Indicadores de desempenho da Atenção Primária à Saúde nos municípios do estado de São Paulo: clusters homogêneos e contratualização intermediada por Organizações Sociais
Data
2021
Autores
Pinheiro Junior, Raimundo Valdemy Borges [UNIFESP]
Orientadores
Wagner, Gabriela Arantes [UNIFESP]
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Objetivo: Analisar o desempenho da Atenção Primária à Saúde, segundo clusters de municípios paulistas que apresentaram indicadores convergentes (Artigo 1) e agrupamentos sob maior influência da contratualização profissional intermediada por Organizações Sociais (Artigo 2). Métodos: Trata-se de estudo descritivo, a partir da análise mista de dados secundários obtidos de fontes oficiais do Sistema Único de Saúde, em termos da situação sanitária, socioeconômica, estrutural e organizacional do sistema municipal de saúde em 2018. Foi elaborada uma matriz de análise, com a proposição de indicadores de desempenho (acesso, efetividade, adequação e eficiência) e contexto (população, determinantes de saúde e financiamento), selecionados, organizados e distribuídos em dimensões e subdimensões. Para caracterizar os grupos de municípios convergentes, utilizou-se a Análise de Cluster. Para determinar a maior influência da contratualização profissional intermediada por Organizações Sociais, foram utilizadas as informações contidas no Cadastro Nacional de Estabelecimentos de Saúde; em análise comparativa à maior influência da gestão municipal, foram realizados testes t-student. Resultados: Foi observado maior acesso em municípios menores; municípios maiores, com menor acesso, apresentaram maior concentração de população em situação de vulnerabilidade, menor investimento em saúde e maior cobertura de planos privados de saúde. Nesse cenário, os indicadores revelaram um desempenho global insatisfatório, com prioridade para o debate em torno da saúde materno-infantil e das condições crônicas de saúde de adultos e idosos. Entre todos os clusters, o cluster 2 se destacou por apresentar maior cobertura e inconsistências na efetividade e adequação das ações e serviços. Quanto à influência das Organizações Sociais, houve menor acesso nos municípios que apresentaram maior número de profissionais intermediados e os indicadores de desempenho, em geral, não traduziram mudanças significativas, ao determinar maior ou menor influência; entretanto, o agrupamento sob maior função gerencial municipal indicou maior presença de mães adolescentes e partos cesáreos. Conclusões: O desempenho não apresentou variações importantes, quando determinada a influência do modelo de gestão exercido pelos municípios. O contexto, por outro lado, evidenciou a persistente desigualdade no acesso, com a situação de saúde diretamente contextualizada pelas condições estruturais dos municípios, o que permitiu apontar para cenários que demandam maiores iniciativas de gestão pública. Reforça-se a importância de acelerar a expansão da Estratégia Saúde da Família para alcançar melhorias na saúde da população, especialmente nos maiores centros; porém, a inadequação observada em realidades de maior cobertura exige intervenções para reorientar os serviços quando associados à vulnerabilidade programática. Diante das contradições nos propósitos da qualidade, com vistas à privatização do trabalho multiprofissional em saúde, o esforço será no sentido de investir na adequação do modelo democrático, no acesso aos avanços técnico-científicos e na elaboração de uma política que viabilize a continuidade da gestão, do trabalho e cuidado em saúde, com foco na família e na comunidade e na garantia de seguridade social e cidadania.
Objective: To analyze the performance of Primary Health Care, according to clusters of municipalities in São Paulo that presented converging indicators (Article 1) and groups under greater influence of professional contracting mediated by Social Organizations (Article 2). Methods: This a descriptive study, based on secondary quantitative data obtained from official sources of the Unified Health System, regarding the sanitary, socioeconomic and structural situation of the health system in 2018. An analysis matrix was elaborated, with the proposition of performance indicators (access, effectiveness, adequacy and efficiency) and context (population, health determinants and financing), selected, organized and distributed in dimensions and sub-dimensions. To characterize the groups of converging municipalities, Cluster Analysis was used. To determine the greatest influence of professional hiring mediated by Social Organizations, the information contained in the National Registry of Health Establishments was used; in a comparative analysis to the greater influence of the municipality, t-student tests were performed. Results: Greater access was observed in smaller municipalities; larger municipalities, with less access, had a greater concentration of vulnerable populations, less investment in health and greater coverage of private health plans. In this scenario, the indicators revealed an unsatisfactory overall performance, with priority being given to the debate around maternal and child health and the chronic health conditions of adults and the elderly. Among all the clusters, cluster 2 stood out, as it presented greater coverage and inconsistencies in the effectiveness and adequacy of actions and services. As for the greater influence of Social Organizations, there was less access in municipalities that had a greater number of mediated professionals and the performance indicators, in general, did not translate significant changes, when determining greater or lesser influence; however, the grouping under greater municipal managerial function indicated a greater presence of adolescent mothers and cesarean sections. Conclusions: The performance did not show important variations regarding the influence of the management model exercised by the municipalities. The context, on the other hand, evidenced the persistent inequality in access, with the health situation directly contextualized by the structural conditions of the municipalities, which made it possible to point out scenarios that demand greater public management initiatives. It reinforces the importance of accelerating the expansion of the Family Health Strategy to achieve improvements in the health of the population, especially in the largest centers; however, the inadequacy observed in realities of greater coverage requires interventions to reorient services when associated with programmatic vulnerability. Faced with the contradictions in the purposes of quality, with a view to the privatization of multidisciplinary work in health, the effort will be to invest in the adequacy of the democratic model, in access to technical-scientific advances and in the elaboration of a policy that enables the continuity of management, work and health care, with a focus on the family and community and in the sense of social security and citizenship.
Objective: To analyze the performance of Primary Health Care, according to clusters of municipalities in São Paulo that presented converging indicators (Article 1) and groups under greater influence of professional contracting mediated by Social Organizations (Article 2). Methods: This a descriptive study, based on secondary quantitative data obtained from official sources of the Unified Health System, regarding the sanitary, socioeconomic and structural situation of the health system in 2018. An analysis matrix was elaborated, with the proposition of performance indicators (access, effectiveness, adequacy and efficiency) and context (population, health determinants and financing), selected, organized and distributed in dimensions and sub-dimensions. To characterize the groups of converging municipalities, Cluster Analysis was used. To determine the greatest influence of professional hiring mediated by Social Organizations, the information contained in the National Registry of Health Establishments was used; in a comparative analysis to the greater influence of the municipality, t-student tests were performed. Results: Greater access was observed in smaller municipalities; larger municipalities, with less access, had a greater concentration of vulnerable populations, less investment in health and greater coverage of private health plans. In this scenario, the indicators revealed an unsatisfactory overall performance, with priority being given to the debate around maternal and child health and the chronic health conditions of adults and the elderly. Among all the clusters, cluster 2 stood out, as it presented greater coverage and inconsistencies in the effectiveness and adequacy of actions and services. As for the greater influence of Social Organizations, there was less access in municipalities that had a greater number of mediated professionals and the performance indicators, in general, did not translate significant changes, when determining greater or lesser influence; however, the grouping under greater municipal managerial function indicated a greater presence of adolescent mothers and cesarean sections. Conclusions: The performance did not show important variations regarding the influence of the management model exercised by the municipalities. The context, on the other hand, evidenced the persistent inequality in access, with the health situation directly contextualized by the structural conditions of the municipalities, which made it possible to point out scenarios that demand greater public management initiatives. It reinforces the importance of accelerating the expansion of the Family Health Strategy to achieve improvements in the health of the population, especially in the largest centers; however, the inadequacy observed in realities of greater coverage requires interventions to reorient services when associated with programmatic vulnerability. Faced with the contradictions in the purposes of quality, with a view to the privatization of multidisciplinary work in health, the effort will be to invest in the adequacy of the democratic model, in access to technical-scientific advances and in the elaboration of a policy that enables the continuity of management, work and health care, with a focus on the family and community and in the sense of social security and citizenship.
Descrição
Citação
PINHEIRO JUNIOR, R V B. Indicadores de desempenho da Atenção Primária à Saúde nos municípios do estado de São Paulo: clusters homogêneos e contratualização intermediada por Organizações Sociais. São Paulo, 136 f. Dissertação (Mestrado em Saúde Coletiva) - Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, 2021.