Working towards health: A model of cervical cancer screening and treatment for factory employees in Haiti.

OBJECTIVE: In Haiti, cervical cancer continues to cause high levels of mortality and morbidity due to lack of resources and political unrest. Haitian women employed in factories are especially vulnerable because they are unable to take time away from work to access health resources. We aimed to describe a low-cost intervention which successfully addressed this need. METHODS: We present a retrospective review of data gathered through a public-private partnership, in which women working in garment factories near Port-au-Prince, Haiti, were offered health education, clinical breast exam, and free human papillomavirus (HPV) self-swab testing at their place of employment. Women testing positive for HPV were subsequently tested using visual inspection with acetic acid (VIA) to inform treatment referrals, and treated with mobile thermocoagulation in factory infirmaries. Factory-employed healthcare workers were trained on cancer screening, including VIA and clinical breast exam. RESULTS: A total of 6843 out of 6983 (98%) female factory employees attended free reproductive health education sessions, and 4005 out of 4153 eligible women (97%) were screened using HPV self-swab testing; 5176 women received a clinical breast exam. Of the women screened for HPV, 1001 (25%) tested positive and 905 (90%) of HPV-positive women received VIA testing and thermocoagulation. The intervention had a total cost of US$76 000, over half of which was spent on an HPV testing machine. CONCLUSIONS: Innovative approaches to the prevention of cervical cancer are especially necessary in very low-resource, politically unstable environments like Haiti. Self-swab and screen-and-treat programs in the workplace were acceptable to employees and factory owners. This low-cost model was reached vulnerable women through a public-private partnership, and tracked them through screening and treatment. It could be implemented elsewhere or extended to include other health services.

How long-term emancipatory programming facilitates participatory evaluation: Building a methodology of participation through research with youth in Honduras.

Empowerment and participation are promoted as critical factors in meaningful development processes; however, action-oriented researchers face challenges in fostering genuine empowerment and meaningful participation within traditional funding cycles and research timelines. This case study illustrates a participatory methodology employed by researchers in partnership with one Honduran non-governmental organization (NGO) to conduct 'practical' participatory evaluation with rural Honduran youth. Through collaborative autoethnography, two components of this methodology are identified and described. The first component - 'foundational elements'- includes the NGO's culture of transformative participation and the organization's attention to synergies in the insider/outsider identities of research partners. The second component includes the ability of the research team to leverage this foundation for the participatory evaluation with rural youth. Importantly, this ability was grounded in and shaped by long-term, trust-based relationships between research partners. These relationships were the catalyst for success in this participatory initiative, connecting the 'foundational elements' identified to the collaborative outcomes experienced. Overall, this case study contributes to current and ongoing scholarly discussions on how to facilitate meaningful participation and capability expansion in research and evaluation contexts.

Developing research priorities for palliative care in Colombia: a priority setting partnership approach.

BACKGROUND: A recent Lancet commission called for more research on palliative care in low- and middle-income (LMIC) countries such as Colombia. A research priority setting approach has been recommended by The Global Forum for Health Research to address the huge gap in research output between LMIC and high-income countries, with influential health service bodies recommending the active involvement of non-research expert stakeholders in establishing research priorities to address service user needs. METHOD: Priority setting partnership (PSP) following the four stages of the James Lind Alliance methodology; establishing the partnership, identifying evidence uncertainties, refining questions and uncertainties, and prioritization. Data from MS forms were analysed using descriptive statistics. RESULTS: A total of 33 stakeholders attended an online PSP workshop and completed the Mentimeter exercise in Microsoft Teams. A total of 48 attended the subsequent in person prioritisation exercise in urban Bogota (n = 22) and rural Popayan (n = 25). The stakeholders were a diverse group of health professionals (physicians, medical students, nurses, dentists, physiotherapists, nutritionist, occupational and speech therapists), financial and administrative staff and patients with life-limiting illness and caregivers. Top research priorities included patient and caregiver needs, service provider education and training, and better integration of palliative care with cancer and non-cancer services. The key challenges included a lack of interest in palliative care research, along with funding, time and resource constraints. Key solutions included collaboration across disciplines and settings, highlighting benefits of palliative research to help secure adequate resources, and multicentre, mixed method research, with patient involvement from the research development stage. CONCLUSION: The findings of this PSP should be disseminated among palliative care associations worldwide to inform international multicentre studies, and among governmental and nongovernmental organisations that promote research in Colombia. A focus on patient and family caregiver palliative care needs in Colombia should be prioritised.

Experiences of a group of indigenous women from the Colombian Amazon with cervical cancer prevention screening. Qualitative study in the context of participatory research to reduce inequalities.

OBJECTIVES: Despite cervical cancer (CC) being a preventable disease, its incidence remains high in marginalized communities due to inequalities that restrict access to health services. This article investigates the experiences, perceptions, and attitudes regarding the screening of indigenous women in a region of the Colombian Amazon during a cervical cancer prevention initiative facilitated by community participation. DESIGN: Qualitative study based on interviews conducted with women and indigenous leaders from Paujil reserve. They participated in research focused on cervical cancer prevention, which employed a methodology of collaboration between academia and communities aimed at enhancing women's health and reducing inequalities in access to healthcare services. The analysis utilized a deductive and inductive approach. RESULTS: Five main themes were addressed: 'Barriers within health services'; 'Individual and cultural constraints'; 'Motivations and facilitators'; 'Positive experiences within the research framework'; and 'Suggestions for encouraging women's participation.' Challenges related to appointment scheduling and result delivery were frequently cited as obstacles to access. Misinformation, feelings of shame, fear, and distrust towards health services played significant roles in the reluctance to undergo screening. Factors such as support from family and community networks, respectful treatment, ease of scheduling appointments, the presence of female healthcare professionals, and involvement of leaders fluent in indigenous languages were identified as positive facilitators of screening acceptance. CONCLUSION: Understanding the factors that influence access to screening is crucial for reducing inequalities in service delivery for indigenous women. The involvement of trained leaders who can identify these factors and motivate women can have a positive impact on the acceptance and guidance of cervical cancer prevention programs.

Promoting equity, diversity, and inclusion in surveys: insights from a patient-engaged study to assess long COVID health-care needs in Brazil.

BACKGROUND AND OBJECTIVE: Long COVID (LC) refers to persistent symptoms after acute COVID-19 infection, which may persist for months or years. LC affects millions of people globally, with substantial impacts on quality of life, employment, and social participation. Ensuring access to effective, patient-centered care for LC demands evidence, grounded in inclusive representation of those affected by the condition. Yet survey studies frequently under-represent people with the most disabling disease presentations and racially and socioeconomically marginalized groups. We aimed to describe a patient-engaged approach to developing a survey to inform public LC health care and to assess its implementation in terms of enabling participation by diverse LC patients in Brazil. METHODS: Survey development was iterative, achieved through an interdisciplinary collaboration among researchers including people living with LC, and grounded in 3 guiding principles: (1) evidence-based; (2) inclusive, intersectional, and patient-centered understanding of chronic illness and research participation; and (3) sensitivity to the context of health-care access. RESULTS: The product of our collaboration was a longitudinal survey using a questionnaire assessing: LC symptoms; their clinical and functional evolution; and impacts on quality of life, household income, health service access, utilization, and out-of-pocket expenses. We illustrate how we operationalized our 3 principles through survey content, instrument design, and administration. Six hundred fifty-one participants with diverse LC symptoms, demography, and socioeconomic status completed the survey. We successfully included participants experiencing disabling symptoms, Black and mixed race participants, and those with lower education and income. CONCLUSION: By centering patient experience, our novel, principles-based approach succeeded in promoting equity, diversity, and inclusion in LC survey research. These principles guiding patient-engaged collaboration have broad transferability. We encourage survey researchers working on chronic illness and in other contexts of marginalization and inequality to adopt them.

Lessons Learned from an Academic Partnership to Review Pennsylvania Network for Student Assistance Services' Annual Survey.

INTRODUCTION: Pennsylvania's Student Assistance Program (SAP) began in the mid-1980s to address student barriers to academic success. SAP teams, groups of trained school and community professionals, review referrals, and connect students to services. State leadership conducts an annual SAP team survey, but capacity to evaluate data and affect change is limited. In 2020, leadership partnered with [institution name] to collaboratively review the survey data. METHODS: Frequencies and percentages were calculated. Open responses were coded. Logistic regression models evaluated the association between SAP team size, team meeting frequency, and team maintenance. RESULTS: The 2019 to 2020 survey had 1003 respondents. Median number of SAP team members was 8 (range 1-21). The majority (54%) indicated their SAP team met once per week/cycle for 30 to 90+ minutes. Larger teams met more often. Annual team maintenance occurred for 38% of teams, and was more common for larger teams. SAP team members identified mental health (68%), trauma (44%), and parent engagement (36%) as top training needs. CONCLUSIONS: An academic partnership successfully provided the capacity to review SAP survey responses, and informed evidenced-based discussion of best practice guidelines and realignment of staff professional development opportunities.

Facilitating biodiversity conservation through partnerships to achieve transformative outcomes.

Conservation biology is a mission-driven discipline that must navigate a new relationship between conservation and science. Because conservation is a social and political as well as an ecological project, conservation biologists must practice interdisciplinarity and collaboration. In a comparative study of 7 cases (Jaguars in the Chaco, Grevy's zebra in Kenya, Beekeeping in Tanzania, Andean cats in Argentina, Jaguars in Mexico, Lobster fishing, and Black bears in Mexico), we examined motivations for collaboration in conservation, who can collaborate in conservation, and how conservation professionals can work well together. In 5 case studies, successful conservation outcomes were prioritized over livelihood benefits. In the other 2 cases, livelihoods were prioritized. All case studies employed participatory approaches. There were multiple external actors, including local and Indigenous communities, nongovernmental organizations, agencies, regional and national governments, and international organizations, which enhanced conservation and wider sustainability outcomes. Key collaboration aspects considered across the case studies were time (mismatch between relationship building and project schedules), trust required for meaningful partnerships, tools employed, and transformative potential for people, nature, and the discipline of conservation biology. We developed guidelines for successful collaboration, including long-term commitment, knowledge integration, multiscalar and plural approaches, cultivation of trust, appropriate engagement, evaluation, supporting students, and efforts for transformation.

Facilitación de la conservación de la biodiversidad a través de colaboraciones para lograr resultados transformadores Resumen La biología de la conservación es una disciplina impulsada por sus objetivos que debe navegar una nueva relación entre la conservación y la ciencia. Dado que la conservación es un proyecto social y político así como ecológico, los biólogos de la conservación deben practicar la interdisciplinariedad y la colaboración. En un estudio comparativo de siete casos (jaguares en el Chaco, cebras de Grevy en Kenia, apicultura en Tanzania, gatos andinos en Argentina, jaguares en México, pesca de langosta, osos negros en México), analizamos las motivaciones para colaborar en la conservación, quién puede colaborar en la conservación y cómo los profesionales de la conservación pueden trabajar bien juntos. En cinco estudios de caso, se priorizaron los resultados satisfactorios de la conservación sobre los beneficios para los medios de subsistencia. En los otros 2 casos, se dio prioridad a los medios de sustento. Todos los estudios de caso emplearon enfoques participativos. Hubo múltiples actores externos, como comunidades locales e indígenas, organizaciones no gubernamentales, agencias, gobiernos regionales y nacionales y organizaciones internacionales, que mejoraron los resultados de conservación y sostenibilidad en general. Los aspectos clave de la colaboración considerados en los estudios de caso fueron el tiempo (desajuste entre el establecimiento de relaciones y los calendarios de los proyectos), la confianza necesaria para establecer colaboraciones significativas, las herramientas empleadas y el potencial transformador para las personas, la naturaleza y la disciplina de la biología de la conservación. Se elaboraron directrices para el éxito de la colaboración, como el compromiso a largo plazo, la integración de conocimientos, los enfoques multiescalares y plurales, el fomento de la confianza, la participación adecuada, la evaluación, el apoyo a los estudiantes y los esfuerzos de transformación. Facilitación de la conservación de la biodiversidad a través de colaboraciones para lograr resultados transformadores.

Recursos Públicos na Esfera Privada: Política de Educação Especial em um Município Paulista de Grande Porte / Public Resources in the Private Sphere: Special Education Policy in a Large Municipality of São Paulo

RESUMO: A Educação Especial brasileira tem marcas históricas da privatização, uma delas é focalizada neste artigo, que tem por objetivo analisar o repasse de recursos financeiros públicos da educação para a esfera privada em um município paulista de grande porte, entre 2012 e 2017. Adotando abordagem qualitativa, são analisados os valores liquidados em favor da Educação Especial direcionados à esfera privada a partir de fontes documentais, abrangendo contratos com empresas terceirizadas, termos de colaboração e aditamento, relatórios de remuneração de profissionais da Educação Especial e documentos de repasse de recursos à esfera privada. Os resultados indicam aumento dos recursos destinados a essa modalidade na esfera privada em decorrência, principalmente, da necessidade de contratação de cuidadoras(es), até aquele momento sem provimento de cargo nessa rede de ensino. Também expressam que a inclusão escolar reproduz modos de financiamento que marcam a história da Educação Especial no Brasil. A parceria com instituições privadas sem fins lucrativos e a contratação de empresas terceirizadas vão ao encontro da perspectiva gerencial da administração pública. No caso analisado, por um lado, a política de inclusão escolar terceirizou a manutenção dos serviços a partir da concessão para a esfera privada; por outro lado, houve crescente aumento do financiamento do setor público municipal.

ABSTRACT: Brazilian Special Education has historical marks of privatization, one of which is focused on this article, which aims to analyze the transfer of public financial resources from education to the private sphere in a large municipality in São Paulo, between 2012 and 2017. Adopting a qualitative approach, the amounts settled in favor of Special Education directed to the private sphere are analyzed based on documentary sources, covering contracts with outsourced companies, terms of collaboration and additions, reports on remuneration of Special Education professionals and documents for the transfer of funds to the private sphere. The results indicate an increase in resources allocated to this modality in the private sphere, mainly due to the need to hire caregivers, until that moment without filling a position in this teaching network. They also express that school inclusion reproduces funding modes that mark the history of Special Education in Brazil. The partnership with non-profit private institutions and the contracting of outsourced companies are in line with the managerial perspective of public administration. On the one hand, in the analyzed case, the school inclusion policy outsourced the maintenance of services from the concession to the private sphere, on the other hand, there was a growing increase in funding from the municipal public sector.

Implementing a multisector public-private partnership to improve urban hypertension management in low-and middle- income countries.

BACKGROUND: Cardiovascular disease presents an increasing health burden to low- and middle-income countries. Although ample therapeutic options and care improvement frameworks exist to address its prime risk factor, hypertension, blood pressure control rates remain poor. We describe the results of an effectiveness study of a multisector urban population health initiative that targets hypertension in a real-world implementation setting in cities across three continents. The initiative followed the "CARDIO4Cities" approach (quality of Care, early Access, policy Reform, Data and digital technology, Intersectoral collaboration, and local Ownership). METHOD: The approach was applied in Ulaanbaatar in Mongolia, Dakar in Senegal, and São Paulo in Brazil. In each city, a portfolio of evidence-based practices was implemented, tailored to local priorities and available data. Outcomes were measured by extracting hypertension diagnosis, treatment and control rates from primary health records. Data from 18,997 patients with hypertension in primary health facilities were analyzed. RESULTS: Over one to two years of implementation, blood pressure control rates among enrolled patients receiving medication tripled in São Paulo (from 12·3% to 31·2%) and Dakar (from 6·7% to 19·4%) and increased six-fold in Ulaanbaatar (from 3·1% to 19·7%). CONCLUSIONS: This study provides first evidence that a multisectoral population health approach to implement known best-practices, supported by data and digital technologies, and relying on local buy-in and ownership, can improve hypertension control in high-burden urban primary care settings in low-and middle-income countries.

Formative Exploration of the Feasibility of Embedding Community Assets Into Primary Health Care: Barbershop and Place of Worship Readiness in Guyana.

INTRODUCTION: Community engagement is key to improving the quality of primary health care (PHC), with asset-based interventions shown to have a positive impact on equity and health outcomes. However, there tends to be a disconnect between community-based interventions and PHC, with a lack of evidence on how to develop sustainable community-primary care partnerships. This paper reports on the formative phases of 2 studies exploring the feasibility of embedding community assets, namely places of worship and barbershops, into the PHC pathway for the prevention and control of NCDs in deprived settings. It describes the participatory approach used to map and gather contextual readiness information, including the enablers and constrainers for collaborative partnerships with PHC. METHODS: Grounded in community-based participatory research, we used elements of ground-truthing and participatory mapping to locate and gather contextual information on places of worship and barbershops in urban and rural communities. Local knowledge, gathered from community dialogs, led to the creation of sampling frames of these community assets. Selected places of worship were administered a 66-item readiness questionnaire, which included domains on governance and financing, congregation profile, and existing health programs and collaborations. Participating barbershops were administered a 40-item readiness questionnaire, which covered barbers' demographic information, previous training in health promotion, and barbers' willingness to deliver health promotion activities. RESULTS: Fourteen barbershops were identified, of which 10 participated in the readiness survey, while 240 places of worship were identified, of which 14 were selected and assessed for readiness. Contextual differences were found within and between these assets regarding governance, accessibility, and reach. Key enablers for both include training in health promotion, an overwhelming enthusiasm for participation and recognition of the potential benefits of a community-primary care partnership. Lack of previous collaborations with the formal health system was common to both. CONCLUSION: The participatory approach extended reach within underserved communities, while the readiness data informed intervention design and identified opportunities for partnership development. Contextual differences between community assets require comprehensive readiness investigations to develop suitably tailored interventions that promote reach, acceptance, and sustainability.

Kidney health for all: bridging the gap in kidney health education and literacy / Saúde dos rins para todos: preenchendo a lacuna de educação e conhecimento sobre a saúde renal

Abstract The high burden of kidney disease, global disparities in kidney care, and the poor outcomes of kidney failure place a growing burden on affected individuals and their families, caregivers, and the community at large. Health literacy is the degree to which individuals and organizations have, or equitably enable individuals to have, the ability to find, understand, and use information and services to make informed health-related decisions and actions for themselves and others. Rather than viewing health literacy as a patient deficit, improving health literacy lies primarily with health care providers communicating and educating effectively in codesigned partnership with those with kidney disease. For kidney policy makers, health literacy is a prerequisite for organizations to transition to a culture that places the person at the center of health care. The growing capability of and access to technology provides new opportunities to enhance education and awareness of kidney disease for all stakeholders. Advances in telecommunication, including social media platforms, can be leveraged to enhance persons' and providers' education. The World Kidney Day declares 2022 as the year of "Kidney Health for All" to promote global teamwork in advancing strategies in bridging the gap in kidney health education and literacy. Kidney organizations should work toward shifting the patient-deficit health literacy narrative to that of being the responsibility of health care providers and health policy makers. By engaging in and supporting kidney health-centered policy making, community health planning, and health literacy approaches for all, the kidney communities strive to prevent kidney diseases and enable living well with kidney disease.

Resumo A elevada carga da doença renal, disparidades globais no cuidado renal e desfechos ruins da insuficiência renal impõem uma sobrecarga crescente aos indivíduos afetados e suas famílias, cuidadores e a própria comunidade geral. Educação em saúde é o grau em que indivíduos e organizações têm, ou que igualmente permitem que indivíduos tenham, capacidade de encontrar, compreender e utilizar informações e serviços para tomar decisões e ações conscientes relacionadas à saúde para si e outros. Mais do que enxergar educação em saúde como um problema dos pacientes, a melhoria dessa educação depende principalmente da comunicação e educação efetiva dos profissionais em parceria com aqueles que apresentam doença renal. Para formuladores de políticas renais, educação em saúde é pré-requisito para que organizações migrem para uma cultura que coloque a pessoa no centro dos cuidados. A crescente capacidade e acesso à tecnologia oferecem novas oportunidades para melhorar educação e conscientização sobre doença renal para todas as partes interessadas. Avanços nas telecomunicações, incluindo redes sociais, podem ajudar a melhorar a educação de pessoas e provedores. O Dia Mundial do Rim declara 2022 como o ano da "Saúde dos Rins para Todos" promovendo trabalho em equipe global no avanço de estratégias para preencher a lacuna na educação e conhecimento em saúde renal. Organizações renais devem trabalhar para mudar a narrativa da educação em saúde como um problema de pacientes, para sendo responsabilidade dos profissionais e formuladores de políticas. Ao engajar-se e apoiar formulação de políticas centradas na saúde renal, planejamento de saúde comunitária e abordagens de educação em saúde para todos, comunidades renais esforçam-se para prevenir doenças renais e permitir viver bem com elas.

Community, Hope, and Resilience: Parental Perspectives on Peer Support in Neonatology.

OBJECTIVES: To describe the perspective of parents who participated in peer-to-peer support meetings with parents of children in a neonatal intensive care unit (NICU) and veteran resource parents with previous NICU experience. STUDY DESIGN: During a longitudinal evaluation in a tertiary care NICU, participating parents were asked to evaluate meetings; with open-ended questions, they were asked about their perspectives. Results were analyzed using mixed methods. RESULTS: Forty-five NICU parents participated over a 10-week study period. They were followed longitudinally after attending at least 1 of the 10 meetings offered; 95% of parents (43 of 45) reported that the meeting was useful to them and gave an overall evaluation of 8.7 out of 10 (average). For each meeting, all the subjects on the checklist of the moderators (veteran resource parents) were discussed with new parents. When describing why and how the meetings were useful to them in their answers to open-ended questions, NICU parents reported 3 major themes: (1) decreasing isolation and being a community (73%), (2) hope and resilience (63%), and (3) getting practical "parent" information (32%). Sharing stories with parents who also had experienced loss, sadness, and grief, NICU parents trusted that it was possible to adapt and thrive. The meetings normalized parents' emotions (92%), decreased negative emotions (eg, anger, sadness, guilt), empowered them in their parental role, and helped them communicate with loved ones and providers. CONCLUSIONS: Peer support meetings are a unique and useful means to support parents. Future investigations will investigate whether and how this type of intervention can improve clinical outcomes.

Rapid establishment of a dedicated COVID-19 hospital in Mexico city during a public health crisis.

Healthcare systems worldwide have adapted and reorganized during the coronavirus disease 2019 (COVID-19) pandemic. Here, we provide a framework based on a public-private partnership that funded, developed, and operated a temporary COVID-19 hospital in Mexico City. We describe the creation of a collaborative network of primary healthcare triage centers and hospitals distributed throughout the city in recognition of demographic and geographic patterns that correlate with COVID-19 infections, including marginalized and impoverished areas of Mexico City. Additionally, we also report the hospital's cumulative outcomes over the 14 months of operation and show that it is feasible to transform a large public venue into a specialized hospital that incorporates a digital platform with robust clinical protocols to provide positive clinical outcomes.

During Mexico's response to the COVID-19 pandemic, the Carlos Slim Foundation (CSF), with a group of local foundations, academic institutions, and the Government of Mexico City, established a synergistic public­private partnership with the purpose of funding, designing, developing, and operating a dedicated COVID-19 hospital. This was achieved in 17 days by rapidly transforming into a hospital the largest convention center in Latin America, which is located in the heart of Mexico City. An ex professo network of eight dedicated respiratory triage community centers in coordination with other 40 federal and state primary health care clinics and hospitals was also established to streamline patient referral, thereby mitigating the impact of the COVID-19 pandemic in Mexico City's metropolitan area. We provide a framework for designing, funding, and executing the operations of a dedicated hospital in response to the COVID-19 pandemic that, from its conception, execution, operation, and closure, involved an exemplary coordination between public-private partnerships during a public health crisis. Referral, admission, treatment, clinical monitoring, discharge, and household follow-up were facilitated by the COVID360 digital health platform. The successful development and implementation of this multi-faceted digital platform allowed a lean patient-centered process, the management of clinical and administrative data, training of healthcare professionals, and the dissemination of accurate health information for data-driven decision making. This rapidly implemented temporary hospital dedicated to the comprehensive care of patients with COVID-19 was critical in coping with the increasing number of cases in Mexico City while achieving outstanding clinical outcomes.

Ecological footprint, public-private partnership investment in energy, and financial development in Brazil: a gradual shift causality approach.

The present study assesses the effect of public-private partnerships in energy and financial development on Brazil's ecological footprint and also takes into account the role of renewable energy and economic growth using data spanning from 1983 to 2017. The study utilized several techniques including autoregressive distributive lag (ARDL) and dynamic ordinary least square (DOLS) to examine the relationship between ecological footprint and the determinants, while the gradual shift causality test was utilized to capture the causal linkage between the series in the presence of a single structural break. The outcomes of the Maki co-integration test revealed evidence of a long-run association among the variables of interest. Furthermore, the results of the ARDL and DOLS tests revealed that economic growth and public and private investment in energy increase environmental degradation, while it is mitigated by both renewable energy and financial development. Moreover, the gradual shift causality test revealed a bidirectional causal linkage between ecological footprint and economic growth. The present study recommends the establishment of a forum that will foster public and private partnerships to enhance communication, which will promote collaboration on new initiatives involving green technological innovations.

Parceria público-privada na gestão hospitalar no Sistema Único de Saúde da Bahia, Brasil / Public-private partnerships in hospital administration in the Brazilian Unified National Health System in Bahia State, Brazil / Colaboración público-privada en la gestión hospitalaria en el Sistema Único de Salud de Bahía, Brasil

Resumo: O processo de construção do Sistema Único de Saúde (SUS) tem sido, desde o início, espaço de disputa entre as forças políticas que defendem a ampliação da participação do setor privado na assistência e gestão dos serviços, e os defensores do fortalecimento da gestão pública. No contexto do subfinanciamento do SUS, associado às restrições impostas pela Lei de Responsabilidade Fiscal, novos modelos de gestão têm sido adotados, especialmente na área de gestão hospitalar, a exemplo da parceria público-privada (PPP). Considerando a relevância de investigar os processos de decisão relativos à adoção desses modelos pelas Secretarias Estaduais de Saúde, este trabalho tem por objetivo analisar os processos de tomada de decisão e incorporação desse modelo de gestão hospitalar no Estado da Bahia, Brasil, primeira concessão administrativa no setor de saúde do Brasil. Trata-se de um estudo de caso que tomou como referencial teórico a teoria do jogo social, elaborada por Carlos Matus, articulada ao modelo analítico do Ciclo de Políticas Públicas. Os dados foram produzidos a partir de pesquisa documental e entrevistas semiestruturadas com informantes-chave que participaram dos momentos de pré-decisão e decisão acerca do modelo PPP. O artigo apresenta o jogo político em torno da escolha dessa alternativa entre outros modelos para gestão hospitalar, além de debater vantagens e desvantagens dos modelos segundo atores-chave entrevistados, e conclui que determinantes não apenas financeiros, mas também políticos e ideológicos marcaram o processo de decisão pelo modelo PPP na Bahia, que teve como fomentador e consultor o braço direito do Banco Mundial, a Corporação Financeira Internacional.

Abstract: The process of building Brazil´s Unified Health System has always been a space of dispute between the political forces that defend greater private sector participation in patient care and administration of services and those who defend strengthening public administration. In the context of underfinancing of the Brazilian Unified National Health System (SUS), associated with the restrictions imposed by the so-called Fiscal Responsibility Law, new management models have been adopted in hospital administration, including public-private partnerships (PPPs). Considering the relevance of investigating decision-making processes pertaining to the adoption of these models by State Health Departments, this study aims to analyze the decision-making processes and incorporation of this hospital administration model in the State of Bahia, Brazil, the first administrative concession in Brazil´s health sector. This is a case study in which the theoretical reference was Social Game Theory elaborated by Carlos Matus, linked to the Public Policy Cycle analytical model. The data were produced with document research and semi-structured interviews with key informants who participated in the pre-decision and decision-making stages of the PPP model. The article presents the political game involved in the choice of this alternative among other hospital administration models, besides debating the models´ advantages and disadvantages according to the key actors and concludes that determinants (not only financial, but also political and ideological) marked the decision-making process for the PPP model in Bahia, in which the driving factor and source of consultancy was the International Finance Corporation, an arm of the World Bank.

Resumen: El proceso de construcción del Sistema Único de Salud ha sido, desde el comienzo, un espacio de disputa entre las fuerzas políticas que defienden la ampliación de la participación del sector privado en la asistencia y gestión de los servicios, y los defensores del fortalecimiento de la gestión pública. En el contexto de la subfinanciación del SUS, asociado a las restricciones impuestas por la Ley de responsabilidad fiscal, se han adoptado nuevos modelos de gestión, especialmente en el área de gestión hospitalaria, como por ejemplo la colaboración público-privada (PPP por sus siglas en portugués). Considerando la relevancia de investigar los procesos de decisión, relativos a la adopción de esos modelos por parte de las Secretarías Estatales de Salud, este trabajo tiene como objetivo analizar los procesos de toma de decisión e incorporación de este modelo de gestión hospitalaria en el Estado de Bahía, Brasil, primera concesión administrativa en el sector de salud de Brasil. Se trata de un estudio de caso, que tomó como marco de referencia teórico la Teoría de Juego Social, elaborada por Carlos Matus, coordinada con el modelo analítico del Ciclo de Políticas Públicas. Los datos fueron producidos a partir de una investigación documental y entrevistas semiestructuradas con informantes-clave que participaron en los momentos de pre-decisión y decisión acerca del modelo PPP. El artículo presenta el juego político en torno de la elección de esa alternativa entre otros modelos para gestión hospitalaria, además de debatir ventajas y desventajas de los modelos, según actores-claves entrevistados, y concluye que determinantes no solo financieros, sino políticos e ideológicos marcaron el proceso de decisión del modelo PPP en Bahía, que tuvo como fomentador y consultor al brazo derecho del Banco Mundial, la Corporación Financiera Internacional.

The Health Impact Fund: making the case for engagement with pharmaceutical laboratories in Brazil, Russia, India, and China.

Despite progress in global health, the general disease burden still disproportionately falls on low- and middle-income countries. The health needs of these countries' populations are unmet because there is a shortage in drug research and development, as well as a lack of access to essential drugs. This health disparity is especially problematic for diseases associated with poverty, namely neglected tropical diseases and microbial infections. Currently, the pharmaceutical landscape focuses on innovations determined by profit margins and intellectual property protection. To expand drug accessibility and catalyze research and development for neglected diseases, a team of researchers proposed the Health Impact Fund as a potential solution. However, the fund is predominantly considering partnerships with pharmaceutical giants in high-income countries. This commentary explores the limitations and benefits in partnering with pharmaceutical companies based in Brazil, Russia, India, and China (BRIC), with the goal of expanding the Health Impact Fund's vision to incorporate long-term, local partnerships. Identified limitations to a BRIC country partnership include lower levels of drug development expertise compared to their high-income pharmaceutical counterparts, and whether the Health Impact Fund and the participating stakeholders have the financial capability to assist in bringing a new drug to market. However, potential benefits include the creation of new incentives to fuel competitive local innovation, more equitable routes to drug discovery and development, and a product pipeline that could involve stakeholders in lower- and middle-income countries. Our commentary explores how partnership with pharmaceutical firms in BRIC countries might be advantageous for all: The Health Impact Fund, pharmaceutical companies in BRIC economies, and stakeholders in low- and middle- income countries.

The Effect of Partnership Presence and Support on HIV Viral Suppression Among Serodiscordant Partnered and Single Heterosexual HIV-Positive Individuals in Brazil.

HIV-negative individuals in serodiscordant partnerships experience reduced risk of HIV acquisition when their partners adhere to ART and achieve undetectable viral loads. Partnership support may encourage ART adherence, reducing viral load and the risk of HIV transmission. This study aims to determine whether HIV viral suppression is associated with partnership status and partnership support among 201 HIV positive (HIV+ individuals in serodiscordant partnerships and 100 HIV+ unpartnered individuals receiving care at Hospital Nossa Senhora da Conceição in Porto Alegre, Brazil between 2014 and 2016. Clinical data and patient-reported questionnaire data were assessed, and propensity scores were used to control for confounding variables in adjusted logistic regression models. Viral suppression did not significantly differ between HIV+ partnered (78.5% virally suppressed) and unpartnered (76.0% virally suppressed) individuals. Among individuals in partnerships, viral suppression was significantly associated with having a partner who attended monthly clinic visits (AOR 2.99; 95% CI 1.00-8.93). Instrumental social support-attending monthly visits-may improve the odds of viral suppression among HIV+ individuals in serodiscordant relationships.

A Case Study in Academic-Community Partnerships: A Community-Based Nutrition Education Program for Mexican Immigrants.

Hispanics are the largest U.S. immigrant group and Mexican Americans are the largest U.S. Hispanic population. Hispanics, particularly Mexican Americans, are among the highest risk groups for obesity, placing them at increased risk for cardiovascular disease and certain types of cancer. Obesity lifestyle interventions incorporating Motivational Interviewing techniques and specific adaptations for the population of interest can have a significant impact on reducing health risks. This paper presents a community-engaged, culturally-sensitive nutrition and dietary counseling intervention conducted between 2016 and 2018 at the Consulate General of Mexico in New York City and reports preliminary findings regarding participant satisfaction and self-reported changes in eating and exercise habits. In addition, it describes the community and academic partners' roles and processes in program development, discusses strengths and challenges posed by a multi-sector partnership and describes adaptations made using the Behavioral Model for Vulnerable Populations to increase the program's sustainability and potential for scalability.

[Cooperation between the department of ophthalmology at the University of Düsseldorf (Germany) and the Fundación Visión in Asunción (Paraguay) as an example of the German hospital partnerships programm]. / Das deutsche Klinikpartnerschaftsprogramm am Beispiel der Kooperation der Klinik für Augenheilkunde des Universitätsklinikums Düsseldorf mit der Fundación Visión in Asunción (Paraguay).

BACKGROUND: A hospital partnership between the University Eye Hospital Düsseldorf (UAK Düsseldorf) and Fundación Visión in Asunción has existed since 2014 based on a memorandum of understanding. Fundación Visión plays a leading role in ophthalmological treatment and prevention of blindness in Paraguay. Since 2016 a program for the promotion of international hospital partnerships of the German government has been in place. MATERIAL AND METHODS: Following a written application in 2016 the hospital partnership Düsseldorf-Asunción is funded by the Federal Ministry for Economic Cooperation in Germany. The aim of the project was to establish modern minimally invasive corneal transplantation techniques with faster postoperative rehabilitation and less follow-up in Paraguay with the help of several activities within a defined schedule. Secondary aims were to obtain first data on the prevalence of eye diseases in a typical patient cohort of the Fundación Visión and to establish an infrastructure for modern eye banking techniques in Paraguay. RESULTS: First a Paraguayan surgeon was trained to carry out Descemet membrane endothelial keratoplasty (DMEK) transplantations in Germany. At the same time, the surgical instruments required for the DMEK technique were purchased and delivered to the Fundación Visión. In September 2018 the first lamellar corneal transplantations were successfully performed in Paraguay by the team from the Fundación Visión under the supervision of an experienced surgical team from Düsseldorf. Subsequently, the split cornea approach using a donor cornea for a posterior and an anterior lamellar keratoplasty (DMEK and DALK) was also implemented in Asunción. In November 2019 epidemiological data on eye diseases were collected during a field campaign of the Fundación Visión in a rural region of Paraguay. In the course of data collection an employee of the University Eye Hospital Düsseldorf learned small incision cataract surgery. In March 2019, a technician from the Fundación Visión was trained in Düsseldorf in corneal tissue culture techniques and preparation of amniotic membrane transplants in the Lions eye bank North-Rhine/Westfalia. CONCLUSION: With the aid of a supported hospital partnership modern minimally invasive corneal transplantation techniques can be successfully transferred to the eye hospital of a developing country and in return surgical skills can be taught to surgeons from Germany who are in training. Therefore, an efficient hospital partnership is the basis for a mutual exchange and is not purely one-way traffic.