Gabriel Bastías

Supporting the delivery of cost-effective interventions in primary health-care systems in low-income and middle-income countries: an overview of systematic reviews

Strengthening health systems is a key challenge to improving the delivery of cost-effective interventions in primary health care and achieving the vision of the Alma-Ata Declaration. Effective governance, financial and delivery arrangements within health systems, and effective implementation strategies are needed urgently in low-income and middle-income countries. This overview summarises the evidence from systematic reviews of health systems arrangements and implementation strategies, with a particular focus on evidence relevant to primary health care in such settings. Although evidence is sparse, there are several promising health systems arrangements and implementation strategies for strengthening primary health care. However, their introduction must be accompanied by rigorous evaluations. The evidence base needs urgently to be strengthened, synthesised, and taken into account in policy and practice, particularly for the benefit of those who have been excluded from the health care advances of recent decades.

Effects of a dairy product fortified with multiple micronutrients and omega-3 fatty acids on birth weight and gestation duration in pregnant Chilean women

OBJECTIVE To test the hypothesis that maternal food fortification with omega-3 fatty acids and multiple micronutrients increases birth weight and gestation duration, as primary outcomes. DESIGN Non-blinded, randomised controlled study. SETTING Pregnant women received powdered milk during their health check-ups at 19 antenatal clinics and delivered at two maternity hospitals in Santiago, Chile. SUBJECT Pregnant women were assigned to receive regular powdered milk (n = 477) or a milk product fortified with multiple micronutrients and omega-3 fatty acids (n = 495). RESULTS Intention-to-treat analysis showed that mean birth weight was higher in the intervention group than in controls (65.4 g difference, 95% confidence interval (CI) 5-126 g; P = 0.03) and the incidence of very preterm birth (0.80 just for mean birth weight and birth length in the on-treatment analysis; birth length in that analysis had a difference of 0.57 cm (95% CI 0.19-0.96 cm; P = 0.003). CONCLUSIONS The new intervention resulted in increased mean birth weight. Associations with gestation duration and most secondary outcomes need a larger sample size for confirmation.

Health care reform in Chile

Chile has maintained a dual health care system under which its citizens can voluntarily opt for coverage by either the public National Health Insurance Fund or any of the countrys private health insurance companies. Currently, 68% of the population is covered by the public fund and 18% by private

Metodología para la evaluación de la relación costo-efectividad en centros de atención primaria de Chile

OBJETIVO: Presentar una metodologia para la evaluacion de la relacion costo-efectividad en centros de atencion primaria de salud (APS) a partir del modelo de atencion familiar promovido en Chile y evaluar los resultados de los dos primeros anos de funcionamiento del primer centro piloto que funciona bajo este nuevo modelo de atencion primaria. METODOS. Se realizo un estudio de costo-efectividad, con una perspectiva social y un horizonte temporal de un ano. Para comparar el centro intervenido (universitario) con el centro de control (municipal) se construyo el indice compuesto de calidad de los centros de salud familiar (ICCESFAM), que combina indicadores tecnicos y la percepcion de los usuarios de los centros en seis dimensiones: accesibilidad, continuidad de la atencion medica, enfoque clinico preventivo y promocional, resolutividad, participacion, y enfoque biopsicosocial y familiar. Para calcular los costos se tomo en cuenta el gasto en los centros, el ahorro producido al resto del sistema sanitario y el gasto de bolsillo de los pacientes. Se estimo la razon costo-efectividad incremental (RCEI) y se realizo un analisis de sensibilidad. RESULTADOS: El centro de salud universitario resulto 13,4% mas caro (US

Interventions for controlling emigration of health professionals from low and middle-income countries

8,93 anuales adicionales por inscrito) y mas efectivo (ICCESFAM 13,3% mayor) que el municipal. Estos resultados hacen que la RCEI sea de US

Interventions to reduce emigration of health care professionals from low- and middle-income countries.

0,67 por cada punto porcentual adicional que aumenta el ICCESFAM. CONCLUSIONES: Segun el modelo elaborado de evaluacion de centros de APS, los centros que siguen el modelo de salud familiar chileno son mas efectivos, tanto por sus indicadores tecnicos como por la valoracion de sus usuarios, que los centros de APS tradicionales.

Governance arrangements for health systems in low‐income countries: an overview of systematic reviews

This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effects of policy interventions to control emigration of health professionals from lowand middle-income countries. 1 Interventions for controlling emigration of health professionals from low and middle-income countries (Protocol) Copyright