“…Furthermore, our study underlines the importance of a community perspective at its core, based on the principles of social participation, equity and participatory evaluation, which are all essential triggers for highquality community action [52]. Social engagement has been one of the strengths of the Salvadoran CPHC in contrast to other PHC implementation experience which sometimes have been more focused on issues of efficiency and effectiveness in health care delivery [53] while showing less concern for equity and community participation in PHC [54,55].…”
Background
One of today’s greatest challenges in public health worldwide - and especially its key management from Primary Health Care (PHC) - is the growing burden of non-communicable diseases (NCDs). In El Salvador, since 2009 the Minister of Health (MoH) has scaled up a national public health system based on a comprehensive PHC approach. A national multi-sectorial strategic plan for a comprehensive approach to NCDs has also been developed. This analysis explores stakeholders’ perceptions related to the management of NCDs in PHC and, in particular, the role of social participation.
Methods
A case-study was developed consisting of semi structured interviews and official document reviews. Semi-structured interviews were developed with chronic patients (14) and PHC professionals working in different levels within PHC (12). Purposive sampling was used to recruit participants. A non-pure, deductive approach was implemented for coding. After grouping codes into potential themes, a thematic framework was elaborated through a reflexive approach and the triangulation of the data. The research was conducted between March and August of 2018 in three different departments of El Salvador.
Results
The structure and the functioning of the Salvadoran PHC system and its intersectoral approach is firstly described. The interdisciplinary PHC-team brings holistic health care closer to the communities in which health promoters play a key role. The findings reflect the generally positive perception of the PHC system in terms of accessibility, quality and continuity of care by chronic patients. Community engagement and the National Health Forum are ensuring accountability through social controllership mechanisms. However, certain challenges were also noted during the interviews related to the shortage of medication and workforce; coordination between the levels of care and the importance of prevention and health promotion programmes for NCDs.
Conclusions
The Salvadoran PHC and its comprehensive approach to NCDs with an emphasis on intersectoral participation has been positively perceived by the range of stakeholders interviewed. Social engagement and the NHF works as a driving force to ensure accountability as well as in the promotion of a preventive culture. The challenges identified provide keys to amplify knowledge for addressing inequalities in health by strengthening PHC and its NCDs management.
“…Furthermore, our study underlines the importance of a community perspective at its core, based on the principles of social participation, equity and participatory evaluation, which are all essential triggers for highquality community action [52]. Social engagement has been one of the strengths of the Salvadoran CPHC in contrast to other PHC implementation experience which sometimes have been more focused on issues of efficiency and effectiveness in health care delivery [53] while showing less concern for equity and community participation in PHC [54,55].…”
Background
One of today’s greatest challenges in public health worldwide - and especially its key management from Primary Health Care (PHC) - is the growing burden of non-communicable diseases (NCDs). In El Salvador, since 2009 the Minister of Health (MoH) has scaled up a national public health system based on a comprehensive PHC approach. A national multi-sectorial strategic plan for a comprehensive approach to NCDs has also been developed. This analysis explores stakeholders’ perceptions related to the management of NCDs in PHC and, in particular, the role of social participation.
Methods
A case-study was developed consisting of semi structured interviews and official document reviews. Semi-structured interviews were developed with chronic patients (14) and PHC professionals working in different levels within PHC (12). Purposive sampling was used to recruit participants. A non-pure, deductive approach was implemented for coding. After grouping codes into potential themes, a thematic framework was elaborated through a reflexive approach and the triangulation of the data. The research was conducted between March and August of 2018 in three different departments of El Salvador.
Results
The structure and the functioning of the Salvadoran PHC system and its intersectoral approach is firstly described. The interdisciplinary PHC-team brings holistic health care closer to the communities in which health promoters play a key role. The findings reflect the generally positive perception of the PHC system in terms of accessibility, quality and continuity of care by chronic patients. Community engagement and the National Health Forum are ensuring accountability through social controllership mechanisms. However, certain challenges were also noted during the interviews related to the shortage of medication and workforce; coordination between the levels of care and the importance of prevention and health promotion programmes for NCDs.
Conclusions
The Salvadoran PHC and its comprehensive approach to NCDs with an emphasis on intersectoral participation has been positively perceived by the range of stakeholders interviewed. Social engagement and the NHF works as a driving force to ensure accountability as well as in the promotion of a preventive culture. The challenges identified provide keys to amplify knowledge for addressing inequalities in health by strengthening PHC and its NCDs management.
“…Problems like the need to work but not being able to find a job, women having to work in addition to carrying out their domestic duties, architectural barriers, lack of resources to support associations, the absence of public transportation, a lack of hygiene in houses, poor access to public spaces, etc., are all health problems because they affect overall well-being and quality of life of the community. When speaking about wellness as part of the health of the community, we must recognize that the public health sector is only one aspect of it, and that other sectors, including structural, social, and political sectors, are often more relevant [ 36 ]. The main problems and health assets that were identified by our study included those detailed below.…”
In primary health care, a community diagnosis is necessary to provide a detailed description of the community as well as an evaluation of the community’s health, including the main factors responsible for it and the needs felt by the population. This article presents a community health diagnosis following a participatory design, taking the perspective of women living in the community, to identify proposals for action. An ethnographic study was carried out in the community of Mañaria (Spain), using semi-structured interviews, in-depth interviews, key informants, participant observation, desk review, and photography. A sample of 21 women were interviewed until reaching saturation of the information. This information was complemented by that provided by five key informants. Data analysis included text analysis, coding, and categorization. Preliminary results were presented to the informants for validation and further refinement, and proposals for action were identified and followed up. Six categories were identified, representing different areas of intervention: population, jobs and economy, public and private spaces, lifestyles, processes of socialization, and health care assets. For each of these areas, the main problems were identified, as were the health care assets and proposals for action. The community diagnosis has been shown to be useful not only to identify health needs but also as an efficacious instrument to trigger social and public health actions that may be undertaken at the institutional level.
“…La utilización de distintos recursos que faciliten el mayor conocimiento de los contextos sociales de las personas 22 que acuden a AP, como los códigos Z entre otros, favorece un abordaje más integral 23 , 24 . Además, pueden servir para una mayor prescripción social 25 y como evidencia para cambios estructurales dentro del sistema sanitario que ayuden a trabajar para la reducción de las desigualdades sociales de la salud 26 con un enfoque comunitario 27 , 28 , de equidad y de justicia social.
Lo conocido sobre el tema
Los códigos Z son utilizados en la historia clínica electrónica de atención primaria para la visibilización de factores sociales que influyen en el proceso salud/enfermedad.…”
Objetivo
Analizar si la utilización de códigos Z en la historia clínica electrónica (HCE) se correlaciona con la realidad socioeconómica de la población atendida en Atención Primaria (AP).
Diseño
Estudio observacional, descriptivo, transversal, de tipo ecológico.
Emplazamiento
90 centros de salud de dos Direcciones Asistenciales de AP, Comunidad de Madrid.
Participantes
El total de pacientes atendidos durante el año 2016 fue de 1.920.124 (54,33% mujeres, 45,67% hombres). El 7,15% recibió algún código Z (67,29% mujeres, 32,71% hombres).
Mediciones principales
Como variable dependiente se estableció la proporción de pacientes con registros de códigos Z en su HCE. Como variables independientes se seleccionaron dos indicadores socioeconómicos que reflejan de forma objetiva las diferencias entre zonas básicas de salud:
renta media disponible per cápita
y
proporción de inmigrantes económicos
. Para evaluar la correlación entre variable dependiente e independientes se recurrió a análisis multivariante de correlación-regresión.
Resultados
Se observó que a mayor renta disponible, menor proporción de registros de episodios Z en las HCE (coeficiente de correlación de Pearson: −0,56). Sin embargo, existe una gran variabilidad de registro de códigos Z y la codificación no consigue visibilizar las realidades socioeconómicas de las poblaciones atendidas (odds ratio diagnóstica: 0,12 [IC: 0,05-0,32]).
Conclusiones
Resulta relevante para una orientación comunitaria de la AP la utilización de distintas herramientas que faciliten visibilizar el impacto en la salud de las desigualdades sociales, así como su evaluación a través de diversas metodologías de investigación. Los códigos Z no visibilizan en la zona estudiada los determinantes sociales de la salud de la población atendida.
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