Background All prevention efforts currently being implemented for COVID-19 are aimed at reducing the burden on strained health systems and human resources. There has been little research conducted to understand how SARS-CoV-2 has affected health care systems and professionals in terms of their work. Finding effective ways to share the knowledge and insight between countries, including lessons learned, is paramount to the international containment and management of the COVID-19 pandemic. The aim of this project is to compare the pandemic response to COVID-19 in Brazil, Canada, China, France, Japan, and Mali. This comparison will be used to identify strengths and weaknesses in the response, including challenges for health professionals and health systems. Methods We will use a multiple case study approach with multiple levels of nested analysis. We have chosen these countries as they represent different continents and different stages of the pandemic. We will focus on several major hospitals and two public health interventions (contact tracing and testing). It will employ a multidisciplinary research approach that will use qualitative data through observations, document analysis, and interviews, as well as quantitative data based on disease surveillance data and other publicly available data. Given that the methodological approaches of the project will be largely qualitative, the ethical risks are minimal. For the quantitative component, the data being used will be made publicly available. Discussion We will deliver lessons learned based on a rigorous process and on strong evidence to enable operational-level insight for national and international stakeholders.

Objectives Public health interventions are increasingly represented as complex systems. Research tools for capturing the dynamic of interventions processes, however, are practically non-existent. This paper describes the development and proof of concept process of an analytical tool, the critical event card (CEC), which supports the representation and analysis of complex interventions' evolution, based on critical events. Methods Drawing on the actor-network theory (ANT), we developed and field-tested the tool using three innovative health interventions in northeastern Brazil. Interventions were aimed to promote health equity through intersectoral approaches; were engaged in participatory evaluation and linked to professional training programs. The CEC developing involve practitioners and researchers from projects. Proof of concept was based on document analysis, face-toface interviews and focus groups. Results Analytical categories from CEC allow identifying and describing critical events as milestones in the evolution of complex interventions. Categories are (1) event description; (2) actants (human and non-human) involved; (3) interactions between actants; (4) mediations performed; (5) actions performed; (6) inscriptions produced; and (7) consequences for interventions.Conclusions The CEC provides a tool to analyze and represent intersectoral internvetions' complex and dynamic evolution.

Background: All prevention efforts currently being implemented for COVID-19 are aimed at reducing the burden on strained health systems and human resources. There has been little research conducted to understand how SARS-CoV-2 has affected healthcare systems and professionals in terms of their work. Finding effective ways to share the knowledge and insight between countries, including lessons learned, is paramount to the international containment and management of the COVID-19 pandemic. The aim of this project is to compare the pandemic response to COVID-19 in Brazil, Canada, China, France, Japan, and Mali. This comparison will be used to identify strengths and weaknesses in the response, including challenges for health professionals and health systems.Methods: We will use a multiple case study approach with multiple levels of nested analysis. We chose these countries as they represent different continents and different stages of the pandemic. We will focus on several major hospitals and two public health interventions (contact tracing and testing). It is a multidisciplinary research approach that will use qualitative data through observations, document analysis, and interviews, as well as quantitative data based on disease surveillance data and other publicly available data. Given that the methodological approaches of the project are largely qualitative, the ethical risks are minimal. For the quantitative component, the data being used are publicly available.Discussion: We will deliver lessons learned based on a rigorous process and on strong evidence to enable operational-level insight for national and international stakeholders.

The present study aims to describe the evolution of an intervention, using a methodology that adopts the critical event as the unit of analysis, and to identify strategic factors that facilitate the continuation of the interventions. Six critical events were identified: dispute care models for health; area of advice: dispute field; change policy; break of interorganizational relations; lack of physical structure and turnover of staff; difficulty in organizing practices in the work process. these are developed into strategic factors: enabling network of allies; meetings and educational activities/building capacity; benefits perceived by community members; mobilization of key actors; intervention’s compatibility with the government’s vision; restoration of interrelationship; and stability of the workforce. These strategic factors form a group of interrelated conditions that provide the strengthened linkages between elements in the intervention, supporting the hypothesis that they collaborate for the sustainability of the interventions in health. Tracking down the transformations of an intervention set by the critical events, it was verified that these factors performed a protective role at times of changes in the intervention process.

Foi realizada revisão da literatura com intuito de sistematizar o conhecimento produzido no campo da promoção da saúde em relação ao tema sustentabilidade. As bases de dados consultadas foram Lilacs, SciELO e Web of Science, no período entre 1989 e 2014. O corpus contou com 35 artigos, sendo analisados conceito de sustentabilidade, metodologia e resultados dos estudos. Verificou-se que os estudos têm se dedicado a encontrar fatores que influenciam a sustentabilidade de intervenções de saúde, no entanto, não há evidências sobre que fatores são suficientes para a sustentabilidade. Conclui-se que há pouca literatura sobre o tema em questão no âmbito nacional e se recomenda novas investigações.

Resumo Objetivou-se avaliar o processo educativo realizado pelo Núcleo Ampliado de Saúde da Família e Atenção Básica na atenção à hipertensão arterial sistêmica e diabetes mellitus em Recife, Pernambuco. Foi realizada uma pesquisa avaliativa orientada pela teoria educacional de Paulo Freire, com elaboração de um modelo teórico. Participaram do estudo quatro profissionais do Núcleo Ampliado de Saúde da Família e Atenção Básica, onze profissionais da Estratégia Saúde da Família e dez usuários com hipertensão e/ou diabetes. Foram realizados grupos focais e os dados coletados, entre novembro de 2018 e fevereiro de 2019, foram submetidos à análise de conteúdo. Evidenciou-se a coexistência do uso pelos profissionais das concepções bancária e problematizadora. Foram identificadas práticas verticalizadas e pouco dialogadas pelos profissionais, bem como uma visão curativista e medicalocêntrica nos discursos dos usuários. Observou-se também ações transformadoras no processo de trabalho dos profissionais e relatos de melhorias das condições de saúde dos usuários participantes dos grupos educativos. Além disso, o incentivo pela busca de direitos durante as ações educativas levou à conquista da implantação do Programa Academia da Cidade no território. Esses achados revelam o poder de transformação das ações educativas quando se tornam participativas e construídas com base nas experiências e necessidades da população.

In 1990 the national health services in the United Kingdom and Sweden started to split up in internal markets with purchasers and providers. It was also the year when Brazil started to implement a national health service (SUS) inspired by the British national health service that aimed at principles of universality, equity, and integrality. While the reform in Brazil aimed at improving equity and effectiveness, reforms in Europe aimed at improving efficiency in order to contain costs. The European reforms increased supply and utilization but never provided the large increase in efficiency that was hoped for, and inequities have increased. The health sector reform in Brazil, on the other hand, contributed to great improvements in population health but never succeeded in changing the fact that more than half of health care spending was private. Demographic and epidemiological changes, with more elderly people having chronic disorders and very unequal comorbidities, bring the issue of integrality in the forefront in all 3 countries, and neither the public purchaser provider markets nor the 2-tier system in Brazil delivers on that front. It will demand political leadership and strategic planning with population responsibility to deal with such challenges.

Resumo A cooperação intergovernamental entre municípios de pequeno porte é operacionalizada por meio de consórcios de saúde, historicamente, no Sistema Único de Saúde (SUS). Tais iniciativas favoreceram a descentralização da saúde no contexto da municipalização. Entretanto, pouco se sabe sobre a sua implementação no processo de regionalização. Este estudo objetivou analisar as razões para a expansão dos consórcios intermunicipais de saúde conduzida pela autoridade sanitária estadual como um fenômeno político institucional novo na regionalização da saúde no SUS em Pernambuco. Trata-se de um estudo retrospectivo de caráter analítico com abordagem qualitativa. Realizaram-se quatro entrevistas semiestruturadas com gestores estaduais, as quais foram analisadas mediante técnica de método de condensação de significados proposta por Kvale. A Teoria das Representações Sociais guiou a análise dos dados. As razões para a indução do consorciamento intermunicipal foram: o fortalecimento da regionalização dos serviços de saúde; a ampliação de oferta e cogestão de serviços de saúde; a absorção de experiências exitosas e a necessidade da indução estadual das políticas regionais de saúde. Os consórcios se configuraram como uma possibilidade positiva na percepção dos gestores estaduais na regionalização de ações de saúde no estado; porém, estudos adicionais são necessários no que diz respeito ao impacto dos indicadores de saúde em escala regional.