Soranz Daniel, Pisco Luís Augusto Coelho
Sistema Único de Saúde (SUS), Secretaria Municipal de Saúde da Cidade do Rio de Janeiro. R. Afonso Cavalcanti 455/701, Cidade Nova. 20211-110 Rio de Janeiro RJ Brasil.
Conselho Diretivo da Administração Regional de Saúde de Lisboa e Vale do Tejo, Serviço Nacional de Saúde. Lisboa Portugal.
Cien Saude Colet. 2017 Mar;22(3):679-686. doi: 10.1590/1413-81232017223.33722016.
On the 30th anniversary of Alma-Ata, the World Health Organization published in 2008 the "Primary Health Care Now More Than Ever" Report, calling on all governments to reflect on the need to reflect on four sets of reforms. These included: (i) universal coverage reforms; (ii) service delivery reforms; (iii) public policies reforms that would ensure healthier communities; and (iv) leadership reforms. In this context, in the period 2005-2016, the cities of Rio de Janeiro and Lisbon developed a profound primary healthcare reform, and did so by sharing many of the solutions based on the best internationally recognized organizational practices. Several factors were fundamental throughout Lisbon and Rio de Janeiro's path of reforms, namely: (i) teamwork with professional motivation; (ii) internal and external communication; (iii) strengthening of training activities; (iv) investment in facilities and equipment; (v) commitment to the information system and computerization; (vi) pay-for-performance; (vii) health care contractualisation between funders and providers; (viii) technical leadership; (ix) political leadership; and finally (x) quality and accreditation of facilities by public agency.
在阿拉木图宣言发表30周年之际，世界卫生组织于2008年发布了《现在比以往任何时候都更需要初级卫生保健》报告，呼吁各国政府思考进行四项改革的必要性。这些改革包括：（一）全民覆盖改革；（二）服务提供改革；（三）确保社区更健康的公共政策改革；（四）领导力改革。在此背景下，2005年至2016年期间，里约热内卢市和里斯本市开展了意义深远的初级卫生保健改革，并且通过分享许多基于国际公认最佳组织实践的解决方案来推进改革。在里斯本和里约热内卢的整个改革进程中，有几个因素至关重要，即：（一）具备职业动力的团队合作；（二）内部和外部沟通；（三）加强培训活动；（四）对设施和设备的投资；（五）对信息系统和计算机化的投入；（六）绩效薪酬；（七）资助方与服务提供方之间的医疗保健合同制；（八）技术领导力；（九）政治领导力；最后是（十）公共机构对设施的质量评估和认证。
