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.

Panorámica de la COVID-19 en tres municipios de Guerrero, México, durante 2020 / Overview of COVID-19 in three municipalities of Guerrero, México during 2020

RESUMEN Objetivo Estimar la magnitud de daños a la salud por la pandemia de COVID-19 y su dinámica en Ometepec, Xochistlahuaca y Tlacoachistlahuaca, en Guerrero, México, durante 2020. Métodos Estudio retrospectivo hecho mediante un análisis secundario de la base de datos de COVID-19 de la Secretaría de Salud de México. Con análisis bivariado y regresión logística binaria, se desarrollaron estimaciones de series de tiempo y de magnitud del daño a la salud por COVID-19. Resultados Durante las semanas epidemiológicas 12 a 40 de 2020, se confirmaron 325 casos y 28 defunciones por COVID-19. De los casos confirmados, solo 16 % fueron indígenas. Dos de cada tres defunciones ocurrieron en las primeras 48 horas del ingreso hospitalario. Las variables predictoras que mejor se ajustaron al modelo de regresión, asociadas a la letalidad hospitalaria, fueron diabetes, neumonía asociada a COVID-19 y edad de 50 años o mayor. Conclusiones Es importante enfatizar los datos de alarma de la COVID-19 a la población indígena (en particular, la dificultad respiratoria) y factores asociados a complicaciones por COVID-19 como diabetes y edad avanzada, para incrementar el uso oportuno de los servicios de salud.

ABSTRACT Objective To estimate the magnitude and dynamics of health outcomes related to the COVID-19 pandemic and the dynamic in Ometepec, Xochistlahuaca and Tlacoachist-lahuaca in Guerrero, Mexico. Methods Retrospective study developed from the secondary analysis of the COVID-19 database, from the Mexican Ministry of Health in 2020. We developed time series and estimated the magnitude of the health effects of the pandemic by means of bivariate analysis and binary logistic regression models. Results The public health services registered 325 confirmed cases and 28 deaths from COVID-19 during epidemiologic weeks 12 to 40 in 2020. Nearly 16% of confirmed cases pertained to patients self-reported as indigenous people. Two out of three deaths occurred within 48 hours of hospital admission. Diabetes, COVID-19 pneumonia and being age 50 years or older were the predictor variables associated with hospital fatality which best fit our regression models. Conclusions It is essential to promote a greater use of government health services among indigenous populations by disseminating culturally relevant information on war-ning signs such as difficulty breathing and risk factors such as suffering from diabetes and being an older adult.