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Teixeira CS, Fernandes TG, Dias MAB, Morais das Neves MDS, Schweickardt JC, Harris MJ, de Sousa Lima RT. Perinatal Health in Amazon Triple Border Region: Cross-Sectional Analysis Comparing Outcomes in the Brazilian, Peruvian and Colombian Population. Matern Child Health J 2023; 27:1876-1884. [PMID: 37278842 DOI: 10.1007/s10995-023-03673-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To investigate the perinatal outcomes in Brazilian, Peruvian, and Colombian women in a Brazilian reference maternity hospital based at Amazon triple border region. METHOD A cross-sectional case study of data from 3242 live birth certificates issued at the Tabatinga public maternity hospital, in the countryside of Amazonas, in the period between January 2015 and December 2017. Maternal and perinatal independent variables were analysed based on central tendency and variability, and frequency distribution for categorical variables. The Pearson's Chi-Square test and univariate analyses were performed to estimate probability ratios (Odds Ratio-OR). RESULTS Significant differences were found in the education level in the three population groups, as well as in the number of previous pregnancies, antenatal consultations, month of initial prenatal care, and type of delivery. Brazilian pregnant women had more prenatal consultations, caesarean sections, and premature births. Peruvian and Colombian women started antenatal care later, and those with high-risk pregnancies tended to deliver in their home country. CONCLUSION FOR PRACTICE Our findings show some singularities in the care of women and infants in the Amazonian triple border region. The Brazilian Unified Health Care System performs an important role in the guarantee of free access to health services, and ensures comprehensive care for women and infants, promoting human rights in border regions regardless of nationality.
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Affiliation(s)
- Camila Soares Teixeira
- Leonidas e Maria Deane Institute, Oswaldo Cruz Foundation - FIOCRUZ, Manaus, Amazonas, Brasil.
| | - Tiótrefis Gomes Fernandes
- Faculty of Physical Education and Physiotherapy, Federal University of Amazonas - UFAM, Manaus, Brazil
| | | | | | | | - Matthew J Harris
- The School of Public Health, Imperial College London, London, UK
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Lopes RLB, Ribeiro LC, Oliveira DMD. [Health promoted by social and community networks of low-income women]. CAD SAUDE PUBLICA 2023; 39:e00218022. [PMID: 37585906 PMCID: PMC10494697 DOI: 10.1590/0102-311xpt218022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/15/2023] [Accepted: 05/11/2023] [Indexed: 08/18/2023] Open
Abstract
Social and community networks constitute an important social determinant of health, especially in the poorer segments of civil society and in their struggles to guarantee the right to health care. This study sought to understand the social and community networks created by women living in a low-income community and their relationship with the development of health care in this social group. Semi-structured interviews were conducted with 11 women participating in a nongovernmental organization in the community, and the data were subjected to content analysis. The analysis highlighted four categories: the community as a large network, formed by multiple interconnected dynamic networks; the network of "aunts", women with an important role in the care of the community, treated as part of the family; the conversation circles, such as the rite of periodic meeting on the sidewalks, indicated as an important space that guarantees emotional stability and quality of life; and the benzedeiras with the use of medicinal plants, they are reference care within the community, providing disease prevention, health treatment, and referral to the health care unit when necessary. We concluded that the social and community networks created by the participants are important social determinants, and health facilities registered in the territory should value such networks.
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3
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Nunes FGDS, Santos AMD, Carneiro ÂO, Fausto MCR, Cabral LMDS, Almeida PFD. Challenges to the provision of specialized care in remote rural municipalities in Brazil. BMC Health Serv Res 2022; 22:1386. [PMID: 36419054 PMCID: PMC9682659 DOI: 10.1186/s12913-022-08805-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 11/08/2022] [Indexed: 11/24/2022] Open
Abstract
This case study analyses the challenges to providing specialized care in Brazilian remote rural municipalities (RRM). Interviews were conducted with managers from two Brazilian states (Piauí and Bahia). We identified that the distance between municipalities is a limiting factor for access and that significant care gaps contribute to different organizational arrangements for providing and accessing specialized care. Physicians in all the RRMs offer specialized care by direct disbursement to users or sale of procedures to managers periodically, compromising municipal and household budgets. Health regions do not meet the demand for specialized care and exacerbate the need for extensive travel. RRM managers face additional challenges for the provision of specialized care regarding the financing, implementation of cooperative arrangements, and the provision of care articulated in networks to achieve comprehensive care, seeking solutions to the locoregional specificities.
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Affiliation(s)
- Fabiely Gomes da Silva Nunes
- grid.8399.b0000 0004 0372 8259Multidisciplinary Health Institute, Federal University of Bahia, Vitória da Conquista, Bahia Brazil
| | - Adriano Maia dos Santos
- grid.8399.b0000 0004 0372 8259Multidisciplinary Health Institute, Federal University of Bahia, Vitória da Conquista, Bahia Brazil
| | - Ângela Oliveira Carneiro
- grid.412386.a0000 0004 0643 9364Federal University of Vale do São Francisco, Petrolina, Pernambuco Brazil
| | | | - Lucas Manoel da Silva Cabral
- grid.412211.50000 0004 4687 5267Hésio Cordeiro Institute of Social Medicine, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Patty Fidelis de Almeida
- grid.411173.10000 0001 2184 6919Collective Health Institute, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
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4
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Mendes LDS, Almeida PFD, Santos AMD, Samico IC, Porto JP, Vázquez ML. Experience with coordination of care between primary care physicians and specialists and related factors. CAD SAUDE PUBLICA 2021; 37:e00149520. [PMID: 34008786 DOI: 10.1590/0102-311x00149520] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 08/20/2020] [Indexed: 11/21/2022] Open
Abstract
The article analyzes the coordination of information and clinical management between levels of care in physicians' experience and explores related labor and organizational factors and attitudes towards the work and interaction. This is a cross-sectional study with application of the COORDENA-BR questionnaire to a sample of 64 primary health care (PHC) physicians and 56 specialized care (SC) from the public system in a medium-sized Brazilian city. The results show limited linkage of care in the Healthcare Network (RAS), with differences between PHC and SC. There is no exchange of information on diagnosis, treatment, or tests. Physicians in PHC agree more on the treatments prescribed by the specialists than vice versa, but repetition of tests is not frequent. PHC physicians refer patients to SC when necessary. Most medical specialists do not refer patients for follow-up consultations in PHC when necessary and do not give orientation to PHC physicians, who in turn fail to resolve their doubts with SC. Both PHC and specialties report long waiting times for specialist consultations. Temporary employment contracts are more common in PHC. Consultation time was considered too short for coordination between the two. Most physicians do not plan to change jobs, despite their heavy dissatisfaction with wages and work. Physicians do not know each other personally, and specialists do not identify physicians in PHC as the coordinators of care. Policies and measures to guarantee structural conditions to improve access, working conditions, and more favorable mutual adaptation need to be implemented systemically to the set of services in the Brazilian Unified National Health System (SUS).
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Affiliation(s)
- Lívia Dos Santos Mendes
- Universidade Federal da Bahia, Instituto Multidisciplinar em Saúde, Vitória da Conquista, Brasil
| | | | - Adriano Maia Dos Santos
- Universidade Federal da Bahia, Instituto Multidisciplinar em Saúde, Vitória da Conquista, Brasil
| | | | - Jéssica Prates Porto
- Universidade Federal da Bahia, Instituto Multidisciplinar em Saúde, Vitória da Conquista, Brasil
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5
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Moraga-Cortés F, Bahia TC, Prada CA. [Spending on primary healthcare in two government administrations in Chile since the dictatorship]. CAD SAUDE PUBLICA 2021; 37:e00244719. [PMID: 33852665 DOI: 10.1590/0102-311x00244719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 08/05/2020] [Indexed: 11/21/2022] Open
Abstract
Since the Declaration of Alma-Ata in 1978, primary healthcare (PHC) is considered an essential component of health systems. In the Chilean case, management of primary care was municipalized during the dictatorship and maintained by the subsequent governments, with some reforms. The aim of this article was to estimate and analyze spending in PHC in Chile, during the governments of Sebastián Piñera and Michelle Bachelet. Collection of financial data was oriented by the model of National Health Accounts (CNS), and later the amounts were deflated according to the Consumer Price Index. The principal source of information was the National System of Municipal Information (SINIM). The results show that during the period there was a permanent increase in spending in PHC; however, the average percent change was slightly higher in the first government compared to the second. The percentage of spending in PHC in relation to public spending in health was 21.4% for the eight years, with few variations. Indicators show that inequalities between administrative and health regions are increasing steadily. Therefore, although transfers to fund primary care services are increasing, they may be poorly distributed. This and other problems like the commodification of services and dismantlement of the network compromise the consolidation of PHC, especially in a health system based on contributive insurance like the Chilean system.
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Freire AR, Freire DEWG, de Araújo ECF, de Almeida Carrer FC, PuccaJúnior GA, de Sousa SA, de Lucena EHG, Cavalcanti YW. Socioeconomic indicators and economic investments influence oral cancer mortality in Latin America. BMC Public Health 2021; 21:377. [PMID: 33602161 PMCID: PMC7890605 DOI: 10.1186/s12889-021-10419-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 02/09/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND It is necessary to recognize the influence of socioeconomic factors on oral cancer indicators in Latin American countries. This study aimed to analyze the influence of socioeconomic indicators and economical investments on oral cancer mortality rates in Latin American countries. METHODS This cross-sectional study considered the age-standardized mortality rate (ASR) of oral cancer within the period 2000-2015. The oral cancer mortality rate (for both sexes and age groups 40-59 and 60 years old or more), socioeconomic aspects (Gini Inequality Index, unemployment rate and Gross Domestic Product (GDP) per capita) and investments in different sectors (%GDP invested in health per capita and by the government, %GDP invested in education by the government and %GDP invested in research and development) were considered. Tweedie multivariate regression was used to estimate the effect of independent variables on the mortality rate of oral cancer, considering p < 0.05. RESULTS This study showed that being male and aged 60 or over (PR = 14.7) was associated with higher mortality rate for oral cancer. In addition, greater inequality (PR = 1.05), higher health expenditure per capita (PR =1.09) and greater investment in research and development (PR = 1.81) were associated with a higher mortality rate from oral cancer. CONCLUSION Socioeconomic factors and economical investments influence the mortality rate of oral cancer in Latin American countries. This emphasizes oral cancer is a socioeconomic-mediated disease.
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Affiliation(s)
- Aldelany Ramalho Freire
- Clinicaland Social DentistryDepartment, DCOS/CCS/UFPB, Federal University of Paraíba, Cidade Universitária, Campus I, João Pessoa, PB 58051-900 Brazil
| | - Deborah Ellen Wanderley Gomes Freire
- Clinicaland Social DentistryDepartment, DCOS/CCS/UFPB, Federal University of Paraíba, Cidade Universitária, Campus I, João Pessoa, PB 58051-900 Brazil
| | - Elza Cristina Farias de Araújo
- Clinicaland Social DentistryDepartment, DCOS/CCS/UFPB, Federal University of Paraíba, Cidade Universitária, Campus I, João Pessoa, PB 58051-900 Brazil
| | | | | | - Simone Alves de Sousa
- Clinicaland Social DentistryDepartment, DCOS/CCS/UFPB, Federal University of Paraíba, Cidade Universitária, Campus I, João Pessoa, PB 58051-900 Brazil
| | - Edson Hilan Gomes de Lucena
- Clinicaland Social DentistryDepartment, DCOS/CCS/UFPB, Federal University of Paraíba, Cidade Universitária, Campus I, João Pessoa, PB 58051-900 Brazil
| | - Yuri Wanderley Cavalcanti
- Clinicaland Social DentistryDepartment, DCOS/CCS/UFPB, Federal University of Paraíba, Cidade Universitária, Campus I, João Pessoa, PB 58051-900 Brazil
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7
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Peres F, Blanco Centurión MP, da Silva JMB, Brandão AL, Verani JFDS, Buglioli M, Ortega E, Brescia A. [Public Health Training Program for Health Workers on the Brazil-Uruguay Border]. Rev Panam Salud Publica 2020; 44:e95. [PMID: 32695148 PMCID: PMC7367405 DOI: 10.26633/rpsp.2020.95] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 06/24/2020] [Indexed: 11/24/2022] Open
Abstract
El principal objetivo del Programa de Formación en Salud Pública para la Frontera Brasil-Uruguay fue fortalecer las capacidades formativas locales en salud pública a través del desarrollo de habilidades y competencias junto a trabajadores de salud de cuatro zonas fronterizas. El diseño metodológico del Programa, basado en talleres docentes con aplicación de metodologías activas de la formación en salud y mediados por tecnologías educacionales, favoreció la organización de un espacio dialógico permanente entre docentes, gestores y actores de la práctica de ambos países que, entre 2017 y 2018, resultó en: a) el desarrollo de capacidades locales para el mapeo de los principales problemas de vigilancia de la salud en las cuatro zonas fronterizas participantes; b) la discusión de los límites y perspectivas de acción de los servicios de salud existentes en ambos países, dentro de los principios y lineamientos del campo de la salud pública; c) la apropiación de herramientas y procesos pedagógicos que permitieron la incorporación del aspecto de salud pública y de la vigilancia de la salud en los diferentes procesos y espacios organizativos del sector salud local; y d) la construcción de una capacidad permanente para el desarrollo de habilidades y competencias junto a trabajadores del sector salud, en una lógica de educación permanente en salud. Los logros del Programa y sus contribuciones a los servicios de salud locales lo habilitan, de manera efectiva, como acción estratégica para el fortalecimiento de capacidades formativas y de investigación en la frontera Brasil-Uruguay.
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Affiliation(s)
- Frederico Peres
- Fundación Oswaldo Cruz (ENSP/Fiocruz) Rio de Janeiro Brasil Fundación Oswaldo Cruz (ENSP/Fiocruz), Rio de Janeiro, Brasil
| | | | | | - Ana Laura Brandão
- Fundación Oswaldo Cruz (ENSP/Fiocruz) Rio de Janeiro Brasil Fundación Oswaldo Cruz (ENSP/Fiocruz), Rio de Janeiro, Brasil
| | - José Fernando de Souza Verani
- Fundación Oswaldo Cruz (ENSP/Fiocruz) Rio de Janeiro Brasil Fundación Oswaldo Cruz (ENSP/Fiocruz), Rio de Janeiro, Brasil
| | - Marisa Buglioli
- Universidad de la República Montevideo Uruguay Universidad de la República, Montevideo, Uruguay
| | - Elizabeth Ortega
- Administradora de los Servicios de Salud del Estado Montevideo Uruguay Administradora de los Servicios de Salud del Estado, Montevideo, Uruguay
| | - Adriana Brescia
- Ministerio de Salud Pública de Uruguay Montevideo Uruguay Ministerio de Salud Pública de Uruguay, Montevideo, Uruguay
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8
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Justino ET, Kasper M, Santos KDS, Quaglio RDC, Fortuna CM. Palliative care in primary health care: scoping review. Rev Lat Am Enfermagem 2020; 28:e3324. [PMID: 32609270 PMCID: PMC7332247 DOI: 10.1590/1518-8345.3858.3324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 04/07/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to map the available evidence on the main topics investigated in palliative care in primary health care. METHOD scoping review type study carried out in five databases, including original articles, based on the descriptors palliative care, palliative care at the end of life, terminal care, terminal state, primary health care and their respective acronyms and synonyms, totaling 18 publications. The extraction of data from primary studies was performed using an instrument produced by the authors and which allowed the construction of the categories presented. RESULTS 18 publications were included in this review. Among the most studied themes are the difficulties of the teams regarding the continuity of care in the health network; the importance of in-service education by the multidisciplinary team; professional unpreparedness; bioethics; the validation and application of scales for prognosis and care for some pathologies such as cancer and diabetes; among others. CONCLUSION it became evident that palliative care in primary health care has been gradually developed, but it is necessary to consider the organization of primary health care and the social policies that support or weaken it, being considered a complex challenge.
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Affiliation(s)
- Eveline Treméa Justino
- Universidade Estadual do Oeste do Paraná, Curso de Enfermagem, Foz do Iguaçu, PR, Brazil.,Scholarship holder at the Fundação Araucária, Foz do Iguaçu, PR, Brazil
| | - Maristel Kasper
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre at the Nursing Research Development, Ribeirão Preto, SP, Brazil.,Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
| | - Karen da Silva Santos
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre at the Nursing Research Development, Ribeirão Preto, SP, Brazil.,Scholarship holder at the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP), Brazil
| | - Rita de Cassia Quaglio
- Universidade de São Paulo, Hospital da Clinicas da Faculdade de Medicina de Ribeirão Preto, Equipe Gestora de Neurologia e Equipe de Interconsulta de Cuidados Paliativos, Ribeirão Preto, SP, Brazil
| | - Cinira Magali Fortuna
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre at the Nursing Research Development, Ribeirão Preto, SP, Brazil
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9
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Pisco L. Reformar a APS, proximidade e qualidade para todos. CIENCIA & SAUDE COLETIVA 2019; 24:1993. [DOI: 10.1590/1413-81232018246.07212019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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10
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Giovanella L, Mendonça MHMD, Buss PM, Fleury S, Gadelha CAG, Galvão LAC, Santos RFD. From Alma-Ata to Astana. Primary health care and universal health systems: an inseparable commitment and a fundamental human right. CAD SAUDE PUBLICA 2019; 35:e00012219. [PMID: 30916174 DOI: 10.1590/0102-311x00012219] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 01/24/2019] [Indexed: 11/22/2022] Open
Affiliation(s)
- Lígia Giovanella
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | | | - Paulo M Buss
- Centro de Relações Internacionais em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Sonia Fleury
- Centro de Estudos Estratégicos, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | | | - Luiz Augusto C Galvão
- Centro de Relações Internacionais em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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Abstract
RESUMO Com o objetivo de discutir a situação atual, limites e possibilidades do Sistema Único de Saúde (SUS) nos próximos anos, tendo em conta as mudanças nos sistemas universais de saúde, este ensaio apresenta uma breve revisão da literatura sobre sistemas e reformas setoriais em saúde. Registra as tendências orientadas para o mercado, discutindo certas diferenças entre sistemas universais de saúde e a proposta político-ideológica de cobertura universal de saúde. Destaca diversos obstáculos no desenvolvimento histórico do SUS, especialmente o subfinanciamento crônico e a falta de prioridade pelos governos. Comenta as ameaças à consolidação e o risco de desmonte do SUS ante as políticas econômicas ultraliberais e as propostas que defendem sistemas de saúde orientados para o mercado. Conclui reiterando que o maior desafio do SUS continua sendo político, sublinhando a relevância das lutas em defesa da democracia e das conquistas civilizatórias que integram o projeto da Reforma Sanitária Brasileira.
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de Almeida ER, de Sousa ANA, Brandão CC, de Carvalho FFB, Tavares G, Silva KC. [National primary health care policy in Brazil: an analysis of the review process (2015-2017)Política Nacional de Atención Básica en Brasil: un análisis del proceso de revisión (2015-2017)]. Rev Panam Salud Publica 2018; 42:e180. [PMID: 31093208 PMCID: PMC6385635 DOI: 10.26633/rpsp.2018.180] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 09/07/2018] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To describe and discuss events associated with the latest review of the national primary health care (PHC) policy in Brazil (Política Nacional de Atenção Básica, PNAB) so as to highlight narratives that may contribute to future analyses focusing on the formulation, implementation, and assessment of this policy. METHOD Participant observation report of the PNAB review process, based on content and document analyses. RESULTS The review process of PNAB, which took place between 2015 and 2017, was strongly marked by technical and political dispute among the Ministry of Health and authorities representing municipal and state health departments. The main changes introduced by the new version of PNAB are the financing of other PHC organizational models in addition to the Family Health Strategy; attribution of additional responsibilities to community health agents; introduction of a national set of core and extended PHC services and actions; and introduction of a manager role as part of PHC teams. CONCLUSIONS Implementation of the revised PNAB, which was the result of interfederation dispute, will depend on the convergence of interests in a PHC that is accessible and effective, strengthening the Unified Health System. This will substantially require societal engagement and leadership in the fight for the right to health in Brazil.
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Affiliation(s)
- Erika Rodrigues de Almeida
- Ministério da Saúde, Secretaria de Atenção à Saúde, Departamento de Atenção Básica, Brasília (DF), Brasil.
| | - Allan Nuno Alves de Sousa
- Ministério da Saúde, Secretaria de Atenção à Saúde, Departamento de Atenção Básica, Brasília (DF), Brasil.
| | - Celmário Castro Brandão
- Ministério da Saúde, Secretaria de Atenção à Saúde, Departamento de Atenção Básica, Brasília (DF), Brasil.
| | - Fabio Fortunato Brasil de Carvalho
- Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública Sérgio Arouca, Programa de Pós-Graduação Stricto Sensu em Saúde Pública, Rio de Janeiro (RJ), Brasil.
| | - Graziela Tavares
- Ministério da Saúde, Secretaria de Atenção à Saúde, Departamento de Atenção Básica, Brasília (DF), Brasil.
| | - Kimielle Cristina Silva
- Universidade do Estado do Rio de Janeiro (UERJ), Instituto de Medicina Social, Rio de Janeiro (RJ), Brasil.
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13
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Integration between Primary Health Care and Emergency Services in Brazil: Barriers and Facilitators. Int J Integr Care 2018; 18:8. [PMID: 30498404 PMCID: PMC6251068 DOI: 10.5334/ijic.4066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction: Characteristics of primary health care and emergency services may hamper their integration and, therefore, reduce the quality of care and the effectiveness of health systems. This study aims to identify and analyse policy, structural and organizational aspects of healthcare services that may affect the integration between primary health and emergency care networks. Theory and Methods: We conducted a qualitative research study based on grounded theory that included: (1) interviews with 30 health care leaders; and (2) documental analysis of the summaries of Regional Interagency Committee meetings from two regions in the state of Sao Paulo, Brazil. Results: The integration between primary health and emergency care network is inefficient. The barriers that contributed to this situation are as follows: (1) policy: the municipal health department is responsible for providing primary health care and the regional health department provides emergency care, but there is a lack of space for the integration of services; (2) structural: distinct criteria for planning mechanisms; and (3) organizational: ineffective point of interaction between different levels of the health system. Conclusions and discussion: Our findings have implications for health management and planning in low-and middle-income countries (LMICs) with suggestions for interventions for overcoming the aforementioned barriers.
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Contribuição para uma agenda política estratégica para a Atenção Primária à Saúde no SUS. SAÚDE EM DEBATE 2018. [DOI: 10.1590/0103-11042018s128] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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15
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Giovanella L. Atenção básica ou atenção primária à saúde? CAD SAUDE PUBLICA 2018; 34:e00029818. [DOI: 10.1590/0102-311x00029818] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 03/14/2018] [Indexed: 11/22/2022] Open
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16
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Aikes S, Rizzotto MLF. [Regional integration of healthcare services in twin cities, Paraná State, Brazil]. CAD SAUDE PUBLICA 2018; 34:e00182117. [PMID: 30133667 DOI: 10.1590/0102-311x00182117] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 04/06/2018] [Indexed: 11/22/2022] Open
Abstract
This field research aimed to identify healthcare integration among four twin cities in Paraná State, Brazil, the determinants of cross-border movements of foreigners, and the obstacles to such integration. Data were collected through in-depth interviews with key informants that were analyzed with thematic content analysis. The results showed that asymmetries in the structure, resources, supply, and quality of the network's health services are determinants of cross-border movements. The experiences with integration are limited basically to emergency measures in health surveillance. Working groups are formed with limited case-resolution capacity, depending on personal, non-institutionalized initiatives. Public underfinancing is a limiting factor for access to health services. Municipal health services managers play a leading role in border areas, and they should be acknowledged as international political actors.
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Affiliation(s)
- Solange Aikes
- Universidade Estadual do Oeste do Paraná, Foz do Iguaçu, Brasil.,Universidade Federal da Integração Latino-Americana, Foz do Iguaçu, Brasil
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Bahia L. [Thirty years of history in the Brazilian Unified National Health System (SUS): a necessary but insufficient transition]. CAD SAUDE PUBLICA 2018; 34:e00067218. [PMID: 30088570 DOI: 10.1590/0102-311x00067218] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 04/26/2018] [Indexed: 11/22/2022] Open
Abstract
This article describes changes in the public, nonprofit, and private components of the health care networks and health insurance and health plan companies in Brazil, based on the accumulated knowledge concerning the gains and obstacles in the Brazilian Unified National Health System (SUS) and differences between policies for democratization and democratizing processes. This central premise allowed analyzing praise versus criticism for the SUS and the contemporary nature of relations between the public and private sectors, drawing on secondary data from agencies in the Executive, Legislative, and Judiciary branches. The article concludes that the highly financialized private and private-charitable sectors imposed anti-democratic and anti-democratizing standards in the use of public funds. The article further concludes that although these sectors have not raised barriers to certain public policies for the expansion of access, they nevertheless prevent the development of the SUS according to the principles set out in the 1988 Constitution.
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Affiliation(s)
- Ligia Bahia
- Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
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Magnabosco GT, Lopes LM, Andrade RLDP, Brunello MEF, Monroe AA, Villa TCS. HIV/AIDS care: analysis of actions and health services integration. ESCOLA ANNA NERY 2018. [DOI: 10.1590/2177-9465-ean-2018-0015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Objective: To analyze the integration of actions and health services in care provided by Specialized Services (SS) in Ribeirão Preto/SP in people living with HIV/AIDS (PLWHA) perception. Methods: Exploratory descriptive study, survey type in which 253 PLWHA were interviewed using a structured questionnaire. The data were analyzed by indicators (classified as unsatisfactory-average from 1 to 2.5; regular-between 2.6 and 3.5; satisfying-3.6 to 5) and multiple correspondence analysis. Results: The integration of health care actions had an average 3.7 (SD = 1.7) classified as satisfactory. The horizontal integration was satisfactory regarding the use of medical records, and the vertical one regarding the referral to other health services. The low utilization of Basic Care and Emergency Care services was also identified. Conclusion: Despite of the satisfactory rating on the integration of assistance to PLWHA, challenges still be done, highlighting the need for greater empowerment of individuals and strengthening reference mechanisms with support of SCS to other points of attention in HIV/AIDS specificities.
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