo previo de las OSC, que consiguió la sensibilización de población y autoridades acerca de las infecciones de transmisión sexual y del virus de inmunodeficiencia humana (ITS-VIH). Contribuyeron con el programa: la coordinación con el Gobierno y con otros actores. Como limitantes se encontraron que la relación con el Gobierno es buena pero informal, que el deterioro económico ha limitado recursos y que las comunidades atendidas son aisladas e inseguras. CONCLUSIONES: Para mejorar la capacidad de las OSC se recomienda realizar un diagnóstico inicial de las comunidades; mayor eficiencia administrativa para mejorar el uso de sus recursos; ampliar las acciones de sensibilización hacia los gobiernos en la importancia de trabajar en la prevención del VIH en PM y formalizar los vínculos de colaboración con los mismos.

OBJECTIVE: To analyze the capacities of Central American civil society organizations (CSOs) to implement HIV prevention and care strategies in mobile groups within the HIV Mesoamerican Project. MATERIALS AND METHODS: During the year 2008, 14 key actors of nine Central American civil society organizations participating in the Mesoamerican Project were interviewed. The information collected was systematized using Atlas-TI software, and content analysis was performed according to its categories and dimensions. RESULTS: These items were a contribution to capacity: the previous work of CSOs allowed the sensibilization of population and authorities to STD-HIV and to the implemented program; the coordination with government and other involved actors. Limitations: a good but informal coordination with the government; the worsening economic situation reduced available resources; attended communities are isolated and unsecure. CONCLUSION: To improve the capacities of CSOs in developing this type of project, it is recommended: that an initial community diagnosis be performed in order to better adapt the proposed interventions; to improve administrative efficiency; to formalize collaborative links with the government; and to seek counseling in the development of HIV prevention strategies that consider population mobility.

La capacidad de las Organizaciones de la Sociedad Civil para mejorar la calidad de vida de los adultos mayores: un estudio cualitativo en zonas urbanas empobrecidas de México / The capacity of Civil Society Organizations to improve the quality of life of the elderly: a qualitative study in impoverished urban areas of Mexico

Recientemente en México se ha incrementado la proporción de adultos mayores (AM) y de Organizaciones de la Sociedad Civil (OSC) que ayudan a los pobres. Nuestro objetivo fue analizar la capacidad que tienen las OSC de implementar acciones para mejorar la calidad de vida de los AM pobres de zonas urbanas. En 2005 se realizaron 14 entrevistas al personal de diez OSC que trabajaban en colonias pobres de cuatro ciudades de México. La guía de entrevista y el análisis se basaron en la estructura interna y el contexto externo que afecta la capacidad de las OSC. Entre los principales logros se destacan una mayor participación y autogestión de la gente y el número de acciones realizadas para mejorar la calidad de vida de las personas. Los principales obstáculos identificados son una demanda poblacional que supera la capacidad de respuesta de las OSC, una población objetivo que generalmente no son los AM y un financiamiento insuficiente. La atención proporcionada por las OSC a los AM, aunque trascendental, es escasa, por tanto es necesario promover una cultura de prevención e interés en los AM y de apoyo a las OSC.

Recently, the proportion of elderly people (EP) has increased considerably in Mexico, as well as the number of Civil Society Organizations (CSOs) dedicated to helping poor people. Our objective was to analyze the capacity of the CSOs to implement actions in order to improve the quality of life of the poor EP in urban areas. In 2005, fourteen interviews were conducted with personnel of ten CSOs who worked in poor zones of four Mexican cities. The interview guide and the analysis were based on the internal structure and the external context that affect CSO's capacity. Within the main achievements, we identified an the increase in the participation and self-management of people and in the number of actions carried out in order to improve quality of people's life. The main obstacles identified were: the CSOs responsiveness, which is always lower than the population demands; their target population is not only EP; and insufficient financing. The attention provided by CSOs to EP is scarce, but essential. It is necessary to promote a culture of prevention and interest in the EP, and support to CSOs.

[Equity and fairness in the Mexican health system reform]. / La equidad y la imparcialidad en la reforma del sistema mexicano de salud.

OBJECTIVE: To assess the equity and fairness of the Mexican health system reform that occurred in the late 1990's. MATERIAL AND METHODS: The Mexican reform process was evaluated using the benchmark-system designed by Daniels et al. This benchmark system was adapted to the Mexican setting by adding specific indicators. A documentary review of the Mexican reform process was conducted to score its performance for each benchmark. RESULTS: Except for housing and nutrition components, the reform included few actions related to health determinants. For health care, the main reform initiatives were those related to extending the coverage of essential health services and decentralizing health care provision to the states. Reform initiatives included few activities related to fair financing, tiering, emphasis on second and third level care, accountability, and transparency. CONCLUSIONS: The late nineties reform of the Mexican health system had some positive effect on access of the poor to health care and administrative efficiency, but little impact on fair financing, quality of care, and democratic governance. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

La equidad y la imparcialidad en la reforma del sistema mexicano de salud / Equity and fairness in the Mexican health system reform

OBJETIVO: Evaluar el impacto de la reforma de finales de la década de 1990 en la equidad e imparcialidad del sistema mexicano de salud. MATERIAL Y MÉTODOS: Para evaluar el impacto de esta reforma se utilizó un sistema de parámetros diseñado por Daniels y colaboradores que se adaptó a la realidad mexicana y al que se adicionaron indicadores específicos. Se hizo, finalmente, una revisión documental de la reforma para calificar su desempeño en cada uno de estos parámetros. RESULTADOS: Excepto por las intervenciones en vivienda y nutricias, la reforma mostró poca preocupación por los determinantes de las condiciones de salud. En relación con la atención a la salud, las principales iniciativas de reforma tuvieron que ver con la ampliación de la cobertura de servicios esenciales y con la descentralización de los servicios de salud. Las actividades relacionadas con la justicia del financiamiento, la fragmentación del sistema, el énfasis en la atención curativa especializada, la rendición de cuentas y la transparencia fueron escasas. CONCLUSIONES: La reforma del sistema mexicano de salud de la segunda mitad de la década de 1990 tuvo cierto impacto sobre el acceso de los pobres a la atención a la salud y la eficiencia administrativa, pero un efecto mínimo sobre la justicia del financiamiento y el gobierno democrático.

Evaluation of breast sensibility using dermatomal somatosensory evoked potentials.

This study was undertaken to prospectively evaluate breast sensibility before and after reduction mammaplasty with a new, objective, and quantitative neurophysiologic method based on the anatomic knowledge of breast innervation and the congruent areas of dermatomal maps. An innovative application of dermatomal somatosensory evoked potentials was used to study the breast regions of 42 healthy women, bilaterally. The areas stimulated in each breast were the superior quadrant, the nipple-areola complex and the medial and lateral quadrants, and the inferior quadrant; these areas correspond to T3, T4, and T5 dermatomes, respectively, following the accepted concepts of segmentary innervation of the skin. The two groups of 21 patients each were formed according to breast size: group I comprised small-breasted, unoperated controls (brassiere cup size A or B); group II comprised macromastia patients (brassiere cup size C or greater) who presented to a general plastic surgery department for breast reduction surgery. First the authors established the normal range of latency and amplitude in the dermatomal somatosensory evoked potentials for the five areas stimulated in patients with small breasts and compared these parameters with those obtained from patients with macromastia. Then, after the macromastia patients underwent reduction mammaplasty using the McKissock technique, the authors compared the postoperative sensory values with their own preoperative values and with those from the small-breasted group. Using dermatomal somatosensory evoked potentials, they found that small breasts were statistically more sensitive than large breasts, which concurs with studies in the literature that use other methods to evaluate breast sensibility. They also found that after breast reduction, the macromastia patients presented statistically significant improvement in breast sensibility in relation to their own preoperative latency and amplitude values, with no statistical difference in amplitude with respect to the small-breasted group; this finding suggests that after breast reduction, sensibility similar to that of the small-breasted group can be considered a possibility. Furthermore, in comparisons of each of the five areas stimulated, there was no significant difference in values within the small-breasted group or within the macromastia group before or after surgery; this supports a possible overlap between adjacent dermatomes. This innovative application of dermatomal somatosensory evoked potentials is an objective, quantitative, and noninvasive method that has allowed the authors to evaluate breast sensibility and to compare postsurgical sensory outcomes.

The feasibility of government partnerships with NGOs in the reproductive health field in Mexico.

In 1995 the Mexican government began to develop policies on establishing collaborative agreements with civil society organisations, and there is currently interest in Mexico in government and NGOs working together. This paper analyses whether the conditions exist in Mexico for successful partnerships between the public sector and NGOs in the reproductive health field. In-depth interviews were carried out with key informants in the public sector at national and state level and the NGO sector in six states in Mexico. Partnerships were found to be an option for the provision of reproductive health services in geographical areas where the population is under-served, and for services the government does not provide. While the contribution of NGOs to the reproductive health field is recognised, at least at federal level, there are still very few public agencies that collaborate with NGOs, and agreements are often limited to short-term financing of projects. The future of NGOs in Mexico will depend largely on their ability to obtain funding from within the country. More effective mechanisms are needed by government to generate resources for health care. Government must recognise the specific contribution of NGOs, including inputs of social capital and creation of community networks, and must share decision-making more equitably with NGO for partnerships to succeed.

Costos de calidad de la prueba de detección oportuna de cáncer cervicouterino en una clínica pública y en una organización no gubernamental / Comparison of cervical cancer screening program costs and quality of care between a public clinic and a non governmental organization

Objetivo. Comparar los costos y la calidad de la prueba de detección oportuna del cáncer cervicouterino, entre una clínica pública y una organización no gubernamental (ONG). Material y métodos. Se trata de un estudio de abordaje cuantitativo y cualitativo hecho en dos establecimientos asistenciales de la ciudad de Cuernavaca, Morelos, entre abril y julio de 1999. Mediante un estudio transversal se comparó el costo del proceso de producción de la prueba, desagregado en cuatro componentes, y para la evaluación de la calidad se utilizó el marco conceptual estructurado por Bruce, que incluye la percepción de las usuarias -acerca de la información recibida y el tiempo de espera- y de los proveedores -disponibilidad de espacio y de equipo-. Resultados. Los costos totales del proceso de producción completo de la clínica pública (144 pesos) fueron 26 por ciento más altos que los costos de la ONG (114 pesos). Por lo que se refiere a la calidad, las usuarias de la ONG informaron una mayor satisfacción con los servicios recibidos. La inconformidad de las mujeres que se realizaron la prueba en la clínica pública se relacionó con el tiempo de espera para la toma de la muestra y para la entrega de los resultados. Conclusiones. Las diferencias en los costos y los indicadores de calidad de la atención entre ambos proveedores sugieren que las ONG deben contemplarse como una al ternativa para ofrecer servicios de detección oportuna de cáncer cervicouterino. El texto completo en inglés de este artículo está disponible en: http://www.insp.mx/salud/index.html