Implementation progress of mental health services in Rwanda: Bugesera district case

RESUMO: O Ministério da Saúde do Governo do Ruanda identifica a saúde mental como uma área de prioridade estratégica para a intervenção em resposta à alta carga dos transtornos mentais no Ruanda. Ao longo dos últimos 20 anos após o genocídio, o sector público reconstruiu sua Resposta Nacional de Saúde Mental com base no acesso equitativo aos cuidados, através do desenvolvimento de uma Política Nacional de Saúde Mental e novas estruturas de saúde mental. A política de Saúde Mental do Ruanda, revista em 2010, prima pela descentralização e integração dos serviços de saúde mental em todas as estruturas nacionais do sistema de saúde e ao nível da comunidade. O presente estudo de caso tem como objetivo avaliar a situação do sistema de saúde mental de um distrito típico de uma área rural no Ruanda, e sugerir melhorias, incluindo algumas estratégias para monitoras as mudanças. Os resultados do estudo permitirão ao Ruanda reforçar a sua capacidade para implementar o Plano Nacional de Saúde Mental ao nível dos distritos. O relatório também será útil para monitorar o progresso da implementação de serviços de saúde mental nos distritos, incluindo a prestação de serviços de base comunitária e a participação dos usuários, suas famílias e outros interessados na promoção, prevenção, assistência e reabilitação em saúde mental. Este estudo também procurou avaliar o progresso da implementação dos cuidados de saúde mental a nível descentralizado, com vista a compreender as implicações em termos de recursos desses processos. Foi realizada uma análise situacional num local do distrito, baseado em entrevistas com as principais partes interessadas responsáveis, usando o Instrumento de Avaliação de Sistemas de Saúde Mental da Organização Mundial da Saúde (WHO-AIMS). Os resultados sugerem que os recursos humanos para a saúde mental e serviços de base comunitária de saúde mental no distrito continuam a ser extremamente limitados. Os profissionais de saúde mental são adicionalmente limitados na sua capacidade para oferecer intervenções de emergência a pacientes psiquiátricos e garantir a continuidade do tratamento farmacológico a pacientes com condições crônicas. Para planejar efetivamente, de acordo com as necessidades da comunidade, sugerimos que o sistema de saúde mental deve envolver também os representantes das famílias e dos usuários no processo de planificação de modo a melhorar a sua contribuição no processo de implementação das atividades de saúde mental. Este estudo de caso do Distrito de Bugesera oferece a primeira análise de nível distrital dos serviços de saúde mental no Ruanda, e pode servir como uma mais-valia para a melhoria do sistema de saúde mental, incluindo a advocacia para a melhoria da qualidade dos cuidados de saúde mental a este nível, aumentando o financiamento para a implementação de serviços clínicos de saúde mental e os recursos humanos disponíveis para a prestação de cuidados de saúde mental, principalmente a nível dos cuidados primários.--------------------- ABSTRACT: To deal with the high burden of mental health disorders resulting from consequences of the 1994 genocide against Tutsis, the Rwanda Ministry of Health (MoH) considers mental health as a priority intervention. For the last 20 years, Ministry of Health focused on rebuilding a national and equity-oriented mental health program responding to the population needs in mental health. Mental health services are now decentralized and integrated in the national health system, from the community level up to the referral level. This study assessed the situation of mental health services in one rural district in Rwanda. It was aimed at assessing the progress of implementation of mental health care at the decentralized level, focusing on resource implications and processes. This study is based on interviews conducted with key stakeholders, using the World Health Organization's Assessment Instrument for Mental Health Systems (WHO-AIMS). Findings show that human resources for mental health care and community-based mental health services of the assessed district remain extremely limited. Mental health professionals face limitation regarding the ability to provide emergency management of psychiatric patients and to ensure continuity of psychopharmacological treatment of patients with chronic conditions. To improve the implementation process of mental health interventions and activities, a planning process based on community needs and the involvement of representatives of families and users in planning process should be considered. The Bugesera case study on the situation of mental health services can serve as a baseline for improvement of the mental health program in Rwanda, in terms of quality care services, infrastructure and equipment, human and financial resources.

Defining risk acceptance criteria in occupational settings: A case study in the furniture industrial sector

The use of appropriate acceptance criteria in the risk assessment process for occupational accidents is an important issue but often overlooked in the literature, particularly when new risk assessment methods are proposed and discussed. In most cases, there is no information on how or by whom they were defined, or even how companies can adapt them to their own circumstances. Bearing this in mind, this study analysed the problem of the definition of risk acceptance criteria for occupational settings, defining the quantitative acceptance criteria for the specific case study of the Portuguese furniture industrial sector. The key steps to be considered in formulating acceptance criteria were analysed in the literature review. By applying the identified steps, the acceptance criteria for the furniture industrial sector were then defined. The Cumulative Distribution Function (CDF) for the injury statistics of the industrial sector was identified as the maximum tolerable risk level. The acceptable threshold was defined by adjusting the CDF to the Occupational, Safety & Health (OSH) practitioners’ risk acceptance judgement. Adjustments of acceptance criteria to the companies’ safety cultures were exemplified by adjusting the Burr distribution parameters. An example of a risk matrix was also used to demonstrate the integration of the defined acceptance criteria into a risk metric. This work has provided substantial contributions to the issue of acceptance criteria for occupational accidents, which may be useful in overcoming the practical difficulties faced by authorities, companies and experts.

Portuguese strengths and fragilities on safety and health practices

Despite improvements over the years, accidents continue to be a scourge in the construction sector, leading to an increase in the number of journal articles addressing the issue, in an attempt to help construction industry to increase safety performance [1]. This paper aims to, helping construction industry and particulary tunneling community, describe the Portuguese approach to most typical health and safety problems in underground excavations performed with the Sequential Excavation Method (SEM). The article will address various topics, from safety management and organizational practices, to collective and personal protection equipment, to emergency planning. nt problems in safety and health matters are similar to several other countries, the paper will expose a compilation of Portuguese best practices used to solve that problems. This enunciation of best practices describes experience from most important and recognized Project Owners and Contractors in Portugal. In a second phase it will be analysed Portuguese weaknesses, identifying preventive measures, and their comparative importance, that should be adopted in Portugal in order to reduce accidents and health diseases.

Nutritional status and food intake at workplace as health indicators for industrial workers

This study aimed to verify the correlation among the nutritional composition of the food consumed in the work environment, the energy expenditure and the nutritional status of workers from different sectors (administration and production) in different industries. The anthropometric data, in addition to the energy expenditure and food intake at lunch were evaluated for 292 workers, all of them included in the Brazilian Worker Food Program (also called PAT). The food consumption was assessed from the direct observation of the meal, for five consecutive days. The obtained data were analyzed by Pearson correlation test and by a Principal Components Analysis. Prevalence of overweight was detected in the studied population, according to the Body Mass Index (BMI). A statistically significant difference was found in terms of the energy expenditure of physical activity and daily energy expenditure in relation to gender and the working sector. The obtained results indicate that there is significant positive correlation (p < 0.01) between the following variables: body weight and BMI (r = 0.84), weight and daily energy expenditure (DEE) (r = 0.52), BMI and DEE (r = 0.27), DEE and energy (r = 0.38), and energy and lipid intake (r = 0.50). These findings seems to indicate the importance of ensuring an adequate balance of nutrients at meals, due to the heterogeneity of workers, in particular in the case of those workers who perform tasks or functions requiring less energy expenditure.

Environment, health and safety policy in small construction sites: an analysis of the situation in Brazil

This paper analyzes the safety, environmental and occupational health of workers in the small construction industry in Brazil. In this sector there are still many unsafe practices, which are very common in small work sites. We used a qualitative approach to understand these problems by long interviews with people who work directly in small construction sites, including occupational physicians, civil engineers, safety engineers, safety technicians, general foremen, construction workers, labor unionists and auditors. This paper aims to demonstrate that the "invisibility" of the small sites workers makes them less safe and therefore more prone to accidents, also weakening their health. The results show that small constructions workers are less visible to society and supervision because of their short periods of work. Therefore, they are also uncovered to the rigorous applicability of principles of safety and accident prevention. Thus, it has been seen in this field of work a precarious application of NR - 18, which was specifically made for the construction sites and it needs simplification to meet normative characteristics of small construction sites. In the State of Rio de Janeiro, some laws on small sites were recently created and implemented. This study concludes that the rules to work are not being taken as seriously as the legislation determinates, remaining practically unknown by many professionals, from the plot command, supervisors, engineers, architects and technicians who work on construction sites. This ignorance creates space for the lack of safety and consequently to accidents, leading to by weakness in the workers health. Therefore, the work process needs to be modified, the safety regulation must be disseminated through safer practices, promoting employee health and ensure that the work of small sites can be visible, especially ensuring the construction workers health and safety.

Horário por turnos : análise do seu efeito numa empresa do sector industrial

O presente estudo teve por objetivo analisar os possíveis efeitos do trabalho por turnos, incluindo o turno noturno, a nível da saúde, vida familiar e social, numa empresa do sector da indústria. Foi construído um questionário que abordava questões relativas aos dados sociodemográficos, organização temporal do trabalho, qualidade do sono, exigências da tarefa e envolvimento, saúde, vida familiar e social, e posteriormente foi aplicado a uma amostra de 24 trabalhadores com idades entre os 29 e os 52 anos (41,58±5,79 anos). Os resultados mostram uma tendência para doenças como a obesidade, colesterol elevado e manifestação de sintomas relacionados com problemas digestivos nos trabalhadores que trabalham por turnos à [sic] mais anos. Antes do primeiro turno noturno o tempo de sono é bastante reduzido e fica aquém do tempo que os trabalhadores sentem que necessitam dormir para se sentirem bem. O turno da tarde é o que permite os trabalhadores ficarem com um tempo de sono mais próximo desse “ideal”. Em relação à idade, todos os trabalhadores do grupo etário mais velho manifestam interrupções do sono diurno. Também se verifica um maior descontentamento destes trabalhadores com o tempo livre para realizar atividades que tragam bem-estar. Este estudo contribui para o conhecimento da realidade do trabalho por turnos na indústria e espera-se que desperte a procura de soluções que otimizem a vida destes trabalhadores.

Producción de información para las políticas públicas: observatorio de salud mental y derechos humanos en la provincia de córdoba. Documented information and indicators for the pubic policies in mental health: human rights obseratory in córdoba

El problema que enfrenta la institucionalidad estatal argentina es que existe un serio déficit de información no solamente en el momento de evaluar un resultado, sino ya al momento de diseñar la política. Las estadísticas oficiales de hechos vitales, salud y educación son difundidas en el mejor de los casos con un año de atraso. La información de indicadores de salud por su nivel de desagregación no permite conocer las realidades locales. Es posible constatar la falta de información sobre las medidas tomadas para asegurar el cumplimiento de las obligaciones del Estado en lo relativo a políticas y programas de salud mental. Del mismo modo que los organismos internacionales determinan los deficits de los sistemas de atención a la salud mental a través de las brechas de tratamiento y aun cuando no se dispone de estimaciones precisas se habla de brechas de información, que expresarían la distancia entre la información necesaria y la efectivamente disponible (OPS, 2009). Desde el mes de diciembre de 2007 se conforma la Mesa de Trabajo Permanente en Salud Mental y Derechos Humanos, con el objeto de instalar en agenda la necesidad de contar con una legislación que brinde el marco normativo para la transformación del sector. En los meses de octubre y noviembre de 2010 se aprobaron sendas leyes de salud mental en la Provincia de Córdoba y a nivel nacional. Ambas proponen la transformación progresiva en los sistemas de atención a los problemas de salud mental de la población. Desde la Mesa de Trabajo Permanente en Salud Mental y Derechos Humanos se afirma que la legislación es un marco necesario pero no suficiente, en tanto se constata que las princiales violaciones a los derechos humanos se producen en situaciones concretas. El presente proyecto nace de la necesidad de contar con un sistema de información que permita conocer la transformación de los servicios de salud mental en la provincia de Córdoba a partir de la sanción de la ley 9848 de Salud Mental en el mes de octubre de 2010. Una vez logrado este objetivo legislativo, se pretende monitorear la gestión con la formulación de los siguientes interrogantes: ¿a través de qué indicadores medir, evaluar y monitorear si la producción de los servicios de salud mental se lleva adelante desde la perspectiva del enfoque de derechos sancionada en el marco normativo vigente?; ¿cuáles son los indicadores que desde dicha perspectiva los organismos estatales de producción de servicios deben elaborar para el compromiso de acción y la rendición de cuentas frente a la ciudadanía? ¿cuáles son los indicadores que la ciudadanía debe reclamar a los fines de monitorear el cumplimiento de dichos compromisos? La puesta en marcha del Observatorio de Salud Mental y Derechos Humanos permitirá analizar las políticas y programas de salud mental desde la perspectiva de los derechos humanos y avanzar en el monitoreo de la producción de los servicios de salud mental. Objetivo General: analizar y hacer visible el cumplimiento de los objetivos sancionados en la ley 9848 de Salud Mental a través de la observación, el monitoreo y la incidencia en las políticas de salud mental de la provincia de Córdoba. Metodología: la construcción de indicadores de derechos humanos para la salud mental. El Observatorio de Salud Mental y Derechos Humanos pretende dar cuenta de las transformaciones que van a ocurrir a partir de la sanción de la ley 9848. Los resultados esperados están ligados a la producción y difusión de información sistematizada sobre las transformaciones en salud mental, a la vigilancia y el análisis del efecto/impacto de las políticas e incidir en las decisiones. El Observatorio pretende reconocer e integrar la información disponible y proponer indicadores que den cuenta de la situación inicial al momento de la implementación de los marcos normativos y permitir el monitoreo de las transformaciones emergentes. This project stems from the need for an information system designed to show the transformation of mental health services in the province of Cordoba after the enactment of the Mental Health Act 9848 in October 2010. Once achieved this legislative objective is to monitor the management with the formulation of the following questions: through which indicators to measure, evaluate and monitor whether the production of mental health services are carried forward from the perspective of rights-based approach enacted in two laws?, What are the indicators from that perspective the production agencies should develop services for the commitment to action and accountability to the public? What are the indicators that the public should demand that the purpose of monitoring compliance with these commitments? The launch of the Centre for Mental Health and Human Rights will review the policies and mental health programs from the perspective of human rights and progress in monitoring the production of mental health services. General Objective: to analyze and highlight the achievement of the objectives sanctioned by the Mental Health Act 9848 through the observation, monitoring and impact on mental health policy in the province of Cordoba. Methodology: building human rights indicators for mental health Mental Observatory Health and Human Rights aims to account for the changes that will occur after the enactment of Law 9848. The expected results are linked to production and dissemination of systematic information about changes in mental health, surveillance and analysis of the effect / impact and influence policy decisions. The Centre aims to recognize and integrate the available information and propose indicators that account for the initial situation at the time of implementation of regulatory frameworks and allow monitoring of change emerging.

Physiotherapy practice in the private sector: organizational characteristics and models.

BACKGROUND: Even if a large proportion of physiotherapists work in the private sector worldwide, very little is known of the organizations within which they practice. Such knowledge is important to help understand contexts of practice and how they influence the quality of services and patient outcomes. The purpose of this study was to: 1) describe characteristics of organizations where physiotherapists practice in the private sector, and 2) explore the existence of a taxonomy of organizational models. METHODS: This was a cross-sectional quantitative survey of 236 randomly-selected physiotherapists. Participants completed a purpose-designed questionnaire online or by telephone, covering organizational vision, resources, structures and practices. Organizational characteristics were analyzed descriptively, while organizational models were identified by multiple correspondence analyses. RESULTS: Most organizations were for-profit (93.2%), located in urban areas (91.5%), and within buildings containing multiple businesses/organizations (76.7%). The majority included multiple providers (89.8%) from diverse professions, mainly physiotherapy assistants (68.7%), massage therapists (67.3%) and osteopaths (50.2%). Four organizational models were identified: 1) solo practice, 2) middle-scale multiprovider, 3) large-scale multiprovider and 4) mixed. CONCLUSIONS: The results of this study provide a detailed description of the organizations where physiotherapists practice, and highlight the importance of human resources in differentiating organizational models. Further research examining the influences of these organizational characteristics and models on outcomes such as physiotherapists' professional practices and patient outcomes are needed.

Public Sector Pay in Finland

This study analyses the forces determining public and private sector pay in Finland. The data used is a 7 per cent sample taken from the Finnish 2001 census. It contains information on 42 680 male workers, of which 8 759 are employed in public and 33 921 in the private sector. The study documents and describes data by education, occupation and industry. We estimate earnings equations for the whole sample as well as for four industries (construction, real estate, transportation and health) that provide an adequate mix of both public and sector workers. The results suggest that the private-public sector pay gap of about one per cent can be accounted for by differences in observable characteristics between the sectors (3.4 per cent) and lower returns from these characteristics (-2.3 per cent). However, the industry-level analysis indicates that the earnings gaps vary across industries, and are negative in some cases. These inter-industry differences in public-private gaps persist even when the usual controls are introduced. This suggests that public sector wage setters need greater local flexibility, which should result in less uniform wages within the public sector.

Response to the discussion paper on proposed Health Information Bill

The Institute of Public Health in Ireland is an all-island body which aims to improve health in Ireland by working to combat health inequalities and influence public policies in favour of health. The Institute promotes North-South co-operation in research, training, information and policy. The Institute commends the Department of Health and Children for producing the Discussion Paper on Proposed Health Information Bill (June 2008) and welcomes the opportunity to comment on it. The first objective of the Health Information: A National Strategy (2004) is to support the implementation of Quality and Fairness: A Health System for You (2001).The National Health Goals - such as ‘Better health for everyone’, ‘Fair access’ and ‘Responsive and appropriate care delivery’ - are expressed in terms of the health of the public as well as patients. The Discussion Paper focuses on personal information, and the data flows within the health system, that are needed to enhance medical care and maximise patient safety. The Institute believes that the Health Information Bill should also aim to more fully support the achievement of the National Health Goals and the public health function. This requires the development of more integrated information systems that link the healthcare sector and other sectors. Assessment of health services performance - in terms of the public’s health, health inequalities and achievement of the National Health Goals - require such information systems. They will enable the construction of public health key performance indicators for the healthcare services.

Asylum Seekers And Refugees Policy Guidance On Access To Health And Social Services (PDF 136 KB)

This policy guidance is intended for staff working within the Health and Personal Social Services sector in Northern Ireland, and aims to provide advice and information on the provision of health and social care services to asylum seekers and refugees. The purpose of the policy is to ensure that asylum seekers and refugees are given equitable access to health and social care services under the terms of the current legislation, with the overall aim of providing a culturally competent health and social care services. åÊ

Action Plan for People Management in the Health Service

In November of 2001 the Government launched its new National Health Strategy â?" â?oQuality and Fairness, A Health System for youâ?Âù (hereafter referred to as Quality and Fairness). Quality and Fairness was developed following one of the largest consultation processes ever undertaken in the public service. It sets out the vision for the health service, the four principles upon which this vision will be built, it also establishes four National goals and finally sets out six â?~frameworks for changeâ?T, which will be used to achieve the vision, principles and goals. One of the six frameworks for change is Developing Human Resources. The health service is one of the largest employers in the public sector, with the employment level at the end of 2001 approaching 93,000 full time employees. These employees are spread across a large number of organisations, in multiple locations and settings across the country. Each employee plays a key role in the delivery of health service, in all settings, to the public. Download document here

Performance-Related Awards: Health Boards Scheme

Performance-Related Awards: Health Boards Scheme This progress report to September 2003 on the performance-related awards scheme for senior health board management has been prepared by the Committee for Performance Awards for the Health Board Scheme, in line with the recommendation in Report No. 38 of the Review Body for Higher Remuneration in the Public Sector, to contribute to the Review Bodyâ?Ts consideration at its next general review (para 13.4). Click here to download PDF 93kb

Department of Health Consolidated Salary Scales December 2004

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Department of Health and Children Consolidated Salary Scales effective from 1st December, 2005

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