Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 647
Filtrar
1.
Sex Health ; 18(1): 41-49, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33653504

RESUMO

The 2016 global commitments towards ending the AIDS epidemic by 2030 require the Asia-Pacific region to reach the Fast-Track targets by 2020. Despite early successes, the region is well short of meeting these targets. The overall stalled progress in the HIV response has been further undermined by rising new infections among young key populations and the unprecedented COVID-19 pandemic. This paper examines the HIV situation, assesses the gaps, and analyses what it would take the region to end AIDS by 2030. Political will and commitments for ending AIDS must be reaffirmed and reinforced. Focused regional strategic direction that answers the specific regional context and guides countries to respond to their specific needs must be put in place. The region must harness the power of innovative tools and technology in both prevention and treatment. Community activism and meaningful community engagement across the spectrum of HIV response must be ensured. Punitive laws, stigma, and discrimination that deter key populations and people living with HIV from accessing health services must be effectively tackled. The people-centred public health approach must be fully integrated into national universal health coverage while ensuring domestic resources are available for community-led service delivery. The region must utilise its full potential and draw upon lessons that have been learnt to address common challenges of the HIV and COVID-19 pandemics and achieve the goal of ending AIDS by 2030, in fulfillment of the United Nations' Sustainable Development Goals.


Assuntos
Síndrome de Imunodeficiência Adquirida/prevenção & controle , Epidemias/prevenção & controle , Síndrome de Imunodeficiência Adquirida/transmissão , Ásia , Assistência à Saúde/organização & administração , Objetivos , Implementação de Plano de Saúde/organização & administração , Humanos , Cooperação Internacional , Ilhas do Pacífico , Política , Desenvolvimento Sustentável , Cobertura Universal do Seguro de Saúde/organização & administração
4.
J Prim Health Care ; 12(3): 193-194, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32988439

RESUMO

COVID-19 pandemic highlighted the importance of public, universal and equal access health-care, and reminded us that challenges are always incumbent for health-care systems. Because accessible and universal health-care systems will be critical into the future, it will be crucial to earmark adequate resources, fostering the financing of sectors that for many years have been neglected such as primary care and public health, and investments in new models of care and in health-related workforce.


Assuntos
Infecções por Coronavirus/epidemiologia , Acesso aos Serviços de Saúde/organização & administração , Pneumonia Viral/epidemiologia , Atenção Primária à Saúde/organização & administração , Cobertura Universal do Seguro de Saúde/organização & administração , Betacoronavirus , Mudança Climática , Humanos , Itália/epidemiologia , Modelos Organizacionais , Pandemias
6.
PLoS One ; 15(8): e0236169, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32745081

RESUMO

In line with the Sustainable Development Goals (SDGs) and the target for achieving Universal Health Coverage (UHC), state level initiatives to promote health with "no-one left behind" are underway in India. In Kerala, reforms under the flagship Aardram mission include upgradation of Primary Health Centres (PHCs) to Family Health Centres (FHCs, similar to the national model of health and wellness centres (HWCs)), with the proactive provision of a package of primary care services for the population in an administrative area. We report on a component of Aardram's monitoring and evaluation framework for primary health care, where tracer input, output, and outcome indicators were selected using a modified Delphi process and field tested. A conceptual framework and indicator inventory were developed drawing upon literature review and stakeholder consultations, followed by mapping of manual registers currently used in PHCs to identify sources of data and processes of monitoring. The indicator inventory was reduced to a list using a modified Delphi method, followed by facility-level field testing across three districts. The modified Delphi comprised 25 participants in two rounds, who brought the list down to 23 approved and 12 recommended indicators. Three types of challenges in monitoring indicators were identified: appropriateness of indicators relative to local use, lack of clarity or procedural differences among those doing the reporting, and validity of data. Further field-testing of indicators, as well as the revision or removal of some may be required to support ongoing health systems reform, learning, monitoring and evaluation.


Assuntos
Reforma dos Serviços de Saúde/organização & administração , Atenção Primária à Saúde/organização & administração , Indicadores de Qualidade em Assistência à Saúde , Desenvolvimento Sustentável , Cobertura Universal do Seguro de Saúde/organização & administração , Instituições de Assistência Ambulatorial/organização & administração , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Academias de Ginástica/organização & administração , Academias de Ginástica/estatística & dados numéricos , Reforma dos Serviços de Saúde/estatística & dados numéricos , Implementação de Plano de Saúde/organização & administração , Implementação de Plano de Saúde/estatística & dados numéricos , Promoção da Saúde/organização & administração , Promoção da Saúde/estatística & dados numéricos , Humanos , Índia , Atenção Primária à Saúde/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde/estatística & dados numéricos , Cobertura Universal do Seguro de Saúde/estatística & dados numéricos
7.
Infect Dis Poverty ; 9(1): 90, 2020 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-32650822

RESUMO

BACKGROUND: Social innovation (SI) in health holds potential to contribute to health systems strengthening and universal health coverage (UHC). The role of universities in SI has been well described in the context of high-income countries. An evidence gap exits on SI in healthcare delivery in the context of low- and middle-income countries (LMICs) as well as on the engagement of universities from these contexts. There is thus a need to build capacity for research and engagement in SI in healthcare delivery within these universities. The aim of this study was to examine the adoption and implementation of network of university hubs focused on SI in healthcare delivery within five countries across Africa, Asia and Latin America. The objectives were to describe the model, components and implementation process of the hubs; identify the enablers and barriers experienced and draw implications that could be relevant to other LMIC universities interested in SI. METHODS: A case study design was adopted to study the implementation process of a network of university hubs. Data from documentation, team discussions and post-implementation surveys were collected from 2013 to 2018 and analysed with aid of a modified policy analysis framework. RESULTS/DISCUSSION: SI university-based hubs serve as cross-disciplinary and cross-sectoral platforms, established to catalyse SI within the local health system through four core activities: research, community-building, storytelling and institutional embedding, and adhering to values of inclusion, assets, co-creation and hope. Hubs were implemented as informal structures, managed by a small core team, in existing department. Enablers of hub implementation and functioning were the availability of strong in-country social networks, legitimacy attained from being part of a global network on SI in health and receiving a capacity building package in the initial stages. Barriers encountered were internal institutional resistance, administrative challenges associated with university bureaucracy and annual funding cycles. CONCLUSIONS: This case study shows the opportunity that reside within LMIC universities to act as eco-system enablers of SI in healthcare delivery in order to fill the evidence gap on SI and enhance cross-sectoral participation in support of achieving UHC.


Assuntos
Assistência à Saúde/organização & administração , Inovação Organizacional , Qualidade da Assistência à Saúde/organização & administração , Cobertura Universal do Seguro de Saúde/organização & administração , Universidades , Humanos , América Latina , Malaui , Filipinas , Formulação de Políticas , Uganda
8.
BMC Public Health ; 20(1): 993, 2020 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-32580720

RESUMO

BACKGROUND: Universal child health services (UCHS) provide an important pragmatic platform for the delivery of universal and targeted interventions to support families and optimize child health outcomes. We aimed to identify brief, evidence-based interventions for common health and developmental problems that could be potentially implemented in UCHS. METHODS: A restricted evidence assessment (REA) of electronic databases and grey literature was undertaken covering January 2006 to August 2019. Studies were eligible if (i) outcomes related to one or more of four areas: child social and emotional wellbeing (SEWB), infant sleep, home learning environment or parent mental health, (ii) a comparison group was used, (iii) universal or targeted intervention were delivered in non-tertiary settings, (iv) interventions did not last more than 4 sessions, and (v) children were aged between 2 weeks postpartum and 5 years at baseline. RESULTS: Seventeen studies met the eligibility criteria. Of these, three interventions could possibly be implemented at scale within UCHS platforms: (1) a universal child behavioural intervention which did not affect its primary outcome of infant sleep but improved parental mental health, (2) a universal screening programme which improved maternal mental health, and (3) a targeted child behavioural intervention which improved parent-reported infant sleep problems and parental mental health. Key lessons learnt include: (1) Interventions should impart the maximal amount of information within an initial session with future sessions reinforcing key messages, (2) Interventions should see the family as a holistic unit by considering the needs of parents with an emphasis on identification, triage and referral, and (3) Brief interventions may be more acceptable for stigmatized topics, but still entail considerable barriers that deter the most vulnerable. CONCLUSIONS: Delivery and evaluation of brief evidence-based interventions from a UCHS could lead to improved maternal and child health outcomes through a more responsive and equitable service. We recommend three interventions that meet our criteria of "best bet" interventions.


Assuntos
Serviços de Saúde da Criança/organização & administração , Serviços de Saúde da Criança/estatística & dados numéricos , Medicina Baseada em Evidências/organização & administração , Medicina Baseada em Evidências/estatística & dados numéricos , Cobertura Universal do Seguro de Saúde/organização & administração , Cobertura Universal do Seguro de Saúde/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino
9.
Sex Reprod Health Matters ; 28(2): 1781583, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32543338

RESUMO

The COVID-19 pandemic is not just a health crisis - it is a full-blown economic and social crisis that is impacting the lives and livelihoods of billions of people. This commentary examines the mutually dependent relationship between health security and universal health coverage (UHC), and how the longstanding underinvestment in both renders us all vulnerable. It also discusses the vulnerability of services for sexual and reproductive health and rights (SRHR) in times of crisis, which is compounded when these services are not included and well integrated into national UHC packages. It concludes with a call for stronger political leadership for UHC and SRHR as the global community strives to "build back better" after COVID-19.


Assuntos
Infecções por Coronavirus/epidemiologia , Nível de Saúde , Pneumonia Viral/epidemiologia , Cobertura Universal do Seguro de Saúde/organização & administração , Betacoronavirus , Acesso aos Serviços de Saúde/normas , Humanos , Pandemias , Política , Saúde Reprodutiva/normas , Direitos Sexuais e Reprodutivos/normas , Saúde Sexual/normas
10.
Int Nurs Rev ; 67(2): 160-163, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32495339

RESUMO

In this paper, we strongly advocate for universal palliative care access during the COVID-19 pandemic. The delivery of universal palliative care services has been called for by leading global health organizations and experts. Nurses are critical to realizing this goal. COVID-19 diagnoses and fatalities continue to rise, underscoring the importance of palliative care, particularly in the context of scant resources. To inform the writing of this paper, we undertook a review of the COVID-19 and palliative care literature and drew on our experiences. It is very clear that investment in nurses is needed to ensure appropriate palliative care services now and into the future. Avoiding futile interventions and alleviating suffering is an ethical imperative for nurses regardless of the setting. Multi-level practices and policies to foster the delivery of safe, high-quality palliative care for all are urgently needed.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Acesso aos Serviços de Saúde/organização & administração , Cuidados Paliativos/organização & administração , Pneumonia Viral/terapia , Cobertura Universal do Seguro de Saúde/organização & administração , Humanos , Pandemias , Pesquisa Qualitativa , Apoio Social
11.
Int J Public Health ; 65(5): 617-625, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32474715

RESUMO

OBJECTIVES: We investigate the reliability of a survey question on forgone healthcare services for financial reasons, based on analysis of actual healthcare use over the 3-year period preceding response to the question. We compare the actual use of different health services by patients who report having forgone health care to those who do not. METHODS: Based on a prospective cohort study (CONSTANCES), we link survey data from enrolled participants to the Universal Health Insurance (UHI) claims database and compare use of health services of those who report having forgone health care to controls. We present multivariable logistic regression models and assess the odds of using different health services. RESULTS: Compared to controls, forgoing care participants had lower odds of consulting GPs (OR = 0.83; 95% CI 0.73, 0.93), especially specialists outside hospitals (gynecologists: 0.74 (0.69, 0.78); dermatologists: 0.81 (0.78-0.85); pneumologists 0.82 (0.71-0.94); dentists 0.71 (0.68, 0.75)); higher odds of ED visits (OR = 1.25; 95% CI 1.19, 1.31); and no difference in hospital admissions (OR = 1.02; 95% CI 0.97, 1.09). Participants with lower occupational status and income had higher odds of forgoing health care. CONCLUSIONS: The perception of those who report having forgone health care for financial reasons is consistent with their lower actual use of community-based ambulatory care (CBAC). While UHI may be necessary to improve healthcare access, it does not address the social factors associated with the population forgoing health care for financial reasons.


Assuntos
Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/estatística & dados numéricos , Visita a Consultório Médico/estatística & dados numéricos , Visita a Consultório Médico/tendências , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Cobertura Universal do Seguro de Saúde/organização & administração , Cobertura Universal do Seguro de Saúde/estatística & dados numéricos , Adolescente , Adulto , Idoso , Teorema de Bayes , Feminino , França , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes , Inquéritos e Questionários , Adulto Jovem
12.
Lancet Glob Health ; 8(6): e829-e839, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32446348

RESUMO

BACKGROUND: Disease Control Priorities, 3rd edition (DCP3), published two model health benefits packages (HBPs). This study estimates the overall costs and individual component costs of these packages in low-income countries (LICs) and lower-middle-income countries (lower-MICs). METHODS: This study reports on our Disease Control Priorities Cost Model (DCP-CM), developed as part of the DCP3 project to determine the overall costs of the 218 health sector interventions recommended in the model HBP termed essential universal health coverage (EUHC). Model inputs included data on intervention unit costs, demographic and epidemiological data to quantify the populations in need of specific interventions, baseline coverage indicators, and estimates of required health system costs to support direct service delivery. The DCP-CM was informed primarily by published estimates of economic costs of interventions measured from the health system perspective. We estimated counterfactual annual costs for the year 2015. We disaggregated costs according to intervention characteristics (delivery platform, delivery timing, and health system objective) and did one-way and probabilistic sensitivity analyses with determination of 95% credible intervals (Crls). FINDINGS: At 80% population coverage, the annual cost of EUHC would be US$79 (95% Crl 60-110) per capita (in 2016 US dollars) in LICs and US$130 (100-180) per capita in lower-MICs. As a share of 2015 gross national income (GNI), additional investments would require 8·0% (95% Crl 5·7-11·3) in LICs and 4·2% (2·9-5·9) in lower-MICs. A highest priority subpackage comprising 115 of the EUHC interventions would cost approximately half of these amounts (3·7% [2·6-5·3] of 2015 GNI in LICs and 2·0% [1·4-2·8] in lower-MICs). Mortality-reducing interventions would require around two-thirds of the overall package costs, with interventions to reduce mortality at age 5-69 years from non-communicable disease and injury comprising the highest share of total EUHC costs in both income groups (37·6% [37·2-37·9] in LICs and 43·0% [42·6-43·4] in lower-MICs). Interventions addressing chronic health conditions (requiring 45·5% [44·8-46·4] 2015 GNI for LICs and lower-MICs combined) and interventions delivered in health centres (requiring 49·8% [49·5-50·2] 2015 GNI for LICs and lower-MICs combined) would each comprise the plurality of costs. INTERPRETATION: Implementation of EUHC would require costly investment, especially in LICs. DCP-CM is available as an online tool that can inform local HBP deliberation and support efficient investment in UHC, especially as countries pivot towards non-communicable disease and injury care. FUNDING: Bill & Melinda Gates Foundation, Trond Mohn Foundation, and Norwegian Agency for Development Cooperation.


Assuntos
Cobertura Universal do Seguro de Saúde/economia , Custos e Análise de Custo , Países em Desenvolvimento , Saúde Global , Prioridades em Saúde , Humanos , Investimentos em Saúde , Modelos Econométricos , Cobertura Universal do Seguro de Saúde/organização & administração
13.
WHO South East Asia J Public Health ; 9(1): 82-91, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32341227

RESUMO

The role of civil society and community-based organizations in advancing universal health coverage and meeting the targets of the 2030 Agenda for Sustainable Development has received renewed recognition from major global initiatives. This article documents the evolution and lessons learnt through two decades of experience in India at national, state and district levels. Community and civil society engagement in health services in India began with semi-institutional mechanisms under programmes focused on, for example, HIV/AIDS, tuberculosis, polio and immunization. A formal system of community action for health (CAH) started with the launch of the National Rural Health Mission in 2005. By December 2018, CAH processes were being implemented in 22 states, 353 districts and more than 200 000 villages in India. Successive evaluations have indicated improved performance on various service delivery parameters. One example of CAH is community-based monitoring and planning, which has been continuously expanded and strengthened in Maharashtra since 2007. This involves regular, participatory auditing of public health services, which facilitates the involvement of people in assessing the public health system and demanding improvements. At district level, CAH initiatives are successfully reaching "last-mile" communities. The Self-Employed Women's Association, a cooperative-based organization of women working in the informal sector in Gujarat, has developed community information hubs that empower clients to access government social and health sector services. CAH initiatives in India are now being augmented by regular activities led and/or participated in by civil society organizations. This is contributing to the democratization of community and civil society engagement in health. Additional documentation on CAH and the further formalization of civil society engagement are needed. These developments provide a valuable opportunity both to improve governance and accountability in the health sector and to accelerate progress towards universal health coverage. Lessons learnt may be applicable to other countries in South-East Asia, as well as to most low- and middle-income countries.


Assuntos
Participação da Comunidade , Setor de Assistência à Saúde/organização & administração , Cobertura Universal do Seguro de Saúde/organização & administração , Humanos , Índia
15.
BMC Health Serv Res ; 20(1): 182, 2020 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-32143629

RESUMO

BACKGROUND: Competing priorities in health systems necessitate difficult choices on which health actions and investments to fund: decisions that are complex, value-based, and highly political. In light of the centrality of universal health coverage (UHC) in driving current health policy, we sought to examine the value interests that influence agenda setting in the country's health financing space. Given the plurality of Kenya's health policy levers, we aimed to examine how the perspectives of stakeholders involved in policy decision-making and implementation shape discussions on health financing within the UHC framework. METHODS: A series of in-depth key informant interviews were conducted at national and county level (n = 13) between April and May 2018. Final thematic analysis using the Framework Method was conducted to identify similarities and differences amongst stakeholders on the challenges hindering Kenya's achievement of UHC in terms of its the optimisation of health service coverage; expansion of the population that benefits from essential healthcare services; and the minimisation of out-of-pocket costs associated with health-seeking behaviour. RESULTS: Our findings indicate that the perceived lack of strategic leadership from Kenya's national government has led to a lack of agreement on stakeholders' interpretation of what is to be understood by UHC, its contextual values and priorities. We observe material differences between and within policy networks on the country's priorities for population coverage, healthcare service provision, and cost-sharing under the UHC dispensation. In spite of this, we note that progressive universalism is considered as the preferred approach towards UHC in Kenya, with most interviewees prioritising an equity-based approach that prioritises better access to healthcare services and financial risk protection. However, the conflicting priorities of key stakeholders risk derailing progress towards the expansion of access to health services and financial risk protection. CONCLUSIONS: This study adds to existing knowledge of UHC in Kenya by contextualising the competing and evolving priorities that should be taken into consideration as the country strategises over its UHC process. We suggest that clear policy action is required from national government and county governments in order to develop a logical and consistent approach towards UHC in Kenya.


Assuntos
Pessoal Administrativo/psicologia , Prioridades em Saúde , Financiamento da Assistência à Saúde , Cobertura Universal do Seguro de Saúde/organização & administração , Política de Saúde , Humanos , Quênia , Formulação de Políticas , Pesquisa Qualitativa , Participação dos Interessados , Cobertura Universal do Seguro de Saúde/economia
16.
Glob Health Action ; 13(sup1): 1694744, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32194010

RESUMO

Background: As called for by the Sustainable Development Goals, governments, development partners and civil society are working on anti-corruption, transparency and accountability approaches to control corruption and advance Universal Health Coverage.Objectives: The objective of this review is to summarize concepts, frameworks, and approaches used to identify corruption risks and consequences of corruption on health systems and outcomes. We also inventory interventions to fight corruption and increase transparency and accountability.Methods: We performed a critical review based on a systematic search of literature in PubMed and Web of Science and reviewed background papers and presentations from two international technical meetings on the topic of anti-corruption and health. We identified concepts, frameworks and approaches and summarized updated evidence of types and causes corruption in the health sector.Results: Corruption, or the abuse of power for private gain, in health systems includes bribes and kickbacks, embezzlement, fraud, political influence/nepotism and informal payments, among other behaviors. Drivers of corruption include individual and systems level factors such as financial pressures, poorly managed conflicts of interest, and weak regulatory and enforcement systems. We identify six typologies and frameworks that model relationships influencing the scope and seriousness of corruption, and show how anti-corruption strategies such as transparency, accountability, and civic participation can affect corruption risk. Little research exists on the effectiveness of anti-corruption measures; however, interventions such as community monitoring and insurance fraud control programs show promise.Conclusions: Corruption undermines the capacity of health systems to contribute to better health, economic growth and development. Interventions and resources on prevention and control of corruption are essential components of health system strengthening for Universal Health Coverage.


Assuntos
Fraude/ética , Fraude/prevenção & controle , Saúde Global/ética , Programas Governamentais/ética , Responsabilidade Social , Cobertura Universal do Seguro de Saúde/ética , Cobertura Universal do Seguro de Saúde/organização & administração , Fraude/estatística & dados numéricos , Saúde Global/estatística & dados numéricos , Programas Governamentais/organização & administração , Programas Governamentais/estatística & dados numéricos , Humanos , Cobertura Universal do Seguro de Saúde/estatística & dados numéricos
17.
Glob Health Action ; 13(sup1): 1695241, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32194014

RESUMO

Background: Pharmaceutical corruption is a serious challenge in global health. Digital technologies that can detect and prevent fraud and corruption are particularly important to address barriers to access to medicines, such as medicines availability and affordability, stockouts, shortages, diversion, and infiltration of substandard and falsified medicines.Objectives: To better understand how digital technologies are used to combat corruption, increase transparency, and detect fraud in pharmaceutical procurement systems to improve population health outcomes.Methods: We conducted a multidisciplinary review of the health/medicine, engineering, and computer science literature. Our search queries included keywords associated with medicines procurement and digital technology in combination with terms associated with transparency and anti-corruption initiatives. Our definition of 'digital technology' focused on Internet-based communications, including online portals and management systems, supply chain tools, and electronic databases.Results: We extracted 37 articles for in-depth review based on our inclusion criteria focused on the utilization of digital technology to improve medicines procurement. The vast majority of articles focused on electronic data transfer and/or e-procurement systems with fewer articles discussing emerging technologies such as machine learning and blockchain distributed ledger solutions. In the context of e-procurement, slow adoption, justifying cost-savings, and need for technical standards setting were identified as key challenges for current and future utilization.Conclusions: Though there is a significant promise for digital technologies, particularly e-procurement, overall adoption of solutions that can enhance transparency, accountability and concomitantly combat corruption, is still underdeveloped. Future efforts should focus on tying cost-saving measurements with anti-corruption indicators, prioritizing centralization of e-procurement systems, establishing regulatory harmonization with standards setting, and incorporating additional anti-corruption technologies into procurement processes for improving access to medicines and to reach the overall goal of Universal Health Coverage.


Assuntos
Fraude/prevenção & controle , Saúde Global/ética , Invenções , Preparações Farmacêuticas/economia , Preparações Farmacêuticas/provisão & distribução , Cobertura Universal do Seguro de Saúde/ética , Cobertura Universal do Seguro de Saúde/organização & administração , Humanos , Estudos Interdisciplinares , Responsabilidade Social
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...