Revista Panamericana De Salud Publica-pan American Journal of Public Health最新文献

{"title":"Point prevalence survey of antibiotics in a pediatric tertiary hospital in the Republic of Panama.","authors":"Ximena Norero, Dora Estripeaut, Elizabeth Castaño, Jacqueline Levy, Paola Lichtenberger, José Pablo Díaz-Madriz, José Luis Bustos, Robin Rojas Cortés, Gabriel Levy-Hara","doi":"10.26633/RPSP.2025.7","DOIUrl":"10.26633/RPSP.2025.7","url":null,"abstract":"<p><strong>Objective: </strong>To conduct a point prevalence survey (PPS) of antibiotic use in the main pediatric tertiary-level hospital in Panama City to establish antibiotic prevalence and identify key areas for addressing antimicrobial resistance.</p><p><strong>Methods: </strong>This point prevalence survey (PPS) conducted in a tertiary-level hospital in Panama followed the Pan American Health Organization's adaptation of the methodology proposed by the World Health Organization for PPSs on antibiotic use. Information obtained included patients' demographic characteristics, antimicrobial prescriptions, indication for antimicrobial use, and prescription's adherence to guidelines.</p><p><strong>Results: </strong>Of 298 patients surveyed from August to September 2023, 176 (59.0%) were treated with antibiotics. The pediatric ward (86.3%) and the neonatal intensive unit (80.0%) had the highest prevalence of antibiotic use. Hospital-acquired infections accounted for 32.6% of antibiotic prescriptions, with piperacillin/tazobactam (29.4%), meropenem (15.3%), amikacin (15.3%), and ampicillin/sulbactam (10.2%) being the most prescribed. Treatment for community-acquired infections represented 55.9% of antibiotic prescriptions, with ampicillin (24.6%), gentamicin (22.6%), and ampicillin/sulbactam (14.0%) being the most frequently used. Of the prescriptions considered in the analysis, 61.0% adhered to hospital guidelines.</p><p><strong>Conclusions: </strong>This PPS observed a high prevalence of antibiotic use. The findings suggest it is necessary to assess the need for ampicillin, gentamicin, and piperacillin-tazobactam use in patients admitted to pediatric critical care units, with special emphasis on children with pneumonia and sepsis diagnosis, the most common pathologies for which an antimicrobial was prescribed.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"49 ","pages":"e7"},"PeriodicalIF":2.0,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143010831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Knowledge, practices, and human seroprevalence of brucellosis in the central dairy-producing area of Cochabamba, BoliviaConhecimentos, práticas e soroprevalência humana de brucelose na área central de produção de laticínios de Cochabamba, Bolívia].","authors":"Rosse Mary Yanez, Rocío Quitón, Ernesto Rojas, Tania Vargas, Daniel Eid, Jean-Jacques Letesson, Patricia Rodríguez","doi":"10.26633/RPSP.2025.5","DOIUrl":"10.26633/RPSP.2025.5","url":null,"abstract":"<p><strong>Objective: </strong>To validate the applicability of the Rose Bengal (RB) test, indirect IgG or IgM enzyme-linked immunosorbent assay (ELISA), and the Brucellacapt test^® to the local context, determine the seroprevalence of brucellosis, and evaluate knowledge of the disease in people at risk in a dairy-producing area of La Maica, Cochabamba (Plurinational State of Bolivia).</p><p><strong>Method: </strong>The tests were initially validated with a group of 76 people; the final study population was 330 people, who also participated in a socio-epidemiological survey.</p><p><strong>Results: </strong>Of 330 samples tested, 12.7% were positive, using either the RB or Brucellacapt test^®. The indirect IgG ELISA gave false positive results, indicating that the cut-off point should be adapted to the local epidemiological situation. Almost all RB-positive cases were asymptomatic. The socio-epidemiological survey highlights a lack of information and awareness about brucellosis, with regard to its zoonotic nature, mode of transmission, and symptoms.</p><p><strong>Conclusion: </strong>This study revealed a high seroprevalence of brucellosis in the La Maica dairy-producing area in Cochabamba (Plurinational State of Bolivia), with many asymptomatic cases and a high number of false positives from IgG indirect ELISA. It is recommended to conduct awareness-raising campaigns on the risks of this disease and to discourage the consumption of raw milk.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"49 ","pages":"e5"},"PeriodicalIF":2.0,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744334/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143010830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Analysis of the surveillance system for adverse events following Immunization (AEFI) related to COVID-19 vaccines in Colombia, 2021-2023Análise do sistema de vigilância de ESAVI por vacinas contra a COVID-19 na Colômbia, 2021-2023].","authors":"William Saza-Londoño, Diana Yisenia Pinzón-Fajardo, María Victoria Urrea-Duque, Eliana Lizeth Pinzón-Niño, Edna Margarita Sánchez-León, Katterine Isabel Urieles-Sierra, Carlos Andrés Pinto-Díaz, Helvert Felipe Molina-León","doi":"10.26633/RPSP.2025.2","DOIUrl":"https://doi.org/10.26633/RPSP.2025.2","url":null,"abstract":"<p><strong>Objective: </strong>To describe the functioning of the surveillance system for adverse events following immunization (AEFI) in Colombia using the evaluation tools proposed by the World Health Organization (WHO).</p><p><strong>Method: </strong>Descriptive study of the performance of the AEFI surveillance system for COVID-19 vaccines between 17 February 2021 and 30 September 2023. WHO indicators for structure, process, and results were adapted. Qualitative information was obtained from official documents and technical consultations, while quantitative data were obtained from VigiFlow^® and from the Integrated Social Protection Information System.</p><p><strong>Results: </strong>In its capacity as the regulatory authority, the National Institute for Drug and Food Surveillance (INVIMA) collaborated with the Ministry of Health and Social Protection and the National Institute of Health in the pharmacovigilance of COVID-19 vaccines. Expert committees were established at the national and subnational levels to evaluate AEFI. VigiFlow^® was implemented for case reporting and management, training was promoted, and signs and regulatory actions were detected, based on Pan American Health Organization (PAHO) and WHO protocols. Information on AEFI was disseminated through bulletins. Technical cooperation between INVIMA and PAHO was strengthened.</p><p><strong>Conclusions: </strong>The AEFI surveillance indicators for COVID-19 were met. The regulations and functions of the health authorities provided a solid basis for vaccine pharmacovigilance activities, allowing effective use of technical resources. A regulatory framework for non-COVID-19 vaccines, continuous training, and greater automation is needed in order to improve the capacity of the vaccine safety program.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"49 ","pages":"e2"},"PeriodicalIF":2.0,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744332/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143010761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of an agenda for research and action on climate change and health in the Caribbean.","authors":"Saria Hassan, Calae Philippe, Renée M West, Shelly McFarlane, Karen Polson-Edwards, Georgiana Gordon-Strachan, C James Hospedales, Robert Dubrow, Caroline F Allen","doi":"10.26633/RPSP.2025.4","DOIUrl":"10.26633/RPSP.2025.4","url":null,"abstract":"<p><p>This paper delineates the development of the Caribbean Research for Action Agenda which aims to empower Caribbean Small Island Developing States to reduce their vulnerabilities to the effects of climate change on health. The Caribbean Research for Action Agenda emerged from collaboration between nongovernmental organizations, academic institutions, and multilateral agencies that organized a conference on climate change and health in the Caribbean. This Agenda was formulated by prioritizing research areas, synthesizing evidence from conference presentations and scientific literature, and holding consultations with stakeholders and experts. The Agenda provides information on 18 priority areas for research and action categorized into four domains: climate change health impacts, exposures, and vulnerability; adaptation, planning, and resilience for health; mitigation actions and health co-benefits; and resources and engagement for climate change and health action. Cross-cutting findings underscore the need for: greater public and professional awareness; a more climate-literate health workforce; interdisciplinary collaboration to address institutional silos; attention to social and economic mediating factors; equitable interventions for vulnerable groups; and enhanced monitoring and surveillance of climate-sensitive health outcomes. The Caribbean Research for Action Agenda is a foundational tool to inform research, guide multisectoral collaboration and capacity-building, develop evidence-based policy, and inspire community action-based advocacy related to climate change and health.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"49 ","pages":"e4"},"PeriodicalIF":2.0,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11726121/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142984673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Pharmacovigilance of COVID-19 Vaccines in Brazil: Actions Taken, Lessons Learned, and Next StepsFarmacovigilancia de las vacunas contra la COVID-19 en Brasil: medidas adoptadas, enseñanzas extraídas y próximos pasos].","authors":"Roberta Mendes Abreu Silva, Cibelle Mendes Cabral, Jadher Percio, Martha Elizabeth Brasil da Nóbrega, Carla Dinamerica Kobayashi, Adriano Ferreira Martins, Felipe Daniel Cardoso, Victor Bertollo Gomes Porto, Leon Capovilla, Mônica Brauner de Moraes, Paulo Henrique Santos Andrade, Eder Gatti Fernandes","doi":"10.26633/RPSP.2025.1","DOIUrl":"10.26633/RPSP.2025.1","url":null,"abstract":"<p><strong>Objective: </strong>To document the actions taken by Brazil's National Immunization Program for the pharmacovigilance of COVID-19 vaccines.</p><p><strong>Methods: </strong>Documentary research on the period 2020 to 2023. Documentary sources from the national Ministry of Health during COVID-19 vaccination were used to analyze and interpret the actions taken. The analysis was split into two stages: preparation and operationalization. The publications were organized according to title, date of publication, description, and URL.</p><p><strong>Results: </strong>A total of 86 documents published during the preparation and operationalization of vaccination were found and evaluated. In the preparation phase, a technical advisory board on immunization was set up and specific technical notes were published for COVID-19 vaccines and the introduction of a new information system. In the operationalization stage, the Interinstitutional Committee for Pharmacovigilance of Vaccines and other Immunobiologicals was created. Also, hospital sentinel surveillance systems were established for adverse events of special interest, and surveillance of COVID-19 vaccination safety in pregnant women was implemented.</p><p><strong>Conclusion: </strong>Pharmacovigilance was strengthened in the context of COVID-19 vaccination in Brazil. Given the gaps in knowledge about the new vaccines, as well as the <i>infodemic</i> surrounding them, it was necessary to adopt strategies to complement the passive surveillance system for monitoring vaccination safety. Inter-institutional collaboration, the availability of additional resources, and flexible and timely information systems all contributed to a comprehensively effective preparation and response in the pharmacovigilance of COVID-19 vaccines in Brazil.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"49 ","pages":"e1"},"PeriodicalIF":2.0,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11726120/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142984669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mental health risk communication and community participation among an Indigenous people in Colombia.","authors":"Felipe Agudelo-Hernández, Lizeth Paola Coral-Vela, Luz Helena Pabuena-Yepes","doi":"10.26633/RPSP.2025.12","DOIUrl":"10.26633/RPSP.2025.12","url":null,"abstract":"<p><strong>Objectives: </strong>To describe and analyze a community participation process to develop recommendations for adequate communication of mental health risks among the Wayuú people of Colombia.</p><p><strong>Methods: </strong>This qualitative study conducted focus groups in the Indigenous cities of Albania and Uribia, Colombia, from January to June 2024, to assess perspectives on mental health risk communication. Participants were adults (>18 years) residing in two municipalities in La Guajira (Uribia and Albania [the Indigenous capital of Colombia]) and included youth group leaders, Indigenous representatives, migrant population representatives, and representatives of official institutions in the region. Thematic analysis was used for data analysis.</p><p><strong>Results: </strong>In total, 42 participants (mean [SD] age, 20.1 years; 24 [57.1%] women and 18 [42.9%] men) participated in four focus groups (two in Albania and two in Uribia). Three main themes were identified in the thematic analysis: consequences of poor communication; community advice for social communication; and recommendations for public mental health in health communication. Based on the data analysis, recommendations for mental health risk communication were proposed for both municipalities and for the territory of La Guajira, Colombia.</p><p><strong>Conclusions: </strong>The findings of this qualitative study highlight the need to improve mental health communication among the Indigenous community by leveraging their perspectives. The involvement of community leaders and the development of mental health communication strategies are needed.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"49 ","pages":"e12"},"PeriodicalIF":2.0,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11726122/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142984685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Brazil's response to public health emergencies in 2023: lessons for the international community.","authors":"Ana Sara Semeão de Souza, João Roberto Cavalcante, Raquel Proença, Carlos Henrique Michiles Frank, Thiago Basílio Mendonça, Giovana Ferreira Costacurta, Igor de Assis Rodrigues, José Lucas Pinho da Fonseca, Daniel Roberto Coradi de Freitas, Edenilo Baltazar Barreira Filho, Ethel Leonor Noia Maciel, Márcio Henrique de Oliveira Garcia","doi":"10.26633/RPSP.2025.15","DOIUrl":"10.26633/RPSP.2025.15","url":null,"abstract":"<p><strong>Objective: </strong>To describe the Brazilian experience of responding to public health emergencies in 2023, the organizational structure, and epidemiological characteristics.</p><p><strong>Methods: </strong>Three emergencies (case studies) that occurred during the study year were analyzed according to the actions implemented during the response and the impacts on the population. The public health emergencies were summarized and analyzed through research on official documents and websites of the Ministry of Health and local health authorities.</p><p><strong>Results: </strong>Case 1 - Emergency due to lack of assistance, considered by the Brazilian government to be a public health emergency of national importance, required an Emergency Operations Center (EOC) for the response due to the complexity of the actions. Case 2 - Emergency due to zoonoses (arboviruses and avian influenza) used the EOC response structure to develop activities aimed at stopping the emergence of arboviruses and preventing an avian influenza emergency in the country. Finally, case 3 - Emergencies due to disasters required local response structures and used the EOC to coordinate their actions with the federal government's support.</p><p><strong>Conclusions: </strong>The Brazilian experience highlights the importance of intrasectoral and intersectoral coordination in managing response actions, constant monitoring and communication to improve response measures, national support for local response efforts, and adaptation of the EOC structure to the different contexts and complexities of the emergencies faced.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"49 ","pages":"e15"},"PeriodicalIF":2.0,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11726124/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142984671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Controlling cystic echinococcosis: outlook in the 21st centuryControle da equinococose/hidatidose cística: perspectivas no século XXI].","authors":"Edmundo Larrieu, Renato Vieira Alves, Marco Vigilato","doi":"10.26633/RPSP.2025.13","DOIUrl":"10.26633/RPSP.2025.13","url":null,"abstract":"<p><p>Cystic echinococcosis (CE) is a serious public health problem in South America, one that the Pan American Health Organization (PAHO) has included in its Plan of Action for the Control of Neglected Infectious Diseases. A logical framework for CE control was defined: this includes establishing the objective to be achieved (eradication or elimination as a public health problem) and determining levels of endemicity which serve as a guide for establishing frequencies of intervention (high endemicity, endemic, and low endemicity, according to rates in the different hosts). There are two validated tools for CE control: systematic deworming of dogs using praziquantel (PZQ) and systematic vaccination of sheep with recombinant EG95 protein, or a combination of both tools. Complementary strategies include the development of sanitary infrastructure on ranches, health education, and active searches for asymptomatic cases followed by timely treatment.Decreased prevalence in dogs and sheep is associated with a loss of acquired immunity, making the animals susceptible to infection.Although ready-to-use tools are available, CE control continues to present difficulties. It is vital that the Veterinary Public Health Unit of PAHO's Pan American Center for Foot-and-Mouth Disease and Veterinary Public Health (PANAFTOSA/VPH-PAHO/WHO) provide support to national programs and local efforts under the CE Initiative for control and surveillance in South America, promoting novel strategies for disease control and early diagnosis of human cases, with a One Health approach.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"49 ","pages":"e13"},"PeriodicalIF":2.0,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11726123/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142984668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospital-based health technology assessment (HTA) in Latin America and the Caribbean: a scoping review.","authors":"Alex Itaborahy, Vania Cristina Canuto Santos, Flávia Cristina Ribeiro Salomon, Caroline Bregman, Iandy Mateus, Marisa Santos","doi":"10.26633/RPSP.2025.8","DOIUrl":"10.26633/RPSP.2025.8","url":null,"abstract":"<p><strong>Objective: </strong>To provide an overview of hospital-based health technology assessment (HB-HTA) activities in Latin America and the Caribbean, including the technologies assessed, resources utilized, evaluation methods employed, and challenges encountered.</p><p><strong>Methods: </strong>A scoping review focused on HB-HTA using frameworks from the Joanna Briggs Institute was conducted across databases and gray literature.</p><p><strong>Results: </strong>Seventeen studies were identified, and another two documents were retrieved manually at a conference, totaling 19 files. Brazil emerged as a key player in HB-HTA activities in Latin America and the Caribbean, with public teaching hospitals leading the efforts. The primary focus of HB-HTA units was assessing medicines/pharmaceuticals and medical devices, using budget impact and cost-effectiveness/utility analyses as the main appraisal tools. The review also identified challenges such as limited human resources and financial support.</p><p><strong>Conclusions: </strong>The study highlights a growing interest in HB-HTA in Latin America and the Caribbean, driven primarily by public institutions. The findings underscore the need for tailored approaches to strengthen evidence-based decision-making in healthcare settings and address the challenges of the region's limited resources and financial constraints.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"49 ","pages":"e8"},"PeriodicalIF":2.0,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11726125/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142984681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Regulation and performance of health systems: a review of analytic frameworksRegulamentação e desempenho dos sistemas de saúde: revisão das estruturas analíticas].","authors":"Ernesto Báscolo, David Debrott Sánchez, Natalia Houghton, Carina Vance","doi":"10.26633/RPSP.2024.42","DOIUrl":"10.26633/RPSP.2024.42","url":null,"abstract":"<p><p>The private health sector has expanded significantly in recent decades, both in Latin America and other regions. Governments and international organizations have dealt with this process in a heterogeneous manner. A policy approach and, above all, a regulatory framework, are required in order to put health objectives and the right to health above the profit motive that drives private sector participation. This paper reviews frameworks for analyzing the performance of health systems and the regulation of financing and service provision, primarily (but not exclusively) in the private sector. This review covers the output of the main international health agencies (Pan American Health Organization and World Health Organization), international development agencies (World Bank and Organization for Economic Cooperation and Development), and academics involved in international health policy debates. Common aspects of the different frameworks are identified, as well as substantive divergences. The purpose of this article, which is part of a larger project, is to contribute to discussions on the regulation of health systems in the Region of the Americas, consider their particularities, and describe the current context.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"48 ","pages":"e42"},"PeriodicalIF":2.0,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11662288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142877835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}