Browsing by Person "De Vos, Pol"

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Aproximación crítico–hermenéutica a la noción de bienestar en el marco del neoliberalismo
(Universidad Del Zulia; Maracaibo, Venezuela, 2018-10-01) Villasana López, Pedro Enrique; Gómez, Rubén Darío; De Vos, Pol
This discussion was developed by six hands, with multiple disagreements, but with the consensus to persevere in the debate. We aimed at contributing to the resignification of the polysemic notion of welfare, questioning a vision of welfare that focuses on consumption, success, and its instrumentalist standardization, and proposing a view toward life, happiness, harmony, and others possible senses of wellbeing. For this purpose, we discuss elements of onto-epistemological character of the configuration process of the prevalent representations of welfare in the neoliberal global village, seen as a political process, and as an expression of historically positioned material interests. Our critical analysis, based on daily experiences, allows to question this interpretation, and to visualize possibilities of undoing the concept of well-being of its purely materialist interpretation, approaching it as a utopia, claiming the decolonization of life.
Assessment of hypertension management and control: A registry-based observational study in two municipalities in Cuba
(BioMed Central, 2019-01-30) Londoño Agudelo, Esteban; Rodríguez Salvá, Armando; Díaz Piñera, Addys; García Roche, René; De Vos, Pol; Battaglioli, Tullia; Van der Stuyft, Patrick
Background - To determine the prevalence of hypertension treatment and control among hypertensive patients in the Cuban municipalities of Cardenas and Santiago and to explore the main associated predictors. Methods - Cross-sectional study, with multistage cluster sampling, conducted between February 2012 and January 2013 in two Cuban municipalities. We interviewed and measured blood pressure in 1333 hypertensive patients aged 18 years or older. Hypertension control was defined as blood pressure lower than 140/90 mmHg. Results - The mean age ± standard deviation (SD) of participants was 59.8 ± 14 years, the mean systolic and diastolic blood pressure ± SD was 130.0 ± 14.4 and 83.1 ± 9.0 mmHg respectively. The majority of patients (91, 95%CI 90–93) were on pharmacological treatment, 49% with a combination of 2 or more classes of drugs. Among diagnosed hypertensive patients 58% (95%CI 55–61) had controlled hypertension. There was no association between hypertension control and gender, age and socio-economic condition. Levels of hypertension control depended on health area and control furthermore was positively associated with post-primary education, not being obese and white ethnicity: adjusted Odds Ratio (95% CI) 1.71 (1.26–2.34), 1.43 (1.09–1.88) and 1.41 (1.09–1.81) respectively. Conclusions - The observed figures are outstanding at the international level and illustrate that hypertension treatment and control are achievable in a resource-constrained setting such as Cuba. The country’s primary health care approach and social equity in access to health care can be seen as key determinants of this success. Nevertheless, there is still room for improvement, as over a third of patients did not have controlled hypertension.
Augmenting frameworks for appraising the practices of community-based health interventions
(Oxford University Press, 2009-04-20) Pérez, Dennis; Lefèvre, Pierre; Romero, Maria Isabel; Sánchez, Lizet; De Vos, Pol; Van der Stuyft, Patrick
This paper aims at augmenting the frameworks proposed by Rifkin in 1996 to distinguish between target-oriented and empowerment approaches to participation in community-based health interventions. In her paper, Rifkin defined three criteria: who makes decisions on resource allocation, expected outcome and outcome assessment. We propose five additional criteria: the definition of community, the characteristics of the capacity-building process, the leadership characteristics, the documentation process, and ethical issues regarding participation. Derived from our analysis of a community-based project, the proposed criteria are discussed in the light of the principles of Popular Education and other literature on community participation. The augmented frameworks are intended to assist health professionals and planners interested in the empowerment approach of community participation to consciously sharpen their practice.
Colombia and Cuba, contrasting models in Latin America's health sector reform
(Wiley, 2006-09-21) De Vos, Pol; De Ceukelaire, Wim; Van der Stuyft, Patrick
Latin American national health systems were drastically overhauled by the health sector reforms the 1990s. Governments were urged by donors and by the international financial institutions to make major institutional changes, including the separation of purchaser and provider functions and privatization. This article first analyses a striking paradox of the far‐reaching reform measures: contrary to what is imposed on public health services, after privatization purchaser and provider functions are reunited. Then we compare two contrasting examples: Colombia, which is internationally promoted as a successful – and radical – example of ‘market‐oriented’ health care reform, and Cuba, which followed a highly ‘conservative’ path to adapt its public system to the new conditions since the 1990s, going against the model of the international institutions. The Colombian reform has not been able to materialize its promises of universality, improved equity, efficiency and better quality, while Cuban health care remains free, accessible for everybody and of good quality. Finally, we argue that the basic premises of the ongoing health sector reforms in Latin America are not based on the people's needs, but are strongly influenced by the needs of foreign – especially North American – corporations. However, an alternative model of health sector reform, such as the Cuban one, can probably not be pursued without fundamental changes in the economic and political foundations of Latin American societies.
Colombia's health reform: False debates, real imperatives [Letter]
(Elsevier, 2010-03-06) Londoño, E.; Dario-Gómez, R.; De Vos, Pol
Commission on Global Governance for Health: Just another report? [Letter]
(Elsevier, 2014-04-19) De Vos, Pol; Schuftan, Claudio; Sanders, David; Labonte, Ronald; Woodward, David; Birn, Anne-Emanuelle; Bodini, Chiara; Stefanini, Angelo; Serag, Hani
Community and health staff perceptions on non-communicable disease management in El Salvador’s health system: A qualitative study
(BioMed Central, 2020-05-27) Vidal, Nicole L.; León García, Montserrat; Jiménez, Marta; Bermúdez, Keven; De Vos, Pol
Background: Non-communicable Diseases (NCDs) are the leading cause of global mortality and disability with a rising burden in low- and middle-income countries. Their multifactorial aetiology, and their requirement of long-term care, implies the need for comprehensive approaches. From 2009, the Ministry of Health (MoH) in El Salvador has developed a national public health system based on comprehensive primary health care. This study aims to describe the different stakeholders’ perceptions about the management of NCDs along the pathways of care in this health system. Methods: During three fieldwork periods in 2018, three complementary qualitative data collection methods were deployed and conducted in settings with high prevalence of NCDs within El Salvador. First, illness narrative methodology was used to document the life histories of people living with a chronic disease and being treated in second and third level health facilities. Second, through social mapping, support resources that NCD patients used throughout the process of their illness within the same settings were analysed. Third, semi-structured interviews were conducted in the same locations, with both chronic patients and health personnel working at different levels of the primary health care setting. Participants were recruited through purposive and snowball sampling, and a deductive approach was implemented for coding during the analysis phase. After grouping codes into potential themes, a thematic framework was developed using a reflexive approach and following triangulation of the data. Results: This innovative approach of combining three well-defined qualitative methods identified key implications for the implementation of a comprehensive approach to NCD management in resource-poor settings. The following elements are identified: 1) social risk factors and barriers to care; 2) patient pathways to NCD care; 3) available resources identified through social connections mapping; 4) trust in social connections; and 5) community health promotion and NCD prevention management. Conclusions: The Salvadoran public health system has been able to strengthen its comprehensive approach to NCDs, combining a clinical approach – including long-term follow-up – with a preventive community-based strategy. The structural collaboration between the health system and the (self-) organised community has been essential for identifying failings, discuss tensions and work out adapted solutions.
Community and health staff perceptions on non-communicable disease management in primary care in El Salvador: A qualitative study
(2019) Vidal, Nicole L.; Jiménez, Marta; León, Montse; De Vos, Pol
This dataset pertains to a qualitative study examining community perceptions related to the management of non-communicable diseases in El Salvador. During different periods of 2018, three complementary qualitative data collection methods have been applied: illness narrative, social mapping and semi-structured interviews.
Community financing or cost recovery: Empowerment or social dumping?
(Wiley, 1996-06) Criel, B.; De Vos, Pol; Van Lerberghe, W.; Van der Stuyft, Patrick
Comprehensive primary health care and non-communicable diseases management: A case study of El Salvador
(BMC, 2020-04-06) Jimenez Carrillo, Marta; León García, Montserrat; Vidal, Nicole L.; Bermúdez, Keven; De Vos, Pol
One of today's greatest challenges in public health worldwide - and especially its key management from Primary Health Care (PHC) - is the growing burden of non-communicable diseases (NCDs). In El Salvador, since 2009 the Minister of Health (MoH) has scaled up a national public health system based on a comprehensive PHC approach. A national multi-sectorial strategic plan for a comprehensive approach to NCDs has also been developed. This analysis explores stakeholders' perceptions related to the management of NCDs in PHC and, in particular, the role of social participation. A case-study was developed consisting of semi structured interviews and official document reviews. Semi-structured interviews were developed with chronic patients (14) and PHC professionals working in different levels within PHC (12). Purposive sampling was used to recruit participants. A non-pure, deductive approach was implemented for coding. After grouping codes into potential themes, a thematic framework was elaborated through a reflexive approach and the triangulation of the data. The research was conducted between March and August of 2018 in three different departments of El Salvador. The structure and the functioning of the Salvadoran PHC system and its intersectoral approach is firstly described. The interdisciplinary PHC-team brings holistic health care closer to the communities in which health promoters play a key role. The findings reflect the generally positive perception of the PHC system in terms of accessibility, quality and continuity of care by chronic patients. Community engagement and the National Health Forum are ensuring accountability through social controllership mechanisms. However, certain challenges were also noted during the interviews related to the shortage of medication and workforce; coordination between the levels of care and the importance of prevention and health promotion programmes for NCDs. The Salvadoran PHC and its comprehensive approach to NCDs with an emphasis on intersectoral participation has been positively perceived by the range of stakeholders interviewed. Social engagement and the NHF works as a driving force to ensure accountability as well as in the promotion of a preventive culture. The challenges identified provide keys to amplify knowledge for addressing inequalities in health by strengthening PHC and its NCDs management.
Cuba's delayed transition needs [Letter]
(Elsevier, 2006-10-12) De Vos, Pol
Cuba's health system: Challenges ahead
(Oxford University Press, 2008-05-02) De Vos, Pol; De Ceukelaire, Wim; Bonet, Mariano; Van der Stuyft, Patrick
Cuba's exclusively public health system has been quite unique in pairing limited resources with excellent results. It continued to perform well during the economic crisis of the 1990s, and now that the hardships are being overcome, new opportunities are developing—as well as threats: (1) economic recovery should permit reinforcing of the system's effectiveness; (2) Cuba's increasing international solidarity in health also poses it corresponding challenges at home; (3) the ageing of the population necessitates adjustments to the health care system. However, the original principles of the health care system are not under question. Cuba can be considered a unique laboratory, and deserves more attention from the international public health community.
Cuba's international cooperation in health: An overview
(Baywood Publishing, 2007-10-01) De Vos, Pol; De Ceukelaire, Wim; Bonet, Mariano; Van der Stuyft, Patrick
In the first years after Cuba's 1959 revolution, the island's new government provided international medical assistance to countries affected by natural disasters or armed conflicts. Step by step, a more structural complementary program for international collaboration was put in place. The relief operations after Hurricane Mitch, which struck Central America in 1998, were pivotal. From November 1998 onward, the “Integrated Health Program” was the cornerstone of Cuba's international cooperation. The intense cooperation with Hugo Chávez's Venezuela became another cornerstone. Complementary to the health programs abroad, Cuba also set up international programs at home, benefiting tens of thousands of foreign patients and disaster victims. In a parallel program, medical training is offered to international students in the Latin American Medical School in Cuba and, increasingly, also in their home countries. The importance and impact of these initiatives, however, cannot and should not be analyzed solely in public health terms.
Cuba's international cooperative efforts in health [Letter]
(BMJ Publishing Group, 2006-09-14) De Vos, Pol; Van der Stuyft, Patrick
Longstanding collaboration with Cuban research institutes makes us privileged witnesses to the country's successes and hardships. Since the collapse of the Soviet Union and the tightening of the US blockade, Cuba has been in dire straits but overall health outcomes have remained excellent and continue to improve. 2 3 International solidarity has always been at the centre of the Cuban societal project, lately from structural health cooperation with Haiti and Venezuela to massive emergency relief to Pakistan after the earthquake last year. 4 The Venezuelan government is developing comprehensive health programmes, aiming at universal coverage (F Armada, speech, Continental Social Forum, Caracas, January 2006).
Cuba's strategy toward universal health
(Sage, 2018-10-06) De Vos, Pol
After 40 years of the Alma Ata Declaration on primary health care, the Pan American Journal of Public Health published an actualized overview of Cuban policies on health and well-being. It describes the longstanding and successful experience of this socialist country, developed in adverse and complex circumstances. The Cuban case remains one of the leading examples of a comprehensive governmental approach toward population health and well-being. The analysis underscores the essential role of continued political will toward population health.
Determinantes sociopolíticos de las políticas internacionales de salud
(Instituto Nacional de Salud, 2013-04) De Vos, Pol; Van der Stuyft, Patrick
Desde hace décadas, dos lógicas opuestas dominan el debate político de la salud: el enfoque de atención integral de salud, con la Declaración de Alma Ata de 1978 como piedra angular, y la lógica de la competencia privada, haciendo hincapié en el papel del sector privado. Presentamos este debate y su influencia en las políticas internacionales de salud en el contexto de las relaciones de poder económicas y sociopolíticas globales. Se ilustra el enfoque neoliberal de la reforma del sector salud de Chile en la década de 1980 y de la reforma colombiana desde 1993. La lógica pública integral se ilustra a través de los modelos de seguridad social en Costa Rica y en Brasil, y a través de los sistemas nacionales de salud pública en Cuba vigentes desde 1959, y en Nicaragua, durante la década de 1980. Estas experiencias ponen de relieve que los sistemas de salud no gravitan naturalmente hacia una mayor equidad y eficiencia, sino que requieren de decisiones políticas explícitas.
The direct costs of home care in Cuba
(Organización Panamericana de la Salud, 2007) Barroso Utra, Isabel M.; García Fariñas, Anai; Rodríguez Salvá, Armando; De Vos, Pol; Bonet‐Gorbea, Mariano; Van der Stuyft, Patrick
OBJECTIVE: To analyze home care services in Cuba and determine how length of stay, per-day cost, and per-patient cost vary by diagnosis and by the area of the country in which the services are rendered.
Empowerment for the right to health: the use of the most significant change- methodology in monitoring
(Harvard School of Public Health, 2015-12-10) Polet, Fanny; Malaise, Geraldine; Mahieu, Anuschka; Utrera, Eulalia; Montes, Jovita; Tablang, Rosalinda; Aytin, Andrew; Kambale, Erick; Luzala, Sylvie; Al-Ghoul, Daoud; Darkhawaja, Ranin Ahed; Rodriguez, Roxana Maria; Posada, Margarita; De Ceukelaire, Wim; De Vos, Pol
Quantitative evaluations might be insufficient for measuring the impact of interventions promoting the right to health, particularly in their ability to contribute to a greater understanding of processes at the individual, community, and larger population level through which certain results are obtained. This paper discusses the application of a qualitative approach, the most significant change- (MSC) methodology, in the Philippines, Palestine, the Democratic Republic of the Congo, and El Salvador between 2010 and 2013 by Third World Health Aid and its partner organizations. MSC is based on storytelling through which the central question-what changes occurred?-is developed in terms of, who did what, when, why, and why was it important?- The approach focuses on personal stories that reflect on experiences of change for individuals over time. MSC implementation over several years allowed the organizations to observe significant change, as well as evolving types of change. Participants shifted their stories from how the programs helped them- and what they could do to help others benefit from the programs- to what they could do to help their organizations.- The MSC technique is useful as a complement to quantitative methods, as it is a slow, participatory, and intensive endeavor that builds capacity while being applied. This makes MSC a useful monitoring tool for programs with participatory and empowering objectives.
Evidencias actuales en las propuestas de intervención local para el estudio y manejo de los determinantes sociales de la salud en la población cubana
(Editorial Ciencias Médicas, 2014-05) Álvarez Pérez, Adolfo G.; Luis Gonzalvez, Isabel P.; Maldonado Cantillo, Geominia; Romero Placeres, Manuel; Bonet‐Gorbea, Mariano; Lage Davila, Carlos; De Vos, Pol; Van der Stuyft, Patrick
Los determinantes sociales de la salud son las condiciones sociales en las cuales las personas que conforman una población determinada nacen, viven y trabajan. El presente artículo tiene el objetivo de documentar las evidencias actuales sobre las propuestas de intervención local para el estudio y manejo de los determinantes sociales de la salud de la población cubana. Desde una perspectiva estructural las variables de servicios de salud muestran diferencias entre territorios, asociadas básicamente a la existencia de un sistema de salud único con cobertura y acceso universal para toda la población. Se observan mayores diferenciales en el comportamiento de los llamados “determinantes no médicos”, como densidad poblacional, producción y circulación económica, mostrando estas diferencias un patrón geográfico. También se observan diferenciales en el comportamiento de la mortalidad materna y la hipertensión arterial entre territorios y en el tiempo. La productividad económica y las condiciones de vida están poco relacionadas con otros indicadores de resultados. Ante lo anteriormente expuesto se presenta una propuesta metodológica para el estudio y manejo de los determinantes sociales de la salud. Se requieren espacios de estudio de los determinantes sociales a nivel local, mediante técnicas multivariadas cuyos resultados aporten insumos para el diseño de intervenciones integrales basadas en los enfoques de planificación estratégica, acción intersectorial y participación social. Se impone insertar en la práctica del sistema de salud cubano un enfoque dirigido a trabajar más con los determinantes sociales de la salud, para lo cual se propone un modelo para el estudio e intervención local.
Fiscal policies in Europe in the wake of the economic crisis: Implications for health and healthcare access. Background paper for The Lancet–University of Oslo Commission on Global Governance for Health.
(University of Oslo, 2014) Kondilis, Elias; Bodini, Chiara; De Vos, Pol; Benos, Alexis; Stefanini, Angelo