The debate on the relevance of technology can only lead to positive results when governments and institutions decide to establish effective mechanisms for the continuous evaluation of technologies in terms of their value in solving concrete problems, as well as the economic, cultural and administrative aspects of service delivery.
The application of the risk approach in relation to the development of appropriate technologies has produced clear manifestations in the field of maternal and child care. Among them are the rationalization of obstetric practices, such as the use of anesthetics, oxytocics, forceps and other types of interventions in normal childbirth care; oral rehydration in the management of childhood diarrhea; surveillance and control of malnutrition; immunizations; and fertility regulation as an alternative for postponing or preventing pregnancy in high-risk women.
From another point of view, the revalidation of behavioral alternatives such as breastfeeding for feeding young children requires the creation and application of effective methods to promote its definitive adoption by the population. The control of acute respiratory infections in children is a priority for research on the epidemiological aspects of the problem, the most appropriate methods for diagnosis, prevention and treatment, and the organization of services for the entire population.
In a broad sense, the infrastructure of health services is made up of the set of institutional and community resources that carry out activities aimed at improving the health status of the population in response to more or less explicit needs and demands, according to organizational patterns that vary depending on different situations.
Usually, service delivery consists of a combination of promotion, prevention, treatment and rehabilitation measures. The forms of organization of services traditionally respond to the professional and occupational characteristics of personnel and to the complexity of the technological resources available.
In this way, the so-called levels of care have been structured. These are defined more by the characteristics of the service supply according to facilities of different complexity than by a true estimate of the real needs of the population.
Consequently, the first level of care, which in theory should be equipped to solve the greatest number of problems at the lowest possible cost, is identified with certain types of facilities that lack the resources needed to meet demand. In addition, they are organized in such a way that they do not succeed in gaining the trust of communities.
By contrast, secondary and tertiary level facilities, which are supposed to represent necessary solutions for concentrating less frequent pathologies and thus regulating the high cost of more complex technology, often invest a large part of their resources in care that could be solved more efficiently through other service modalities.
In most countries, it is possible to observe that lower-complexity services, especially in urban areas, are little used by the population, which prefers to attend outpatient clinics and emergency services in hospitals. Some studies show that programs based exclusively on promotion and prevention activities fail to attract community interest and that, on the other hand, communities have a stronger preference for curative services, as reflected in the high consumption of medicines obtained through different channels.
Research into these phenomena may include experiments and simulation models on administrative activities, such as cost analysis, production, productivity, legal matters, public relations, standards and procedures, space requirements, information systems, hospital administration, occupational profiles of personnel, educational research and others.
Unfortunately, most of the results of these studies are never actually applied in a way that would allow the necessary changes to be introduced into the forms of service organization in order to achieve greater efficiency and effectiveness.
It is necessary to understand the usefulness of studies in the field of administration as a way to rationalize the use of resources. However, the concern regarding the goals of health for all by the year 2000 lies in the need to find new ideas aimed at satisfying the health needs of the entire population.
The development of outpatient medical care services is a particularly attractive field for the search for more effective alternatives for extending service coverage through the rationalization of the use of available resources.
Thus, for example, it has been shown that a high proportion of surgical procedures traditionally performed under hospitalization conditions can be carried out in outpatient services, with a notable saving of resources.
In most countries, the health service delivery system is characterized by its fragmentation into multiple institutions with different approaches and policies regarding beneficiary population groups. It is also characterized by deep differences in the content and coverage of the services offered.
Consequently, recognition of this institutional plurality requires the search for forms that make institutional objectives and policies compatible with major national objectives and policies, that allow resources to be applied, and that are operational, so that they contribute to the principles of equity, efficiency and effectiveness adopted by governments.
