Eronildo Felisberto

Atenção à saúde da criança: uma análise do grau de implantação e da satisfação de profissionais e usuários em dois municípios do estado de Pernambuco, Brasil

OBJECTIVES: to evaluate the implementation of child health care at two municipalities of the state of Pernambuco, Brazil. METHODS: evaluative research, implementation analysis. It was considered as units of analysis: unit of the Family Health Program (FHP) with professionals trainned in the Integrated Management of Childhood Illness Strategy (IMCI), unit without this training and conventional health care unit. The degree of implementation was achieved by case management and structure evaluation. Professional and users perceptions were appraised by interview and focus group discussion. RESULTS: degree of implementation satisfactory for FHP services, insatisfactory at the conventional unit in Municipality 1 and insatisfactory for units in Municipality 2. Professionals considered effectiveness of services and interpersonal relationship as good, but difficulties in the reference system and lack of integration with work group of conventional units. Users reported, good services effectiveness, but access and interpersonal relationship difficulties. CONCLUSIONS: deficiencies in case management and potentiality of the health care provided by nurse professional were determinant aspects for the variability on implementation degree. It was not possible to define the influence of the IMCI strategy. There is better professional and user satisfaction at FHP units, but problems of access and integrality of health care.

Óbitos infantis evitáveis em hospital de referência estadual do Nordeste brasileiro

OBJETIVOS: classificar os obitos de menores de um ano ocorridos de janeiro a dezembro de 2000, em hospital de referencia em Pernambuco, segundo criterios de evitabilidade da causa basica. METODOS: estudo descritivo de corte transversal, utilizando-se como fonte de dados o Sistema de Informacao sobre Mortalidade, processado na instituicao. As causas basicas presentes nas Declaracoes de Obitos, corrigidas a partir do prontuario medico e codificadas segundo as regras da 10 revisao da Classificacao Internacional de Doencas, foram agrupadas segundo os criterios de evitabilidade de obitos propostos pela Fundacao SEADE em 1991. Calculou-se o coeficiente de mortalidade infantil hospitalar. RESULTADOS: a maioria dos obitos estava classificada entre as causas reduziveis por medidas de atencao a saude, com mortalidade proporcional de 77,4% (infantil), 75,3% (neonatal) e 60,1% (pos-neonatal) representando um coeficiente de mortalidade infantil hospitalar de 103,7 obitos por 1.000 internacoes. Quase metade era neonatos, desses, 31% eram reduziveis por diagnostico e tratamento precoces. No grupo pos-neonatal, 44% foram causadas principalmente pelas doencas infecciosas intestinais e do aparelho respiratorio. CONCLUSOES: os altos percentuais de mortes por causas evitaveis, sugerem problemas de acesso aos servicos de saude, cobertura e/ou na qualidade da assistencia prestada.

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.

Análise da sustentabilidade de uma política de avaliação: o caso da atenção básica no Brasil

This study analyzes the sustainability of Brazils National Policy for the Evaluation of Primary Health Care, based on the identification and categorization of representative critical events in the institutionalization process. This was an evaluative study of two analytical units: Federal Management of Primary Health Care and State Health Secretariats, using multiple case studies with data collected through interviews and institutional documents, using the critical incidents technique. Events that were temporally classified as specific to implementation, sustainability, and mixed were categorized analytically as pertaining to memory, adaptation, values, and rules. Federal management and one of the State Health Secretariats showed medium-level sustainability, while the other State Secretariat showed strong sustainability. The results indicate that the events were concurrent and suggest a weighting process, since the adaptation of activities, adequacy, and stabilization of resources displayed a strong influence on the others. Innovations and the development of technical capability are considered the most important results for sustainability.

Política de monitoramento e avaliação da atenção básica no Brasil de 2003 a 2006: contextualizando sua implantação e efeitos

OBJETIVOS: este artigo apresenta um estudo da Implantacao da Politica de Monitoramento e Avaliacao da Atencao Basica no Brasil. Estima o grau de implantacao dos dispositivos institucionais e da Intervencao, alem de avaliar a sua influencia nos efeitos produzidos a partir da interacao com o contexto politico-organizacional. METODOS: pesquisa avaliativa do tipo analise de implantacao. Estudo de caso com niveis de analise imbricados e triangulacao de metodos. Para estimar o grau de implantacao consideraram-se os dispositivos institucionais produzidos, representativos dos componentes do modelo logico da intervencao. Foram realizadas 20 entrevistas e analisados 29 documentos relacionados. RESULTADOS: a intervencao foi classificada como implantada em um grau Avancado, com 78% das acoes realizadas. O contexto politico-institucional foi caracterizado pela conjuncao de decisao politico-institucional, recursos financeiros, mecanismos tecnicos e estrategias organizacionais de qualificacao dos recursos humanos para avaliacao com vistas a construcao da capacidade institucional. Foi encontrado conjunto significante de efeitos nao-intencionais como decorrencia da pluralidade de dispositivos utilizados para a implantacao da intervencao. CONCLUSOES: A politica revela um franco esforco objetivando a integracao das acoes no âmbito institucional e a descentralizacao das acoes de avaliacao. Neste sentido, duas caracteristicas sao marcantes: o desenvolvimento de capacidade tecnica, por meio de processos avaliativos formativos, e o foco no fortalecimento das Secretarias Estaduais de Saude.

Contribuindo com a institucionalização da avaliação em saúde: uma proposta de auto-avaliação

In the context of measures to institutionalize the evaluation of primary health care in Brazil, the Ministry of Health proposed a formative and normative evaluation of the implementation of the project entitled Technical Capacity-Building of State Health Departments for Monitoring and Evaluation, as part of the National Policy for the Evaluation of Primary Care. One of the objectives was to develop a self-evaluation model using the rapid evaluation method (REM). This article presents the stages concluded to date in the self-evaluation model, together with the theoretical references. The final self-evaluation proposal was based on a theoretical evaluation model developed for formative evaluation and included the principal actions proposed for State health management, with all the tested indicators, thus increasing the internal validity and consistency. The final perspective is that this instrument, used with a participatory approach as provided in the proposal, helps assess the extent to which the projects objectives and actions are achieved, while identifying situations that can interfere in different contexts.

Evaluation model for tuberculosis control program

The implementation process is one of the steps of policy cycle, corresponding to the execution of activities which the purpose is to achieve previously defined targets. It could also be considered that policys formulation and implementation means a process, subject to context and intervening actions. The building of theoretical models allows the evaluation of policies and programs to go beyond the dichotomist view of input x results and enables to understand the reasons of successful actions in different contexts and population groups. The evaluation process becomes an instrument to continuous reformulation of public policies and possibly leads to their reversal or substitution. An evaluation study based on programs theory shows the mechanisms which lead to changes. A self-evaluation model is proposed as a way to assist the manager in the identification of problems, the characterization of favorable factors to successful interventions and the measurement of effects. The present proposal was based upon three evaluation studies on actions for tuberculosis control which used of different methods and multiple sources of evidence. Main results observed were: lack of technical and managerial autonomy, shortage of both human and financial resources and also a deficient link among the programs ability to achieve the development of actions control.

Acesso a hospitais regionais de urgência e emergência: abordagem aos usuários para avaliação do itinerário e dos obstáculos aos serviços de saúde

A perspectiva do usuario e imprescindivel para o aprimoramento das politicas de saude direcionadas a garantia dos principios constitucionais da universalidade e integralidade. Este estudo descritivo-transversal teve como objetivo avaliar o acesso ao servico de urgencia e emergencia em hospitais regionais de Pernambuco, com base no itinerario e nos obstaculos dos usuarios ate a assistencia no referido setor. Selecionou-se uma amostra estratificada e aleatoria, realizando-se 853 entrevistas semiestruturadas com usuarios de sete hospitais distribuidos nas mesorregioes Zona da Mata, Agreste e Sertao. Dentre os entrevistados, 74,9% sao residentes do municipio em que o hospital esta localizado e 66,9% reconheceram-se cadastrados em Equipes de Saude da Familia. A maioria dos usuarios recorreu ao hospital como primeira unidade assistencial (77,1%), destacando a confianca no atendimento do servico como principal motivo para a selecao do setor de urgencia e emergencia. Em relacao ao itinerario, os entrevistados predominantemente (99,5%) buscaram apenas um atendimento previo, tendo-se submetido a consulta medica (75,4%). Entretanto, 42,8% foram referenciados e, destes, a maioria (78,9%) foi encaminhada ao hospital avaliado. Dentre aqueles que demandaram assistencia previa, a ausencia de profissional (65,5%) foi a principal razao para o nao atendimento, destacando-se a deficiencia na resolutividade e a distância entre a residencia e o hospital como importantes obstaculos ao itinerario. Os resultados revelam um cenario em que o hospital permanece como eixo central da assistencia a saude, indicando a necessidade de fortalecimento da rede de saude integral, com vistas a reducao das iniquidades sociais em âmbito locorregional.

Monitoramento do desempenho da gestão da vigilância em saúde: instrumento e estratégias de uso

Propoe-se um instrumento para monitorar o desempenho da Vigilância em Saude no âmbito estadual e estrategias para ampliar seu uso. Advoga-se o emprego de metodologias participativas em todas as etapas do monitoramento, desde a elaboracao do instrumento ate a analise e interpretacao dos indicadores, como forma de envolver os interessados e (co)responsabiliza-los nas decisoes tomadas, aumentando sua utilizacao. O instrumento de monitoramento foi construido apos o delineamento do modelo logico da gestao da vigilância em saude e os indicadores representativos de cada componente da gestao passaram por processo de validacao. Alem de subsidiar a tomada de decisao, o monitoramento e entendido enquanto pratica reflexiva capaz de promover o aprendizado pessoal e institucional, melhoria continua dos processos de gestao, maior transparencia e responsabilizacao.This work is a survey of information gathered from waste pickers in the south, southeast and northeast of Brazil in order to provide input for the development of a waste collection vehicle and a support system to define waste collection routes. Thus, the research sought to establish the profile of waste pickers, diagnose their working conditions and identify the physical and operational structure of the organizations to which they are linked. To achieve these objectives it was necessary to apply questionnaires to waste pickers from organizations who performed the collection of recyclable materials using human- and animal-drawn vehicles and the waste picking organizations themselves. These results were subsequently used for the development of the proposed technologies. It can be concluded that the profession of waste picker still suffers from numerous forms of deprivation, resulting in marginalization, prejudice and exclusion of individuals who make their livings from it. It is therefore indispensable to promote activities that contribute to the full productive inclusion of waste pickers.

Análise da implantação de um programa com vistas à institucionalização da avaliação em uma Secretaria Estadual de Saúde

Objectives: to evaluate the implementation of the Strengthening of Technical Capacity in Monitoring and Evaluation Project at a State Department of Health and thereby assessing the degree to which the program has been introduced and the influence of the political and institutional context. Methods: an evaluative implementation analysis study was carried out using the theoretical concepts proposed by Denis & Champagne (1997) and Matus (1987; 1996). These concepts form the basis of the analysis and allow for dialogue between theories of evaluation and planning. Results: 80% of the project was found to have been implemented, 91% in the field of technical financial management, 95% in information and communications, and only 56% in the field of integration. Conclusions: implementation of the program was found to be satisfactory, thereby corroborating the Government Project and the Government Capacity. Although a certain degree of governability had been achieved, limitations were identified regarding insufficient integration of sectors, difficulties in relation to the department in the capital city and electoral changes, which explain the partial implementation of the Integration component of Monitoring and Evaluation.