Sector-wide analysis of early childhood development and education in emergencies in Colombia and considerations to strengthen systems globally.

There is an urgent need to strengthen early childhood development and education in emergencies (ECDEiE) globally. Colombia has faced protracted and acute crises for decades. Also, the country has applied a unique approach to holistic and integrated ECDE policy formulation. We argue that these characteristics offer a valuable country-case to identify barriers and levers to the operationalization of ECDEiE. We applied a sector-wide analysis protocol that harmonized components of the Humanitarian Programme Cycle by the Inter-Agency Standing Committee and of a framework to characterize the governance of ECDE systems. The study outlines how the policy and program characteristics identified may represent levers or barriers to the effective operationalization of ECDEiE in Colombia. We discuss how these attributes could be considered in the trans-sectoral dialogue between ECDE and humanitarian actors with the aim of strengthening ECDEiE systems globally.

Conditional cash transfer programs and the health and nutrition of Latin American children.

OBJECTIVE: To 1) describe the benefits, conditions, coverage, funding, goals, governance, and structure of well-established conditional cash transfer programs (CCTs) in Latin America and 2) identify their health and nutritional impacts among children under 5 years old. METHODS: A realist review was conducted. CCTs were included if they met the following inclusion criteria: 1) current national-level program; 2) coverage of at least 50% of the target population; 3) continuous operation at scale for 10+ years; 4) clear description of structure, funding sources, and governance; 5) both health/nutrition- and education-related conditions for participation; and 6) available impact evaluation studies with health, development, and/or nutrition indicators among children under 5 years old. Three CCTs (one each in Brazil, Colombia, and Mexico) met the criteria. RESULTS: There was consistent evidence that the three CCTs selected for review had positive impacts on child health and nutrition outcomes in their respective countries. In all three countries, the programs were scaled up and positive impacts were documented relatively quickly. All three programs had strong political support and clear and transparent governance structures, including accountability and social participation mechanisms, which might explain their success and sustainability. CONCLUSIONS: CCTs in Latin America have had a positive impact on child health and nutrition outcomes among the poorest families. A key challenge for the future is to reform these programs to help families move out of not only extreme poverty but all poverty in order to lead healthy and productive lives, as called for in the post-2105 Sustainable Development Goals.

Conditional cash transfer programs and the health and nutrition of Latin American children / Los programas de transferencias de efectivo condicionadas y la salud y alimentación de los niños latinoamericanos

ABSTRACT Objective To 1) describe the benefits, conditions, coverage, funding, goals, governance, and structure of well-established conditional cash transfer programs (CCTs) in Latin America and 2) identify their health and nutritional impacts among children under 5 years old. Methods A realist review was conducted. CCTs were included if they met the following inclusion criteria: 1) current national-level program; 2) coverage of at least 50% of the target population; 3) continuous operation at scale for 10+ years; 4) clear description of structure, funding sources, and governance; 5) both health/nutrition- and education-related conditions for participation; and 6) available impact evaluation studies with health, development, and/or nutrition indicators among children under 5 years old. Three CCTs (one each in Brazil, Colombia, and Mexico) met the criteria. Results There was consistent evidence that the three CCTs selected for review had positive impacts on child health and nutrition outcomes in their respective countries. In all three countries, the programs were scaled up and positive impacts were documented relatively quickly. All three programs had strong political support and clear and transparent governance structures, including accountability and social participation mechanisms, which might explain their success and sustainability. Conclusions CCTs in Latin America have had a positive impact on child health and nutrition outcomes among the poorest families. A key challenge for the future is to reform these programs to help families move out of not only extreme poverty but all poverty in order to lead healthy and productive lives, as called for in the post-2105 Sustainable Development Goals.

RESUMEN Objetivo (1) Describir los beneficios, requisitos, cobertura, financiamiento, objetivos, gobernanza y estructura de programas bien consolidados de transferencias de efectivo condicionadas (TEC) en América Latina y (2) determinar su efecto en la salud y el estado nutricional de los niños menores de 5 años. Métodos Se llevó a cabo una revisión realista. Se incluyeron en ella los programas de TEC que satisfacían los siguientes criterios de inclusión: (1) programa de alcance nacional en curso; (2) cobertura de 50% de la población destinataria como mínimo; (3) funcionamiento en gran escala sin interrupción durante 10 años o más; (4) descripción explícita de la estructura, fuentes de financiamiento y gobernanza; (5) requisitos para la participación basados en criterios de salud y nutrición, así como de educación; y (6) disponibilidad de estudios de evaluación de efectos con indicadores de salud, desarrollo o estado nutricional en niños menores de 5 años. Tres programas de TEC (uno en el Brasil, uno en Colombia y otro en México) satisficieron estos criterios. Resultados Hay pruebas contundentes de que los tres programas de TEC seleccionados para la revisión tuvieron efectos favorables en la salud y el estado nutricional de los niños en sus respectivos países. En los tres países los programas se ampliaron y los efectos positivos se documentaron con relativa rapidez. Los tres programas gozaron de un sólido apoyo político y tuvieron estructuras de gobernanza explícitas y transparentes con mecanismos de rendición de cuentas y de participación social, lo cual podría explicar sus buenos resultados y sostenibilidad. Conclusiones En América Latina, las TEC han tenido un efecto favorable en la salud de los niños y en el estado nutricional de las familias más pobres. Un reto para el futuro estriba en reformar estos programas para ayudar a las familias a salir no solo de la extrema pobreza, sino de la pobreza en general a fin de que puedan llevar vidas saludables y productivas, en conformidad con los Objetivos de Desarrollo Sostenible para después del 2015.

[Forms of management of the national school meals program]. / As formas de gestão do programa nacional de alimentação escolar (PNAE).

The National School Meals Programme (PNAE in Portuguese initials) is a supplementary program to education that aims to provide school meals for pupils across the school system enrolled in public and philanthropic schools of primary education, secondary education, youth education, adult education and comprehensive education. The principles of the program are the universality and the expansion of student services in order to meet the Organic Law on Food and Nutritional Security (LOSAN), as well as the Food Security and Nutrition System. The objective of this study is to discuss forms of PNAE management to ensure that the students' right to school meals. This study is a reflection on how the resources of school meals are being managed, be it with a centralized, decentralized, semi-centralized or outsourced model. We conclude that the knowledge of the different forms of managing federal resources for food for school communities allows for making an informed choice regarding implementation and enforcement of PNAE.

Programa de tamizaje universal e intervención precoz (PTUIP) en hipoacusia sensorioneural bilateral congénita: Tarea pendiente desde la perspectiva de políticas públicas de salud en Chile / Universal screening program and early intervention (uspei) in congenital bilateral sensorineural hearing loss in Chile

Congenital hearing loss is the total or partial inability to hear sounds through the ears. It is the most common disability in newborns in Chile and worldwide, and is a permanent condition. The direct impact on children who are not adequately diagnosed is the alteration in acquisition of language and cognitive skills and a decline in their social and school insertion, jeopardizing their professional and potentially productive life. Universal screening programs for hearing loss are essential for the diagnosis, since 50% of infants with hearing loss have no known risk factor. Screening before one month of age, confirmation before 3 months, and effective intervention before 6 months, allows the development of these children as if they had normal hearing. In Chile there is a selective program of screening for infants aged less than 32 weeks or 1,500 grams, as part of Explicit Health Guarantees, but it covers only 0.9% of newborns per year. Therefore, a large majority of children remain without diagnosis. The aim of this review is to compare the situation in Chile with other countries, raising the need to move towards a universal neonatal hearing loss screening program, and propose necessary conditions in terms of justification and implementation of a universal screening public policy.

[Universal screening program and early intervention (USPEI) in congenital bilateral sensorineural hearing loss in Chile]. / Programa de tamizaje universal e intervención precoz (PTUIP) en hipoacusia sensorioneural bilateral congénita: Tarea pendiente desde la perspectiva de políticas públicas de salud en Chile.

Congenital hearing loss is the total or partial inability to hear sounds through the ears. It is the most common disability in newborns in Chile and worldwide, and is a permanent condition. The direct impact on children who are not adequately diagnosed is the alteration in acquisition of language and cognitive skills and a decline in their social and school insertion, jeopardizing their professional and potentially productive life. Universal screening programs for hearing loss are essential for the diagnosis, since 50% of infants with hearing loss have no known risk factor. Screening before one month of age, confirmation before 3 months, and effective intervention before 6 months, allows the development of these children as if they had normal hearing. In Chile there is a selective program of screening for infants aged less than 32 weeks or 1,500 grams, as part of Explicit Health Guarantees, but it covers only 0.9% of newborns per year. Therefore, a large majority of children remain without diagnosis. The aim of this review is to compare the situation in Chile with other countries, raising the need to move towards a universal neonatal hearing loss screening program, and propose necessary conditions in terms of justification and implementation of a universal screening public policy.

Case study: the Argentina Road Safety Project: lessons learned for the decade of action for road safety, 2011-2020.

This case study of the Argentina Road Safety Project demonstrates how the application of World Bank road safety project guidelines focused on institution building can accelerate knowledge transfer, scale up investment and improve the focus on results. The case study highlights road safety as a development priority and outlines World Bank initiatives addressing the implementation of the World Report on Road Traffic Injury's recommendations and the subsequent launch of the Decade of Action for Road Safety, from 2011-2020. The case study emphasizes the vital role played by the lead agency in ensuring sustainable road safety improvements and promoting the shift to a 'Safe System' approach, which necessitated the strengthening of all elements of the road safety management system. It summarizes road safety performance and institutional initiatives in Argentina leading up to the preparation and implementation of the project. We describe the project's development objectives, financing arrangements, specific components and investment staging. Finally, we discuss its innovative features and lessons learned, and present a set of supplementary guidelines, both to assist multilateral development banks and their clients with future road safety initiatives, and to encourage better linkages between the health and transportation sectors supporting them.

Application of the enterprise management tools Lean Six Sigma and PMBOK in developing a program of research management / Aplicação das ferramentas de gestão empresarial Lean Seis Sigma e PMBOK no desenvolvimento de um programa de gestão da pesquisa científica

OBJECTIVE: Introduce a program for the management of scientific research in a General Hospital employing the business management tools Lean Six Sigma and PMBOK for project management in this area. METHODS: The Lean Six Sigma methodology was used to improve the management of the institution's scientific research through a specific tool (DMAIC) for identification, implementation and posterior analysis based on PMBOK practices of the solutions found. RESULTS: We present our solutions for the management of institutional research projects at the Sociedade Beneficente Israelita Brasileira Albert Einstein. The solutions were classified into four headings: people, processes, systems and organizational culture. A preliminary analysis of these solutions showed them to be completely or partially compliant to the processes described in the PMBOK Guide. CONCLUSION: In this post facto study, we verified that the solutions drawn from a project using Lean Six Sigma methodology and based on PMBOK enabled the improvement of our processes dealing with the management of scientific research carried out in the institution and constitutes a model to contribute to the search of innovative science management solutions by other institutions dealing with scientific research in Brazil.

OBJETIVO: Implementar um programa de gestão da pesquisa científica em um hospital geral aplicando as ferramentas de gestão empresarial Lean Seis Sigma e PMBOK no gerenciamento de projetos nessa área. MÉTODOS: Foi utilizada a metodologia Lean Seis Sigma para melhoria do processo de gestão da pesquisa científica institucional por meio de ferramenta específica (DMAIC) para identificação, implementação e posterior análise das soluções encontradas, tendo como base as boas práticas descritas no PMBOK. RESULTADOS: São apresentadas as soluções implementadas na Sociedade Beneficente Israelita Brasileira Albert Einstein para o gerenciamento dos projetos de pesquisa institucionais. As soluções foram categorizadas em quatro instâncias: pessoas, processos, sistema e cultura organizacional. Uma análise preliminar das soluções implementadas mostra que essas são, total ou parcialmente, aderentes às preconizadas no Guia PMBOK. CONCLUSÃO: Neste estudo de caso post facto, verificou-se que as soluções implementadas a partir do projeto Lean Seis Sigma e baseadas no PMBOK permitiram a melhoria de processo da gestão da pesquisa científica institucional, constituindo um modelo que pretende contribuir com a busca de soluções inovadoras na gestão da pesquisa pelas diferentes instituições com atividade científica no Brasil.

Application of the enterprise management tools Lean Six Sigma and PMBOK in developing a program of research management.

OBJECTIVE: Introduce a program for the management of scientific research in a General Hospital employing the business management tools Lean Six Sigma and PMBOK for project management in this area. METHODS: The Lean Six Sigma methodology was used to improve the management of the institution's scientific research through a specific tool (DMAIC) for identification, implementation and posterior analysis based on PMBOK practices of the solutions found. RESULTS: We present our solutions for the management of institutional research projects at the Sociedade Beneficente Israelita Brasileira Albert Einstein. The solutions were classified into four headings: people, processes, systems and organizational culture. A preliminary analysis of these solutions showed them to be completely or partially compliant to the processes described in the PMBOK Guide. CONCLUSION: In this post facto study, we verified that the solutions drawn from a project using Lean Six Sigma methodology and based on PMBOK enabled the improvement of our processes dealing with the management of scientific research carried out in the institution and constitutes a model to contribute to the search of innovative science management solutions by other institutions dealing with scientific research in Brazil.

Renal health models in Latin America: development of national programs of renal health.

PURPOSE: To verify the actions and degree of progress achieved in countries of Latin America and the Caribbean in the implementation of the Sustainable and Tenable Renal Health Model promoted by the Latin American Society of Nephrology and Hypertension (SLANH), together with local societies and the participation of the Pan-American Health Organization. (PAHO/WHO). METHOD: The implementation of workshops (e.g., "Toward a Sustainable and Tenable Renal Health Model") in each country involving health ministries, social security agencies, PAHO, scientific societies, medical organizations, and NGOs, among others, as well as start-up conferences with a special emphasis on local problems. Working teams will state the bases for planning, programming and evaluation in the Logical Framework Matrix and Matrix of Activities and Resources in the First Level of Care. The signature of the document "Declaration" with commitments undertaken by both public and private parties and a work schedule are required. RESULTS: So far, eleven countries in the region have conducted workshops and started activity in the frame of the Model/Program of Renal Health, which articulates the traditional vertical programs and generates a cross-program in the First Level of Care. Its components and strategies make up a cost-efficient control of cardiovascular, renal and endocrine-metabolic health. CONCLUSION: The Renal Health Model and its program is being built into public health care policies of countries in Latin America and the Caribbean and adapted to the needs of each country with an increasing acceptance on the part of health care professionals. It should not be implemented in isolation but within the framework of non transmissible diseases.

Malaria control reinvented: health sector reform and strategy development in Colombia.

The consequences of health sector reforms on control of malaria were analysed using Colombia as an example. One of the most complex health sector reform programmes in Latin America took place in the 1990s; it included transferring the vertical vector-borne disease control (VBDC) programme into health systems at state and district levels. A series of studies was undertaken in 1998-2000 at the national level (Ministry of Health Study), at the state level (Departamento Study) and at the health district level (District Study) using formal and informal interviews among control staff and document analysis as data collection tools. A government-financed national training programme for VBDC staff - which included direct observation of control operations - was also used to analyse health workers' performance in the postreform period (longitudinal study). The results showed that some shortcomings of the old vertical system, such as the negative aspects of trade union activity, have not been overcome while some positive aspects of the old system, such as capacity building, operational planning and supervision have been lost. This has contributed to a decrease in control activity which, in turn, has been associated with more malaria cases. Malaria control had to be reinvented at a much larger scale than anticipated by the reformers caused by a whole series of problems: complex financing of public health interventions in the new system, massive staff reductions, the difficulty of gaining access to district and state budgets, redefining entire organizations and - in addition to the reforms - introducing alternative strategies based on insecticide-treated materials and the growth of areas of general insecurity in many parts of Colombia itself. However, positive signs in the transformed system include: the strengthening of central control staff (albeit insufficient in numbers) when transferred from the Ministry of Health to the National Institute of Health, the opportunities offered by the Basic Health Plan (PAB) for new planning initiatives and intersectoral co-operation and the integration of malaria diagnosis and treatment into the general health services (associated with a decrease of malaria mortality). The potentials of the new system have not yet been fully exploited: capacity building, communication and management skills need to be improved and it require guidance from the national level.

Notice of availability of funding for alternative projects, known as Wilson/Fish Projects, to implement alternative means of providing interim financial assistance, medical assistance, social services, and case management to refugees and Cuban and Haitian entrants. Office of Refugee Resettlement (ORR), ACF, DHHS.

The Office of Refugee Resettlement (ORR) announces that competing applications will be accepted from public and private non-profit organizations under a standing announcement for Wilson/Fish projects which propose alternative approaches to serving refugees. The purpose of an alternative project is to provide integrated services and cash assistance to refugees in order to increase refugees' prospects for early employment and self-sufficiency, reduce their level of welfare dependence, enhance acculturation, and promote coordination among voluntary resettlement agencies and service providers. Projects will be accepted under either of two categories: (1) Projects to establish or maintain a refugee program in a State where the State is not participating in the refugee program or is dropping out of the refugee program or a portion of the program; and (2) projects to provide an alternative to the existing system of assistance and services to refugees. Funding is available to these projects under the "Wilson/Fish" authority.

A guide for the development of diabetes prevention & control programs in the Caribbean

The guide represents the culmination of a participatory process started in 1995 by the PAHO/WHO Office of Caribbean Program Coordination (CPC). The process involved Ministries of Health and Diabetes Associations in Barbados, The Bahamas, Jamaica, Suriname, Trinidad & Tobago, and the eastern Caribbean countries of Anguilla, Antigua & Barbuda, the British Virgin Islands, Dominica, Grenada, Montserrat, St. Kitts & Nevis, Saint Lucia and St. Vincent & the Grenadines; the Commonwealth Caribbean Medical Research Council, now the Caribbean Health Research Council; the Caribbean Food and Nutrition Institute; the PAHO/WHO Secretariat in Barbados, Guyana and Washington; and the University of the West Indies. Through a technical working group meeting in August 1995, a regional workshop in January 1996 and a second technical working group meeting in December 1996, priority issues were identified, strategies suggested and program guidelines formulated. Subsequently, drafts were reviewed and comments and suggestions incorporated into the final version of the Guide. The Guide is meant to assist persons in both governmental and non-governmental organizations to develop and/or strengthen programs for the prevention and control of diabetes. It is for all persons involved in the planning, implementation and evaluation of such programs. Many diabetes-related publications have previously been produced by various Caribbean and international agencies and organizations. This Guide will not repeat information available in those publications, but will provide relevant references for the reader. The Guide is a practical, "how-to" manual which will guide the design of programs tailored to the situation in individual countries. Such programs must emphasize strategies to create the supportive environments and encourage and enable adoption of the healthy lifestyles which program beneficiaries need to achieve and maintain health and well-being. The Caribbean Charter for Health Promotion, annexed in the Guide, provides an appropriate framework for the development of comprehensive diabetes prevention and control programs.

Breastfeeding promotion and priority setting in health.

An increase in exclusive breastfeeding prevalence can substantially reduce mortality and morbidity among infants. In this paper, estimates of the costs and impacts of three breastfeeding promotion programmes, implemented through maternity services in Brazil, Honduras and Mexico, are used to develop cost-effectiveness measures and these are compared with other health interventions. The results show that breastfeeding promotion can be one of the most cost-effective health interventions for preventing cases of diarrhoea, preventing deaths from diarrhoea, and gaining disability-adjusted life years (DALYs). The benefits are substantial over a broad range of programme types. Programmes starting with the removal of formula and medications during delivery are likely to derive a high level of impact per unit of net incremental cost. Cost-effectiveness is lower (but still attractive relative to other interventions) if hospitals already have rooming-in and no bottle-feeds; and the cost-effectiveness improves as programmes become well-established. At an annual cost of about 30 to 40 US cents per birth, programmes starting with formula feeding in nurseries and maternity wards can reduce diarrhoea cases for approximately $0.65 to $1.10 per case prevented, diarrhoea deaths for $100 to $200 per death averted, and reduce the burden of disease for approximately $2 to $4 per DALY. Maternity services that have already eliminated formula can, by investing from $2 to $3 per birth, prevent diarrhoea cases and deaths for $3.50 to $6.75 per case, and $550 to $800 per death respectively, with DALYs gained at $12 to $19 each.

PIP: During April 1992 to March 1993, in Santos, Brazil, in San Pedro Sula, Honduras, and in Mexico City, Mexico, interviews were conducted with 200-400 women in each of three hospitals and at their homes at 1 month and at 2-4 months postpartum as part of a study of the cost and effectiveness of three breast feeding promotion programs in hospital-based maternity services. The hospital in Mexico and, in the past, the one in Brazil used infant formula, while the hospital in Honduras and the hospital in Brazil removed infant formula. Various nutrition and policy specialists estimated the costs and impacts of these programs to develop cost effectiveness measures and then compared them with other health interventions. At a net incremental cost ranging from about US$0.30 to US$0.40 per birth, infant feeding programs with formula feeding in nurseries and maternity wards can reduce diarrhea cases for about US$0.65 to US$1.10 each, prevent diarrhea-related deaths for US$100 to US$200 each, and reduce the burden of disease for about US$2 to US$4 per disability-adjusted life year (DALY). On the other hand, by investing US$2 to US$3 per birth, maternity services that no longer provide infant formula can prevent diarrhea cases and deaths for US$3.50 to US$6.75 per case and US$550 to US$800 per death, respectively, and gain DALYs at a cost of US$12 to US$19 each. The estimates obtained indicate that breast feeding promotion in hospitals competes very closely with measles and rotavirus vaccination as the most efficient option for diarrheal disease control and is markedly more cost-effective than oral rehydration therapy and cholera immunization even when infant formula is no longer offered. In fact, investments in breast feeding promotion are among the most cost-effective health interventions. The cost effectiveness of breast feeding promotion programs improved as programs became institutionalized. These findings show that such programs are a very efficient way of improving the health status of children.

Informe de consultoria Secretaria de Salud OPS/OMS Bolivia. 31 de enero al 4 de marzo / sss

Con el propósito de introducir los nuevos lineamientos que establece la Ley de Participación Popular se consideró la idea de ampliar la cobertura de los servicios de salud, tomando en cuenta el marco de Reforma del Sector Público; por esta razón, el presente trabajo se desarrolló en dos campos: - Apoyando la elaboración de un Plan de Gestión para la Secretaria Nacional para la Reforma en el Sector Salud, que le permita identificar las acciones inmediatas a corto y mediano plazo. - Realizando Talleres de Negociación en búsqueda de viabilidad politica para el Proyecto de Servicios Integrados de Salud, entre la Secretaria Nacional de Salud y el Sistema de Seguros de Salud, tanto a nivel nacional como regional y local

Introduçäo ao Programa UNI / Introduction for UNI Program

O objetivo geral da programaçäo da Fundaçäo W.K. Kellogg para o setor saúde é contribuir para a organizaçäo de um sistema de saúde comunitário mais coordenado, mais eficiente e eficaz, integrado e integral, acessível a todas as pessoas, e que responda a suas necessidades. O Programa UNI representa um novo degrau no processo de desenvolvimento do setor saúde, sendo uma oportunidade para unir, consolidar e empreender novos esforços para alcançar mudanças concretas em seus três elementos constitutivos: a Universidade, os Sistemas Locais de Saúde, e a Comunidade

Introducción al Programa UNI / Introduction for UNI Program

El objetivo general de la programación de la Fundación Kellogg para el sector salud es contribuir a la organización de un sistema de salud comunitario más coordinado, más eficiente y eficaz, integrado e integral, accesible a todas las personas, en respuesta a sus necesidades. Requiere la aplicación de varias estrategias simultáneas de programación, entre ellas el desarrollo de servicios locales de salud y el de modelos de formación de recursos humanos para operar tales sistemas. Para la implementación e institucionalización de ambos modelos se requieren líderes; sistemas de información para documentar sus procesos, productos e impactos, y de un proceso de difusión para apoyar las decisiones político-institucionales que afectan al aplicarse a toda la sociedad o nación. Representa una nueva etapa en el proceso de desarrollo del sector salud, constituyendo una oportunidad de unir, consolidar y emprender nuevos esfuerzos a fin de lograr cambios concretos en sus tres elementos constitutivos: la Universidad, los Sistemas Locales de Salud y la Comunidad

Informe de consultoria Secretaria Nacional de Salud del 3 al 24 de noviembre de 1993 / sss

El presente trabajo se desarrolló en cuatro campos: Reforma de la Secretaria de Salud; Descentralización de los servicios de salud: nivel nacional-nivel regional; Plan de trabajo y mecanismos de abordaje en la gerencia de Recursos Humanos; Programa de capacitación en Alta Gerencia en la Secretaria de Salud y Seguro Social