A Semiautomated Classification System for Producing Service Directories in Social and Health Care (DESDE-AND): Maturity Assessment Study.

BACKGROUND: DESDE-LTC (Description and Evaluation of Services and DirectoriEs for Long-Term Care) is an international classification system that allows standardized coding and comparisons between different territories and care sectors, such as health and social care, in defined geographic areas. We adapted DESDE-LTC into a computer tool (DESDE-AND) for compiling a directory of care services in Andalucia, Spain. OBJECTIVE: The aim of this study was to evaluate the maturity of DESDE-AND. A secondary objective of this study is to show the practicality of a new combined set of standard evaluation tools for measuring the maturity of health technology products. METHODS: A system for semiautomated coding of service provision has been co-designed. A panel of 23 domain experts and a group of 68 end users participated in its maturity assessment that included its technology readiness level (TRL), usability, validity, adoption (Adoption Impact Ladder [AIL]), and overall degree of maturity [implementation maturity model [IMM]). We piloted the prototype in an urban environment (Seville, Spain). RESULTS: The prototype was demonstrated in an operational environment (TRL 7). Sixty-eight different care services were coded, generating fact sheets for each service and its geolocation map. The observed agreement was 90%, with moderate reliability. The tool was partially adopted by the regional government of Andalucia (Spain), reaching a level 5 in adoption (AIL) and a level 4 in maturity (IMM) and is ready for full implementation. CONCLUSIONS: DESDE-AND is a usable and manageable system for coding and compiling service directories and it can be used as a core module of decision support systems to guide planning in complex cross-sectoral areas such as combined social and health care.

[Being an active citizen and the elderly: Old concepts, new approaches. A systematic review and qualitative meta-synthesis]. / Ciudadanía activa y personas mayores: viejos conceptos, nuevos abordajes. Una revisión sistemática y metasíntesis cualitativa.

The politics of active ageing present active citizenship of the elderly as a key challenge for the coming years. Active citizenship has been defined in different ways (as complimentary in most cases), outlining an eclecticism of participatory activities that includes political engagement in a participatory and deliberative manner, as well as community and voluntary action. This term is found in different contexts such as formal politics, work, civil society, and the home. This paper, based on a systematic review, identifies the context in which this concept emerges in relation to older people and people with dementia. It also analyses the different expressions of active citizenship used, and provides key elements to be taken into account in the formulation of policies in a context of accelerated demographic ageing and where dementia is a public health priority. The notion of active citizenship in old age is a step forward from active ageing to a broader concept that integrates the principle of equality between people irrespective of gender, age and the need for support.

[Impact assessment of a multisectoral plan for the promotion of health and social wellbeing in Andalusia (Spain)]. / Evaluación del impacto de un plan multisectorial de promoción de la salud y el bienestar social en Andalucía.

OBJECTIVE: To evaluate the impact of the Plan for the promotion of personal autonomy and prevention of disability in Andalusia (2016-2020) in 13 public administrations during the first year of its implementation; and to analyse the usability and feasibility of the impact assessment ladder used. METHOD: The Plan addresses the promotion of personal autonomy and the prevention of disabilities and dependencies through a multisectoral approach. It is structured in strands or lines of work, objectives and actions that have been assessed through the Adoption Impact Ladder (AIL). The analysis of the face validity, feasibility and inter-rater reliability of the impact assessment ladder was carried out in 30 actions of the Plan that were rated by 20 experts from the 13 ministries and public agencies involved in the Plan, and an external rater. RESULTS: 176 actions and programmes were launched in 2017. Of these, 67.2% were implemented during the first year. Only one of the 16 objectives had no action initiated during the first year. Moreover, 7 out of 15 objectives implemented were fully multisectoral involving more than three Regional Ministries. The face validity, feasibility and inter-rater reliability of the AIL were good (κ: 0.72). CONCLUSIONS: This Plan has provided a novel framework to coordinate a broad range of proposed policies and actions within the public administration of Andalusia. For the first time, a multisectoral impact analysis has been conducted providing an effective guide for monitoring, planning and setting public priorities in health, social services, ageing and disabilities.

Creation Process of the Digital Platform to Foster Healthy and Active Aging: enbuenaedad.

Andalusia is a region in the south of Spain with 8,4 million inhabitants of which 1,3 million are over 65 years old. Andalusia has been recognized as Reference Site by the European Commission within the European Innovation Partnership on Active and Healthy Aging. The Regional Ministry of Health of Andalusia has put in place strategies to promote healthy and active aging. One of these strategies is enbuenaedad, a digital platform which main aim is to foster active and healthy aging. The target audience is people over 55 years old, caregivers of older adults, as well as health and other key professionals who work with this population. Content sections are inspired in the three pillars of the World Health Organization (WHO) policy framework for active and healthy aging: health, participation, and security, but introducing an additional one which is lifelong learning. One of the strengths of this platform is the creation process. Using a co-thinking design, all target groups get voice under the umbrella of empathy and are empowered by providing support, training, knowledge, and best practices. For its development, dissemination, maintenance, and improvement, the project advocates the unavoidable participation of key stakeholders representing all sectors involved: The Senior Council of Andalusia; Primary Health Care professionals; local authorities; Guadalinfo agents; Permanent Adult Education; and Active Participation Centers. Quantitative and qualitative data obtained within the process support this project. Since its launching, 10,779 users have registered to the platform with more than 157,000 visits. Focusing on WHO four pillars on active and healthy aging Enbuenaedad is based on, preliminary results show effectiveness regarding participation and social interaction. Furthermore, achieving high participation coverage is a necessary but not sufficient input to the provision of adequate approach to older people. More comprehensive evaluation of the four pillars must be taken to ensure a holistic approach. A challenge is a cooperation between three traditionally independent sectors, cooperative work between health, social services, and education is crucial for the future sustainability of this intervention.

[Is a strategy of bio-socio-ethic necessary?]. / ¿Es necesaria una estrategia integrada de biosocioética?

AIM: The aim of this paper is to assess the need for a common ethics strategy shared by 2 of the cornerstones of human welfare: the healthcare and social services sectors. METHOD: An observational cross-sectional descriptive study was performed by surveying social services and healthcare professionals. A purposive sampling technique was used. The questionnaire consisted of 10 questions about ethical conflicts in professional practice and respondents' views on a proposed shared approach to bioethics and ethics in social intervention. RESULTS: 124 professionals completed the questionnaire, 56% of the health sector and 44% of the social services sector. About 90% professionals surveyed had had to make difficult ethical decisions in their work and would welcome a common approach to ethics in the social services and healthcare sectors. 75% said that conflicts are occurring more frequently in both sectors simultaneously and that they were resolved preferably individually and independently. CONCLUSIONS: The survey respondents believe that a common approach to tackling ethical conflicts in professional practice is required. Nevertheless, it is still rare for ethics committees to intervene in the conflict resolution process and for decision-making support and evaluation tools to be used.

[Predictors of institutionalization of elderly persons in dependency situation in Andalusia]. / Factores predictores de la institucionalización de personas mayores en situación de dependencia en Andalucía.

OBJECTIVE: Identifying preferences regarding type of care and risk factors for institutionalization of elderly persons in dependency situations in Andalusia. METHODS: The data on 200,039 persons registered in the System for Autonomy and Dependency Care over the period 2007-2012 were analysed. The study population was described in terms of: age, dependency situation, preferences, support network and clinical factors at the time of inclusion in the study. Separate analysis was made for men and women. A logistic regression model was designed to determine the risk factors for institutionalization for each sex. RESULTS: 87,4% of women and 85,9% of men expressed their wish to receive care in their own home. The risk of institutionalization is three times higher among men than among women. Among women, the risks of institutionalization are: level of dependency, wishing to move into a residential care home, medium consistency and fragility of support network and being diagnosed with dementia. Among men, the risks are: wishing to move into a residential care home and low or medium consistency of support network. CONCLUSIONS: Care in the home is the preferred alternative for elderly persons in dependency situations. The risk of institutionalization is conditioned more by the preferences of the person and their family and the characteristics of the support network than by individual's clinical condition.

Longevidad y revolución digital. Contribucion de las tecnologías de la información y de la comunicacion al envejecimiento saludable / Longevity and digital revolution. The contribution of information and communication technologies to healthy aging

OBJETIVO: Sintetizar el conocimiento disponible sobre la contribución de las tecnologías de la información y de la comunicación al envejecimiento activo y saludable. METODOLOGÍA: En la primera fase de búsqueda se utilizó la base de datos GERION de la Biblioteca Virtual del Sistema Sanitario Público Andaluz (SSPA). En la segunda fase se realizó una búsqueda en Cochrane Library, PubMed, EMBASE, Medline, SciELO, MedlinePlus y ScienceDirect. Se utilizaron descriptores de lenguaje natural y lenguaje controlado. Se incluyeron estudios publicados en castellano e inglés en el período comprendido entre enero de 2013 y enero de 2018. Se realizó una metasíntesis cualitativa. RESULTADOS: Se seleccionaron 262 estudios; se excluyeron 240: por estar duplicados, por no cumplir con los criterios de inclusión, por no disponer del texto completo y por no guardar relación con el objeto de estudio. Se incluyeron 22 estudios en la síntesis cualitativa. A partir de la identificación de temas emergentes y su agrupación en categorías, se construyó un modelo conceptual que explica la relación entre envejecimiento activo y saludable e innovación tecnológica. CONCLUSIONES: Las tecnologías de la información y de la comunicación contribuyen al empoderamiento de las personas para el autocuidado; mejoran su autoeficacia y ayudan a mantener su autonomía en la toma de decisiones; favorecen su participación efectiva en los sistemas sanitarios y de cuidados, y contribuyen a la democratización de la salud. Su utilización está condicionada por el compromiso y la implicación de las personas mayores en su diseño, la adaptación a los entornos y preferencias de la persona usuaria, su simplicidad, comprensibilidad, utilidad percibida y facilidad de uso

OBJECTIVE: synthesize the available knowledge on the contribution of information and communication technologies to active and healthy ageing. METHODOLOGY: GERION database from the Virtual Library of the Public Health System of Andalusia was used in the first search phase. In the second phase, a search was performed using Cochrane Library, PubMed, EMBASE, MEDLINE, SciELO, MedlinePlus, and Science Direct. Natural language and controlled language descriptors were used. Studies published in Spanish and English in the period January 2013 to January 2018 were included. Qualitative meta-synthesis was carried out. RESULTS: 262 studies were selected; 240 were excluded due to: duplication, not meeting the inclusion criteria, missing the full text, or not related to the object of study.22 studies were included in the qualitative synthesis. From the identification of emerging issues and their grouping into categories, a conceptual model was constructed that explains the relationship between active and healthy ageing and technological innovation. CONCLUSIONS:Information and communication technologies contribute to the empowerment of people for self-care; improve their self-efficacy; help maintain their autonomy in decision-making; favor their effective participation in health and care systems; and contribute to the democratization of health. Its use is conditioned by the commitment and involvement of older people in its design, adaptation to the environments and preferences of the user, its simplicity, comprehensibility, perceived utility and ease of use

Más allá del COVID-19. Diseño de un nuevo modelo de atención compartida entre farmacia comunitaria y atención primaria / Beyond COVID-19. Design of a new model of shared services between community pharmacies and primary health care

INTRODUCCIÓN: Las farmacias comunitarias representan un papel clave en la respuesta al COVID-19 y especialmente en el control de enfermedades crónicas más allá de la pandemia. OBJETIVO: Diseño de un nuevo modelo de atención compartida entre farmacia comunitaria y atención primaria para prevenir la fragilidad y promover el autocuidado en personas mayores. MÉTODO: Estudio cualitativo de investigación-acción con mapeo de actores, segmentación de perfiles, grupos de discusión, entrevistas en profundidad y sesiones de diseño creativo. Las técnicas utilizadas aseguraron la participación de personas mayores y profesionales en todas las etapas de diseño. RESULTADOS: Se generaron circuitos comunes de comunicación para los nuevos servicios y protocolos de actuación compartidos. Se propusieron nuevos roles profesionales en respuesta a las necesidades, expectativas y preferencias de las personas mayores. Se diseñaron los servicios de detección de fragilidad, adherencia a nuevos medicamentos, toma de constantes y refuerzo terapéutico. El modelo aporta sistemas de comunicación bidireccional entre atención primaria y farmacia comunitaria y reconoce el papel de la farmacia comunitaria en la promoción del autocuidado y gestión de la patología crónica y la medicación. CONCLUSIONES: Se evidencia la importancia de crear un ecosistema más abierto que dé lugar a innovaciones organizativas que aprovechen la proximidad y capilaridad de las oficinas de farmacia, así como la incorporación de la omnicanalidad en la atención, esencial en situaciones de crisis sanitaria como la actual. Asimismo, queda demostrado que las técnicas de diseño cooperativo favorecen la participación de los agentes involucrados, aumentando su contribución e impacto potencial sobre los resultados

INTRODUCTION: Community pharmacies play a key role in response to COVID-19 and especially in the control of chronic diseases beyond the pandemic. OBJECTIVE: To design a new model of health assistance focused on frailty prevention and the self-care promotion among older adults, using share care services between the community pharmacy and the primary healthcare. METHOD: We conducted a qualitative study of action research using methods as actor mapping, segment profile, discussion groups, in-depth interviews and creative design sessions. Using those techniques during all the design stages allowed us to get an effective participation of older adults and professionals. RESULTS: Common communications circuits for the new services, new professional roles and shared action protocols were created. Furthermore, we designed early frailty detection, medication review associated with fall risk, assessment and intervention for adherence to new medications, vital sign checking and hypertension, diabetes and COPD therapeutic reinforcement services. This model provides two-way communication systems with the primary health care and recognizes the community pharmacy functions in the scope of self-care promotion and chronic pathology and medication self-management. CONCLUSIONS: It is highlighted the importance of creating a more open ecosystem within the community. The feedback obtained will allow to design organizational innovations. This has to be done taking advantage of the community pharmacies proximity and capillarity in the territory, as well as the new incorporation of the omni-channel care. Besides, cooperative design techniques have proved to be an encouragement for the participation of the involved agents, increasing their contribution and potential impact on the results

Experiencias, modelos y claves para la coordinación e integración de servicios sociales y sanitarios / Experiences, models and key factors for the coordination and integration of social and health services

No disponible

¿Es necesaria una estrategia integrada de biosocioética? / Is a strategy of bio-socio-ethic necessary?

OBJETIVO: El presente artículo reflexiona sobre la necesidad de apostar por la articulación de una estrategia de ética que incluya 2 de los pilares básicos que afectan al bienestar de las personas, la atención de los servicios sanitarios y de los servicios sociales. El objetivo es realizar un acercamiento a la percepción de profesionales de los servicios sociales y sanitarios en Andalucía acerca de la necesidad de desarrollar un espacio de encuentro entre la bioética y la ética de la intervención social. MÉTODO: Estudio observacional, transversal y descriptivo, mediante encuesta a profesionales de los servicios sociales y sanitarios. Se utilizó una técnica de muestreo intencional. El cuestionario constaba de 10 preguntas sobre conflictos éticos en la práctica profesional social y sanitaria, y la percepción de desarrollo de un espacio compartido para la bioética y la ética de la intervención social. RESULTADOS: La muestra constó de 124 profesionales, un 56% del sector sanitario y un 44% del sector de servicios sociales. Alrededor del 90% de las personas encuestadas se habían enfrentado a decisiones éticas difíciles de abordar en su práctica profesional y valoraron positivamente un abordaje común social y sanitario. El 75% afirmaron que los conflictos se presentan en los 2 ámbitos simultáneamente más que por separado. La gestión de los asuntos éticos se realizaba preferentemente de manera individual y de forma independiente. CONCLUSIONES: El social y el sanitario son sistemas que poseen identidad y características diferenciadas, pero tienen una afinidad especial pues comparten saberes, espacios y valores comunes, que requieren de una profunda y comprometida reflexión, en aras a crear metodologías conjuntas de actuación, gestión y deliberación ética

AIM: The aim of this paper is to assess the need for a common ethics strategy shared by 2 of the cornerstones of human welfare: the healthcare and social services sectors. Method: An observational cross-sectional descriptive study was performed by surveying social services and healthcare professionals. A purposive sampling technique was used. The questionnaire consisted of 10 questions about ethical conflicts in professional practice and respondents' views on a proposed shared approach to bioethics and ethics in social intervention. RESULTS: 124 professionals completed the questionnaire, 56% of the health sector and 44% of the social services sector. About 90% professionals surveyed had had to make difficult ethical decisions in their work and would welcome a common approach to ethics in the social services and healthcare sectors.75% said that conflicts are occurring more frequently in both sectors simultaneously and that they were resolved preferably individually and independently. CONCLUSIONS: The survey respondents believe that a common approach to tackling ethical conflicts in professional practice is required. Nevertheless, it is still rare for ethics committees to intervene in the conflict resolution process and for decision-making support and evaluation tools to be used

Factores predictores de la institucionalización de personas mayores en situación de dependencia en Andalucía / Predictors of institutionalization of elderly persons in dependency situation in Andalusia

OBJETIVO: Identificar las preferencias acerca del recurso asistencial y los factores de riesgo de institucionalización de personas mayores en situación de dependencia en Andalucía. MÉTODO: Se analizaron datos de 200.039 personas registradas en el Sistema para la Autonomía y Atención a la Dependencia, en el período 2007-2012. Se describió en la población: la edad, situación de dependencia, preferencias, red de apoyo y factores clínicos a la entrada en el estudio. El análisis se realizó por separado para hombres y mujeres. Se diseñó un modelo de regresión logística para determinar los factores de riesgo de institucionalización para cada sexo. RESULTADOS: El 87,4% de las mujeres y el 85,9% de los hombres manifestaron su deseo de recibir los cuidados en su domicilio particular. Los hombres tienen 3 veces más riesgo de institucionalización que las mujeres. En mujeres los factores de riesgo de institucionalización son: el nivel de dependencia, desear vivir en residencia, una consistencia y una fragilidad medias de la red de apoyo y tener un diagnóstico de demencia. En hombres: desear vivir en una residencia y una consistencia baja o media de la red de apoyo. CONCLUSIONES: El cuidado en el domicilio es la alternativa de preferencia para las personas mayores en situación de dependencia. El riesgo de institucionalización está condicionado por las preferencias de la persona y su familia y las características de la red de apoyo, más que por las condiciones clínicas del individuo

OBJECTIVE: Identifying preferences regarding type of care and risk factors for institutionalization of elderly persons in dependency situations in Andalusia. METHODS: The data on 200,039 persons registered in the System for Autonomy and Dependency Care over the period 2007-2012 were analysed. The study population was described in terms of: age, dependency situation, preferences, support network and clinical factors at the time of inclusion in the study. Separate analysis was made for men and women. A logistic regression model was designed to determine the risk factors for institutionalization for each sex. RESULTS: 87,4% of women and 85,9% of men expressed their wish to receive care in their own home. The risk of institutionalization is three times higher among men than among women. Among women, the risks of institutionalization are: level of dependency, wishing to move into a residential care home, medium consistency and fragility of support network and being diagnosed with dementia. Among men, the risks are: wishing to move into a residential care home and low or medium consistency of support network. CONCLUSIONS: Care in the home is the preferred alternative for elderly persons in dependency situations. The risk of institutionalization is conditioned more by the preferences of the person and their family and the characteristics of the support network than by individual's clinical condition

Ciudadanía activa y personas mayores: viejos conceptos, nuevos abordajes. Una revisión sistemática y metasíntesis cualitativa / Being an active citizen and the elderly: old concepts, new approaches. A systematic review and qualitative meta-synthesis

Las políticas de envejecimiento activo presentan el concepto de «ciudadanía activa» como un desafío clave en el ámbito del envejecimiento para los próximos años. La ciudadanía activa ha sido definida de diferentes maneras, en la mayoría de los casos de forma complementaria, describiendo un eclecticismo de actividades participativas que incluye la política, el mercado y la acción comunitaria y voluntaria. El término se sitúa en diferentes contextos como la política formal, el trabajo remunerado, la sociedad civil y el hogar. Este trabajo, a partir de una revisión sistemática, identifica el contexto en el que emerge este concepto en relación con las personas mayores y las personas con demencia, analizando las diferentes expresiones de ciudadanía activa utilizadas y aportando elementos clave a tener en cuenta en la formulación de políticas en un contexto de acelerado envejecimiento demográfico y donde la demencia es una prioridad de salud pública. La noción de ciudadanía activa en la vejez supone un paso adelante que parte del envejecimiento activo a un concepto más amplio que integra el principio de igualdad entre las personas con independencia del género, edad y necesidad de apoyos

The politics of active ageing present active citizenship of the elderly as a key challenge for the coming years. Active citizenship has been defined in different ways (as complimentary in most cases), outlining an eclecticism of participatory activities that includes political engagement in a participatory and deliberative manner, as well as community and voluntary action. This term is found in different contexts such as formal politics, work, civil society, and the home. This paper, based on a systematic review, identifies the context in which this concept emerges in relation to older people and people with dementia. It also analyses the different expressions of active citizenship used, and provides key elements to be taken into account in the formulation of policies in a context of accelerated demographic ageing and where dementia is a public health priority. The notion of active citizenship in old age is a step forward from active ageing to a broader concept that integrates the principle of equality between people irrespective of gender, age and the need for support

Evaluación del impacto de un plan multisectorial de promoción de la salud y el bienestar social en Andalucía / Impact assessment of a multisectoral plan for the promotion of health and social wellbeing in Andalusia (Spain)

OBJETIVO: Evaluar el impacto del Plan de Promoción de la Autonomía Personal y Prevención de la Dependencia de Andalucía (2016-2020) en 13 organismos públicos participantes tras su primer año, y analizar la usabilidad y la fiabilidad de la escala de evaluación del impacto que se ha empleado. MÉTODO: El Plan aborda la promoción de la autonomía personal y la prevención de la discapacidad y la dependencia con un enfoque multisectorial. Se estructura en líneas, objetivos y actuaciones que han sido evaluadas mediante la escala Adoption Impact Ladder (AIL). El análisis de la validez simple, la viabilidad y la fiabilidad de la escala se ha realizado en 30 actuaciones evaluadas por 20 expertos de la Administración pública y un evaluador externo independiente. RESULTADOS: En 2017 se pusieron en marcha 176 actuaciones y programas del Plan. Se han implementado el 67,2% de las actuaciones propuestas y solo uno de los 16 objetivos no se ha asociado a actuaciones ejecutadas en el primer año. Siete de los 15 objetivos ejecutados fueron enteramente multisectoriales, involucrando a tres o más consejerías. La validez simple, la viabilidad y la fiabilidad interexaminadores de la escala AIL fueron buenas (κ: 0,72). CONCLUSIONES: El Plan ha proporcionado un marco novedoso para coordinar un amplio rango de políticas y actuaciones en la Administración pública de Andalucía. Por primera vez se presenta un análisis del impacto multisectorial que proporciona una guía efectiva para el seguimiento, la planificación y el establecimiento de prioridades públicas en salud, servicios sociales y atención a personas mayores y personas con discapacidad

OBJECTIVE: To evaluate the impact of the Plan for the promotion of personal autonomy and prevention of disability in Andalusia (2016-2020) in 13 public administrations during the first year of its implementation; and to analyse the usability and feasibility of the impact assessment ladder used. METHOD: The Plan addresses the promotion of personal autonomy and the prevention of disabilities and dependencies through a multisectoral approach. It is structured in strands or lines of work, objectives and actions that have been assessed through the Adoption Impact Ladder (AIL). The analysis of the face validity, feasibility and inter-rater reliability of the impact assessment ladder was carried out in 30 actions of the Plan that were rated by 20 experts from the 13 ministries and public agencies involved in the Plan, and an external rater. RESULTS: 176 actions and programmes were launched in 2017. Of these, 67.2% were implemented during the first year. Only one of the 16 objectives had no action initiated during the first year. Moreover, 7 out of 15 objectives implemented were fully multisectoral involving more than three Regional Ministries. The face validity, feasibility and inter-rater reliability of the AIL were good (κ: 0.72). CONCLUSIONS: This Plan has provided a novel framework to coordinate a broad range of proposed policies and actions within the public administration of Andalusia. For the first time, a multisectoral impact analysis has been conducted providing an effective guide for monitoring, planning and setting public priorities in health, social services, ageing and disabilities

Gestión de proyectos de cooperación internacional en salud / No disponible

La salud es hoy una prioridad en la agenda mundial debido a su probada relación con el desarrollo. El compromiso mundial alrededor de la salud se ha hecho explícito a través de los Objetivos de Desarrollo del Milenio (ODM), los cuales exigen respuestas internacionales coordinadas. En esta última década, este pacto global ha generado una cantidad sin precedentes de compromisos y alianzas, reafirmados en sucesivas reuniones y conferencias. A pesar de ello, los logros alcanzados aún no son suficientes. Una respuesta eficaz a los ODM estaría fundamentada en los determinantes sociales de la salud. Estos factores explican la mayor parte de las diferencias injustas y evitables observadas en y entre los países, en lo que respecta a la situación sanitaria. Sobre esta base y con el objetivo de disminuir o eliminar las desigualdades es que se desarrollan los proyectos de cooperación internacional en salud. Los actores, enfoques e instrumentos de la cooperación internacional han evolucionado a lo largo de su más de 60 años de historia. Actualmente los principios de Apropiación, Armonización, Alineación, Resultados y Mutua Responsabilidad son los que orientan la nueva cooperación internacional. En este marco, y para el desarrollo eficiente de los proyectos, se ha consolidado la utilización el Enfoque de Marco Lógico como una herramienta que facilita el proceso de conceptualización, diseño, ejecución y evaluación de proyectos. Esta metodología enfatiza la orientación por objetivos y la orientación hacia los grupos beneficiarios y facilita la participación y la comunicación entre los actores involucrados (AU)

Currently, health is a priority item on the global agenda because of its proven link to development. The world´s commitment to issues revolving around health has been made explicit through the Millennium Development Goals (MDG), goals, which can only be attained through coordinated international efforts. Over the last decade, this global pact has generated an unprecedented number of commitments and alliances that have been reaffirmed in successive meetings and conferences. Nonetheless, and despite such efforts, the gains attained are still insufficient. A more effective approach to meeting the MDGs would be one based on the social determinants of health. Such factors can explain in large share of the unjust and avoidable differences in the health situation that can be observed within and among countries. International cooperation projects based on this approach seek to diminish or eliminate these inequalities. Over the course of more than 60 years of history, the stakeholders involved in international cooperation activities, as well as the approaches and tools used, have evolved. Currently, activities in the “new” international cooperation are guided by the principles of Ownership. Harmonisation, Alignment, Results and Mutual Accountability. In this context, and to ensure efficient project development, the Logical Framework Approach has been consolidated as to tool to facilitate the process of conceptualization, design, execution and project evaluation. This method emphasizes goal-oriented activities, placing the focus on beneficiary groups, and facilitates participation and communication among the diverse actors involved (AU)