The project
The project Health for All in Latin America is is financed within
the framework of the @LIS programme. @LIS, Alliance for the
Information Society, is a cooperation programme with Latin America
aiming to promote the information society and fight the digital
divide throughout Latin America.
Adopted in 2001, the @LIS programme has a budget of EUR 77.5
millions of which EUR 63.5 millions will be financed by the
European Commission. @LIS covers a wide spectrum of objectives
aiming to create a long-term partnership between the two regions
in the field of the Information Society. The programme focuses
on the following activities: a dialogue on policy and regulatory
aspects, the development of standards, the implementation of
demonstration projects in favour of the civil society, a network
of regulators and the interconnection of research centres.
Further information at: http://europa.eu.int/alis.
Justification
Most Latin American countries in the past decade have introduced
profound changes in their health care system, with virtually
every country in South America and the Caribbean having embarked
on far-reaching reforms in this field. According to the Pan
American Health Organization (PAHO), the goal of these
reforms is mainly the achievement of "more equitable service
delivery, more efficient management, and more effective impact,
thereby meeting the populations needs."1
Equity of health care, cost of care, accessibility, efficiency,
quality of care and disease prevention are therefore important
priorities in the Governments' agendas in these regions. As
part of these reforms, many countries are re-evaluating their
approach to primary care services, and there is an increasing
emphasis on a family-oriented model of health care. In this
reformed model, comprehensive care, inter-sector co-ordination,
outpatient care, disease prevention and health promotion are
particularly addressed. In this new scenario, Family
Medicine2 or more
generally Family Care are
seen as the pillars of the future health care systems and are
therefore asked to improve their capability to provide continuous,
comprehensive, and cost-effective health care service to all
segments of the society3. It is also generally recognised that
a Family Care based health care model is the only one able to
cope with the need of decentralisation of most Latin American
countries characterised, in their rural parts, by large expands
of land and disperse population.
The main actor of this strategy based on Family and Community
Care is the Family Care Team
i.e. a team, with a variable composition, which practices in
the community settings. The basic team is composed of a doctor
and a nurse but larger teams also exist where the basic set-up
is complemented with other professionals such as social workers,
health promoters, dentists, family physicians, village health
workers, public health nurses, nurse practitioner/physician
assistants, primary care technicians, psychologists, nutritionists,
obstetricians/gynaecologists, paediatricians, internists, epidemiologists,
and physical therapists.
The strength of the Family Care Team lies in its ability to
operate autonomously and to be integrated in the local community,
which enables it to provide a care in a highly decentralised
manner. The reverse of the medal is the difficulty to keep up-to-date
and develop the professional and managerial skills of the staffs
composing the Family Care Team with traditional approaches to
Continuous Professional Development.
The selection of the regions above has not been done at random.
The Regions of Bahia and Minas
Gerais in Brazil have
been selected for piloting the governmental program called Saúde
da Familia (Family Health) which was launched by the Brazilian
Ministry of Health in 1994. This program aims at the development
of new approaches to solving the health problems of the resident
population and in particular to promoting community care, and
has a strong educational component. The cornerstone of this
program is the Care Team, whose members include a medical doctor,
a nurse, a nurse auxiliary and, normally, six health agents
who monitor health indicators and provide basic care at the
local level.4
Starting from 1993 the Government of Bolivia has launched a
Health Reform called "Reforma del Seguro Basico de Salud"
to improve the access of the population to Health Services.
In the District of Potosì
three different healthcare systems operate in parallel: the
Institutional National system, the Private System (promoted
by the Catholic Church and a number of NGOs) and the Traditional
Medicine System which is still quite widespread in the rural
areas. These three systems operate independently from one another
without any co-ordination or communication. This situation gives
rise to an unnecessary duplication of efforts and to a waste
of resources. Moreover in Potosì, Primary Care shows
several negative features such as the poor professional training
of personnel and the poor integration of the local health system
with the national one. The principal cause of this unsatisfactory
situation has been identified in the lack of communication among
the different actors operating in the health care arena and
the poor professional training of family doctors.
In all the selected pilots site (Bolivia Brazil), the shift
towards Family Care has dramatically improved the equity of
access to care for all citizens. However, in all the three demonstration
sites, the difficulty in providing CPD in a traditional way
to Family Care Teams deployed over a wide geographical area
has been identified as one of the main factors which hamper
the full implementation of the health reforms promoted by the
national governments.
1Organización Panamericana de la Salud,
"La Cooperación de la Organización Panamericana
de la Salud ante los procesos de reforma sectorial", (Washington,
DC: PAHO, 1997), p. 13
2It means a medical speciality with expertise in primary care
of the individual, viewed within the context of his or her family
and community. The family physician provides continuous, comprehensive
health care ("from conception to death") to persons
of all ages and both sexes. Family Medicine is based on the
bio-psycho-social model of health and emphasises disease prevention,
health promotion, the diagnosis and treatment of illness, rehabilitation,
and referral to other medical specialities when appropriate.
3Pan American Health Organization and the Department of Family
and Community Medicine of Baylor College of Medicine, "The
Status of Family Health Care and Family Medicine in the Region
of the Americas", by G. Robert Parkerson III, F. Marconi
Monteiro, Carolyn Pepper, Valory N. Pavlik and Stephen J. Spann,
October 2001
4idem.
DOWNLOAD PRESENTATION:
|
