RESUMEN Objetivo Analizar el proceso de contratación de médicos cubanos por parte del Gobierno de Portugal y comprender la percepción de los profesionales cubanos sobre el ejercicio de la profesión en el exterior. Métodos Se realizó un estudio de caso cualitativo-descriptivo-analítico, con triangulación de datos a partir de la recolección de información de múltiples fuentes de evidencia. Se entrevistó a un total de 16 informantes clave, se analizaron documentos y se realizó observación directa. Resultados Los resultados más evidentes muestran que se estableció una cooperación para hacer frente a la escasez crónica de médicos en atención primaria; la elección de médicos de nacionalidad cubana tiene una dimensión política. Se llevó a cabo un acuerdo entre las partes para permitir el registro de médicos cubanos en la Orden de Médicos de Portugal. Conclusiones Hubo un resultado positivo en la contratación de médicos cubanos por parte de Portugal, ya que aumentó el número de usuarios con acceso a los servicios y también se tuvo una brecha de tiempo para que el gobierno tomara algunas medidas para mitigar el problema de la escasez de médicos.

ABSTRACT Objective To analyze the process of recruitment of Cuban doctors by the government of Portugal and to understand the perception of these Cubans about the exercise of their professions abroad. Methods A qualitative-descriptive-analytical case study was carried out, with data triangulation, based on the collection of information from multiple sources of evidence. Sixteen key informants were interviewed, documents were analyzed, and direct observation was carried out. Results The most evident results demonstrate that the cooperation was established to address the chronic shortage of doctors in primary care; the choice of Cuban doctors had a political dimension. An arrangement was made to enable the registration of Cuban doctors in the Portuguese Medical Association. Conclusions There was a positive outcome in the recruitment of Cuban doctors by Portugal since it increased the number of patients with access to services, and allowed a time gap for the government to take some measures in order to mitigate the problem of shortage of doctors.

RESUMO A crise socioambiental é cada vez mais presente na realidade urbana e rural. A experiência agroecológica neorrural é uma inovação que pode transformar o paradigma produtivo predominante e propor novas formas de relacionamento entre as pessoas. Além disso, pode contribuir para o desenvolvimento de sistemas alimentares que promovem justiça socioambiental, segurança alimentar e nutricional, criação de territórios saudáveis e sustentáveis. O objetivo deste relato de experiência foi apresentar a Comunidade que Sustenta a Agricultura, Educação e Saúde (CSAES) na Chácara Bindu, que desenvolve tecnologias sociais nas áreas de agricultura, educação e saúde no Distrito Federal. O relato da experiência foi desenvolvido em sete itens relacionados com criação, conservação produtiva, educação e saúde no organismo socioagrícola da Chácara Bindu. Destacam-se os vínculos com base na confiança e cooperação, o processo de expansão do modelo da CSAES Bindu a partir de uma Comunidade que Sustenta a Agricultura, a continuidade das entregas de produtos cultivados sem insumos sintéticos e sem agrotóxicos e o acesso das famílias coagricultoras a alimentos saudáveis no contexto de isolamento social imposto pela pandemia da Covid-19.

ABSTRACT The socio-environmental crisis is increasingly present in the urban and rural reality. A neorural agroecological experience is an innovation that can transform the predominant productive paradigm and propose new ways of relationship between people. Furthermore, it can contribute to the development of food systems that promote social and environmental justice, food and nutrition security, and the creation of healthy and sustainable territories. The objective of this experience report was to present the Community that Sustains Agriculture, Education, and Health (CSAES) at Chácara Bindu, which has social technologies in the fields of agriculture, education, and health in the Federal District. The experience report was developed in seven items related to creation, productive conservation, education, and health in the social-agricultural organization of Chácara Bindu. The linkages based on trust and cooperation, the expansion process of the CSAES from a Community that Sustains Agriculture, the continued delivery of products cultivated without synthetic inputs and without pesticides, and the access of co-agricultural families to healthy food stand out in the context of social isolation imposed by the Covid-19.

RESUMO A formação-ação no contexto da saúde coletiva pode ser estratégica para a resistência a esse modelo de agronegócio deletério e excludente, pois engendra um conjunto de práticas que modificam a maneira de sentir, pensar e agir em relação aos usos da terra; e fortalecem o movimento agroecológico, as práticas integrativas complementares de cuidado e as formas solidárias, democráticas e inclusivas de se relacionar com a natureza. A formação-ação: Cultivo Biodinâmico de Plantas Medicinais em Agroflorestas na Promoção de Territórios Saudáveis e Sustentáveis no Distrito Federal, nasce da confluência de outras experiências associada à necessidade de construir estratégias para a formação de profissionais e comunidades relacionados com ações em saúde para a promoção de territórios saudáveis e sustentáveis, constituído de bases teórico-metodológicos que envolvem educandos, educadores e comunidades, e articula diferentes categorias de análise para a construção e ressignificação do conhecimento, contando com ferramentas pedagógico-metodológicas baseadas na Pedagogia da Alternância e organizadas em tempos distintos do processo ensino-aprendizagem. A matriz curricular organiza-se em dois módulos: Desenvolvimento, Ciência e Saúde; e Agrofloresta, Arranjos Produtivos e Saúde. A formação é um meio de transformar a realidade local, de promover a saúde, de dialogar com as comunidades e de reconhecer os territórios.

ABSTRACT Training-action, in the context of collective health, can be strategic for resisting this harmful and exclusive agribusiness model, as it engenders a set of practices that modify not only the way of feeling, thinking and acting in relation to land uses, and they strengthen the agroecological movement, complementary integrative care practices and the solidary, democratic, and inclusive ways of relating to nature. Training-action: Biodynamic Cultivation of Medicinal Plants in Agroforestry in the Promotion of Healthy and Sustainable Territories in the Federal District arises from the confluence of other experiences associated with the need to build strategies for the training of professionals and communities related to health actions to promote healthy and sustainable territories, constituted by theoretical-methodological bases that involve students, educators, and communities, and articulates different categories of analysis for the construction and reframing of knowledge, having pedagogical-methodological tools based on the Pedagogy of Alternation and organized at different times of the teaching-learning process. The curriculum matrix has 2 modules: Development, Science, and Health; and Agroforestry, Productive Arrangements, and Health. Training is a means to transform the local reality, to promote health, to dialogue with communities, and to recognize the territories.

RESUMO A formação-ação no contexto da saúde coletiva pode ser estratégica para a resistência a esse modelo de agronegócio deletério e excludente, pois engendra um conjunto de práticas que modificam a maneira de sentir, pensar e agir em relação aos usos da terra; e fortalecem o movimento agroecológico, as práticas integrativas complementares de cuidado e as formas solidárias, democráticas e inclusivas de se relacionar com a natureza. A formação-ação: Cultivo Biodinâmico de Plantas Medicinais em Agroflorestas na Promoção de Territórios Saudáveis e Sustentáveis no Distrito Federal, nasce da confluência de outras experiências associada à necessidade de construir estratégias para a formação de profissionais e comunidades relacionados com ações em saúde para a promoção de territórios saudáveis e sustentáveis, constituído de bases teórico-metodológicos que envolvem educandos, educadores e comunidades, e articula diferentes categorias de análise para a construção e ressignificação do conhecimento, contando com ferramentas pedagógico-metodológicas baseadas na Pedagogia da Alternância e organizadas em tempos distintos do processo ensino-aprendizagem. A matriz curricular organiza-se em dois módulos: Desenvolvimento, Ciência e Saúde; e Agrofloresta, Arranjos Produtivos e Saúde. A formação é um meio de transformar a realidade local, de promover a saúde, de dialogar com as comunidades e de reconhecer os territórios.

ABSTRACT Training-action, in the context of collective health, can be strategic for resisting this harmful and exclusive agribusiness model, as it engenders a set of practices that modify not only the way of feeling, thinking and acting in relation to land uses, and they strengthen the agroecological movement, complementary integrative care practices and the solidary, democratic, and inclusive ways of relating to nature. Training-action: Biodynamic Cultivation of Medicinal Plants in Agroforestry in the Promotion of Healthy and Sustainable Territories in the Federal District arises from the confluence of other experiences associated with the need to build strategies for the training of professionals and communities related to health actions to promote healthy and sustainable territories, constituted by theoretical-methodological bases that involve students, educators, and communities, and articulates different categories of analysis for the construction and reframing of knowledge, having pedagogical-methodological tools based on the Pedagogy of Alternation and organized at different times of the teaching-learning process. The curriculum matrix has 2 modules: Development, Science, and Health; and Agroforestry, Productive Arrangements, and Health. Training is a means to transform the local reality, to promote health, to dialogue with communities, and to recognize the territories.

RESUMO A crise socioambiental é cada vez mais presente na realidade urbana e rural. A experiência agroecológica neorrural é uma inovação que pode transformar o paradigma produtivo predominante e propor novas formas de relacionamento entre as pessoas. Além disso, pode contribuir para o desenvolvimento de sistemas alimentares que promovem justiça socioambiental, segurança alimentar e nutricional, criação de territórios saudáveis e sustentáveis. O objetivo deste relato de experiência foi apresentar a Comunidade que Sustenta a Agricultura, Educação e Saúde (CSAES) na Chácara Bindu, que desenvolve tecnologias sociais nas áreas de agricultura, educação e saúde no Distrito Federal. O relato da experiência foi desenvolvido em sete itens relacionados com criação, conservação produtiva, educação e saúde no organismo socioagrícola da Chácara Bindu. Destacam-se os vínculos com base na confiança e cooperação, o processo de expansão do modelo da CSAES Bindu a partir de uma Comunidade que Sustenta a Agricultura, a continuidade das entregas de produtos cultivados sem insumos sintéticos e sem agrotóxicos e o acesso das famílias coagricultoras a alimentos saudáveis no contexto de isolamento social imposto pela pandemia da Covid-19.

ABSTRACT The socio-environmental crisis is increasingly present in the urban and rural reality. A neorural agroecological experience is an innovation that can transform the predominant productive paradigm and propose new ways of relationship between people. Furthermore, it can contribute to the development of food systems that promote social and environmental justice, food and nutrition security, and the creation of healthy and sustainable territories. The objective of this experience report was to present the Community that Sustains Agriculture, Education, and Health (CSAES) at Chácara Bindu, which has social technologies in the fields of agriculture, education, and health in the Federal District. The experience report was developed in seven items related to creation, productive conservation, education, and health in the social-agricultural organization of Chácara Bindu. The linkages based on trust and cooperation, the expansion process of the CSAES from a Community that Sustains Agriculture, the continued delivery of products cultivated without synthetic inputs and without pesticides, and the access of co-agricultural families to healthy food stand out in the context of social isolation imposed by the Covid-19.

Abstract: Biosphere reserves have among their functions to support scientific research, education, training and monitoring. In the Cape Horn Biosphere Reserve (RBCH), created in 2005, this function has been fulfilled with the creation of the Omora Ethnobotanical Park in 2000, and its implementation in 2008 as a co-founder site of the Chilean Network of Studies Long-Term Socio- Ecological (LTSER-Chile). In 2016, this network has been strengthened with the addition of the new Cape Horn Long-Term Socio-Ecological Research Network (LTER-Cape Horn). The latter includes the Omora Ethnobotanical Park, and three new sites added to the monitoring of the sub-Antarctic Magellanic ecoregion. From south to north, the four sites are: (1) Gonzalo Island (56°31’S; 68°43’O), at the southern end of the Diego Ramírez Archipelago, with sub- Antarctic vegetation dominated by grasses and cryptogams, devoid of woody species; (2) Horn Island (55°58’S; 67°13’O), at the southern end of the Cape Horn Archipelago, hosting the southernmost forest ecosystems on the planet, which are dominated by the evergreen beech (Nothofagus betuloides); (3) Omora Ethnobotanical Park (54°57’S; 67°40’O), Navarino Island, an ideal site for studies on climate change and its impact on biota and sub-Antarctic ecosystems, since it protects a watershed that includes a representative mosaic of characteristic habitats of the RBCH in an altitudinal gradient with a thermal decrease analogous to that which occurs with increases in latitude; and (4) Caleta 2 de Mayo Site (54°52’S; 68°41’O), Yendegaia Bay, in an ecotonal zone between evergreen and deciduous forests (product of the local climate gradient), at a site that will be central to future connectivity between Continental Chile, Tierra del Fuego, Navarino Island, and the RBCH. In 2015, UNESCO approved the Report of the First Periodic Review of the RBCH that proposed the protection of the Diego Ramírez Archipelago and the creation of the Diego Ramírez Islands-Drake Passage Marine Park. This goal was achieved with the promulgation of this new park on February 2, 2018, and its entry into force on January 21, 2019 with the publication of the creation decree in the Diario Oficial of Chile. In this context, the new LTER-Cape Horn network acquires great local, national and global relevance. At the local scale, it covers a representative environmental heterogeneity of the great diversity of landscapes and terrestrial, freshwater and marine ecosystems of the RBCH and the sub-Antarctic Magellanic ecoregion. At the national scale, it incorporates sub-Antarctic sites, located at the southern end of South America, to LTSER-Chile and to the Monitoring Network of the Ministry of the Environment. On a global scale, the terrestrial ecosystems of the LTER-Cape Horn network stands out for two main reasons: (1) these sub-Antarctic ecosystems lack a geographical replicate in other continents of the southern hemisphere, and (2) high latitude ecosystems are especially sensitive to global climate change. Thus, the LTER-Cape Horn network helps to overcome critical geographical gaps in the implementation of the International Network for Long-Term Ecological Research (ILTER). In order to articulate these four sites and strengthen the training of technical capacities and knowledge transfer to decision makers in the area of special interest tourism and other sustainable economic activities, the LTER-Cape Horn network will be managed locally from the new Cape Horn Sub-Antarctic Center (Cape Horn Center) that will be inaugurated in Puerto Williams in 2021. The implementation of the LTER-Cape Horn network is based on a close collaboration with various public institutions: Ministry of National Assets, Ministry of the Environment, Subsecretary of Fisheries and Aquaculture of the Ministry of Economy Development and Tourism, National Forestry Service, General Water Directorate of the Ministry of Public Works, Navy of Chile, Chilean Police (Carabineros), Municipality of Cape Horn, Provincial Government of Chilean Antarctica, and the Regional Government of Magallanes and Chilean Antarctica. In the following phases, the LTER-Cape Horn network and the Cape Horn Center aim to strengthen the participation of the local community, especially the Yahgan Indigenous Community of Bahía Mejillones, artisanal fisheries, tour operators, and the educational community, including private actors. Located at the “southern summit” of the Americas, Puerto Williams, capital of the Chilean Antarctic Province emerges as a global hub for transdisciplinary sub-Antarctic research, equipped with a new center and the network of long-term socio-ecological studies. Collaboration with regional, national and international actors will allow the LTER-Cape Horn network and the Cape Horn Center to: (i) provide critical data, which will open up new opportunities for monitoring climate change and its impact on biodiversity and ecosystems in sub-Antarctic latitudes; (ii) consolidate long-term monitoring, which is an essential component to effectively design mitigation and adaptation actions; (iii) strengthen a local sustainable development model that, associated with the Cape Horn Biosphere Reserve, contributes from the south of the world, to a biocultural conservation model that meets the needs of socio-economic well-being and environmental sustainability at multiple regional and planetary scales.

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On March 11, 2020, the World Health Organization (WHO) stated that the number of cases of COVID-19 multiplied by 13 outside China, with a threefold increase in the number of affected countries. The WHO expressed its concern about the alarming levels of spread and severity of the outbreak, declaring the pandemic. This pandemic context is generating a social pact that seeks to ensure collective protection over individual freedoms. To meet the challenge, Governments must make decisions based on the principles that govern the State- These should consider the differences and particularities of those affected, without diverting attention from collective social protection. The following is a proposal on the ethical principles that should guide a State that makes decisions in public health emergencies.

ABSTRACT Objective Describe the current status of the implementation of the Model of Comprehensive Care in Family and Community Health (MAIS, by its acronym in Spanish) in primary care in Chile. Methods Cross-sectional study that evaluated the implementation of MAIS in a total of 1 263 primary care facilities. Through correlations, the relationship between internal self-evaluation and external evaluation of health services for each center was studied. The factors of facilities, communes and regions associated with the level of implementation of the MAIS were evaluated with multilevel analyses. Results The correlation between internal self-evaluation and the external evaluation of the total implementation of the MAIS was very high (0.819, p <0.001). The technology axis presented the highest implementation (83.0% compliance), and family focus the lowest (37.8% compliance). The facilities with the highest implementation were family health centers, the urban communes, those with the highest number of enrollees and those with the lowest poverty index. A statistically significant association was not identified between the implementation of the MAIS and the total community expenses (p = 0.122) nor specific health expenditures (p = 0.244). Conclusions Most of the primary care health facilities have evaluated the level of implementation of the MAIS. The accompanying strategies for its implementation are priorities for primary care facilities located in rural areas and with a low number of registered users. Improving the family focus and the quality of care —key aspects of health care— are still a challenge.

RESUMEN Objetivo Describir el estado actual de la implementación de Modelo de Atención Integral en Salud Familiar y Comunitaria (MAIS) en la atención primaria de Chile. Métodos Estudio transversal que evaluó la implementación del MAIS en un total de 1 263 establecimientos de atención primaria. Por medio de correlaciones se estudió la relación entre la autoevaluación (interna) y la evaluación de los servicios de salud (externa) para cada centro. Con los análisis multinivel se evaluaron los factores de establecimientos, comunas y regiones asociados con el nivel de implementación del MAIS. Resultados La correlación entre autoevaluación interna y la evaluación externa de la implementación total del MAIS fue muy alta (0,819, p < 0,001). El eje tecnología presentó mayor implementación (83,0% de cumplimiento) y enfoque familiar (37,8% de cumplimiento), el menor. Los centros de salud familiar, las comunas urbanas, aquellas con mayor número de inscritos y con menor índice de pobreza, fueron los establecimientos que presentaron mayor implementación. No se identificó una asociación estadísticamente significativa entre la implementación del MAIS y los gastos comunales totales (p = 0,132) ni específicos de salud (p = 0,244). Conclusiones La mayoría de los establecimientos de salud de atención primaria han evaluado el nivel de implementación del. MAIS. Las estrategias de acompañamiento para su implementación son prioritarias para establecimientos de atención primaria ubicados en zonas rurales y con bajo número de usuarios inscritos. Aún persiste el desafío de avanzar en la instalación del enfoque familiar y la calidad del cuidado como centro de la atención de salud.

RESUMO Objetivo Descrever o estado atual da implementação do Modelo de Assistência Integral em Saúde da Família e da Comunidade (MAIS) na atenção primária no Chile. Métodos Estudo transversal que avaliou a implementação do MAIS em um total de 1 263 estabelecimentos de atenção primária. Por meio de correlações, foi estudada a relação entre a autoavaliação (interna) e a avaliação dos serviços de saúde (externa) para cada centro. Os fatores dos estabelecimentos, municípios e regiões associados ao nível de implementação do MAIS foram avaliados com análises multiníveis. Resultados A correlação entre a autoavaliação interna e a avaliação externa da implementação total do MAIS foi muito alta (0,819, p <0,001). O eixo tecnológico apresentou maior implementação (83,0% de cumprimento) e foco familiar o menor (37,8% de cumprimento). Os centros de saúde da família, as comunas urbanas, aqueles com maior número de inscritos e com o menor índice de pobreza, foram os estabelecimentos que apresentaram a maior implementação. Não foi identificada associação estatisticamente significativa entre a implementação do MAIS e as despesas totais da comunidade (p = 0,122) nem gastos específicos com saúde (p = 0,244). Conclusões A maioria dos estabelecimentos de atenção primária avaliaram o nível de implementação do MAIS. As estratégias de acompanhamento para sua implementação são prioritárias para estabelecimentos de atenção primária em áreas rurais e com baixo número de usuários cadastrados. Enfatiza-se o desafio de avançar na instalação do enfoque familiar e na qualidade de atenção.

Public healthcare policies in Central America incorporate social participation as a fundamental elemental for improving healthcare services and achieving social equality. Nevertheless, there are mechanisms that weaken, distort, and produce low levels of participation and impede their promotion. The article analyzes this type of public policy in Guatemala, El Salvador, Nicaragua and Costa Rica, involving different categories of traditional modes of public policy analysis: Luhmann’s societal view and Habermas’ normativity. Methodologically, it uses exploratory documental research of electronic bibliographic sources. As a result, the policies present post-conventional elements that do not influence the implementation or the evaluation of policy and its tendency towards hierarchy, therefore, the challenge is to overcome the presence of the “conscious actor”.

As Políticas de saúde pública na América Central incorporam a participação social como um elemento fundamental para otimizar os serviços de saúde e alcançar a equidade social. No entanto, existem mecanismos que enfraquecem, distorcem, produzem baixos níveis de participação, dificultam a sua promoção e aprofundam o nível central delas. O artigo analisa esse tipo de política pública na Guatemala, El Salvador, Nicarágua e Costa Rica, envolvendo diferentes categorias dos modos tradicionais de análise das políticas públicas: a visão societária de Luhmann e a normatividade de Habermas. Metodologicamente, se usa a pesquisa de tipo exploratório documental das fontes bibliográficas eletrônicas. Como resultado, as políticas apresentam elementos pôs convencionais que não atuam na implementação nem na avaliação da política e sua tendência no sentido da hierarquia, portanto, o desafio é superar a presença do “ator onisciente”.

Las políticas públicas en salud de Centroamérica incorporan la participación social como elemento fundamental para la optimización de los servicios de salud y la consecución de la equidad social. No obstante, en éstas, subyacen mecanismos que las debilitan, distorsionan, producen bajos niveles de participación, obstaculizan su promoción y profundizan el nivel central. El artículo analiza este tipo de políticas públicas en Guatemala, El Salvador, Nicaragua y Costa Rica, implicando categorías de análisis diferentes a los modos tradicionales de análisis de política pública: visión societal luhmanniana y normatividad habermasiana. Metodológicamente, se usa la investigación de tipo exploratoria documental de fuentes bibliográficas electrónicas. Como resultado, las políticas presentan elementos postconvencionales, que no operan en la implementación ni evaluación de la política, y la tendencia es hacia la jerarquía, por lo cual, el desafío es superar la presencia del “actor omnisciente”.