[Patient- and provider-related factors in the success of multidrug tuberculosis treatment in ColombiaFatores de êxito do tratamento da tuberculose multirresistente relacionados com o paciente e com a equipe de saúde na Colômbia]. / Factores de éxito del tratamiento de la tuberculosis multidrogorresistente relacionados con el paciente y el personal sanitario en Colombia.

OBJECTIVE: To identify patient- and provider-related factors associated with the success of multidrug-resistant tuberculosis (MDR-TB) treatment in the six municipalities of Colombia with the highest number of MDR-TB cases. METHODS: Bivariate and multivariate logistic regressions were used to analyze the association between treatment success (cure or treatment completion) and characteristics of the patients and physicians, nursing professionals, and psychologists involved in their treatment. The importance of knowledge in the management of MDR-TB cases was explored through focus groups with these providers. RESULTS: Of 128 cases of TB-MDR, 63 (49.2%) experienced treatment success. Only 52.9% of the physicians and nursing professionals had satisfactory knowledge about MDR-TB. Logistic regression showed that being HIV negative, being affiliated with the contributory health insurance scheme, being cared for by a male physician, and being cared for by nursing professionals with sufficient knowledge were associated with a successful treatment outcome (p ≤ 0.05). Qualitative analysis showed the need for in-depth, systematic training of health personnel who care for patients with MDR-TB. CONCLUSIONS: Some characteristics of patients and healthcare providers influence treatment success in MDR-TB cases. Physicians' and nurses' knowledge about MDR-TB must be improved, and follow-up of MDR-TB patients who are living with HIV and of those affiliated with the subsidized health insurance scheme in Colombia must be strengthened, as these patients have a lower likelihood of a successful treatment outcome.

OBJETIVO: Identificar os fatores associados ao êxito do tratamento da tuberculose multirresistente (TBMR) relacionados ao paciente e à equipe de saúde nos seis municípios da Colômbia com o maior número de casos. MÉTODOS: Mediante regressão logística bifatorial e multifatorial, analisou-se a associação entre o êxito do tratamento (cura ou completude do tratamento) e as características dos pacientes e dos médicos, profissionais de enfermagem e psicólogos envolvidos neste. Explorou-se a importância do conhecimento no manejo de casos de TBMR mediante grupos focais com os mesmos profissionais. RESULTADOS: Dos 128 casos de TBMR, 63 (49.2%) lograram êxito no tratamento. Somente 52.9% dos médicos e profissionais de enfermagem tinham conhecimentos satisfatórios sobre TBMR. A regressão logística demonstrou que soronegatividade para o HIV, cobertura pelo sistema de saúde sob o regime de contribuinte, atendimento por um médico do sexo masculino e atendimento por profissionais de enfermagem com conhecimento suficiente foram fatores associados ao êxito do tratamento (p ≤ 0,05). A análise qualitativa demonstrou necessidade de aprofundar e sistematizar a capacitação do pessoal de saúde que atende casos de TBMR. CONCLUSÕES: Algumas características do paciente e da equipe de saúde influenciam no êxito do tratamento de casos de TBMR. É preciso fortalecer os conhecimentos dos médicos e profissionais de enfermagem sobre a TBMR e reforçar o seguimento dos pacientes com TBMR que vivem com HIV e os filiados ao sistema de saúde colombiano pelo regime subsidiado, os quais têm menor probabilidade de êxito do tratamento.

Correction to: Gender inequality in the health workforce in the midst of achieving universal health coverage in Mexico.

An amendment to this paper has been published and can be accessed via the original article.

Gender inequality in the health workforce in the midst of achieving universal health coverage in Mexico.

BACKGROUND: The third Sustainable Development Goal aims to ensure healthy lives and to promote well-being for all at all ages. The health system plays a key role in achieving these goals and must have sufficient human resources in order to provide care to the population according to their needs and expectations. METHODS: This paper explores the issues of unemployment, underemployment, and labor wastage in physicians and nurses in Mexico, all of which serve as barriers to achieving universal health coverage. We conducted a descriptive, observational, and longitudinal study to analyze the rates of employment, underemployment, unemployment, and labor wastage during the period 2005-2017 by gender. We used data from the National Occupation and Employment Survey. Calculating the average annual rates (AAR) for the period, we describe trends of the calculated rates. In addition, for 2017, we calculated health workforce densities for each of the 32 Mexican states and estimated the gaps with respect to the threshold of 4.45 health workers per 1000 inhabitants, as proposed in the Global Strategy on Human Resources for Health. RESULTS: The AAR of employed female physicians was lower than men, and the AARs of qualitative underemployment, unemployment, and labor wastage for female physicians are higher than those of men. Female nurses, however, had a higher AAR in employment than male nurses and a lower AAR of qualitative underemployment and unemployment rates. Both female physicians and nurses showed a higher AAR in labor wastage rates than men. The density of health workers per 1000 inhabitants employed in the health sector was 4.20, and the estimated deficit of workers needed to match the threshold proposed in the Global Strategy is 70 161 workers distributed among the 16 states that do not reach the threshold. CONCLUSIONS: We provide evidence of the existence of gender gaps among physicians and nurses in the labor market with evident disadvantages for female physicians, particularly in labor wastage. In addition, our results suggest that the lack of physicians and nurses working in the health sector contributes to the inability to reach the health worker density threshold proposed by the Global Strategy.

The gap in human resources to deliver the guaranteed package of prevention and health promotion services at urban and rural primary care facilities in Mexico.

BACKGROUND: The purpose of this study was to estimate the gap between the available and the ideal supply of human resources (physicians, nurses, and health promoters) to deliver the guaranteed package of prevention and health promotion services at urban and rural primary care facilities in Mexico. METHODS: We conducted a cross-sectional observational study using a convenience sample. We selected 20 primary health facilities in urban and rural areas in 10 states of Mexico. We calculated the available and the ideal supply of human resources in these facilities using estimates of time available, used, and required to deliver health prevention and promotion services. We performed descriptive statistics and bivariate hypothesis testing using Wilcoxon and Friedman tests. Finally, we conducted a sensitivity analysis to test whether the non-normal distribution of our time variables biased estimation of available and ideal supply of human resources. RESULTS: The comparison between available and ideal supply for urban and rural primary health care facilities reveals a low supply of physicians. On average, primary health care facilities are lacking five physicians when they were estimated with time used and nine if they were estimated with time required (P < 0.05). No difference was observed between available and ideal supply of nurses in either urban or rural primary health care facilities. There is a shortage of health promoters in urban primary health facilities (P < 0.05). CONCLUSION: The available supply of physicians and health promoters is lower than the ideal supply to deliver the guaranteed package of prevention and health promotion services. Policies must address the level and distribution of human resources in primary health facilities.

[Contributions of training to the promotion of health in State Health Services: comparative analysis in eight states in Mexico]. / Aportes de la capacitación a la promoción de la salud en los Servicios Estatales de Salud: análisis comparativo en ocho estados de México.

OBJECTIVE: To evaluate the results of the training provided by the National Public Health Institute (INSP per its abbreviation in Spanish) in health promotion to institutional staff of local health services during 2007 and 2008. MATERIALS AND METHODS: A non -experimental evaluative research with comparison group was conducted, in which quantitative and qualitative methods were used. RESULTS: In states intervened a better conceptualization of health promotion, social participation and components of the Health Promotion Operating Model was observed; participatory action research was the basic strategy to work in the community and management showed a tendency to be more participatory and inclusive. CONCLUSION: A better conceptualization of health promotion has allowed health personnel develop more sustainable work processes in the community and has driven the search for consent and participatory management.

Aportes de la capacitación a la promoción de la salud en los Servicios Estatales de Salud: análisis comparativo en ocho estados de México / Contributions of training to the promotion of health in State Health Services: comparative analysis in eight states in Mexico

OBJETIVO: Evaluar los resultados de la capacitación impartida por el Instituto Nacional de Salud Pública en promoción de la salud al personal institucional de los Servicios Estatales de Salud durante el periodo 2007 y 2008. MATERIAL Y MÉTODOS: Se realizó una investigación evaluativa no experimental con grupo de comparación y se combinaron métodos cuantitativos y cualitativos. RESULTADOS: En los estados intervenidos se observó mejor conceptualización de promoción de la salud, participación social y componentes del Modelo Operativo de Promoción de la Salud; la Investigación y Acción Participativa fue la estrategia básica de implementación del trabajo de promoción de la salud en comunidad y la gestión presentó una tendencia a ser más participativa e inclusiva. CONCLUSIÓN: La capacitación ha permitido fortalecer en el personal de salud las competencias para la promoción de la salud y el desarrollo de procesos de trabajo más sostenibles en la comunidad impulsando procesos de gestión concertados y participativos.

OBJECTIVE: To evaluate the results of the training provided by the National Public Health Institute (INSP per its abbreviation in Spanish) in health promotion to institutional staff of local health services during 2007 and 2008. MATERIALS AND METHODS: A non -experimental evaluative research with comparison group was conducted, in which quantitative and qualitative methods were used. RESULTS: In states intervened a better conceptualization of health promotion, social participation and components of the Health Promotion Operating Model was observed; participatory action research was the basic strategy to work in the community and management showed a tendency to be more participatory and inclusive. CONCLUSION: A better conceptualization of health promotion has allowed health personnel develop more sustainable work processes in the community and has driven the search for consent and participatory management.