Alcindo Antônio Ferla

Integrality in the population's health care programs

This article examines integrality as one of the doctrinal principles of the Brazilian State Health Policy - the Unified Health System (SUS) - whose aim is to offer health care as a right and as a service. Integrality is the foundation around which managerial activity practices are organized and whose main challenge is guaranteeing access to the health care systems most complex assistance levels. We developed an analytical reference grounded on three dimensions: service organization, knowledge, the practices of health workers and government policy formulation with input from the population. Managerial practices are fertile ground for integrality and are the political arena in which public managers of different government levels, private service providers, health care workers and organized civil society participate. Integrality in health care can only occur through the democratic interaction of subjects involved in the creation of government responses which are capable of contemplating the differences expressed in the health care needs.

O Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica: várias faces de uma política inovadora

O presente artigo contextualiza a formulacao do Programa Nacional de Melhoria do Acesso e da Qualidade da Atencao Basica (PMAQ-AB), analisa, com apoio de referenciais da analise de politicas, diferentes papeis do programa na nova Politica Nacional de Atencao Basica (PNAB), reunindo, para isso, alguns resultados em seus primeiros tres anos de implantacao, em perspectiva adotada pela saude coletiva para o estudo de politicas, em particular, no que se refere a sua implementacao, alem de considerar, na perspectiva das analises institucionais, o PMAQ-AB como revelador da PNAB. Os dados analisados compoem o banco de dados do PMAQ-AB e indicadores de financiamento federal do Sistema Unico de Saude (SUS), permitindo perceber um incremento nos recursos destinados, no âmbito federal, a Atencao Basica e um percurso inovador no que se refere ao conteudo da politica, a mobilizacao local e a producao de uma cultura de monitoramento e avaliacao embasada na utilizacao de indicadores de autoavaliacao e de Avaliacao Externa.

A Atenção Básica no Brasil e o Programa Mais Médicos: uma análise de indicadores de produção

This study analyzes the number of medical appointments and referrals performed in primary health care in Brazil focusing on the Mais Medicos Program (More Doctors Program). It is a cross-sectional study on the work of physicians included, or not, to the Mais Medicos Program in 2014. Based on validation protocols, a unified database was created from two health information system databases – SIAB and ESUS. Absolute indicators were defined: the total of medical appointments per month; medical referrals and community health education activities. In addition, other indicators were considered, such as weekly rates and productivity of appointments, in line with the profile of Brazilian municipalities. The mean of all appointments was 285 per month corresponding to an average of 14.4 appointments/day. In the poorest municipalities, the figures for the Mais Medicos Program physicians were higher than national rates. The educational activities provided by primary care teams that included a Mais Medicos Program professional were higher in Brazilian capital cities. The Mais Medicos Program achieved one of its main goals, which was to increase health access for vulnerable populations and to contribute towards the consolidation of primary health care in Brazil.This study analyzes the number of medical appointments and referrals performed in primary health care in Brazil focusing on the Mais Médicos Program (More Doctors Program). It is a cross-sectional study on the work of physicians included, or not, to the Mais Médicos Program in 2014. Based on validation protocols, a unified database was created from two health information system databases - SIAB and ESUS. Absolute indicators were defined: the total of medical appointments per month; medical referrals and community health education activities. In addition, other indicators were considered, such as weekly rates and productivity of appointments, in line with the profile of Brazilian municipalities. The mean of all appointments was 285 per month corresponding to an average of 14.4 appointments/day. In the poorest municipalities, the figures for the Mais Médicos Program physicians were higher than national rates. The educational activities provided by primary care teams that included a Mais Médicos Program professional were higher in Brazilian capital cities. The Mais Médicos Program achieved one of its main goals, which was to increase health access for vulnerable populations and to contribute towards the consolidation of primary health care in Brazil.

Challenges in organizing care networks for the elderly in two regions of Brazil

The global trend of ageing populations is present in Brazil. Brazilian society is going through an intensive process of transformation, where young adults are increasingly fewer, thus raising the question of who will take care of the elderly in the 21st Century? There is an urgent need to establish care networks for the elderly, covering primary care, including care with housing (Healthy Housing), as well as to ensure access to secondary and tertiary levels of care, providing early diagnoses and rapid access to treatment. This article reports two Brazilian experiences: the restructuring of a shelter for elderly indigents, with 500 elderly residents in Rio de Janeiro, which involved a broad process of humanization, with strong physical restructuring of the buildings that dated from 1930; and the process of organizing the care referral line for the elderly within the Conceição Hospital Group, in Rio Grande do Sul State, which included a health care complex with diverse health units, encompassing all stages of care: from primary care to the most complex hospital treatment.

Desenvolvimento e validação de um índice de vulnerabilidade social aplicado a políticas públicas do SUS

The article outlines the development and initial validation of a Social Vulnerability Index (SVI) including five social determinants of risk to health and demonstrates its application in the financing of primary care by the Unified Health System (SUS) in the State of Rio Grande do Sul. Municipal indicators of vulnerability relating to poverty and population dispersion were obtained from the 2010 population census of the Brazilian Institute of Geography and Statistics. Both exploratory and confirmatory factor analysis suggests that the five items can constitute a reliable and acceptable measurement scale. The SVI-5 was then generated based on the first main component, measuring municipal inequalities in social vulnerability relating to poverty and population in the territory in Z-scores. The external validity of SVI-5 was examined in relation to health outcomes using DATASUS 2007-2011 data, revealing that infant mortality and hospitalizations for conditions treatable by primary care are greater in more vulnerable municipalities The results suggest that the SVI-5 is a valid measure of inequalities in social vulnerability between municipalities, applicable to socially equitable policies in health.

Gestão da educação e do trabalho na saúde: enfrentando crises ou enfrentando o problema?

O artigo de Monica Carvalho e Maria Fatima de Sousa traz para o debate umaquestao muito relevante, que pertence a uma agenda ainda nao concluida naspoliticas de saude do Brasil: a gestao da educacao e do trabalho na saude e omodo como essa gestao se articula com as politicas de saude. Esse e um tema quemobiliza diferentes perspectivas. Queremos aborda-lo sob a de politica publica -com o foco que as autoras propoem, ou seja, tomando o provimento e a fixacaode profissionais como questao marcadora - e dialogar com a afirmacao de que enecessario definir um “marco regulatorio” para orientar as acoes dos diferentesatores.Inicialmente, e preciso considerar que as politicas de saude induziram aampliacao da oferta de servicos de saude no pais. Considerando os dados daPesquisa de Assistencia Medico-Sanitaria de 2009 (IBGE, 2010), verificamos umcrescimento de 220% no numero de estabelecimentos de saude no periodo de1988 a 2009, sendo que tal fenomeno e maior no setor publico (o numero deestabelecimentos mais que dobrou de 21,5 mil para 50,3 mil) do que na iniciativaprivada (de 12,2 mil para 24,5 mil no mesmo periodo). Ainda entre 1988 e 2009,os dados mostram tambem uma pequena retracao nos estabelecimentos de saudecom internacao e um grande crescimento nos servicos de saude sem internacao(26,5 mil para 67,9 mil), tanto no segmento publico (19,6 mil para 47,4 mil)quanto no privado (6,9 mil para 20,5 mil). Esse crescimento do numero e dadiversificacao dos servicos produziu um incremento substancial no numero deempregos em todo o pais, aumentando de pouco mais de 575 mil, em 1980, paramais de 2 milhoes de empregos em 2009 (IBGE, 2010). Esses dados nao sereferem ao setor de saude como um todo, mas aos servicos assistenciais. Alem daampliacao da rede, esses dados informam a mudanca substancial do perfil dotrabalho, efeito que esta associado, em grande medida, a implantacao de politicasde atencao basica, em particular, a Estrategia de Saude da Familia; portanto, comexpectativa de reorganizacao de praticas. A questao que se coloca e: como essamudanca no perfil dos servicos foi absorvida pela formacao dos trabalhadores?O proprio artigo informa que essa mudanca passou ao largo da formacao e dasdiversas iniciativas pontuais feitas no periodo, tanto nos aspectos quantitativosquanto qualitativos. Sem alongarmos essa argumentacao, basta o registro de queas tentativas de aproximacao da gestao da educacao e do trabalho nao obtiveram

Contribution towards studying the contemporary social imaginary: rhetoric and images of biosciences in popular scientific periodicals

Artigo analitico sobre a retorica das imagens de biociencias em periodicos em bancas de jornal, que pretende contribuir para pesquisas empiricas sobre representacoes sociais dominantes no imaginario contemporâneo, analisando as imagens das capas da midia impressa sobre vida, saude e doenca. As mensagens veiculadas buscam ser impressionantes, atrativas e, sobretudo, convincentes, o que mobiliza a analise da retorica, com sua capacidade de convencimento da palavra fortalecida pela imagem. O texto articula um ensaio teorico sobre metodologia de analise da retorica, com a apresentacao de resultados preliminares de campo, coletados em Porto Alegre e Rio de Janeiro. A abordagem contribui para a analise do papel social da divulgacao das biociencias na cultura atual.

Ideias, imagens e crenças na produção de políticas públicas : o caso do Programa Mais Médicos

O artigo analisa as manifestacoes dos candidatos a cargos eletivos de âmbito federal e estadual, durante o processo eleitoral do ano de 2014, quanto ao Programa Mais Medicos, presentes na midia comercial impressa e on-line, identificando ideias, imagens e crencas sobre tal politica publica. Um mapeamento do posicionamento dos candidatos objetivava identificar sentidos e significados sobre o programa, explicitando a descricao de problemas e solucoes acerca da provisao de trabalhadores no Sistema Unico de Saude. Os dados obtidos demonstraram que o tema do provimento emergencial de medicos extrapolou o subsistema ou campo da Saude e foi assumido como agenda no sistema politico. Tanto os candidatos manifestamente favoraveis ao programa quanto aqueles que faziam criticas expressaram publicamente a imagem de um programa necessario e uma estrategia com a qual estariam comprometidos. O programa ampliou muito a visibilidade da agenda setorial da Saude.O artigo analisa as manifestacoes dos candidatos a cargos eletivos de âmbito federal e estadual, durante o processo eleitoral do ano de 2014, quanto ao Programa Mais Medicos, presentes na midia comercial impressa e on-line, identificando ideias, imagens e crencas sobre tal politica publica. Um mapeamento do posicionamento dos candidatos objetivava identificar sentidos e significados sobre o programa, explicitando a descricao de problemas e solucoes acerca da provisao de trabalhadores no Sistema Unico de Saude. Os dados obtidos demonstraram que o tema do provimento emergencial de medicos extrapolou o subsistema ou campo da Saude e foi assumido como agenda no sistema politico. Tanto os candidatos manifestamente favoraveis ao programa quanto aqueles que faziam criticas expressaram publicamente a imagem de um programa necessario e uma estrategia com a qual estariam comprometidos. O programa ampliou muito a visibilidade da agenda setorial da Saude.

Socioeconomic and regional inequalities of pap smear coverage.

Objectives To identify socioeconomic and regional inequalities of pap smear coverage in the state of Rio Grande do Sul. Methods An ecological study based on data of the 2011-2012 national health information system to estimate the annual coverage of pap smears for the overall female population of the state and for women without private health insurance. We estimated annual pap smear coverage according to the Municipal Social Vulnerability Index and health macro-regions and regions of the state. Results The percentage of women without private health insurance ranged from 38.1% to 94.2% in the health regions. Pap smear coverage was 17.3% for the overall female population and 23.8% for women without private health insurance. Pap smear coverage was higher in more socially vulnerable municipalities and regions with a higher percentage of women with private health insurance. Conclusions The prevalence of private health insurance should be considered in studies that address the coverage of the Brazilian Unified Health System (SUS).Objectives To identify socioeconomic and regional inequalities of pap smear coverage in the state of Rio Grande do Sul. Methods An ecological study based on data of the 2011-2012 national health information system to estimate the annual coverage of pap smears for the overall female population of the state and for women without private health insurance. We estimated annual pap smear coverage according to the Municipal Social Vulnerability Index and health macro-regions and regions of the state. Results The percentage of women without private health insurance ranged from 38.1% to 94.2% in the health regions. Pap smear coverage was 17.3% for the overall female population and 23.8% for women without private health insurance. Pap smear coverage was higher in more socially vulnerable municipalities and regions with a higher percentage of women with private health insurance. Conclusions The prevalence of private health insurance should be considered in studies that address the coverage of the Brazilian Unified Health System (SUS).

Como médicos se tornaram deuses : reflexões acerca do poder médico na atualidade

A concepcao atual de saude refere-se a um conceito mais amplo de condicoes do que a ausencia de doenca. Esse conceito destaca a importância de um cuidado em saude que possa levar em consideracao nao apenas os sintomas apresentados pelas pessoas. Porem, o modelo de atencao a saude vigente e um modelo centrado na figura do medico, na doenca como foco das intervencoes e no uso excessivo de medicamentos. Este artigo propoe reflexoes acerca de como o medico passou a ocupar papel central na modernidade e ganhou legitimidade para decidir sobre o valor das vidas humanas. Primeiramente serao feitas consideracoes sobre o nascimento da biopolitica, a partir das contribuicoes de Michel Foucault, seguindo com a relacao entre medicina, vida nua e poder soberano, a partir das reflexoes propostas por Giorgio Agamben. Por fim, serao apresentadas consideracoes sobre a medicalizacao da vida, a partir das contribuicoes de Joao Biehl.