Capacity building in human resources for health: The experience of the region of the Americas.

SETTING: Since the year 2003, most countries of the Region of the Americas have experienced sustained economic growth and inclusive development policies. In the health sector, achieving universal access became the overarching goal. However, the structural limitations of the health workforce represented a formidable obstacle to change. National Health Authorities were confronted with the challenge of developing critical capacities to redress entrenched inequalities in access to qualified health personnel. INTERVENTION: Under the auspices of the Pan American Health Organization, the Ministers of Health of the Region adopted, in September 2007, twenty regional goals for Human Resources for Health 2007-2015, aligned with the renewed strategy of Primary Health Care. Subsequently, a set of indicators and a methodology were developed to assess the goals and to monitor progress at the country level. OUTCOMES: Fifteen countries carried out a baseline assessment in 2009 or 2010 and conducted a second assessment in 2013. Although differences were noted across goals and between countries, the results suggested improvements in all twenty goals overall. The goals linked to the distribution of personnel, the management of migration, and the cooperation with education institutions appeared to be more resilient to change. IMPLICATIONS: The twenty Regional Goals for Human Resources for Health provided a common vision for action and a framework for cooperation within and among countries, and was a catalyst for change. Faced with evolving challenges, the countries should consider adopting a new shared agenda that builds on progress made and further supports intergovernmental policy alignment and capacity building in health workforce development, governance and management.

Assessment of human resources for health programme implementation in 15 Latin American and Caribbean countries.

BACKGROUND: The health systems in the Americas region are characterized by fragmentation and segmentation, which constitute an important barrier to expanding coverage, achieving integrated primary health care, and reducing inefficiency and discontinuity of care. An assessment of the human resources for health (HRH) programmes that have been implemented at the country level was developed as part of the measurement of the 20 HRH regional goals for 2007-2015, adopted in 2007 by the Pan American Sanitary Conference (CSPA). METHODS: The exercise was a combination of academic research and the development/application of an advocacy tool involving policy makers and stakeholders to influence the decision-making in the development, implementation, or change of HRH programmes while building evidence through a structured approach based on qualitative and quantitative information and the exchange and dissemination of best practices. RESULTS: This paper covers the methodological challenges, as well as a summary of the main findings of the study, which included 15 countries: Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua and Panama in the Central America, Dominican Republic in the Caribbean, Chile, Colombia, Ecuador and Peru in the Andean sub region, and Argentina, Paraguay, and Uruguay in the South Cone. Despite the different contexts, the results showed that the programmes evaluated faced common challenges, such as lack of political support and financial unsustainability. CONCLUSIONS: The evaluation process allowed the exchange and dissemination of practices, interventions, and programmes currently running in the region. A shared lesson was the importance of careful planning of the implementation of programmes and interventions. The similarities in the problems and challenges of HRH among the participating countries highlighted the need for a cooperation programme on the evaluation and assessment of implementation strategies in the Americas region.

[Core competencies in public health: a regional framework for the Americas]. / Competencias esenciales en salud pública: un marco regional para las Américas.

The response is described to the 2010 call from the Pan American Health Organization to develop a Regional Framework on Core Competencies in Public Health, with a view to supporting the efforts of the countries in the Americas to build public health systems capacity as a strategy for optimal performance of the Essential Public Health Functions. The methodological process for the response was divided into four phases. In the first, a team of experts was convened who defined the methodology to be used during a workshop at the National Institute of Public Health of Mexico in 2010. The second phase involved formation of the working groups, using two criteria: experience and multidisciplinary membership, which resulted in a regional team with 225 members from 12 countries. This team prepared an initial proposal with 88 competencies. In the third phase, the competencies were cross-validated and their number reduced to 64. During the fourth phase, which included two workshops, in March 2011 (Medellín, Colombia) and June 2011 (Lima, Peru), discussions centered on analyzing the association between the results and the methodology.

Competencias esenciales en salud pública: un marco regional para las Américas / Core competencies in public health: a regional framework for the Americas

Se describe la respuesta a un llamado de la Organización Panamericana de la Salud, realizado en 2010, para conformar el Marco Regional de Competencias Esenciales en Salud Pública, con el propósito de apoyar a los Estados de las Américas en sus esfuerzos por fortalecer las capacidades de sus sistemas de salud pública, en tanto estrategia para el desempeño óptimo de las Funciones Esenciales de Salud Pública. El proceso metodológico de dicha respuesta se dividió en cuatro fases. En la primera se convocó a un equipo de expertos que definieron la metodología a seguir durante un taller en el Instituto Nacional de Salud Pública de México en 2010. La segunda fase fue la constitución de grupos de trabajo, utilizando dos criterios: experiencia y composición multidisciplinaria, lo cual derivó en un equipo regional con 225 integrantes de 12 países. Estos equipos elaboraron una propuesta inicial de 88 competencias. En la tercera fase se realizó una validación cruzada de las competencias, cuyo número se redujo a 64. Durante la cuarta fase, que incluyó dos talleres en marzo (Medellín, Colombia) y junio (Lima, Perú) de 2011, las discusiones se centraron en analizar la correspondencia de los resultados con la metodología.

The response is described to the 2010 call from the Pan American Health Organization to develop a Regional Framework on Core Competencies in Public Health, with a view to supporting the efforts of the countries in the Americas to build public health systems capacity as a strategy for optimal performance of the Essential Public Health Functions. The methodological process for the response was divided into four phases. In the first, a team of experts was convened who defined the methodology to be used during a workshop at the National Institute of Public Health of Mexico in 2010. The second phase involved formation of the working groups, using two criteria: experience and multidisciplinary membership, which resulted in a regional team with 225 members from 12 countries. This team prepared an initial proposal with 88 competencies. In the third phase, the competencies were cross-validated and their number reduced to 64. During the fourth phase, which included two workshops, in March 2011 (Medellín, Colombia) and June 2011 (Lima, Peru), discussions centered on analyzing the association between the results and the methodology.

Propuesta de agenda para las instituciones de educación en salud pública y marco de referencia para la cooperación técnica / Proposed agenda for public health education institutions and techinal cooperation framework

El presente documento intenta contribuir a la construcción colectiva de objetivos y estrategias tendientes a promover la agenda de salud en los ámbitos relevantes por parte de las instituciones de formación y de capacitación en salud pública de la región de las Américas. La propuesta contempla dos objetivos principales. En primer lugar, sugiere a las instituciones de educación lineamientos generales para que actúen útilmente en el análisis de su situación actual y para que formulen una respuestas cohorente con los desafíos globales y locales en salud. Y en segundo lugar, se espera que los mismos sirvan como marco de referencia para facilitar la optimización del potencial de la cooperación interinstitucional e internacional en el logro de objetivos compartidos

Salud internacional: el nuevo desafío para la educación de enfermería / International health: a new challenge to nursing education

Para identificar las actividades de salud internacional (SI) en escuelas de enfermería y analizarlas en forma preliminar, se utilizó una muestra de 110 escuelas norteamericanas y, paralelamente, se enviaron cuestionarios a 4 escuelas latinoamericanas y a una del Caribe (ALC). Parte significativa de las escuelas norteamericanas y todas las 5 escuelas de ALC tienen actividades de salud internacional. Dicho interés es básicamente un fenómeno de los últimos cinco a dez años. Hubo diferencias en la estructura de las actividades de SI entre las escuelas, pero el tipo de apoyo ofrecido para actividades internacionales era similar, tanto en los EEUU como en ALC. El componente de SI el en currículo de las escuelas norteamericanas estaba dentro de cursos sobre cultura...