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1.
West Afr J Med ; 36(2): 103-111, 2019.
Artigo em Inglês, Francês | MEDLINE | ID: mdl-31385594

RESUMO

BACKGROUND: Out of pocket payment for health services in the midst of financial hardship is a major contributor to poor access to healthcare in Nigeria with the resultant poor health indices. Towards the goal of Universal Health Coverage, Community Based Health Insurance (CBHI) was introduced in addition to the National Health Insurance Scheme but with minimal impact and utilization. OBJECTIVE: The objective of this study was to assess health insurance-related knowledge and attitudes and to examine the uptake of CBHI. METHODS: This was a descriptive cross-sectional study. A multi-stage sampling method was used to select 419 respondents from the Ajeromi-Ifelodun community. A semi-structured interviewer-administered questionnaire was used to collect data for the study. Data analysis was done using Microsoft Excel and Epi-Info 7.1. RESULTS: Most of the respondents (80.2%) had not heard of Community-Based Health Insurance and only about 9% of respondents had good knowledge about it. However, most (62.5%) of the respondents had a positive attitude towards health insurance generally. Only 4.5% of the respondents were enrolled in the CBHI scheme and had paid their premium up to date. There was a significant association between the respondents' knowledge and their uptake of the scheme (<0.001), and also between their attitudes and uptake (p = 0.002). CONCLUSION: This study suggests that for CBHI to be successful, certain strategies must be implemented towards increasing awareness and knowledge about CBHI. This will in turn increase the uptake of the scheme, a necessary requirement for achieving the goal of Universal Health Coverage.


Assuntos
Assistência à Saúde/organização & administração , Conhecimentos, Atitudes e Prática em Saúde , Acesso aos Serviços de Saúde/economia , Seguro Saúde , Programas Nacionais de Saúde , Participação da Comunidade , Estudos Transversais , Humanos , Nigéria
3.
Pan Afr Med J ; 33(Suppl 2): 9, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31402967

RESUMO

Introduction: The 2014-2016 Ebola virus disease (EVD) outbreak in Liberia highlighted the importance of robust preparedness measures for a well-coordinated response; the initially delayed response contributed to the steep incidence of cases, infections among health care workers, and a collapse of the health care system. To strengthen local capacity and combat disease transmission, various healthcare worker (HCW) trainings, including the Ebola treatment unit (ETU) training, safe & quality services (SQS) training and rapid response team (RRT), were developed and implemented between 2014 and 2017. Methods: Data from the ETU, SQS and RRT trainings were analyzed to determine knowledge and confidence gained. Results: The ETU, SQS and RRT training were completed by a total of 21,248 participants. There were improvements in knowledge and confidence, an associated reduction in HCWs infection and reduced response time to subsequent public health events. Conclusion: No infections were reported by healthcare workers in Liberia since the completion of these training programs. HCW training programmes initiated during and post disease outbreak can boost public trust in the health system while providing an entry point for establishing an Epidemic Preparedness and Response (EPR) framework in resource-limited settings.


Assuntos
Surtos de Doenças/prevenção & controle , Pessoal de Saúde/organização & administração , Mão de Obra em Saúde/organização & administração , Doença pelo Vírus Ebola/prevenção & controle , Fortalecimento Institucional , Assistência à Saúde/organização & administração , Epidemias/prevenção & controle , Doença pelo Vírus Ebola/epidemiologia , Humanos , Libéria/epidemiologia , Saúde Pública
5.
Implement Sci ; 14(1): 76, 2019 08 05.
Artigo em Inglês | MEDLINE | ID: mdl-31382994

RESUMO

BACKGROUND: Translating research into practice is an important issue for implementing health interventions effectively for Indigenous communities. He Pikinga Waiora (HPW) is a recent implementation framework that provides a strong foundation for designing and implementing health interventions in Indigenous communities for non-communicable diseases around community engagement, culture-centred approach, systems thinking and integrated knowledge translation. This study addresses the following research question: How are the elements of the HPW Implementation Framework reflected in studies involving the implementation of a non-communicable disease health intervention in an Indigenous community? METHODS: A systematic review was conducted using multiple databases. Studies were included if they involved the implementation or evaluation of a health intervention targeting non-communicable diseases for Indigenous communities in Australia, Canada, New Zealand or the United States of America. Published quantitative and qualitative literature from 2008 to 2018 were included. Methodological appraisal of the included articles was completed using the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information. Data on the population, topic, methods, and outcomes were detailed for each individual study. Key data extracted included the HPW elements along with study characteristics, who delivered the intervention and health outcomes. Data analysis involved a qualitative synthesis of findings as guided by a coding scheme of the HPW elements. RESULTS: Twenty-one studies were included. Health topics included diabetes, nutrition, weight loss, cancer and general health. The key themes were as follows: (a) two thirds of studies demonstrated high levels of community engagement; (b) from the culture-centred approach, two-thirds of studies reflected moderate to high levels of community voice/agency although only a third of the studies included structural changes and researcher reflexivity; (c) about a quarter of studies included multi-level outcomes and activities consistent with systems thinking, 40% had individual-level outcomes with some systems thinking, and 33% included individual-level outcomes and limited systems thinking; and (d) almost 40% of studies included high levels of end user (e.g., policy makers and tribal leaders) engagement reflective of integrated knowledge translation, but nearly half had limited end-user engagement. CONCLUSIONS: The HPW Implementation Framework is a comprehensive model for potentially understanding implementation effectiveness in Indigenous communities. The review suggests that the studies are reflective of high levels of community engagement and culture-centredness. The long-term sustainability and translation of evidence to practice may be inhibited because of lower levels of systems thinking and integrated knowledge translation. REGISTRATION: Not registered.


Assuntos
Doença Crônica/terapia , Assistência à Saúde/organização & administração , Serviços de Saúde do Indígena/organização & administração , Doença Crônica/etnologia , Acesso aos Serviços de Saúde , Humanos
6.
J Glob Health ; 9(1): 010423, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31263546

RESUMO

Background: Tuberculosis (TB) is a major global health burden, which has been inadequately addressed. This study aims to analyze different patterns and gaps of care along the care cascade across countries and to develop a model to examine the relationship between performance of tuberculosis programmes in high and low burden countries along the tuberculosis care cascade and tuberculosis disease burden. Methods: We used the World Health Organization's Global TB Database for the year 2016 to construct tuberculosis care cascade consisting of four steps: incidence, diagnosed, treatment started and treatment completed. Based on the constructed care cascades, we analyzed the relationship between health system performance indicators and tuberculosis cascades performance: diagnosed rate, treatment started rate, and treatment completed rate. Results: There are wide differences in access to diagnosis and treatment between high-burden countries and non-high-burden countries. The largest gap was found between incidence and diagnosed rate, with 65% of diagnosed rate for high burden countries and 80% of diagnosed rate for non-high burden countries. We found variations in care performance among high-burden countries. We found a negative relationship between the population health indicators related to the mortality rate and TB care cascade performance. There was a positive relationship between immunization coverage rate and antenatal care indicators and TB care cascade performance. Conclusions: Well-functioning tuberculosis care cascades and effective health systems are important for the successful management of tuberculosis. While improving screening performance is essential for tuberculosis control especially for high-burden countries, resource should be allocated to improve health system performance, which is weak in high-burden countries. Performance of TB programmes across care cascade could be used as a useful tracer to measure performance of health systems.


Assuntos
Assistência à Saúde/organização & administração , Saúde Global/estatística & dados numéricos , Tuberculose/prevenção & controle , Bases de Dados como Assunto , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Incidência , Modelos Organizacionais , Avaliação de Programas e Projetos de Saúde , Tuberculose/epidemiologia , Organização Mundial da Saúde
9.
Soins Pediatr Pueric ; 40(309): 14-15, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31331595

RESUMO

The last decade has witnessed an increasing number of reforms of the French healthcare system. The main objectives are to control healthcare costs by reducing spending and pooling resources. This is not achieved without difficulties, the economic criteria sometimes overshadowing humanist and altruistic values. These changes influence the organisation of care, even in paediatrics.


Assuntos
Assistência à Saúde/organização & administração , Reforma dos Serviços de Saúde , Administração Hospitalar , Criança , Assistência à Saúde/economia , França , Humanos , Pediatria/organização & administração
10.
Soins ; 64(837): 24-27, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31345304

RESUMO

The use of artificial intelligence and robotics in health care means ethical principles need to be established. Artificial and human intelligence must be implemented in such as way as to complement each other. From humanism to anthropotechnics, the definitions of human and humanism are not set in stone. A philosophical reflection can enable their definition to be shaped.


Assuntos
Inteligência Artificial , Obrigações Morais , Assistência à Saúde/organização & administração , Humanismo , Humanos , Robótica
11.
Women Birth ; 32(5): 412-426, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31262706

RESUMO

BACKGROUND: Culturally secure care is considered foundational for good perinatal outcomes for Indigenous women. It is unknown what literature reports on whether Indigenous women giving birth in urban areas receives appropriate cultural care. The aim of this scoping review was to examine and summarise relevant evidence which reports on culturally secure care for Indigenous women using urban maternity services at any time during the perinatal period. METHODS: Ten journal databases plus grey literature and theses databases were searched for relevant material dated 1986-2018. Articles were included if they were about Indigenous women from Australia, New Zealand, Canada or the USA; care was provided anytime during the perinatal period, in an urban area; and cultural security (or variations of this term) were used. RESULTS: 6856 titles and abstracts were screened, of these: 25 studies, 15 grey literature documents and 9 theses matched the search criteria. Studies were mostly qualitative (13/25) and from Australia (18/25). Studies showed women's access to and experiences of culturally secure maternity care in urban areas as variable. The grey literature originated from Australia (8/15); New Zealand (4/15); and Canada (3/15); while theses were from Canada (7/9) and Australia (2/9). CONCLUSION: The scoping review results showed substantial qualitative evidence on Indigenous women's experience during the perinatal period in urban areas. In-depth analysis of these studies is required to inform future practice and policy on what works and what needs improvement. Culturally secure midwifery care shows promising results.


Assuntos
Assistência à Saúde Culturalmente Competente , Assistência à Saúde/organização & administração , Serviços de Saúde do Indígena/organização & administração , Tocologia/métodos , Assistência Perinatal , Austrália , Canadá , Competência Cultural , Assistência à Saúde/métodos , Feminino , Humanos , Nova Zelândia , Parto , Gravidez , População Urbana
12.
Women Birth ; 32(5): 437-448, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31326383

RESUMO

BACKGROUND: Good quality antenatal care is essential to improve the perinatal outcomes of Aboriginal and Torres Strait Islander women in Australia. Group antenatal care (GAC) is an innovative model which places clinical assessment, education and social support into a group setting. Previous studies have found GAC to be associated with improved perinatal outcomes, particularly for vulnerable populations, and high satisfaction levels among group members. No implementations of GAC, or evaluations of its acceptability, for an Indigenous population in Australia have been previously conducted. AIM: To explore the perceptions of a group of Indigenous health workers (n=5) in a health service in Far North Queensland, Australia, towards the prospective acceptability of GAC as an additional choice of model of care for their Indigenous women clients. METHODS: This qualitative acceptability study employed a descriptive/exploratory methodology. Data collection was by semi structured interview. Data analysis was guided by a theoretical framework of acceptability and conducted following a process of iterative categorisation. FINDINGS: No overall precluding factors were identified to render the model unacceptable for Indigenous women in this locality. Some features of the model would not suit all women. Indigenous health workers were interested in increased involvement with antenatal care and participation in a GAC model. CONCLUSION: A foundation of acceptability exists upon which the implementation of a GAC model could offer benefits to Indigenous women in this health service. The positive response of the Indigenous health workers to the concept of GAC endorsed the potential of this model to contribute to the provision of culturally appropriate and effective antenatal care within mainstream services.


Assuntos
Assistência à Saúde/organização & administração , Serviços de Saúde do Indígena/organização & administração , Serviços de Saúde Materna/organização & administração , Bem-Estar Materno/etnologia , Grupo com Ancestrais Oceânicos/etnologia , Cuidado Pré-Natal/métodos , Adulto , Austrália , Feminino , Pessoal de Saúde , Disparidades em Assistência à Saúde , Humanos , Grupo com Ancestrais Oceânicos/psicologia , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Parto , Gravidez , Pesquisa Qualitativa , Qualidade da Assistência à Saúde
13.
Codas ; 31(3): e20180092, 2019 Jun 27.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31271577

RESUMO

PURPOSE: The present study aimed to analyze the degree of implementation of the national health care policy at the state level. METHODS: This qualitative evaluation study was carried out in two stages. Firstly, the policy was modelled by means of document analysis and the application of the Delphi technique for consensus among experts. In the second stage, a qualitative, exploratory evaluative research was conducted, designed as a single case study in a Brazilian state through semi-structured interviews with health managers. RESULTS: The experts reached a consensus for a logical model and an evaluation matrix of the policy implementation. The results at the state level evinced an incipient degree of implementation, as the level of government characteristics achieved 45% of the maximum score; management, 41%; and system organization, 33%. CONCLUSION: The degree of implementation in the state evaluated was classified as incipient. Barriers were identified in the management and organization levels of the system, as well as in the political context.


Assuntos
Política de Saúde , Perda Auditiva , Programas Nacionais de Saúde , Brasil , Assistência à Saúde/organização & administração , Humanos , Programas Nacionais de Saúde/organização & administração , Avaliação de Programas e Projetos de Saúde , Pesquisa Qualitativa
14.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(6): 643-647, 2019 Jun 10.
Artigo em Chinês | MEDLINE | ID: mdl-31238612

RESUMO

Objective: To analyze the epidemiological characteristics, trend and related factors of tuberculosis patients that delayed for care, in Wuhan from 2008 to 2017. Methods: Data regarding tuberculosis (TB) patients was collected from the tuberculosis management information system (TMIS), a part of the China information system for disease control and prevention from 2008 to 2017. A total of 64 208 tuberculosis patients, aged 0 to 95 years were included for the analysis. Unconditional logistic regression method was used to estimate those factors that associated with this study. Results: Days of delay among TB patients appeared as M=10 (P(25)-P(75): 3-28) day, in Wuhan, 2008-2017. The prevalence of the delay was 52.5% (33 703/64 208), presenting a downward trend from 2008 to 2017 (trend χ(2)=10.64, P<0.001), but the proportions of women and ≥65 year-olds were gradually increasing. Results from the multivariate logistic regression analysis showed that factors as: patients living far away from the city vs. near the city (OR=1.29, 95%CI: 1.25-1.35), and age above 45 years vs. younger than 25 years (the age 45-64 years group vs. aged less than 25 years group, OR=1.22, 95%CI: 1.15-1.29; the age 65 or above group vs. aged less than 25 years group, the OR=1.30, 95%CI: 1.22-1.39) were under higher risk on the delay of seeking care. Occupation, way of case-finding and classification of tuberculosis patients also appeared as influencing factors on this issue. Conclusions: Prevalence on the delay of care was 52.5% among tuberculosis patients in Wuhan, 2008-2017, but with an annual decrease. Attention should be paid to female, wrinkly or elderly tuberculosis patients regarding the delay of care on TB, in Wuhan.


Assuntos
Antituberculosos/uso terapêutico , Diagnóstico Tardio , Conhecimentos, Atitudes e Prática em Saúde , Acesso aos Serviços de Saúde , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Características de Residência/estatística & dados numéricos , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/tratamento farmacológico , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , China/epidemiologia , Assistência à Saúde/organização & administração , Feminino , Humanos , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Prevalência , Distribuição por Sexo , Tuberculose Pulmonar/epidemiologia , Tuberculose Pulmonar/microbiologia , Adulto Jovem
15.
Soins ; 64(836): 18-23, 2019 Jun.
Artigo em Francês | MEDLINE | ID: mdl-31208576

RESUMO

Today, sending people into space has become almost routine. However, it is a potentially dangerous environment for humans. Astronauts' health is closely monitored to ensure they are fit to continue their mission. The conquest of space has also resulted in the development of numerous tools and medicines beneficial for all living beings on Earth.


Assuntos
Astronautas , Assistência à Saúde/organização & administração , Difusão de Inovações , Voo Espacial , Humanos
16.
Clin Ter ; 170(3): e177-e180, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31173046

RESUMO

BACKGROUND: In the wound care field, effective communication within the interdisciplinary staff is essential and the use of tools that foster it is important. The use of a common language among professionals in the assessment and monitoring process, along with documentation of the outcome, avoids the useless repetition of performances by professionals, with a considerable save of time. OBJECTIVE: One year after its publication, we wanted to evaluate the effectiveness of the Toven Evaluation Form as an interdisciplinary communication tool, for the assessment of cutaneous lesions, according to the Toven Method. MATERIAL: The instrument got under observation also allows the graphic recording of the characteristics of the skin lesions (size, wound conditions, undermining and perilesional skin) according to specific pre-established rules, in an easy and intuitive way for the evaluator and the rest of the multidisciplinary team. It is an integral part of the Toven File. An anonymous, specially created questionnaire containing 20 questions was used for its evaluation. METHODS: A fact-finding inquiry was initiated by recruiting a multidisciplinary sample of 101 professionals who managed skin lesions in their activity. Before completing the form, all the participants attended a two-hour training course, which took place through a lecture and a practical session. RESULTS: Sample composition: 76.2% females, 23.8% males; 63.4% nurses, 10.9% Wound Care Specialist nurses; 16,8% doctors; 8.9% physiotherapists. Of these, 69.3% had work experience >5 years. The technical quality of the instrument was considered excellent by 83.2% of professionals and good by 16.8% of them. The data recorded with the aid of the instrument were considered complete by 100% of the sample. Furthermore, 99% of the sample interviewed declared that the tool is easy to use and would be interested in including it in daily practice; 100% declares that the use of the form can facilitate its work, which can be easily understood and used by the entire multidisciplinary team and which can be an effective tool for the improvement of interdisciplinary communication.


Assuntos
Comunicação , Assistência à Saúde/organização & administração , Comunicação Interdisciplinar , Pele/patologia , Feminino , Humanos , Masculino , Médicos/organização & administração
17.
BMC Health Serv Res ; 19(1): 402, 2019 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-31221153

RESUMO

BACKGROUND: The majority of perinatal deaths occurring in low- and middle- income countries are preventable. South Africa is a middle-income country with consistently high perinatal mortality rates and most factors contributing to preventable deaths are linked to the functioning of the health system. Particularly of concern in South Africa is the high perinatal mortality in district hospitals, where most births occur and where intrapartum care is provided to women of low and intermediate risk. Therefore, it is crucial to strengthen the health system for perinatal care in district hospitals. There is currently no consolidated documented framework outlining contextual health system domains and indicators that are key to providing effective perinatal care in district hospitals. The purpose of this study was to derive key health system domains and indicators necessary to measure the performance of the health system for perinatal care in South African district hospitals. METHODS: The Delphi technique was used in collecting data from a panel with experts drawn from disciplines connected with the functioning of the health system for perinatal care in South Africa. The study enrolled thirteen experts from whom data on key health system domains and indicators for perinatal care were derived. The project reference group gave guidance to the development of the framework and ascertained its relevance to the South African setting. RESULTS: The Facility Based Health System Framework for Perinatal Care comprising domains and indicators necessary to measure health system performance in South African district hospitals was derived from data. The broad structure of the proposed framework aligns with the WHO Health Systems Framework. Each critical building block has detailed domains and indicators that illuminate essential facility-level and programme-specific elements that require attention for strengthening the health system for perinatal care. CONCLUSION: The proposed framework can enable district hospital management teams to identify gaps in the health system for perinatal care, which need to be strengthened in order to alleviate the burden of perinatal deaths in district hospitals.


Assuntos
Assistência à Saúde/organização & administração , Hospitais de Distrito , Assistência Perinatal/organização & administração , Técnica Delfos , Feminino , Humanos , Recém-Nascido , Gravidez , África do Sul
18.
J Emerg Manag ; 17(3): 225-238, 2019 May/Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31245834

RESUMO

OBJECTIVE: Individuals leading nongovernmental organizations (NGOs) often lack adequate training to best serve their communities' needs during disaster recovery even as they are often tasked with filling in gaps left by governmental and private resources. Thus, it is essential that education and training initiatives address NGO efforts specifically. This paper identifies training and education needs as proffered by organizational representatives that have themselves been involved in long-term recovery efforts following disasters in the past 10 years across Texas. DESIGN, SETTING, AND SUBJECTS: Qualitative interviews with nearly 100 local NGO representatives, government officials, and regional and state-level NGO representatives were conducted using purposive and snowball sampling. The participants conducted recovery activities in six different locations in Texas since 2008. RESULTS: Many respondents noted that they had little experience in disaster recovery and a lack of understanding of what recovery involved. Interviewees identified needs for training including how to coordinate recovery tasks among multiple organizations and agencies (eg, who to involve, what skillsets are needed, what group structure should be formed), how to distribute financial and nonfinancial resources (eg, how to prioritize needs, how to distribute funds, who should receive funding), and how to manage media and external organizational attention. CONCLUSION: This paper provides recommendations for augmenting existing NGO training and educational activities and developing new training schemes offering practical advice from recovery leaders who have been on the frontline of recent disasters.


Assuntos
Assistência à Saúde/organização & administração , Medicina de Desastres/educação , Planejamento em Desastres/organização & administração , Desastres , Organizações , Humanos , Texas
19.
Nurs Adm Q ; 43(3): 263-266, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31162345

RESUMO

It is strategic to describe and disseminate available examples of how nurses find the modus operandi to being fully integrated in their organizations, including the nurse role in determining improvements in clinical practice, management, education, and/or research. This article describes the recent experiences of Gruppo San Donato International Nursing Academy. The disruptive case shared here underlines the worth of nursing within health care organizations. The Gruppo San Donato International Nursing Academy aims to be a striking model to innovate health care delivery through the optimal utilization of the nursing workforce, uniting the areas of nursing management, nursing education, and research into a unique organizational platform.


Assuntos
Assistência à Saúde/organização & administração , Internacionalidade , Papel do Profissional de Enfermagem , Escolas de Enfermagem/tendências , Humanos , Itália , Sociedades de Enfermagem/organização & administração
20.
BMC Public Health ; 19(1): 729, 2019 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-31185993

RESUMO

BACKGROUND: While frameworks exist for strengthening health care systems and public health systems, there are no practical frameworks to describe, assess and strengthen systems for chronic disease prevention (CDP) using complex systems approaches. METHODS: A systematic and integrative review of peer reviewed literature was conducted to answer the following questions: How can systems for CDP be defined? What are key attributes of effective systems? How are complex systems approaches discussed? Search terms were identified and the Medline, SCOPUS, and Global Health databases were searched December 2017 and January 2018. Reference lists and selected journals were hand searched. A working definition for a system for CDP was developed to provide a guideline for inclusion. Key exclusion criteria were literature did not address the research questions or working definition; was published in a language other than English and before 2000; focused on specific chronic diseases and/or risk factors and not CDP broadly; concentrated on the health care sector and clinical services and/or health status and surveillance data; and described evaluations of setting specific actions such as policies, programs, interventions, approaches, projects, laws, or regulations. Selected literature (n = 141) was coded in terms of the extent to which the research questions and the working definition of systems for CDP were addressed. Data was then analysed and synthesized to determine key themes. RESULTS: A revised definition of systems for CDP and seven attributes of effective systems for CDP are reported (collaborative capacity, health equity paradigm, leadership and governance, resources, implementation of desired actions, information and complex systems paradigm). A framework was developed to provide a foundation for describing, assessing and strengthening systems for CDP. CONCLUSIONS: The results of this literature review provide a strong foundation for a framework to help strengthen systems for CDP. The framework consolidates not only well-established attributes of effective CDP but also highlights theoretical and practical insights from complex systems perspectives.


Assuntos
Doença Crônica/prevenção & controle , Assistência à Saúde/organização & administração , Análise de Sistemas , Humanos , Políticas
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