Cintia Cejas - Academia.edu (original) (raw)
Papers by Cintia Cejas
Health Affairs, Nov 30, 2023
The Global Health Network eBooks, May 31, 2023
salud pública, aprendizaje automático, inferencia causal, ciencia de datos y sistemas de informac... more salud pública, aprendizaje automático, inferencia causal, ciencia de datos y sistemas de información en el CIIPS-IECS.
Background: The effective attainment of sexual, reproductive, and maternal health and rights (SRM... more Background: The effective attainment of sexual, reproductive, and maternal health and rights (SRMHR) requires a holistic life-course approach. This approach should address disparities in healthcare access and rights, guarantee the delivery of high-quality care devoid of discrimination, and underscore rigorous accountability mechanisms throughout the implementation process. Latin American and Caribbean (LAC) countries face significant disparities in SRMHR within and between nations. Vulnerable populations, such as indigenous communities, Afro-descendants, LGBTQI+ population, persons with disabilities, older adults, and migrants, often endure discrimination and stigmatization, severely impacting their access to healthcare and health rights. This paper discusses the findings of a qualitative component of a broader scoping study aimed at developing a priority research agenda to address the health gaps that affect SRHR of vulnerable populations. This study aimed to identify critical chal...
Cost Effectiveness and Resource Allocation
Background: The effective attainment of sexual, reproductive, and maternal health and rights (SRM... more Background: The effective attainment of sexual, reproductive, and maternal health and rights (SRMHR) requires a holistic life-course approach. This approach should address disparities in healthcare access and rights, guarantee the delivery of high-quality care devoid of discrimination, and underscore rigorous accountability mechanisms throughout the implementation process. Latin American and Caribbean (LAC) countries face significant disparities in SRMHR within and between nations. Vulnerable populations, such as indigenous communities, Afro-descendants, LGBTQI+ population, persons with disabilities, older adults, and migrants, often endure discrimination and stigmatization, severely impacting their access to healthcare and health rights. This paper discusses the findings of a qualitative component of a broader scoping study aimed at developing a priority research agenda to address the health gaps that affect SRHR of vulnerable populations. This study aimed to identify critical chal...
Cost Effectiveness and Resource Allocation
Objective Our study analyzes the cost-effectiveness of the COVID-19 vaccination campaigns in Arge... more Objective Our study analyzes the cost-effectiveness of the COVID-19 vaccination campaigns in Argentina, Brazil, Chile, Colombia, Costa Rica, Mexico, and Peru. Methods Using a previously published SVEIR model, we analyzed the impact of a vaccination campaign (2021) from a national healthcare perspective. The primary outcomes were quality adjusted life years (QALYs) lost and total costs. Other outcomes included COVID-19 cases, hospitalizations, deaths, and life years. We applied a discount rate of 3% for health outcomes. We modeled a realistic vaccination campaign in each country (the realistic country-specific campaign). Additionally, we assessed a standard campaign (similar, “typical“ for all countries), and an optimized campaign (similar in all countries with higher but plausible population coverage). One-way deterministic sensitivity analyses were performed. Findings Vaccination was health improving as well as cost-saving in almost all countries and scenarios. Our analysis shows t...
This publication reports on some of the health challenges facing cities. It aims to serve as a gu... more This publication reports on some of the health challenges facing cities. It aims to serve as a guide for public managers and decision makers optimize the great potential of cities to improve the well-being of those who reside in the cities of Latin America and the Caribbean. It is organized in two parts. The first part, Health Inequalities in Latin American Cities, focuses on identifying the ways in which social inequality has led to negative health outcomes, in order to make visible the relevance of the challenge of inequality and the urgency to grapple with it. The second part, Urban Policies for Healthy Cities, focuses on how cities can contribute to improving the health standards in their population. The publication addresses critical issues for urban health, such as the interdependence between physical-social factors and health, the relationship between urban characteristics and the incidence of COVID-19, the connections between social inequality and exposure to pollution envir...
AI for Global Health Research
This technical document, produced by the Center for Implementation and Innovation in Health Polic... more This technical document, produced by the Center for Implementation and Innovation in Health Policies (CIIPS) of the Institute forof Clinical and Health Effectiveness (IECS), focuses on the impact of Artificial Intelligence (AI) on healthcare in Latin America and the Caribbean (LAC). It provides an exploratory analysis of the current state of AI implementation in the region, identifying challenges and opportunities. The document highlights the heterogeneity and fragmentation of AI projects in LAC, mainly concentrated at the meso and micro-management levels. Absence of AI governance, regulations, and electronic health records are among the major barriers faced. However, there is growing interest and investment in AI by healthcare providers and technology companies, suggesting potential for future development. The importance of AI education for healthcare professionals, research to drive innovation, and the collaborative role of tools like ChatGPT in supporting the healthcare system ar...
UNSTRUCTURED During COVID-19 pandemic the world has faced a crisis exacerbating existing and emer... more UNSTRUCTURED During COVID-19 pandemic the world has faced a crisis exacerbating existing and emerging challenges in terms of equity and public health, above all on vulnerable population groups. One of the challenges is inequality in terms of internet access and connectivity, because it implies timely access to health care, and also teleworking, ordering food online, virtually attending classes or socializing. Thus, affordable internet connection should be considered as new "Digital Determinants of Health" and a basic service, as important as any other infrastructure, such as water and sewer systems. Following this principle, governments should take action, including universal connectivity in national plans and strategies for access and universal health coverage. Such action, plus programs that pay attention to digital literacy, gender gaps in the ownership of mobile phones and options for appropriate technologies among people with disabilities can contribute to reducing th...
Revista Argentina de Salud Pública, Mar 1, 2010
PLOS Global Public Health, 2022
The global impact of COVID-19 has challenged health systems across the world. This situation high... more The global impact of COVID-19 has challenged health systems across the world. This situation highlighted the need to develop policies based on scientific evidence to prepare the health systems and mitigate the pandemic. In this scenario, governments were urged to predict the impact of the measures they were implementing, how they related to the population’s behavior, and the capacity of health systems to respond to the pandemic. The overarching aim of this research was to develop a customizable and open-source tool to predict the impact of the expansion of COVID-19 on the level of preparedness of the health systems of different Latin American and the Caribbean countries, with two main objectives. Firstly, to estimate the transmission dynamics of COVID-19 and the preparedness and response capacity of health systems in those countries, based on different scenarios and public policies implemented to control, mitigate, or suppress the spread of the epidemic. Secondly, to facilitate poli...
Estudios económicos, 2013
Se propone analizar la estructura del mercado de servicios de salud en Neuquén, los mecanismos de... more Se propone analizar la estructura del mercado de servicios de salud en Neuquén, los mecanismos de contratación y pago y los resultados generados, a partir del mapeo de actores, la realización de entrevista y la administración de un cuestionario a establecimientos de salud. A pesar de la estructura de pagos por prestación, las aseguradoras y clínicas establecen mecanismos de transferencia de riesgos financieros aguas abajo mediante techos prestacionales y gestión de débitos. La existencia de copagos y la capacidad de diferenciación limitan la absorción directa. Por otro lado, en una provincia que no ha suscripto la normativa de reintegro mediante la figura del Hospital de Gestión Descentralizada, la capacidad de recupero financiero se encuentra asociada a la gestión del Hospital.
Studies in health technology and informatics, 2020
Digital Health is one of the three pillars for the effective implementation of Universal Health C... more Digital Health is one of the three pillars for the effective implementation of Universal Health Coverage in Argentina. The Ministry of Health published the National Digital Health Strategy 2018-2024 in order to establish the conceptual guidelines for the design and development of interoperable health information systems as a state policy. The World Health Organization "National eHealth Strategy Toolkit", "Global Strategy on Digital Health" and other international and local evidence and expert recommendations were taken into account. The path to better healthcare involves adopting systems at the point of care, allowing for the primary recording of information and enabling information exchange through real interoperability. In that way, people, technology and processes will synergize to enhance integrated health service networks. In this paper, we describe the plan and the first two years of implementation of the strategy.
Integrated Health Service Delivery Networks (IHSDN) based on primary health care (PHC) are the mo... more Integrated Health Service Delivery Networks (IHSDN) based on primary health care (PHC) are the most promising solution for health systems to satisfy the health needs of the population and to address access, efficiency, quality and equity challenges faced by health systems of the world. PHCs essential attributes (people and family centered care, comprehensiveness, continuity, longitudinality) position this approach as one of the key strategies for countries to meet the aspiration of achieving universal health coverage. Creating care networks has been a common thread running through Latin America and the Caribbeans health policy agendas. In terms of actually putting the IHSDN model in action, there is a wide range of interpretations and experiences, with designs, scales, organizational methods, and maturity levels that vary within and between countries. This book shares evidence of the progress made in forming and launching IHSDN in Latin America based on four case studies conducted i...
Studies in health technology and informatics, 2020
The Ministry of Health (MoH) stated the National Digital Health Strategy 2018-2024 in order to es... more The Ministry of Health (MoH) stated the National Digital Health Strategy 2018-2024 in order to establish the conceptual guidelines for the design and development of interoperable health information systems. It included the creation of a National Digital Health Network, and a Citizen Health Portal to inform and empower patients about their rights. For instance, the Digital Vaccination Card is already available and has equal legal validity as its paper version. The platform also works as a personal privacy manager, to configure the consent for Health Information Exchange through the network, or to check the access logs. This paper outlines the implementation experience of this powerful tool at a national level.
BMJ Global Health, 2019
High-performing primary health care (PHC) is essential for achieving universal health coverage. H... more High-performing primary health care (PHC) is essential for achieving universal health coverage. However, in many countries, PHC is weak and unable to deliver on its potential. Improvement is often limited by a lack of actionable data to inform policies and set priorities. To address this gap, the Primary Health Care Performance Initiative (PHCPI) was formed to strengthen measurement of PHC in low-income and middle-income countries in order to accelerate improvement. PHCPI’s Vital Signs Profile was designed to provide a comprehensive snapshot of the performance of a country’s PHC system, yet quantitative information about PHC systems’ capacity to deliver high-quality, effective care was limited by the scarcity of existing data sources and metrics. To systematically measure the capacity of PHC systems, PHCPI developed the PHC Progression Model, a rubric-based mixed-methods assessment tool. The PHC Progression Model is completed through a participatory process by in-country teams and s...
Health systems and reform, Jan 26, 2018
The reform of a health care system requires attention to specific components but also to the crea... more The reform of a health care system requires attention to specific components but also to the creation of an environment that supports change. Argentina has achieved nominal universal health coverage (UHC) but it still needs to work on achieving effective universal health coverage, especially with regard to quality and equity. Nominal coverage means that everyone has been enrolled and has the right to access, and effective coverage means that people have actually received prioritized health care services. In this article, we present our proposals to advance UHC in Argentina. The article includes an overview of Argentina's health system, then introduces the driving forces for reform, and finally analyzes four key issues where we provide our action plan to implement health reform for moving Argentina forward. Overall, our ultimate goal is to provide actual UHC and not aspirational UHC in Argentina by strengthening provincial health systems through enforcing public insurance schemes...
Local health systems-Social insurance-Payment mechanisms-Risk transfer-Contracts artÍculos origin... more Local health systems-Social insurance-Payment mechanisms-Risk transfer-Contracts artÍculos originales-Maceira y Col.-Sistemas de salud locales: análisis de la relación entre aseguramiento y mecanismos de contratación y pago en Córdoba, Salta y Tucumán artículoS originaleS palabraS clave: Sistemas provinciales de salud-Aseguramiento social-Mecanismos de pago-Transferencia de Riesgo-Contratos revista argentina de salud Pública |
Bajo un contexto de descentralización de servicios públicos de salud, la capacidad local para hac... more Bajo un contexto de descentralización de servicios públicos de salud, la capacidad local para hacer frente a las necesidades de la población se convierte en un aspecto crucial en la política provincial, más aún cuando las restricciones presupuestarias son significativas y ...
Health Affairs, Nov 30, 2023
The Global Health Network eBooks, May 31, 2023
salud pública, aprendizaje automático, inferencia causal, ciencia de datos y sistemas de informac... more salud pública, aprendizaje automático, inferencia causal, ciencia de datos y sistemas de información en el CIIPS-IECS.
Background: The effective attainment of sexual, reproductive, and maternal health and rights (SRM... more Background: The effective attainment of sexual, reproductive, and maternal health and rights (SRMHR) requires a holistic life-course approach. This approach should address disparities in healthcare access and rights, guarantee the delivery of high-quality care devoid of discrimination, and underscore rigorous accountability mechanisms throughout the implementation process. Latin American and Caribbean (LAC) countries face significant disparities in SRMHR within and between nations. Vulnerable populations, such as indigenous communities, Afro-descendants, LGBTQI+ population, persons with disabilities, older adults, and migrants, often endure discrimination and stigmatization, severely impacting their access to healthcare and health rights. This paper discusses the findings of a qualitative component of a broader scoping study aimed at developing a priority research agenda to address the health gaps that affect SRHR of vulnerable populations. This study aimed to identify critical chal...
Cost Effectiveness and Resource Allocation
Background: The effective attainment of sexual, reproductive, and maternal health and rights (SRM... more Background: The effective attainment of sexual, reproductive, and maternal health and rights (SRMHR) requires a holistic life-course approach. This approach should address disparities in healthcare access and rights, guarantee the delivery of high-quality care devoid of discrimination, and underscore rigorous accountability mechanisms throughout the implementation process. Latin American and Caribbean (LAC) countries face significant disparities in SRMHR within and between nations. Vulnerable populations, such as indigenous communities, Afro-descendants, LGBTQI+ population, persons with disabilities, older adults, and migrants, often endure discrimination and stigmatization, severely impacting their access to healthcare and health rights. This paper discusses the findings of a qualitative component of a broader scoping study aimed at developing a priority research agenda to address the health gaps that affect SRHR of vulnerable populations. This study aimed to identify critical chal...
Cost Effectiveness and Resource Allocation
Objective Our study analyzes the cost-effectiveness of the COVID-19 vaccination campaigns in Arge... more Objective Our study analyzes the cost-effectiveness of the COVID-19 vaccination campaigns in Argentina, Brazil, Chile, Colombia, Costa Rica, Mexico, and Peru. Methods Using a previously published SVEIR model, we analyzed the impact of a vaccination campaign (2021) from a national healthcare perspective. The primary outcomes were quality adjusted life years (QALYs) lost and total costs. Other outcomes included COVID-19 cases, hospitalizations, deaths, and life years. We applied a discount rate of 3% for health outcomes. We modeled a realistic vaccination campaign in each country (the realistic country-specific campaign). Additionally, we assessed a standard campaign (similar, “typical“ for all countries), and an optimized campaign (similar in all countries with higher but plausible population coverage). One-way deterministic sensitivity analyses were performed. Findings Vaccination was health improving as well as cost-saving in almost all countries and scenarios. Our analysis shows t...
This publication reports on some of the health challenges facing cities. It aims to serve as a gu... more This publication reports on some of the health challenges facing cities. It aims to serve as a guide for public managers and decision makers optimize the great potential of cities to improve the well-being of those who reside in the cities of Latin America and the Caribbean. It is organized in two parts. The first part, Health Inequalities in Latin American Cities, focuses on identifying the ways in which social inequality has led to negative health outcomes, in order to make visible the relevance of the challenge of inequality and the urgency to grapple with it. The second part, Urban Policies for Healthy Cities, focuses on how cities can contribute to improving the health standards in their population. The publication addresses critical issues for urban health, such as the interdependence between physical-social factors and health, the relationship between urban characteristics and the incidence of COVID-19, the connections between social inequality and exposure to pollution envir...
AI for Global Health Research
This technical document, produced by the Center for Implementation and Innovation in Health Polic... more This technical document, produced by the Center for Implementation and Innovation in Health Policies (CIIPS) of the Institute forof Clinical and Health Effectiveness (IECS), focuses on the impact of Artificial Intelligence (AI) on healthcare in Latin America and the Caribbean (LAC). It provides an exploratory analysis of the current state of AI implementation in the region, identifying challenges and opportunities. The document highlights the heterogeneity and fragmentation of AI projects in LAC, mainly concentrated at the meso and micro-management levels. Absence of AI governance, regulations, and electronic health records are among the major barriers faced. However, there is growing interest and investment in AI by healthcare providers and technology companies, suggesting potential for future development. The importance of AI education for healthcare professionals, research to drive innovation, and the collaborative role of tools like ChatGPT in supporting the healthcare system ar...
UNSTRUCTURED During COVID-19 pandemic the world has faced a crisis exacerbating existing and emer... more UNSTRUCTURED During COVID-19 pandemic the world has faced a crisis exacerbating existing and emerging challenges in terms of equity and public health, above all on vulnerable population groups. One of the challenges is inequality in terms of internet access and connectivity, because it implies timely access to health care, and also teleworking, ordering food online, virtually attending classes or socializing. Thus, affordable internet connection should be considered as new "Digital Determinants of Health" and a basic service, as important as any other infrastructure, such as water and sewer systems. Following this principle, governments should take action, including universal connectivity in national plans and strategies for access and universal health coverage. Such action, plus programs that pay attention to digital literacy, gender gaps in the ownership of mobile phones and options for appropriate technologies among people with disabilities can contribute to reducing th...
Revista Argentina de Salud Pública, Mar 1, 2010
PLOS Global Public Health, 2022
The global impact of COVID-19 has challenged health systems across the world. This situation high... more The global impact of COVID-19 has challenged health systems across the world. This situation highlighted the need to develop policies based on scientific evidence to prepare the health systems and mitigate the pandemic. In this scenario, governments were urged to predict the impact of the measures they were implementing, how they related to the population’s behavior, and the capacity of health systems to respond to the pandemic. The overarching aim of this research was to develop a customizable and open-source tool to predict the impact of the expansion of COVID-19 on the level of preparedness of the health systems of different Latin American and the Caribbean countries, with two main objectives. Firstly, to estimate the transmission dynamics of COVID-19 and the preparedness and response capacity of health systems in those countries, based on different scenarios and public policies implemented to control, mitigate, or suppress the spread of the epidemic. Secondly, to facilitate poli...
Estudios económicos, 2013
Se propone analizar la estructura del mercado de servicios de salud en Neuquén, los mecanismos de... more Se propone analizar la estructura del mercado de servicios de salud en Neuquén, los mecanismos de contratación y pago y los resultados generados, a partir del mapeo de actores, la realización de entrevista y la administración de un cuestionario a establecimientos de salud. A pesar de la estructura de pagos por prestación, las aseguradoras y clínicas establecen mecanismos de transferencia de riesgos financieros aguas abajo mediante techos prestacionales y gestión de débitos. La existencia de copagos y la capacidad de diferenciación limitan la absorción directa. Por otro lado, en una provincia que no ha suscripto la normativa de reintegro mediante la figura del Hospital de Gestión Descentralizada, la capacidad de recupero financiero se encuentra asociada a la gestión del Hospital.
Studies in health technology and informatics, 2020
Digital Health is one of the three pillars for the effective implementation of Universal Health C... more Digital Health is one of the three pillars for the effective implementation of Universal Health Coverage in Argentina. The Ministry of Health published the National Digital Health Strategy 2018-2024 in order to establish the conceptual guidelines for the design and development of interoperable health information systems as a state policy. The World Health Organization "National eHealth Strategy Toolkit", "Global Strategy on Digital Health" and other international and local evidence and expert recommendations were taken into account. The path to better healthcare involves adopting systems at the point of care, allowing for the primary recording of information and enabling information exchange through real interoperability. In that way, people, technology and processes will synergize to enhance integrated health service networks. In this paper, we describe the plan and the first two years of implementation of the strategy.
Integrated Health Service Delivery Networks (IHSDN) based on primary health care (PHC) are the mo... more Integrated Health Service Delivery Networks (IHSDN) based on primary health care (PHC) are the most promising solution for health systems to satisfy the health needs of the population and to address access, efficiency, quality and equity challenges faced by health systems of the world. PHCs essential attributes (people and family centered care, comprehensiveness, continuity, longitudinality) position this approach as one of the key strategies for countries to meet the aspiration of achieving universal health coverage. Creating care networks has been a common thread running through Latin America and the Caribbeans health policy agendas. In terms of actually putting the IHSDN model in action, there is a wide range of interpretations and experiences, with designs, scales, organizational methods, and maturity levels that vary within and between countries. This book shares evidence of the progress made in forming and launching IHSDN in Latin America based on four case studies conducted i...
Studies in health technology and informatics, 2020
The Ministry of Health (MoH) stated the National Digital Health Strategy 2018-2024 in order to es... more The Ministry of Health (MoH) stated the National Digital Health Strategy 2018-2024 in order to establish the conceptual guidelines for the design and development of interoperable health information systems. It included the creation of a National Digital Health Network, and a Citizen Health Portal to inform and empower patients about their rights. For instance, the Digital Vaccination Card is already available and has equal legal validity as its paper version. The platform also works as a personal privacy manager, to configure the consent for Health Information Exchange through the network, or to check the access logs. This paper outlines the implementation experience of this powerful tool at a national level.
BMJ Global Health, 2019
High-performing primary health care (PHC) is essential for achieving universal health coverage. H... more High-performing primary health care (PHC) is essential for achieving universal health coverage. However, in many countries, PHC is weak and unable to deliver on its potential. Improvement is often limited by a lack of actionable data to inform policies and set priorities. To address this gap, the Primary Health Care Performance Initiative (PHCPI) was formed to strengthen measurement of PHC in low-income and middle-income countries in order to accelerate improvement. PHCPI’s Vital Signs Profile was designed to provide a comprehensive snapshot of the performance of a country’s PHC system, yet quantitative information about PHC systems’ capacity to deliver high-quality, effective care was limited by the scarcity of existing data sources and metrics. To systematically measure the capacity of PHC systems, PHCPI developed the PHC Progression Model, a rubric-based mixed-methods assessment tool. The PHC Progression Model is completed through a participatory process by in-country teams and s...
Health systems and reform, Jan 26, 2018
The reform of a health care system requires attention to specific components but also to the crea... more The reform of a health care system requires attention to specific components but also to the creation of an environment that supports change. Argentina has achieved nominal universal health coverage (UHC) but it still needs to work on achieving effective universal health coverage, especially with regard to quality and equity. Nominal coverage means that everyone has been enrolled and has the right to access, and effective coverage means that people have actually received prioritized health care services. In this article, we present our proposals to advance UHC in Argentina. The article includes an overview of Argentina's health system, then introduces the driving forces for reform, and finally analyzes four key issues where we provide our action plan to implement health reform for moving Argentina forward. Overall, our ultimate goal is to provide actual UHC and not aspirational UHC in Argentina by strengthening provincial health systems through enforcing public insurance schemes...
Local health systems-Social insurance-Payment mechanisms-Risk transfer-Contracts artÍculos origin... more Local health systems-Social insurance-Payment mechanisms-Risk transfer-Contracts artÍculos originales-Maceira y Col.-Sistemas de salud locales: análisis de la relación entre aseguramiento y mecanismos de contratación y pago en Córdoba, Salta y Tucumán artículoS originaleS palabraS clave: Sistemas provinciales de salud-Aseguramiento social-Mecanismos de pago-Transferencia de Riesgo-Contratos revista argentina de salud Pública |
Bajo un contexto de descentralización de servicios públicos de salud, la capacidad local para hac... more Bajo un contexto de descentralización de servicios públicos de salud, la capacidad local para hacer frente a las necesidades de la población se convierte en un aspecto crucial en la política provincial, más aún cuando las restricciones presupuestarias son significativas y ...