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Analyses of cataract surgery performed by the Unified Health System in Brazil, 2006-2007

CALIGARIS, Ligia Santos Abreu; MEDINA, Norma Helen; LANSINGH, Van C.; WALDMAN, Eliseu Alves; YAACOV-PENA, Fernando
Fonte: PAN AMER HEALTH ORGANIZATION Publicador: PAN AMER HEALTH ORGANIZATION
Tipo: Artigo de Revista Científica
ENG
Relevância na Pesquisa
75.79%
Objective. Estimate cataract surgical rates (CSR) for Brazil and each federal unit in 2006 and 2007 based on the number of surgeries performed by the Unified Health System to help plan a comprehensive ophthalmology network in order to eliminate cataract blindness in compliance with the target set by the World Health Organization (WHO) of 3 000 cataract surgeries per million inhabitants per year. Methods. This descriptive study calculates CSR by using the number of cataract surgeries carried out by the Brazilian Unified Health System for each federal unit and estimates the need for cataract surgery in Brazil for 2006-2007, with official population data provided by the Brazilian Institute of Geography and Statistics. The number of cataract surgeries was compared with the WHO target. Results. To reach the WHO goal for eliminating age-related cataract blindness in Brazil, 560 312 cataract surgeries in 2006 and 568 006 surgeries in 2007 needed to be done. In 2006, 179 121 cataract surgeries were done by the Unified Health System, corresponding to a CSR of 959 per million population; in 2007, 223 317 were performed, with a CSR of 1 179. With the Brazilian Council of Ophthalmology estimation of 165 000 surgeries each year by the non-public services...

"A saúde bucal e o Sistema Único de Saúde: integralidade seletiva em uma conjuntura neoliberal" ; Oral health and the Brazilian Unified Health System (SUS): selective comprehensiveness in a neoliberal conjuncture.

Zilbovicius, Celso
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Dissertação de Mestrado Formato: application/pdf
Publicado em 08/04/2005 PT
Relevância na Pesquisa
65.83%
Nesta pesquisa foram avaliados o atual processo de inserção da saúde bucal no Sistema Único de Saúde (SUS) sob a perspectiva de política macroeconômica neoliberal vigente no país desde as duas últimas décadas do século XX e a aplicação dos princípios de universalidade e integralidade no sistema através da análise da oferta de serviços especializados em saúde bucal na rede pública do Sistema Único de Saúde dos municípios que compõem o Estado de São Paulo, o perfil de recursos humanos que compõem a equipe de saúde bucal dos serviços, o acesso da população à assistência odontológica por faixas etárias e a oferta de ações coletivas para esta população. Através da colaboração da Área Técnica de Saúde Bucal da Secretaria de Estado da Saúde do Estado de São Paulo foi enviado um questionário para as secretarias de saúde de todos os municípios que integram o Estado (total de 645). Obteve-se o retorno de 377 respostas (58,4%) de municípios de todas as direções Regionais de Saúde do Estado, sendo todos credenciados em alguma modalidade do SUS. Entre as especialidades oferecidas, a endodontia apresentou-se em primeiro lugar, porém com uma baixa percentagem (29,7%), seguida por Cirurgia Oral Menor (26...

O acesso na rede pública de saúde no município de Ijuí/RS: um cenário de controvérsias; The users access to the public health system in the borough of Ijuí/RS: a controversial scenery.

Weiller, Teresinha Heck
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Tese de Doutorado Formato: application/pdf
Publicado em 28/11/2008 PT
Relevância na Pesquisa
65.87%
O objetivo deste estudo é compreender a organização da regulação do acesso dos usuários à rede pública de saúde em um município do interior do Estado do Rio Grande do Sul, descrever a conformação da rede de atenção à saúde e analisar o acesso dos usuários na Atenção Básica e de Média Complexidade. O quadro teórico do acesso e regulação da atenção de saúde foi escolhido para subsidiar a análise do acesso na rede de atenção de saúde em Ijuí/RS. O fundamento empírico foi construído a partir de entrevistas gravadas com gestores, prestadores de serviços e um representante dos usuários, totalizando dez entrevistas, bem como a realização de focal com usuários da rede de atenção pública. Juntamente às entrevistas e grupo focal foi realizado estudo sobre o perfil dos usuários da rede pública de saúde que acessaram os serviços do Pronto-Socorro local, complementado por observações realizadas nas UCS, ESF e PS/HCI. A partir da abordagem qualitativa, apoiada na análise temática, o material empírico foi interpretado e discutido. Identificamos quatro categorias empíricas: a) rede no espaço local; b) acesso na atenção básica as várias portas de entrada; c) organização do acesso à Média Complexidade; e d) relações conflituosas na rede de atenção. A análise permitiu compreender a organização do acesso dos usuários da rede pública de saúde de Ijuí/RS aos serviços de Atenção Básica e de Média Complexidade. Verificamos na Atenção Básica a existência de fragilidades e dificuldades para receber os serviços...

O direito à internação psiquiátrica no Sistema Único de Saúde e no Sistema de Saúde Suplementar: as representações sociais no Tribunal de Justiça de São Paulo; The right to psychiatric admission in the Public Health System and in the Insurance Health System: the Tribunal de Justiça de São Paulo' social representations

Salvatori, Rachel Torres
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Tese de Doutorado Formato: application/pdf
Publicado em 13/12/2013 PT
Relevância na Pesquisa
65.85%
Segundo o Ministério da Saúde, no Brasil, 3% da população sofrem com transtornos mentais severos e persistentes e 6% apresentam transtornos psiquiátricos em virtude do uso de álcool e outras drogas. Só recentemente a assistência à saúde mental, notadamente no que concerne às internações psiquiátricas por via judicial, começa a suscitar questionamentos entre operadores do direito e profissionais da assistência à saúde, embora, desde o advento da Lei n. 10.216/2001, há mais de 10 anos, tenham-se estabelecido as diretrizes do novo modelo de saúde mental a ser implementado no País. Nesse sentido, é relevante saber os entendimentos que o Poder Judiciário tem sobre as questões relativas às internações psiquiátricas. A presente pesquisa teve o objetivo geral de conhecer as representações sociais do Tribunal de Justiça de São Paulo - TJSP, sobre o direito à internação psiquiátrica, e os objetivos específicos de: 1) Caracterizar as demandas relacionadas à internação psiquiátrica submetidas ao TJSP; 2) Identificar como as demandas relacionadas à internação psiquiátrica são sustentadas pela parte apelante em juízo; 3) Identificar como as demandas relacionadas à internação psiquiátrica são defendidas pela parte apelada em juízo; 4) Identificar as representações sociais presentes nos posicionamentos de 2a Instância do TJSP na jurisprudência acumulada sobre as demandas relativas à internação psiquiátrica; 5) Comparar os resultados das decisões de 2a Instância com os de 1a Instância. Foi utilizada uma abordagem com métodos mistos de coleta e análise de dados...

Health-weighted Composite Quality Metrics Offer Promise to Improve Health Outcomes in a Learning Health System

Braithwaite, Scott; Stine, Nicholas
Fonte: AcademyHealth Publicador: AcademyHealth
Tipo: Artigo de Revista Científica
Publicado em 28/10/2013 EN
Relevância na Pesquisa
65.83%
Health system leaders sometimes adopt quality metrics without robust supporting evidence of improvements in quality and/or quantity of life, which may impair rather than facilitate improved health outcomes. In brief, there is now no easy way to measure how much “health” is conferred by a health system. However, we argue that this goal is achievable. Health-weighted composite quality metrics have the potential to measure “health” by synthesizing individual evidence-based quality metrics into a summary measure, utilizing relative weightings that reflect the relative amount of health benefit conferred by each constituent quality metric. Previously, it has been challenging to create health-weighted composite quality metrics because of methodological and data limitations. However, advances in health information technology and mathematical modeling of disease progression promise to help mitigate these challenges by making patient-level data (eg, from the electronic health record and mobile health (mHealth) more accessible and more actionable for use. Accordingly, it may now be possible to use health information technology to calculate and track a health-weighted composite quality metric for each patient that reflects the health benefit conferred to that patient by the health system. These health-weighted composite quality metrics can be employed for a multitude of important aims that improve health outcomes...

Bulgaria : Improving Quality and Sustainability of the Health System

World Bank
Fonte: Washington, DC Publicador: Washington, DC
EN_US
Relevância na Pesquisa
65.88%
Bulgaria has undertaken several significant health sector reforms during the past decade, but a large unfinished policy agenda remains. Compared to other EU countries, the share of out-of-pocket spending is significantly higher in Bulgaria, while government spending on health is relatively low. Various indicators of reported public satisfaction with the health system in Bulgaria are frequently the lowest in the EU. The hospital sector has seen rapid growth in recent years, putting the sustainability of the system in doubt and crowding out expenditures on more pressing priorities such as primary health care and the reimbursement of cost-effective drugs. Contrary to the imperative of improving health system efficiency, in recent years the Bulgarian hospital sector has grown in number of facilities, total number of hospitalizations, and the budget share dedicated to inpatient services. Each of these indicators is out of line with European standards. The primary health care system is well established but does not live up to its potential to provide efficient...

Risk Pooling in Health Care Financing : The Implications for Health System Performance

Smith, Peter C.; Witter, Sopie N.
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
EN_US
Relevância na Pesquisa
65.85%
Pooling is the health system function whereby collected health revenues are transferred to purchasing organizations. Pooling ensures that the risk related to financing health interventions is borne by all the members of the pool and not by each contributor individually. Its main purpose is to share the financial risk associated with health interventions for which there is uncertain need. The arguments in favor of risk pooling in health care embody equity and efficiency considerations. The equity arguments reflect the view that society does not consider it to be fair that individuals should assume all the risk associated with their health care expenditure needs. The efficiency arguments arise because pooling can lead to major improvements in population health, can increase productivity, and reduces uncertainty associated with health care expenditure. The report considers four classes of risk pooling: no risk pool, under which all expenditure liability lies with the individual; unitary risk pool, under which all expenditure liability is transferred to a single national pool; fragmented risk pools...

Early-age mortality, socio-economic development and the health system in Mongolia

Neupert, Ricardo F
Fonte: Health Transition Centre, National Centre for Epidemiology and Population Health, Publicador: Health Transition Centre, National Centre for Epidemiology and Population Health,
Tipo: Artigo de Revista Científica Formato: 70742 bytes; application/pdf
EN_AU
Relevância na Pesquisa
65.85%
Since the 1920s Mongolia has developed an extensive and well-staffed health care system that has made modern health technologies accessible to most of its population. In addition, the country experienced rapid economic and social development whose benefits were equitably distributed among the population. In spite of this progress, infant and child mortality levels are high by contemporary standards and during the past 20 years these rates have remained virtually constant. The modern health care delivery system, externally imposed, failed to take into account the specific characteristics of the Mongolian culture; this fact is identified as one of the major determinants of the unexpected levels of early-age mortality. The excessive orientation toward curative medicine, the lack of health prevention and promotion activities and the lack of community participation have resulted in the people continuing to believe in traditional therapeutic patterns and self-care. They perceive the modern system exclusively in curative terms and not with regard to health preservation and disease prevention. Most Mongolians do not fully understand the health care system, and use its services mainly because they have no alternative, or because of coercion rather than conviction based on the learning and internalization of its basic principles. In practices and ideas of child care...

Equity and Public Governance in Health System Reform : Challenges and Opportunities for China

Brixi, Hana; Mu, Yan; Targa, Beatrice; Hipgrave, David
Fonte: Banco Mundial Publicador: Banco Mundial
Tipo: Publications & Research :: Policy Research Working Paper
ENGLISH
Relevância na Pesquisa
65.87%
Achieving the objective of China's current health system reform, namely equitable improvements in health outcomes, will be difficult not least because of the continuously growing income disparities in the country. The analysis in this paper shows that since 2000, disparity in selected health outcomes has been declining across provinces, largely due to earmarked central government allocations. By contrast, public expenditure on health is increasingly regressive (positively correlated with local income per capita) across provinces, and across prefectures and lower levels within provinces. The increasing inequity in public expenditure at sub-national levels indicates that incentives, responsibilities, and resources at sub-national levels are not well aligned with China's national priorities. To address the weaknesses in equity and efficiency that characterize China's health system and health outcomes, China's health system reform may require complementary reforms to improve governance for public service delivery across sectors.

Republic of Uruguay Integrated National Health System : Analysis of the Governability of the SNIS Benefit Plan

World Bank
Fonte: Washington, DC Publicador: Washington, DC
Tipo: Economic & Sector Work :: Other Health Study; Economic & Sector Work
ENGLISH; EN_US
Relevância na Pesquisa
65.86%
Today the health reform in Uruguay is a mature, ongoing process in which major progress has been consolidated. At the same time, like all systems, it faces challenges in the immediate, medium, and long term, and how they are resolved will not only shape the ultimate outcome of many of the processes currently under way, and but will also impact the sustainability of the accomplishments so far. The purpose of this study is to contribute to development of the integrated national health system (SNIS) by analyzing and identifying policy options aimed at improving its governance, equity, efficiency, and sustainability through the government's use of control variables in order to achieve and maintain conditions of governability and efficiency, which will contribute to the stability and sustainability of the results. The present study analyzes the main variables that Uruguay has at its disposal to manage a central aspect of regulating the sector namely, the plan of benefits that the population receives to cover their health needs. This plan has important consequences for both health and the economy. The specific objectives of the study were to analyze the following three aspects of the SNIS: (i) the conditions of governance and governability of its benefit plan...

Twenty Years of Health System Reform in Brazil : An Assessment of the Sistema Único de Saúde

Gragnolati, Michele; Lindelow, Magnus; Couttolenc, Bernard
Fonte: Washington, DC: World Bank Publicador: Washington, DC: World Bank
Tipo: Publications & Research :: Publication; Publications & Research :: Publication
ENGLISH; EN_US
Relevância na Pesquisa
65.9%
It has been more than 20 years since Brazil's 1988 Constitution formally established the Unified Health System (Sistema Unico de Saude, SUS). Building on reforms that started in the 1980s, the SUS represented a significant break with the past, establishing health care as a fundamental right and duty of the state and initiating a process of fundamentally transforming Brazil's health system to achieve this goal. This report aims to answer two main questions. First is have the SUS reforms transformed the health system as envisaged 20 years ago? Second, have the reforms led to improvements with regard to access to services, financial protection, and health outcomes? In addressing these questions, the report revisits ground covered in previous assessments, but also brings to bear additional or more recent data and places Brazil's health system in an international context. The report shows that the health system reforms can be credited with significant achievements. The report points to some promising directions for health system reforms that will allow Brazil to continue building on the achievements made to date. Although it is possible to reach some broad conclusions...

Health Systems Analysis for Better Health System Strengthening

Berman, Peter; Bitran, Ricardo
Fonte: Banco Mundial Publicador: Banco Mundial
Tipo: Publications & Research :: Working Paper; Publications & Research
ENGLISH; EN_US
Relevância na Pesquisa
65.91%
Health system strengthening and reform are often necessary actions to achieve better outcomes. The World Bank's 2007 strategy for health, nutrition, and population emphasizes the importance of health system strengthening for results. This paper proposes 'health systems analysis' as a distinct methodology that should be developed and practiced in the design of policies and programs for health system strengthening. It identifies key elements of health systems analysis and situates them in a logical framework supported by a wide range of data and methods and a sizable global literature. Health systems analysis includes evidence on health system inputs, processes, and outputs and the analysis of how these combine to produce the outcomes. It considers politics, history, and institutional arrangements. Health systems analysis proposes causes of poor health system performance and suggests how reform policies and strengthening strategies can improve performance. It contributes to implementation and evaluation. Examples from Mexico...

Review of World Bank's Experience with Country-Level Health System Analysis

Bitrán, Ricardo; Gómez, Paulina; Escobar, Liliana; Berman, Peter
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Tipo: Publications & Research :: Working Paper; Publications & Research
ENGLISH; EN_US
Relevância na Pesquisa
65.89%
The World Bank often carries out in-depth analysis of the conditions and challenges facing different sectors in our client countries as a contribution to developing the analytical and information base for lending, policy dialogue, and more in-depth analytical work. In the health sector, we have identified a substantial body of this type of work focusing on analyzing the performance of health systems, its causes, and potential strategies for performance improvement. The Bank's 2007 Health, Nutrition and Population (HNP) strategy emphasizes the importance of our work on health system strengthening. HSA is often the analytical foundation of this work in countries. This paper reviews a sample of HSAs, 12 major studies carried out since 2000 across all Bank regions. Using the health systems framework of the flagship program on health sector reform and sustainable financing, a comparable synopsis of each study has been prepared in a simple two page chart which traces the analysis from measures of health system performance to its causes and then from policy 'control knobs' to proposals for reform which are intended to improve that performance. Several key questions about the conceptual basis...

Albania - Out-of-Pocket Payments in Albania’s Health System : Trends in Household Perceptions and Experiences 2002-2008

World Bank
Fonte: World Bank Publicador: World Bank
Tipo: Economic & Sector Work :: Health Sector Review
ENGLISH
Relevância na Pesquisa
65.86%
In many countries absent or poorly functioning prepayment mechanisms for health care expose families to the financial risks associated with accidents and sickness. The report exploits a specially designed health governance and accountability module that was added to the 2008 wave of the Albania LSMS to gain additional insight into the determinants of informal payments and household perceptions and experiences of governance in the health sector more generally. This report is structured in four parts. Following the motivation, introduction and summary of the report's findings in part one, part two sets the institutional context for readers not already familiar with Albania's health system, and presents data showing public perceptions of health care and answers to subjective questions included in the health governance and accountability module of the 2008 Albania LSMS. These data have been combined with prior waves of the LSMS to show how the incidence of informal payments has changed in recent years. Part three shows the impact out-of-pocket payments -both formal and informal- have on household consumption and the incidence of poverty. Part fourth presents the results of statistical analysis...

Reforming China's Rural Health System

Wagstaff, Adam; Lindelow, Magnus; Wang, Shiyong; Zhang, Shuo
Fonte: World Bank Publicador: World Bank
Tipo: Publications & Research :: Publication; Publications & Research :: Publication
ENGLISH
Relevância na Pesquisa
65.87%
This book began in 2003 during the initial formulations of China's 11th five-year plan, which covers the period 2006-10. During the entire period, the rural health Analytic and Advisory Activities (AAA) team analyzed the sector and debated reform options with government officials and scholars. It is helped the government in its extensive reform efforts over the past few years. The publication can serve two important functions: to provide an analytical framework for thinking about what happened in China's rural health system and why, and to present a global perspective on the options for further strengthening the sector. China is well on its way to achieving a modern, equitable, and well-functioning rural health sector, but this is not an easy task for any country. This book can provide a useful reference for policy makers in the next phase of health reform and beyond.

Brazil - Governance in Brazil's Unified Health System : Raising the Quality of Public Spending and Resource Management

World Bank
Fonte: Washington, DC Publicador: Washington, DC
Tipo: Economic & Sector Work :: Other Financial Accountability Study; Economic & Sector Work
ENGLISH; EN_US
Relevância na Pesquisa
65.83%
This report on governance in Brazil's unified health system assesses resource allocation and management, planning and budgeting functions, and budget execution at different levels of government for public expenditures on health services. The emphasis is on understanding the incentives generated for service providers, and the overall soundness of the accountabilities established in the public health services expenditure system. The analysis seeks to identify weaknesses of accountabilities for service provision that stem from the structure and process of intergovernmental and provider funding flows and related managerial practices. The paper draws on and enhances an accepted governance tool, public expenditure tracking, in both tracking funding and analyzing the governance and corresponding managerial challenges that impede effective public sector financing. The tracking instrument was applied to a sample of states, municipalities and healthcare facilities in the country in 2004.

The Impact of the Degree of Risk-Sharing in Health Financing on Health System Attainment

Carrin, Guy; Zeramdini, Riadh; Musgrove, Philip; Poullier, Jean-Pierre; Valentine, Nicole; Xu, Ke
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Tipo: Publications & Research :: Working Paper; Publications & Research
ENGLISH; EN_US
Relevância na Pesquisa
65.85%
A simple econometric analysis is undertaken concerning the impact of the degree of risk sharing in countries' health financing organization on the goals of the health system, as defined in the World Health Report 2000, i.e., the level of health and its distribution across the population, the level of responsiveness and its distribution across the population, and fair financing. The degree of risk sharing varies according to whether countries have a universal coverage system, financed via social health insurance or general taxation, or systems with less well-developed coverage including variants of social health insurance and/or general taxation benefiting specific population groups. The research undertook a classification of countries according to the degree of risk sharing, based primarily on the health care financing legislation of the World Health Organization's 191 member states and on its data base of Health System Profiles. The results obtained give empirical support to the hypothesis that the degree of risk sharing in health financing organizations impacts positively on health system attainment...

Investing in People: Health System Strengthening Through Education

Stoertz, Aaron
Fonte: Universidade Duke Publicador: Universidade Duke
Tipo: Tese de Doutorado
Publicado em //2011
Relevância na Pesquisa
65.82%

Health system strengthening is now recognized as a pressing global health priority. Motivated and productive health workers are a critical component of health systems. Low and middle-income countries need many more health workers, but not simply more of the same. Insufficient collaboration between the health and education sectors creates a crippling mismatch between professional health service education and the realities of health service delivery. A transformative scale-up of health education is needed to increase the capacity of health systems to respond to population needs. We make the case for multi-sector innovation during the scale-up of health education-- ranging from new recruitment strategies, faculty development and curricular reform on the institutional level to cross-sector planning and investment on the national level. Such a transformation will require a broad process of multi-sector reform.

In Uganda the lack of formal health management education is a barrier to improved health systems and improved population health outcomes. Duke University partnered with executive leadership from the Ugandan Catholic and Protestant medical bureaus, the public health sector and the three leading schools of health management in Uganda to conduct a series of activities to strengthen the capacity for health management and leadership in Uganda. After a formative research process to describe the national health management training landscape...

HÓRUS: inovação tecnológica na assistência farmacêutica no sistema único de saúde; Innovación tecnológica Horus en el servicio farmacéutico en el sistema único de salud brasileño; HORUS: technological innovation in pharmaceutical assistance within the Brazilian unified health system

Costa, Karen Sarmento; Nascimento Jr., José Miguel do
Fonte: Universidade de São Paulo. Faculdade de Saúde Pública Publicador: Universidade de São Paulo. Faculdade de Saúde Pública
Tipo: info:eu-repo/semantics/article; info:eu-repo/semantics/publishedVersion; Artigo Avaliado pelos Pares Formato: application/pdf
Publicado em 01/12/2012 POR
Relevância na Pesquisa
65.82%
OBJETIVO: Analisar resultados do Sistema Hórus, comparando elementos desse Sistema com algumas experiências internacionais. MÉTODOS: Hórus é uma inovação tecnológica introduzida em 2009 no sistema de informações para a Assistência Farmacêutica do Sistema Único de Saúde. Em 2011, gestores locais e profissionais de saúde de 1.247 municípios (16 estados) que aderiram ao Hórus responderam a questionários sobre a assistência farmacêutica na atenção básica e sobre o Sistema Hórus. Estudo descritivo e exploratório, desenvolvido com emprego de método quali-quantitativo de pesquisa. Foram utilizados instrumentos multivariados de coleta de dados e suporte interpretativo da inferência estatística e da análise temática. RESULTADOS: As principais mudanças identificadas após a implantação desse Sistema foram: melhoria do controle técnico e científico da qualidade da assistência farmacêutica, da dispensação dos medicamentos e da atenção à saúde; capacitação dos recursos humanos e gestão do conhecimento; melhoria da relação gestores de saúde/usuários de medicamentos; da gestão administrativa e maior gestão interfederativa; e melhoria da infraestrutura tecnológica. Em termos de sistemas de informação em saúde...

Barriers to sustainable tuberculosis control in the Russian Federation health system

Atun,R.A.; Samyshkin,Y.A.; Drobniewski,F.; Skuratova,N.M.; Gusarova,G.; Kuznetsov,S.I.; Fedorin,I.M.; Coker,R.J.
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/03/2005 EN
Relevância na Pesquisa
65.83%
The Russian Federation has the eleventh highest tuberculosis burden in the world in terms of the total estimated number of new cases that occur each year. In 2003, 26% of the population was covered by the internationally recommended control strategy known as directly observed treatment (DOT) compared to an overall average of 61% among the 22 countries with the highest burden of tuberculosis. The Director-General of WHO has identified two necessary starting points for the scaling-up of interventions to control emerging infectious diseases. These are a comprehensive engagement with the health system and a strengthening of the health system. The success of programmes aimed at controlling infectious diseases is often determined by constraints posed by the health system. We analyse and evaluate the impact of the arrangements for delivering tuberculosis services in the Russian Federation, drawing on detailed analyses of barriers and incentives created by the organizational structures, and financing and provider-payment systems. We demonstrate that the systems offer few incentives to improve the efficiency of services or the effectiveness of tuberculosis control. Instead, the system encourages prolonged supervision through specialized outpatient departments in hospitals (known as dispensaries)...