Suchergebnisse

OBJECTIVE: To evaluate the Programa Mais Médicos (More Doctors Program; PMM) in Brazil by estimating the proportional increase in the number of doctors in participating muni­cipalities and the program costs, stratified by cost component and funding source. METHODS: Official data from the 2013 edition of Demografia Médica no Brasil (Medical Demography in Brazil) was used to estimate the number of doctors prior to PMM. The number of doctors at the end of the fourth PMM recruiting cycle (July 2014) was obtained from the Ministry of Health. Cost components were identified and estimated based on PMM legislation and guidelines. The participating municipalities were chosen based on four criteria, all related to vulnerability. RESULTS: The PMM provided an additional 14 462 physicians to highly vulnerable, remote areas in 3 785 municipalities (68% of the total) and 34 Special Indigenous Sanitary Districts. There was a greater increase of physicians in the poorest regions (North and Northeast). The estimated annual cost of US$ 1.1 billion covered medical provision, continuing education, and supervision/mentoring. Funding was largely centralized at the federal level (92.6%). CONCLUSION: The cost of PMM is considered relatively moderate in comparison to its potential benefits for population health. The greater increase of doctors for the poorest and most vulnerable met the target of correcting imbalances in health worker distribution. The PMM experience in Brazil can contribute to the debate on reducing physician shortages.

ABSTRACT There is much evidence suggesting that mitigating the COVID-19 pandemic requires syndromic surveillance and isolation of suspected/confirmed cases. The availability of diagnostic tests in the Brazilian Unified Health System (SUS) is essential, which could be facilitated by national sovereignty in development and production, considering the high demand/lack of supply in the international market. This study identified the stages of translational research into diagnostic tests for COVID-19 in Brazil, verifying their geographic distribution, among other indicators. A cross-sectional, exploratory study based on a public database with 789 Research, Development, and Innovation (RD&I) projects regarding COVID-19, complemented by other searches, including the researchers' curricula (CVLattes). There were 89 diagnostic test projects in the database. In 45 cases, it was possible to obtain additional information to classify them according to the translational research stages. Fifteen innovations that reached the T3 stage were identified, with their products incorporated into clinical protocols in healthcare, even considering the deep budget restrictions in RD&I. Brazil has the potential to develop and implement technological products in the field of diagnostic tests for SARS-CoV-2. Public health RD&I policies need to be prioritized to expand national and international cooperation to promote effective national autonomy in syndromic surveillance and population health.

RESUMO Existe ampla evidência que a contenção da pandemia de Covid-19 requer vigilância sindrômica e isolamento de casos suspeitos/confirmados. É essencial a disponibilidade de testes diagnósticos no Sistema Único de Saúde, que poderia ser facilitada pela soberania nacional no desenvolvimento e produção, considerando-se a alta demanda/escassez no mercado internacional. Este estudo identificou as etapas da pesquisa translacional de testes diagnósticos para Covid-19 no Brasil, verificando sua distribuição geográfica, entre outros indicadores. Estudo transversal, exploratório, partindo de banco público com 789 projetos de Pesquisa, Desenvolvimento e Inovação (PD&I) em Covid-19, complementado com outras buscas, inclusive no CVLattes dos pesquisadores. No banco, havia 89 projetos de testes diagnósticos. Em 45 casos, foi possível obter informações complementares para classificá-los conforme as etapas da pesquisa translacional. Identificaram-se 15 inovações que atingiram o estágio T3, ou seja, tiveram seus produtos incorporados em protocolos clínicos na atenção à saúde, mesmo considerando-se as profundas restrições orçamentárias em PD&I. O Brasil possui potencial de desenvolvimento e implementação de produtos tecnológicos na área de testes de diagnóstico para Sars-CoV-2. Políticas públicas de PD&I em saúde necessitam ser priorizadas para ampliação de cooperações nacionais e internacionais, a fim de promover efetiva autonomia nacional na vigilância sindrômica e à saúde da população.

ABSTRACT The study aims to investigate the flows of Covid-19 hospitalizations in the 450 Brazilian health regions and 117 health macro-regions between March and October 2020. This descriptive study includes all Covid-19 hospitalizations registered in the Influenza Epidemiological Surveillance Information System between the eighth and forty-fourth epidemiological weeks of 2020. In Brazil, 397,830 admissions were identified for Covid-19. Emigration was 11.9% for residents in health regions and 6.8% in macro-regions; this pattern was also maintained during the peak period of Covid-19 hospitalizations. The average evasion for residents of health regions was 17.6% in the Northeast and 8.8% in the South. Evasion was more accentuated in health regions with up to 100 thousand inhabitants(36.9%), which was 7 times greater than that observed in health regions with more than 2 million inhabitants (5.2%). The negative migratory efficacy indicator (-0.39) revealed a predominance of evasion. Of the 450 Brazilian health regions, 117 (39.3%) had a coefficient of migratory efficacy between-1 and-0.75, and 113 (25.1%) between-0.75 and-0.25. Results indicate that the regionalization of the health system exhibited adequate organization of healthcare in the territory; however, the long distances traveled are still worrisome.

RESUMO A pandemia de Covid-19 reforçou a necessidade de esforços globais para garantir cobertura e acesso universal à saúde, impondo desafios na gestão da Atenção Primária à Saúde (APS). Este estudo objetivou desen- volver e aplicar um instrumento de avaliação da responsividade das Unidades Básicas de Saúde (UBS) diante da Covid-19, baseado na coprodução entre pesquisadores universitários e equipes técnicas da APS. O instrumento, dividido em dois módulos, incluiu identificação; horário de funcionamento; processo de trabalho; estrutura física, equipamentos, mobiliário, suprimentos e Equipamentos de Proteção Individual (EPI); atendimento, exames e acompanhamento de Usuários Sintomáticos Respiratórios (USR); vigilância, integração, comunicação e gestão. Todas as 165 UBS foram convidadas a completar o instrumento. Principais resultados: houve readequação da estrutura física (salas de espera, espaços internos/externos); fornecimento de EPI e de testes Covid-19, busca ativa de USR/suspeitos Covid-19 por telefone/visitas domiciliares, monitoramento de fluxos de transferência de pacientes e telessaúde. Concluindo, as UBS reorganizaram seus serviços para atender necessidades da pandemia. Fornecer informações sobre estrutura e capacidade de resposta das UBS pode subsidiar sistemas de saúde para planejamento e tomada de decisões, em diferentes níveis de gestão, crucial para determinar estratégias para reforçar a responsividade da APS em situações de pandemias e outras calamidades.

ABSTRACT The COVID-19 pandemic reinforced the need for global efforts to grant universal health coverage and access, which imposes management challenges for Primary Health Care (PHC). This study aimed to develop and apply an instrument to assess the PHC Units' responsiveness to COVID-19, based on co-production efforts between university researchers and PHC technical teams. The instrument composed of two modules, included identification, operating hours, workforce, work process, structure, equipment, furniture, supplies, Personal Protection Equipment (PPE), Symptomatic Respiratory Patient (SRP) examinations and follow-up, information, surveillance, integration, communication, and management. All the 165 PHC Units in Brasília were invited to complete the instrument. Main results: there was physical structure adaptation (adequate configuration of waiting rooms, internal and external spaces allowing safe distance); provision of PPE and COVID-19 tests; active search for SRP/COVID-19 suspects by phone, mobile or home visits; monitoring flows of patient transfer and telehealth implementation. In conclusion, the PHC Units reorganized their services to meet the demands of the pandemic context. Providing information about structure and responsiveness of PHC Units may subside health systems for planning and decision-making at different levels of management, which is crucial to determine strategies to empower and reinforce PHC responsivity in situations of pandemics and other calamities.