The Institute for Global Health and Development
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Item The role of social movements in strengthening health systems: The experience of the National Health Forum in El Salvador (2009–2018)(SAGE Publications, 2020-02-19) León, Montserrat; Jiménez, Marta; Vidal, Nicole L.; Bermúdez, Keven; De Vos, PolIn 2009, the newly elected FMLN government of El Salvador launched a comprehensive health reform, which gave the National Health Forum (NHF) a key role in developing community participation. This study aims to examine and analyze the content and impact of this social movement during the study period 2009–2018. The context was analyzed through relevant documents, which helped identify key stakeholders. Semi-structured interviews took place at 3 levels of decision making: the political level, the health professionals, and the community. Data were analyzed using a qualitative methodology. Participation is carried by a structure created by the Ministry of Health, the National Health Forum. The NHF developed 3 strategies: (1) leadership building in the communities through the strengthening of social, political, and economic skills, where they developed social accountability mechanisms at all decision-making levels of the health system; (2) the strategy carried by the sectoral working groups, where they responded to prioritized needs identified by the community; and (3) advocacy for human rights-based policies. The NHF, and its role in the strengthening of the National Public Health System, provides strong evidence of community participation strategies and co-governance with the health system within the social determinants of health scope.Item Determinantes sociopolíticos de las políticas internacionales de salud(Instituto Nacional de Salud, 2013-04) De Vos, Pol; Van der Stuyft, PatrickDesde 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.Item Primary Health Care in the 21st century: Primary care providers and people’s empowerment(Wiley, 2010-02-09) Van Olmen, Josefien; Criel, Bart; Devadasan, Narayanan; Pariyo, George; De Vos, Pol; Van Damme, Wim; Van Dormael, Monique; Marchal, Bruno; Kegels, GuyInternational health debates often confront enduring values with new realities. The events and publications surrounding the 30th anniversary of Alma Ata, the Primary Health Care (PHC) focus of the 2008 World Health Report and the report(s) of the Commission on Social Determinants of Health illustrate the durability of PHC values such as equity, self-determination, participation, trans-sectoral collaboration and the right to health (Gilson et al. 2007; Chan 2008; Lawn et al. 2008; Reich et al. 2008; Walley et al. 2008; World Health Organisation 2008; Hanson et al. 2009). Taking into account recent transitions that are changing the relationship between primary care providers and their patients, we examine the role providers can play in enhancing people’s individual and collective empowerment, an important but rather neglected component of PHC (Walley et al. 2008).Item 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, PatrickBackground - 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.