An evidence-informed policymaking (EIPM) competency profile for the Brazilian Health System developed through consensus: process and outcomes

BACKGROUND

Evidence-informed policymaking (EIPM) requires a set of individual and organizational knowledge, skills and attitudes that should be articulated with background factors and needs. In this regard, the development of an EIPM competency profile is important to support the diagnosis, planning and implementation of EIPM.

PURPOSE

To present the process and outcomes of the development of an EIPM competency profile by an expert committee, to be applied in different contexts of the Brazilian Health System.

METHODS

A committee of experts in EIPM shared different views, experiences and opinions to develop an EIPM competency profile for Brazil. In six consensus workshops mediated by facilitators, the committee defined from macro problems to key actions and performances essential for the competency profile. The development steps consisted of: (1) Constitution of the committee, including researchers, professionals with practical experience, managers, and educators; (2) Development of a rapid review on EIPM competency profiles; (3) Agreement on commitments and responsibilities in the processes; (4) Identification and definition of macro problems relating to the scope of the competency profile; and (5) Outlining of general and specific capacities, to be incorporated into the competency profile, categorized by key actions.

RESULTS

The development of the EIPM competency profile was guided by the following macro problems: (1) lack of systematic and transparent decision-making processes in health policy management; (2) underdeveloped institutional capacity for knowledge management and translation; and (3) incipient use of scientific evidence in the formulation and implementation of health policies. A general framework of key actions and performances of the EIPM Competency Profile for Brazil was developed, including 42 specific and general key actions distributed by area of activity (Health Management, Scientific Research, Civil Society, Knowledge Translation, and Cross-sectional areas).

CONCLUSIONS

The competency profile presented in this article can be used in different contexts as a key tool for the institutionalization of EIPM.

Percepção dos moradores de uma ocupação urbana sobre o ‘empoderamento’ em saúde

RESUMO Aglomerados populacionais em ocupações urbanas revelam desigualdades sociais, condições desfavoráveis de habitação e saúde, com impactos negativos na qualidade de vida. Contexto desafiador, dada a relação entre condições de moradia, de vida e de saúde, faz-se essencial a legitimação de direitos e deveres sociais dos indivíduos. Objetivou-se analisar a percepção dos moradores de ocupação urbana sobre ‘empoderamento’ em saúde. Pesquisa exploratória de abordagem qualitativa sobre a percepção dos moradores da ocupação urbana Eliana Silva II (ES), em Belo Horizonte (MG), acerca do ‘empoderamento’ em saúde. A coleta de dados ocorreu após aprovação nos Comitês de Ética em Pesquisa. Utilizou-se roteiro semiestruturado de entrevista. A amostra totalizou nove participantes residentes na ocupação, com mais de 18 anos de idade e, pelo menos, um ano de residência. A análise, à luz do referencial de Bardin, evidenciou duas categorias temáticas: Saúde e determinação social: reconhecendo as influências sobre a saúde das pessoas; Protagonizando a própria história: o movimento de luta em busca da garantia dos direitos à saúde. Para que as necessidades dos moradores da ocupação estejam na pauta de prioridade do governo, faz-se necessário mobilizar. A luta para conquista e garantia dos direitos é fundamental.

Healthcare professionals' behavior, skills, knowledge and attitudes on evidence-based health practice: a protocol of cross-sectional study

BACKGROUND

In Brazil, as in most countries nowadays, there is a pursuit for healthcare quality improvement and sustainability in public and private systems. Healthcare professionals' perceptions, knowledge and attitudes determine evidence-based practice (EBP), which remain uncertain among Brazilian practitioners. A standardised national instrument whose wide use will identify gaps and flaws in establishing an EBP could contribute to an effective resources allocation from health professionals willing to use an EBP.

OBJECTIVES

To present a study protocol on the development and validation of an instrument to measure Brazilian healthcare professionals' behaviour, skills, self-efficacy, knowledge and attitudes towards EBP.

METHODS

This is a validation study with Brazilian healthcare professionals to develop a valid and reliable questionnaire, including selection of domains and formulation of questions. Construct and content validity will be assess by a panel of experts, with data collection and analysis following a Delphi-like methodology. Further, a pilot survey will be accomplished with a representative sample of different healthcare professionals from all main Brazilian regions. An exploratory factor analysis and a confirmatory factor analysis will be conducted afterwards. The ratio of χ² and df (χ²/df), comparative fit index, goodness of fit index and root mean square error of approximation will be used for assessing the model fit. In addition, the reliability of the instrument will be estimated by test-retest reproducibility and Cronbach's alpha coefficient (α).

ETHICS AND DISSEMINATION

This study has received ethical approval from the Pharmaceutical Sciences Faculty of the São Paulo State University (1.425.808). The use among a wide national sample is expected to promote an extensive view of evidence-based decision-making, identifying the knowledge gaps in this area. Study findings will be circulated to healthcare professionals and scientists in the field through the publication in peer-reviewed journals and conference presentations.

Acolhimento de imigrantes haitianos via integração ensino-serviço-pesquisa na atenção primária à saúde: relato de experiência

Este artigo objetiva relatar a experiência do acolhimento a uma comunidade de imigrantes haitianos pela Atenção Primária à Saúde (APS) no âmbito do ‘Internato de Atenção Integral à Saúde’ do curso de Medicina da Unifenas - BH. A experiência ocorreu no Centro de Saúde Novo Aarão Reis (CSNAR) mediante estratégia multifacetada de acolhimento do serviço composta por: 1) interlocução com entidade de apoio a imigrantes, o Centro Zanmi; 2) busca ativa e visitas domiciliares pela agente comunitária de saúde e internas de medicina, 3) aplicação de questionário; 4) apresentação dos resultados à comunidade de imigrantes haitianos, aos profissionais de saúde do CSNAR, à comunidade acadêmica da Unifenas - BH e a outros membros da comunidade interessados. Pelo contato com os primeiros haitianos identificados na comunidade, e por meio de busca ativa, outros foram encontrados e incluídos no estudo. Em conjunto com a aplicação dos questionários, foi possível avaliar o contexto em que estes se encontravam e, assim, buscar nas ferramentas da APS e do território formas de incluir esses imigrantes na comunidade e auxiliá-los em suas demandas. Este processo permitiu acolher a comunidade de imigrantes haitianos no CSNAR, otimizar seu cadastro no Sistema Único de Saúde, sensibilizar os profissionais de saúde para a importância do desenvolvimento de competência cultural e oportunizar intercâmbio de conhecimentos sobre o sistema de saúde haitiano e brasileiro.

Fronteiras da autonomia da gestão local de saúde: inovação, criatividade e tomada de decisão informada por evidências

O propósito deste artigo foi identificar as fronteiras da autonomia da gestão municipal no contexto do pacto federativo do Sistema Único de Saúde brasileiro e a importância e possibilidade de fomentar inovação, criatividade e tomada de decisão, informada pelas melhores evidências pelos governos locais. Metodologicamente partimos de questões que propiciaram diálogo com a literatura específica, visando identificar a influência das políticas com formulação centralizada nos espaços de autonomia local para, em seguida, identificar estratégias de incentivo à inovação, criatividade e uso sistemático da evidência de pesquisas na implementação de políticas em saúde. Constatamos uma redução gradativa da autonomia decisória pelo maior comprometimento financeiro dos municípios, decorrente das novas responsabilidades assumidas, bem como a possibilidade de reversão dessa tendência no contexto mais recente. Analisamos também determinantes e desafios para a difusão de práticas inovadoras e apresentamos experiências nacionais e internacionais com essa finalidade. Concluímos ser possível tornar mais efetivo o processo decisório local, desde que se consolidem iniciativas que estimulem essa cultura e a formulação e implementação de políticas informadas por evidências.

[Current status of the Evidence-Informed Policy Network (EVIPNet) in Brazil: case report]

OBJECTIVE

To describe and discuss the activities deployed by EVIPNet Brazil in 2013, highlighting the network's actions to promote evidence-based decision-making for the development and implementation of health policies.

METHODS

A descriptive approach was employed to present the actions carried out by EVIPNet Brazil in 2013, especially processes relating to capacity-building, product development, and event participation.

RESULTS

In 2013, 10 training programs were carried out (four technical meetings and six workshops), involving 34 institutions and 193 participants. One evidence brief for policy was reviewed and republished, and five others were developed. Moreover, one process of deliberative dialogue was conducted. A scientific paper was published on the experience of EVIPNet Brazil in the development of evidence-informed polices. The first issue of the EVIPNet Brazil Newsletter was published, along with the posting of news articles online. EVIPNet Brazil's actions were presented on national and international lectures, conferences, and round tables. The impacts of EVIPNet Brazil may be observed in the federal, state, and local contexts.

CONCLUSIONS

A successful development, implementation, and monitoring of evidence-informed policies depends on actions such as those carried out by EVIPNet, including professional capacity-building to help expand and consolidate the network, creation of new local Health Evidence Centers to encourage the use of evidence in decision-making, production of evidence briefs for health policies, and organization of deliberative dialogues.

[Making progress in the use of health policies and practices informed by evidence: the Piripiri-Piauí experience]

Evidence-informed decision making (EIDM) can optimize health services and systems. EIDM involves defining problems, identifying measures to tackle them, assessing the quality of global and local evidence and translating it for the main stakeholders in line with social values and laws. Brazil encourages the use of EIDM in health policy in Piripiri, a municipality of 61,840 inhabitants in the country's poorest region, and launched Brazil's first Evidence Use in Health Care (NEv) center in 2010. The development and preliminary results of the NEv center are reported and its vision, composition, mandate, and activities are presented. The NEv center experience has the support of the Evidence-Informed Policy Network, the Latin American and Caribbean Center of Information on Health Sciences and federal and municipal governments. The decentralization of financing and the provision of healthcare services, the expansion of EIDM in management, and the local political context illustrate the progress of the experiment. Its activities include the production and dissemination of deliberative briefs and dialogues with opinion shapers, workers and health service users. Monitoring and evaluation are underway and the results will help to broaden the scale of activities in Brazil and abroad.

Morphology of the midgut of Rhipicephalus sanguineus (Latreille, 1806) (Acari: Ixodidae) adult ticks in different feeding stages

The intestinal epithelial cells of ticks are fundamental for their full feeding and reproductive success, besides being considered important sites for the development of pathogens. Rhipicephalus sanguineus ticks are known for their great medical and veterinary importance, and for this reason, the knowledge of their intestinal morphology may provide relevant subsidies for the control of these animals, either by direct acaricidal action over these cells or by the production of vaccines. Therefore, this study aimed to describe the midgut morphology of male and female R. sanguineus ticks in different feeding stages, by means of histological analysis. Significant differences were observed between the genders, and such alterations may refer mainly to the distinct demands for nutrients, much higher in females, which need to develop and carry out the egg-laying process. In general, the midgut is coated by a thin muscle layer and presents a pseudostratified epithelium, in which two basic types of cells can be observed, connected to a basal membrane-generative or stem and digestive cells. The latter was classified as follows: residual, deriving from the phase anterior to ecdysis; pinocytic, with vesicles containing liquid or pre-digested components of blood; phagocytic, with entire cells or remnants of nuclear material inside cytoplasmic vesicles; and mature, free in the lumen. Digestion is presumably intracellular and asynchronous and corresponds to a process which starts with the differentiation of generative cells into pinocytic digestive cells, which subsequently start to phagocytize intact blood cells and finally detach from the epithelium, being eliminated with feces.

Curso ‘Uso de evidências na gestão municipal da saúde’: uma experiência pioneira

É apresentada a experiência do curso Uso de evidências na gestão municipal da saúde, realizado durante o XXVI Congresso do CONASEMS com o objetivo de promover a incorporação da evidência científica como subsídio do processo de tomada de decisão de gestores e profissionais de saúde. O curso foi concebido, planejado e realizado no âmbito das parcerias institucionais da EVIPNet Brasil e seus resultados apontam aspectos relevantes para discussão acerca das estratégias e ferramentas para disseminação e utilização de evidências de pesquisa em saúde na gestão do Sistema Único de Saúde no Brasil.