Primeros pasos de la administración médica en el IMSS / First steps of medical administration at the IMSS

La creación de una organización tan grande como el Instituto Mexicano del Seguro Social (IMSS) requirió de mucha planeación para lograr administrar todas las prestaciones que se brindan a la población. Siendo así una necesidad contar con personal de salud con conocimientos y experiencia en administración en servicios de salud. El presente manuscrito es un reconocimiento a los doctores Manuel Barquín Calderón, Antonio Ríos Vargas y Carlos Zamarripa Torres, pioneros y protagonistas reconocidos en la planeación y organización (administración) de los servicios médicos del IMSS entre 1945 y 1955, quienes además tuvieron iniciativas racionales y constructivas, cumpliendo con su deber. Por otro lado, el Instituto expuso y proyectó que las actividades médico-administrativas eran una tarea compleja, y que su práctica necesitaba conocimientos especializados que no podían dejarse al azahar, al empirismo, a la buena voluntad, a las creencias o a la imaginación no objetiva.

The creation of an institution as large as the Instituto Mexicano del Seguro Social (IMSS) required a lot of planning to manage all the benefits provided to the population. Thus, it is necessary to have health personnel with knowledge and experience in health services administration. This manuscript is an acknowledgment to doctors Manuel Barquín Calderón, Antonio Ríos Vargas and Carlos Zamarripa Torres, pioneers and recognized protagonists in the planning and organization (administration) of the IMSS medical services between 1945 and 1955, who also had rational initiatives and constructive, doing their duty. On the other hand, the Institute exposed and projected that medical-administrative activities were a complex task, and that its practice required specialized knowledge that could not be left to chance, empiricism, good will, beliefs or nonobjective imagination.

Genealogía de la reforma hospitalaria en España: la gestación de una nueva cultura hospitalocéntrica de la sanidad / Genealogy of hospital reform in Spain: the gestation of a new hospital-centric culture of health

A finales de los años cincuenta del siglo pasado, en Asturias, se empezó a implantar una nueva manera de entender el hospital, cuya influencia terminaría siendo enorme y decisiva en la modernización de la organización hospitalaria española. Proyectado para ser utilizado por cualquier tipo de enfermo, tanto por su patología como por su situación económica, el Hospital General de Asturias (HGA) se convirtió en el pionero del Estado español en imple-mentar una estructura jerárquica en todos sus servicios médicos, clínicos y comunes, tanto en hospitalización como en consultas externas y en urgencias. Otra de sus consecuencias más palpables fue la introducción de la formación sanitaria especializada en España mediante la creación del primer programa de médicos residentes. Hasta entonces, el hospital era todavía un recurso asistencial poco accesible a amplios sectores de la ciudadanía, lo que demuestra la existencia de un desajuste cronológico en relación con lo sucedido en otros países europeos de referencia. El modelo organizativo del HGA supuso el punto de inflexión para el desarrollo de un proceso más amplio de reforma hospitalaria que acabó rompiendo definitivamente con los conceptos ya obsoletos de hospital «autónomo» y «cerrado». El primero se integró dentro de una coordinación funcional y escalonada de hospitales en red, conocida como «regionalización», y el segundo quedó eclipsado por la hegemonía del hospital «abierto» a toda la comunidad. Esta nueva realidad exigió el desarrollo e implantación de unos rigurosos criterios de acreditación en los hospitales para homologarse con los establecidos por la doctrina hospitalaria internacional y para ofrecer un mínimo de garantías, a empresas aseguradoras y usuarios, de la calidad y racionalidad de su oferta de servicios (AU)

John B Grant and public health in India.

From 1939 to 1945, John Black Grant a Rockefeller Foundation officer and former Professor of Public Health at the Peking Union Medical College served as the Director of the All Institute of Hygiene and Public Health, Calcutta. Grant's India tenure is important for his efforts to ameliorate the condition of public health in India. Much has been written about Grant's contribution to transforming public health in China but his work in India has not received sufficient attention. This article acquaints readers with some of his more noteworthy ideas and endeavours to remodel the colonial public health and medical system. His views on Indian public health may also be viewed as a critique of the colonial health system.

[The medical major of health management in Universidad Nacional Mayor de San Marcos: 30 years training managers for the health sector]. / La especialidad medica de gestión en salud en la Universidad Nacional Mayor de San Marcos: 30 años formando gestores para el sector salud.

A historical account of the 30 years of the medical major of Health Management at Universidad Nacional Mayor de San Marcos is presented. The major was created in 1988 as Comprehensive General Medicine in response to the shortage of management specialists. The name of the major remained until 1994, when it changed to Integral Medicine and Health Management to emphasize its managerial orientation. In 2002, the curricular plan was modified considering the importance of having an exclusive medical specialization in management for the health sector. The specialty is a pioneer in a gradual education in three levels: micro-management, meso-management, and macro-management. The new curricular plan allowed residents the possibility to access better rotations at public and private institutions. Since 2007, the major is labeled Health Management, and its specialists maintain their solid training that enables them to perform in the decision-making, management, administration, and operation processes of the health systems. The vision of the creators of this major is current to this day; Health Management specialists work in the different institutions of the health system, contributing their knowledge and skills, and generating an impact on the health of the Peruvian population.

Se presenta un recuento histórico de los 30 años de la especialidad médica de Gestión en Salud en la Universidad Nacional Mayor de San Marcos. La especialidad fue creada en 1988 como Medicina General Integral en respuesta a la escasez de médicos especialistas en gestión. El nombre de la especialidad se mantuvo hasta 1994, cuando cambia a Medicina Integral y Gestión en Salud para enfatizar su orientación gerencial. En 2002, se modifica el plan curricular considerando la importancia de tener una especialización médica exclusiva de gestión para el sector salud. La especialidad es pionera en una formación gradual en tres niveles: microgestión, mesogestión y macrogestión. El nuevo plan curricular permitió a los residentes la posibilidad de mejores rotaciones en instituciones públicas y privadas. A partir del 2007, la especialidad es denominada Gestión en Salud, cuyos médicos especialistas mantienen su sólida formación para desempeñarse en los procesos de decisión, conducción, dirección y operatividad de los sistemas de salud. La visión de los creadores de la especialidad se encuentra vigente, los especialistas de Gestión en Salud se desempeñan en las diferentes instituciones del sistema de salud, aportando sus conocimientos y habilidades, y generando un impacto en la salud de la población peruana.

"Everything Possible Is Being Done": Labour, Mobility, and the Organization of Health Services in Mid-20th Century Newfoundland.

This article is the Presidential Address to the 2018 meeting of the Canadian Society for the History of Medicine at the University of Regina. It examines the organization of the nursing service in Newfoundland during the 1950s and 1960s, as well as the recruitment and retention of nurses in cottage hospitals and nursing stations in outport communities. A number of interconnected strategies were used by the Newfoundland government to staff the nursing service, including recruiting internationally educated nurses, adjusting expectations with respect to registration standards, and using both trained and untrained workers to support nurses' labour. Although this article is intended more as a reconnaissance suggesting the possibilities of such research, it does analyze the interconnected issues of geography, funding and pay, the nursing shortage, and the renegotiation of nursing labour that characterized this period. Furthermore, although this is a case study of Newfoundland and Labrador, it is worth considering how, or whether, the linked strategies used in the province were transferable to other communities across rural, remote, or northern Canada.

La especialidad médica de gestión en salud en la Universidad Nacional Mayor de San Marcos: 30 años formando gestores para el sector salud / The medical major of health management in Universidad Nacional Mayor de San Marcos: 30 years training managers for the health sector

Se presenta un recuento histórico de los 30 años de la especialidad médica de Gestión en Salud en la Universidad Nacional Mayor de San Marcos. La especialidad fue creada en 1988 como Medicina General Integral en respuesta a la escasez de médicos especialistas en gestión. El nombre de la especialidad se mantuvo hasta 1994, cuando cambia a Medicina Integral y Gestión en Salud para enfatizar su orientación gerencial. En 2002, se modifica el plan curricular considerando la importancia de tener una especialización médica exclusiva de gestión para el sector salud. La especialidad es pionera en una formación gradual en tres niveles: microgestión, mesogestión y macrogestión. El nuevo plan curricular permitió a los residentes la posibilidad de mejores rotaciones en instituciones públicas y privadas. A partir del 2007, la especialidad es denominada Gestión en Salud, cuyos médicos especialistas mantienen su sólida formación para desempeñarse en los procesos de decisión, conducción, dirección y operatividad de los sistemas de salud. La visión de los creadores de la especialidad se encuentra vigente, los especialistas de Gestión en Salud se desempeñan en las diferentes instituciones del sistema de salud, aportando sus conocimientos y habilidades, y generando un impacto en la salud de la población peruana.

A historical account of the 30 years of the medical major of Health Management at Universidad Nacional Mayor de San Marcos is presented. The major was created in 1988 as Comprehensive General Medicine in response to the shortage of management specialists. The name of the major remained until 1994, when it changed to Integral Medicine and Health Management to emphasize its managerial orientation. In 2002, the curricular plan was modified considering the importance of having an exclusive medical specialization in management for the health sector. The specialty is a pioneer in a gradual education in three levels: micro-management, meso-management, and macro-management. The new curricular plan allowed residents the possibility to access better rotations at public and private institutions. Since 2007, the major is labeled Health Management, and its specialists maintain their solid training that enables them to perform in the decision-making, management, administration, and operation processes of the health systems. The vision of the creators of this major is current to this day; Health Management specialists work in the different institutions of the health system, contributing their knowledge and skills, and generating an impact on the health of the Peruvian population.

Telma Reca en la gestión estatal de la sanidad argentina (1930-1948) / Telma Reca: an argentine physician in the state (1930-1948)

Este artículo aporta nuevos datos sobre la médica argentina Telma Reca (1904-1979), particularmente en relación con su inserción en ámbitos académicos y en la gestión estatal a partir de los años treinta del siglo XX. Nos focalizaremos en su trayectoria profesional desde que obtuvo su doctorado en la Universidad de Buenos Aires (1932) hasta que se retiró de la División de Maternidad e Infancia del Departamento Nacional de Higiene en 1948. Durante ese período aplicó en la gestión estatal sus investigaciones sobre el estudio de las condiciones sociales de la delincuencia juvenil y de la educación. Su perspectiva crítica, lejos de implementar medidas punitivas generadoras de una mayor exclusión social, buscó la integración de los menores en la comunidad por medio de políticas educativas y sanitarias

This article will reconstruct the biography of the Argentine physician Telma Reca (1904-1979) who managed to get involved in academic fields and the state administration in the 30's. We will address ourselves to tracking her professional career from her PhD degree in Medicine (1932) until her withdrawal from the División de Maternidad e Infancia del Departamento Nacional de Higiene (Maternity and Childhood Division of the National Hygiene Department) in 1948. During this period, she focused her research on the study of the social conditions of juvenile delinquency on the public administration. With a critical eye, far from social exclusion and punitive measures, she managed to promote social integration through health and education policies

La planeación estratégica en el Sistema de Salud cubano / The strategic planning in the Cuban Health System

En este artículo se ofrece una breve descripción de la evolución histórica de la planeación estratégica en el mundo y especialmente en Cuba, que incluye algunas definiciones de autores foráneos y la posterior conceptualización del término. De igual modo, se exponen las etapas que ha atravesado la planeación estratégica a nivel nacional, se reflexiona sobre la que realizan los directivos de salud cubanos en los diferentes niveles de atención sanitaria y, por último, se describen los pasos metodológicos para su confección, con lo cual el sistema organizacional lograría grandes avances.

A brief description of the strategic planning historical evolution in the world and especially in Cuba is offered in this work, that includes some definitions of foreign authors and the later conceptualization of the term. In a same way, the stages that the strategic planning has gone through at national level are exposed, it is meditated on the one that the Cuban health managers carry out in the different levels of health care and, lastly, the methodological steps to make it are described, with which the organizational system would achieve great advances.

Perspective: lessons from the past.

A considered analysis of some factors used in the past 50-70 years in medical education, care on a hospital ward, organisation of health services, medical research and the attitudes of media and politics to health services is described. The possible reasons for changes in these areas over time are considered, and recommendations are made in each area on how current practice could be improved in the light of past experience.

Health services management and research at Nordic School of Public Health.

In Anglo-Saxon countries the subject of health services research has long been an important academic theme. In the Nordic countries, however, this research and training area has been limited and partly hidden by integration into various other sections at universities and colleges. In this respect the Nordic School of Public Health was an exception, as the provision of managerial skills to healthcare professionals and persons working with public health was the backbone of the school during all 60 years. A variety of research in health services management, as well as publications of text books, accompanied the presented courses. Several of the scholars have earned important positions in international networks and editorial boards, as well as in boards for assessments of research grants. In the near future, this academic field will require alternative support.

[Early decentralization of health services in Argentina: the construction of the health system in Córdoba, 1930-1955]. / La temprana descentralización de los servicios de salud en la Argentina: la construcción del sistema sanitario en Córdoba, 1930-1955.

This paper analyzes the process of construction of the Argentine public health system, highlighting the limitations that occurred in the proposed nationalization of health policy in the postwar period and the central role played by subnational jurisdictions, making the provision of services rendered on a provincial basis. More precisely, in this respect it is seen how the expansion of health services in some provinces shows us how, in the second quarter of the twentieth century, it was primarily the result of the action of local rather than national departments. In order to better elucidate this process, the trajectory of public healthcare facilities in the province of Córdoba between 1930 and 1955 was studied.

Gestión del trabajo: implicaciones para el cuidado en la Atención Primaria de Salud / Gestão do trabalho: implicações para o cuidado na Atenção Primária à Saúde / Work management: implications for care in Primary Health Care

Objetivo: Describir las implicaciones de la gestión del trabajo en el cuidado en la Atención Primaria a la Salud. Método: Investigación cualitativa, un estudio de caso. La unidad de análisis fue una Unidad de Salud Familiar de un municipio de Rio Grande do Sul, Brasil. Se realizaron observaciones, entrevistas con los trabajadores y usuarios e ivestigaciones en documentos y en registros. El periodo de la colecta de datos fue de febrero a julio de 2012 y el análisis conforme orientación de estudio de caso. Resultados: La gestión de la unidad se caracterizó por la falta de escucha y singularidad con el equipo y autoritarismo; el equipo se sintió abandonado por la gestión y las Agentes Comunitarias de Salud por las enfermeras. Hubo discontinuidad en el cuidado. Discusión: La gestión en salud necesita pautar el tema de la autonomía y responsabilidad del trabajador. La no responsabilización es un efecto de la postmodernidad. La gestión del trabajo está relacionada con la continuidad del cuidado. Conclusiones: Los conceptos de pluralidad humana y de potencial de poder pueden ayudar en la construcción de ambientes de trabajo más humanos. Se apunta a la integración con la comunidad (AU)

Objetivo: descrever as implicações da gestão do trabalho no cuidado na Atenção Primária à Saúde. Método: pesquisa qualitativa, um estudo de caso. A unidade de análise foi uma Unidade de Saúde da Família de um município do Rio Grande do Sul, Brasil. Foram realizadas observações, entrevistas com os trabalhadores e usuários e pesquisas em documentos e em registros. O período de coleta de dados foi fevereiro a julho de 2012 e a análise conforme orientação de estudo de caso. Resultados: a gestão da unidade caracterizou-se pela falta de escuta e singularidade com a equipe e autoritarismo; a equipe sente-se abandonada pela gestão e as Agentes Comunitárias de Saúde pelas enfermeiras. Há descontinuidade no cuidado. Discussão: a gestão na saúde precisa pautar o tema da autonomia e responsabilidade do trabalhador. A não responsabilização é um efeito da pós-modernidade. A gestão do trabalho está relacionada com a continuidade do cuidado. Conclusões: os conceitos de pluralidade humana e de potencial de poder podem auxiliar na construção de ambientes de trabalhos mais humanos. Aponta-se para a integração com a comunidade como caminho para a transformação da realidade. A pesquisa pela temática deve responsabilizar-se pela produção de saúde e pelo outro, individual ou coletivamente

Objective: To describe the implications of the management of care work in Primary Health Care. Methods: Qualitative research, a case study. The unit of analysis was one of the Family Health Unit of a city in Rio Grande do Sul, Brazil. Observations, interviews with workers and users and research documents and records were made. The data collection period was from February to July 2012 and as directed analysis of a case study. Results: unit management was characterized by lack of listening and uniqueness with the staff and authoritarianism, the team feels abandoned by management and the Community Health Agents by nurses. There is discontinuity in care. Discussion: Managing health needs guided the theme of autonomy and responsibility of the employee. The accountability is not an effect of post modernity. The management of labor is related to continuity of care. Conclusions: The concepts of human plurality and potential power can assist in building a more humane work environment. It looks to the integration with the community as a way to transform reality. The search for the theme should be responsible for the production of health and the other, individually or collectively (AU)

La temprana descentralización de los servicios de salud en la Argentina: la construcción del sistema sanitario en Córdoba, 1930-1955 / Early decentralization of health services in Argentina: the construction of the health system in Córdoba, 1930-1955

Este trabajo analiza el proceso de construcción del sistema público de salud argentino, poniendo en evidencia las limitaciones que se produjeron en el proyecto de nacionalización de las políticas sanitarias en la postguerra y el papel central que tuvieron las jurisdicciones subnacionales, provincializando la provisión de los servicios. Más precisamente se visibiliza cómo, en el segundo cuarto del siglo XX, la ampliación de los servicios de salud en algunas provincias fue principalmente el resultado de la acción de las reparticiones locales antes que nacionales. Con el propósito de dilucidar mejor ese proceso, estudiamos la trayectoria de los dispositivos sanitarios públicos en la provincia de Córdoba entre 1930 y 1955.

This paper analyzes the process of construction of the Argentine public health system, highlighting the limitations that occurred in the proposed nationalization of health policy in the postwar period and the central role played by subnational jurisdictions, making the provision of services rendered on a provincial basis. More precisely, in this respect it is seen how the expansion of health services in some provinces shows us how, in the second quarter of the twentieth century, it was primarily the result of the action of local rather than national departments. In order to better elucidate this process, the trajectory of public healthcare facilities in the province of Córdoba between 1930 and 1955 was studied.

[Who was the head of the General Military Medical Department in 1917-1918].

The article describes the history of the central governing body of the Russian military medicine - the General Military Medical-Department (GMMD) - during the most difficult period of its history - 1917-1918. There is still no clear evidence about the head of GMMD of those times in historical literature. The authors tried to reconstruct the history of GMMD during the revolution, gave the list of chiefs in chronological order on the basis of primary documents of the central military archives. The authors provide some biographical information about professors V.A. Yurevich and N.N. Burdenko, and also about A. Ya.Evdokimov, A.A. Tsvetaev and others, who headed GMMD, etc. for the first time.

[The General Military Medical Department during the Great Patriotic War].

The article is devoted to the contribution of the General Military Medical Department of the Red Army (GMMD) to organisation of health care support during the Great Patriotic War of 1941-1945. In the summary you may follow the main ways of activity of the central governing body of medical (health) services of the Red. Army. The main focus of the article is made on conditions under which GMMD had to organize medical support of the Red. Army at the beginning of the war, the most difficult period of the Great Patriotic War. The authors payed attention to the forms and methods of the work of the head of GMMD and its subordinate departments under the conditions of rapidly changing environment of combat and rear situation, as well as interaction with GMMD People Commissariat of Health. The authors tried to highlight not well known but not less important moments in the activities of the Red Army GMMD.

Relaciones entre el Estado y los sindicatos y sus consecuencias en torno al régimen de obras sociales en Argentina: un análisis histórico-político / The relationship between the State and workers’ unions and its impacts in the union-based health coverage regime in Argentina: an historical and political analysis

El presente trabajo se propone realizar una reconstrucción histórico-política, cuyo período transita desde fines del siglo XIX hasta la actualidad, que indague sobre la relación entre el Estado argentino y los sindicatos y sus repercusiones en torno a la constitución, consolidación y potencial ocaso del sistema de prestación de atención médica a los trabajadores administrado por los sindicatos, denominado en Argentina como obras sociales. Asimismo, sostendrá la hipótesis de que el financiamiento obtenido por parte de las cúpulas sindicales a través de las obras sociales ha sido un instrumento eficaz para sostener un modelo sindical centralizado que garantizó, en ciertos casos, gobernabilidad no solo a las cúpulas sino también a los diferentes gobiernos nacionales.

This paper aims at developing a political and historical reconstruction of the period spanning from the late nineteenth century to the present. In particular, this work investigates the relationship between the Argentine State and workers’ unions and the impacts of that relationship in the establishment, consolidation and potential decline of the health coverage system administrated by unions, in Argentina called obras sociales. This work will also support the hypothesis that the financing obtained by union leaders through this health coverage system has been an efficient instrument for sustaining a centralized union model and has in some cases guaranteed the continued governance of both union leaders and different national governments.