BackgroundThe health systems in the Americas region are characterized by fragmentation and segmentation, which constitute an important barrier to expanding coverage, achieving integrated primary health care, and reducing inefficiency and discontinuity of care.An assessment of the human resources for health (HRH) programmes that have been implemented at the country level was developed as part of the measurement of the 20 HRH regional goals for 2007–2015, adopted in 2007 by the Pan American Sanitary Conference (CSPA).MethodsThe exercise was a combination of academic research and the development/application of an advocacy tool involving policy makers and stakeholders to influence the decision-making in the development, implementation, or change of HRH programmes while building evidence through a structured approach based on qualitative and quantitative information and the exchange and dissemination of best practices.ResultsThis paper covers the methodological challenges, as well as a summary of the main findings of the study, which included 15 countries: Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua and Panama in the Central America, Dominican Republic in the Caribbean, Chile, Colombia, Ecuador and Peru in the Andean sub region, and Argentina, Paraguay, and Uruguay in the South Cone. Despite the different contexts, the results showed that the programmes evaluated faced common challenges, such as lack of political support and financial unsustainability.ConclusionsThe evaluation process allowed the exchange and dissemination of practices, interventions, and programmes currently running in the region. A shared lesson was the importance of careful planning of the implementation of programmes and interventions. The similarities in the problems and challenges of HRH among the participating countries highlighted the need for a cooperation programme on the evaluation and assessment of implementation strategies in the Americas region.
SETTING: Since the year 2003, most countries of the Region of the Americas have experienced sustained economic growth and inclusive development policies. In the health sector, achieving universal access became the overarching goal. However, the structural limitations of the health workforce represented a formidable obstacle to change. National Health Authorities were confronted with the challenge of developing critical capacities to redress entrenched inequalities in access to qualified health personnel. OUTCOMES: Fifteen countries carried out a baseline assessment in 2009 or 2010 and conducted a second assessment in 2013. Although differences were noted across goals and between countries, the results suggested improvements in all twenty goals overall. The goals linked to the distribution of personnel, the management of migration, and the cooperation with education institutions appeared to be more resilient to change. IMPLICATIONS:The twenty Regional Goals for Human Resources for Health provided a common vision for action and a framework for cooperation within and among countries, and was a catalyst for change. Faced with evolving challenges, the countries should consider adopting a new shared agenda that builds on progress made and further supports intergovernmental policy alignment and capacity building in health workforce development, governance and management.KEY WORDS: Human Resources for Health; capacity building; Latin America; health policy; governance; evaluation and monitoring La traduction du résumé se trouve à la fin de l'article.
For nurses to become major contributors to international health, nursing curriculum content must shift from "international nursing" to "international health." Programs of nursing education should include study of social, economic, and political factors that affect health care systems. Schools should develop partnership agreements.
WRIGHT, M.da G.M.; KORNIEWICZ, D.M; GODUE, C.; MANFREDI, M. Salud internacional: el nuevo desafío para la educación de enfermería. Rev.latino-am.enfermagem, Ribeirão Preto, v. 6, n. 3, p. 5-10, julho 1998. INTRODUCCIÓNLas dimensiones ideológicas, políticas y económicas de la salud son asuntos internacionales. Los sectores social, económico y de la salud son influenciados por la interdependencia y globalización de la economía mundial. El desarrollo económico y de la salud están crecientemente interligados, obligando a varios gobernantes a revisar el papel del Estado como un proveedor de servicios a la población. Como resultado, se está creando una consciencia internacional de la necesidad de mejorar la salud y el bienestar de la población como un de los requisitos para la paz y solidariedad entre las naciones (FRENK & CHACÓN, 1992; CONTANDRIOLOULOS, 1992;BUSTELLO, 1992; PAHO, 1992).El aumento de la complejidad e importancia de las relaciones internacionales estas elevando el campo de salud internacional a una posición de destaque como un área de estudio, práctica y de investigación. Las características de los problemas de salud no reconocen las fronteras nacionales; al contrario, pueden abrir o reforzar áreas de cooperación o, en otra ocasiones, crear conflictos en la comunidad internacional. La interrelación del campo de salud internacional con el desarrollo de un país enfatiza la salud internacional como un instrumento o una meta para disminuir el espacio entre la universidad, la sociedad y la población. También introduce, el enfoque interdisciplinario como una estrategia para alcanzar los resultados esperados en las áreas de educación y salud.El nuevo modelo reconoce la diversidad económica, política y social entre los países, así como la manera que estos aspectos condicionan el proceso de desarrollo y salud de la población.De acuerdo con PANISSET (1992) y ROVERE (1992), salud internacional está en dos dimensiones de la
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