Unpacking participation in healthcare governance: Lessons from two local health councils in Brazil and Spain.

This paper describes and compares the integration of cross-sector actors' participation into the governance of two local health councils, one located in Salvador de Bahia (Brazil) and the other in the Canary Islands (Spain). Based on the cross-national comparative research conducted as part of a doctoral thesis, a qualitative design based on secondary data analysis was proposed on the three stages of the organisational integration process of participation. We used information from individual semi-structured interviews (n = 70), situational observation, focus groups, literature review, and field notes to understand participatory processes of networking between multiple cross-sector actors and to show how such processes might be associated with innovative practices. For these innovations to be successfully implemented, stakeholders need to acquire adequate competencies in cross-sector collaboration, enabling them to learn about new organisational practices and to adapt the network of actors to the often unpredictable influences of contextual factors.

Impacto de los determinantes sociales de la salud sobre la tasa de contagios por COVID-19 / Impact of the social determinants of health on the rate of infections by COVID-19

RESUMEN Objetivo Analizar el impacto entre los determinantes sociales en salud en México y la tasa de contagios por COVID-19. Método Estudio ecológico cuantitativo a nivel nacional y municipal. Las principales variables fueron tasa de contagios por COVID-19, población total no hablante de español, ingreso per cápita, pobreza e índice de desarrollo humano (IDH). La tasa media nacional de contagios fue de 2 880/100 000 habitantes. Se aplicó la prueba T-test y, para determinar la fuerza de asociación entre la tasa de contagios y las variables, se aplicó la prueba de correlación de Pearson. Resultados Las entidades con menos tasa de población no hablante de español tuvo la menor tasa de contagios por COVID-19. El análisis de correlación mostró que los estados con tasas de contagio por COVID-19 por arriba de la media nacional tienen mejores condiciones de desarrollo. Discusión En nuestros resultados se revela una correlación negativa entre las tasas contagios por COVID-19 y la variable pertenecer a población indígena. Es necesario analizar desde la perspectiva de las comunidades las necesidades para afrontar escenarios de pandemia.

ABSTRACT Objective To analyze the impact between the social determinants in health and the rate of COVID-19 infection. Methods Quantitative ecological study at national and municipal levels. The main variables were COVID-19 infection rate, total non-Spanish-speaking population, per capita income, poverty, and human development index (HDI). The average national infection rate was 2 880/100 000 inhabitants. The T-test was applied, and Pearson's correlation test was performed to determine the strength of the association between the infection rate and the variables. Results Entities with the lowest rate of non-Spanish-speaking population had the lowest rate of COVID-19 infections. The correlation analysis showed that states with COVID-19 infection rates above the national average have better development conditions. Discussion Our results reveal a negative correlation between COVID-19 infection rates and the variable belonging to an indigenous population. It is necessary to analyze from the perspective of the communities the needs to face pandemic scenarios.

The Analytical Framework of Governance in Health Policies in the Face of Health Emergencies: A Systematic Review.

The Governance Analytical Framework (MAG) defines governance as a social fact, endowed with analyzable and interpretable characteristics, through what it calls observable constitutive elements of governance: the problem, the actors, the social norms, the process of decision-making and scope or nodal points; in the sense that each society develops its modes of governance, its decision-making or conflict resolution systems among its members, its norms, and institutions. In this perspective, the purpose of this article was to carry out a systematic review of the scientific literature to understand the role of governance in health policies in health emergencies, such as that caused by the SARS-CoV-2. The systematic review was designed based on the methodology proposed in the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) Declaration. The literature search was carried out in six databases: Psychology and Behavioral Sciences, APA-PsycInfo, MEDLINE, eBook Collection (EBSCOhost), PubMED, and MedicLatina, published in the last 5 years. Fifteen articles that met quality and evidence criteria were analyzed. The governance approach alluding to the health emergency problem in health policies was the most addressed by the authors (80%), followed by a description of the actors (40%), the process of decision-making spaces (33%), and ultimately, social norms or rules with 13%. Formulating a coherent set of global health policies within a large-scale global governance framework is mostly absent. Although the countries adopt international approaches, it is a process differentiated by the social, economic, and political contexts between countries, affecting heterogeneous health outcomes over the pandemic.

Gobernanza en el sistema de salud ante la pandemia por Covid-19 en México / Governance in health system in the face of the Covid-19 pandemic in Mexico

Resumen: Objetivo: Analizar la gobernanza en el sistema de salud en México, en las políticas frente a la pandemia por Covid-19. Material y métodos: Estudio cualitativo, analítico, realizado entre junio y noviembre de 2020. Se analizaron 41 entrevistas semiestructuradas que se aplicaron a actores clave del sistema de salud y que se organizaron en el software ATLAS.ti 9. El análisis se adhirió a los principios teórico-metodológicos del Marco Analítico de Gobernanza. Resultados: El problema: la formulación de políticas fue centralizada; los actores: sólo los altos mandos participan en las decisiones; las normas: los valores sociales y el liderazgo determinan su nivel de responsabilidad; toma de decisiones: los altos mandos reconocieron poder para proponer modificaciones al Marco Normativo; los nodos: las políticas federales fueron adaptadas a nivel estatal de manera diferenciada. Conclusiones: La gobernanza centralizada, los niveles diferenciados de convocatoria de los actores, su poder de decisión, acuerdos, responsabilidad y liderazgo, definieron el alcance de la gobernanza y, a su vez, el nivel de respuesta ante la pandemia por Covid-19.

Abstract: Objective: Analyze governance in the Mexican health system, with regards to policies to combat the Covid-19 pandemic. Materials and methods: Qualitative, analytic study carried out from June to November, 2020. Forty-one semi-structured interviews with key actors in the health system were analyzed and organized in ATLAS.ti-v.9 software. The analysis followed theoretical-methodological principles of the Governance Analytical Framework. Results: The problem: the policy-making was centralized; the actors: only high level actors participated in the decisions; decision-making: high level actors recognized power to propose modifications in the regulatory framework; nodes: federal policies were adapted at the state level in a differential manner. Conclusions: Centralized governance, differential levels of convocation of actors, decision-making power, level of agreements, as well as responsibility and leadership, all defined the reach of governance and, in turn, the level of response to the Covid-19 pandemic.

Gobernanza en el sistema de salud ante la pandemia por Covid-19 en México.

Objetivo. Analizar la gobernanza en el sistema de salud en México, en las políticas frente a la pandemia por Covid-19. Material y métodos. Estudio cualitativo, analítico, realizado entre junio y noviembre de 2020. Se analizaron 41 entrevistas semiestructuradas que se aplicaron a acto-res clave del sistema de salud y que se organizaron en el software ATLAS.ti 9. El análisis se adhirió a los principios teórico-metodológicos del Marco Analítico de Gobernanza. Resultados. El problema: la formulación de políticas fue centralizada; los actores: sólo los altos mandos participan en las decisiones; las normas: los valores sociales y el liderazgo determinan su nivel de responsabilidad; toma de decisio-nes: los altos mandos reconocieron poder para proponer modificaciones al Marco Normativo; los nodos: las políticas federales fueron adaptadas a nivel estatal de manera diferen-ciada. Conclusiones. La gobernanza centralizada, los niveles diferenciados de convocatoria de los actores, su poder de decisión, acuerdos, responsabilidad y liderazgo, definieron el alcance de la gobernanza y, a su vez, el nivel de respuesta ante la pandemia por Covid-19.