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Objective. Identify mechanisms reported in primary health care (PHC) interventions in rural and marginal urban populations from 1997 to 2019. Methods. A scoping review was used to identify the literature. The literature search was conducted using the Medline (PubMed and Ovid), Global Health, Embase, Web of Science, Scopus, and Lilacs databases. Inclusion criteria considered literature on primary intervention and observational studies using qualitative, quantitative, or mixed methods. Articles in English, Portuguese, and Spanish published from 1997 to 2019 were included. Rayyan QCRI was used for definitive document selection; sources of information from gray literature or research in progress were excluded. Results. At the individual level, three groups of mechanisms were identified: levels of relationships between interventions and subjects, transformations that can occur in individuals, and reciprocal relationships. At the institutional level, mechanisms were related to temporality, money, power relations, trust relations, the health system, expectations, and administrative conditions. Conclusions. Individual mechanisms are similar in different contexts. Institutional mechanisms are susceptible to variations in context and are expressed in terms of temporality, economic resources, power and trust relations, the health system, expectations, and administrative conditions. [ABSTRACT FROM AUTHOR]

Objectives. Present the methodology for comprehensive evaluation of the implementation of the Mental Health Global Action Programme (mhGAP) in Chile and describe the program's results. Methods. Cross-sectional evaluative study based on a survey of key program informants deployed in 29 public health services in the country, as well as individual interviews and focus groups with key actors and experts. The evaluation was focused on the relevance and impact of mhGAP on the provision of mental health services and on the implementation of the program. Results. The participants gave a positive evaluation of the progressive implementation of mhGAP in Chile. In particular: 1) They reported having better tools for detecting, diagnosing, and treating common disorders, and efficient referral strategies; (2) They rated all modules as important, the most relevant being self-harm/suicide (... = 4.77) and mental and behavioral disorders in children and adolescents (... = 4.58); (3) They favorably assessed the National Mental Health Day training courses and the subsequent courses repeated at the local level, indicating that these courses contributed to successful implementation of mhGAP; (4) They agreed on the need to incorporate new actors, strengthen certain aspects, and expand information on the program. Conclusions. The implementation of mhGAP in Chile is an emblematic example of learning supported by the development of community mental health and family health, among other factors. These accomplishments offer a unique opportunity to continue advancing the implementation of this program in the country and to implement this experience in other contexts in Latin America and the Caribbean. [ABSTRACT FROM AUTHOR]

Objective. To forecast the impact of alternative scenarios of coverage changes in Brazil's Family Health Strategy (Estratégia Saúde da Família) (ESF)--due to fiscal austerity measures and to the end of the Mais Médicos (More Doctors) Program (PMM)--on overall under-5 mortality rates (U5MRs) and under-70 mortality rates (U70MRs) from ambulatory care sensitive conditions (ACSCs) up through 2030. Methods. A synthetic cohort of 5 507 Brazilian municipalities was created for the period 2017-2030. A municipal-level microsimulation model was developed and validated using longitudinal data. Reductions in ESF coverage, and its effects on U5MRs and U70MRs from ACSCs, were forecast based on two probable austerity scenarios, as compared to the maintenance of current ESF coverage. Fixed effects longitudinal regression models were employed to account for secular trends, demographic and socioeconomic changes, variables related to health care, and program duration effects. Results. In comparison to maintaining stable ESF coverage, with the decrease in ESF coverage due to austerity measures and PMM termination, the mean U5MR and U70MR would be 13.2% and 8.6% higher, respectively, in 2030. The end of PMM would be responsible for a mean U5MR from ACSCs that is 4.3% higher and a U70MR from ACSCs that is 2.8% higher in 2030. The reduction of PMM coverage due only to the withdrawal of Cuban doctors who have been working in PMM would alone be responsible for a U5MR that is 3.2% higher, and a U70MR that is 2.0% higher in 2030. Conclusions. Reductions in primary health care coverage due to austerity measures and the end of the PMM could be responsible for many avoidable adult and child deaths in coming years in Brazil. [ABSTRACT FROM AUTHOR]

The Cuban family medicine model has been developed, for more than three decades, as the third model of medical care of the revolutionary period in Cuba. It is the complete expression of the application of the primary health care strategy. However, it is still possible to improve the organization, quality and efficiency of health services in the first level of health care. The objective of this article is to describe the model, its singularities, distinctive elements, main achievements, and challenges. A documentary review was made from journal articles, books and official documents of the Ministry of Public Health of Cuba on the creation and development of the model; documents were selected and analyzed by experts for the preparation of this report. Conceptual elements of the model are presented, as well as indicators supporting the information. The main characteristics of family medicine in Cuba, its fundamental achievements, and challenges are presented. Based on its results, Cuba's family medicine model is a reference for the Region of the Americas. It is still a model in development, however, perfectible and susceptible to transformations to face new challenges, more importantly to renew the model keeping and strengthening the foundational ideas of the program. [ABSTRACT FROM AUTHOR]

Objectives. Three highly effective vaccines are available to prevent human papillomavirus (HPV) infection, and they have been introduced in many countries around the world. This article describes advances and challenges in introducing HPV vaccines in the Expanded Program of Immunization (EPI) of countries in Latin America and the Caribbean (LAC). Methods. We reviewed national and regional sources of information to identify LAC countries with and without universal HPV vaccination, along with the year of introduction, type of HPV vaccine, vaccination scheme, age groups targeted, and coverage level reached. Incidence rates of cervical cancer were compared across countries with and without an HPV vaccination program, in order to identify inequities in access to HPV vaccines. Results. So far, 10 LAC countries have supplied data on their vaccination policies and vaccination coverage rates to the Pan America Health Organization. The majority of those 10 started their vaccination programs using quadrivalent vaccine. Only Chile, Ecuador, and Mexico started their programs using a two-dose scheme. However, by the end of 2016, most of the other countries had switched from a three-dose to a two-dose scheme. Different age groups are targeted in the various programs. Some countries vaccinate one-year birth cohorts, while others vaccinate multiple-year birth cohorts. By the end of 2014, coverage with at least two doses ranged from a low of 2% to a high of 86%. With the exception of Venezuela, the LAC countries with the largest populations introduced universal HPV vaccination between 2010 and 2014. Despite the progress that has occurred in some LAC countries, there are still 10 LAC nations with cervical cancer rates above the LAC average (21.2 cases per 100 000) that have not introduced an HPV vaccine in their EPI. Conclusions. With several key adjustments, HPV vaccination programs across Latin America and the Caribbean could be substantially strengthened. Ongoing monitoring of HPV infection outcomes is needed in order to assess the impact of different vaccination policies. [ABSTRACT FROM AUTHOR]

In the last 10 years, implementation research has come to play a critical role in improving the implementation of already-proven health interventions by promoting the systematic uptake of research findings and other evidence-based strategies into routine practice. The Alliance for Health Policy and Systems Research and the Pan American Health Organization implemented a program of embedded implementation research to support health programs in Latin America and the Caribbean (LAC) in 2014-2015. A total of 234 applications were received from 28 countries in the Americas. The Improving Program Implementation through Embedded Research (iPIER) scheme supported 12 implementation research projects led by health program implementers from nine LAC countries: Argentina, Bolivia, Brazil, Chile, Colombia, Mexico, Panama, Peru, and Saint Lucia. Through this experience, we learned that the "insider" perspective, which implementers bring to the research proposal, is particularly important in identifying research questions that focus on the systems failures that often manifest in barriers to implementation. This paper documents the experience of and highlights key conclusions about the conduct of embedded implementation research. The iPIER experience has shown great promise for embedded research models that place implementers at the helm of implementation research initiatives. [ABSTRACT FROM AUTHOR]

Objective. To verify the degree of adequacy of prenatal care in Brazil and to determine whether it is associated with sociodemographic characteristics of women. Methods. This nationwide hospital-based study was performed with 23 894 women in 2011 and 2012. Data were obtained from interviews with puerperal women and from the prenatal card recording prenatal care appointments. Adequate prenatal care was defined as that started no later than the 12th gestational week, with performance of at least six consultations (with number of consultations adjusted for gestational age at delivery), record in the prenatal card of at least one result for each of the recommended routine prenatal tests, and guidance regarding the maternity hospital for delivery. Multivariate logistic regression was performed to verify the association between maternal characteristics and the adequacy of prenatal care. Results. Early onset of prenatal care was observed in 53.9% of participants, adequate number of consultations in 73.2%, record of at least one of each recommended test in 62.9%, guidance regarding maternity hospital in 58.7%, and overall adequate prenatal care in 21.6%. Less adequate prenatal care was observed in women who were younger, black, multiparous, who did not have a partner, without paid employment, having fewer years of formal schooling, belonging to lower socioeconomic classes, and living in the North and Northeast of Brazil. After adjustment of maternal characteristics, no differences were observed between public or private health care services regarding adequacy of prenatal care. Conclusions. Even though the coverage of prenatal care is virtually universal in Brazil, regional and social differences in the access and adequacy of care still persist. The implementation of strategies to facilitate early access to prenatal care is essential. [ABSTRACT FROM AUTHOR]

Objective. Assess the impact of activities by the nongovernmental organization Refazer in support of medical care for children at social risk. Methods. A longitudinal study was conducted of 77 patients from Rio de Janeiro in treatment at the Fernandes Figueira Institute and supported by Refazer. The assessment period was two years, one before and the other during the intervention period while being supported by the NGO. The percentage of hospitalizations, average length of stay, severity of the illness, use of technology, number of outpatient consultations, and clinical conditions involved were compared. Results. The indicators linked with the hospitalizations revealed changes during the intervention period. There was a reduction in the average time and percentage of hospitalization. The most common pathologies were congenital malformations, chromosomal anomalies, and diseases of the nervous system. These diseases and HIV/AIDS were more prevalent in children that remained hospitalized even after receiving support from the NGO. Conclusions. Analysis of the indicators showed that the outcomes are adequate to the NGO's mission and that the population helped benefits from participation in the social support network. Although it cannot be stated that the benefits found are due exclusively to the activities of the NGO, a simple and easy-to-use evaluation of adequacy was developed that NGOs themselves can use, representing progress toward the institutional use of evaluations by NGOs working in health. [ABSTRACT FROM AUTHOR]