Municipal Health Managers Research Articles

Structure Of The Single Health System For Diagnosis Of Htlv-1/2 In The Northern Region Of Tocantins

Background: The Human T-cell Lymphotropic Virus (HTLV), the first human retrovirus discovered, is associated with oncogenesis and is subdivided into several groups, with types 1 and 2 being the most prevalent and clinically relevant. Its main forms of transmission include unprotected sexual intercourse, blood transfusions, tissue and organ transplants, as well as vertical transmission (mother to newborn). In Brazil, mandatory testing for HTLV was implemented in the 1990s for blood donations and transplants, and expanded in 2024 by Ordinance No. 3,148 of the Ministry of Health, which includes testing during prenatal care. Objective: This study aimed to evaluate the structure of the Unified Health System (SUS) in the municipalities of the far north of Tocantins for the diagnosis of HTLV-1/2. Methodology: This is a qualitative study, in which semi-structured questionnaires were applied to Primary Care professionals and municipal health managers. Results: The results indicated significant deficiencies in knowledge of national protocols and the absence of a structured municipal flow for testing. Conclusion: It can be concluded that the health structure of the municipalities evaluated is insufficient for the effective diagnosis of HTLV-1/2

Does pay-for-performance design matter? Evidence from Brazil.

Pay-for-performance (P4P) schemes have been shown to have mixed effects on health care outcomes. A challenge in interpreting this evidence is that P4P is often considered a homogenous intervention, when in practice schemes vary widely in their design. Our study contributes to this literature by providing a detailed depiction of incentive design across municipalities within a national P4P scheme in Brazil [Primary Care Access and Quality (PMAQ)] and exploring the association of alternative design typologies with the performance of primary health care providers. We carried out a nation-wide survey of municipal health managers to characterize the scheme design, based on the size of the bonus, the providers incentivized and the frequency of payment. Using OLS regressions and controlling for municipality characteristics, we examined whether each design feature was associated with better family health team (FHT) performance. To capture potential interactions between design features, we used cluster analysis to group municipalities into five design typologies and then examined associations with quality of care. A majority of the municipalities included in our study used some of the PMAQ funds to provide bonuses to FHT workers, while the remaining municipalities spent the funds in the traditional way using input-based budgets. Frequent bonus payments (monthly) and higher size bonus allocations (share of 20-80%) were strongly associated with better team performance, while who within a team was eligible to receive bonuses did not in isolation appear to influence performance. The cluster analysis showed what combinations of design features were associated with better performance. The PMAQ score in the 'large bonus/many workers/high-frequency' cluster was 8.44 points higher than the 'no bonus' cluster, equivalent to a difference of 21.7% in the mean PMAQ score. Evidence from our study shows how design features can potentially influence health provider performance, informing the design of more effective P4P schemes.

State capacity impact on COVID-19 mortality in Brazil.

This study addresses the State's capacity to combat the COVID-19 pandemic and contributes to the literature on crisis management in health care. We analyzed whether the capacity level impacted the State response to COVID-19 in Brazilian healthcare regions in 2020 using a set of statistical analysis techniques and public health impact analysis, including propensity score matching (PSM). Results revealed that a low COVID-19 mortality was associated with participation in municipal health consortia, schooling level of municipal health managers and the resources allocated by the Brazilian National Program for Improvement of Access and Quality of Basic Care (PMAQ). Conversely, the number of intensive care units (ICU) and life-sustaining equipment available were associated with higher mortality, as locations with a larger population concentrated operational capacity to treat the most severe cases. In conclusion, the different levels of State capacity in health regions led to different outcomes in combating the pandemic. This reinforces the importance of discussing State capacity and crisis management, since the COVID-19 confrontation in Brazil related to the level of existing resources concerning health system capacity, bureaucratic capacity and participation in consortia for sharing inputs and ensuring the provision of health services to the population.

Coping strategies for COVID-19 primary care: a mixed method study.

This article aims to analyse the COVID-19 coping strategies adopted by municipal health managers in two regions. A mixed method study of the sequential explanatory type was carried out with municipal health managers and primary care coordinators. The quantitative stage was developed with the application of an instrument to 42 managers to identify coping actions and associations with demographic and epidemiological data of COVID-19 in the municipalities. The results aimed at the definition of 15 participants and the collection of data in the qualitative stage, enabling approximation of the meta inferences of the study. Of the actions implemented, there were immediate actions to monitor cases, organize new care flows and encourage the population to adopt nonpharmacological measures. Regional articulation was the device that allowed for expansion and municipal autonomy for testing, reducing contamination and deaths among citizens. Municipal coping strategies that focused on the surveillance of cases and expansion of testing showed positive outcomes in terms of the number of infections and deaths from COVID-19.

What aspects influence the prioritization of Primary Health Care by municipal managers in Rio Grande do Sul - Brazil?

Primary Health Care (PHC) is capable of achieving broad coverage and effectiveness. This study evaluated the factors associated with the prioritization that municipal health managers in the state of Rio Grande do Sul (RS) give to PHC. A cross-sectional analytical study was carried out between August 2017 and May 2019 using an online FormSUS questionnaire, consisting of 44 questions divided into 4 blocks, sent to 497 municipal health managers. Multiple logistic regression was performed to analyze factors associated with PHC prioritization. Out of 404 participants, 66.8% reported a maximum degree of prioritization. Managers with a postgraduate degree showed greater prioritization than those with elementary education (78.5% vs 58.8%, p<0.01). Regarding the postgraduate area, managers with training in public health prioritized PHC more than in other areas, or with no postgraduate studies, respectively with 84%, 77.1% and 61.8% (p<0.01). After adjusting for covariates, having a postgraduate degree in public health or in another area remained associated with greater chances of prioritization. The results may encourage initiatives that consider the level and area of education for this position focusing on technical, and not strictly political criteria.

Strategies for the improvement of home medical waste management during the COVID-19 pandemic

ABSTRACT Home care services (HCS) are important to assist patients with difficulties in accessing conventional health services. Nevertheless, in times of COVID-19 pandemic, the traditionally offered service needs to be restructured to protect health professionals, patients and their families. In this context, this article aims to identify the impacts resulting from the COVID-19 pandemic on home medical waste management (MWM), converting threats into opportunities, and weaknesses into management strengths. Three months before the pandemic (from October to December), a comprehensive survey was conducted on the practices of home care services and MWM with health professionals, caregivers and patients in Caruaru (Brazil). Quali-quantitative information was collected by structured and semi-structured interviews. For evaluation, the SWOT-TOWS analysis was applied to identify the threats and weaknesses of the practices of HCS and MWM, and to propose strategies to ensure the protection of public health and the environment. The results showed that the main weaknesses found were the lack of training of health professionals and the lack of guidance given by them to caregivers of patients, both related to MWM. Except for sharp waste, all other MWM practices have proved to be inadequate, posing threats, especially in a pandemic period. Four action strategies to improve HCS and MWM were identified: (i) providing MWM training to HCS personnel based on ISO standards; (ii) providing MWM information to caregivers and patients; (iii) planning actions to optimize the service during the pandemic; and (iv) sharing HCS management with municipal decision makers. Between December 2020 and January 2021, semi-structured interviews were performed only with health professionals, to verify the impacts and changes that have occurred in HCS in the COVID-19 pandemic. Comparing the results of the two surveys, improvements were achieved, including the incorporation during the pandemic of some strategies identified in the first phase of the research. Implications: Home care service plays a fundamental role in the quality of life of patients and in the sustainability of the public health system in Brazil. In the pandemic period, HCS was impacted with routine changes and the adoption of new personal protective equipment. Our results showed the need to promote strategies to improve HCS to preserve the health of professionals and patients attended, in the pandemic and post-pandemic period. The strategies identified in the study contributed to improvements in the provision of the service and in the management of medical waste that is still inadequate. Such issues are of interest to municipal health management, which has adopted some of the suggested strategies. The thousands of HCS distributed in Brazilian municipalities can also adopt the strategic actions resulting from this research.

Contributions of the Simplified Competency Management Model to a Municipal Health Secretariat.

Objective: to present the contributions of the Simplified Competency Management Model in a municipal health secretariat. Method: research of integrated mixed methods of exploratory-descriptive type. The model was applied in a southern Brazilian city, in the following stages: documentary, questionnaire, mapping of gaps and educational proposal.Results: in the first stage, after documentary research, a total of 14 general core competences were described and a questionnaire with specific core competences was chosen, with confirmation of correlation among them; in the second stage, the importance and expression competence at work degrees were obtained, after the questionnaires were filled out by 74 municipal public health managers; in the third one, a formula was adopted for the training priority degree and its classification; the fourth stage presented an educational proposal for the development of one of the competences with the highest priority degree.Conclusion: the model brings contributions by describing general core competences, after documentary research; carrying out the correlation between a questionnaire, containing specific core competences with the general ones; by mapping gaps; and by the proposal of learning trails for the development of competences.

Oral health of institutionalized elderly: management and primary health care

Objective: The purpose of this paper was to evaluate the actions developed in oral health directed toward the institutionalized senior population from the perspective of municipal health managers and oral health professionals in primary care in Brazil. Methods: A qualitative, observational, and analytical study was developed and carried out in 11 municipalities between 2008 and 2010. Semi-structured interviews and analysis by ALCESTE software were used. The results from 48 subjects were analyzed. Results: The analysis revealed a 64% and 77% success rate for the corpus of health managers and oral health professionals, respectively. An Ishikawa diagram was generated using the subjects’ responses to identify the quality problem. Conclusions: This study verified that there is a lack of implementation of public policies directed toward seniors and also highlighted that there was lack of incentives and training to assist seniors in the municipalities. Therefore, it is necessary to invest in greater attention for senior patients who reside in homes for the aged.

Exploratory analysis based on leprosy epidemiological and operational indicators in the city of Governador Valadares/MG/Brazil

Governador Valadares (GV) is a municipality of recognized leprosy hyperendemicity. From 2001 to 2010, the municipal health management invested in a heterogeneous way in the decentralization of control actions to expand access to diagnosis, highlighting the years 2002 and 2004, when training-campaigns took place in the Family’s Health Program. It is an epidemiological study, of a descriptive nature, of a longitudinal type, developed in the city of GV/Minas Gerais/Brazil. The variables collected were: Age group, categorized as &lt;15 years and&gt; 15 years; Gender; Year of notification; Operational classification categorized as paucibacillary and multibacillary; Number of registered household and outside contacts, classified by whole numbers starting with zero (no communications), and mode of entry, as new or not. The estimates obtained from the analysis of municipal indicators reveal that the coefficients of general detection and children under 15 years old remained at hyperendemic levels during the ten years of study with an apparent decrease in general detection to the period studied. Furthermore, according to national parameters, it was observed maintenance of a consistent number of diagnoses in children under 15 and insufficient contact examination coverage. Our study points to the importance of continuing leprosy control actions over time. Observing the findings related to some epidemiological and operational leprosy indicators in GV from 2001 to 2010 makes us aware of a high disease burden. Keywords: Epidemiological parameters, leprosy, operational indicators

Assistência pré-natal segundo registros profissionais presentes na caderneta da gestante

Objetivo: descrever a assistência pré-natal segundo registros profissionais presentes na caderneta da gestante. Método: estudo quantitativo, realizado com puérperas de uma maternidade filantrópica, localizada em um município do interior do Estado do Ceará. Os dados sociodemográficos foram coletados em entrevista e as informações do pré-natal por meio da caderneta da gestante. Os dados foram analisados com base na estatística descritiva. Resultados: participaram 52 puérperas que possuíam de 15 a 40 anos. Observaram-se falhas no registro de informações do pré-natal, sendo as mais graves no que diz respeito aos exames laboratoriais e à avaliação nutricional da gestante. Considerações Finais: faz-se necessário uma mudança na conduta dos profissionais, por meio de qualificação acerca da assistência pré-natal e acompanhamento frequente por parte dos gestores de saúde do município, pois por meio do registro correto das informações obtidas durante a consulta é possível realizar acompanhamento adequado durante o parto e puerpério.

Comissão intergestores regional em Minas Gerais: fatores que influenciam o processo decisório

Com o objetivo de compreender os fatores que influenciam o processo decisório na Comissão Intergestores Bipartite Regional do Estado de Minas Gerais (CIR)foi realizado um estudo de caso qualitativo, com uma abordagem metodológica que possibilitou a imersão no contexto desta instância colegiada. Os sujeitos da pesquisa foram seis gestores municipais de saúde e três sujeitos representantes estaduais, membros da Comissão Intergestores, totalizando nove sujeitos. Os dados foram coletados por meio da observação das reuniões e entrevistas semiestruturadas que foram submetidas à análise de conteúdo. Os resultados mostram que as decisões são influenciadas por múltiplos aspectos tais como; conhecimento, informação, capacidade técnica, interesses particulares diversos, perfil, experiência prévia em gestão, fator político, realidade local, planejamento da gestão pública capacidade de articulação e de convencimento dos atores envolvidos, o que provoca distintos anseios em relação à participação efetiva dos membros nas decisões.

Teleconsultoria na atenção primária no norte de Minas Gerais: cenário e fatores associados à não utilização por médicos

Este artigo objetiva descrever o cenário e identificar fatores associados à não utilização da teleconsultoria pelos médicos da atenção primária na macrorregião Norte de Minas Gerais. Trata-se de um estudo transversal. Para a coleta de dados, foi direcionado um questionário autoaplicado, previamente testado, aos gestores municipais de todos os municípios dessa área. Após análises bivariadas para identificação dos fatores associados à não utilização da teleconsultoria, foi empregada regressão de Poisson com variância robusta. Participaram do estudo 86 gestores municipais de saúde. Importantes barreiras estruturais à implementação da teleconsultoria foram identificadas: falta de computadores com acesso à internet nas unidades básicas de saúde (76,7%) e a qualidade insatisfatória de conexão da internet (16,3%). Na análise múltipla dos fatores associados, apenas a falta de estratégias de motivação por parte dos gestores mostrouse associada (p&lt;0,007; RP=2,19; IC-95%:1,24-3,86) à não utilização da teleconsultoria. Os resultados reforçam o papel do gestor de saúde na promoção do uso do serviço de teleconsultoria na atenção primária.

Consórcio Público de Saúde como arranjo para relação federativa e o processo de regionalização

A relação federativa e a regionalização são dimensões relevantes para a organização de arranjos de cooperação no âmbito do desenvolvimento dos territórios, possibilitando o fortalecimento do federalismo, respeitando a autonomia municipal e vislumbrando o estabelecimento de relações de interdependência entre estes gestores. Nesse sentido, o consórcio público de saúde encontra-se posicionado como uma ferramenta estratégica. Ao longo da história do federalismo no Brasil, esses arranjos foram previstos nas constituições brasileiras, mas ocuparam espaços de pouco destaque no que tange à organização territorial e política no país. Diante desse cenário, desenvolveu-se um estudo de natureza qualitativa, com dimensão exploratória e investigativa, que teve como sujeitos os atores da gestão em saúde no âmbito municipal de uma região, além de representantes da gestão estadual, do consórcio e do Ministério da Saúde. O local de estudo foi a região de saúde do Médio Paranapanema, na macrorregião Norte do Paraná. A coleta de dados se deu por meio de entrevistas e grupos focais no primeiro trimestre de 2017, com roteiros semiestruturados e a metodologia de análise adotada foi a análise do discurso. Os resultados do presente estudo mostram que, após o Decreto Federal nº 7508/2011, surgem novas perspectivas de fortalecimento da regionalização, em que os consórcios públicos de saúde podem se configurar com um papel inovador no elenco das prioridades territoriais das regiões de saúde, da tomada de decisões no âmbito regional e na construção de uma identidade coletiva em meio às necessidades dos entes.

Policies of attention to the elderly according to the voice of the municipal managers of health.

To analyze the understanding of municipal managers of health about public policies destined to the elderly population and the way they are effected in the city. Qualitative study, developed with 14 municipal managers of health. Data were collected through a semi-structured interview and analyzed according the precepts of content analysis. The results show the lack of knowledge of the municipal health managers, related to public policies of attention to the elderly. Also, the attention given to the elderly in the studied municipalities focuses on measures to control health problems. The municipalities do not have specific health care policies for the elderly population. Thus, these results can support reflections about care for the elderly in health services, their relationship with legislation, and the applicability of public health policies.

Quality of life in municipal public health managers: a cross-sectional study from Brazil

Quality of life in municipal public health managers: a cross-sectional study from Brazil

Gestão pública no SUS: considerações acerca do PMAQ-AB

RESUMO O estudo teve como objetivo investigar as percepções dos gestores municipais de saúde na 28ª Região de Saúde do Rio Grande do Sul quanto aos impactos do Programa de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB) na organização do trabalho e assistência à saúde, bem como os aspectos que traduzem as percepções e o envolvimento deles com o Programa. Trata-se de uma pesquisa qualitativa com 11 gestores de saúde, com análise de dados a partir da Análise de Conteúdo. Os resultados apresentam aspectos positivos e negativos acerca do PMAQ-AB, evidenciam deficiências no envolvimento dos gestores com o programa, todavia, demonstram impactos positivos para a gestão e assistência em saúde da região em estudo.

Death surveillance as an indicator of the quality of health care for women and children.

The study aimed to evaluate the implementation of a regional death surveillance network, reflecting on challenges and potentialities of performance as observatory of violence against women. The research involved nine municipalities of a health region set at the Zona da Mata, Minas Gerais, Brazil. We followed the meetings of the regional death surveillance committee and conducted semi-structured interviews with professional members of the committee and municipal health managers. Furthermore, we analyzed information concerning investigations conducted and, in one municipality, we analyzed the notifications of deaths and cases of violence against women. The results point to some difficulties: lack of recognition of the death surveillance activity; work overload; failure in communication between institutions and poor resources, infrastructure and professional training. There were also improvements, namely: greater interaction between municipalities; increased investigations and greater awareness of the importance of death surveillance among workers. We identified cases of domestic, obstetric and institutional violence through the investigation of deaths. The experience as a regional committee reinforces the strategy of strengthening death surveillance and the network of care for women in situation of violence.

Financing of Pharmaceutical Services in the municipal management of the Brazilian Unified Health System.

ABSTRACTOBJECTIVE To discuss factors related to the financing of the Basic Component of Pharmaceutical Services within the municipal management of the Brazilian Unified Health System.METHODS The Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil – Serviços (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services) is a cross-sectional, exploratory, and evaluative study that performed an information survey in a representative sample, stratified by Brazilian regions It considered different study populations in the sampling plan, which represent primary health care services in the cities. Data were collected in 2015 by two methods: in person, by applying direct observation scripts and interviews with users, physicians, and professionals responsible for the dispensing of medicines in primary care services; by telephone interviews with municipal health managers and municipal professionals responsible for Pharmaceutical Services. The results were extracted from the questionnaires applied by telephone.RESULTS Of the sample of 600 eligible cities, we collected 369 interviews (61.5%) with secretaries and 507 (84.5%) with pharmaceutical services managers. 70.8% of the cities have a computerized management system; and 11.9% have qualification/training of professionals. More than half (51.3%) of the cities received funds for the structuring of pharmaceutical services, and almost 60% of these cities performed this type of spending. In 35.4% of cases, municipal secretaries of health said that they use resources of medicines from the Componente Básico da Assistência Farmacêutica (CBAF – Basic Component of Pharmaceutical Services) to cover demands of other medicines, but only 9.7% believed that these funds were sufficient to cover the demands. The existence of a permanent bidding committee exclusively for acquiring medicines was reported in 40.0% of the cities.CONCLUSIONS We found serious deficiencies in the public financing of medicines, as well as little concern about the formality in the use of public resources, expenses that meet individual demands to the detriment of the community, insufficient resources allocated to the Basic Component of Pharmaceutical Services, and exhaustion of the financing model.

NAS MÃOS DE QUEM ESTÁ A GESTÃO DO SUS? PERCEPÇÕES DOS GESTORES MUNICIPAIS SOBRE GERENCIAMENTO

Este estudo teve como objetivo analisar as percepções dos gestores municipais de saúde de uma Comissão Intergestora Regional do Estado de Goiás, sobre os instrumentos de gestão do Sistema Único de Saúde (SUS). Trata-se de uma pesquisa descritiva, com abordagem qualitativa, desenvolvida em uma região de saúde, a amostra foi constituída por nove gestores. Os resultados apontam predominância feminina na gestão do SUS. Quanto ao grau de escolaridade nota-se que 78% dos gestores possuem curso superior. A admissão ao cargo de gestor do sistema municipal de saúde ocorreu por meio de indicação política para 100% dos entrevistados. Os dados apresentados mostram que a gestão municipal do SUS é realizada, por indivíduos que embora a maioria tenhaformação superior na área da saúde , o conhecimento ainda é incipiente e ineficiente, no que se refere à concepção do SUS e instrumentos básicos de gestão.Descritores: Sistema Único de Saúde; Planejamento em Saúde; Gestão em Saúde.

PROBLEMS OF INTEGRATED MANAGEMENT OF LABOR PROTECTION IN EDUCATIONAL INSTITUTIONS

In article the author considers the complex of measures of state and municipal occupational health management in institutions of higher education. The article also discusses the main problems of implementing the state policy in the field of labor protection, aimed at preventing industrial injuries and occupational diseases, ensuring the social protection of the workforce and students through the organization of coordinated interaction of subjects of management at all levels, the introduction of economic methods of management, development of social partnership. In this paper the essential theoretical aspects of labour protection in the Russian Federation, the problems of administrative-legal regulation of relations in the sphere of labour protection and the ways of its solution, justifies the author’s position on the subject. The level of effectiveness of the implementation of state management of labor protection in the Russian Federation depends on the dynamics of implementing the system specific security and occupational health aimed at the prevention of accidents, incidents, dangerous occurrences and damage to health. The problem of labour protection in the field of education is one of the topical, as every year in educational institutions of the country injured thousands of children and adolescents, the disabled, dozens of children die from injuries sustained during the educational process. The article may be of interest to researchers, teachers, postgraduates and students of educational institutions of higher education, employees of public administration.