Globalization and Health Inequities in Latin America by Ligia Malagón de Salazar & Roberto Carlos Luján Villar

Author:Ligia Malagón de Salazar & Roberto Carlos Luján Villar
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

The proposed theoretical and methodological approach involved applying an analytical technique known as strategic analysis , that is, the analysis of the appropriateness of the intervention under study in the context of the Rio de Janeiro Metropolitan Area. Following Champagne et al. (2011a), an intervention’s appropriateness or suitability depends primarily on the epidemiological, sociocultural, financial, political, and geographical contexts in which it occurs.

This type of analysis is intended to respond to a series of context-related questions , such as the following: (a) Is it appropriate to intervene in this problem, given its importance? (b) Is the proposed intervention consistent with the problem’s solution? (c) Is the intervention the most appropriate in the existing context? (d) Does the intervention address the main determinants of the problem and its target population? (e) Is it appropriate to intervene in this manner? (f) Are the goals initially set appropriate to the problem’s solution and meeting local needs? and (g) Are those responsible for the intervention acting appropriately, considering their functions and skills? (Cardoso et al. 2017).

The case study design used to operationalize the proposed analysis valorizes the study phenomenon in its real-life context, that is, where the boundaries between phenomenon and context are not readily identifiable. In that situation, the setting is selected deliberately in view of its relation to the intervention selected for study (Yin 2015), in this case the municipality of Rio de Janeiro, where seven CnaRs have existed since their introduction in 2009. Multiple information collection techniques were used, as described in what follows, so as to triangulate and complement the analysis (Greene et al. 2001).

Champagne et al. (2011a) consider that the first step in a strategic analysis involves describing and delimiting the problem situation that led to the need to institutionalize the intervention (in this case, CnaRs, operating under Ministry of Health guidelines). To that end, first, texts produced by the national coordination and official documents , including guidelines, ministerial orders, technical standards, and so on, were examined in order to understand the problem in relation to its national context and, subsequently, in relation to the Rio de Janeiro municipal context. In addition, workshops and conversation groups were held, with the participation of key informants, such as national and municipal CnaR managers and health personnel, so as to understand the configuration of the problem in Brazil and in Rio de Janeiro (Teixeira and Fonseca, 2015)

The second step of a strategic analysis seeks to analyze the appropriateness of the goals of the intervention . This required constructing a theoretical-logic model and an operational-logic model of the intervention. The models are visual representations of cognitive representations. Accordingly, the theoretical-logic model —visually describing a planned intervention based on a formal theory of actions—contemplates the causal hypotheses of the intervention, together with its resources, activities, and effects, in view of the objectives and targets it is intended to attain (Champagne et al. 2011b). The operational-logic model represents how the program will achieve the goals of the intervention, that is, what resources will be needed,

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