Suchergebnisse

Comment évaluer l'écart entre les besoins sanitaires des PVD et l'offre de l'aide internationale ? Cette question a une évidente dimension politique et en appelle d'autres relatives à la multiplication abusive des institutions d'aide, au non-respect de la stratégie des soins de santé primaires, au choix trop limité des populations cibles, à une gestion trop rigide des projets et au manque de prise en compte de l'avis et des caractéristiques des populations bénéficiaires.

L'intérêt d'une approche systémique dans la santé réside dans son appropriation et sa validation par les acteurs. C'est en mettant en valeur les rôles de chacun et les liens entre acteurs qu'elle contribue au renforcement des systèmes de santé. Cet article revient rapidement sur l'évolution des paradigmes dans les politiques de santé puis présente l'apport de la recherche. Plus spécifiquement, le GRAP-PA santé (Groupe de Recherche en Appui à la Politique- GRAP) étudie la mise en œuvre de l'agenda pour l'efficacité de l'aide (déclarations de Paris-Accra- PA) en utilisant, entre autre, des méthodologies systémiques. ; info:eu-repo/semantics/published

Session parallèle: "The Paris Declaration on aid effectiveness and sector wide approaches", 17 novembre 2010 ; info:eu-repo/semantics/nonPublished

Objectives: The objective is to analyze the content of the Paris Declaration (PD) on aid effectiveness and Accra Agenda for Action (AAA), and their practical implications for the health sector in aid-recipient countries. Design/methods: The study draws on (i) a critical analysis of the two declarations, (ii) a review of the literature on their implementation and (iii) interviews of people in charge of implementing them – both donors and government representatives. Results: The PD and AAA both have a "missing link" between, on the one hand, international cooperation policies (five pillars of the PD) and national development (health) plans; and, on the other hand, the operational level that is supposed to deliver results. They presume that by changing aid management and respecting a few principles, development results will automatically improve as through a "black box". The influence of international and national policies over health systems, service providers' behaviour and health impacts is not treated at all by the agenda for aid effectiveness, while it is crucial for its success. Moreover, that agenda is mostly dealt with at a too high level (international forums or at best national sector level), thus deepening the disconnexion from field realities. Conclusions/policy implications: This "missing link" entails the risk that, if the "black box" does not perform as expected – that is, if health systems and health service providers' behaviour do not evolve in a positive way – and health impacts do not improve, the aid effectiveness agenda may be rejected at all, notwithstanding its (incomplete) added value. Hence the need to closely monitor the processes of national health plans implementation, so in order to better understand how these processes are translated on the field and what could be done to ensure that health service delivery and health results ultimately improve. ; Peer reviewed

Objective. To assess the patient information process before sputum sample collection, the quality of sputum sample and transmission of acid-fast bacilli (AFB) examination results to TB suspects, in three local areas of Nicaragua. Methods. (a) directed interviews of consecutive series of TB suspects whose sputum had been examined for AFB; (b) directed interview of health personnel; and (c) assessment of the sputum sample quality. Results. A total of 115 TB suspects and 33 health personnel were interviewed and 625 sputum samples were assessed. Results show multiple weaknesses in the process of information to the patient during sputum collections, as well as in the communication of results. Conclusions. This study unveiled an aspect usually overlooked of case finding, that is, the information process during sputum production, sputum sample quality, and the communication of results to the TB suspects. The results illustrate the need for routine assessment of the whole diagnostic process.Keywords: tuberculosis; diagnostic; patient-provider communication; NicaraguaAddress reprint requests to: Jean Macq; Ecole de Santé Publique, Département Politiques et Systèmes de Santé; Université Libre de Bruxelles; Campus Erasme, CP 597; Route de Lennik, 808; B-1070 Brussels; Belgium. Email: jmacq@ulb.ac.be ; Objective. To assess the patient information process before sputum sample collection, the quality of sputum sample and transmission of acid-fast bacilli (AFB) examination results to TB suspects, in three local areas of Nicaragua. Methods. (a) directed interviews of consecutive series of TB suspects whose sputum had been examined for AFB; (b) directed interview of health personnel; and (c) assessment of the sputum sample quality. Results. A total of 115 TB suspects and 33 health personnel were interviewed and 625 sputum samples were assessed. Results show multiple weaknesses in the process of information to the patient during sputum collections, as well as in the communication of results. Conclusions. This study unveiled an ...

In Rwanda, the Ministry of Health is rebuilding the health sector destroyed during the genocide while trying to guarantee the financial accessibility of the population to the services through the setting up of a prepayment scheme. Membership remains low in the three pilot districts where the prepayment scheme was introduced four years before (15,6%). In two of these districts, the curative consultation and maternity utilisation has increased appreciably. The members of the prepayment scheme make greater use of the services than the rest of the population. There is a significantly higher prepayment scheme membership among households with a relatively high income and those with a large family (more than 5 family members). Overall, non-members of the prepayment scheme spend more on health services than members do. There are indications that developing the prepayment scheme would be very useful for the people in Rwanda if specific strategies geared to the poor were set up. ; Peer reviewed

Rwanda has made the setting up of a prepayment scheme a priority in its health sector reform in order to make health services more financially accessible to the population. A pilot study was carried out in three districts. The yearly family subscription charge was fixed at 7.9 US dollars, which covers care delivered at Health Centre level as well as some services at the hospital. The beneficiaries and providers mention difficulties in order to mobilise the subscription charges all at a time, the insufficiency of the offer of services at the hospital and the absence of involvement of the political authorities in the process. The Ministry of Health did initiate the experiment but the choice of the privileged pilot districts prevents results from being extrapolated to the country taken as a whole with a view to a possible extension at a later stage. Given the relatively short time in which it has taken place, the population could neither understand the contingency and solidarity issues implied nor have the opportunity to feel personally involved in the system. As a conclusion, the study advocates the continuation of the experiment with a reinforcement of the coordination which should take the weak points identified into account. ; Peer reviewed

La mise en place des Objectifs du millénaire pour le développement (OMD) n'a pas réussi à traduire et favoriser les principes de liberté, d'équité et de solidarité soulignés par la Déclaration du millénaire au tournant des années 2000. Malgré les efforts pour la réalisation des OMD, les inégalités semblent en effet avoir augmenté au niveau international et national. En outre, aujourd'hui, ces inégalités grandissentégalement et de plus en plus dans les pays du Nord. Des mouvements sociaux comme Via Campesina et le Mouvement sans terre, ou plus récemment Occupy et le Printemps arabe, nous rappellent combien ce mal-être vis-à-vis d'inégalités croissantes est devenu un enjeu social et politique mondial. Dans le débat sur l'adoption d'un nouveau cadre de développement post-OMD, il est aujourd'hui proposé d'intégrer de manière plus large les questions d'égalité et d'équité, et d'adresser cet objectif autant aux pays du Sud que du Nord. A partir de l'expérience des acteurs belges, cet atelier veut approfondir la question de l'intégration des inégalités dans le nouveau cadre post-2015 et aboutir à des propositions pour la contribution de la Belgique à son développement et opérationnalisation. ; info:eu-repo/semantics/published

Abstract
The EFSA Pesticide Residue Intake Model (PRIMo) has, since its first version in 2007, become the standard tool used at the EU level to estimate the short‐ and long‐term dietary exposure to pesticide residues. It is a deterministic model and is primarily used as a prospective screening tool for dietary risk assessment in the framework of Regulation (EC) No 396/2005 and Regulation (EU) No 1107/2009. Unlike its previous Excel‐based versions, PRIMo 4 has been converted to an online web‐application. The aim of the present report is to describe the features and functionalities of the latest version of PRIMo and provide guidance to its future users. One of the main novelties is that the model uses individual consumption data from the Comprehensive Food Consumption Database of EFSA, where the foods reported as consumed were disaggregated to their ingredients and converted to their raw primary commodity (RPC) equivalents by means of the EFSA RPC model. This innovation allows to have more detailed exposure assessment results, including results for minor products and processed foods.