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Pharmaceutical procurement and pricing.
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DOI: 10.1108/OXAN-DB251557
ISSN: 2633-304X
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Akwatu Khenti, Jaime C. Sapag, Consuelo Garcia‐Andrade, Fernando Poblete, Ana Raquel Santiago de Lima, Andres Herrera, Pablo Diaz, Henok Amare, Avra Selick and Sandra Reid
Since 2002, the Centre for Addiction and Mental Health in Ontario, Canada, has been working closely with partners in Latin America and the Caribbean (LAC) to implement mental…
Abstract
Purpose
Since 2002, the Centre for Addiction and Mental Health in Ontario, Canada, has been working closely with partners in Latin America and the Caribbean (LAC) to implement mental health capacity‐building focused on primary health care. From an equity perspective, this article seeks to critically analyze the process and key results of this capacity‐building effort and to identify various implications for the future.
Design/methodology/approach
This analysis of capacity‐building approaches is based on a critical review of existing documents such as needs assessments and evaluation reports, as well as reflective discussion. Previous health equity literature is used as a framework for analysis.
Findings
More than 1,000 professionals have been engaged in various kinds of training in Chile, Peru, Brazil, Nicaragua, Mexico, and Trinidad and Tobago. These capacity‐building initiatives have had an impact on primary health care from both an equity and systems perspective because participants were engaged at all stages of the process and implementation lessons incorporated into the final efforts. Stigma was also reduced through the collaborations.
Originality/value
Using concrete examples of capacity‐building in mental primary healthcare in LAC, as well as evidence gathered from the literature, this article demonstrates how primary healthcare can play a strong role in addressing health equity and human rights protection for people with mental health and/or substance abuse problems.
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Hernán Montenegro, Reynaldo Holder, Caroline Ramagem, Soledad Urrutia, Ricardo Fabrega, Renato Tasca, Gerardo Alfaro, Osvaldo Salgado and Maria Angelica Gomes
This paper aims to: analyze the challenge of health services fragmentation; present the attributes of integrated health service delivery networks (IHSDNs); review lessons learned…
Abstract
Purpose
This paper aims to: analyze the challenge of health services fragmentation; present the attributes of integrated health service delivery networks (IHSDNs); review lessons learned on integration; examine recent developments in selected countries; and discuss policy implications of implementing IHSDNs.
Design/methodology/approach
A literature review, expert meetings, and country consultations (national, subregional, and regional) in the Americas resulted in a set of consensus‐based essential attributes for implementing IHSDNs. The analysis of 11 country case studies on integration allowed for the identification of lessons learned.
Findings
Studies suggest that IHSDNs could improve health systems performance. Principal findings include: integration processes are difficult, complex, and long term; integration requires extensive systemic changes and a commitment by health workers, health service managers and policymakers; and, multiple modalities and degrees of integration can coexist within a system. The public policy objective is to propose a design that meets each system's specific organizational needs.
Research limitations/implications
The analysis presented in this paper is qualitative.
Practical implications
Some policy implications for implementing IHSDNs are presented in the paper.
Originality/value
The research and evidence on integration remains limited. The paper expands the knowledge‐base on the topic, presenting lessons learned on integration and recent developments in selected countries, which can support integration efforts in the region.
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Kelley Newlin Lew, Yolanda McLean, Sylvia Byers, Helen Taylor and Karina Cayasso
The purpose of this paper is to explore physical environmental, medical environmental, and individual factors in a sample of ethnic minority adults with or at-risk for type 2…
Abstract
Purpose
The purpose of this paper is to explore physical environmental, medical environmental, and individual factors in a sample of ethnic minority adults with or at-risk for type 2 diabetes (T2D) on the Atlantic Coast of Nicaragua.
Design/methodology/approach
The study used a cross-sectional descriptive design guided by a community-based participatory research framework. Three coastal communities in the South Atlantic Autonomous Region (RAAS) of Nicaragua were sampled. Inclusion criteria were: lay adult with or at-risk for T2D, ⩾21 years of age, self-identification as Creole or Miskito, and not pregnant. Convenience sampling procedures were followed. Data were collected via objective (A1C, height, and weight) and self-report (Pan American Health Organization surveys, Diabetes Care Profile subscales, and Medical Outcomes Survey Short Form-12 (MOS SF-12) measures. Univariate and bivariate statistics were computed according to level of measurement.
Findings
The sample (N=112) was predominately comprised of Creoles (72 percent), females (78 percent), and mid-age (M=54.9, SD±16.4) adults with T2D (63 percent). For participants with T2D, A1C levels, on average, tended to be elevated (M=10.6, SD±2.5). Those with or at-risk for T2D tended to be obese with elevated body mass indices (M=31.7, SD±8.1; M=30.2, SD±6.0, respectively). For many participants, fresh vegetables (63 percent) and fruit (65 percent) were reported as ordinarily available but difficult to afford (91 and 90 percent, respectively). A majority reported that prescribed medication(s) were available without difficulty (56 percent), although most indicated difficulty in affording them (73 percent). A minority of participants with T2D reported receipt of diabetes education (46 percent). A1C levels did not significantly vary according to diabetes education received or not (M=10.9, SD±2.9; M=10.4, SD±2.5; t=−0.4, p=0.71). Participants at-risk for T2D were infrequently instructed, by a provider, to follow an exercise program (4.8 percent) or meal plan (4.8 percent) and receive diabetes education (2.38 percent). MOS SF-12 findings revealed participants with T2D (M=41.84, SD=8.9; M=37.8, SD±8.5) had significantly poorer mental and physical health quality of life relative to at-risk participants (M=45.6, SD±8.4; M=48.1, SD±9.5) (t=−2.9, p<0.01; t=−2.5, p=0.01).
Research limitations/implications
Salient physical environmental, medical environmental, and individual factors were identified in a sample of adults with or at-risk for T2D on Nicaragua’s Atlantic Coast.
Practical implications
Findings informed the development of community-based clinics to address the problem of T2D locally.
Social implications
The community-based clinics, housed in trusted church settings, provide culturally competent care for underserved ethnic minority populations with or at-risk for T2D.
Originality/value
This is the first quantitative assessment of the T2D problem among diverse ethnic groups in Nicaragua’s underserved RAAS.
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The calls follow similar warnings from the Pan American Health Organisation (PAHO), which said last month that low vaccination coverage was hindering efforts to stem the pandemic.