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      Sistema de saúde em um contexto de crise humanitária: o caso do Haiti Translated title: Health System in a context of humanitarian crisis: the case of Haiti

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          Abstract

          Resumo O objetivo desta pesquisa é analisar a organização do sistema de saúde do Haiti, entre 2010 e 2020, com base no Postulado de Coerência proposto por Mário Testa. O estudo utilizou fontes públicas que foram compiladas e codificadas com auxílio do software QSR NVivo 10.0.641.0, para posterior análise crítica de conteúdo. Os resultados revelaram que o manejo de infecções sexualmente transmissíveis (IST) constituía a maior oferta de serviços, porém de forma fragmentada, sendo que as principais causas de morbimortalidade eram as doenças isquêmicas do coração e demais doenças cardiovasculares, devido a uma transição epidemiológica não identificada como problema prioritário no país. Destaca-se que a eletricidade irregular, a falta de equipamentos para fornecer água e instalações sanitárias, nas instituições de saúde, despontaram como questões estruturais a serem enfrentadas. Identificou-se que doadores contribuíram com mais da metade das despesas em saúde em 2010-2019, evidenciando uma dependência de financiamento externo. Conclui-se que a situação de contínua instabilidade política afeta significativamente o desempenho e a melhoria do sistema de saúde haitiano, mas a colaboração efetiva entre os atores identificados pode aportar mudanças significativas.

          Translated abstract

          Abstract This research aims to analyze the organization of Haiti's health system between 2010 and 2020, based on the Postulate of Coherence proposed by Mário Testa. The study used public sources compiled and coded with the help of the QSR NVivo 10.0.641.0 software, for subsequent critical content analysis. The results revealed that the management of sexually transmitted infections (STIs) were the largest range of services, but in a fragmented manner, with the main causes of morbidity and mortality being ischemic heart disease and other cardiovascular diseases, due to an unidentified epidemiological transition as a priority problem in the country. It is noteworthy that irregular electricity, the lack of equipment to supply water and sanitary facilities in health institutions emerged as structural issues to be faced. It was identified that donors contributed more than half of health expenses in 2010-2019, highlighting a dependence on external financing. It is concluded that the situation of continued political instability significantly affects the performance and improvement of the Haitian health system, but effective collaboration between the identified actors can bring about significant changes.

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          Demographic, epidemiological, and health transitions: are they relevant to population health patterns in Africa?

          Background Studies of trends in population changes and epidemiological profiles in the developing world have overwhelmingly relied upon the concepts of demographic, epidemiological, and health transitions, even though their usefulness in describing and understanding population and health trends in developing countries has been repeatedly called into question. The issue is particularly relevant for the study of population health patterns in Africa and sub-Saharan Africa, as the history and experience there differs substantially from that of Western Europe and North America, for which these concepts were originally developed. Objective The aim of this study is two-fold: to review and clarify any distinction between the concepts of demographic transition, epidemiological transition and health transition and to identify summary indicators of population health to test how well these concepts apply in Africa. Results Notwithstanding the characteristically diverse African context, Africa is a continent of uncertainties and emergencies where discontinuities and interruptions of health, disease, and mortality trends reflect the enduring fragility and instability of countries and the vulnerabilities of individuals and populations in the continent. Africa as a whole remains the furthest behind the world's regions in terms of health improvements and longevity, as do its sub-Saharan African regions and societies specifically. This study documents: 1) theoretically and empirically the similarities and differences between the demographic transition, epidemiological transition, and health transition; 2) simple summary indicators that can be used to evaluate their descriptive and predictive features; 3) marked disparities in the onset and pace of variations and divergent trends in health, disease, and mortality patterns as well as fertility and life expectancy trajectories among African countries and regions over the past 60 years; 4) the rapid decline in infant mortality and gains in life expectancy from the 1950s through the 1990s in a context of preponderant communicable diseases in all African countries; 5) the salient role of adult mortality, mostly ascribed to HIV/AIDS and co-morbidities, since the 1990s in reversing trends in mortality decline, its interruption of life expectancy improvements, and its reversal of gender differences in life expectancies disadvantaging women in several countries with the highest prevalence of HIV/AIDS; 6) the huge impact of wars in reversing the trends in under-five mortality decline in sub-Saharan countries in the 1990s and beyond. These assessments of these transition frameworks and these phenomena were not well documented to date for all five regions and 57 countries of Africa. Conclusion Prevailing frameworks of demographic, epidemiological, and health transitions as descriptive and predictive models are incomplete or irrelevant for charting the population and health experiences and prospects of national populations in the African context.
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            Consciência moral e agir comunicativo

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              Success factors for implementing and sustaining a mature electronic medical record in a low-resource setting: a case study of iSanté in Haiti.

              Electronic health information systems, including electronic medical records (EMRs), have the potential to improve access to information and quality of care, among other things. Success factors and challenges for novel EMR implementations in low-resource settings have increasingly been studied, although less is known about maturing systems and sustainability. One systematic review identified seven categories of implementation success factors: ethical, financial, functionality, organizational, political, technical and training. This case study applies this framework to iSanté, Haiti's national EMR in use in more than 100 sites and housing records for more than 750 000 patients. The author group, consisting of representatives of different agencies within the Haitian Ministry of Health (MSPP), funding partner the Centers for Disease Control and Prevention (CDC) Haiti, and implementing partner the International Training and Education Center for Health (I-TECH), identify successes and lessons learned according to the seven identified categories, and propose an additional cross-cutting category, sustainability. Factors important for long-term implementation success of complex information systems are balancing investments in hardware and software infrastructure upkeep, user capacity and data quality control; designing and building a system within the context of the greater eHealth ecosystem with a plan for interoperability and data exchange; establishing system governance and strong leadership to support local system ownership and planning for system financing to ensure sustainability. Lessons learned from 10 years of implementation of the iSanté EMR system are relevant to sustainability of a full range of increasingly interrelated information systems (e.g. for laboratory, supply chain, pharmacy and human resources) in the health sector in low-resource settings.
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                Author and article information

                Journal
                physis
                Physis: Revista de Saúde Coletiva
                Physis
                PHYSIS - Revista de Saúde Coletiva (Rio de Janeiro, RJ, Brazil )
                0103-7331
                1809-4481
                2024
                : 34
                : e34040
                Affiliations
                [1] Feira de Santana Bahia orgnameUniversidade Estadual de Feira de Santana Brazil
                Article
                S0103-73312024000100618 S0103-7331(24)03400000618
                10.1590/s0103-7331202434040pt
                1b3a6ca7-9e89-4f55-91f4-39b330afafd6

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 17 October 2022
                : 16 November 2023
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 34, Pages: 0
                Product

                SciELO Brazil

                Categories
                Artigo original

                Health financing,Sistema de saúde,Haiti,Health organization,Health System,Financiamento saúde,Organização em saúde

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