Browsing by Person "Van der Stuyft, Patrick"

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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.
Community financing or cost recovery: Empowerment or social dumping?
(Wiley, 1996-06) Criel, B.; De Vos, Pol; Van Lerberghe, W.; Van der Stuyft, Patrick
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).
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.
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.
The functioning of the Cuban home hospitalization programme: A descriptive analysis
(BMC, 2007-05-31) De Vos, Pol; Barroso, Isabel; Rodríguez, Armando; Bonet, Mariano; Van der Stuyft, Patrick
Background Over the last decades hospital at home (HaH) programmes have been set up in many, mainly European, countries. The Cuban HaH programme is not hospital driven, but the responsibility of the first line health services, and family doctors play a pivotal role.
Health and human rights in Cuba [Letter]
(Elsevier, 2004-12-18) De Vos, Pol; Bonet, Mariano; Van der Stuyft, Patrick
Health through people’s empowerment: A rights-based approach to participation
(Harvard University Press, 2009-06) De Vos, Pol; De Ceukelaire, Wim; Malaise, Geraldine; Pérez, Dennis; Lefèvre, Pierre; Van der Stuyft, Patrick
Analysis of the academic discourse on participation, empowerment, and the right to health since the 1978 Alma-Ata International Conference on Primary Health Care and the subsequent Alma-Ata Declaration shows that each phase of the evolution of these concepts added important new aspects to the discussion. This article focuses on three crucial issues that relate to these additions: the importance of social class when analyzing the essentials of community participation, the pivotal role of power highlighted in the discussion on empowerment, and the role of the state, which refers to the concepts of claim holders and duty bearers included in a rights-based approach to health. The authors compare these literature findings with their own experiences over the past 20 years in the Philippines, Palestine, and Cuba, and they offer some lessons learned. The concept of “health through people’s empowerment” is proposed to identify and describe the core aspects of participation and empowerment from a human rights perspective and to put forward common strategies. If marginalized groups and classes organize, they can influence power relations and pressure the state into action. Such popular pressure through organized communities and people’s organizations can play an essential role in ensuring adequate government policies to address health inequities and in asserting the right to health.
Morbidity, utilization of curative care and service entry point preferences in metropolitan Centro Habana, Cuba
(Scientific Electronic Library Online, 2016-11-03) Rodríguez Salvá, Armando; Díaz Piñera, Addys; Balcindes, Susana; García Roche, René; De Vos, Pol; Van der Stuyft, Patrick
First-line health services with a primary health care approach are a strong trigger for adequate health-care-seeking behavior. Research on the association between prevalence of chronic diseases and acute illnesses and use of health services emphasizes the importance of socioeconomic determinants in such patterns of utilization. In a cross-sectional study of 408 families in Centro Habana, Cuba, home interviews were conducted between April and June 2010 to analyze socio-demographic determinants of acute and chronic health problems and use of formal health services. Bivariate and logistic regression models were used. 529 persons reported a chronic disease. During the previous month, 155 of the latter reported an exacerbation and 50 experienced an unrelated acute health problem. 107 persons without chronic diseases reported acute health problems. Age was the strongest determinant of chronic disease prevalence. Adult women and the elderly were more likely to report acute problems. Acute patients with underlying chronic disease used formal services more often. No socio-demographic variable was associated with services use or consultation with the family physician. While the family physician is defined as the system's entry-point, this was the case for only 54% of patients that had used formal services, thus compromising the physician's role in counseling patients and summarizing their health issues. The importance of chronic diseases highlights the need to strengthen the family physician's pivotal role. New economic policies in Cuba, stimulating self-employment and private initiative, may increase the strain on the exclusively public health care system. Still, the Cuban health system has demonstrated its ability to adapt to new challenges, and the basic premises of Cuba's health policy are expected to be preserved.
Nicaragua's debt burden: A permanent hurricane [Letter]
(Elsevier, 1998-12-19) Van der Stuyft, Patrick; De Vos, Pol
Public health services, an essential determinant of health during crisis. Lessons from Cuba, 1989–2000
(Wiley, 2012-02-01) De Vos, Pol; García‐Fariñas, Anaí; Álvarez‐Pérez, Adolfo; Rodríguez Salvá, Armando; Bonet‐Gorbea, Mariano; Van der Stuyft, Patrick
During the 1990s, Cuba was able to overcome a severe crisis, almost without negative health impacts. This national retrospective study covering the years 1989–2000 analyses the country’s strategy through essential social, demographic, health process and health outcome indicators. Gross domestic product (GDP) diminished by 34.76% between 1989 and 1993. In 1994 slow recuperation started. During the crisis, public health expenses increased. The number of family doctors rose from 9.22 to 27.03 per 104 inhabitants between 1989 and 2000. Infant mortality rate and life expectancy exemplify a series of health indicators that continued to improve during the crisis years, whereas low birth weight and tuberculosis incidence are among the few indicators that suffered deterioration. GDP is inversely related to tuberculosis incidence, whereas the average salary is inversely related to low birth weight. Infant mortality rate has a strong negative correlation with the health expenses per inhabitant, the number of maternal homes, the number of family doctors and the proportion of pregnant women receiving care in maternal homes. Life expectancy has a strong positive correlation with health expenses, the number of nursing personnel and the number of medical contacts per inhabitant. The Cuban strategy effectively resolved health risks during the crisis. In times of serious socio‐economic constraints, a well conceptualized public health policy can play an important role in maintaining the overall well‐being of a population.
Public hospital management in times of crisis: Lessons learned from Cienfuegos, Cuba (1996–2008)
(MEDICC, 2010-04) De Vos, Pol; Orduñez-García, Pedro; Santos-Peña, Moisés; Van der Stuyft, Patrick
Cuba’s public health system is well known for its integrated first line services based on family medicine. Less publicized is the country’s experience in public hospital management. After a harsh economic crisis in the first half of the 1990s had brought the Cienfuegos hospital near to collapse, from 1996 onwards the hospital management team took advantage of the incipient economic recovery to launch an ambitious recovery process. This article reconstructs this endeavor, based on annual hospital reports, scientific publications by the hospital staff, and interviews with key decision-makers. First the endless waiting list for elective surgery was tackled through a more efficient use of the surgery department, and an increase of ambulatory surgery. Next, overall hospital efficiency was improved in the aim to drastically reduce the average length of stay, reaching a decrease from an average stay of 12 days to a little more than 6 days in 1999. Also the emergency department was reorganized, setting up a triage system based on a color code, linked to specific emergency protocols. Attention for improving the clinical efficiency for AMI and stroke coincided with a drop in their intrahospital lethality. Clinical guidelines for the most important diagnoses were collectively developed, adapting international evidence to the local setting. An individual and collective performance evaluation system was elaborated in a participatory way, and further evolved into a ‘total quality management’ process. This experience of Cienfuegos hospital provides an interesting example on how a public hospital – embedded in a well developed national public health system – can be effective and efficient, even in circumstances of limited resources.
Public hospital management in times of crisis: Lessons learned from Cienfuegos, Cuba (1996–2008)
(Elsevier, 2010-01-27) De Vos, Pol; Orduñez-García, Pedro; Santos-Peña, Moisés; Van der Stuyft, Patrick
Cuba's public health system is well known for its integrated first line services based on family medicine. Less publicized is the country's experience in public hospital management. After a harsh economic crisis in the first half of the 1990s had brought the Cienfuegos hospital near to collapse, from 1996 onwards the hospital management team took advantage of the incipient economic recovery to launch an ambitious recovery process. This article reconstructs this endeavor, based on annual hospital reports, scientific publications by the hospital staff, and interviews with key decision-makers. First the endless waiting list for elective surgery was tackled through a more efficient use of the surgery department, and an increase of ambulatory surgery. Next, overall hospital efficiency was improved in the aim to drastically reduce the average length of stay, reaching a decrease from an average stay of 12 days to a little more than 6 days in 1999. Also the emergency department was reorganized, setting up a triage system based on a color code, linked to specific emergency protocols. Attention for improving the clinical efficiency for AMI and stroke coincided with a drop in their intrahospital lethality. Clinical guidelines for the most important diagnoses were collectively developed, adapting international evidence to the local setting. An individual and collective performance evaluation system was elaborated in a participatory way, and further evolved into a ‘total quality management’ process. This experience of Cienfuegos hospital provides an interesting example on how a public hospital – embedded in a well developed national public health system – can be effective and efficient, even in circumstances of limited resources.
The right to health in times of economic crisis: Cuba's way [Comment]
(Elsevier, 2009-11-05) De Vos, Pol; Van der Stuyft, Patrick
Shifting the demand for emergency care in Cuba's health system
(Elsevier, 2004-07-09) De Vos, Pol; Murlá, Pedro; Rodriguez, Armando; Bonet, Mariano; Màs, Pedro; Van der Stuyft, Patrick
Cuba has developed a programme of quality improvement of its health services, which includes an extramural emergency care system in which polyclinics and general practitioner networks play an important role. Using routine health information from the decentralised first line emergency units (FLES) and from the hospital emergency service (HES) for the period 1995–2000, we evaluated the effects of the emergency care subsystem reform on the utilisation rates of first line and hospital services in Baracoa and Cerro, a rural and a metropolitan municipality, respectively. In the self-contained health system of Baracoa, the reform of the emergency subsystem resulted in a first phase of increased utilisation of the FLES, followed by a second phase of gradual decrease, during which there was an increased utilisation of general practitioners. In contrast, the overall results of the reform in Cerro were unclear. The proximity to a hospital seems to be the most important element in the patient's decision on which entry point to the Cerro health system to use. A potential adverse effect of the reform is an increased emergency services utilisation in situations where GP care remains below patients’ expectations. Given the current world-wide trends in health-care reform, the organisational alternatives developed in the Cuban health system might remain specific to the local contextual setting.