There are important geographical differences in Chile with respect to mortality and other health outcomes, income and environmental conditions, and the financing and utilization of health care services. The information that is collected regularly and is available to characterize the health-related variables frequently has limitations in terms of quality, sustainability, and access. In Chile it would be pointless to focus the greatest efforts on reorganizing the information systems. The existing indicators showing marked inequalities are adequate to support the planning of interventions aimed at making urgently needed improvements in the situation of the worst-off Chileans.

Objetivos: Determinar el nivel de satisfacción del usuario (SU) en centros de salud (CS) y hospitales del MINSA; analizar la relación entre SU y nivel socioeconómico (NSE); e identificar los factores sociodemográficos y de accesibilidad asociados. Materiales y Métodos: Análisis secundario de los datos de Encuesta Nacional de Niveles de Vida (ENNIV) 2000. Fueron entrevistados 376 y 327 usuarios de los CS y hospitales, respectivamente. Las variables de estudio fueron SU, niveles socioeconómico y características sociodemográficas y accesibilidad para la atención. Se aplicó estadística descriptiva y multivariada. Resultados: Los usuarios de los establecimientos muestran características diferenciadas. La SU fue 68,1% y 62,1% para los CS y hospitales, respectivamente. Los usuarios de menor NSE presentaron mayor satisfacción. La edad, educación, distancia al establecimiento y el tiempo de espera presentan asociaciones con la SU. Conclusiones: Existen factores sociodemográficos, económicos y de accesibilidad para la atención, que muestran relación con la satisfacción del usuario; tales factores se comportan de manera particular según el tipo de establecimiento de salud (centro de salud, hospital), debido fundamentalmente a que la población usuaria es distinta. Esto último relativiza la comparación del nivel de satisfacción y de sus factores asociados entre tales establecimientos.

Resumen: En su desarrollo respectivo, tanto la ética médica y, luego, la bioética como la salud pública han llegado a un punto de encuentro. Este proceso se traduce en una puesta en tensión de los principios fundadores de la bioética, debido a las contradicciones que surgen entre lo individual y lo social. Sin embargo, la búsqueda de nuevos valores puede ayudar a enfocar esta aparente oposición. En este recorrido, la bioética trae consigo su valioso método de debate abierto y contradictorio, mientras la salud pública presenta una tradición de organización de las acciones sanitarias basada en conceptos sociales (solidaridad, responsabilidad, interculturalidad). Esto permite reflexionar, además, a propósito de las condiciones concretas del ejercicio de la bioética en los servicios de salud.

Eight hundred and twenty newborn babies with a mean weight of < or = 2500g from the Maternity Hospital P Boland in Santa Cruz- Bolivia were examined in 1988-1989 by different methods to diagnose Chagas disease, (placental pathology, serology, parasitologically and clinically) to determine the efficiency and cost of these methods. The histopathological exam detected 87 cases of placenta infection. Out of this total 43 (49%) newborns were positive on the parasitological exam of the chord blood. This number increased by repeating the blood test during the first month of the baby's life, reaching the same level as the histopathology. With the serology, only 2 cases were detected as positive. The clinical sign with a high specificity in children infected with Chagas disease is the hepatosplenomegaly. The advantages and disadvantages regarding the cost and feasibilty of two strategies to detect congenital Chagas disease are being discussed. The first in based on the histopathology and the other over on parasitology. It is concluded that the control programs for this non vectorial form of Chagas' disease cannot be uniform since the aspects to consider are: prevalence of the disease, existence of the vector and availability to laboratory techniques.

In order to know the significance of placental infection by T. cruzi 820 newborn infants (NB) weighing less than or equal to 2500 grs were examined both clinically and by the Strout method and histopathological sections of the placenta in order to detect congenital infection with Chagas' disease. Thirty five (4.26%) NB presented a placentary infections by T. cruzi, but having a negative direct parasitological examination in the cord blood, these NB were followed up parasitologically (microhematocrit), in order to detect an eventual positive change in the post-partum period. The follow-up was done at 7, 15, 30 and 60 days after birth, and with xenodiagnosis 15 days later. In 27 newborn (3.29%) it was possible to complete their follow-up with detection of T. cruzi in every case. In the control group, constituted by NB which were negative to both methods, there was no positivisation at all during the follow-up period. These observations show a high frequency of congenital T. cruzi infection in Santa Cruz.

For a decade, numerous projects in Bolivia have tried to put in practice the concept of local health systems. But, so far, no significant changes have been made and local health services still are the 'poor relation' of the system. The main components of the projects-expansion of health facilities, training of health personnel and institutional decentralization-were not designed to respond to the complexity of the problems encountered. Decentralization was implemented at the level of health districts but not accompanied by redefinition of functions at the central level, and challenged by civil servants' attempts to save their jobs. While training activities did introduce new methods and subjects, they were too often reduced to short workshops or seminars. Health facilities were built without regard for their significance beyond health care. A strategic approach is needed to adapt the planning process to the degree of liberty allowed by society. keywords local health services, strategic planning, decentralization, teaching methods, Bolivia

The present article proposes an analysis of the USA-Bolivia relationships in the health sector between 1971 and 2010 based on a grey and scientific literature review and on interviews. We examined United States Agency for International Development (USAID) interventions, objectives, consistency with Bolivian needs, and impact on health system integration. USAID operational objectives--decentralization, fertility and disease control, and maternal and child health--may have worked against each other while competing for limited Ministry of Health resources. They largely contributed to the segmentation and fragmentation of the Bolivian health system. US cooperation in health did not significantly improve health status while the USAID failed to properly tackle anti-drugs, political, and economic US interests in Bolivia.

With AIDS/HIV, early detection is of key importance to public health, as well as disseminating prevention information and providing timely and appropriate treatment. In Bolivia, at the end of 2006 approximately 50% had AIDS at the time of diagnosis, detection having occurred late in the illness. The HIV/AIDS epidemic in Bolivia is concentrated, with prevalence rates over 5% among the at-risk population, primarily men who have sex with men. From January 1984 through October 2006, the total number of HIV/AIDS cases reported in Bolivia rose to 2 190, with 1 239 HIV and 951 AIDS cases, and underreporting estimated to be over 70% country-wide. The United National Joint Program on AIDS (UNAIDS) estimated that by the end of 2006 there would be 6 700 people living with HIV/AIDS in Bolivia. In the context of this scenario, the article describes the challenges facing the HIV/AIDS program and the strategies developed to address the epidemic in Bolivia. In addition, the UNAIDS/PAHO strategies are stressed and must get underway for HIV/AIDS prevention and control activities in the country.