Implementation of Strategies Relevant to National Health Care and Specific Centers in the Emerging...
-
date post
19-Dec-2015 -
Category
Documents
-
view
215 -
download
1
Transcript of Implementation of Strategies Relevant to National Health Care and Specific Centers in the Emerging...
Implementation of Strategies Relevant to
National Health Care and Specific Centers in the
Emerging World:
Implementation of Strategies Relevant to
National Health Care and Specific Centers in the
Emerging World: The View of Central American and Caribbean CountriesThe View of Central American and Caribbean Countries
Raúl Herrera-Valdés, MD, PhDInstitute of NephrologyHavana – Cuba
Raúl Herrera-Valdés, MD, PhDInstitute of NephrologyHavana – Cuba
Context of the Americas
Health inequalities reflect
socio-economic structural inequalities
Health inequalities reflect
socio-economic structural inequalities
Values
Equity – Excellence – Respect – Integrity
Mission:
Promote equity in health, combat disease, and improve quality of life and life expectancy in the region.
34 countries
Population: 76 million
Poverty: + 40%
Countryside: 45%
34 countries
Population: 76 million
Poverty: + 40%
Countryside: 45%
Wealthiest 20%
INCOME
Poorest 20%
16 times
Central American and Caribbean Countries
Segregation
Marginalization
Stress
Extreme living conditions
Education
Information
Health Services
DiseasePoverty
+
-
-
-
+
Illiteracy
Central America5%- 36%
Central America5%- 36%
Latin Caribbean:4%- 51%Latin Caribbean:4%- 51%
Non- Latin Caribbean:2%- 19%Non- Latin Caribbean:2%- 19%
Infant mortality rate: > 30 x 1,000 l.b. Life expectancy: < 70 years
Infectious diseases Tendency Aging
Non-Comm. Chr. Diseases
Communicable Diseases Non- Communicable
Morbidity – Mortality Morbidity – Mortality
Health Picture
Near-poor population: Obesity epidemic
Diabetes: 6% - 8%
Hypertension: 8% - 30%
IncreasingPrevalence
Ethnic Composition / Socio-economic
conditions
Ethnic Composition / Socio-economic
conditions
Health Picture: Risk factors for Renal Disease
Incidence Prevalence
289
6356 50
32 205
0
50
100
150
200
250
300
Pu
ert
o R
ico
Co
sta
Ric
a
Cu
ba
Pan
amá
R. D
om
inic
ana
Sal
vad
or
Ho
nd
ura
s
Gu
ate
mal
a
Nic
arag
ua
Reg. L.A. de Diálisis y Trasplante.2001
Patients/MH
País
830
103 8960 42 38 30 23
0
100
200
300
400
500
600
700
800
900
Pu
ert
o R
ico
Pan
amá
Cu
ba
R. D
om
inic
ana
Sal
vad
or
C. R
ica
Ho
nd
ura
s
Gu
ate
mal
a
Nic
arag
ua
Patients/MH
País
Incidence & Prevalence of ESRD in RRT
Situation
Not enough professionals trained to meet health care needs.
Existing resources are inequitably distributed, concentrated mainly
in the big cities.
Low salaries.
Internal and external migration.
Imbalance in the composition of healthcare workforce.
Minimal development of information resources.
Oriented towards curative care rather than prevention.
Human Resources
Central America6.2 to 15 per 10,000 inh.
Central America6.2 to 15 per 10,000 inh.
Nephrologists:
• < 20 p.m.p in vast majority of countries
• None in several non-Latin Caribbean nations
Nephrologists:
• < 20 p.m.p in vast majority of countries
• None in several non-Latin Caribbean nations
Physicians
Non-Latin Caribbean1.5 to 21.5 per 10,000 inh.
Non-Latin Caribbean1.5 to 21.5 per 10,000 inh.
Latin Caribbean2.5 to 58.2 per 10,000 inh.
Latin Caribbean2.5 to 58.2 per 10,000 inh.
Central
America
Latin
Caribbean
Non–Latin
Caribbean
Hospitals per 100 000 inhab. 1.5 2.1 3.0
Hospital beds per 1 000 inhab. 1.4 2.8 3.6
Out-patient facilities per 10 000 inhab. 2.5 5.4 1.6
Health Care Infrastructure
No preventive strategies in place for chronic renal insufficiency
No institution which acts as a regional reference center
No preventive strategies in place for chronic renal insufficiency
No institution which acts as a regional reference center
In the Central American and Caribbean context, Cuba
shares many of the economic limitations of other
countries, and at the same time, has advanced along the
route of equity described by PAHO as critical to
improving health in the region, as one of the countries
with the least social disparity.
In the Central American and Caribbean context, Cuba
shares many of the economic limitations of other
countries, and at the same time, has advanced along the
route of equity described by PAHO as critical to
improving health in the region, as one of the countries
with the least social disparity.
The health system is universal, public, and free-of-
charge, with full coverage of the population.
Cuba’s resource-scarce environment, coupled with
public health principles, has reinforced a
commitment to primary health care and prevention
as the centerpiece of the system.
Cuba’s National Health System
Total population 11.251 million
Percent urban population 75.4%
Literacy rate 96.2%
Average educational level 9th grade
Infant mortality rate ( x 1000 live births) 6.5
Life expentancy 76.15
Physicians per 10,000 population 59.6
Total number of family physicians 31,059
Population served by family physicians 99.2%
Hospital beds ( x1000 population) 5.0
Health Care Situation in Cuba. Basic Indicators 2002
International Cooperation in Health (2003)
Cuban health professionals
serving abroad:14,691 in 64
countries
Cuban health professionals
serving abroad:14,691 in 64
countries
International medical students in Cuba:
9,023 from 83 countries
International medical students in Cuba:
9,023 from 83 countries
TRANSPLANTATION
PRIMARY
PREVENTION
SECONDARY
PREVENTION
TERTIARY
PREVENTION
HEALTHY
POPULATION AND
RISK GROUPS
HEALTHY
POPULATION AND
RISK GROUPS
CHRONIC RENAL
INSUFFICIENCY
CHRONIC RENAL
DISEASES
CHRONIC RENAL
INSUFFICIENCY
CHRONIC RENAL
DISEASES
ESRDESRD
CLINICAL
NEPHROLOGY
PRIMARY
CARE: FAMILY
DOCTORS
DIALYSIS
Cuban’s National Chronic Renal Disease Program:
TRANSPLANTATION CENTERS: 9
TISSUE TYPING LABORATORIES: 5
ORGAN PROCUREMENT CENTERS: 33NEPHROLOGISTS: 385
Adult: 214
Pediatric: 66
Residents: 105
100% Free Health Care
PHYSICIANS: 67,000
FAMILY DOCTORS: 31,000
NATIONAL COORDINATING CENTER
NEPHROLOGY SERVICES: 34
OPENING: 13
Cuban’s National Chronic Renal Disease Program:Organization and Resources
National Chronic Renal Disease Program: Basic Indicators
HD Incidence
0
200
400
600
800
1000
1200
2001 2002 2003
97.1
1088
CRF patients
CRI Patients in follow-up *
HD Prevalence Trasplants Incidence
0
0,2
0,40,6
0,8
1
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
YEAR
RA
TE
PM
P
0
20
40
60
80
100
120
140
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1997
1999
2000
2001
2002
2003
RA
TE
PM
P
YEAR
YEAR
RA
TE
PM
P
0
4
8
12
16
20
24
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003 YEA
R
RA
TE
PM
P
880
13419.5
Transplantation
PATIENT AND GRAFT SURVIVAL MORBIDITY SEPSIS REJECTION
Dialysis
MORTALITY MORBIDITY
Ca-P METABOLISM CONTROL SEPSIS HEART DISEASE ANEMIA NUTRITION ADEQUATE DIALYSIS
ESRD
CRI
CRD
EARLY REPLACEMENT THERAPY VASCULAR ACCESS HB VACCINATION SYSTEMIC DETERIORATION CONTROL OF PROGRESSION RISK FACTORS ACTIVE FOLLOW-UP CAUSAL TREATMENT EARLY DETECTION ACTIVE SCREENING ADEQUATE TREATMENT EARLY DIAGNOSIS
Population´s
Epidemiological
Characterístics
CONTROL OF CAUSES AND RISK ACTORS IDENTIFICATION OF RISK FACTOR GROUPS POSITIVE LIFESTYLES HEALTH PROMOTION HEALTH EDUCATION
Tertiary
Prevention
Tertiary
Prevention
Secondary
Prevention
Secondary
Prevention
Primary
Prevention
Primary
Prevention
QUALITY
OF
LIFE
Prevention Program: Specific Objectives
47 Nephrology Services (Regions)
385 Nephrologists
444 Community Polyclinics ( Health Areas)
31 000 Family Physicians
99.2% Population
National CRD Program: Implementation of Prevention Strategies
1 Municipal Health Service
1 Nephrology Service
5 Nephrologists
3 Community Polyclinics-Health Areas
105 Family Physicians
81,000 Persons
Objective: Epidemiological follow-up for chronic renal diseases in total population by studying family units over time.
Isle of YouthIsle of Youth
National CRD Program: Epidemiological Laboratory
Total population
Phases of the project Actions Outcomes
Screening • Dipstick for proteinuria• Short questionnaire
CRD Diagnosisconfirmation.Etiology.
Case-control
study
Follow-up study
Intervention
Surveillance
Proteinuria (+)
Proteinuria (-)
CRD Cases
Total Cases
Cohort
Therapeutic intervention
Proteinuria (-)
Dipstick for microalbuminuria in risk groups
Microalbuminuria (+)
Longer questionnaire Laboratory test Physical exam
Laboratory test Physical exam
Intervention
Microalbuminuria (-)
Surveillance system
Control group
Sample
Cohort
Preventive actions
CRD Prevalence
• CRD Incidence• CRD etiological risk factors• CRD progression
Identify risk factors for CRD
• Risk reduction• CRD control
• Morbidity patterns• Mortality tendencies• Distribution dialysis and kidney transplant
Community epidemiological laboratory for study of chronic renal disease (CRD). Isle of Youth project. Cuba.
• Cuban School of Nephrology
• National Reference Center
• National Coordinating Center
Institute of Nephrology
National Chronic Renal Disease
Program
Raising the Level of Medical
Care
Training Specialized Human
Resources
Developing Scientific Research
• Prevention• Clinical Nephrology• Dialysis• Transplantation
• Management• Telenephrology• Epidemiological Laboratory
National CRD Program: National Coordinating Center
National Institute of Nephrology
National Network of Nephrology Services.
National Health System’s National Telematics Network (INFOMED)
Second Opinion Services.
Teleconferencing.
Distance learning.
Epidemiological control (PC).
o Selection of donor-recipient pairs.
o CRI and Dialysis.
o Statistics.
XML Web services
National CRD Program: Telenephrology Network
We place this modest Cuban experience at the
disposal of our Central American and Caribbean
colleagues and of nephrology societies
internationally, inviting them to share with us
their observations, reflections and expertise.
We place this modest Cuban experience at the
disposal of our Central American and Caribbean
colleagues and of nephrology societies
internationally, inviting them to share with us
their observations, reflections and expertise.
Conclusions
To prevent chronic renal disease in Central America and the Caribbean, we must:
• Reduce poverty• Increase equity• Improve nutrition• Advance education• Develop health services• Formulate prevention policies• Create reference institutions
To prevent chronic renal disease in Central America and the Caribbean, we must:
• Reduce poverty• Increase equity• Improve nutrition• Advance education• Develop health services• Formulate prevention policies• Create reference institutions
“These are dangerous times for the well-being of the world. In many regions, some of the most formidable enemies of health
are joining forces with the allies of poverty to impose a double burden of disease,
disability and premature death on many millions of people. It is time for us to close
ranks against this growing threat. “
“These are dangerous times for the well-being of the world. In many regions, some of the most formidable enemies of health
are joining forces with the allies of poverty to impose a double burden of disease,
disability and premature death on many millions of people. It is time for us to close
ranks against this growing threat. “
Gro Harlem Bruntland M.D.Director – General
World Health Organization
Gro Harlem Bruntland M.D.Director – General
World Health OrganizationThe World Health Report. WHO. 2002The World Health Report. WHO. 2002