Plaaslike regerings speel 'n belangrike rol in die ontwikkeling van die lewensbestaan van plaaslike gemeenskappe in Suid-Afrika. Plaaslike regerings is verantwoordelik vir die verskaffing en lewering van basiese dienste soos lopende water, behoorlike sanitasie, skoon energie, afvalverwydering en ordentlike behuising. Openbare deelname (PP) is waarskynlik 'n noodsaaklike element van plaaslike demokrasie waardeur plaaslike gemeenskappe kan bydra tot verbeterde dienslewering. Die huidige studie het gefokus op die assessering van die rol van PP in dienslewering in die Ekurhuleni Metropolitaanse Munisipaliteit. Dit is gedoen deur 'n beskrywende navorsingsontwerp aan te neem. Data oor die faktore wat PP beïnvloed, is ingesamel van vier verskillende gemeenskapsgroepe (d.w.s. burgers, besighede, munisipale bestuurders en wykskomiteelede), met behulp van vraelyste en onderhoude. Die resultate het getoon dat inligting oor PP verkry word via radio, televisie, koerante en selfone. Oor die algemeen is die inisiatiewe wat aan die 'Batho Pele'-beginsels voldoen, aanvaarbaar in die Ekurhuleni-gemeenskap. Verder, met betrekking tot die kwaliteit van die dienste wat deur die munisipaliteit gelewer word, het die bevindinge vasgestel dat burgers saamstem dat die munisipaliteit bewus is van die diensgehalte wat in die EMM aangebied word. Alhoewel sommige landsburgers saamstem met die gehalte van die dienslewering, meen sommige van hulle dat die proses steeds nie konsekwent is nie.

Local governments play an important role in the development of the livelihoods of local communities in South Africa. Local governments are responsible for the provision and delivery of basic services such as running water, proper sanitation, clean energy, waste removal, and decent housing. Public participation (PP) is arguably an essential element of local democracy through which local communities can contribute to improved service delivery. The current study focused on assessing the role of PP in service delivery in the Ekurhuleni Metropolitan Municipality. This was done by adopting a descriptive research design. Data on the factors affecting PP were collected from four different community groups (i.e., citizens, businesses, municipal managers, and ward committee members), using questionnaires and interviews. The results showed that information about PP is obtained via radio, television, newspapers, and mobile phones. Generally the initiatives relating to the 'Batho Pele' principles are acceptable in the Ekurhuleni community. Furthermore, concerning the quality of the services delivered by the municipality, the findings established that citizens agree that the municipality is aware of the service quality offered in the EMM. Although some citizens agree with the quality of the service delivery, some of them believe that the process still lacks consistency.

ABSTRACT The objective of this research was to determine how beneficiaries of the Mexican Institute of Social Security (IMSS) perceive the universal health care reform project in terms of the variables of financing and provision of services in the city of San Luis Potosí, Mexico. The study was carried out under a quantitative, non-experimental, cross-sectional, descriptive, and correlational methodological approach, applying a questionnaire to a stratified sample of 384 IMSS beneficiaries. Although the results highlight the low knowledge of the aspects of the reform project towards the universality of health services, users confirm the need for changes in the current health system and their willingness to make an additional contribution conditioned to the improvement of the service. The conclusions highlight some progress in the migration towards a universal health system, although there is still time to get the reform approved. This work aims to contribute to the existing literature by offering practical reflections that support the design and implementation of public policies in the health sector.

RESUMEN El objetivo de esta investigación consistió en determinar cómo perciben los derechohabientes del Instituto Mexicano del Seguro Social (IMSS) el proyecto de reforma de universalización de salud en cuanto a las variables financiamiento y prestación de servicios en la ciudad de San Luis Potosí, México. El estudio se ejecutó bajo un enfoque metodológico cuantitativo, no experimental, transversal, descriptivo y correlacional, aplicando un cuestionario a una muestra estratificada de 384 derechohabientes del IMSS. Si bien los resultados destacan el bajo conocimiento de los aspectos del proyecto de reforma hacia la universalidad de los servicios de salud, los usuarios confirman la necesidad de cambios en el sistema de salud actual y su disposición para realizar una aportación adicional condicionada a la mejora del servicio. Las conclusiones resaltan algunos avances en la migración hacia un sistema de salud universal, aunque todavía falta tiempo para lograr la aprobación de la reforma. Este trabajo pretende contribuir a la literatura existente ofreciendo reflexiones prácticas que sustenten el diseño e implementación de políticas públicas del sector salud.

INTRODUCTION: The Work Ability Screening Profile (WASP) was conceptualised and developed by occupational therapists at the University of Durban Westville to provide a basic vocational screening assessment. Its purpose was to screen competence in generic work skills which reflected performance in activities essential to workplace participation relevant to the South African context. The assessment was revised in 2005 and renamed the WASP II. It was decided this screening assessment tool would be continuously reviewed using action research with clinicians involved in the ongoing evaluation so ensure validity and reliability for the population with which it is used. This study considered the clinical evaluation, useability and utility of the WASP II in order to inform further revision. METHOD: A cross sectional survey was used to gather data from 70 occupational therapy clinicians familiar with or using the WASP II in clinical practice. RESULTS: A sample of 70 respondents indicated the WASP II was suitable to assess current work ability and production speed with a variety of clients with physical and mental health dysfunction. Ten of the 12 subtests were used by at least 40% of the time by the 28 respondents who used the WASP II frequently. These respondents reported good to adequate useability in terms of cost, sensitivity to clients' educational level and ease of understanding instructions, incorporation into clinical practice contexts while supporting clinical reasoning and judgement. The accommodation of clients' language and provision of standard scores were indicated as inadequate. Utility was considered adequate for all aspects including discrimination of moderate to severe dysfunction, informing the choice of other assessmentsas well as supporting vocational rehabilitation intervention. The WASP II outcomes were also understood by other service providers, employers, referring parties as well asclients. CONCLUSION: While the WASP II was considered appropriate for use in the South African context and has adequate useability and utility, some subtests need to be updated and revised in terms of the standard times and content validity for current practice in the work environment. IMPLICATIONS FOR PRACTICE: The WASP II has useability • aligned with generic work skills of acquiring information or following directions numeracy, conveying information and written communication • for with those with work experience and with scholars and students yet to enter the workplace The WASP II has utility in relation to • cost and clients' educational levels • detailed instructions on the task layout but some standardisation needs to be interpreted with care • sensitivity to all aspects of assessment of generic work skills, except discrimination of mild dysfunction

An analysis of the impacts of the Covid-19 pandemic on the South African water sector is presented. The study identified and focused on three main themes: water revenue collection, water service delivery, and water sector operations. The Covid-19 pandemic negatively impacted these aspects and exacerbated pre-existing problems in the water provision landscape of South Africa. Business continuity management was identified as a top priority for water sector institutions in South Africa to ensure the continued provision of critical water services. In-depth case study research is recommended to establish how water sector institutions in South Africa dealt with the Covid-19 pandemic and how this can inform their disaster preparedness and management going forward.

The purpose of this article is to demonstrate how the once-off increase in regional income that will result from investment in roads and the recurring increase in regional income that will stem from the use of economically viable new roads can be estimated. Once-off economic benefits occur because of the multiplier effect triggered by the initial investment expenditure on a road, while recurring economic benefits result from the income accelerator effect that use of the road during its service period will have. To determine the regional income multiplier effect of the investment expenditure on a proposed road during its construction period, it is necessary to estimate (i) the tax amounts included in the investment amount as a ratio of the total project investment amount, (ii) the monetary amount saved by project workers as a ratio of the total project investment amount, and (iii) the expenditure on imported project inputs as a ratio of the total project investment amount. An analysis that incorporates the above-mentioned three fund leakages from the circular flow of regional income will show that the representative income multiplier of South African rural paved road construction projects has a value of 4,58. The gross national income multiplier effect stemming from road construction expenditure can be categorised as follows: In the rating scale above, a gross national income multiplier effect stemming from road construction projects with a value of less than 2,00 is regarded as "poor", because such a multiplier value is usually associated with economically unviable road projects. Gross national road construction multiplier effects with a value of 2,00 or more are associated with economically viable projects. An analysis as referred to above will show that, with a once-off gross income multiplier value of 4,58, the construction of economically viable roads will afford the government a "very good" opportunity to generate income effectively, especially considering that the national economy-wide gross income multiplier in South Africa is 3,27, which shows that the gross income multiplier of road construction is 40% higher than the economy-wide gross income multiplier. The reasons why the once-off gross regional income multiplier stemming from construction expenditure on rural road projects is "very good" are as follows: Multiplier Rating 1 – 1,99 Poor 2 – 2,99 Satisfactory 3 – 3,99 Good 4 – 4,99 Very good < 5 Excellent (1) A substantial proportion of the payroll of road construction workers is subject to zero or low personal income tax rates. (2) The propensity to consume among rural, unskilled and semi-skilled workers (in areas where rural roads are constructed) is generally high, which implies a low savings leakage. (3) Labourers needed for road construction are usually recruited from (or from close by) the areas where a road is to be built. Furthermore, low-income earners tend to buy and consume goods that are produced locally. (4) Generally, there is a relatively small need to import economic resources for road construction projects. Items like timber, sand, stone, gravel, filling material, bitumen, cement, steel and most of the road construction equipment are of regional or, at least, South African origin. The pace at which an economically viable road will stimulate regional income will be reflected by the new traffic it induces and any existing traffic that it diverts from less beneficial roads. In the social cost-benefit analysis of a road, it is estimated by what proportion induced and diverted traffic will increase the road user surplus. This expected proportional increase in road user surplus will accelerate (stimulate) the once-off regional multiplier and is termed the "regional income stimulation factor". Project-driven induced investment activities - i.e. downstream investment activities made possible by the provision of the road - usually (a) involve technically more sophisticated construction projects than the analysed road itself, (b) require the importation of a greater proportion of finished goods and specialised equipment, and (c) involve more skilled and highly skilled workers, whose income is subject to high income tax rates and who exhibit a higher propensity for saving than unskilled workers. Such downstream activities will collectively have a greater leakage effect than that incorporated in the once-off regional multiplier pertaining to construction of the road, which will depress the magnitude of the recurring regional income accelerator. The different formulae used to calculate the recurring income accelerator are detailed in the body of the article.

Hierdie artikel dui aan hoe die eenmalige verhoging in streeksinkome wat uit investeringsbesteding tydens die bou van 'n pad spruit, en die herhalende bykomende streeksinkome wat uit die gebruik van 'n ekonomies geregverdigde nuwe pad spruit, deur onderskeidelik streeksinkomevermenigvuldigerontleding en streeksinkome-versnellerontleding beraam kan word. Om die effek van die streeksinkomevermenigvuldiger van die uitgawe verbonde aan die bou van 'n pad te bepaal, moet (i) die belastings wat by die bou-uitgawe ingesluit is, as 'n verhouding van die totale bou-uitgawe, (ii) die bedrae geld wat deur projekwerkers gespaar word, as 'n verhouding van die totale bou-uitgawe, en (iii) die besteding aan ingevoerde projekinsette, as 'n verhouding van die totale bou-uitgawe, bepaal word. Ontledings wat bogenoemde drie fondslekkasies uit die kringloop van streeksinkome in ag neem, toon dat die verteenwoordigende inkomevermenigvuldiger van Suid-Afrikaanse bouprojekte vir buitestedelike geplaveide paaie 'n waarde van 4,58 het. Op die beoordelingskaal van inkomevermenigvuldigerwaardes vir die bou van buitestedelike paaie bied dit aan die staat 'n "baie goeie" geleentheid om inkome te genereer, veral as in ag geneem word dat die gemiddelde inkomevermenigvuldiger van besteding in die Suid-Afrikaanse ekonomie 'n waarde van 3,27 het. Die formules waarmee die eenmalige inkomevermenigvuldiger beraam word, word in die liggaam van die artikel uiteengesit. Die herhalende versnelde streeksinkome wat uit die gebruik van 'n ekonomies lewensvat-bare pad spruit, is gelyk aan die produk van (a) die huidige waarde van die herhalende pad-gebruikersvoordele wat uit die gebruik van die pad spruit, en (b) die waarde van die streeks-inkomeversneller van die gebruik van die pad. 'n Streeksinkomeversneller wat as verstekwaarde kan dien in die ekonomiese-impakontleding van 'n ekonomies lewensvatbare geplaveide buitestedelike pad in gevalle waar dit nie haalbaar is om 'n projek-eie versneller te probeer beraam nie, word in die artikel bereken. Die formules waarmee die herhalende-inkomeversneller beraam word, word in die liggaam van die artikel uiteengesit.

This article deals with the nature of social cost-benefit analysis (SCBA) and economic impact analysis (ECIA) of road projects and describes the coherence of and distinctions between the two types of analysis. In the final part of the article, the reasons are given for not including in an SCBA the economic impacts of a road as determined through an ECIA, regardless of how positive they may be. The SCBA of a road project is a systematic procedure to determine the economic viability of the road project by considering the costs and benefits that accrue when the road is constructed and during the service period of the project. The cost component in the SCBA of a road project is the once-off investment or capital cost of taking the road into service or improving it. The benefit component in the SCBA of a road is the difference between recurring costs associated with an improved road and without the road improvement. Recurring costs of a road include (a) road user costs, (b) external costs arising from road use and (c) maintenance costs to protect and preserve the usefulness of the road. The beneficiaries in an SCBA are the road users. The following road user groups can be distinguished: (i) Normal traffic (consisting of existing, normal-growth and non-induced development traffic; (ii) diverted traffic; and (iii) induced traffic (consisting of generated, induced development, and transferred traffic.) To assess the efficiency of resource allocation, an SCBA is based on the consideration of social cost. From the perspective of allocative efficiency, as determined by an SCBA, a road project is regarded as economically viable when the current value of the reduction in recurring costs associated with the road during its service life exceeds the current value of the once-off investment cost of taking the road into service. Road provision and use have economic impacts. Unlike an SCBA, which focuses on the efficiency with which a road project increases accessibility for and the mobility of road users, a regional economic impact analysis (ECIA) focuses on the effectiveness of a project to affect the performance of the economy of a region by enhancing time and place utilities creation by non-road-users. Consequently, an analysis of the effect construction, operation and use of a road will have on regional economic performance should focus on their expected income multiplier and accelerator effects on the number and size of activities in the economy of a region. The following non-road-user groups can be distinguished: (a) The public, (b) landowners, occupants and land users, (c) roadside enterprises, (d) utility enterprises and (e) goods consignors and consignees (in their capacity as non-road-users). An ECIA is based on a consideration of market prices. In an ECIA the following objectives serve as criteria for judging the impact of a road project on the performance of the economy: • Economic growth (including economic development) • Full employment • Price stability • Balance of payments stability • Equitable distribution of income These impacts, regardless of how positive they may be, are not included in an SCBA for the following reasons: • A comprehensive economic assessment consists of two components that are performed in tandem, namely an SCBA and an ECIA. An SCBA relies on allocative efficiency as assessment criterion, while an ECIA relies on output effectiveness as assessment criterion. The inclusion of effectiveness criteria among efficiency criteria in an SCBA will result in a misrepresentation of project viability. • Double counting of benefits will occur when road user cost savings and economic impacts are combined. • Not all the economic benefits obtained through coordinated investment in various sectors, one of which may be a road, can be ascribed to the investment in the road alone. The reason for conducting an ECIA of a road project is to determine to what measure the analysed road is expected to affect the performance of the economy of the region concerned. Although the results of an ECIA do not form part of the outcome of an SCBA, an ECIA can be used as an instrument in the pursuit of the economic policy objectives of a government.

Die hoofdoel van die sosialekoste-voordeel-ontleding (SKVO) van 'n pad is om die inligting oor die koste en voordele te verskaf wat nodig is om die lewensvatbaarheid, al dan nie, van die voorsiening en gebruik van die pad te beraam. Die kostekomponent in die SKVO is die eenmalige investeringskoste om die pad tot stand te bring, en die voordeelkomponent is die daling van die herhalende koste wat uit die gebruik en instandhouding van die pad sal spruit. Die hoofdoel van die ekonomiese-impakontleding (EKIO) van 'n pad behels dat die verwagte gevolge van die voorsiening en gebruik van die pad op die ekonomiese vertoning van 'n bepaalde streek geïdentifiseer en bereken word. Dié ontleding berus hoofsaaklik op die volgende: (a) die beraming van die verwagte eenmalige streeksinkome-vermenigvuldigereffek wat uit die investeringsbesteding aan die pad sal spruit, en (b) die beraming van die herhalende streeksinkome-versnellereffek wat uit die gebruik en instandhouding van die pad sal spruit. Die ekonomiese uitwerking van 'n padprojek word nie by 'n SKVO ingereken nie. Die rede hiervoor is drievoudig: Eerstens berus 'n SKVO op toewysingsdoelmatigheid as beoordelingsnorm, en 'n EKIO op doeltreffendheid as beoordelingsnorm. Die kombinering van doeltreffendheidsnorme en doelmatigheidsnorme sal tot 'n wanvertolking van 'n projek se ekonomiese lewensvatbaarheid lei. Tweedens sal voordele dubbeld getel word indien padgebruikerskostebesparings en ekonomiese impakte saamgevoeg word. Derdens kan ekonomiese voordele wat verkry word deur gekoördineerde investering in verskeie sektore, waarvan een 'n pad is, nie alles aan investering in die pad toegeskryf word nie.

INTRODUCTION: Caries and gingival disease are prevalent oral health issues affecting more than 80% of school-going children including those with special needs attending special schools. Schools play a crucial role in promoting oral health, providing education and identifying issues early. These school-based health programmes are essential for addressing these issues and can reach more than 1 billion children worldwide, as well as school staff, families and the community. AIMS AND OBJECTIVES: To determine the current delivery of oral health care programmes in the identified special schools by means of a semi-structured interview with school managers. DESIGN: A descriptive qualitative study design. METHODS: All school managers (principals) who were responsible for the facilitation of the implementation and delivery of oral health services in each of the 22 special schools were invited to participation in the study. Purposive sampling was used to select the managers at the various special schools. Data collection comprised face-to-face, semi-structured interviews to explore the specific provision of oral health-related interventions and programmes (1 interview was conducted per school, n=22). RESULTS: Six emergent themes were present in the study: oral health activities, implementation and evaluation process, implementation challenges, policy content perceptions, dental examinations and oral health prevalence in special schools. Oral hygiene was identified as a priority, with educators and school nurses responsible for school oral health education, supervised teeth brushing programme, pain management, oral examinations in some cases and referral for dental treatments through engaging parents, learners and health workers in oral health promotion, which was supported by the school's health policy with the departmental heads responsible for programme evaluation. However, the implementation of the programmes was impacted by five factors: lack of parental support, lack of professional guidance, lack of resources, lack of support from the oral health department and the Covid-19 pandemic further exacerbated these challenges. CONCLUSION: The study reveals that special schools have preventative and promotive oral health programmes, but they need therapeutic or curative services to address unmet treatment needs. Factors affecting these programmes have led to gaps in implementation processes. Together, these findings point to an urgent need for a review of oral health care programmes in KwaZulu-Natal special schools to ensure proper support and collaboration between key stakeholders to reduce negative effects and improve overall oral health programmes.

RESUMEN Este estudio busca diseñar e implementar un programa educativo innovador en el Banco Internacional, sede Ibarra, inspirado en el enfoque de excelencia en el servicio de Disney, con el propósito de fortalecer las habilidades del personal en la prestación de servicios al cliente. Para ello, se adopta un enfoque cuantitativo y cualitativo con un diseño de estudio longitudinal. Se utilizan encuestas estructuradas a una muestra de empleados para evaluar percepciones sobre habilidades blandas y cultura organizacional. Los resultados respaldan la efectividad del programa implementado al revelar un aumento en las habilidades del personal, mejoras en la orientación al cliente y la adaptabilidad. De esta manera se logra un impacto positivo en la cultura organizacional. Estos resultados respaldan la efectividad de la iniciativa y ofrecen una base sólida para recomendar la continuidad de programas educativos similares.

ABSTRACT This study seeks to design and implement an innovative educational program at Banco Internacional, Ibarra headquarters, inspired by Disney's approach to service excellence, with the purpose of strengthening staff skills in providing customer services. To this end, a quantitative and qualitative approach is adopted with a longitudinal study design. Structured surveys are used with a sample of employees to evaluate perceptions about soft skills and organizational culture. The results support the effectiveness of the implemented program by revealing an increase in staff skills, improvements in customer orientation and adaptability. In this way, a positive impact is achieved on the organizational culture. These results support the effectiveness of the initiative and offer a solid basis for recommending the continuation of similar educational programs.

RESUMEN La prestación de un servicio de calidad en hoteles de tres estrellas no solo incide en la reputación y credibilidad del establecimiento, sino que también asegura ingresos económicos sostenidos. Este estudio, centrado en el contexto ecuatoriano, se propone analizar, implementar y evaluar herramientas eficaces para medir y mejorar la experiencia del cliente. Los resultados subrayan la necesidad de un manual específico y estrategias continuas de capacitación para el personal, al enfocarse en áreas de mejora como la comunicación y la eficiencia en la atención. La demografía de clientes, principalmente entre 18 y 45 años con educación superior, ofrece oportunidades para adaptar estrategias y generar ingresos sostenibles. La implementación de medidas personalizadas no solo eleva la satisfacción del cliente, sino que también fortalece la competitividad del sector hotelero de tres estrellas en Ecuador.

ABSTRACT The provision of quality service in three-star hotels not only affects the reputation and credibility of the establishment, but also ensures sustained economic income. This study, focused on the Ecuadorian context, aims to analyze, implement, and evaluate effective tools to measure and improve customer experience. The results highlight the need for a specific manual and continuous training strategies for staff, focusing on areas of improvement such as communication and efficiency in care. The customer demographic, primarily between 18 and 45 years old with higher education, offers opportunities to adapt strategies and generate sustainable income. The implementation of personalized measures not only increases customer satisfaction, but also strengthens the competitiveness of the three-star hotel sector in Ecuador.

Abstract This article seeks to identify user satisfaction in relation to wheelchairs and the provision of public and private health services in the Baixada Santista Metropolitan Region. It involved a cross-sectional study with a quantitative approach. Participants answered a sociodemographic questionnaire and the Brazilian version of the Quebec Assistive Technology User Satisfaction Assessment. Data were analyzed using descriptive and comparative statistics by means of Student’s t test. Cohen’s d effect sizes were also calculated. Participants (n = 42) were “more or less satisfied” with the wheelchairs and “quite satisfied” with the services provided. Rigid frame wheelchair users were significantly more satisfied with their wheelchairs compared to users of wheelchairs weighing over 198 lbs. (p = 0.010, d = 1.04). Users of private services showed significantly greater satisfaction with the provision of the service compared to public services users (p = 0.021, d = 0.75). Wheelchair users in the Baixada Santista Metropolitan Region are more satisfied with the rigid frame wheelchair and less satisfied with public services.

Resumo O objetivo deste artigo é identificar a satisfação dos usuários em relação às cadeiras de rodas e à prestação de serviços públicos e privados de saúde da Região Metropolitana da Baixada Santista. Estudo transversal com abordagem quantitativa. Os participantes responderam a um questionário sociodemográfico e à versão brasileira do Quebec Assistive Technology User Satisfaction Assessment. Os dados foram analisados utilizando a estatística descritiva e comparativa por meio do teste t de Student. Os tamanhos de efeito d de Cohen foram calculados. Os participantes (n = 42) estavam “mais ou menos satisfeitos” com as cadeiras de rodas e “pouco satisfeitos” com a prestação de serviços. Os usuários de cadeiras de rodas monobloco apresentaram satisfação significativamente maior com suas cadeiras em comparação com usuários de cadeiras de rodas acima de 90kg (p = 0,010, d = 1,04). Os usuários de serviços privados apresentaram satisfação significativamente maior com a prestação de serviço em comparação aos usuários de serviços públicos (p = 0,021, d = 0,75). Os usuários de cadeiras de rodas da Região Metropolitana da Baixada Santista estão mais satisfeitos com as cadeiras de rodas monobloco e menos satisfeitos com os serviços públicos.

Resumo O objetivo deste artigo é apreender os desafios nas vivências dos usuários e profissionais de Banco de Leite Humano no atendimento a homens transgêneros no contexto da amamentação sob à luz da Interseccionalidade. Estudo qualitativo descritivo-exploratório a partir de entrevistas realizadas com seis profissionais do Banco de Leite Humano, que atenderam previamente homens trans no contexto de amamentação, e dois homens trans bissexuais, que amamentaram ao peito. Os dados foram tratados pela Análise Temática com auxílio do software Atlas.ti versão 9.0. Observam-se lacunas nas esferas educacionais, institucionais e na gestão, associadas a questões pessoais e sociais, que reproduzem um modelo pré-concebido normativo, desconsiderando as singularidades requeridas no atendimento à população trans no contexto da amamentação. A cisheteronormatividade e a supremacia do profissional operam em âmbitos pessoais, sociais e institucionais para a segregação de homens transgêneros nos serviços de suporte à amamentação. A análise interseccional destes desafios permite uma visão global dos fatores de segregação e a implementação de políticas públicas promotoras da justiça social.

Abstract This article tried, from an intersectional standpoint, to grasp the challenges experienced by health professionals and service users of human milk banks in provision of care for transgender men chestfeeding. This exploratory, descriptive qualitative study drew on interviews of six human milk bank staff, who had previously assisted trans men in relation to chestfeeding and two bisexual trans men, who chestfed. The data was treated by thematic analysis, supported by Atlas.ti software, version 9.0. Lacunas in the educational, institutional and management spheres, associated with personal and social issues, reproduce a pre-conceived normative model and disregard the special demands of providing chestfeeding care for the trans population. Cisheteronormativity and “professional supremacy” operate in personal, social and institutional respects to segregate transgender men in lactation support services. Intersectional analysis of these challenges affords an overall view of segregative factors and enables public policies to be introduced to promote social justice.

Resumo Este estudo tem como objetivo analisar os atributos da Atenção Primária à Saúde (APS) abrangente a partir da atuação das equipes de Saúde da Família com foco nas doenças crônicas não transmissíveis. Pesquisa qualitativa realizada entre agosto de 2018 a julho de 2019, na APS de Vitória da Conquista, Bahia, com 40 profissionais de saúde, por meio de grupos focais e entrevistas. A partir da análise temática, os temas centrais corresponderam aos sete atributos da APS abrangente. Como resultados, as potencialidades do trabalho das equipes relacionaram-se com a priorização do acesso, ao amplo leque de serviços oferecidos e o reconhecimento da realidade comunitária/familiar. Destacaram-se obstáculos relacionados a oferta, acessibilidade e cobertura dos serviços, fragmentação na coordenação assistencial e informacional, dificuldades de desenvolvimento de práticas inclusivas com a família e etnicamente situadas, bem como na continuidade da assistência, notadamente para o contexto rural. Espera-se que os resultados apresentados possam confirmar a necessidade de investimentos e a instituição de processos sistemáticos de avaliação do trabalho das equipes de saúde da família, a fim de acompanhar a trajetória de consolidação da APS no contexto do Sistema Único de Saúde brasileiro.

Abstract This study aims to analyze the attributes of comprehensive Primary Health Care (PHC) based on the work of the family health teams focused on non-communicable chronic diseases. Qualitative research conducted from August 2018 to July 2019, in primary health care in Vitória da Conquista, Bahia, Brazil, with 40 health professionals, through interviews and focus groups. From the thematic analysis, the central themes were defined, corresponding to the seven attributes of comprehensive PHC. As a result, the potentials work of the family health teams was related to prioritizing access, the wide range of services offered and the recognition of the community and family reality. The study highlighted obstacles related to service provision, accessibility, coverage, care fragmentation and in information coordination, challenges in developing practices with the family, in practices ethnically situated, and continuity of care, notably for the rural context. It is expected that the results presented may confirm the need for investments and the institution of systematic evaluation processes regarding the work of family health teams, in order to follow the trajectory of PHC consolidation in the context of the Brazilian Unified Health System.Resumo: Este estudo tem como objetivo analisar os atributos da Atenção Primária à Saúde (APS) abrangente a partir da atuação das equipes de Saúde da Família com foco nas doenças crônicas não transmissíveis. Pesquisa qualitativa realizada entre agosto de 2018 a julho de 2019, na APS de Vitória da Conquista, Bahia, com 40 profissionais de saúde, por meio de grupos focais e entrevistas. A partir da análise temática, os temas centrais corresponderam aos sete atributos da APS abrangente. Como resultados, as potencialidades do trabalho das equipes relacionaram-se com a priorização do acesso, ao amplo leque de serviços oferecidos e o reconhecimento da realidade comunitária/familiar. Destacaram-se obstáculos relacionados a oferta, acessibilidade e cobertura dos serviços, fragmentação na coordenação assistencial e informacional, dificuldades de desenvolvimento de práticas inclusivas com a família e etnicamente situadas, bem como na continuidade da assistência, notadamente para o contexto rural. Espera-se que os resultados apresentados possam confirmar a necessidade de investimentos e a instituição de processos sistemáticos de avaliação do trabalho das equipes de saúde da família, a fim de acompanhar a trajetória de consolidação da APS no contexto do Sistema Único de Saúde brasileiro.

Studies of training in integrative and complementary practices have concentrated on the analysis of the curriculums of health courses and further more in-depth research into professionals’ perceptions about training processes is needed. This study aimed to identify training processes and capacity building for professionals who offer integrative and complementary practices in psychosocial care centers in a metropolitan region. We conducted an exploratory descriptive study involving semi-structured interviews with 45 professionals. The interview transcripts were analyzed using content analysis. The most common routes taken by the professionals were post-graduate qualifications, degrees, in-service training and private education. The results reveal that training in this area was diffuse. Our results can inform the development of educational strategies for the organization of human resources in the area of integrative and complementary practices.

Estudos sobre a formação em Práticas Integrativas e Complementares têm se concentrado na análise curricular dos cursos da Saúde e as pesquisas abrangendo as percepções dos profissionais a respeito dos processos formativos devem ser mais elucidadas. O estudo objetiva identificar os processos de formação e capacitação dos profissionais ofertantes de Práticas Integrativas e Complementares nos Centros de Atenção Psicossocial de uma região metropolitana. Trata-se de um estudo descritivo, exploratório, de abordagem qualitativa. Realizaram-se entrevistas semiestruturadas com 45 profissionais, as quais foram posteriormente analisadas segundo a Análise de Conteúdo Temática. As pós-graduações, graduação, formações em serviço e o ensino privado foram as trajetórias adotadas pelos profissionais, revelando a existência de uma formação difusa para a oferta no cenário investigado. Esses resultados podem subsidiar o planejamento de estratégias educacionais para a ordenação dos recursos humanos em Práticas Integrativas e Complementares.

Los estudios sobre la formación en Prácticas Integradoras y Complementarias se han concentrado en el análisis curricular de los cursos de la salud y las investigaciones que incluyen las percepciones de los profesionales con relación a los procesos de formación deben elucidarse más. El objetivo del estudio es identificar los procesos de formación y capacitación de los profesionales ofertantes de Prácticas Integradoras y Complementarias en los Centros de Atención Psicosocial de una región metropolitana. Se trata de un estudio descriptivo, exploratorio, de abordaje cualitativo. Se realizaron entrevistas semiestructuradas con 45 profesionales que fueron posteriormente analizadas según el Análisis de Contenido Temático. Los postgrados, graduación, formaciones en servicio y la enseñanza privada fueron las trayectorias adoptadas por los profesionales, revelando la existencia de una formación difusa para la oferta en el escenario investigado. Esos resultados pueden subsidiar la planificación de estrategias educativas para la ordenación de los recursos humanos en las Prácticas Integradoras y Complementarias.

BACKGROUND: South African legislation advocates for equitable access to mental healthcare services integrated into general healthcare settings. Mental, neurological, and substance use (MNS) disorders are often comorbid. Pharmacoepidemiology provides indirect evidence of service provision for conditions amenable to medicine treatment. AIM: The study aims to evaluate medicine procurement for MNS disorders at different service levels in the health system. SETTING: The Public health sector, Gauteng province formed the setting for the study. METHOD: A secondary analysis of the Gauteng pharmaceutical database was conducted using Anatomic Therapeutic Chemical (ATC) and defined daily dose (DDD) methodology. Anatomic Therapeutic Chemical classes of medicines for MNS disorders were included. Defined daily doses and costs were calculated per 1000 population served by each facility and service level. Statistical comparisons were made using chi-square testing. RESULTS: General healthcare settings accounted for 90% (R118 638 248) and specialised hospitals for 10% (R13 685 032) of expenditure on medicines for MNS disorders, procuring 94% (n = 49 442 474) and 6% (n = 3 311 528) of DDDs, respectively. Although district clinics procured 60% of DDDs, they procured the least per 1000 population served, whereas district hospitals procured the most. For almost all ATC classes, procurement differed significantly between municipalities at every service level and between specialised hospitals. CONCLUSION: In Gauteng province, most medicines for MNS disorders are procured by general healthcare services, but access to care may not be equitable. While population coverage at district clinics appears low, district hospitals may experience the greatest care burden. Research regarding quality of care at each service level is recommended. CONTRIBUTION: This study provides insight into service provision for MNS disorders.

BACKGROUND: Non-specialist health professionals are required to provide mental health services given the burden of disease due to mental illness. The study aimed to explore the attitudes of clinical associates towards those with mental illness as well as their interest in mental health work and additional mental health training METHODS: A cross-sectional study design was utilised. The study population consisted of clinical associates based in South Africa. An electronic questionnaire was developed that incorporated the 16-item Mental Illness Clinicians' Attitudes version 4 scale (MICA-4), which is scored out of 96 with higher scores indicating more stigmatising attitudes. Multivariate linear regression was used to determine factors associated with the MICA-4 score RESULTS: The mean MICA-4 score for the 166 participants who completed all 16 questions was 37.55 (standard deviation 7.33). In multivariate analysis, the factors associated with significantly lower MICA-4 scores were falling in the 25- to 29-year-old age category and indicating that a mental health rotation formed part of the undergraduate degree. More than 80% of the participants (140/167, 83.8%) indicated an interest in mental health work. Two-thirds of the participants (111/167, 66.5%) indicated an interest in a specialisation in mental health CONCLUSION: The mean MICA-4 score recorded for clinical associates indicates low stigma levels towards those with mental illness. Additionally, there is significant interest in working and training in mental health CONTRIBUTION: Training programmes should take note of the contribution of a mental health rotation to a positive attitude to mental health patients. Clinical associates' attitudes towards mental illness together with their interest in working and training in mental health suggest that they could be more widely utilised in mental health service provision