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ABSTRACT Objective: Determine the relationship between the budget execution of financial transfers from the SIS (Seguro Integral de Salud) and the availability of medical supplies in third-level establishments of the Ministry of Health of Metropolitan Lima. Material and method: Analytical and cross-sectional study, carried out in the 20 level III establishments of the MINSA in Lima; Likewise, documentary information was used such as Closing Minutes of Financial Supervision of the Macroregional Management of the SIS from which information on budget execution was obtained and the availability of medical supplies was obtained from the Mundo IPRESS web portal (Institutions Providing Health Services). After evaluating normality with the Shapiro-Wilk test, the Spearman correlation test was used. Result: Overall budget execution was not related to the availability of medical supplies (rho=-0.014; p=0.955). The evaluation by components showed that budget execution on medicines was positively related to the availability of supplies (rho=0.417; p=0.045), which was also valid in the segmented analysis only for hospitals (rho: 0.594; p=0.032). Although budget execution in segmented materials and supplies for hospitals was related to the availability of supplies, this relationship was inverse (rho=-0.552; p=0.043). Conclusions: The general budget execution of financial transfers from the SIS was not related to the availability of medical supplies, but the spending component on medicines was.

ABSTRACT Objective: Determine the relationship between the budget execution of financial transfers from the SIS (Seguro Integral de Salud) and the availability of medical supplies in third-level establishments of the Ministry of Health of Metropolitan Lima. Material and method: Analytical and cross-sectional study, carried out in the 20 level III establishments of the MINSA in Lima; Likewise, documentary information was used such as Closing Minutes of Financial Supervision of the Macroregional Management of the SIS from which information on budget execution was obtained and the availability of medical supplies was obtained from the Mundo IPRESS web portal (Institutions Providing Health Services). After evaluating normality with the Shapiro-Wilk test, the Spearman correlation test was used. Result: Overall budget execution was not related to the availability of medical supplies (rho=-0.014; p=0.955). The evaluation by components showed that budget execution on medicines was positively related to the availability of supplies (rho=0.417; p=0.045), which was also valid in the segmented analysis only for hospitals (rho: 0.594; p=0.032). Although budget execution in segmented materials and supplies for hospitals was related to the availability of supplies, this relationship was inverse (rho=-0.552; p=0.043). Conclusions: The general budget execution of financial transfers from the SIS was not related to the availability of medical supplies, but the spending component on medicines was.

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RESUMEN En un contexto de búsqueda de oportunidades de inversion, la impresión inicial que sobre un emprendedor se forme un inversionista influye de manera directa en su propio proceso decisional. En ese sentido, el presente trabajo busca estudiar las implicaciones que subyacen a este panorama inicial, puntualmente en un escenario de decisiones de inversion sobre iniciativas que apuestan por el desarrollo sostenible (i.e., inversiones de impacto). Para ello, haciendo uso de un caso de estudio, se despliega un proceso de análisis cualitativo que permite identificar las especificidades del estilo de liderazgo de un emprendedor de impacto determinado, así como la forma en que este mismo estilo podr'a afectar la eventual decision de un potencial inversionista. En ese orden de ideas, el presente trabajo contribuye a la transferibilidad y profundización del tópico en cuestión, en diversas áreas del conocimiento. СLASIFICACIÓN JEL: 126, Q56

AВSTRАСT In a context of seeking investment opportunities, the initial impression that an investor forms on an entrepreneur influences their own decision-making process. In this sense, the present work seeks to study the implications underlying this initial panorama, specifically in a scenario of investment decisions on initiatives that are committed to reach a sustainable development (i.e., impact investments). For this purpose, and using a case study a qualitative analysis process is deployed, allowing the identification of the corresponding leadership style of a given impact entrepreneur; as well as the way in which this same style could affect the eventual decision of a potential investor In that order of ideas, the present work contributes to the transferability and deepening of the topic at issue in various areas of knowledge. JEL CLASSIFICATION: 126, Q56

RESUMO No contexto da busca de oportunidades de investimento, a impressão inicial que um investidor tem de um empresário tem uma influência direta em seu próprio processo de tomada de decisão. Neste sentido, este documento procura estudar as implicações que estão na base deste panorama inicial, especificamente em um cenário de decisões de investimento em iniciativas comprometidas com o desenvolvimento sustentável (ou seja, investimentos de impacto). Para este fim, utilizando um estudo de caso, é implantado um processo de análise qualitativa para identificar as especificidades do estilo de liderança de um determinado empreendedor de impacto, bem como a forma como este mesmo estilo poderia afetar a eventual decisão de um investidor potencial. Neste sentido, este trabalho contribui para a transferibilidade e aprofundamento do tema em questão, em várias áreas do conhecimento. CLASSIFICAÇÃO JEL: 126, Q56

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Resumo Apesar de lançado em 2011, o título de impacto social (SIB, na sigla em inglês social impact bonds) é um instrumento ainda em desenvolvimento e que encontra inúmeros desafios. Este artigo tem como objetivo apresentar características dos SIBs e desafios relativos à sua implementação como mecanismo para financiamento de projetos públicos com propósito social. Após revisão bibliográfica e documental, foram identificadas e apresentadas as principais críticas ao modelo. Três casos internacionais de SIBs que já encerraram seus ciclos de maturidade foram selecionados para a análise de aspectos éticos e metodológicos, de métricas, de resultados e de atores. Implicações para projetos no Brasil foram consideradas com base nas análises dos casos internacionais.

Resumen A pesar de haber sido lanzado en 2011, el contrato de impacto social (SIB, acrónimo del término inglés social impact bond) es un instrumento inmaduro que enfrenta numerosos desafíos. Este artículo tiene como objetivo presentar las características de los SIB y los desafíos relativos a su implementación como mecanismos para financiar proyectos públicos con propósito social. Después de la revisión bibliográfica y documental, se identificaron y presentaron las principales críticas al modelo. Se seleccionaron tres casos internacionales de SIB que ya completaron sus ciclos de madurez para el análisis de aspectos éticos, metodológicos, de métricas de resultados y de actores. Las implicaciones para proyectos en Brasil se consideraron a partir del análisis de estos casos internacionales.

Abstract Despite being launched in 2011, the social impact bond (SIB) is an instrument under development that faces numerous challenges. This article presents the characteristics of SIBs and challenges related to their implementation as mechanisms to finance public projects with a social purpose. After a bibliographical and documentary review, three international cases of SIBs that have completed their maturity cycles, relevant for critical analysis of possible projects in Brazil, were selected. Ethical, methodological, metrics, results, and actor networks are analyzed in the three SIBs. Implications for projects in Brazil were considered from the analysis of these international cases.

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Introdução: A razão de mortalidade materna é importante não somente para avaliar a saúde das mulheres, mas também é indicador de desenvolvimento econômico e de desigualdades sociais, sendo base para avaliar a eficiência dos sistemas de saúde de países. O financiamento desses sistemas é fundamental para caracterizá-los em sua dimensão de serviços e ações para as populações. Este trabalho teve o objetivo de avaliar a associação entre os gastos federais de custeio em Atenção Básica e de Média e Alta Complexidade, desde 2008 até 2017, e a mortalidade materna. Métodos: O estudo foi ecológico, quantitativo e utilizou dados secundários dos bancos do Ministério da Saúde, analisando correlação entre financiamento e mortalidade materna. Resultados e Conclusão: Entre os resultados, não foi encontrada associação significativa entre custeio federal de AB e MAC e mortalidade materna; o Brasil apresenta mortalidade materna ainda alta e praticamente sem modificações nos últimos dez anos, ainda que existam diferenças de até quatro vezes na taxa de mortalidade materna entre as regiões, porém sem significativa associação com o financiamento.

Introduction: Maternal mortality rates are important not only to assess women's health but also as an indicator of economic development and social inequalities, supporting the assessment of the efficacy of country's health systems. Financing of these systems is essential to characterize them as services and actions for populations. This study aimed to assess the association of federal funding expenses on Primary Health Care (PHC) and Medium and High Complexity Health Care (MHCHC) from 2008 to 2017 with maternal mortality. Method: This quantitative, ecological study used secondary data from databases of the Brazilian Ministry of Health to analyze the correlation between financing and maternal mortality. Results and Conclusion: The results did not show a significant association of federal financing of PHC and MHCHC with maternal mortality; in Brazil high maternal mortality rates are still high and have remained almost unchanged over the last ten years, although there are differences of up to four-fold in mortality rates among regions, but with no significant association with financing.

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Financial inclusion has been broadly recognized as critical in alleviating poverty and achieving inclusive economic growth. The capability of borrowers to repay their microcredit loans is a critical concern and is the first risk of Microfinance institutions sustainability. Exploring the determinants of credit risk is an issue of substantial importance in microfinance. The purpose of this research was to identify the savings group members' characteristics that have impact on default risk. We have used a multivariate regression model to identify the factors that affect default behaviour among microcredit borrowers from savings groups. We have analysed a sample of more than different 400 Savings Groups and 7251 active users of the "Saving and Learning" program in Ecuador. Empirical results demonstrated that factors such as seniority, accumulated savings and the number of members in the savings groups are determinant variables of default risk. The significant positive sign on variable "Gender" is consistent with the previous authors that indicate that the probability of having problems in loan repayment is higher for males than for females. The generalizability of our findings should, of course, be interpreted with caution, as they may be idiosyncratic of the sample, period or region. To contrast and contextualize these results, we had in-depth discussions with the Savinco managers and their field agent in Ecuador. There are many contributions. For practitioners, relevant factors that can affect savings groups default rates have been identified. For academics, the rich information provided by the Savinco mobile App could be a starting point for further quantitative research.

Il est largement reconnu que l'inclusion financière est essentielle pour réduire la pauvreté et parvenir à une croissance économique inclusive. La capacité des emprunteurs à rembourser leurs prêts de microcrédit est une préoccupation essentielle et constitue le premier risque pour la pérennité des institutions de microfinance. L'étude des déterminants du risque de crédit est une question d'une importance capitale en microfinance. Le but de cette étude est d'identifier les caractéristiques des membres de groupes d'épargne qui ont un impact sur le risque de défaut de paiement. Nous avons utilisé un modèle de régression multivariée pour identifier les facteurs qui affectent le comportement de défaut de paiement parmi les emprunteurs de microcrédit au sein de groupes d'épargne. Nous avons analysé un échantillon de plus de 400 groupes d'épargne différents et 7 251 utilisateurs actifs du programme « Épargne et apprentissage ¼ en Équateur. Les résultats empiriques ont démontré que des facteurs tels que l'ancienneté, l'épargne accumulée et le nombre de membres dans les groupes d'épargne sont des variables déterminantes du risque de défaut de paiement. Sur la variable « Genre ¼, le signe positif significatif est cohérent avec les études précédentes qui indiquent que la probabilité d'avoir des problèmes de remboursement de prêt est plus élevée chez les hommes que chez les femmes. Bien entendu, le caractère généralisable de nos résultats doit être interprété avec prudence, car ces résultats peuvent être uniques à l'échantillon, à la période ou à la région. Pour contraster et contextualiser ces résultats, nous avons eu des discussions approfondies avec les gestionnaires de Savinco et leur agent de terrain en Équateur. Les contributions sont nombreuses. Pour les praticiens, ont été identifiés les facteurs pertinents pouvant affecter le taux de défaut de paiement des groupes d'épargne. Pour les universitaires, les riches informations fournies par l'application mobile Savinco pourraient être un point de départ pour d'autres études quantitatives.

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ABSTRACT Objective: To analyze the discourses of health professionals about technologies in home care. Method: Qualitative research conducted in four public home care services in Minas Gerais. Data obtained from interviews with 52 professionals submitted to Critical Discourse Analysis. Results: The results indicate the functional and economic-financial discourse about the technologies. The economic discourse is dominant and reveals the contradiction between investing in high-cost equipment and the insufficiency of basic inputs for care. There is a tendency to reproduce hospital-centered logic with high technological density. The inventiveness and a process of adaptation at home are evidenced. Conclusion: The discourses of health professionals indicate that the circumstances of home care are determinants of the adaptations and improvisations that occur in this context and are due to the contradictions between innovating, inventing, and investing in technologies in home care.

RESUMEN Objetivo: Analizar los discursos profesionales sobre las tecnologías en el cuidado del hogar. Método: Investigación cualitativa realizada en cuatro servicios públicos de atención domiciliaria en Minas Gerais. Datos obtenidos de entrevistas con 52 profesionales sometidos a Análisis Crítico del Discurso. Resultados: Los resultados indican el discurso funcional y económico-financiero sobre las tecnologías. El discurso económico es dominante y revela la contradicción entre invertir en equipos de alto costo y una atención básica insuficiente. Existe una tendencia a reproducir lógica centrada en el hospital con alta densidad tecnológica. Se evidencia la inventiva y un proceso de adaptación en el hogar. Conclusión: Los discursos de los profesionales de la salud señalan que las circunstancias de la atención domiciliaria son determinantes de las adaptaciones e improvisaciones que se dan en este contexto y se deben a las contradicciones entre innovar, inventar e invertir en tecnologías en atención domiciliaria.

RESUMO Objetivo: Analisar discursos de profissionais de saúde sobre as tecnologias na atenção domiciliar. Método: Pesquisa qualitativa realizada em quatro serviços públicos de atenção domiciliar de Minas Gerais. Dados obtidos de entrevistas com 52 profissionais, submetidas à Análise de Discurso Crítica. Resultados: Os resultados indicam o discurso funcional e econômico-financeiro sobre as tecnologias. O discurso econômico é dominante e revela a contradição entre investir em equipamentos de alto custo e a insuficiência de insumos básicos para o cuidado. Há uma tendência de reprodução da lógica hospitalocêntrica com alta densidade tecnológica. Evidencia-se a inventividade e um processo de adaptação no domicílio. Conclusão: Os discursos dos profissionais de saúde indicam que as circunstâncias do cuidado domiciliar são determinantes das adaptações e improvisos que ocorrem neste contexto e são decorrentes das contradições entre inovar, inventar e investir nas tecnologias na AD.

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Un estimado de 12 millones y medio de muertes anuales, las cuales representan casi la cuarta parte de la letalidad global, se atribuyen a ambientes no saludables. La OMS identificó factores medioambientales susceptibles a gestión o cambio, que pueden ser modificados mediante intervenciones clave, a fin de disminuir la morbimortalidad de un centenar de enfermedades o afecciones. Este estudio tuvo como finalidad comparar y analizar las actitudes del personal de enfermería comunitaria sobre intervenciones ambientales para la prevención de enfermedades infecciosas y parasitarias, condiciones neonatales y nutricionales, y enfermedades no transmisibles; ya que en la medida que estuvieran predispuestos y tuvieran una actitud positiva hacia las intervenciones, esto debería influir en su conducta proactiva y en sus próximas actividades de promoción de la salud. La muestra final de 158 participantes estuvo compuesta por 21 enfermeros y 137 enfermeras, con edades comprendidas entre 22 y 53 años, con una mediana de 29 años (±6,74). Para la elaboración del cuestionario de actitudes se tomó como base la sección "Enfermedades y lesiones e intervenciones ambientales clave" del informe global de la OMS titulado "Prevenir enfermedades mediante ambientes saludables" Se obtuvieron los índices de actitud por intervención y categoría de acuerdo al modelo propuesto por Manassero & Vásquez. Los resultados mostraron que los índices actitudinales, para la categoria "adecuada" son positivos y los más altos, ligeramente positivos los de las plausible y levemente negativos para "ingenuas", es decir, los enfermeros, pueden identificar acciones adecuadas con mayor facilidad, se le dificulta identificar las frases plausibles y más las ingenuas. Lo que permite comprobar que las actitudes de los enfermeros pueden ser paradójicas y confusas. Siendo evidente la necesidad de realizar sesiones educativas continúos y acorde con las actualizaciones científicas y políticas internacionales y nacionales. Se recomienda incluir la reflexión explícita y personal como instrumento básico para lograr el cambio actitudinal(AU)

An estimated of 12.5 million annual deaths, which represent nearly a quarter of global fatalities, are attributed to unhealthy environments. WHO identified environmental factors susceptible to management or change, which can be modified through key interventions, in order to reduce the morbidity and mortality of a hundred diseases or conditions. The purpose of this study was to compare and analyze the attitudes of community nursing staff regarding environmental interventions for the prevention of infectious and parasitic diseases, neonatal and nutritional conditions, and non-communicable diseases; since to the extent that they were predisposed and had a positive attitude towards the interventions, this should influence their proactive behavior and their next health promotion activities. The final sample of 158 participants was made up of 21 male nurses and 137 female nurses, aged between 22 and 53 years, with a median of 29 years (±6.74). For the elaboration of the questionnaire of attitudes, the section "Diseases and injuries and key environmental interventions" of the WHO global report entitled "Preventing diseases through healthy environments" was taken as a basis. Attitude indices were obtained by intervention and category according to the model proposed by Manassero & Vásquez. The results showed that the attitudinal indices for the "adequate" category are positive and the highest, slightly positive for the plausible and slightly negative for "naive", that is, the nurses, can more easily identify appropriate actions, It makes it difficult for him to identify plausible sentences and more naive ones. This allows verifying that nurses' attitudes can be paradoxical and confusing. Being evident the need to carry out continuous educational sessions and in accordance with international and national scientific and political updates. It is recommended to include explicit and personal reflection as a basic instrument to achieve attitudinal change(AU)

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BACKGROUND: Alternative approaches to analyzing and evaluating health care investments in state-of-the-art technologies are being increasingly discussed in the literature, especially with the advent of Healthcare 4.0 (H4.0) technologies or eHealth. Such investments generally involve computer hardware and software that deal with the storage, retrieval, sharing, and use of health care information, data, and knowledge for communication and decision-making. Besides, the use of these technologies significantly increases when addressed in bundles. However, a structured and holistic approach to analyzing investments in H4.0 technologies is not available in the literature. OBJECTIVE: This study aims to analyze previous research related to the evaluation of H4.0 technologies in hospitals and characterize the most common investment approaches used. We propose a framework that organizes the research associated with hospitals' H4.0 technology investment decisions and suggest five main research directions on the topic. METHODS: To achieve our goal, we followed the standard procedure for scoping reviews. We performed a search in the Crossref, PubMed, Scopus, and Web of Science databases with the keywords investment, health, industry 4.0, investment, health technology assessment, healthcare 4.0, and smart in the title, abstract, and keywords of research papers. We retrieved 5701 publications from all the databases. After removing papers published before 2011 as well as duplicates and performing further screening, we were left with 244 articles, from which 33 were selected after in-depth analysis to compose the final publication portfolio. RESULTS: Our findings show the multidisciplinary nature of the research related to evaluating hospital investments in H4.0 technologies. We found that the most common investment approaches focused on cost analysis, single technology, and single decision-maker involvement, which dominate bundle analysis, H4.0 technology value considerations, and multiple decision-maker involvement. CONCLUSIONS: Some of our findings were unexpected, given the interrelated nature of H4.0 technologies and their multidimensional impact. Owing to the absence of a more holistic approach to H4.0 technology investment decisions, we identified five promising research directions for the topic: development of economic valuation methodologies tailored for H4.0 technologies; accounting for technology interrelations in the form of bundles; accounting for uncertainties in the process of evaluating such technologies; integration of administrative, medical, and patient perspectives into the evaluation process; and balancing and handling complexity in the decision-making process.

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