En este momento estás viendo Rosa Elcarte: «La calidad es el eje que está movilizando al Servicio Nacional de Salud»

Rosa Elcarte: «La calidad es el eje que está movilizando al Servicio Nacional de Salud»

La representante de UNICEF en el país, Rosa Elcarte, conversó con SNS Digital sobre los avances y retos del Servicio Nacional de Salud, destacó los grandes esfuerzos realizados para reducir la mortalidad materna y neonatal, así como el compromiso mostrado con la calidad de los servicios, mejoramiento de infraestructuras, equipamiento y contratación de personal en los centro de la Red Pública de Servicios de Salud.

SNS Digital: ¿Cómo valora UNICEF el sistema sanitario de la República Dominicana y en especial la prestación de servicios públicos de salud?

Rosa Elcarte: A partir de que el sistema de salud se dividió en un ente rector y un ente implementador, creo que ha sido un reto poder diferenciar las funciones de cada uno. Paulatinamente se han ido clarificando los roles y cada día estamos más seguros de quién debe hacer qué. En este caso, el Servicio Nacional de Salud tiene el reto de prestar los servicios y prestarlos con calidad.

Ha sido complejo corregir una serie de malos hábitos que habían existido, del personal que fichaba y no iba, personal que se contrataba y se le daba a otra persona y para ser sinceros, también de una falta de calidad de atención en muchos de los servicios. En los últimos dos años ha habido un cambio radical, hemos visto un sistema nacional de salud completamente comprometido, desde el eje central, en cambiar y mejorar esta situación.

Nosotros como UNICEF nos centramos en la salud materna infantil. En este caso, dado los resultados epidemiológicos que tiene el país, la mortalidad materna y neonatal y la transmisión vertical de VIH son las áreas en las que trabajamos en conjunto con el Servicio Nacional de Salud.

Hemos visto con muchísimo agrado que finalmente el tema de la calidad está siendo el eje que moviliza al Servicio Nacional de Salud en los temas en los que estamos trabajando y la calidad implica un análisis de los recursos humanos existentes, los insumos y en el accionar de los proveedores de salud para ver si realmente se están apegando a los protocolos y las normas para obtener buenos resultados.

Esta última parte es la más difícil, pero conjuntamente estamos trabajando con una metodología de mejora continua de la calidad de atención, que se basa fundamentalmente en una observación externa de cómo se hacen las prácticas clínicas y se van midiendo de acuerdo a los estándares. Ahí se refleja claramente aquellos hospitales que tienen una mejor o peor calidad en determinados parámetros, relacionados todo con atención materna y neonatal y no solo en esos parámetros, sino cuáles actividades concretas se hacen.

Por ejemplo, puedes tener una mala puntuación en control prenatal o en postparto, pero sabes exactamente, porque te lo dijo la metodología, en qué y por qué tienes esa mala puntuación y por lo tanto, se pueden hacer y se están haciendo unos planes de mejora.

Estamos viendo con infinito agradecimiento y júbilo cómo finalmente ese esfuerzo conjunto, análisis de recursos humanos, supervisión de los insumos y vigilancia intensiva de la calidad de atención, están dando resultados satisfactorios. Teníamos una mortalidad neonatal estancada en los últimos 30 años y por primera vez estamos viendo una increíble reducción.

Lo que me preocupa en este momento es que estamos en época de cambio de gobierno y sería importante que lo que se ha avanzado no eche marcha atrás, porque es difícil arrancar, es difícil comprometerse y tenemos a muchos hospitales comprometidos, a muchos directores nacionales y de hospitales que están esforzándose cada día más y estamos poniéndoles nuevos retos, vamos avanzando y esa mejora continua de la calidad de atención es lo que realmente va a dar éxito y va a hacer que salgamos de esas cifras tan vergonzosas que tenía el país.

Yo estoy muy agradecida con el Servicio Nacional de Salud, de como en tan poco tiempo ha hecho tan gran esfuerzo a pesar de todas las adversidades y estamos teniendo tremendos resultados.

SNS Digital: ¿Cuáles entiende han sido los principales logros del Servicio Nacional de Salud?

Rosa Elcarte: En nuestro ámbito, la reducción de la mortalidad materna y neonatal fue clave en el año 2019, hacía 30 años que no movíamos la hoja. Sabíamos que era difícil, pero sabíamos como UNICEF que se podía reducir y teníamos una metodología que estábamos empujando pero que no conseguíamos que encajara y fuera apropiada. Con la institucionalidad y el Servicio Nacional de Salud ahora está apropiada y estamos haciendo el modelo informático, que entiendo se puede unir al repositorio para darle un plus y mostrar no solamente la cantidad, sino la calidad.

SNS Digital: El tema de reducir la mortalidad materna y neonatal es una prioridad para el Estado dominicano ¿entiende se están tomado las acciones correctas o aún faltan algunas que no se han implementado?

Rosa Elcarte: Se están tomando acciones correctas, pero faltan más. Se ha hecho un esfuerzo muy grande en la observación de la calidad. Estoy muy contenta, va mejorando porque va incluyendo nuevos temas, falta todavía más en apoyo a la preparación de los planes de mejora de los hospitales y el acompañamiento. Hay que trabajar con los Servicio Regionales de Salud para que asuman más esa función y desde el nivel central se puede reforzar aún más.

Esta reducción que hemos experimentado en la mortalidad materna y neonatal, si se refuerza con el acompañamiento en los planes de mejora, el año que viene sería doble.

SNS Digital: ¿Cómo evalúa los avances en materia de infraestructura, equipos y personal capacitado?

Rosa Elcarte: En el país ha habido una mejora increíble en cuanto a infraestructuras y una contratación de personal como nunca se había visto. Ahora estamos cerrando el círculo, hemos empezado a hacer y todavía nos falta mucho por mejorar pero la dirección que estamos tomando es la correcta.

SNS Digital: Si usted tuviera que despedirse mañana del país, de la representación de UNICEF ¿cuál diría es el mayor logro de su gestión y cuál ha sido el principal desafío?

Rosa Elcarte: Yo consideraría dos logros, el rol que UNICEF ha jugado en la reducción de la mortalidad neonatal, me llena de satisfacción y haber puesto en la agenda pública y política la necesidad de reducir el matrimonio infantil, diría que estos son los dos logros más importantes, pero hay muchos otros, hemos aumentado el registro de nacimiento en los hospitales.

El mayor desafío son las pautas culturales machistas que impregnan casi todo lo que se hace y que provoca que haya violencia obstétrica, abuso sexual, explotación sexual, embarazo en adolescentes, matrimonio infantil y que muchas de esas cosas se normalicen en la sociedad.

Necesitamos un cambio de comportamiento, es prácticamente lo que estamos haciendo con la metodología de calidad, un cambio de comportamiento de las pautas de trabajo del personal sanitario pero también un cambio de comportamiento en la propia sociedad, eso es lo que más me cuesta y creo es lo que mas dificulta que el país siga avanzando.

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