Vanira Matos Pessoa

Implementation research : towards universal health coverage with more doctors in Brazil

Abstract Objective To evaluate the implementation of a programme to provide primary care physicians for remote and deprived populations in Brazil. Methods The Mais Médicos (More Doctors) programme was launched in July 2013 with public calls to recruit physicians for priority areas. Other strategies were to increase primary care infrastructure investments and to provide more places at medical schools. We conducted a quasi-experimental, before-and-after evaluation of the implementation of the programme in 1708 municipalities with populations living in extreme poverty and in remote border areas. We compared physician density, primary care coverage and avoidable hospitalizations in municipalities enrolled (n = 1450) and not enrolled (n = 258) in the programme. Data extracted from health information systems and Ministry of Health publications were analysed. Findings By September 2015, 4917 physicians had been added to the 16 524 physicians already in place in municipalities with remote and deprived populations. The number of municipalities with ≥ 1.0 physician per 1000 inhabitants doubled from 163 in 2013 to 348 in 2015. Primary care coverage in enrolled municipalities (based on 3000 inhabitants per primary care team) increased from 77.9% in 2012 to 86.3% in 2015. Avoidable hospitalizations in enrolled municipalities decreased from 44.9% in 2012 to 41.2% in 2015, but remained unchanged in control municipalities. We also documented higher infrastructure investments in enrolled municipalities and an increase in the number of medical school places over the study period. Conclusion Other countries having shortages of physicians could benefit from the lessons of Brazil’s programme towards achieving universal right to health.

Pesquisa-ação: proposição metodológica para o planejamento das ações nos serviços de atenção primária no contexto da saúde ambiental e da saúde do trabalhador

O Sistema Unico de Saude no Brasil propoe a operacionalizacao de acoes de saude ambiental e do trabalhador, com vistas a abordar a complexidade do processo saude-doenca nos territorios. Objetiva-se apresentar a pesquisa-acao como um percurso metodologico, facilitador da analise das complexas tramas do desenvolvimento economico e as implicacoes no trabalho, ambiente e saude, em comunidades do Nordeste brasileiro. A pesquisa-acao foi concebida com um grupo de 14 sujeitos e foi conduzida no formato de oficinas. Na feitura da pesquisa fluiram vinculos e elaboracao de proposicoes, a partir da reflexao-teorizacao-acao dos sujeitos. Destaca-se que o metodo apresenta um potencial para desnudar problemas complexos relacionados a saude ambiental e do trabalhador, pois favorece a interacao humana integrada ao lugar em que vive.

Implicações do desenvolvimento econômico no trabalho, ambiente e saúde em comunidades portuárias no Ceará, Brasil

This paper discusses aspects of economic development and the implications on work, the environment and health in the surrounding communities of the Industrial and Harbor Complex in Pecem in the State of Ceara. Qualitative research was adopted as the methodological strategy, by conducting participatory research with document analysis and a focus group. The reports of the subjects involved in the fieldwork were analyzed as being representative of their perceptions regarding the changes occurring in the territory and the impacts on health. Results observed in the use and appropriation of land by entrepreneurs are based on a belief in progress and development, contradicting the way of living, producing and interacting with nature submitted by the community that seeks to resist this intervention supported by social movements. These changes are out of step with the development of other public policies to mitigate the impacts with regard to environmental protection of the territory and the promotion of the health of this population.

A implementação do Programa Mais Médicos e a integralidade nas práticas da Estratégia Saúde da Família.

The Mais Medicos (More Doctors) Program is a Brazilian government program that aims to expand access to medical care and thus improve the quality of primary healthcare delivery. This study aims to analyze the perceptions of nondoctor members of the Family Health Strategy teams regarding comprehensiveness of care after the inclusion of doctors from the program. The study encompassed 32 poor municipalities in Brazils five geographical regions. A total of 78 health workers were interviewed. The interviews were transcribed and analyzed using content analysis and the software Atlas.ti Version 1.0.36. The study found that the program led to: an increase in access to and accessibility of services provided under the Family Health Strategy; humanized care and the establishment of bonds - understanding, partnership, friendship and respect; going back to clinical approaches - dedicated time, listening attentively, and detailed physical examination; the desire and willingness to resolve problems; continuity of care; guarenteeing home visits; and coordination of multidisciplinary teams in networks. It was concluded that the Mais Medicos Program contributed to the enhancement of comprehensiveness, thus leading to improvements in primary health care delivery.The Mais Médicos (More Doctors) Program is a Brazilian government program that aims to expand access to medical care and thus improve the quality of primary healthcare delivery. This study aims to analyze the perceptions of nondoctor members of the Family Health Strategy teams regarding comprehensiveness of care after the inclusion of doctors from the program. The study encompassed 32 poor municipalities in Brazils five geographical regions. A total of 78 health workers were interviewed. The interviews were transcribed and analyzed using content analysis and the software Atlas.ti Version 1.0.36. The study found that the program led to: an increase in access to and accessibility of services provided under the Family Health Strategy; humanized care and the establishment of bonds - understanding, partnership, friendship and respect; going back to clinical approaches - dedicated time, listening attentively, and detailed physical examination; the desire and willingness to resolve problems; continuity of care; guarenteeing home visits; and coordination of multidisciplinary teams in networks. It was concluded that the Mais Médicos Program contributed to the enhancement of comprehensiveness, thus leading to improvements in primary health care delivery.

Percepções de gestores municipais de Saúde sobre o provimento e a atuação dos médicos do Programa Mais Médicos

No Brasil, o desafio da redistribuicao de medicos foi alvo de diversas intervencoes governamentais. Objetivou-se analisar o provimento de medicos do Programa Mais Medicos, segundo as percepcoes de gestores municipais de Saude. Trata-se de um estudo qualitativo realizado com 63 gestores em 32 municipios do Brasil. As entrevistas foram submetidas a analise de conteudo com a ajuda do software ATLAS.ti. Destacam-se as contribuicoes dos medicos do programa na melhoria da Atencao a Saude, nas praticas clinicas humanizadas e diferenciadas e nas mudancas na rede de Atencao a Saude, apos a implementacao do programa. Os gestores reafirmam a importância da implementacao, no que concerne ao provimento e a fixacao de medicos na Atencao Basica, em municipios vulneraveis e de dificil acesso.No Brasil, o desafio da redistribuicao de medicos foi alvo de diversas intervencoes governamentais. Objetivou-se analisar o provimento de medicos do Programa Mais Medicos, segundo as percepcoes de gestores municipais de Saude. Trata-se de um estudo qualitativo realizado com 63 gestores em 32 municipios do Brasil. As entrevistas foram submetidas a analise de conteudo com a ajuda do software ATLAS.ti. Destacam-se as contribuicoes dos medicos do programa na melhoria da Atencao a Saude, nas praticas clinicas humanizadas e diferenciadas e nas mudancas na rede de Atencao a Saude, apos a implementacao do programa. Os gestores reafirmam a importância da implementacao, no que concerne ao provimento e a fixacao de medicos na Atencao Basica, em municipios vulneraveis e de dificil acesso.

Occupational health in primary care: perceptions and practices in family health teams

Thais Lacerda e Silva(a) Elizabeth Costa Dias(b) Vanira Matos Pessoa(c) Luisa da Matta Machado Fernandes(d) Edinalva Maria Gomes(e) (a) Doutoranda em Saude Publica, Escola Nacional de Saude Publica, Fundacao Oswaldo Cruz (Fiocruz). Avenida Trinta e Um de Marco, 1100; apto. 303, Dom Cabral. Belo Horizonte, MG, Brasil. 30535-000. thaislacerda@gmail.com (b) Departamento de Medicina Preventiva e Social, Faculdade de Medicina, Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil. bethdias@ medicina.ufmg.br (c) Fiocruz. Fortaleza, CE, Brasil. vanirapessoa@gmail.com (d) Departamento de Acoes Programaticas Eestrategicas, Secretaria de Atencao a Saude, Ministerio da Saude. Brasilia, DF, Brasil. luisa@mattamachado.org (e) Coordenadoria de Saude do Trabalhador, Secretaria de Estado da Saude do Tocantins. Palmas, TO, Brasil. edinalvagomes25@ gmail.com This study sought to recognize the perceptions of family health teams regarding work-health-illness relationships, and to identify strategies, facilities and difficulties relating to providing workers with healthcare. Focus groups were conducted among primary care professionals in three Brazilian cities: Palmas (TO), Sobral (CE), and Alpinopolis (MG). The Bardin technique for content analysis was used to organize and analyze the data. The results showed that the healthcare actions provided to workers were unsystematic and out of line with the guidelines and objectives of the Brazilian National Occupational Health Policy. The major problems identified were: work overload; unpreparedness among the teams regarding issues involving work-health-illness relationships; and lack of institutional support, among others. Central organizational support for healthcare teams, provided by occupational health reference centers and other parts of the Brazilian National Health System, was identified as a facilitator of actions. Keywords: Occupational health. Unified Health System. Primary health care.O estudo buscou conhecer a percepcao de equipes de Saude da Familia sobre as relacoes trabalho-saude-doenca e identificar estrategias, facilidades e dificuldades para prover o cuidado aos trabalhadores. Foram realizados grupos focais com profissionais de unidades basicas em: Palmas (TO), Sobral (CE) e Alpinopolis (MG). Utilizou-se analise de conteudo de Bardin para sistematizacao e analise dos dados. Os resultados revelam que as acoes de cuidado dos trabalhadores sao pontuais e pouco articuladas com as diretrizes e objetivos da Politica Nacional de Saude do Trabalhador e da Trabalhadora. Entre as dificuldades estao: sobrecarga de trabalho; despreparo das equipes para as questoes que envolvem as relacoes trabalho-saude-doenca; falta de apoio institucional, entre outros. O apoio matricial as equipes de saude pelos Centros de Referencia em Saude do Trabalhador e outras instâncias do SUS foi identificado como facilitador das acoes.

Saúde do trabalhador na Atenção Primária: percepções e práticas de equipes de Saúde da Família

Thais Lacerda e Silva(a) Elizabeth Costa Dias(b) Vanira Matos Pessoa(c) Luisa da Matta Machado Fernandes(d) Edinalva Maria Gomes(e) (a) Doutoranda em Saude Publica, Escola Nacional de Saude Publica, Fundacao Oswaldo Cruz (Fiocruz). Avenida Trinta e Um de Marco, 1100; apto. 303, Dom Cabral. Belo Horizonte, MG, Brasil. 30535-000. thaislacerda@gmail.com (b) Departamento de Medicina Preventiva e Social, Faculdade de Medicina, Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil. bethdias@ medicina.ufmg.br (c) Fiocruz. Fortaleza, CE, Brasil. vanirapessoa@gmail.com (d) Departamento de Acoes Programaticas Eestrategicas, Secretaria de Atencao a Saude, Ministerio da Saude. Brasilia, DF, Brasil. luisa@mattamachado.org (e) Coordenadoria de Saude do Trabalhador, Secretaria de Estado da Saude do Tocantins. Palmas, TO, Brasil. edinalvagomes25@ gmail.com This study sought to recognize the perceptions of family health teams regarding work-health-illness relationships, and to identify strategies, facilities and difficulties relating to providing workers with healthcare. Focus groups were conducted among primary care professionals in three Brazilian cities: Palmas (TO), Sobral (CE), and Alpinopolis (MG). The Bardin technique for content analysis was used to organize and analyze the data. The results showed that the healthcare actions provided to workers were unsystematic and out of line with the guidelines and objectives of the Brazilian National Occupational Health Policy. The major problems identified were: work overload; unpreparedness among the teams regarding issues involving work-health-illness relationships; and lack of institutional support, among others. Central organizational support for healthcare teams, provided by occupational health reference centers and other parts of the Brazilian National Health System, was identified as a facilitator of actions. Keywords: Occupational health. Unified Health System. Primary health care.O estudo buscou conhecer a percepcao de equipes de Saude da Familia sobre as relacoes trabalho-saude-doenca e identificar estrategias, facilidades e dificuldades para prover o cuidado aos trabalhadores. Foram realizados grupos focais com profissionais de unidades basicas em: Palmas (TO), Sobral (CE) e Alpinopolis (MG). Utilizou-se analise de conteudo de Bardin para sistematizacao e analise dos dados. Os resultados revelam que as acoes de cuidado dos trabalhadores sao pontuais e pouco articuladas com as diretrizes e objetivos da Politica Nacional de Saude do Trabalhador e da Trabalhadora. Entre as dificuldades estao: sobrecarga de trabalho; despreparo das equipes para as questoes que envolvem as relacoes trabalho-saude-doenca; falta de apoio institucional, entre outros. O apoio matricial as equipes de saude pelos Centros de Referencia em Saude do Trabalhador e outras instâncias do SUS foi identificado como facilitador das acoes.

La salud del trabajador en la atención primaria: percepciones y prácticas de equipos de salud de la familia

Thais Lacerda e Silva(a) Elizabeth Costa Dias(b) Vanira Matos Pessoa(c) Luisa da Matta Machado Fernandes(d) Edinalva Maria Gomes(e) (a) Doutoranda em Saude Publica, Escola Nacional de Saude Publica, Fundacao Oswaldo Cruz (Fiocruz). Avenida Trinta e Um de Marco, 1100; apto. 303, Dom Cabral. Belo Horizonte, MG, Brasil. 30535-000. thaislacerda@gmail.com (b) Departamento de Medicina Preventiva e Social, Faculdade de Medicina, Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil. bethdias@ medicina.ufmg.br (c) Fiocruz. Fortaleza, CE, Brasil. vanirapessoa@gmail.com (d) Departamento de Acoes Programaticas Eestrategicas, Secretaria de Atencao a Saude, Ministerio da Saude. Brasilia, DF, Brasil. luisa@mattamachado.org (e) Coordenadoria de Saude do Trabalhador, Secretaria de Estado da Saude do Tocantins. Palmas, TO, Brasil. edinalvagomes25@ gmail.com This study sought to recognize the perceptions of family health teams regarding work-health-illness relationships, and to identify strategies, facilities and difficulties relating to providing workers with healthcare. Focus groups were conducted among primary care professionals in three Brazilian cities: Palmas (TO), Sobral (CE), and Alpinopolis (MG). The Bardin technique for content analysis was used to organize and analyze the data. The results showed that the healthcare actions provided to workers were unsystematic and out of line with the guidelines and objectives of the Brazilian National Occupational Health Policy. The major problems identified were: work overload; unpreparedness among the teams regarding issues involving work-health-illness relationships; and lack of institutional support, among others. Central organizational support for healthcare teams, provided by occupational health reference centers and other parts of the Brazilian National Health System, was identified as a facilitator of actions. Keywords: Occupational health. Unified Health System. Primary health care.O estudo buscou conhecer a percepcao de equipes de Saude da Familia sobre as relacoes trabalho-saude-doenca e identificar estrategias, facilidades e dificuldades para prover o cuidado aos trabalhadores. Foram realizados grupos focais com profissionais de unidades basicas em: Palmas (TO), Sobral (CE) e Alpinopolis (MG). Utilizou-se analise de conteudo de Bardin para sistematizacao e analise dos dados. Os resultados revelam que as acoes de cuidado dos trabalhadores sao pontuais e pouco articuladas com as diretrizes e objetivos da Politica Nacional de Saude do Trabalhador e da Trabalhadora. Entre as dificuldades estao: sobrecarga de trabalho; despreparo das equipes para as questoes que envolvem as relacoes trabalho-saude-doenca; falta de apoio institucional, entre outros. O apoio matricial as equipes de saude pelos Centros de Referencia em Saude do Trabalhador e outras instâncias do SUS foi identificado como facilitador das acoes.