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Analysis of the health situation: scientific-methodological tool for the work of the General practitioner
Análisis de la situación de salud: herramienta científico-metodológica para el trabajo del médico de familia
Liliam María Mejías Chao1*
Marilyn Hernández Gómez1
Miriam María González
Morrell1
1Medicine Faculty. Villa Clara University of Medical Sciences. Cuba
*Author for correspondence. E-mail: liliammc@infomed.sld.cu
ABSTRACT
The health situation analysis constitutes the appropriate scientific-methodological instrument to identify, prioritize and solve the problems of a specific community, with a positive impact on the modification of the health status of its inhabitants. The purpose of this research paper is to offer its background, definition and other aspects that facilitate its teaching in medical education, highlighting its importance in the work of primary health care, in which the care, teaching and research function is united, so that its teaching must be systematic and daily.
MeSH: diagnosis of health situation; analysis of situation; comprehensive health care; education, medical.
RESUMEN
El análisis de situación de salud constituye el instrumento científico-metodológico adecuado para identificar, priorizar y solucionar los problemas de una determinada comunidad, con incidencia positiva en la modificación del estado de salud de sus habitantes. Es objetivo de esta comunicación ofrecer sus antecedentes, definición y otros aspectos que faciliten su impartición en la educación médica, destacando su importancia en el trabajo de la atención primaria, en la que se unen la función asistencial, docente e investigativa, por lo que su enseñanza debe ser sistemática y cotidiana.
DeSC: diagnóstico de la situación de salud; análisis de la situación; atención integral de salud; educación médica.
Submitted: 12/03/2019
Accepted: 26/06/2019
The Analysis of the Health Situation at the community level in Cuba has a very interesting background. In 1937, as a response to the regional policy of the Pan American Sanitary Bureau aimed essentially at controlling malaria, the Marianao Health Unit was created where there was a great focus of this disease. The basic activities of the unit were the maternal and child care, childcare and environmental sanitation with very good results for the local public health, in addition the most frequent transmissible diseases in the territory were studied, home visiting activities started with the community work of nursing, a parasitology and vaccination service was created, health education activities were permanently carried out, and intersectoral and community relations were developed through constant work with teachers, neighbors, and associations of neighbors and parents. Every three months, a technical-administrative staff meeting was held with all the staff of the unit, to analyze the health situation based on epidemiological work.(1)
During the first decade of the triumph of the Revolution (1959-1969), the health system recognized the performance of analysis of health problems at higher, intermediate and local levels before making decisions, in addition to the experience in the Polyclinic «Aleida Fernández Chardiet». Coinciding with the start of the National Health System (NHS), a guide was used for regulatory purposes that provided information on the health situation in a very descriptive way -diagnostic of health-, and which was promoted by the regional organization CENDES-OPS. Its extension limited daily utility, in addition to its well-defined purpose was related to the binomial planning/resources; hence the mistake of moving these indicators schematically to the community context. From an early stage as 1962, the concepts «epidemiological picture» and «hygienic picture» were incorporated, with them it was intended to characterize the areas, municipalities, provinces and even the country.(1,2)
At the end of the 1980s, the health status of the population was studied only by mortality, morbidity and other damages indexes; Later, with the application of the scientific method to the study of social health, the «causal analysis» of the identified health problems was included and of course its solution, this process was called the Health Situation Diagnosis (HSD).
In 1992, the concept was changed to Analysis of the comprehensive Health Situation (ACHS), proposed by PAHO, since in practice the step of identifying the causes of the problems was ignored. The term created some confusion because its meaning was the same as that of the (HSD). In Cuba the use of the term (ACHS) was extended, but in other countries the term of the (HSD)and other concepts such as Health Plan and Problem Solving Process (PSP) are maintained.
The HSD-ACHS-PSP in groups, community or the whole population is considered as an operational research in health systems and services, which applies the scientific method, as in the clinic, with the difference that it applies to the generally ill individual.(2,3,4)
The HSD or ACHS is an essential instrument for any level of the health system and it´s fundamental in primary care, in order to know the current status of a population's health level, to identify its problems and causes in order to control or eradicate them, which allows eliminating its causal factors to improve social health.
To better understand the HSD-ACHS-PSP, the category «health» should be considered as a process in the life of men, in relation to their physical, mental and social well-being, which is general, particular or individual, dynamic and variable , expressed by the living conditions with their determinants or mediators (as independent variables) of the socioeconomic, natural and biological environment; and whose product, effects or results can be measured by the components (or dependent variables) of the health status of the population.(1)
The HSD)-ACHS or PSP can be operationally defined in the following way: it is the procedure that applies the scientific method to analyze the health situation of groups, community or population, in order to identify or diagnose health problems, determine their causal factors that allow its control or elimination, for the solution of the detected problems, so the ACHS is defined as a process by means of which the health services and the community, jointly, carry out a description and explanation of the socio-epidemiological profile in a specific area of the behavior of the health-disease process and its interrelations with the environment.(5) It constitutes the appropriate scientific-methodological instrument to identify, prioritize and solve the problems of a given community, with a positive impact on the modification of the health status of its inhabitants.
It is the main research work of the General practitioner and its objectives include: understanding the causes and consequences of community health problems, estimating the needs of the population, performing causal investigations based on the problems detected, making proposals to improve its quality and usefulness, and evaluate medical and dentistry care.
With the emergence of the new university polyclinic model and the presence of students from the first year of the career in primary care, the conditions have been created to carry out the teaching of the analysis of the health situation with greater efficiency and quality.
The analysis of the health situation identifies the health problems and establishes priorities to adopt an intervention plan with specific measures and specific deadlines that allow improving the health status of the community. It goes through six stages: obtaining information, analyzing and interpreting information, identifying health problems, prioritizing these problems, the action plan for prioritized problems, and monitoring and evaluating the action plan.(6,7)
When identifying health problems, the general practitioner must have this concept well defined: it is nothing more than the gap that exists between what at social actor expects to find and what actually exists, it´s an undesirable situation that needs to be modified, and that it will continue to exist if something is not done to change it, it is the difference between what it is and what it should be.
To identify them and determine their priority, specific qualitative techniques are used: in the identification, the analysis of indicators , brain storming, the nominal group and the focal group; to prioritize them, the method of ranking -the most used- and Hamlon's, among others.(8,9)
From the identification and diagnosis phase, actions are defined to undertake the solution of the main health problems with the active participation of the community, this plan contains the objectives, activities to achieve them, implementation time and those responsible (phase of action). The ACHS is the process through which the different sectors of the community itself, in a joint manner and led by the health sector, identify, from their perception, the main problems or risks that affect their health situation and undertake responsible and sustainable actions to its positive transformation.(9)
BIBLIOGRAPHIC REFERENCES
1. Martínez Calvo S, Pría Barros MC. Análisis de la situación de salud. En: Medicina General Integral. La Habana: Ed Ciencias Médicas; 2014: p. 665-675.
2. Borroto Chao R. Participación popular en el análisis de la situación de salud. Identificación y priorización de problemas. En: Medicina General Integral. La Habana: Ed. Ciencias Médicas; 2014: p.684-687.
3. Presno Labrador MC, Fernández Díaz IE, Cuesta Mejías L. Análisis de la situación de salud con enfoque de género. Rev Cubana Med Gen Integr [Internet]. 2014 [citado 06/03/2018];30(2):[aprox. 7 p.]. Disponible en: http://scielo.sld.cu/pdf/mgi/v30n2/mgi09214.pdf
4. Sansó Soberats FJ. Análisis de la situación de salud en Cuba. Rev Cubana Salud Pública [Internet]. 2003 [citado 26/01/2019];29(3):[aprox. 8 p.]. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0864-34662003000300010&lng=es
5. López-Lara R. Análisis de la situación de salud poblacional en América Latina y el Caribe, entre 2000 y 2017. Reflexiones y desafíos. Rev Facultad Nacional de Salud Pública [Internet]. 2018 [citado 25/01/2019];36(3):[aprox. 12 p.]. Disponible en: http://aprendeenlinea.udea.edu.co/revistas/index.php/fnsp/article/view/330061
6. Zacca Peña E, Zacca González G, Rodríguez Hernández P. Epidemiología de la Atención Primaria de Salud. En: Álvarez Sintes R. Medicina General Integral. La Habana: Ed. Ciencias Médicas; 2014: p.728-786.
7. Alemañy Pérez EJ, Segredo Pérez AM, Presno Labrador MC, de la Torre Castro GM. Aproximación de la universidad a la situación de salud de la población y a los servicios de salud en Cuba. Rev Cubana Med Gen Integr [Internet]. 2011[citado 06/03/2015];27(4):[aprox. 12 p.]. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0864-21252011000400012&lng=es&nrm=iso&tlng=es
8. Rojas Ochoa F. Interdisciplina e intersectorialidad. Rev Cubana Salud Pública [Internet]. 2010 [citado 06/09/2018];36(3):[aprox. 1 p.]. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0864-34662010000300001&lng=es
9. Martínez Calvo S. Renovación del Análisis de Situación de Salud en los servicios de medicina familiar en Cuba. Rev Cubana Salud Pública [Internet]. 2013 [citado 01/09/2018];39(4):[aprox. 11 p.]. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0864-34662013000400011&lng=es
Declaration of interests
The authors declare no conflict of interest.
Contribution of the authors
Liliam María Mejías Chao and Marilyn Hernández Gómez: they carried out the bibliographical searches and wrote the article.
Miriam María González Morrell: analyzed the searches and helped in the creation of the article.
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