C e n t r o d e Pe s q u i s a s

AGGEU MAGALHES

MESTRADO PROFISSIONAL EM SADE PBLICA

sexta-feira dia 07 de outubro 2016

das 09h s 12h

BY
PART 1

Please answer questions 1 to 8 with reference to Text 1. There is one and only one correct answer to each
question.

Q1. When was Amnesty Internationals 2015 State of the Worlds Human Rights report published?
A. Last year
B. In the last quarter of 2015
C. In September 2016
D. In the first quarter of 2016

Q2. Which of the following is true according to Paragraph 1?

A. 160 countries around the world provide no health care whatsoever for their citizens
B. In some countries, health care is only provided in prisons
C. There has never been so much migration around the world as there is now
D. The Brazilian public health care system is hanging by a thread

Q3. Which of the following statements is true according to Paragraph 2?

B. Around 3.8 million children were internally displaced in Syria in 2015
C. Seven hundred and fifty undocumented immigrants have been arrested in Spain for seeking healthcare
D. Greece had an excellent healthcare system before it was overwhelmed by refugees
E. The Canadian government was overthrown in November 2015 because of opposition to mass resettlement of Syrian
refugees

Q4. According to Paragraph 3,

A. Haiti has provided health care services for over 10,000 refugees
B. there were three times as many cases of cholera in Haiti in the first semester of 2015 compared to the first semester
of 2014
C. hundreds of thousands of emergency workers were mobilized by the April 2015 earthquake in Nepal
D. adequate funding for Haitis healthcare needs has been undermined by government corruption

Q5. According to Paragraph 4,

A. Pakistan and Sudan have recently been devastated by plague
B. Islamic State has added 697 health professionals to the Syrian workforce since 2011
C. in 2015, the South Kordofan region of Sudan had only one hospital per 600,000 people
D. Kordofans invasion of Sudan destroyed around 26 hospitals

Q6. According to Paragraph 5,

A. women who have experienced violence tend to deny that they have health problems
B. almost no countries criminalize abortion these days
C. there has been a dramatic increase in violence against women in recent years
D. not much progress has been made recently with regard to womens health
Q7. Which of the following is NOT mentioned in Paragraph 6?
A. One fifth of Madagascars children live in poverty
B. Boko Haram recruits children as soldiers
C. Nearly half of the population of Madagascar aged under five years has insufficient access to food and medical
services
D. Boko Haram was responsible for more than eight thousand killings in 2015

Q8. Which of the following does NOT mean more or the less the opposite of the word optional in Paragraph 7?
A. alternative
B. compulsory
C. obligatory
D. mandatory
TEXT 1
Health - an explicit human right
www.thelancet.com Vol 387 March 5, 2016
1. The past year severely tested the international
systems capacity to respond to crises and mass
forced displacements of people, and found it woefully
inadequate. So begins Amnesty Internationals
annual report for 2015, The state of the worlds human
rights, published last week. Set against the backdrop
of unprecedented and worldwide migration, recurring
themes include access to health services, the effects
of conflict on health, women and childrens health,
sexual rights, and the denial of health care in prisons.
In this comprehensive review of human rights in 160
countries, health is an explicit and constant underlying
thread.
2. Many of the human rights injustices in 2015 were
shaped by waves of migration, as refugees faced
inadequate provision of health care in countries that
struggled with existing poor infrastructures; accounts
of ill treatment, torture, and abuse were commonplace
in many countries. In 2015, a further 1 million Syrian
people fled the country, on top of internal displacement
of 7.6 million Syrians (half of them children). In Spain,
there were an estimated 750,000 unofficial migrants
living without access to health care. Greece continued
to be overwhelmed with asylum seekers, putting
pressure upon health-care systems that were not
adequate to begin with. Amnestys report also draws
attention to Greece and Croatias Roma populations
where extremely poor housing conditions are having
a devastating effect on health. On a positive note,
Canadas new incoming government in November
laid out plans to resettle 25 000 Syrian refugees by
early 2016, along with a guarantee of health coverage
for all.
3. Regarding access to health services, already poor
rural services and health-care infrastructures were
exacerbated by natural disasters in many regions.
Nepals April 2015 earthquake led to the near collapse
of health-care services. With 8,856 confirmed deaths,
and 22,309 injured, the complete destruction of at least
602,257 homes, and the displacement of more than
100,000 people, emergency support workers faced
often insurmountable challenges, and the country is
still rebuilding itself. In Haiti, in addition to a lack of
health-care services for tens of thousands of refugees,
a cholera epidemic in the first 6 months of 2015 led
to a three-fold increase in cases compared with the
same period during the previous year. An underfunded
humanitarian response to these crises has denied
Haitians their basic right to health.
4. Political conflict has led to continuing devastating
violence, often directed against medical workers
and hospitals, and the subsequent denial of health as
a human right, in countries including Pakistan and
Sudan. Repeated bombing of health facilities in the
South Kordofan area of Sudan have destroyed some
26 hospitals and clinics since 2011, leaving just two
hospitals in 2015 to serve a population of 1.2 million
people. In Syria, the armed Islamic State (IS) groups
violence has led to closure of multiple health facilities
and widespread denial of access to health care, in
addition to 697 medical workers being killed since
April 2011.
5. As violence against women and girls continues to
be problematic in many countries, and unsafe or
criminalized abortions are documented in many
country profiles, there are few positive developments
around womens health and sexual health. Several
countries are addressing problems through health
policy reviews, but common denial of basic rights
for people identifying as lesbian, gay, bisexual,
transgender or intersex, and for women who have
experienced violence, continues to be a widespread
issue.
6. Childrens rights are threatened through the recruitment
of children for military purposes in many war-stricken
territories. Amnesty cites the Boko Haram armed group
in Nigeria, Somalia, and Sudan, who recruited children
to carry out much of their destruction, that in 2015
led to more than 8,200 deaths. Elsewhere, children
are also hard hit and poorly served through limited or
non-existent access to health care. In Madagascar, the
fifth poorest maritime country in the world, the report
cites UNICEFs 2015 findings that 47% of children
younger than 5 years are malnourished and have no
access to basic health care.
7. Amnestys report does note positive developments: the
adoption of the UN Sustainable Development Goals,
and evidence of social and economic progress in some
countries. However, as Salil Shetty states in the report
foreword, protecting and strengthening systems of
human rights and civilian protection cannot be seen
as optional. It is literally a matter of life and death.
In reviewing the state of the worlds human rights in
2015, it is clear that denial of the fundamental right to
health is an urgent and recurring theme that must be
addressed by the global community.
PART 2

Please answer questions 9 to 14 with reference to Text 2. There is one and only one correct answer to each
question.

Q9. The word core in the title of the WHO report could be replaced by which of the following without
substantially altering the meaning?
A. Color
B. Cardiac
C. Seed
D. Central

Q10. According to Paragraph 3, the WHO report states that

A. the number of health workers increased tenfold in Latin America between 2005 and 2015
B. the number of health workers may not have increased in countries that lack them
C. the number of health workers is growing at more or less the same rate in all European countries
D. there are now 10% more health workers worldwide than there were ten years ago

Q11. Paragraph 4 states that

A. less than 30% of European physicians are now aged under 55
B. there are now 6% more retired physicians worldwide than there were seven years ago
C. the percentage of European physicians aged over 55 rose from around 27% in 2008 to around 33% in 2015
D. physicians aged over 55 now number over 33 million worldwide

Q12.Which of the following statements is true, according to Paragraphs 5 and 6?

A. Some Eastern European nations have less than 200 physicians
B. Albania had only 261 fully qualified physicians in 2013
C. The number of nurses has declined nine-fold in some European countries since 2013
D. Albania had far fewer physicians per capita than Greece in 2013

Q13. Which of the following health statistics is NOT explicitly mentioned as appearing in the WHO report,
according to Paragraph 8?
A. the incidence of specific diseases
B. death rates
C. information on population
D. how much money is spent on health

Q14. The term human resources in the last paragraph could be replaced by which of the following without
substantially altering the meaning?
A. Donated organs
B. Funding
C. Population
D. Personnel
TEXT 2
More Health Workers Needed
Bull World Health Organ 2016; 94:8081
1. Some countries in the WHO European Region may not
have enough health workers to respond to the growing
health needs of their ageing populations in coming
years, according to a WHO report.
2. The report, entitled Core health indicators in the WHO
European Region 2015, with a special focus on human
resources, shows that health workforce shortages and
imbalances constitute a major public health concern
for the region that requires prompt action.
3. Although the number of health-care workers has
increased overall in the region by nearly 10% over
the last decade, this growth was uneven between
countries and not necessarily in the countries where
health professionals are most needed, the report said.
4. One in three physicians is more than 55 years old, an
increase of 6 percentage points over the past 7 years.
5. The report found that there were five times more
physicians in some countries than in others, and that
some countries had nine times fewer nurses than others
calculated per head of population. Greece registered
619 physicians per 100,000 population in 2013, for
example, while Albania had 128.
6. The number of medical graduates must increase to
replace them, for example, in Albania, Bosnia and
Herzegovina, Kyrgyzstan and Turkey, where the
number of physicians per 100,000 habitants is below
200. In Albania, only 261 physicians graduated in
2013.
7. The report is an annual publication providing an
overview of the European health situation. The
most recent edition provides key statistics on health
workforce employment and education.
8. The report also includes other key health statistics, such
as mortality and morbidity data, demographic and
socioeconomic indicators, health services utilization
and health expenditure.
9. Human resources are the cornerstone of the health
system in any country, and the planning, regulation
and management of the health workforce requires
extensive cross-sector collaboration both topics
are at the heart of the Health 2020 policy, says Dr
Zsuzsanna Jakab, WHO Regional Director for Europe,
referring to its core strategy.
PART 3

Please answer questions 15 to 20 with reference to Text 3. There is one and only one correct answer to each
question.

Q15. The words improve, maintain and restore in Paragraph 2 could be replaced by which of the following
without substantially altering the meaning?
A. test, uphold and remain
B. ameliorate, renovate and accumulate
C. enhance, sustain and recover
D. promote, moderate and resurrect

Q16. Which of the following does universal health coverage entail, according to Paragraph 3?
A. Patient information should not be disclosed
B. Patients should not be afraid of painful medical procedures
C. Health services should be good enough to produce desirable results
D. Triage may be used to deny treatment in hopeless cases

Q17. The phrase getting to consensus about the causes of underperformance in Paragraph 4 means
A. establishing common-sense explanations of behavior
B. agreeing on why outcomes fall short of expectations
C. arguing about the reasons for lack of funding
D. avoiding subjectivity when evaluating human resources

Q18. According to Paragraph 5, collective health security

A. is action to protect societies from military invasion
B. can help to bring about universal health coverage
C. is not an integral part of the definition of universal health coverage
D. is the same thing as health system strengthening

Q19. Which of the following is a cause-and-effect relationship mentioned in Paragraph 6?

A. Confusion and inefficiency strengthen health systems
B. Resilience results in investment and reform
C. Investments and reforms lead to resilience
D. Universal health coverage is a separate program that does not contribute to strengthening the health system as a
whole

Q20. According to Paragraph 6,

A. there was a need to substantially change the health system in countries hit by the Ebola epidemic
B. the health system was functioning well in Ebola-affected countries before the outbreak
C. countries not affected by the Ebola virus have not transformed their health systems
D. most Ebola patients recover fully from the disease
TEXT 3
Health systems strengthening,
universal health coverage, health
security and resilience
Joseph Kutzin & Susan P Sparkes
1. Global and national initiatives focused on health
systems strengthening, universal health coverage,
health security, and resilience suffer when these terms
are not well understood or believed to be different ways
of saying the same thing. Here we aim to facilitate
understanding and highlight key policy considerations
by identifying critical attributes of each concept and
emphasizing the distinction between ends and means
in health policy.
2. Set within the political and institutional framework of a
country, a health system is the ensemble of all public
and private organizations, institutions, and resources
mandated to improve, maintain or restore health. This
definition, along with efforts to more concretely specify
the functions, building blocks, or control knobs
of a health system, focus on the characteristics or policy
instruments of the system itself. Strengthening health
systems involves a significant, purposeful effort to
improve performance. This goes beyond merely
investing in inputs; it means reforming how the health
system actually operates.
3. Universal health coverage means that all people are able
to receive needed health services of sufficient quality to
be effective, without fear that the use of those services
would expose the user to financial hardship. Based on
this definition, universal health coverage comprises a
set of objectives equity in service use, quality, and
financial protection towards which all countries
strive. Progress is assessed at population scale, rather
than only those served by specific schemes or programs.
Non-discrimination is a core principle; policies that
exclude certain individuals or groups are inconsistent
with universal health coverage. Because people need
individual and public health services, ensuring that
both are delivered effectively falls within the scope
of universal health coverage. Criticizing the universal
health coverage concept by arguing that public health
services are excluded is wrong, though in practice this
argument may have validity. Finally, universal health
coverage is globally relevant; all countries can do
something to reduce the gap between the need for and
the use of quality health services.
4. Health system strengthening comprises the means (the
policy instruments), while universal health coverage is
a way of framing the objectives of policy. Without this
distinction, there is a risk that instruments of reform
become the objective, with the perception that the
problem to be solved is the absence or presence of a
particular policy instrument. When this occurs, policy
dialogue shifts quickly away from where it needs to be
getting to consensus about the nature and causes of
underperformance relative to universal health coverage
goals to what is often an ideologically polarized debate
about the inherent merits or flaws of particular reform
instruments. In health financing, for example, this has
been observed in the debate on social or community-
based health insurance, performance-based financing
and user fees. Similarly, simply calling something a
universal health coverage reform does not convey
any meaning as to the actual content of what is being
planned or implemented.
5. Beyond the objectives embedded in universal health
coverage, it entails individual health security the
intrinsic value of protection against risk. Individuals are
better off when they are secure in the knowledge that
if something should happen they will be able to obtain
quality health services without becoming impoverished
as a result. Collective health security reducing the
vulnerability of societies to health threats that spread
across national borders is a goal that extends beyond
the definition of universal health coverage. But there is a
clear link, because health systems that progress towards
universal health coverage also contribute to collective
health security. Therefore, health systems strengthening
is needed to make progress towards universal health
coverage and health security.
6. The resilience of a health system refers to its ability
to absorb disturbance, to adapt and respond with the
provision of needed services. Thus, resilience is not an
action to be implemented but rather a dynamic objective
of investments and reforms. In the case of Ebola-
affected countries, for example, this has required efforts
to not only restore how the system functioned before
the crisis but to transform and fundamentally improve
the health system. Conceptual clarity is essential for a
systematic approach to policy-making. Confusion and
inefficiency arise when health system strengthening is
defined as an objective and also when universal health
coverage, health security or resilience are described
as separate programs to be implemented. So here is
a simple guide: health system strengthening is what
we do; universal health coverage, health security and
resilience are what we want.
C e n t r o d e Pe s q u i s a s
AGGEU MAGALHES

sexta-feira dia 07 de outubro 2016

das 09h s 12h

MESTRADO PROFISSIONAL
EM SADE PBLICA

MESTRADO PROFISSIONAL EM SADE PBLICA

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