Suchergebnisse

There is much in the literature which laments the condition of the common man in nineteenth-century Mexico. Most of the evidence for this sad interpretation, however, is circumstantial and qualitative in substance and leaves one groping at times for more convincing arguments. This pessimistic view seems inappropriate for the North where historical interpretation in these matters is deeply influenced by generalizations arising from studies of the South and Center. Careful examination demonstrates that for at least one region of the North a distinct and varied natural and human environment produced a different set of living conditions. This study assesses the living standards in low-income hacienda laborers in the State of Zacatecas during the period 1820–80. The results suggest a reconsideration of the notion that all nineteenth-century Mexicanpeoneswere oppressed and malnourished step-children of thelatifundiasystem.

SummaryThis article analyzes the role of government stewardship in the expansion of primary health care in post‐conflict Guatemala. By the time the Peace Accords were signed in 1996, the country's primary health care system was scarcely functioning with virtually no services available in rural indigenous areas. To address this gaping void/deficiency, the Ministry of Public Health and Social Assistance (MSPAS) embarked on a progressive expansion of primary services aimed at covering the majority of rural poor. Through a series of legal, policy, and program reforms up to 2014, the MSPAS dramatically expanded primary coverage and greatly improved basic health indicators for the entire population. To succeed in this effort, the MSPAS and its partners needed to simultaneously grow their stewardship capacity to oversee and develop the primary health system. On the basis of recent health systems strengthening literature, we propose a stewardship framework of 6 critical functions and use it to analyze the gains in government capacity that enabled the achievement of many of the country's primary health goals. Of the 6 stewardship functions, "building relationships, coalitions, and partnerships" especially with civil society organizations stands out as one of the keys to MSPAS success.

SummaryThe World Health Organization (WHO) introduced the concept of stewardship to clarify the practical components of governance in the health sector. For the WHO, stewardship concentrated on how government actors take responsibility for the health system and the wellbeing of the population, fulfill health system functions, assure equity, and coordinate interaction with government and society. This article overviews the contents of this special issue, which offers examples of how health stewards in a variety of countries have addressed issues of health security, primary care expansion, family planning, and quality of care. The contributors' articles draw lessons for policy, programs, and management useful for practitioners and scholars. Our overview identifies several themes emerging from the articles: the foundational role of legal frameworks for effective stewardship, the importance of institutional arrangements as enablers, the influence of regional and global entities on national stewardship, the connection between credible decision‐making structures and stewardship, and pathways to sustainable financing and domestic resource mobilization. The discussion concludes with highlighting several gaps in knowledge and practice related to health stewardship.