Ana Luiza Queiroz Vilasbôas

Atenção primária à saúde: estrutura das unidades como componente da atenção à saúde

OBJECTIVES: to assess the structure of the primary health care units in two municipalities, comparing the Family Health Units(FHU) and the conventional units. METHODS: a quantitative cross-sectional study was carried out using structured interviews and observation of the work routine of the teams as data collection techniques. Three components were evaluated: the physical environment, material resources, and staff. RESULTS: the findings provided evidence of structural shortcomings in all three components, these being more serious in the Family Health Units. The shortcomings in terms of physical structure were more serious in municipality B, where the items under evaluation were fund in less than 70% of FHUs. In both municipalities, less than 50% of units had basic equipment. In municipality A, all the conventional units had doctors and nurses, while in municipality B, 27.3% of FHUs had no doctor. Shortcomings were revealed that jeopardize biosafety and there was an absence of structures that favor the development of the kind of collective intervention that is necessary for changing the model of care by placing more emphasis on health surveillance. CONCLUSIONS: although the chains of causation that link the structure of health services to their effects are complex and involve various factors, the study findings reiterate the need for more attention to be paid to structural components when evaluating health management.

Acessibilidade geográfica à atenção primária à saúde em distrito sanitário do município de Salvador, Bahia

OBJECTIVES: to assess the geographical accessibility of primary health care for the population served by the Community Health Agents Program (PACS) and the Family Health Program (PSF) in one sanitary district in the city of Salvador, Brazil. METHODS: a evaluative cross-sectional study was carried out. The data were collected using interviews with health workers from the eleven PACS and PSF teams. Analysis of the data took two factors into account: access of the population and the logic of territorialization. RESULTS: the district has a relatively rugged landscape and all the teams reported the existence of geographical barriers in the area, in particular steps and steep hills. There was no difference in accessibility between the PACS and the PSF. The process of territorialization was unrelated to the concept of territory as a process. Some areas covered by the teams were located some distance from the UBS and this constituted a significant obstacle to access. CONCLUSIONS: the implantation of the PACS/PSF strategy in the district and the model of territorialization were not in line with the principles that should guide primary health care, resulting in geographical restrictions on access for the population served. It is recommended that the current territorial design be reviewed to ensure that it is more line with PSF guidelines and to enable better access to primary care.

Implantação das ações intersetoriais de mobilização social para o controle da dengue na Bahia, Brasil

Discussions on the health-disease process and health promotion indicate the need to reach beyond the limits of the health sector itself to link knowledge from various fields in order to promote better health conditions for the population. Inter-sector approaches have thus emerged as a new rationale for guiding public policies. This study aimed to analyze the implementation of inter-sector actions in social mobilization for dengue control in Bahia State, Brazil, from 2008 to 2009, using evaluative research. A log frame was developed to define criteria for assessing the degree of implementation of the above-mentioned actions (implemented; partially implemented; not implemented). The results identified political support from government agencies as the main positive factor for inter-sector practices. Barriers included the concentration of responsibilities in a single sector and lack of planning as a work tool. The results emphasize inter-sector linkage as a persistent challenge.

Promoção da saúde e prevenção de doenças crônicas: o que fazem as equipes de Saúde da Família?

Este estudo objetiva descrever as acoes de promocao da saude e prevencao de doencas cronicas realizadas pelas equipes de saude que aderiram ao Programa Nacional de Melhoria do Acesso e da Qualidade da Atencao Basica (PMAQ-AB) no Brasil e cotejar as informacoes prestadas pelos profissionais de saude com aquelas obtidas pelos entrevistadores atraves de comprovacao documental. E um estudo transversal com dados secundarios obtidos da base de dados do PMAQ-AB. Os resultados demonstraram a incipiencia da realizacao das acoes analisadas, especialmente aquelas dirigidas para idosos e para a deteccao de problemas entre escolares, alem de pouca comprovacao das acoes realizadas, traduzindo a baixa institucionalizacao dessas acoes no âmbito da Estrategia Saude da Familia.

Coordenação do cuidado na atenção primária à saúde: estudo avaliativo em município sede de macrorregião do nordeste brasileiro

International and Brazilian studies have highlighted the importance of the coordination of care for the organization of local health systems. This study aimed to analyze the coordination of care by Primary Health Care (PHC) in a municipal health system in the State of Bahia. This study was conducted in the lead municipality of the macro-region and involved two levels of analysis: PHC team and municipal management. Outlining conditions for the study were defined (hypertension and diabetes mellitus) and an objective image corresponding to the coordination of care was developed based on current national and international literature review. Semi-structured interviews with professionals, managers of PHC services were conducted and current documentary sources were also used. It was demonstrated that the coordination of care has not been met by municipal systems, where only 14 of the 22 proposed criteria have been met. The main difficulties and reasons were: a lack of health care protocols and the non-implementation of computer systems and telecommunication technologies. The results and the conceptual framework to assess the coordination of care are relevant contributions to this study, which can be applied to other contexts with similar characteristics.Resumo Estudos internacionais e nacionais tem destacado a importância da coordenacao do cuidado para a organizacao de sistemas locais de saude. Este estudo avaliou a coordenacao do cuidado pela Atencao Primaria a Saude (APS) em um sistema local de saude do Estado da Bahia. Trata-se de um estudo de caso em municipio sede de macrorregiao, com dois niveis de analise: equipe e gestao municipal. Adotou-se condicoes tracadoras (hipertensao arterial e diabetes mellitus) e elaborou-se uma imagem-objetivo correspondente a coordenacao do cuidado, a partir da revisao atualizada da literatura nacional e internacional. Foram realizadas entrevistas semiestruturadas com profissionais, gestores da APS e utilizadas outras fontes documentais. Evidenciou-se que a coordenacao do cuidado nao tem sido alcancada no municipio, onde apenas 14 dos 22 criterios propostos foram atendidos, destacando-se como principais dificuldades a ausencia de protocolos assistenciais, de sistemas informatizados e de outras tecnologias de informacao e comunicacao. As evidencias e a operacionalizacao conceitual de um modelo para avaliar a coordenacao do cuidado sao contribuicoes relevantes deste estudo, que podem ser aplicadas a outros contextos com caracteristicas similares.

Consumo de frutas, vegetais, óleos e gorduras e nível de atividade física em população portadora de hipertensão arterial e/ou diabetes mellitus adscrita à Estratégia de Saúde da Família em Salvador, Bahia

Comportamento alimentar; Atividade motora; Hipertensao; Diabetes mellitus; Saude da familia.