Vera Lúcia Almeida Formigli

Avaliação em saúde: limites e perspectivas

This is a literature review of theoretical and methodological issues on health care evaluation of research and technical reports. Conceptual frameworks, approaches, subject matter, strategies, and study designs are identified and analyzed. Evaluative research designs are compared with epidemiological ones. A diverse terminology was encountered, and many methodological problems in the literature were examined. The incorporation of evaluative procedures in health planning or health policy-making and administration is still limited in Brazil, particularly at the local level. Recent implementation of projects for the reorganization of the health services system based on the administrative autonomy of Local Health Units raises the need for more appropriate strategies aimed at health care evaluation. Perspectives for the development of alternative strategies are indicated.

Avaliação de um serviço de atenção integral à saúde do adolescente

The authors evaluate the Adolescent Health Clinic in the Emaus community in Belem, Para, Brazil with regard to coverage, adequacy, accessibility, and utilization for the period 1994 to 1996. Coverage was calculated on the basis of clinical records and information collected from the target population. Adequacy was analyzed by comparing the service performance with goals established by PAHO/WHO for this kind of institution. Accessibility and utilization patterns were evaluated from information obtained by a population-based survey among adolescents living in the area. Results showed: a good degree of program adequacy vis-a-vis the final purpose, although some adjustments are needed, especially in human resources; lack of barriers to user access; reasonable coverage, despite the low proportion of consultations by adolescents; and utilization pattern compatible with the service provision profile, mainly directed towards curative and individual care. Recommendations are made to revise the hegemonic health care model to emphasize preventive, collective, and educational activities.

Avaliação da atenção à saúde através da investigação de óbitos infantis

All deaths of children under one year of age and residing in the Pau da Lima Health District, in the city of Salvador, Bahia, Brazil, during the year 1991 were investigated through home visits and analysis of patient files. The study measured effectiveness of health services by verifying potentially avoidable deaths and the level of medical care these children received. More than half of the total of 47 deaths were related to causes considered amenable to prompt action by health services; 10 (21.3%) of the deaths occurred at home or in public (outside of health care facilities). Loss of information occurred in 36 (76.6%) of the mothers interviews, related to incomplete information on the death certificate and to changes of address. Analysis of patient files in the health clinics showed a 58.3% loss of information, indicating low-quality organization of hospital statistics; there was a prevalence of consultations classified as inadequate or barely adequate, due mainly to problems with physical examination and treatment. Despite this studys operational limitations, the results point to problems of access, effectiveness, and adequacy in the health care process.

Avaliação da qualidade de serviço de saúde para adolescentes

OBJETIVO: Avaliar a qualidade tecnico-cientifica do atendimento oferecido a adolescentes, gestantes adolescentes e seus filhos, por um servico de saude. METODOS: Os dados para caracterizacao da clientela e dos criterios do atendimento de saude foram coletados de 360 prontuarios e comparados com padroes da Organizacao Panamericana da Saude/Organizacao Mundial da Saude e do Ministerio da Saude. RESULTADOS: Os resultados foram satisfatorios: no atendimento de adolescentes, na avaliacao antropometrica e de maturacao sexual; no pre-natal, o intervalo entre consultas, os registros de peso e de pressao arterial e as condutas nas intercorrencias; no atendimento a criancas: na insercao precoce no servico, o calendario vacinal atualizado, os registros de peso/desenvolvimento motor e a adequacao nas condutas clinicas. Os resultados menos satisfatorios foram: baixo registro de condutas clinicas para adolescentes e elevado percentual de condutas inadequadas ou parcialmente adequadas; ingresso tardio ao pre-natal e baixa frequencia de registros de imunizacao antitetânica de gestantes; indices elevados de desmame precoce e sub-registro da estatura de criancas. CONCLUSAO: O tipo de avaliacao adotado e de facil execucao, permite avaliar a qualidade do atendimento prestado e possibilita o redirecionamento de atividades e condutas clinicas, no sentido de oferecer uma atencao a saude mais qualificada e voltada as necessidades e demandas da populacao.

Coberturas vacinais superestimadas? Novas evidências a partir do inquérito de Pau da Lima

To evaluate vaccination coverage in children 0 to 5 years of age, a cross-sectional study based on a household survey was carried out in 1992 in the Pau de Lima Health District, Salvador, Bahia, Brazil, using a cluster sampling technique. The district was subdivided into 30 small areas that were homogeneous with respect to socioeconomic characteristics. Information on the vaccination status of 385 children was obtained through verification of a vaccination card or campaign voucher, or, in the absence of these items, through verbal confirmation from the mother or other responsible person. Based on all the sources of information, the study found vaccination coverage rates in the entire age range of 69% for polio vaccine; 56% for DTP; 74% for measles vaccine; and 87% for BCG. These results suggest that rates obtained from routine records of the health services and vaccination campaigns may be overestimates. The authors discuss the implications of the low coverage rates found in the entire age group and especially among children under 1 year old.

O contexto político-administrativo da implantação de Distritos Sanitários no Estado da Bahia, Brasil

This investigation was conducted in order to determine the political and administrative context prevailing during the implementation of health districts in the state of Bahia, Brazil. The documentary review includes laws, agreements, and contracts at the State and Federal levels from 1987 to 1989. This period corresponded to the first phase of the State government after the 1986 elections. Information was also obtained from key informants and former directors of the State Secretariat of Health at the central level. We describe how the policy for regionalization by territory and population was formulated, and we review both State and national planning procedures, identifying the events leading to the decision to create health districts. We list the political instruments related to this decision and analyze the positions of the various actors in the Brazilian Health System in relation to this strategic choice. Brief comments are given about the difficulties faced by this proposal during the period studied.