Prioritization criteria in policies and manage- ment of human resources for health: a proposal for a validated methodology / Criterios para la asignación de prioridades en materia de políticas y gestión de recursos humanos para la salud: propuesta de una metodología validada / Critérios de priorização em políticas e gerenciamento de recursos humanos em saúde: proposta para uma metodologia validada

[ABSTRACT]. Objective. To create and validate criteria for prioritizing problems related to policies and management of the health workforce. Methods. This methodological study was divided into three stages. First, the criteria were elaborated by means of a systematized literature review. Second, the criteria were evaluated online by a committee of judges comprised of eight specialists. In the third stage, an evaluation was carried out by the target audience in a hybrid workshop. The participants evaluated the material using the Suitability Assessment of Materials instrument, adapted for the research. Results. Three prioritization criteria (relevance, window of opportunity and acceptability) and a scoring scale were developed based on the literature review. In the evaluation by the committee of judges, the approval percentage of the criteria and prioritization method was 84%. Modifications were made based on suggestions in relation to the material presented to the specialists. In the pre-test stage, the approval percentage varied by item, with six of them reaching a maximum approval of 100% (corresponding to approximately 46% of the items), four reaching 92% and three achieving 83% each, indicating positive results. Conclusions. The developed criteria were considered valid for use in the context of policies and management in the area of human resources for health.

[RESUMEN]. Objetivo. Crear y validar criterios para priorizar los problemas relacionados con las políticas y la gestión de los recursos humanos para la salud. Métodos. Este estudio metodológico se dividió en tres etapas. En la primera se elaboraron los criterios mediante una revisión sistematizada de la bibliografía. En la segunda un comité de ocho especialistas evaluó en línea los criterios. Y la tercera consistió en una evaluación por parte del público destinatario en un taller híbrido. Los participantes evaluaron el material utilizando el instrumento de evaluación de la idoneidad de los materiales, que fue adaptado para la investigación. Resultados. Sobre la base de la revisión de la bibliografía, se elaboraron tres criterios para la asignación de prioridades (relevancia, ventana de oportunidad y aceptabilidad) y una escala de puntuación. En la evaluación realizada por el comité de especialistas, el porcentaje de aprobación de los criterios y del método de asignación de prioridades fue del 84%. Se realizaron modificaciones basadas en sugerencias planteadas con respecto al material presentado a los especialistas. En la etapa posterior de prueba preliminar, el porcentaje de aprobación varió en los distintos puntos, de tal manera que en seis puntos (es decir, en aproximadamente el 46% de los puntos) se alcanzó una aprobación máxima del 100%, en cuatro una aprobación del 92% y en tres una aprobación del 83% en cada uno, lo que indica unos resultados positivos. Conclusiones. Se consideró que los criterios elaborados son válidos para su uso en el contexto de las políticas y la gestión en el ámbito de los recursos humanos para la salud.

[RESUMO]. Objetivo. Criar e validar critérios para priorizar problemas relacionados a políticas e gerenciamento da força de trabalho em saúde. Métodos. O presente estudo metodológico foi dividido em três fases. Primeiro, foram elaborados critérios por meio de revisão sistematizada da literatura. A seguir, os critérios foram avaliados on-line por uma comissão de juízes composta por oito especialistas. Na terceira fase, o público-alvo fez uma avaliação dos critérios em uma oficina de formato híbrido. Os participantes avaliaram o material usando o instrumento Suitability Assessment of Materials, adaptado para esta pesquisa. Resultados. Com base na revisão da literatura, foram elaborados três critérios de priorização (relevância, janela de oportunidade e aceitabilidade) e uma escala de pontuação. Na avaliação da comissão de juízes, a porcentagem de aprovação dos critérios e do método de priorização foi de 84%. Foram feitas alterações com base em sugestões relacionadas ao material apresentado aos especialistas. Na fase de pré-teste, a porcentagem de aprovação variou de acordo com o item. Seis deles (aproximadamente 46% dos itens) atingiram aprovação máxima de 100%, quatro atingiram 92% e três atingiram 83%, indicando resultados positivos. Conclusões. Os critérios desenvolvidos foram considerados válidos para uso no contexto de políticas e ger- enciamento na área de recursos humanos em saúde.

Implementation of policy and management interventions to improve health and care workforce capacity to address the COVID-19 pandemic response: a systematic review.

BACKGROUND: The COVID-19 pandemic highlighted pre-existing weaknesses in health and care systems and services and shortages of health and care workers (HCWs). As a result, policymakers needed to adopt measures to improve the health and care workforce (HCWF) capacity. This review aims to identify countries' range of policies and management interventions implemented to improve HCWs' capacity to address the COVID-19 pandemic response, synthesize their evidence on effectiveness, and identify gaps in the evidence. METHODS: The literature was searched in PubMed, Embase, Scopus, LILACS-BVS, WHO's COVID-19 Research Database and the ILO, OECD and HSRM websites for literature and documents published between January 2020 and March 2022. Eligibility criteria were HCWs as participants and policy and management interventions aiming to improve HCWF capacity to address the COVID-19 pandemic response. Risk of bias was assessed with Joanna Briggs Institute (JBI) Critical Appraisal Tools (CAT) and certainty of the evidence in presented outcomes with GRADE. RESULTS: The searches retrieved 3378 documents. A total of 69 were included, but only 8 presented outcomes of interventions implemented. Most of the selected documents described at least one intervention implemented by countries at the organizational environment level to increase the flexibility and capacity of the HCWF to respond to the pandemic, followed by interventions to attract and retain HCWs in safe and decent working environments. There was a lack of studies addressing social protection, human resources for health information systems, and regarding the role of community health workers and other community-based providers. Regarding the risk of bias, most of documents were rated as medium or high quality (JBI's CAT), while the evidence presented for the outcomes of interventions was classified as mostly low-certainty evidence (GRADE). CONCLUSIONS: Countries have implemented various interventions, some innovative, in response to the pandemic, and others had their processes started earlier and accelerated by the pandemic. The evidence regarding the impact and efficacy of the strategies used by countries during the pandemic still requires further research.

Oral health policies and decision-making process in Brazil, Colombia and Chile.

Public health policies are crucial for the well-being of the general population; however, the health systems of developed countries still do not include oral health in its system. Thus, it is necessary to understand the process of decision-making in oral health policies to create opportunities for countries to achieve an overall positive health outcome, including oral health. This study aimed to identify the factors influencing the inclusion of oral health on the political agenda in Brazil, Colombia, and Chile. The study sample involved decision-makers at political, technical, and academic levels. The extracted data were analyzed using the software Maxqda® and Kingdon´s theoretical model; defining interactive variables that produce a "window of opportunity" to define the agenda and the insertion of theme in formulating public policies. The decision-making process regarding oral health is influenced by many factors like the need to improve the overall oral health of the population, identified through national epidemiological studies, and the importance of individuals in positions involving political decision-making, who advocate for oral health. Strategies were developed in partnership with the academy that focused on the health rights of the population provided by law; territorial and national programs were also developed. The inclusion and creation of oral health policies depend on actors who advocate for thematic and scientific evidence to support decision-making. A close relationship between academia and stakeholders and knowledge translation is important for the development of public policies that can be effective for health systems.

Oral health policies and decision-making process in Brazil, Colombia and Chile

Abstract Public health policies are crucial for the well-being of the general population; however, the health systems of developed countries still do not include oral health in its system. Thus, it is necessary to understand the process of decision-making in oral health policies to create opportunities for countries to achieve an overall positive health outcome, including oral health. This study aimed to identify the factors influencing the inclusion of oral health on the political agenda in Brazil, Colombia, and Chile. The study sample involved decision-makers at political, technical, and academic levels. The extracted data were analyzed using the software Maxqda® and Kingdon´s theoretical model; defining interactive variables that produce a "window of opportunity" to define the agenda and the insertion of theme in formulating public policies. The decision-making process regarding oral health is influenced by many factors like the need to improve the overall oral health of the population, identified through national epidemiological studies, and the importance of individuals in positions involving political decision-making, who advocate for oral health. Strategies were developed in partnership with the academy that focused on the health rights of the population provided by law; territorial and national programs were also developed. The inclusion and creation of oral health policies depend on actors who advocate for thematic and scientific evidence to support decision-making. A close relationship between academia and stakeholders and knowledge translation is important for the development of public policies that can be effective for health systems.

Compreensão do processo de implementação de Programas e Políticas de Saúde Bucal na América Latina / Understanding the implementation process of Oral Health Programs and Policies in Latin America

Introdução: As políticas em saúde pública são importantes para o bem-estar da população em geral, e a saúde bucal está inserida no contexto de saúde integral, desta forma os responsáveis por criarem as políticas e programas de saúde bucal são elementos chaves para a criação de políticas que visam melhorar a saúde da população de um país. Objetivos: Identificar como foi o processo de implementação das políticas de saúde bucal, no contexto do uso da evidência, agenda política e barreiras de implementação nos países envolvidos: Brasil, Colômbia e Chile. Métodos: Trata-se de um estudo qualitativo com entrevistas presenciais com atores-chaves no processo de implementação em cada país, foi realizada análise de conteúdo e os dados foram categorizados com uso do Maxqda®. Resultados: Apesar dos países apresentarem sistemas de saúde diferentes, observou-se que durante o processo de implementação das políticas de saúde, o uso da evidência científica ainda é restrito e a participação da academia mostrou-se necessária para a elaboração das políticas de saúde. Em relação ao processo de inclusão na agenda, os resultados de estudos epidemiológicos tiveram um papel indutor, além da necessidade de atores chaves que advoguem a favor do tema. A principal barreiras citada pelos países é a formação do dentista, que ainda é voltada para o atendimento clínico individual e privado. Conclusão: Os formuladores de políticas devem compreender a importância da odontologia no sistema de saúde, a academia deve se aproximar da gestão de modo a informar as políticas para ser elaborada com uso da evidência cientifica e estimular a sensibilização dos futuros profissionais para este tema.

O processo de trabalho em saúde bucal coletiva em tempos de pandemia: a contribuição da teleducação com a teleodontologia / The work process in collective oral health in times of a pandemic: the contribution of tele-education with teledentistry

A pandemia da COVID-19 impôs ações assertivas em todos os níveis da sociedade. Aqui se relata o apoio emergencial na Resposta Rápida do Núcleo de Evidências e Análises Econômicas da Faculdade de Odontologia da Universidade de São Paulo (EvipOralHealth) para a coordenadoria estadual de saúde bucal de São Paulo, em prol da tomada de decisão e ressignificação do processo de trabalho. Foram implementadas duas estratégias de teleodontologia para a educação permanente (EP) dos trabalhadores de saúde bucal: 1. Lives com pesquisadores, estudantes, gestores e trabalhadores das diversas áreas da saúde pública e da Odontologia para estabelecer marcos teóricos; 2. Ambulatórios virtuais - via webconferência. Reuniu-se gestores e trabalhadores para a condução de diálogos de políticas sobre o dia a dia do enfrentamento e de adaptações e condições de trabalho de cada região. A experiência revela a importância da relação ensino-serviço-comunidade efetiva, pautada na tradução do conhecimento e na construção de espaços de troca possibilitando a implementação de práticas, programas e políticas. Precisamos repensar as estratégias de EP, sermos mais ágeis, mais flexíveis, menos acadêmicos e capazes de adaptar conteúdos e formatos às necessidades. A teleodontologia e a teleducação podem conferir escala e fazer chegar mais facilmente o conhecimento aos que necessitam.

Brazilian Oral health teams in primary care and oral cancer: Results of a national evaluation.

Oral cancer is one of the most prevalent cancers in Brazil. An understanding of how public policies are implemented to address this problem can contribute to the construction of solutions. The "Programa de Melhoria do Acesso e da Qualidade" (PMAQ-AB and PMAQ-CEO) at the level of primary and secondary care are evaluations that also collect data on prevention and monitoring strategies for oral cancer. This study aimed to analyze the results of the incorporation of oral health teams to evaluate the strategies adopted by Brazil regarding the impact on the diagnosis of oral cancer. Of the 17,202 family health teams evaluated, 72.10% had oral health teams (OHT). Considering the strategies for prevention, screening, campaign, and follow-up of suspected cases, 72.27% of the campaign teams and 59.09% of the teams who accompanied suspected cases had OHT. In secondary care, more than 65% of the teams in the Southeast and South regions registered cases of oral cancer, and the referral network was more represented. The inclusion of OHT had a positive impact on campaign actions, follow-up, referral to specialists, and registration of suspected cases throughout Brazil.

Brazilian Oral health teams in primary care and oral cancer: Results of a national evaluation

Abstract Oral cancer is one of the most prevalent cancers in Brazil. An understanding of how public policies are implemented to address this problem can contribute to the construction of solutions. The "Programa de Melhoria do Acesso e da Qualidade" (PMAQ-AB and PMAQ-CEO) at the level of primary and secondary care are evaluations that also collect data on prevention and monitoring strategies for oral cancer. This study aimed to analyze the results of the incorporation of oral health teams to evaluate the strategies adopted by Brazil regarding the impact on the diagnosis of oral cancer. Of the 17,202 family health teams evaluated, 72.10% had oral health teams (OHT). Considering the strategies for prevention, screening, campaign, and follow-up of suspected cases, 72.27% of the campaign teams and 59.09% of the teams who accompanied suspected cases had OHT. In secondary care, more than 65% of the teams in the Southeast and South regions registered cases of oral cancer, and the referral network was more represented. The inclusion of OHT had a positive impact on campaign actions, follow-up, referral to specialists, and registration of suspected cases throughout Brazil.

A COVID-19 na América Latina e suas repercussões para a odontologia

[Extract]. Diante do novo coronavírus, se observa pouca ou nenhuma discussão sobre a saúde bucal em tempos de COVID-19. Entre os profissionais que mais se expõem aos aerossóis, principal rota de transmissão do vírus, estão o dentista e sua equipe. Além disso, o dentista está, invariavelmente, em contato com a saliva, responsável por boa parte das infecções. Devido ao alto risco de exposição ao coronavírus pelos dentistas, é urgente que se estabeleçam medidas seguras de trabalho, considerando a viabilidade dos sistemas de saúde e a preservação da saúde de pacientes e profissionais. Levando em conta esses aspectos, e cumprindo a missão de dar visibilidade às ações de saúde pública e de saúde bucal em países latinos, os pesquisadores do Observatório Iberoamericano de Políticas Públicas em Saúde Bucal organizaram em seu site um espaço todo dedicado ao coronavírus (https://sites.usp.br/iberoamericanoralhealth/). No site, disponível nos idiomas inglês, português, espanhol e francês, o leitor tem acesso a recomendações informadas pelas melhores evidências, compiladas pelo grupo de pesquisadores, por formuladores de políticas e por outros stakeholders, para orientar o funcionamento dos serviços de odontologia durante os momentos mais agudos da pandemia. As informações sobre as ações governamentais que estão sendo realizados são organizadas por país, destacando-se as características específicas de como estão funcionando as quarentenas e as restrições de circulação de pessoas. Juntamente com protocolos de atendimento odontológico e boletins epidemiológicos, todo o material pode ser acessado de forma rápida, intuitiva e organizada.

Teledentistry and the Unified Health System: An Important Tool for the Resumption of Primary Health Care in the Context of the COVID-19 Pandemic

Abstract This paper describes the possibilities of using Teledentistry to expand and qualify health care in oral health care networks. WHO already recommended to its member countries, even before the pandemic, Telehealth as a strategy to improve the quality of services, especially in universal systems, as the Unified Health System (SUS). Teledentistry opens opportunities for oral health to resume the provision of various services, remotely, such as: 1) Tracking, active search, monitoring of priority users, those at risk and with systemic problems, suspicions of COVID-19 and contacts, through Telemonitation; 2) Initial listening, individual or collective educational activities, through Teleorientation; 3) Discussion of clinical cases for the definition of the opportunity / need for operative procedures, matrix support, sharing, solution of doubts among professionals and between these and teaching and research institutions, by Teleconsulting, among others. In addition to a review of Teledentistry in the context of the pandemic, we conceptualized the terms used and possibilities offered to SUS professionals, in addition to specifying the possible protocols for recording these activities to provide safe data for their monitoring and evaluation. Besides, we bring a brief discussion with promising experiences, carried out in the pre- and trans-pandemic contexts, which can be important strategies for the resumption of oral health in the post-pandemic scenario.