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

{"title":"Integrated control of neglected tropical diseases in Brazil: document review of a national campaign in light of WHO recommendations.","authors":"Rosa Castália Ribeiro Soares,&nbsp;Amanda Gabriela de Carvalho,&nbsp;João Gabriel Guimarães Luz,&nbsp;Ana Luiza Zílio Lucas,&nbsp;Eliane Ignotti","doi":"10.26633/RPSP.2023.23","DOIUrl":"https://doi.org/10.26633/RPSP.2023.23","url":null,"abstract":"<p><strong>Objective: </strong>To describe the results of a national campaign aimed at the integrated control of neglected tropical diseases in Brazil in light of the World Health Organization (WHO) official documentation related to the integration of strategies for the prevention, control, and elimination or eradication of neglected tropical diseases.</p><p><strong>Methods: </strong>A document review that included official WHO documents published between 2007 and 2020 and campaign results extracted from the official technical report produced by the Brazilian Ministry of Health.</p><p><strong>Results: </strong>The integrated control of neglected tropical diseases was gradually incorporated in the WHO documentation over time. Preventive chemotherapy through mass drug administration, intensified case management, and integrated vector management were extensively recommended as strategies for integrated control. The Brazilian campaign was carried out in four iterations between 2013 and 2017. Children aged 5 to 14 years enrolled in municipal public schools nationwide were targeted. In summary, a total of 1 074 and 73 522 new cases of leprosy and trachoma, respectively, were detected. Nearly 18 million doses of preventive chemotherapy for soil-transmitted helminthiasis were administered. More than 700 cases of schistosomiasis were diagnosed and treated.</p><p><strong>Conclusions: </strong>The integrated strategies implemented in Brazil throughout the campaign generated results aligned with the WHO recommendations for the control of neglected tropical diseases, especially those regarding mass drug administration, active case detection, and intensified case management. Therefore, the continuity of the campaign with adequate evaluation tools must be encouraged as a constant public health policy in the Brazilian government agenda.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"47 ","pages":"e23"},"PeriodicalIF":2.6,"publicationDate":"2023-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/0c/f6/rpsp-47-e23.PMC10521583.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41157727","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":"The SickKids Caribbean Initiative to improve care for children with cancer and blood disorders.","authors":"Michelle Reece-Mills,&nbsp;Jo-Anna B Baxter","doi":"10.26633/RPSP.2023.130","DOIUrl":"https://doi.org/10.26633/RPSP.2023.130","url":null,"abstract":"<p><p>To improve pediatric hematology and oncology outcomes, there is a recognized potential for partnerships between low- and high-resource institutions within health care systems. The SickKids Caribbean Initiative is a partnership between health care professionals at the Hospital for Sick Children in Toronto, Canada, and seven Caribbean institutions across six countries (Bahamas, Barbados, Jamaica, Saint Lucia, Saint Vincent and the Grenadines, and Trinidad and Tobago). The primary aim of the SickKids Caribbean Initiative has been to improve the outcomes and the quality of life of children in the Caribbean aged <18 years who have cancer and blood disorders. This article describes five key activities undertaken within the SickKids Caribbean Initiative, including providing education and training, assisting with case consultations and diagnostic services, developing local oncology databases, engaging in advocacy and ensuring stakeholder engagement, and coordinating administration and project management.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"47 ","pages":"e130"},"PeriodicalIF":2.6,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/49/cc/rpsp-47-e130.PMC10516326.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41152695","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":"Regional collaboration for the development of national childhood cancer plans in Latin America and the Caribbean.","authors":"Patrícia Loggetto,&nbsp;Marta Jarquin-Pardo,&nbsp;Soad Fuentes-Alabi,&nbsp;Liliana Vasquez,&nbsp;Sara Benitez Majano,&nbsp;Alejandra Gonzalez Ruiz,&nbsp;Mauricio Maza,&nbsp;Monika L Metzger,&nbsp;Paola Friedrich,&nbsp;Silvana Luciani,&nbsp;Catherine G Lam","doi":"10.26633/RPSP.2023.125","DOIUrl":"https://doi.org/10.26633/RPSP.2023.125","url":null,"abstract":"<p><p>This article aims to describe the activities conducted by the National Childhood Cancer Plan Working Group to support the development of national childhood cancer plans in Latin America and the Caribbean in the period 2019-2022, and to present the stage of plan development. The Working Group activities were supported by the Pan American Health Organization and St. Jude Children's Research Hospital, which is the World Health Organization (WHO) Collaborating Centre for Childhood Cancer. Year after year, the workshops and activities developed with the Working Group mobilized key stakeholders: pediatric oncologists, representatives of the Ministry of Health, foundations supporting childhood cancer initiatives, and hospital administrators. As of February 2023, one regional framework is in place, approved by the Council of Ministries of Health of Central America and the Dominican Republic, nine countries are currently implementing national plans or laws that include childhood cancer, and ten countries are writing new plans. The WHO three-step framework helped to guide the Working Group activities. All plans were supported by a situational analysis, which highlighted the importance of having systematized data for evidence-based policies. To increase implementation success, an accompanying budget and timeline help to ensure the adequate implementation of the interventions. More than anything, committed stakeholders remain the most fundamental element to successfully write and approve a national childhood cancer plan. This is an opportunity to share these countries' experience so the strategy can be adapted to support other countries developing a childhood cancer plan and extended to other public health areas.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"47 ","pages":"e125"},"PeriodicalIF":2.6,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d4/b5/rpsp-47-e125.PMC10516325.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41133172","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":"[The role of civil society in improving childhood cancer care in Latin AmericaO papel da sociedade civil na melhoria da atenção ao câncer infantil na América Latina].","authors":"C Marcela Zubieta Acuña","doi":"10.26633/RPSP.2023.104","DOIUrl":"https://doi.org/10.26633/RPSP.2023.104","url":null,"abstract":"<p><p>In Latin America, childhood cancer includes a number of resource-intensive diseases, with inequalities in access to timely and appropriate diagnosis and treatment. In this context, civil society plays a fundamental role in improving childhood cancer care. The Region's organizations in this sector have become stronger and they now play a leading role in the delivery of services and in the promotion of awareness and advocacy for children's health. The Global Initiative for Childhood Cancer, promoted by the World Health Organization and other relevant actors, is an opportunity for governments and civil society to work together to implement best practices in the control of childhood cancer. This article addresses the role of civil society in the care of pediatric cancer in Latin America, highlighting the importance of its commitment to the fight against cancer, participation in awareness-raising, and defense of public policies that favor access to quality health services. It also focuses on the problems and opportunities for civil society in the Region in relation to the implementation of strategies to improve the survival and quality of life of children and adolescents living with cancer.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"47 ","pages":"e104"},"PeriodicalIF":2.6,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/91/5d/rpsp-47-e104.PMC10516327.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41146048","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":"Strengthening public health policies for childhood cancer: Peru's achievements through the WHO Global Initiative for Childhood Cancer.","authors":"Essy Maradiegue,&nbsp;Claudia Pascual,&nbsp;Liliana Vasquez,&nbsp;Ivan Maza,&nbsp;Cecilia Ugaz,&nbsp;Jackeline Montoya,&nbsp;Arturo Zapata,&nbsp;Henry García,&nbsp;Sharon Chavez,&nbsp;Katy Ordoñez,&nbsp;Jonathan Rossi,&nbsp;Rosdali Diaz,&nbsp;Roxana Morales,&nbsp;Viviana Trigoso,&nbsp;Romy Ames,&nbsp;Edinho Celis,&nbsp;Isela Barzola,&nbsp;Liliana Torres,&nbsp;Melitta Cosme,&nbsp;Fanny Tarrillo,&nbsp;Ninoska Rojas,&nbsp;Carlos Santillan,&nbsp;Yuly Quispe,&nbsp;Víctor Palacios,&nbsp;Victoria Godoy,&nbsp;Mariela Tello,&nbsp;Duniska Tarco,&nbsp;Antonio Wachtel,&nbsp;Estela Malaver,&nbsp;Elizabeth Diaz,&nbsp;Marlene Goyburu,&nbsp;Vivian Perez,&nbsp;Ivy Talavera,&nbsp;Maria Edith Baca,&nbsp;Mauricio Maza,&nbsp;Lily Saldaña,&nbsp;Alexis Holguin,&nbsp;Marta Jarquin,&nbsp;Patricia Loggetto,&nbsp;Monika Metzger,&nbsp;Paola Friedrich,&nbsp;Cath Lam,&nbsp;Carlos Rodriguez Galindo","doi":"10.26633/RPSP.2023.132","DOIUrl":"https://doi.org/10.26633/RPSP.2023.132","url":null,"abstract":"<p><strong>Objective: </strong>To report the progress in Peru, since June 2019, in the implementation of the World Health Organization Global Initiative for Childhood Cancer using the Cure<i>All</i> framework, which can be replicated in low- and middle-income countries.</p><p><strong>Methods: </strong>A mixed method was used of participatory and documentary evaluation. The participatory evaluation included stakeholders from various government institutions, nonprofit organizations, and international partners. The documentary aspect consisted of a review of data on the regulatory environment, national projects, and interventions implemented. The Ministry of Health engaged more than 150 participants to form working committees, which have developed policy and regulatory documents to strengthen care services.</p><p><strong>Results: </strong>Achievements include a decrease in the national treatment abandonment rate from 18.6% to 8.5%, the approval of the Childhood Cancer Law, improvements in the management of patients with febrile neutropenia, and a reduction in rates of events of clinical deterioration and mortality of hospitalized patients. The Cure <i>All</i> implementation framework allows local teams to implement specific strategies and monitor early outcomes in pediatric oncology.</p><p><strong>Conclusions: </strong>The results obtained reflect the teamwork, the leadership of the authorities, the technical support of professionals, and the support of involved organizations. Further actions will be needed to guarantee sustainability, and monitoring tools are needed to assure success in the planned activities.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"47 ","pages":"e132"},"PeriodicalIF":2.6,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/db/96/rpsp-47-e132.PMC10516323.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41169710","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":"Health literacy on quality of life for children with cancer: modules on pediatric palliative care.","authors":"Ximena García-Quintero, Daniel Bastardo Blanco, Liliana Vásquez, Soad Fuentes-Alabí, Sara Benites-Majano, Mauricio Maza, Cecilia Ugaz, Roxana Morales, Justin N Baker, Michael J McNeil","doi":"10.26633/RPSP.2023.134","DOIUrl":"10.26633/RPSP.2023.134","url":null,"abstract":"<p><strong>Objective: </strong>To describe the development of educational materials for parents and other caregivers of children with cancer, which utilized a culturally sensitive approach to reduce acceptance barriers to palliative care (PC).</p><p><strong>Methods: </strong>The Pan American Health Organization (PAHO), St. Jude Children's Research Hospital, and partners in Latin America and the Caribbean collaborated in a three-phase project, beginning with a needs assessment survey of caregivers of children with cancer in Peru. Based on this finding, an interdisciplinary team of pediatric PC experts developed educational content that was designed and validated by an international committee of PC and communication experts.</p><p><strong>Results: </strong>The collaboration resulted in the development of an eight-module series that introduces caregivers to key concepts of pediatric PC, including management of pain, quality of life, and end of life care. The series was designed to reduce caregiver stigma associated with PC through culturally sensitive education that addresses the low levels of health literacy among caregivers in Latin America and the Caribbean. In the 15 months since the launch, these modules have been distributed throughout Latin America and were downloaded 2 825 times.</p><p><strong>Conclusions: </strong>Educational materials and anticipatory guidance of PC were considered to be a priority for parents and other caregivers of children with cancer throughout Latin America. The materials developed through this project have been widely utilized and are available through the PAHO website and the <i>Together by St. Jude™</i> online resource.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"47 ","pages":"e134"},"PeriodicalIF":2.6,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e9/e7/rpsp-47-e134.PMC10516324.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41164785","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":"Advances in the Global Initiative for Childhood Cancer: implementation in Latin America and the Caribbean.","authors":"Liliana Vásquez, Soad Fuentes-Alabí, Patricia Loggetto, Sara Benitez-Majano, Monika L Metzger, Marta Jarquin-Pardo, Naomi Echeandia-Abud, Sumit Gupta, Avram Denburg, Paola Friedrich, Roberta Ortiz, Catherine Lam, Silvana Luciani, Andre Ilbawi, Carlos Rodríguez-Galindo, Mauricio Maza","doi":"10.26633/RPSP.2023.128","DOIUrl":"10.26633/RPSP.2023.128","url":null,"abstract":"<p><p>This report describes the status of childhood cancer control initiatives in Latin America and the Caribbean (LAC). Progress between 2017 and 2023 is measured using the outcome indicators from the Pan American Health Organization (PAHO) childhood cancer logic model aligned with the World Health Organization Global Initiative for Childhood Cancer (GICC). This report also describes the advances, barriers, and facilitators for the implementation of the GICC at the Regional level. Methods used in this report encompassed a comprehensive approach, incorporating a literature review, interviews, surveys, and a Delphi study developed by the technical team of the PAHO Non-Communicable Diseases and Mental Health Department and by the GICC LAC working group. Since 2017, there has been a substantial increase in the number of countries that have included childhood cancer in their national regulations. Currently, 21 LAC countries are involved in the GICC implementation, activities, and dialogues. However, the objectives for 2030 will only be achieved if Member States overcome the barriers to accelerating the pace of initiative implementation. There is an urgent need to increase the efforts in childhood cancer control in LAC, especially regarding the prioritization of timely detection, essential diagnostics, access to cancer treatment, palliative care, and close follow-up of children and adolescents with cancer.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"47 ","pages":"e128"},"PeriodicalIF":2.6,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/1c/f1/rpsp-47-e128.PMC10516329.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41165743","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":"[Qualitative analysis of health preparedness policies in ChileUma análise qualitativa das políticas de preparação na área de saúde no Chile].","authors":"Clara Marín-Carballo, Mario Cruz-Peñate, María Pía Martín","doi":"10.26633/RPSP.2023.131","DOIUrl":"10.26633/RPSP.2023.131","url":null,"abstract":"<p><strong>Objective: </strong>Analyze health preparedness policies in Chile and identify their strengths and weaknesses. No other studies to date provide an analysis of the country's preparedness policies.</p><p><strong>Methods: </strong>A desk review and semi-structured interviews with experts in emergency preparedness and response were conducted to identify the regulatory framework, key actors, and the strengths and weaknesses of health preparedness policies.</p><p><strong>Results: </strong>The researchers identified 103 standards and interviewed seven preparedness experts. The reviewed standards and interviews show that Chile is in a transitional phase between the old National Civil Protection System and the new National Disaster Prevention and Response System. Only three standards were directly related to health, but the preparedness regulations provide for a multidisciplinary set of actors to address any threat. The experts gave a positive assessment of the Chilean system, although they agreed that certain weaknesses must be corrected. The country's main strength is its disaster response experience, along with its coordination mechanisms. The main shortcomings include risk communication, mitigation, preparedness and assessment, and human resources.</p><p><strong>Conclusions: </strong>Chile has a solid regulatory framework with an all-hazards approach and a set of multisectoral institutions. The new National Disaster Prevention and Response System must build on its strengths to correct the weaknesses that limit its emergency preparedness and response capacity.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"47 ","pages":"e131"},"PeriodicalIF":2.0,"publicationDate":"2023-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/0f/fd/rpsp-47-e131.PMC10464640.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10136704","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":"[Deaths from traffic injuries and social inequality in Colombia, 2019Mortalidade por acidentes de trânsito e desigualdades sociais na Colômbia, 2019].","authors":"Jackeline Murillo-Hoyos, Lina M García-Moreno, Natalia Tinjacá, Ciro Jaramillo","doi":"10.26633/RPSP.2023.121","DOIUrl":"10.26633/RPSP.2023.121","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the association between social inequalities and deaths from traffic injuries in Colombia in 2019.</p><p><strong>Methods: </strong>This ecological study evaluated the association between social inequalities and deaths from traffic injuries among users of the road transport system in Colombia in 2019, based on secondary information sources, using the department level as the administrative and geographic unit of study. A descriptive statistical analysis of health indicators and equity stratifiers was performed. Absolute and relative measures were used to determine social inequality gaps.</p><p><strong>Results: </strong>In 2019, 6 580 people died from road traffic injuries in Colombia. The majority of them (82%) were men. The most critical user condition was being a motorcyclist. The age group with the most victims was approximately 30 years old. Departments with populations between 500 000 and 2 000 000 were the most represented. The most critical equity stratifier was the number of registered motorcycles per 100 000 population. Significant inequality gaps between departments were observed.</p><p><strong>Conclusions: </strong>Inequalities in deaths from road traffic injuries in Colombia were observed. Policies and actions should focus on helping to reduce identified inequities, resulting in better quality of life, well-being, and health for the population.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"47 ","pages":"e121"},"PeriodicalIF":2.0,"publicationDate":"2023-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/bc/67/rpsp-47-e121.PMC10464641.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10127561","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":"Using mixed methods to understand and tackle barriers to accessing health services.","authors":"Natalia Houghton, Ernesto Bascolo, Andrés Coitiño, Theadora S Koller, James Fitzgerald","doi":"10.26633/RPSP.2023.117","DOIUrl":"10.26633/RPSP.2023.117","url":null,"abstract":"<p><p>This report describes the experience and lessons learnt from designing and implementing a combined quantitative and qualitative method to assess barriers to accessing health services. This approach was developed to study barriers to access in five dimensions: availability; geographical, financial, and organizational accessibility; acceptability; contact; and effective coverage. The study design was used in six countries in the World Health Organization Region of the Americas. The findings highlight the importance of having a well defined analysis framework and the benefits of adopting a mixed-methods approach. Using existing data and contextualizing findings according to specific population groups and geographical areas were essential for relevance and utilization of the study outcomes. The findings demonstrate the feasibility of using mixed methods to understand the complexity of access problems faced by different subpopulations. By involving decision-makers from the beginning and allowing flexibility for sustained discussions, the analysis and findings had an impact. The engagement of health authorities and key stakeholders facilitated the use of the findings for collaborative identification of policy options to eliminate access barriers. Lessons learnt from the study emphasized the need for active participation of decision-makers, flexibility in the process, and sustained opportunities for discussion to ensure impact. Giving consideration to local priorities and adapting the methods accordingly were important for the relevance and use of the findings. Future efforts could consider incorporating mixed methods into national and local monitoring and evaluation systems.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"47 ","pages":"e117"},"PeriodicalIF":2.6,"publicationDate":"2023-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b0/6f/rpsp-47-e117.PMC10441553.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10414371","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}