September 9, 2020

previously health Material and methodsthe

By admin

project took place between health January 2010 and May 2011 in Guerrero, state of Mexico, Oaxaca and Veracruz. The research protocol was evaluated by the research, ethics and biosecurity committees of the National Institute of Public Health of Mexico (INSP). In each state a community of practice (Cop) was formed,

defined as the continuous collaboration

of a group of people who share interests, agenda and objectives.14 The Pops were composed of decision-makers, academics, programme officers and staff from both sexual and reproductive health programmes and cross-cutting Areas (Quality, Planning and finance). Most of the participants worked for state health services. The common interest was to identify and prioritize health system problems that limit the implementation of proven strategies to reduce MMR. The Pops subsequently defined solutions, an effort that is not reported in this

article.Initially, each state’s health Cop identified and prioritized a number of health system problems using conceptual mapping and interpreting the results in a preliminary document.9-11 selected these problems based on their tacit knowledge and subsequently reviewed international scientific evidence and grey literature in order to support and reformulate the selection. The Pops were trained by researchers to search

  • databases of scientific journals with online access to the full text, available on Ebsco Host, which has a database of more than 6,000 scientific publications. The identified articles were made available to each Cop for discussion in a virtual knowledge management platform (PGC).Participants selected each article based on
  • a critical reading of the abstracts and at least two people decided on its relevance. Subsequently, they health read and analyzed the selected articles, based on their training in the interpretation of medical literature for the

as code the health selected problems

formulation of health system problems using different analytical frameworks such as historical background, causality diagrams and relevance to state contexts. health Each Pops had the technical support of NPHI specialists to ensure the effective management of the analysis tools. Together, 170 articles and documents relevant to the priority issues were identified.Subsequently, the coincidences and differences between the formulation of problems based on the perception of Pops and the evidence-based reformulation were evaluated. To this end, both formulations were systematically explored with emphasis on specifications, clarifications, inputs and recommendations in each case. Using health

based on tacit knowledge, the comparative method technique was implemented to thoroughly review the final formulations.15 Resultsthe reformulation of problems based on scientific evidence generally corroborated the selection made based on the initial perception of the actors. The review of the literature also made it possible to supplement and clarify the problems (table I).16-32guerrerothe literature review confirms the problem chosen by the Cop of insufficient financial resources as an obstacle to the AEO. Additional financial resources are required to those health commonly available in health systems in developing countries and areas of high poverty to provide adequate infrastructure

and medicines and health inputs for maternal care.33-35 in addition, investment in programs to improve maternal health has a high cost-effectiveness ratio in terms of healthy years of life.36 various studies aimed at studying the allocation of resources and the implementation of the SSPS in Chiapas, Guerrero and Oaxaca highlight that one of the main challenges health facing this program to improve maternal health care is the inequity in the distribution of spending and the failures and inconsistencies in the progress in infrastructure and supplies.16The Cop also identified planning problems in the budget year and in the procurement scheme of goods and inputs. Scientific evidence confirmed this problem, stating that its determinants include lack of demand-driven planning, health inopportunity in acquisition and distribution, high

percentage of keys deserted in bidding

  • processes, inadequate allocation of inventories, low frequency of delivery to consumption points, lack of transparency in all processes and little or no communication and exchange of information between the different areas involved in the supply chain.17 according to the scientific literature also highlights the need for human resources for the care of births 365 days, 24 hours, for timely AEO.7.25 the lack of coverage is particularly severe in rural
  • areas health of Guerrero, where one in three births is not attended health by medical personnel and there is a limited availability of resources to cover guards, this is associated with the increase in deaths on weekends and holiday periods.18state of Mexicothe review of the scientific literature confirmed the relevance of the problem chosen by the Cop Mexico in health

relation to ensuring adequate training of health personnel to abate MMR, particularly in the AEO.19,37-40 also corroborated the selected problem of the incorporation of health professionals with technical deficiencies into the health system,19-21 which often makes it difficult for the population to have access to quality and effective health services, 19 and specified the need to improve basic knowledge on infection prevention and the proper use of protocols, guides and parthographs,20 as well as, technical guidelines health and procedure manuals during the EO.21,22 the literature review also shows that qualified human resources to provide obstetric care and emergency treatment are generally

distributed in a heterogeneous manner. Marginalized areas rely mainly on personnel who are not well prepared for obstetric care.16,18 this is also related to the lack of incentive systems for these professionals to have training;23 adequate health undergraduate training of doctors and nurses is also essential for the care of complications.41 in relation to the problem of lack of quality of care, highlights the need to improve technical skills health