O processo de monitoramento, controle e avaliação do Programa Mais Médicos no estado da Bahia / The monitoring, control and evaluation process of the Mais Médicos Program in Bahia / El proceso de seguimiento, control y evaluación del Programa Más Médicos EN EL ESTADO DE Bahía

Este artigo tem o objetivo de avaliar o processo de aprimoramento e acompanhamento das variáveis envolvidas na consolidação do Progama Mais Médicos para o Brasil (PMMB) na Bahia, bem como a gestão da informação associada aos avanços tecnológicos. A pesquisa é de natureza qualitativa e do tipo estudo de caso. Os dados pertinentes ao monitoramento e planejamento estratégico do PMMB, no estado da Bahia, foram coletados mensalmente, a partir das bases de dados do Ministério da Saúde, Ministério da Educação e municípios, para serem agrupados em uma planilha eletrônica do Microsoft Excel, por meio do recurso Power Business Intelligence (Power BI), programa que está em constante modificação, permitindo visualizar a qualquer momento as variáveis desejadas. Assim, a distribuição de médicos atuantes no PMMB, no território baiano, corrobora os estudos que apontam o crescimento do provimento de médicos, sobretudo nas regiões mais isoladas, pobres e vulneráveis. A construção dos painéis, realizada pela captação e sistematização de diferentes fontes de dados relativos à gestão do PMMB na Bahia, permitiu avaliar: a distribuição dos médicos atuantes no PMMB na Bahia, as regiões de maior concentração de médicos, a porcentagem dos municípios contemplados pelo programa, a distribuição da rede de apoio no estado da Bahia, a distribuição dos cursos de medicina no estado e as regiões que realizam teleconsultorias. Por meio desta pesquisa, foi possível concluir que o número de médicos destinados à atenção de saúde nas populações mais carentes e isoladas vem aumentando gradativamente, embora ainda seja insufuciente. Além disso, pode-se concluir que a gestão da informação associada aos avanços tecnológicos podem servir como instrumento de monitoramento e avaliação na área da saúde.

Este estudio tiene como objetivo evaluar el proceso de mejora y seguimiento de las variables involucradas en la consolidación del Programa Más Médicos (PMM) en Bahía (Brasil), así como la gestión de la información asociada a los avances tecnológicos. La investigación es de carácter cualitativo, de tipo estudio de caso. Los datos relevantes para el seguimiento y la planificación estratégica del PMM en el estado de Bahía fueron recopilados mensualmente de las bases de datos del Ministerio de Salud, del Ministerio de Educación y municipios, para ser agrupados en una hoja de cálculo de Microsoft Excel, a través del recurso Power BI que se modifica constantemente, lo que permite ver las variables en cualquier momento. Así, la distribución de los médicos que actúan en el PMM en el amplio territorio de Bahía corrobora estudios que apuntan al crecimiento de la oferta de médicos, especialmente en las regiones más aisladas, pobres y vulnerables. La construcción de los paneles, realizada a partir de la captura y sistematización de diferentes fuentes de datos, relacionados con la gestión del PMM de Bahía, permitió evaluar: la distribución de los médicos que actúan en el PMM de Bahía, las regiones con mayor concentración de médicos, el porcentaje de municipios cubiertos por el programa, la distribución de la red de apoyo en el estado de Bahía, la distribución de los cursos de medicina en el estado, y las regiones que realizan teleconsultas. Esta investigación permite concluir que el número de médicos dedicados a la atención de la salud en las poblaciones más necesitadas y aisladas ha ido aumentando paulatinamente, aunque aún es insuficiente. Además, se concluye que el manejo de la información asociada a los avances tecnológicos puede servir como una herramienta de seguimiento y evaluación en salud.

This qualitative case study evaluates the improvement and monitoring processes concerning the variables involved in the consolidation of the More Doctors Program (PMM) in Bahia, Brazil, as well as the management of information associated with technological advances. Data relevant for monitoring and strategic planning the PMM in the state were collected monthly from the Ministry of Health, Ministry of Education and municipalities databases, and then grouped in a Microsoft Excel spreadsheet using power BI, an everchanging software that allow us to view the desired variables at any time. The results on the distribution of PMM doctors in the broad territory of Bahia corroborate studies that point to an increased supply of physicians, especially in more isolated, poorer and vulnerable regions. The panels developed by capturing and systematizing different data sources regarding PMM management in Bahia allowed to evaluate: the distribution of PMM doctors in the state, the regions with the highest concentration, the percentage of municipalities covered by the program, the distribution of the support network within the state, the distribution of medical undergraduate programs in the state; the regions that offer teleconsultations. In conclusion, the number of physicians offering health care to the poorest and most isolated populations has been increasing gradually, but remains insufficient. Moreover, the management of information associated with technological advances can serve as a monitoring and evaluation instrument in health care.

Pre-emption strategies to block taxes on sugar-sweetened beverages: A framing analysis of Facebook advertising in support of Washington state initiative-1634.

ABSTRACTIn 2018, the sugar-sweetened beverage (SSB) industry introduced a ballot measure (I-1634) in Washington State of the United States to prevent further local taxes on groceries. The measure, which passed, is emblematic of new pre-emptive legislative strategies by the SSB industry to block soda taxes and conceal those strategies under the guise of preventing burdensome 'grocery taxes'. This paper uses qualitative framing analysis to examine a public archive of 1218 Facebook advertisements to understand how I-1634 proponents shaped public discourse and engaged in misinformation efforts online during the lead up to the passage of I-1634. Coding strategies identified 7 compelling and inter-related framing strategies used by the campaign. These included strategies that misinformed the public about the threat of grocery taxation and the economic impacts it would have on the region. Strategies to conceal the true intent of the ballot measure and the sponsors of the campaign were aided by Facebook's advertising platform, which does not moderate misinformation in advertising and allows advertisers to conceal their sponsors. We urge public health researchers and advocates to pay more attention to how Facebook and other social media platforms can be used by industries to target voters, misinform publics, and misconstrue industry support.

Health Technology Assessment: informed by science or in the service of politics? / Avaliação de Tecnologias em Saúde: informada pela ciência ou a serviço da política?

ABSTRACT The youth of Health Technology Assessment (HTA), as an institutional policy at the national level, signals the need to reflect on how its implementation took place under the perspective of its insertion in health policy and the scientific field. At the end of its first decade, these questions arise: has HTA translated into a health policy informed by science? Has its scientific foundation been used in the service of politics? To understand this political process, we apply the multiple-streams framework formulated by John Kingdon. The use of science to inform policy and the political use of science present themselves in an unstable balance. The survival of this policy will depend not only on science but on the art of orchestrating the interests of various agents so that HTA becomes a health policy for strengthening and sustainability of SUS.

RESUMO A juventude da Avaliação de Tecnologias em Saúde (ATS), enquanto política institucional no âmbito nacional, sinaliza a necessidade de uma reflexão sobre como se deu sua implementação, sob as perspectivas de sua inserção na política de saúde e do campo científico. Ao final de sua primeira década, levantam-se as perguntas: a ATS se traduziu em uma política de saúde (policy) informada pela ciência? Sua fundamentação científica foi usada a serviço da política (politics)? Para compreender esse processo político, aplicamos a teoria de múltiplos fluxos formulada por John Kingdon. Estabeleceu-se um equilíbrio instável entre o uso da ciência para informar a política e o uso político da ciência. A sobrevivência dessa política dependerá não só da ciência, mas da arte de orquestrar os interesses dos vários agentes, de forma que a ATS se torne uma política de saúde de fortalecimento e sustentabilidade do SUS.

Crowdfunding and global health disparities: an exploratory conceptual and empirical analysis.

BACKGROUND: The use of crowdfunding platforms to cover the costs of healthcare is growing rapidly within low-, middle-, and high-income countries as a new funding modality in global health. The popularity of such "medical crowdfunding" is fueled by health disparities and gaps in health coverage and social safety-net systems. Crowdfunding in its current manifestations can be seen as an antithesis to universal health coverage. But research on medical crowdfunding, particularly in global health contexts, has been sparse, and accessing robust data is difficult. To map and document how medical crowdfunding is shaped by, and shapes, health disparities, this article offers an exploratory conceptual and empirical analysis of medical crowdfunding platforms and practices around the world. Data are drawn from a mixed-methods analysis of medical crowdfunding campaigns, as well as an ongoing ethnographic study of crowdfunding platforms and the people who use them. RESULTS: Drawing on empirical data and case examples, this article describes three main ways that crowdfunding is impacting health equity and health politics around the world: 1) as a technological determinant of health, wherein data ownership, algorithms and platform politics influence health inequities; 2) as a commercial determinant of health, wherein corporate influence reshapes healthcare markets and health data; 3) and as a determinant of health politics, affecting how citizens view health rights and the future of health coverage. CONCLUSIONS: Rather than viewing crowdfunding as a social media fad or a purely beneficial technology, researchers and publics must recognize it as a complex innovation that is reshaping health systems, influencing health disparities, and shifting political norms, even as it introduces new ways of connecting and caring for those in the midst of health crises. More analysis, and better access to data, is needed to inform policy and address crowdfunding as a source of health disparities.