Adriana Falangola Benjamin Bezerra

Direito à saúde e integralidade: uma discussão sobre os desafios e caminhos para sua efetivação

O presente artigo discute aspectos que interferem na garantia do direito a saude e sua relacao com o principio da integralidade. Para tanto, sao descritas questoes historicas e culturais que contextualizam esta realidade. Tambem sao apontados os limites e as possibilidades para garantia da integralidade como parte do direito a saude, com foco no SUS. A abrangencia do conteudo do direito a saude e a limitacao daquilo que e efetivamente alcancado demonstram a dificuldade para sua garantia plena, aspecto igualmente observado em outros paises. O direito compartimentado vivenciado na pratica do SUS e antagonico ao principio da integralidade em seus diferentes sentidos. Apesar dos desafios para efetivacao da integralidade, diversas iniciativas foram identificadas e tem sido utilizadas na perspectiva de superar as dificuldades e alcancar o direito a saude em sua plenitude.El objetivo fue desarrollar una discusion sobre los puntos que afectan a la garantia del derecho a la salud y su relacion con el principio de la integridad. Se describen los aspectos historicos y culturales de esta realidad y se senalan los limites y las posibilidades de asegurar la e integridad como parte del derecho a la salud, centrandose en el Sistema Unico de Salud. La amplitud de los contenidos del derecho a la salud y el limite de lo que fue posible alcanzar muestran la dificultad para su plena garantia. Lo mismo se observa en otros paises. El derecho estricto en la practica del Sistema Unico es opuesto al principio de la integridad en sus diferentes significados. A pesar de los desafios a la realizacion de la integridad, iniciativas han sido identificadas y utilizadas en la perspectiva de superar las dificultades y lograr el derecho a la salud en su plenitud.

Evaluation of measures to prevent vertical transmission of HIV and syphilis in public maternity hospitals in four municipalities in Northeast Brazil

This article evaluates the care provided to women in four public maternity hospitals in Northeast Brazil in relation to interventions adopted by the Projeto Nascer to reduce vertical transmission of HIV and syphilis in 2005. This was a multiple case study including one retrospective and another cross-sectional approach. The logical model for the intervention has five components: prevention, epidemiological surveillance, and pharmaceutical, laboratory, and clinical care. For each component, structure and process indicators were selected. The maternity hospitals were classified as: acceptable, partially implemented, unacceptable, and not implemented. The highest adherence to the standards was in maternity hospital A (62.5%), classified as partially implemented, and the lowest in maternity hospital C (30.6%), considered unacceptable. The study highlights the importance of preventive measures, epidemiological surveillance, and pharmaceutical, laboratory, and clinical care to reduce vertical transmission of HIV and syphilis.This article evaluates the care provided to women in four public maternity hospitals in Northeast Brazil in relation to interventions adopted by the Projeto Nascer to reduce vertical transmission of HIV and syphilis in 2005. This was a multiple case study including one retrospective and another cross-sectional approach. The logical model for the intervention has five components: prevention, epidemiological surveillance, and pharmaceutical, laboratory, and clinical care. For each component, structure and process indicators were selected. The maternity hospitals were classified as: acceptable, partially implemented, unacceptable, and not implemented. The highest adherence to the standards was in maternity hospital A (62.5%), classified as partially implemented, and the lowest in maternity hospital C (30.6%), considered unacceptable. The study highlights the importance of preventive measures, epidemiological surveillance, and pharmaceutical, laboratory, and clinical care to reduce vertical transmission of HIV and syphilis.

Integralidade no cuidado ao câncer do colo do útero: avaliação do acesso

OBJECTIVE To evaluate integrity of access to uterine cervical cancer prevention, diagnosis and treatment services. METHODS The tracer condition was analyzed using a mixed quantitative and qualitative approach. The quantitative approach was based on secondary data from the analysis of cytology and biopsy exams performed between 2008 and 2010 on 25 to 59 year-old women in a municipality with a large population and with the necessary technological resources. Data were obtained from the Health Information System and the Regional Cervical Cancer Information System. Statistical analysis was performed using PASW statistic 17.0 software. The qualitative approach involved semi-structured interviews with service managers, health care professionals and users. NVivo 9.0 software was used for the content analysis of the primary data. RESULTS Pap smear coverage was low, possible due to insufficient screening and the difficulty of making appointments in primary care. The numbers of biopsies conducted are similar to those of abnormal cytologies, reflecting easy access to the specialized services. There was higher coverage among younger women. More serious diagnoses, for both cytologies and biopsies, were more prevalent in older women. CONCLUSIONS Insufficient coverage of cytologies, reported by the interviewees allows us to understand access difficulties in primary care, as well as the fragility of screening strategies.OBJECTIVE To evaluate integrity of access to uterine cervical cancer prevention, diagnosis and treatment services. METHODS The tracer condition was analyzed using a mixed quantitative and qualitative approach. The quantitative approach was based on secondary data from the analysis of cytology and biopsy exams performed between 2008 and 2010 on 25 to 59 year-old women in a municipality with a large population and with the necessary technological resources. Data were obtained from the Health Information System and the Regional Cervical Cancer Information System. Statistical analysis was performed using PASW statistic 17.0 software. The qualitative approach involved semi-structured interviews with service managers, health care professionals and users. NVivo 9.0 software was used for the content analysis of the primary data. RESULTS Pap smear coverage was low, possible due to insufficient screening and the difficulty of making appointments in primary care. The numbers of biopsies conducted are similar to those of abnormal cytologies, reflecting easy access to the specialized services. There was higher coverage among younger women. More serious diagnoses, for both cytologies and biopsies, were more prevalent in older women. CONCLUSIONS Insufficient coverage of cytologies, reported by the interviewees allows us to understand access difficulties in primary care, as well as the fragility of screening strategies.

Política de práticas integrativas em Recife: análise da participação dos atores

OBJECTIVE To examine the involvement of stakeholders in the implementation of a local policy of integrative practices. METHODOLOGICAL PROCEDURES Qualitative study conducted in the city of Recife, Northeastern Brazil. Data was collected from local health board records between 2004 and 2009, interviews with managers and key informants and focus groups with providers and users. The analysis was performed using the condensation of meaning model. The results were grouped into four categories of stakeholders according to their influence and interest, namely: subjects; population; leaders; and players. ANALYSIS OF RESULTS Five years after the policy was implemented in Recife, only a single service offered integrative practices. The population, or users, did not have any effective involvement and did not make any contributions to the policy, and health providers, despite their willingness to participate in the process, were not involved. The leaders included the local health board, managers and medical organizations; the latter two were also players as they were effectively involved in the formulation of the policy. CONCLUSIONS The involvement of few stakeholders in the formulation of an integrative practice policy makes it difficult its implementation and widens the gap between formulation and implementation, hindering the achievement of expected results.OBJETIVO: Analisar a participacao dos atores envolvidos na evolucao de politica municipal de praticas integrativas. PROCEDIMENTOS METODOLOGICOS: Estudo com abordagem qualitativa em Recife, PE. A coleta dos dados foi realizada por meio de consultas as atas do conselho municipal de saude, entre 2004 e 2009, entrevistas com informantes-chave e gestores, e grupos focais com profissionais e usuarios. Os dados foram analisados segundo o modelo de condensacao de significados. Para apresentacao dos resultados, quatro categorias de atores foram formadas, segundo seu poder e interesse, a saber: sujeitos, populacao, lideres e jogadores. RESULTADOS: Apos cinco anos da implantacao da politica em Recife, so um servico oferecia praticas integrativas. A populacao ou os usuarios nao tiveram participacao efetiva e nao contribuiram com a politica; os profissionais de saude, apesar do interesse em participar do processo, nao foram incluidos. Os lideres encontrados foram o Conselho Municipal de Saude, os gestores e as entidades medicas, sendo os dois ultimos tambem considerados jogadores, pois participaram efetivamente da elaboracao da politica. CONCLUSOES: A participacao de poucos atores na construcao de uma politica de praticas integrativas dificulta sua consolidacao e amplia a distância entre formulacao e implementacao, prejudicando o alcance dos resultados esperados.

Risk factor control in hypertensive and diabetic subjects attended by the Family Health Strategy in the State of Pernambuco, Brazil: the SERVIDIAH study

The SERVIDIAH study (Evaluation of Health Services for Diabetic and Hypertensive Subjects) was conducted in 2010 in the State of Pernambuco, Brazil. A multi-stage random sample of 785 hypertensive and 823 diabetic patients was drawn from 208 Family Health Strategy (FHS) units selected throughout 35 municipalities. Patients underwent a structured interview and weight, height, blood pressure and HbA1c levels (for diabetic patients) were measured. Mean age was approximately 60 years, and women were overrepresented in the sample (70%). 43.7% of hypertensive subjects and 25.8% of diabetic subjects achieved adequate blood pressure control and 30.5% of diabetic subjects had HbA1c levels below 7%. Despite 70% of the patients being overweight or obese, few had adhered to a weight-loss diet. The study of this representative sample of hypertensive and diabetic patients attended by the FHS in the State of Pernambuco shows that improvements in the management of hypertension and diabetes are needed in order to prevent the occurrence of serious and costly complications, especially given the context of increasing incidence of these two conditions.

Despesa pública municipal com saúde em Pernambuco, Brasil, de 2000 a 2007

In order to assess the impact of macro-political measures implemented in the latter half of the 1990s on the increase in public spending on health and the possible reduction in allocation inequity, a descriptive, quantitative, cross-sectional study was carried out involving 184 municipalities in the state of Pernambuco, Brazil. Data from the Public Health Budget Information System was used, with the selected indicator being spending on health per inhabitant under the responsibility of the municipality. The correlations of this variable with the municipal Human Development Index, population size and value of the municipal budget per capita were analyzed. It was seen that, although the mean increase in municipal spending on health is 190.76%, the value per capita has remained relatively low - at around R

Análise de custos da assistência à saúde aos portadores de diabetes melito e hipertensão arterial em uma unidade de saúde pública de referência em Recife - Brasil

183.79 - which is below the national and macro-regional averages. Both spending on health per capita and growth percentages are distributed irregularly among health regions as well as among municipalities within a single region. In conclusion, there is marked allocation inequity among municipalities with regard to the distribution of public resources for health, despite the macro-political measures adopted to reduce this inequity.

Conhecimento e uso do Sistema de Informações sobre Orçamentos Públicos em Saúde (SIOPS) pelos gestores municipais, Pernambuco, Brasil

Objective: To analyze health care costs of patients with diabetes mellitus and hypertension, and to estimate the cost of medium complexity outpatient procedures, compared with the standard reimbursement values used in Brazil. Materials and methods: We analyzed direct health costs in a public health reference unit in Recife/PE, in 2007. Costs were determined and allocated using the techniques of absorption costing and apportionment. Results: Direct costs and the amount reimbursed by the SUS totaled R

A definição de prioridade de investimento em saúde: uma análise a partir da participação dos atores na tomada de decisão

4,855,291.82 and R

Confiabilidade dos dados relativos ao cumprimento da Emenda Constitucional nº. 29 declarados ao Sistema de Informações sobre Orçamentos Públicos em Saúde pelos municípios de Pernambuco, Brasil

2.118.893,56, respectively. The greatest groups of expenditure were medications, with R