Sistema de saúde em um contexto de crise humanitária: o caso do Haiti / Health System in a context of humanitarian crisis: the case of Haiti

Resumo O objetivo desta pesquisa é analisar a organização do sistema de saúde do Haiti, entre 2010 e 2020, com base no Postulado de Coerência proposto por Mário Testa. O estudo utilizou fontes públicas que foram compiladas e codificadas com auxílio do software QSR NVivo 10.0.641.0, para posterior análise crítica de conteúdo. Os resultados revelaram que o manejo de infecções sexualmente transmissíveis (IST) constituía a maior oferta de serviços, porém de forma fragmentada, sendo que as principais causas de morbimortalidade eram as doenças isquêmicas do coração e demais doenças cardiovasculares, devido a uma transição epidemiológica não identificada como problema prioritário no país. Destaca-se que a eletricidade irregular, a falta de equipamentos para fornecer água e instalações sanitárias, nas instituições de saúde, despontaram como questões estruturais a serem enfrentadas. Identificou-se que doadores contribuíram com mais da metade das despesas em saúde em 2010-2019, evidenciando uma dependência de financiamento externo. Conclui-se que a situação de contínua instabilidade política afeta significativamente o desempenho e a melhoria do sistema de saúde haitiano, mas a colaboração efetiva entre os atores identificados pode aportar mudanças significativas.

Abstract This research aims to analyze the organization of Haiti's health system between 2010 and 2020, based on the Postulate of Coherence proposed by Mário Testa. The study used public sources compiled and coded with the help of the QSR NVivo 10.0.641.0 software, for subsequent critical content analysis. The results revealed that the management of sexually transmitted infections (STIs) were the largest range of services, but in a fragmented manner, with the main causes of morbidity and mortality being ischemic heart disease and other cardiovascular diseases, due to an unidentified epidemiological transition as a priority problem in the country. It is noteworthy that irregular electricity, the lack of equipment to supply water and sanitary facilities in health institutions emerged as structural issues to be faced. It was identified that donors contributed more than half of health expenses in 2010-2019, highlighting a dependence on external financing. It is concluded that the situation of continued political instability significantly affects the performance and improvement of the Haitian health system, but effective collaboration between the identified actors can bring about significant changes.

Financing for tuberculosis prevention, diagnosis and treatment services in the Western Pacific Region in 2005–2020

@#Objective: This paper provides an overview of financing for tuberculosis (TB) prevention, diagnostic and treatment services in the World Health Organization (WHO) Western Pacific Region during 2005–2020. Methods: This analysis uses the WHO global TB finance database to describe TB funding during 2005–2020 in 18 low- and middle-income countries (LMICs) in the Western Pacific Region, with additional country-level data and analysis for seven priority countries: Cambodia, China, the Lao People’s Democratic Republic, Mongolia, Papua New Guinea, the Philippines and Viet Nam. Results: Funding for the provision of TB prevention, diagnostic and treatment services in the 18 LMICs tripled from US$ 358 million in 2005 to US$ 1061 million in 2020, driven largely by increases in domestic funding, which rose from US$ 325 million to US$ 939 million over the same period. In the seven priority countries, TB investments also tripled, from US$ 340 million in 2005 to US$ 1020 million in 2020. China alone accounted for much of this growth, increasing its financing for TB programmes and services five-fold, from US$ 160 million to US$ 784 million. The latest country forecasts estimate that US$ 3.8 billion will be required to fight TB in the seven priority countries by 2025, which means that unless additional funding is mobilized, the funding gap will increase from US$ 326 million in 2020 to US$ 830 million by 2025. Discussion: Increases in domestic funding over the past 15 years reflect a firm political commitment to ending TB. However, current funding levels do not meet the required needs to finance the national TB strategic plans in the priority countries. An urgent step-up of public financing efforts is required to reduce the burden of TB in the Western Pacific Region.

O impacto financeiro na saúde pública contra ist's em específico hiv no município de Ji-Paraná: análise de dados (2019 a 2022) / The financial impact on public health against ist's in specific hiv in the municipality of Ji-Paraná: data analysis (2019 to 2022) / Impacto financiero en la salud pública contra el vih en el municipio de Ji-Paraná: análisis de datos (2019 a 2022)

O investimento financeiro desempenha um papel fundamental no combate ao HIV, sendo essencial no financiamento de programas de prevenção, como campanhas de conscientização pública, distribuição de preservativos, testagem, tratamento e pesquisas. Sem investimento adequado, as taxas de infecção podem aumentar e as pessoas que vivem com HIV podem não ter acesso aos tratamentos e serviços de que precisam. Este estudo tem como objetivo analisar sobre o aumento de investimento na área da vigilância epidemiológica relativa ao combate a Infecções Sexualmente Transmissíveis (IST's) com um olhar para o vírus da imunodeficiência humana HIV, no município de Ji- Paraná no período de 2019 a 2022. Adotou-se como metodologia uma pesquisa elaborada de forma quantitativa, de caráter exploratório, por meio de uma análise de dados dos registros públicos epidemiológicos e também dos investimentos no fundo municipal de saúde publicados no portal de transparência do município de Ji-Paraná. O seguinte estudo possibilitou a análise dos investimentos realizados no fundo municipal de saúde para a realização de ações voltadas para o controle, diagnósticos e tratamento da Human Immuno Deficiency Virus (HIV) que teve influência direta na diminuição dos casos registrados pelo portal do Sistema de Informações de Agravos de Notificação (SINAN) no período de 2019 a 2020. Conclui-se que o investimento em saúde pública para o combate ao HIV/AIDS é fundamental e pode ser um grande desafio financeiro para os municípios, especialmente em tempos de crise econômica e escassez de recursos, a alocação de recursos adequados para programas de prevenção, tratamento, cuidados de saúde, serviços de apoio, pesquisa e monitoramento pode ajudar a reduzir a incidência de novos casos de HIV e garantir que as pessoas que vivem com HIV recebam o suporte necessário para gerenciar sua condição.

Financial investment plays a fundamental role in the fight against HIV, being essential in financing prevention programs, such as public awareness campaigns, condom distribution, testing, treatment, and research. Without adequate investment, infection rates can increase and people living with HIV may not have access to the trea- tments and services they need. This study aims to analyze the increase in investment in the area of epidemiological surveillance related to the fight against Sexually Transmitted Infections (STIs) with a focus on the Human Immunodeficiency Virus (HIV) in the mu- nicipality of Ji-Paraná from 2019 to 2022. A quantitative exploratory research methodo- logy was adopted, through an analysis of data from public epidemiological records and also investments in the municipal health fund published on the transparency portal of the municipality of Ji-Paraná. This study enabled the analysis of investments made in the municipal health fund for actions aimed at the control, diagnosis, and treatment of the Human Immuno Deficiency Virus (HIV), which had a direct influence on the decrease in cases recorded by the Notification of Aggravations Information System (SINAN) portal from 2019 to 2020. It is concluded that public health investment for the fight against HIV/AIDS is essential and can be a significant financial challenge for municipalities, especially in times of economic crisis and resource scarcity. Adequate allocation of re- sources for prevention programs, treatment, healthcare, support services, research, and monitoring can help reduce the incidence of new HIV cases and ensure that people living with HIV receive the necessary support to manage their condition. KEYWORDS: AIDS/HIV; Public Health; Financing.

La inversión financiera juega un papel fundamental en la lucha contra el VIH, siendo esencial para el financiamiento de programas de prevención, como campañas de concientización pública, distribución de preservativos, pruebas, tratamiento e investi- gaciones. Sin una inversión adecuada, las tasas de infección pueden aumentar y las per- sonas que viven con VIH pueden no tener acceso a los tratamientos y servicios que nece- sitan. Este estudio tiene como objetivo analizar el aumento de la inversión en el área de la vigilancia epidemiológica en relación a la lucha contra las Infecciones de Transmisión Sexual (ITS), con un enfoque en el virus de la inmunodeficiencia humana VIH, en el municipio de Ji-Paraná en el período de 2019 a 2022. Se adoptó como metodología una investigación elaborada de forma cuantitativa, de carácter exploratorio, a través de un análisis de datos de registros públicos epidemiológicos y también de las inversiones en el fondo municipal de salud publicadas en el portal de transparencia del municipio de Ji- Paraná. Este estudio permitió el análisis de las inversiones realizadas en el fondo munici- pal de salud para llevar a cabo acciones enfocadas en el control, diagnóstico y tratamiento del Virus de Inmunodeficiencia Humana (VIH), lo que tuvo una influencia directa en la disminución de los casos registrados por el portal del Sistema de Información de Agravios de Notificación (SINAN) en el período de 2019 a 2020. Se concluye que la inversión en salud pública para la lucha contra el VIH/SIDA es fundamental y puede ser un gran de- safío financiero para los municipios, especialmente en tiempos de crisis económica y es- casez de recursos, la asignación de recursos adecuados para programas de prevención, tratamiento, cuidado de la salud, servicios de apoyo, investigación y monitoreo puede ayudar a reducir la incidencia de nuevos casos de VIH y garantizar que las personas que viven con VIH reciban el apoyo necesario para manejar su condición.

Continuum de desmontes da saúde pública na crise do covid-19: o neofascismo de Bolsonaro / Continuum of public health dismantling during the covid-19 crisis: Bolsonaro's neofascism

Resumo Neste artigo, aprofunda-se a discussão crítica às políticas adotadas pelo governo Bolsonaro em relação à saúde pública, particularmente no que tange ao financiamento em geral, ao enfrentamento da pandemia e ao primeiro ano de implantação do novo modelo de "financiamento" para a Atenção Primária à Saúde (APS). A análise evidencia o acirramento da legitimidade restrita do regime político, assumida por políticas ultraneoliberais e pelo neofascismo do governo Bolsonaro. Estas formas de dominação - política e econômica - engendram uma conjuntura interna que visa remodelar a acumulação de capital na saúde pública via APS por meio de mecanismos "operacionais" burocráticos sutis de desconstrução da universidade do "financiamento". Na primeira parte, discute-se a abrangência da crise tripla do capital - sanitária, econômica e ecológica - e sua relação orgânica com o Estado no capitalismo dependente brasileiro, abrindo espaço para o crescimento da restrição do regime político endossado pela ascensão do neofascismo. Na segunda parte, aborda-se a escalada do desfinanciamento do Sistema Único de Saúde (SUS) em plena crise de covid-19 e os efeitos da implementação do modelo de financiamento da APS, evidenciando a continuidade do processo de valorização de um "SUS operacional" em detrimento do seu princípio de universalidade como dimensão neofascista do governo Bolsonaro.

Abstract This article deepens the critical discussion about the policies of the Bolsonaro government regarding public health, particularly regarding the general financing, the confrontation of the pandemic, and the first year of implementation of the new financing model for Primary Health Care (PHC). The analysis evidences the aggravation of the restrict legitimacy of the political regime, assumed by ultra-neoliberal policies and by the neofascism of the Bolsonaro government. These forms of domination - political and economic - produce an internal conjuncture that seeks to remodel the capital accumulation in public health by PHC by subtle bureaucratic "operational" mechanisms of deconstruction of financing universality. In the first part, the coverage of the triple crisis of the capital - sanitary, economic and ecological - and its organic relationship to the State in the Brazilian dependent capitalism is discussed, opening space to the increase of the restriction of the political regime endorsed by the ascension of the neofascism. In the second part, the increase of the de-financing of the Unified Health System (SUS) right in the middle of the covid-19 crisis and the effects of the implementation of the financing model of the PHC, evidencing the continuity of the process of valuing an "operational SUS" in detriment of its universality principle as a neofascist dimension of Bolsonaro's government.

Evolução da estrutura e resultados da Atenção Primária à Saúde no Brasil entre 2008 e 2019 / Evolution of the structure and results of Primary Health Care in Brazil between 2008 and 2019

Resumo Descreve a evolução da estrutura e resultados da Atenção Primária à Saúde (APS) no Brasil, entre 2008 e 2019. Foram calculadas a mediana de variáveis como: despesa per capita em APS por habitante coberto, cobertura da APS e as taxas de mortalidade e internações por condições sensíveis à atenção primária (CSAP) de 5.565 municípios brasileiros estratificados segundo porte populacional e quintil do Índice Brasileiro de Privação (IBP) e analisada a tendência mediana no período. Houve aumento de 12% na mediana da despesa em APS. A cobertura da APS expandiu, sendo que 3.168 municípios apresentaram 100% de cobertura em 2019, contra 2.632 em 2008. A mediana das taxas de mortalidade e internações por CSAP aumentou 0,2% e diminuiu 44,9% respectivamente. A despesa em APS foi menor nos municípios com maior privação socioeconômica. Quanto maior o porte populacional e melhores as condições socioeconômicas dos municípios, menor a cobertura da APS. Quanto maior a privação socioeconômica dos municípios, maiores foram as medianas das taxas de mortalidade por CSAP. Este estudo demonstrou que a evolução da APS foi heterogênea e está associada tanto ao porte populacional como às condições socioeconômicas dos municípios.

Abstract This paper describes the structure and results of Primary Health Care (PHC) in Brazil between 2008 and 2019. The medians of the following variables were calculated: PHC spending per inhabitant covered, PHC coverage, and rates of mortality and hospitalizations due to primary care sensitive conditions (PCSC), in 5,565 Brazilian municipalities stratified according to population size and quintile of the Brazilian Deprivation Index (IBP), and the median trend in the period was analyzed. There was a 12% increase in median PHC spending. PHC coverage expanded, with 3,168 municipalities presenting 100% coverage in 2019, compared to 2,632 in 2008. The median rates of PCSC mortality and hospitalizations increased 0.2% and decreased 44.9%, respectively. PHC spending was lower in municipalities with greater socioeconomic deprivation. The bigger the population and the better the socioeconomic conditions were in the municipalities, the lower the PHC coverage. The greater the socioeconomic deprivation was in the municipalities, the higher the median PCSC mortality rates. This study showed that the evolution of PHC was heterogeneous and is associated both with the population size and with the socioeconomic conditions of the municipalities.

Financiamiento en investigación en salud: obteniendo financiamiento. Consejos útiles para aumentar las chances de éxito. Parte 2 / Health research funding: obtaining grants. Tips to improve the success rate. Part 2

Esta es la segunda parte de un artículo sobre la búsqueda de financiamiento para un proyecto de investigación. Todo proyecto de investigación requiere una fuente de financiamiento para poder ser llevado adelante. La búsqueda de fondos es una tarea que lleva tiempo y esfuerzo con una baja tasa de éxito. Compartimos algunos consejos que podrían ayudar a aumentar esa tasa de éxito en relación con: 1) cómo reconocer la necesidad de búsqueda de una fuente de financiamiento externo, 2) de dónde provienen los fondos, 3) qué gastos se pueden financiar habitualmente con los fondos y 4) cómo mejorar la escritura y la presentación a una convocatoria. (AU)

This is the second part of our series on searching funds for a research plan. Every research proposal requires a source of funding to be carried out. Looking for funds is a time and effort consuming task with a low success rate. We share some tips that may help to improve that success rate related to (1) how to recognize the need of an external funding source, (2) where the funds are coming from, (3) what costs can be funded and (4) how to improve a proposal writing and submission. (AU)

Análise do financiamento federal do Sistema Único de Saúde para o enfrentamento da Covid-19 / Analysis of the federal funding of the Unified Health System to fight the COVID-19

RESUMO O objetivo deste artigo é o de analisar o financiamento federal do Sistema Único de Saúde (SUS) para o enfrentamento da pandemia da Covid-19 em 2020 e durante o primeiro quadrimestre de 2021 - períodos caracterizados como da primeira e da segunda ondas. Realizou-se pesquisa documental com levantamento de dados disponíveis em sítios eletrônicos oficiais. A pandemia se instalou no Brasil em fevereiro de 2020, no contexto do subfinanciamento crônico do SUS, que se aprofundou com o estrangulamento de dotações verificado a partir da Emenda Constitucional 95/2016, que definiu o teto das despesas primárias e o congelamento do piso federal do SUS até 2036, no mesmo valor do piso de 2017. Essa medida constitucional viabilizou o aprofundamento da política de austeridade fiscal pela via da redução das despesas primárias e da dívida pública em relação ao Produto Interno Bruto. Tais objetivos condicionaram também o financiamento federal para o combate à pandemia da Covid-19 em 2020 e 2021, cuja execução orçamentária e financeira pode ser caracterizada como reativa e retardatária. Essa forma de execução comprometeu o atendimento das necessidades de saúde da população, além de prejudicar a gestão do SUS nas esferas de governo subnacionais.

ABSTRACT The purpose of this article is to analyze the federal funding of the Unified Health System (SUS) to fight the COVID-19 pandemic in 2020 and during the first four months of 2021 - periods characterized as the first and second waves. Documentary research was carried out, with data available on official websites. The pandemic took hold in Brazil in February 2020, in the context of the chronic underfunding of SUS, which deepened with the strangulation of appropriations verified from the Constitutional Amendment 95/2016, which defined the ceiling on primary expenditure and the freezing of the federal floor of SUS until 2036, at the same value as the 2017 floor. This constitutional measure made it possible to deepen the fiscal austerity policy by reducing primary expenditure and public debt in relation to the Gross Domestic Product. These goals also conditioned federal funding to combat the COVID-19 pandemic in 2020 and 2021, whose budget and financial execution can be characterized as reactive and delayed. This form of execution compromised meeting the health needs of the population, in addition to harming the management of SUS in subnational government spheres.

Financiamiento del sistema de salud colombiano: Tendencias y desafíos / Financing of the Colombian health system: Trends and challenges

RESUMEN El financiamiento es una función fundamental que contribuye al propósito que tienen los sistemas de salud de mejorar el estado de salud de la población. Esta función se concreta en la recaudación de fondos, su mancomunación y asignación, y en ella se diferencian las fuentes y los usos de los recursos, especialmente en cuanto al carácter público o privado y a la forma como se cubren los costos de los servicios de salud. En este artículo se presenta una mirada de largo plazo sobre el financiamiento de la salud en Colombia, identificando los antecedentes y la evolución a partir de la reforma de 1993. Se identifican cuatro momentos en esta evolución: I. incremento significativo de recursos, al momento de expedir las Leyes 60 y 100 de 1993; II. contención fiscal, en el marco de la crisis de 1998 y 1999; III. mayor esfuerzo fiscal, especialmente a partir de 2010, y IV. sustitución de fuentes, de cotizaciones a impuestos generales, que se inició en 2012. Se evidencia un desarrollo importante de la función de financiamiento, con un fortalecimiento a partir de la Administradora de los Recursos del Sistema (ADRES), la reducción en la dependencia de las cotizaciones, el proceso de igualación per cápita entre regímenes de aseguramiento, y un mayor aporte de impuestos generales para buscar el equilibrio del sistema. Todo ello implica mantener el predominio público y garantizar la protección financiera en salud.

ABSTRACT Financing is a fundamental function that contributes to the purpose of health systems to improve the health status of the population. This function takes the form of fundraising, pooling and allocation, and it differentiates the sources and uses of resources, especially in terms of their public or private nature and the way in which health costs are covered. This article presents a long-term view of health financing in Colombia, identifying the background and evolution since the 1993 reform. Four moments in this evolution are identified: I. significant increase in resources, at the time of issuing Laws 60 and 100 of 1993; II. fiscal containment, in the context of the 1998 and 1999 crisis; IV. greater fiscal effort, especially since 2010, and V. substitution of sources, from contributions to general taxes, which began in 2012. An important development of the financing function is evident, with a strengthening of the System's Resources Administrator (ADRES), a reduction in the dependence on contributions, the process of equalization of the capita among insurance regimes, and a greater contribution of general taxes to seek the balance of the system, all of which implies maintaining public predominance and guaranteeing financial protection in health.

Fragility and challenges of health systems in pandemic:lessons from India's second wave of coronavirus disease 2019(COVID-19) / 《全球健康杂志（英文）》

The unprecedented healthcare demand due to sudden outbreak of coronavirus disease 2019(COVID-19)pandemic has almost collapsed the health care systems especially in the developing world.Given the disastrous outbreak of COVID-19 second wave in India,the health system of country was virtually at the brink of collapse.Therefore,to identify the factors that resulted into breakdown and the challenges,Indian healthcare system faced during the second wave of CO VID-19 pandemic,this paper analysed the health system challenges in India and the way forward in accordance with the six building blocks of world health organization(WHO).Applying integrated review approach,we found that the factors such as poor infrastructure,inadequate financing,lack of transparency and poor healthcare management resulted into the overstretching of healthcare system in India.Although health system in India faced these challenges from the very beginning,but early lessons from first wave should have been capitalized to avert the much deeper crisis in the second wave of the pandemic.To sum-up given the likely future challenges of pandemic,while healthcare should be prioritized with adequate financing,strong capacity-building measures and integration of public and private sectors in India.Likewise fiscal stimulus,risk assessment,data availability and building of human resources chain are other key factors to be strengthened for mitigating the future healthcare crisis in country.

Cost of hospitalization of pediatric covid-19 patients in a tertiary pediatric hospital in the Philippines

BACKGROUND@#Out of pocket expenses still comprises a major share in health financing. A reactive approach in COVID-19 treatment may be problematic for the patient’s finances. National health insurance systems like PHIC have COVID-related care benefits, but whether these offer sufficient coverage is unknown.@*OBJECTIVES@#This study aims to describe the hospitalization costs incurred by pediatric COVID-19 patients admitted at a Filipino tertiary pediatric hospital, to determine the major cost drivers of hospitalization, and to determine how various payment methods provide coverage in paying for hospitalizations costs.@*METHODS@#Financial statements of pediatric COVID-19 patients were reviewed, from which costs were categorized. Deductions were also compared with total hospitalization to determine adequacy of various financial assistance programs.@*RESULTS@#Fifty-six charts and financial statements were reviewed for a 9-month period. Majority of the patients are of the 1-month to 6-year-old group (39.3%), of critical severity (66.1%), and with comorbidities (76.8%). Aggregated hospitalization costs of all COVID-19 patients amounted to PHP 9.5 million; medical costs accounted for the majority of the hospital costs at 35.40%. Mean total hospitalization cost per patient was determined to be PHP 170,170 and mean daily cost was PHP 16,870. PHIC COVID-19 packages may provide deducted as much as 90.56% of the overall costs, but only 28.6% of patients were able to avail of this privilege. Out-of-pocket expenditure remains at 33% of the total hospitalization cost.@*CONCLUSION@#COVID-19 hospitalization in this institution mainly consists of the 1-month to 6 years old, and the costs in the average can reach up approximately PHP 170,000, as basic medical fees drive the majority of the costs. Patients with no known comorbids tend to have higher costs of care but more data is needed to elaborate on the trend. Availing PHIC packages can greatly ameliorate the financial burden of hospitalization. However, checks in timely and accurate filing of claims should be in place to assure those that can avail this assistance are rightfully supported.@*RECOMMENDATIONS@#A larger patient base with equal representation of patient categories is recommended in order to determine more comprehensive cost patterns and make significant associations.