Luiza Helena de Oliveira Cazola

A incorporação da avaliação da atenção básica no nível estadual do Sistema Único de Saúde através de processos participativos de ensino-aprendizagem-trabalho

OBJETIVOS: desenvolver uma metodologia de intervencao e aplica-la as equipes das Secretarias Estaduais de Saude (SES) objetivando incorporar a pratica de monitoramento e avaliacao da atencao basica atraves de processo de capacitacao e realizacao de atividade real de planejamento e programacao em saude. METODOS: foi desenvolvido um processo de ensino-aprendizagem-trabalho que incorporou ao processo de capacitacao uma atividade de planejamento em saude. A qualidade dos dois processos e assegurada atraves do estabelecimento de principios e criterios para a organizacao da capacitacao, para a elaboracao da proposta metodologica de monitoramento e avaliacao e para a conducao didatico-pedagogica do curso. RESULTADOS: a metodologia foi aplicada nos Estados de Mato Grosso do Sul (MS), Tocantins (TO) e Amazonas (AM), respeitando as particularidades locais em termos de organizacao da SES e da qualificacao e capacidade dos tecnicos responsaveis pela atencao basica. Foram produzidas propostas metodologicas estruturalmente semelhantes, mas diferentes nas suas prioridades e propostas de desenvolvimento. Dois anos apos o termino da intervencao, efeitos desse trabalho ainda estao sendo identificados. CONCLUSOES: os resultados obtidos em MS, TO e AM revelam a capacidade que a abordagem baseada na triade ensino-aprendizagem-trabalho possui para a institucionalizacao de novas praticas de trabalho nos servicos de saude.

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.

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.

Assessment of Chronic Illness Care (ACIC): avaliação da aplicabilidade e resultados

Estudo descritivo de abordagem quanti-qualitativa, cujo objetivo foi avaliar a aplicacao do Assessment of Chronic Illness Care (ACIC) e seus resultados junto aos profissionais de equipes da Estrategia Saude da Familia, em Campo Grande (MS). A amostra constituiu-se de 30 profissionais em 5 equipes, e a coleta de dados foi realizada em maio e junho de 2014, por meio do instrumento ACIC. A media das equipes resultou em capacidade razoavel para atencao as condicoes cronicas, sendo o sistema de informacao clinica a principal fragilidade e o desenho do sistema de prestacao de servicos de saude, o maior potencial.

Processo regulatório da Estratégia Saúde da Família para a assistência especializada

It was aimed to know the regulatory process of the Family Health Strategy for specialized care in Campo Grande, Mato Grosso do Sul. Descriptive study, with 53 physicians, whose data collection used a structured and self-administered questionnaire. The professionals (50.9%) considered that the regulation contributes to the coordination of the care, that the return of the referrals is due to the lack of clarity of the test results (57.1%) and that the main measure to improve the access to the specialized care would be the increase of positions. A greater communication among the professionals involved in the regulatory process should be encouraged, in order to provide the full exercise of their functions.

Maternal mortality according to race/skin color in Mato Grosso do Sul, Brazil, from 2010 to 2015

Objectives: to investigate the epidemiological profile, by race/skin color, of maternal deaths in the state of Mato Grosso do Sul, Brazil. Methods: the present epidemiological study of maternal death distribution by race/skin color was based on data extracted from Brazilian mortality and livebirth information systems from 2010 to 2015. The maternal mortality ratio and the specific maternal mortality ratio were calculated and analyzed according to obstetric variables. Results: the death risk for black (RR = 4.3, CI95%= 2.08-8.71) and indigenous women (RR = 3.7, CI95% 2.2-6.23) was approximately fourfold in comparison to the risk for white women. For direct causes of death, the state of Mato Grosso do Sul showed higher levels, 74.1%, as well as for most races/skin colors in the first triennium. The specific maternal mortality ratio was higher among black and indigenous women aged30 to 39 years old (416.7 and 651.8, respectively) per 100,000 live births (p<0.05). Conclusions: higher maternal mortality ratio for indigenous and black women and the predominance of deaths related to direct obstetric causes among race/skin color categories reflect inadequate health care during pregnancy and puerperium.

The incorporation of activities to control dengue by community health agents

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.

Incorporación en actividades de control del dengue por el agente comunitario de salud

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.

La incorporación del control de la dengue por agentes comunitarios de salud

The purpose of this study was to identify self-perceived differences in the work processes of community health agents (CHA) in two counties of Mato Grosso do Sul, regarding dengue control and Family Health Strategy (FHS) activities. Structured interviews were applied to 57 CHA. The subjects had similar sociodemographic characteristics. Agents in Rio Verde de Mato Grosso county, who performed only FHS tasks, failed to complete essential data of the Form A. In São Gabriel do Oeste county, CHA currently perform tasks pertaining to dengue fever control, previously conducted by Endemic Disease Control Agents (now abolished), while in Rio Verde de Mato Grosso county, dengue control remained assigned to the latter group. In São Gabriel do Oeste county, CHA did not view the double workload of two programs as affecting their professional productivity. The pooling of tasks from the two programs proved to be feasible, with no detrimental effects on performance.O estudo objetivou caracterizar as diferencas no processo de trabalho de agentes comunitarios de saude (ACS) em dois municipios sul-mato-grossenses, segundo sua percepcao, frente as atividades desenvolvidas no controle da dengue e na saude da familia. Aplicaram-se entrevistas estruturadas a 57 ACS. Constatou-se que os ACS apresentavam caracteristicas sociodemograficas semelhantes. Os de Rio Verde de Mato Grosso, que executavam apenas acoes da saude da familia, nao priorizaram o preenchimento da Ficha A. Em Sao Gabriel do Oeste, os ACS incorporaram as atividades do controle da dengue, extinguindo-se o Agente de Controle de Endemias, enquanto em Rio Verde de Mato Grosso ambos se mantiveram. Na percepcao dos ACS de Sao Gabriel do Oeste, a acumulacao dos dois programas nao influiu em sua produtividade. A unificacao das acoes dos dois programas em um mesmo profissional se mostrou viavel, sem prejuizos as atividades desenvolvidas.