Fernando Mitano

Right to health: (in) congruence between the legal framework and the health system

Objective to discuss the right to health, incorporation into the legal instruments and the deployment in practice in the National Health System in Mozambique. Method this is a documentary analysis of a qualitative nature, which after thorough and interpretative reading of the legal instruments and articles that deal with the right to health, access and universal coverage, resulted in the construction of three empirical categories: instruments of humans rights and their interrelationship with the development of the right to health; the national health system in Mozambique; gaps between theory and practice in the consolidation of the right to health in the country. Results Mozambique ratified several international and regional legal instruments (of Africa) that deal with the right to health and which are ensured in its Constitution. However, their incorporation into the National Health Service have been limited because it can not provide access and universal coverage to health services in an equitable manner throughout its territorial extension and in the different levels of care. Conclusions the implementation of the right to health is complex and will require mobilization of the state and political financial, educational, technological, housing, sanitation and management actions, as well as ensuring access to health, and universal coverage.Objetivo discutir el derecho a la salud, su incorporacion en los instrumentos juridicos y las consecuencias en la practica en el Sistema Nacional de Salud, en Mozambique. Metodo se trata de un analisis documental, de orden cualitativo, que despues de lectura exhaustiva e interpretativa de los instrumentos juridicos y de obras que versan sobre el derecho a la salud, acceso y cobertura universal, resultaron en la construccion de tres categorias empiricas: instrumentos de los derechos humanos y su interrelacion con la construccion del derecho a la salud; sistema nacional de salud en Mozambique; y vacios entre teoria y practica en la consolidacion del derecho a la salud en el pais. Resultados Mozambique ratifico varios instrumentos juridicos internacionales y regionales (de Africa) que tratan sobre el derecho a la salud y los aseguro en su Constitucion. Sin embargo, su incorporacion por el Sistema Nacional de Salud ha sido limitada, ya que no consigue ofrecer acceso y cobertura universal a los servicios de salud de forma ecuanime en toda su extension territorial y en los distintos niveles de atencion. Conclusiones la efectuacion del derecho a la salud es compleja y exigira del Estado una movilizacion de acciones conjuntas de politicas financieras, educacionales, tecnologicas, habitacionales, saneamiento y administracion, asi como, la garantia del acceso y cobertura universal a la salud.

Planning pathways in the transfer of Directly Observed Treatment of Tuberculosis

1 Artículo parte de tesis de doctorado “The planning and transfer of the Directly Observed Treatment of Tuberculosis policy in the municipality of Porto Alegre RS”, presentada en la Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Centro Colaborador de la OPS/OMS para el Desarrollo de la Investigación en Enfermería, Ribeirão Preto, SP, Brasil. Apoyo financiero del Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brasil. 2 Estudiante de postdoctorado, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Centro Colaborador de la OPS/OMS para el Desarrollo de la Investigación en Enfermería, Ribeirão Preto, SP, Brasil. Enfermera, Departamento de Ações em Saúde, Secretaria Estadual de Saúde do Rio Grande do Sul, Porto Alegre, RS, Brasil. 3 PhD, Profesor Doctor, Escola de Medicina, Universidade de Lúrio, Marrere, Nampula, Mozambique. 4 Estudiante de doctorado, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil. Estadística, Departamento de Planejamento Governamental, Secretaria de Planejamento, Governança e Gestão do Rio Grande do Sul, Porto Alegre, RS, Brasil. 5 Estudiante de doctorado, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil. Enfermera, Unidade de Terapia Intensiva Neonatal, Fundação Maternidade Sinhá Junqueira, Ribeirão Preto, SP, Brasil. 6 PhD, Profesor Asociado, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Centro Colaborador de la OPS/OMS para el Desarrollo de la Investigación en Enfermería, Ribeirão Preto, SP, Brasil. Vías de la planificación en la transferencia del Tratamiento Directamente Observado de la tuberculosis1ABSTRACT Objective: to investigate the planning pathways in the transfer of Directly Observed Treatment of tuberculosis. Method: a qualitative study conducted using interviews and a semi-structured guide, administered to five subjects who were among the coordinators and managers of the tuberculosis control programs, and the secretary of health of a municipality in the south of Brazil. Situational Strategic Planning and Discourse Analysis of the French matrix were the theoretical and analytical references used, respectively. Results: three reflexive axes were identified: weaknesses in the process of planning the Directly Observed Treatment transfer, antagonism between planning and daily requirements and formulation of planning and execution. Lack of systematization regarding the planning and execution for transfer the Directly Observed Treatment policy, demonstrates the fragility and incipience of this activity, and the possibility of its non-existence. Conclusion: the urgent need for managers and coordinators to better appropriate the theoretical framework for changing public policies, and the related planning mechanisms, includes a proposal for reorganization and qualification of the diffusion process, both practical-operative and political-organization.

Directly Observed Treatment: planning perspectives, improvisation and transfer of policy

OBJECTIVE to investigate the possibilities of positive and negative association of improvisation and the understanding of what will be the planning by managers and coordinators of tuberculosis control programs, in a context of transference of the Directly Observed Treatment policy. METHOD this is a qualitative study, developed through semi-structured interviews analyzed in the light of French Discourse Analysis. RESULTS there was a weakening of the constructive and operational planning process, which is at the mercy of political will and the need of putting out fires. This, in turn, along with achômetro (Brazilian popular expression used on unsubstantiated point of view or opinion that is based solely and exclusively on the intuition of the person who says it), composed the metaphor of improvisation in its negative perspective, understood by automatism and unsystematization process. Improvisation, however, emerged as a representation of innovation, creativity, and contextual change. FINAL CONSIDERATIONS both the planning and the transfer of public policies constitute processes that need to be strengthened and qualified in the field of public health.

Discursos sobre a terapia de curta duração para o controle da tuberculose

Objetivo: analisar os sentidos produzidos por meio das experiencias e percepcoes dos profissionais de saude sobre a implementacao da estrategia do tratamento diretamente observado de curta duracao para o controle da tuberculose. Metodo: estudo qualitativo realizado em Mocambique com 15 profissionais de saude. Criterios de inclusao: atuacao no Programa de Controle da Tuberculose ha mais de um ano e estar em atividade profissional no periodo da entrevista. Para a coleta de dados foi usado um roteiro semiestruturado e as entrevistas realizadas individualmente foram gravadas. Resultados: emergiram tres unidades discursivas: os procedimentos no tratamento do doente; o papel de Agente Comunitario da Saude e da familia; as dificuldades na aplicacao do tratamento diretamente observado de curta duracao. Conclusao: o tratamento da tuberculose requer um envolvimento constante da familia, da comunidade e principalmente do Estado na criacao e aplicacao de politicas de formacao dos recursos humanos e melhoria de infraestruturas.Objective: to analyze the meanings produced through the experiences and perceptions of healthcare professionals on the implementation of the strategy of directly observed treatment short course for tuberculosis control. Method: qualitative study carried out in Mozambique with 15 healthcare professionals. Inclusion criteriawerehaving acted in the Tuberculosis Control Program for more than one year, and exercising professional activity at the time of interview. A semi-structured script was used for data collection, and individual interviews were recorded. Results: three discursive units emerged: patient treatment procedures; community health agent and family roles; difficulties in the application of directly observed treatment short course. Conclusion: treatment of tuberculosis requires constant involvement of the family, community, and especially the State in the creation and implementation of personnel training policies and infrastructure improvement.

Discursos sobre la terapia de corta duración para el control de la tuberculosis

Objetivo: analisar os sentidos produzidos por meio das experiencias e percepcoes dos profissionais de saude sobre a implementacao da estrategia do tratamento diretamente observado de curta duracao para o controle da tuberculose. Metodo: estudo qualitativo realizado em Mocambique com 15 profissionais de saude. Criterios de inclusao: atuacao no Programa de Controle da Tuberculose ha mais de um ano e estar em atividade profissional no periodo da entrevista. Para a coleta de dados foi usado um roteiro semiestruturado e as entrevistas realizadas individualmente foram gravadas. Resultados: emergiram tres unidades discursivas: os procedimentos no tratamento do doente; o papel de Agente Comunitario da Saude e da familia; as dificuldades na aplicacao do tratamento diretamente observado de curta duracao. Conclusao: o tratamento da tuberculose requer um envolvimento constante da familia, da comunidade e principalmente do Estado na criacao e aplicacao de politicas de formacao dos recursos humanos e melhoria de infraestruturas.Objective: to analyze the meanings produced through the experiences and perceptions of healthcare professionals on the implementation of the strategy of directly observed treatment short course for tuberculosis control. Method: qualitative study carried out in Mozambique with 15 healthcare professionals. Inclusion criteriawerehaving acted in the Tuberculosis Control Program for more than one year, and exercising professional activity at the time of interview. A semi-structured script was used for data collection, and individual interviews were recorded. Results: three discursive units emerged: patient treatment procedures; community health agent and family roles; difficulties in the application of directly observed treatment short course. Conclusion: treatment of tuberculosis requires constant involvement of the family, community, and especially the State in the creation and implementation of personnel training policies and infrastructure improvement.

Discourses on short-coursetherapy for tuberculosis control

Objetivo: analisar os sentidos produzidos por meio das experiencias e percepcoes dos profissionais de saude sobre a implementacao da estrategia do tratamento diretamente observado de curta duracao para o controle da tuberculose. Metodo: estudo qualitativo realizado em Mocambique com 15 profissionais de saude. Criterios de inclusao: atuacao no Programa de Controle da Tuberculose ha mais de um ano e estar em atividade profissional no periodo da entrevista. Para a coleta de dados foi usado um roteiro semiestruturado e as entrevistas realizadas individualmente foram gravadas. Resultados: emergiram tres unidades discursivas: os procedimentos no tratamento do doente; o papel de Agente Comunitario da Saude e da familia; as dificuldades na aplicacao do tratamento diretamente observado de curta duracao. Conclusao: o tratamento da tuberculose requer um envolvimento constante da familia, da comunidade e principalmente do Estado na criacao e aplicacao de politicas de formacao dos recursos humanos e melhoria de infraestruturas.Objective: to analyze the meanings produced through the experiences and perceptions of healthcare professionals on the implementation of the strategy of directly observed treatment short course for tuberculosis control. Method: qualitative study carried out in Mozambique with 15 healthcare professionals. Inclusion criteriawerehaving acted in the Tuberculosis Control Program for more than one year, and exercising professional activity at the time of interview. A semi-structured script was used for data collection, and individual interviews were recorded. Results: three discursive units emerged: patient treatment procedures; community health agent and family roles; difficulties in the application of directly observed treatment short course. Conclusion: treatment of tuberculosis requires constant involvement of the family, community, and especially the State in the creation and implementation of personnel training policies and infrastructure improvement.

Derecho a la salud: (in)congruencia entre la estructura jurídica y el sistema de salud

Objective to discuss the right to health, incorporation into the legal instruments and the deployment in practice in the National Health System in Mozambique. Method this is a documentary analysis of a qualitative nature, which after thorough and interpretative reading of the legal instruments and articles that deal with the right to health, access and universal coverage, resulted in the construction of three empirical categories: instruments of humans rights and their interrelationship with the development of the right to health; the national health system in Mozambique; gaps between theory and practice in the consolidation of the right to health in the country. Results Mozambique ratified several international and regional legal instruments (of Africa) that deal with the right to health and which are ensured in its Constitution. However, their incorporation into the National Health Service have been limited because it can not provide access and universal coverage to health services in an equitable manner throughout its territorial extension and in the different levels of care. Conclusions the implementation of the right to health is complex and will require mobilization of the state and political financial, educational, technological, housing, sanitation and management actions, as well as ensuring access to health, and universal coverage.Objetivo discutir el derecho a la salud, su incorporacion en los instrumentos juridicos y las consecuencias en la practica en el Sistema Nacional de Salud, en Mozambique. Metodo se trata de un analisis documental, de orden cualitativo, que despues de lectura exhaustiva e interpretativa de los instrumentos juridicos y de obras que versan sobre el derecho a la salud, acceso y cobertura universal, resultaron en la construccion de tres categorias empiricas: instrumentos de los derechos humanos y su interrelacion con la construccion del derecho a la salud; sistema nacional de salud en Mozambique; y vacios entre teoria y practica en la consolidacion del derecho a la salud en el pais. Resultados Mozambique ratifico varios instrumentos juridicos internacionales y regionales (de Africa) que tratan sobre el derecho a la salud y los aseguro en su Constitucion. Sin embargo, su incorporacion por el Sistema Nacional de Salud ha sido limitada, ya que no consigue ofrecer acceso y cobertura universal a los servicios de salud de forma ecuanime en toda su extension territorial y en los distintos niveles de atencion. Conclusiones la efectuacion del derecho a la salud es compleja y exigira del Estado una movilizacion de acciones conjuntas de politicas financieras, educacionales, tecnologicas, habitacionales, saneamiento y administracion, asi como, la garantia del acceso y cobertura universal a la salud.

Direito à saúde: (in)congruência entre o arcabouço jurídico e o sistema de saúde

Objective to discuss the right to health, incorporation into the legal instruments and the deployment in practice in the National Health System in Mozambique. Method this is a documentary analysis of a qualitative nature, which after thorough and interpretative reading of the legal instruments and articles that deal with the right to health, access and universal coverage, resulted in the construction of three empirical categories: instruments of humans rights and their interrelationship with the development of the right to health; the national health system in Mozambique; gaps between theory and practice in the consolidation of the right to health in the country. Results Mozambique ratified several international and regional legal instruments (of Africa) that deal with the right to health and which are ensured in its Constitution. However, their incorporation into the National Health Service have been limited because it can not provide access and universal coverage to health services in an equitable manner throughout its territorial extension and in the different levels of care. Conclusions the implementation of the right to health is complex and will require mobilization of the state and political financial, educational, technological, housing, sanitation and management actions, as well as ensuring access to health, and universal coverage.Objetivo discutir el derecho a la salud, su incorporacion en los instrumentos juridicos y las consecuencias en la practica en el Sistema Nacional de Salud, en Mozambique. Metodo se trata de un analisis documental, de orden cualitativo, que despues de lectura exhaustiva e interpretativa de los instrumentos juridicos y de obras que versan sobre el derecho a la salud, acceso y cobertura universal, resultaron en la construccion de tres categorias empiricas: instrumentos de los derechos humanos y su interrelacion con la construccion del derecho a la salud; sistema nacional de salud en Mozambique; y vacios entre teoria y practica en la consolidacion del derecho a la salud en el pais. Resultados Mozambique ratifico varios instrumentos juridicos internacionales y regionales (de Africa) que tratan sobre el derecho a la salud y los aseguro en su Constitucion. Sin embargo, su incorporacion por el Sistema Nacional de Salud ha sido limitada, ya que no consigue ofrecer acceso y cobertura universal a los servicios de salud de forma ecuanime en toda su extension territorial y en los distintos niveles de atencion. Conclusiones la efectuacion del derecho a la salud es compleja y exigira del Estado una movilizacion de acciones conjuntas de politicas financieras, educacionales, tecnologicas, habitacionales, saneamiento y administracion, asi como, la garantia del acceso y cobertura universal a la salud.