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Implementation of promotion and prevention activities in decentralized health systems: comparative case studies from Chile and Brazil.

机译：在权力下放的卫生系统中开展促进和预防活动：智利和巴西的比较案例研究。

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The policies for restructuring health systems in Latin America during the 1990s have included an emphasis on changing in the model of health care delivery to one that incorporates prevention and promotion activities. At the same time, health systems have been decentralized in their management, allowing room for greater variation in local interpretation and implementation of policy directives. Despite rhetoric and policy debate, there is no documentation or evaluation of actual experiences of prevention and promotion within decentralized health systems in Latin America. This paper explores the ways in which the national structure of a health system influences the implementation of activities for prevention and promotion through a comparison of the experiences in four local health systems in each of Brazil and Chile. These experiences in Brazil and Chile are presented by key themes of national health system structure, local health system structure, partnership and intersectorality, human resources and introducing a family health approach. Five clear factors emerge as operating at the national level that influence prevention and promotion activities in local health systems: vertical (Chile) versus horizontal (Brazil) structure of health system; greater awareness of prevention and promotion issues in Chile; greater urban bias in Chile compared with Brazil; strategies to attract human resources to primary care and rural areas; importance of local capacity building especially in rural areas. This account of case study experiences in Brazil and Chile provides a series of examples of arrangements and strategies that can facilitate implementation and usefully highlights a number of issues that policy-makers and health system managers need explicitly to consider. As such, the paper hopes to provoke debate about the structures and strategies for supporting the implementation of prevention and promotion programmes in Latin America and further health systems research in this field.
机译：1990年代拉丁美洲的卫生系统改组政策包括强调改变卫生保健的提供方式，使其纳入预防和促进活动。同时，卫生系统的管理已分散，为地方解释和政策指令的实施留出更大的空间。尽管进行了激烈的辩论和政策辩论，但在拉丁美洲的分散式卫生系统中，没有关于预防和推广的实际经验的文档或评估。本文通过比较巴西和智利四个地方卫生系统的经验，探索了卫生系统的国家结构影响预防和促进活动实施的方式。巴西和智利的这些经验以国家卫生体系结构，地方卫生体系结构，伙伴关系和跨部门性，人力资源以及采用家庭卫生方法的关键主题为代表。在国家一级开展工作时，会出现五个明显的因素，这些因素会影响当地卫生系统的预防和促进活动：卫生系统的纵向（智利）与横向（巴西）结构;在智利提高对预防和促进问题的认识;与巴西相比，智利的城市偏见更大;将人力资源吸引到初级保健和农村地区的战略;当地能力建设的重要性，特别是在农村地区。对巴西和智利的案例研究经验的介绍提供了一系列安排和策略的示例，这些示例可以促进实施，并有效地突出了决策者和卫生系统管理人员需要明确考虑的许多问题。因此，本文希望引起有关在拉丁美洲实施预防和促进计划以及进一步开展卫生系统研究的结构和战略的辩论。

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