Sandra Aparecida Venâncio de Siqueira

Children health care evaluation (0-5 years) according to users' perceptions in the Family Health Strategy of Teresópolis, Rio de Janeiro State

O PSF representa um dos principais programas publicos em saude no Brasil, cobrindo em 2006 um total de 5.601 municipios (91,8%). O estudo avaliou o PSF do municipio de Teresopolis (RJ) por meio da percepcao e das informacoes prestadas pelos responsaveis por criancas na faixa de 0-5 anos e que utilizam estes servicos, por meio de questionarios aplicados aos responsaveis nos proprios modulos de atendimento ou em visitas domiciliares. Resultados foram comparados entre areas urbanas e rurais e diferencas significativas foram observadas para determinados itens e elevado vinculo da clientela ao programa e uma percepcao predominantemente positiva sobre o estado de saude das criancas. O acesso se mostrou adequado segundo os criterios utilizados quando se refere ao atendimento de rotina. Os pontos criticos observados incluem baixa cobertura de visitas domiciliares, dificuldades na realizacao de exames solicitados e no fornecimento regular de medicamentos. As areas rurais apresentaram um numero elevado de criancas que trataram condicoes agudas em casa sem assistencia medica. A satisfacao manifestada pelos usuarios quanto aos medicos, aos agentes de saude, aos profissionais de enfermagem e ao conjunto dos servicos foi elevada. A clientela nao visitada por agentes de saude apresentou menor acesso a distribuicao de medicamentos.

Reforma psiquiátrica, federalismo e descentralização da saúde pública no Brasil

O trabalho analisa as relacoes entre a reforma psiquiatrica brasileira, a adocao dos Centros de Atencao Psicossocial (CAPS) e o desenvolvimento do Sistema Unico de Saude (SUS) por meio do pacto federativo. A aderencia dos governos municipais foi uma variavel condicionante da disseminacao da reforma, especialmente em funcao da dimensao continental e da fragmentacao federativa do pais. O trabalho demonstra uma trajetoria de consistente estabilidade institucional da reforma psiquiatrica no Brasil ao longo de duas decadas. A institucionalidade do processo decisorio no espaco publico brasileiro ofereceu a agenda da reforma condicoes de implantacao nos Municipios dos novos formatos organizacionais por meio da imitacao, dos incentivos financeiros e pela bem sucedida defesa das vantagens sobre o modelo hospitalar e asilar dominante nas decadas passadas. As intervencoes indutivas, reforcadas e acolhidas pela Lei 10.216/2001, transformaram a agenda da reforma psiquiatrica, limitada a cidades pioneiras, em uma politica publica nacional.

Satisfação e responsividade em serviços de atenção à saúde da Fundação Oswaldo Cruz

The paper discusses the results of research into user satisfaction in three healthcare facilities at Oswaldo Cruz Foundation in Rio de Janeiro. The analysis is based on the concepts of user satisfaction and responsiveness. Perceptions and opinions of outpatients from Instituto de Pesquisa Evandro Chagas, Instituto Fernandes Figueira and Centro de Saude Escola Germano Sinval Faria were investigated. Intention samples were drawn for each institution and a total of 1.339 valid questionnaires were obtained. The study found that patients are satisfied with healthcare at Fiocruz, especially with health professionals. Nevertheless, restroom hygiene and privacy during consultations were less well evaluated. The improvement of these aspects depends not only on financial and technological investments but on changes in organizational culture. The first part of the paper discusses the literature on user satisfaction and responsiveness, with the definition of the categories that guided the study. The methodology is then presented as well as the four health services dimensions assessed - dignity, agility, facilities and communication - and the results are analyzed.

Modelo alternativo para o controle da esquistossomose: estado atual do projeto no Estado do Espírito Santo, Brasil

An intervention study for schistosomiasis control is being carried out in the county of Afonso Cláudio, state of Espírito Santo, Brazil, having begun in February 1992. This study is an alternative response to classical control methods. The project is being developed using an interdisciplinary approach and involves both research and service institutions. The organization of health services at the primary care level is part of the project. Participant observation is seen as the methodological point of departure for guiding data collection and analysis and the intervention process in local reality. Control methods are restricted to the medical treatment given to all infected individuals and to improvements in the sanitation facilities available in the area. These methods are obviously integrated with the above-mentioned social actions. Consisting of three phases - pre-control, control (intervention), and final evaluation - the project is now in its intervention phase, lasting approximately three years.

Políticas de Promoção de Equidade em Saúde para grupos vulneráveis: o papel do Ministério da Saúde

This article aims to analyze Equity Promotion Policies in Health implemented by the Ministry of Health for vulnerable groups, through the Department of Strategy and Participative Management based on race, ethnicity, gender and lifestyle markers. The three structural elements of these policies are identified as: participatory management, transversality and awareness / professional qualifications. In carrying out research for this article, different documental sources were used including: policies, videos, conferences and minutes from council meetings as well as information from health committees. The results showed positive aspects and shortcomings in the implementation process of these policies. Also, they revealed that there are permanent tensions between equality policies and equity policies which pose challenges to guaranteeing the right to health of these populations. Finally, it can be reaffirmed that only in democratic societies can these rights be recognized and guaranteed.