Intersectoral action for health at a municipal level in Cuba

Abstract

ObjectiveTo consider how Cuba’s acknowledged achievement of excellent health outcomes may relate to how health determinants are addressed intersectorally.MethodsOur team of Canadian and Cuban researchers and health policy practitioners undertook a study to consider the organization and practices involved in addressing health determinants in 2 municipalities (1 urban and 1 rural). The study included a questionnaire of municipal Health Council members and others involved in health and non-health sectors, key informant interviews of policy makers, focus groups in each municipality and examination of three common case scenarios.ResultsRegular engagement of different sectors and other agencies in addressing health determinants was quite systematic and comparable in both municipalities. Specific policies and organizational structures in support of intersectoral actions were frequently cited and illustrated in case scenarios that demonstrate how maintenance of regular linkages facilitates regular pursuit of intersectoral approaches.ConclusionsThe study demonstrates the feasibility of examining processes of intersectoral action for health processes and suggests that further examination in evaluating factors such as training, particular practices, etc., can be a fruitful direction to pursue comparatively and with analytical designs.

A intersetorialidade no Programa Saúde na Escola: avaliação do processo político-gerencial e das práticas de trabalho

“…Dialog, the exchange of knowledge and experience, joint efforts and coordination with other social structures in the territory are important strategies to connect different initiatives, enabling synergy across actions taken to address any problems identified. It is understood that developing local actions involving the subjects that are directly impacted have a greater chance of delivering positive and long-lasting results 7,9,10 . Regarding the factors that make the development of the HSP program difficult in the city selected, the interviewees pointed to the large number of families the FHS must follow, compromising the frequency and quality of school visits.…”

“…The international debate on intersectorality in the field of healthcare has stressed interventions on the social determinants of health [4][5][6] , and creating partnerships and alliances for implementation 7,8 . They also point out that local interventions are more likely to produce sustainable and satisfactory results 9,10 . In Brazil, intersectorality is valued in numerous public policies, such as those regarding Education, Healthcare and Social Services.…”

Anchoring contextual analysis in health policy and systems research: A narrative review of contextual factors influencing health committees in low and middle income countries

“…For example, in contrast to the experiences in most other countries where female involvement was often insufficient, the majority of Peru's CLAS members are female, reflecting the country's history of femaledominated community organizations (Iwami and Petchey, 2002). Similarly, HCs in Cuba were found to prioritize intersectoral collaboration particularly related to income security, standard of living and healthy child development, reflecting social mobilization and a history of political engagement on these issues (Pagliccia et al, 2010, Spiegel et al, 2012. In contrast, in Brazil, due to the history of authoritarianism, health council dynamics tended to echo the larger political culture which was about contestation, rather than dialog or collaboration (Cornwall, 2008).…”

Inequalities: the “gap” remains; can surveillance aid in closing the gap?

“…In sum, we need to now focus on data collection and analyses that address the problems invoked by the social determinants of health and how they lead to inequities in health at a population level (some works going in this direction have been already published in this Journal, see, for instance, Spiegel et al 2012;Salonna et al 2012;Klein et al 2012). This is the public health challenge.…”