Edson Mamoru Tamaki

O papel da avaliação para a tomada de decisão na gestão de serviços de saúde

The management of health services is a complex administrative practice due to the breadth of the field of health and the need to reconcile individual, corporate and collective interests that are not always convergent. In this context, the evaluation needs to have specific characteristics in order to fulfill its role. The scope of this study was to establish the characteristics that the evaluation for the management of health services should have to contribute to decision-making. Usefulness, opportunity, feasibility, reliability, objectivity and directionality represent the set of principles upon which the evaluation should be based. Evaluations should lead to decisions that guarantee not only their efficiency and effectiveness but also their implementation. The evaluation process should ensure that decisions involve all stakeholders in order to render the implementation of decisions feasible, and take into account the health needs of the population and the goals set for the services. The scope of this article is to elicit a debate among different stakeholders in the evaluation in the hope that it can contribute to the reflection on the real usefulness of evaluations in which the political component in management has been increasingly prevalent.

Metodologia de construção de um painel de indicadores para o monitoramento e a avaliação da gestão do SUS

This study sought to develop methodology for the construction of a Panel for the Monitoring and Evaluation of Management of the Unified Health System (SUS). The participative process used in addition to the systematization conducted made it possible to identify an effective strategy for building management tools in partnership with researchers, academic institutions and managers of the SUS. The final systematization of the Panel selected indicators for the management of the SUS in terms of Demand, Inputs, Processes, Outputs and Outcomes in order to provide a simple, versatile and useful tool for evaluation at any level of management and more transparent and easier communication with all stakeholders in decision-making. Taking the management of the SUS as the scope of these processes and practices in all normative aspects enabled dialog between systemic theories and those which consider the centrality of the social actor in the decision-making process.

Conhecimento e prática sobre os fatores de risco para o câncer de mama entre mulheres de 40 a 69 anos

OBJECTIVES: to investigate knowledge of and practices regarding risk factors for breast cancer among users of the Family Health Strategy (FHS). METHODS: a cross-sectional study was carried out among 393 women aged between 40 and 69 years using the FHS in the city of Dourados, in the Brazilian State of Mato Grosso do Sul. An interview was conducted using a semi-structured questionnaire to investigate socio-demographic variables, family history and awareness/practices regarding the risk factors for breast cancer. The variables were described using simple frequency and a percentage. The association between awareness of the risk factors and the variables was confirmed using Fishers exact test and the chi-square with a level of significance of 5%. RESULTS: the mean age was 52.5 ± 8.1 years, the mean years of schooling was 4.4±3.6 years, 52.4% of the women were black/colored and 66.6% had a partner. Of the women, 86.5% had received some information on breast cancer. The risk factors for the disease are known by 54.2% of the women. Awareness of the risk factors was associated with family history (p=0.004) and years of schooling (p=0.01). Where the risk factors were known, 52.2% of the women took preventive measures. CONCLUSION: the identification of variables related to greater awareness of the disease may facilitate the adoption of strategies aimed at the most vulnerable groups.

Vulnerabilidade de homens que fazem sexo com homens no contexto da AIDS

The number of AIDS cases in men who have sex with men (MSM) decreased in the initial years of the epidemic, but the percentage of cases in this group has remained unaltered in the last five years. This study, aimed to improve knowledge on the impact of AIDS in the daily lives of MSM, was conducted in Campo Grande, Mato Grosso do Sul State, Brazil, using a questionnaire and interviews. The results show that MSM perceive their vulnerability to HIV infection, referring to inconsistent condom use and multiple sex partners, given that 65% of homosexuals, 75% of bisexuals, and 33% of transvestites reported up to 5 partners in the previous month and emphasizing that 59% of the group reported more than 11 partners during the same period. The susceptibility of certain groups and the identification and understanding of their specificities pose a major challenge in any geographic context where such conditions are present.

Avaliação da descentralização do programa de controle da tuberculose do nível secundário para o nível primário do sistema de saúde de Dourados-MS

O objetivo deste estudo foi avaliar a descentralizacao das acoes do controle da tuberculose do nivel secundario para o nivel primario do sistema de saude de Dourados-MS, realizado atraves da implantacao do Programa Nacional de Controle da Tuberculose (PNCT), no periodo de 2003 a 2006. A pesquisa constituiu-se em avaliacao normativa com a utilizacao de dados secundarios para obter o conhecimento do contexto e dos resultados das acoes desenvolvidas. Foram utilizadas como categorias de analise: estrutura, processo e resultados. Ao analisar o processo de descentralizacao foi possivel observar mudancas na atencao proporcionada aos usuarios, nao somente pela melhoria no acesso, mas, principalmente, pela postura dos profissionais de saude evidenciada atraves de aumento significativo na busca dos sintomaticos respiratorios, na coleta de escarro para a baciloscopia e na deteccao dos baciliferos entre o total dos casos pulmonares encontrados. Todavia, os avancos verificados nao trouxeram os resultados esperados para o municipio, indicando a existencia de fragilidades ou lacunas de conhecimento que comprometeram os esforcos dispensados no desenvolvimento de acoes do programa.

O controle da dengue em duas áreas urbanas do Brasil central: percepção dos moradores

Com a implementacao da Estrategia Saude da Familia, o controle da dengue, anteriormente realizado por Agente de Controle de Endemias (ACE), tambem passou a ser tarefa do Agente Comunitario de Saude (ACS). Em Rio Verde de Mato Grosso (RVMT), o controle da dengue continuou a ser desenvolvido pelos dois tipos de agentes e, em Sao Gabriel do Oeste (SGO), municipio pertencente a mesma microrregiao, essa atividade foi incorporada pelo ACS, deixando de existir a figura do ACE. O estudo visou verificar se a qualidade do trabalho do ACS foi afetado na percepcao da populacao desses dois municipios de Mato Grosso do Sul. Realizaram-se grupos focais com moradores dos municipios e, para organizacao dos conteudos, utilizou-se a tecnica do Discurso do Sujeito Coletivo. Em ambos os municipios, a populacao esta satisfeita com o trabalho dos ACS, revelando que em SGO, o acumulo das atividades de controle da dengue nao afetou a qualidade de seu servico. Em RVMT, a populacao considera que o trabalho com a dengue e especifico do ACE, mas manifesta maior satisfacao com a atuacao do ACS. Apesar da sobrecarga do ACS, o estudo revela o potencial que a organizacao de trabalho adotado por SGO tem para a melhoria do controle da dengue no que se refere a atencao basica.

Atendimentos a brasileiros residentes na fronteira Brasil-Paraguai pelo Sistema Único de Saúde

OBJETIVO: Identificar e analisar as caracteristicas dos atendimentos realizados no Sistema Unico de Saude (SUS) a brasileiros residentes no exterior em Ponta Pora, Coronel Sapucaia, Paranhos e Sete Quedas, municipios fronteiricos de Mato Grosso do Sul com o Paraguai. METODOS: Os dados foram colhidos durante 30 dias atraves de um formulario para cada atendimento efetuado. Foram estudados todos os servicos de saude do SUS disponiveis nos quatro municipios (14 unidades basicas de saude da familia, quatro unidades basicas de saude, cinco hospitais e quatro laboratorios). Tambem foram realizadas entrevistas semiestruturadas com informantes-chave (secretarios de saude, gerentes das unidades de saude e representantes do conselho municipal de saude). RESULTADOS: Constatou-se que a maior demanda de atendimentos a brasileiros nao residentes no Pais foi nos servicos de atencao basica: 11,9% nas unidades basicas de saude da familia de Coronel Sapucaia, 1,1% nas de Sete Quedas, 3,5% em Paranhos e 3,5% em Ponta Pora. Nas unidades basicas de saude, o percentual foi de 21,1, 43,8, 14,7 e 2,3%, respectivamente. As entrevistas confirmaram a percepcao de que existe um numero importante de brasileiros que moram no exterior recebendo atencao pelo SUS nessas cidades. CONCLUSOES: Uma proporcao consideravel de brasileiros nao residentes no Pais busca atendimento pelo SUS nos municipios brasileiros. Entretanto, essa demanda nao e considerada no planejamento dos servicos e pode causar impacto na qualidade da atencao prestada.

Os desafios da avaliação na gestão do SUS

A Revista Ciência & Saúde Coletiva tem dedicado publicações ao tema da avaliação abordando principalmente aportes metodológicos e desenhos alternativos de pesquisa avaliativa. A presente edição vem contribuir na divulgação de trabalhos de avaliação realizados com o propósito de favorecer o debate sobre os problemas enfrentados pelos SUS no desenvolvimento da gestão em saúde e desta maneira propiciar alternativas de tomada de decisão mais objetivas e efetivas na busca dos princípios da universalidade, integralidade e equidade. Os artigos apresentados abordam temas como: a potencialidade proporcionada pela utilização da avaliação para a tomada de decisão com maior efetividade; metodologias de construção de painel de monitoramento aplicável à gestão do SUS; pressupostos necessários para a avaliação de desempenho; análise dos alcances e limites da gestão descentralizada; metodologias de avaliação orçamentário-financeira; a identificação dos principais passos para o planejamento e monitoramento da gestão municipal e as condições necessárias para avaliação de políticas; e de construção de agendas estratégicas. Esta edição além de disseminar construções teóricas e experimentais realizadas no campo da avaliação em saúde, reflete parcela do esforço desenvolvido por membros do GT de Avaliação da Abrasco no sentido de estimular a realização de avaliações em todas as instancias de gestão, trabalho este que contou com a importante e significativa contribuição da Secretaria de Gestão Estratégica e Participativa do Ministério da Saúde no ano de 2010, por intermédio do Departamento de Monitoramento e Avaliação da Gestão do SUS. Temos certeza de que apesar do esforço não foi possível contemplar todos os importantes aspectos da gestão que seriam beneficiados por trabalhos de avaliação. Porém, a atenta leitura dos artigos proporcionará aos gestores e aos pesquisadores identificar contribuições importantes que a avaliação pode oferecer ao aprimoramento da gestão de serviços, dos sistemas e dos programas de saúde no SUS.

The context of leprosy in Brazil-Paraguay border

In Brazil, leprosy is endemic in three regions: the North, Northeast, and Mid-West. Counties with contiguous binational urban areas are characterized by a constant flow of people, goods, and services, which facilitates the transmission of diseases and influences the epidemiological profile of leprosy. The purpose of this study was to examine territorial differences in relation to the incidence of leprosy, focusing on border counties with contiguous binational urban areas or otherwise. Each county was taken as an information unit for leprosy cases reported during 2001-2011, based on data from original notification records of the states Department of Health. In counties with contiguous binational urban areas detection rates showed tendency to increase, Virchowian (lepromatous) disease and disability grade II predominated when compared with Groups II and III: 0.64 and 0.54/100,000 inhabitants for Virchowian disease and 0.14 and 0.27/100,000 inhabitants for disability grade II respectively, and were associated with higher transmission rates. The findings demonstrate the role of border areas in maintaining the endemicity of leprosy.

Incorporação das atividades de controle da dengue pelo agente comunitário de saúde

OBJECTIVE : To evaluate the performance of Community Health Agents when dengue control activities were added to their tasks. METHODS : Performance was measured comparing the evolution of selected indicators from the Brazilian National Dengue Control Program and the Family Health Strategy for 2002 to 2008 in the municipality of Sao Gabriel do Oeste, MS, Central Western Brazil, with those of Rio Verde de Mato Grosso, neighboring municipality with demographic, socioeconomic and health services similarities. Data were collected from municipal databases of the Information System for Yellow Fever and Dengue and the Information System for Primary Healthcare of the Mato Grosso do Sul State Health Office. The variables selected for the family health strategy activities were: monthly home visits, pregnant women whose antenatal care began in the first trimester, children under one with up-to-date vaccinations and hypertensive patients. Those selected for the Brazilian National Dengue Control Program were: properties inspected with Aedes aegypti and properties not inspected. RESULTS : The two municipalities maintained a similar trend in dengue control indicators in the period studied. With regard to the Family Health Strategy, in 2002 Sao Gabriel do Oeste was better off in three of the four indicators studied, however, this situation was reversed at the end of the period when the county was overtaken by Rio Verde de Mato Grosso in three of the four indicators analyzed, including, the monthly average community health worker visits per registered family, the main activity of a Family Health Strategy agent. CONCLUSIONS: Incorporating the National Dengue Control Program into the Family Health Strategy is viable and developed without prejudice to dengue control activities, however, the same did not occur with the activities of family health in Sao Gabriel do Oeste. The additional workload of the community health workers is the most likely hypothesis for the declining performance of these agents in the Family Health Strategy activities.OBJECTIVE To evaluate the performance of Community Health Agents when dengue control activities were added to their tasks. METHODS Performance was measured comparing the evolution of selected indicators from the Brazilian National Dengue Control Program and the Family Health Strategy for 2002 to 2008 in the municipality of Sao Gabriel do Oeste, MS, Central Western Brazil, with those of Rio Verde de Mato Grosso, neighboring municipality with demographic, socioeconomic and health services similarities. Data were collected from municipal databases of the Information System for Yellow Fever and Dengue and the Information System for Primary Healthcare of the Mato Grosso do Sul State Health Office. The variables selected for the family health strategy activities were: monthly home visits, pregnant women whose antenatal care began in the first trimester, children under one with up-to-date vaccinations and hypertensive patients. Those selected for the Brazilian National Dengue Control Program were: properties inspected with Aedes aegypti and properties not inspected. RESULTS The two municipalities maintained a similar trend in dengue control indicators in the period studied. With regard to the Family Health Strategy, in 2002 Sao Gabriel do Oeste was better off in three of the four indicators studied, however, this situation was reversed at the end of the period when the county was overtaken by Rio Verde de Mato Grosso in three of the four indicators analyzed, including, the monthly average community health worker visits per registered family, the main activity of a Family Health Strategy agent. CONCLUSIONS: Incorporating the National Dengue Control Program into the Family Health Strategy is viable and developed without prejudice to dengue control activities, however, the same did not occur with the activities of family health in Sao Gabriel do Oeste. The additional workload of the community health workers is the most likely hypothesis for the declining performance of these agents in the Family Health Strategy activities.