Planejamento em saúde : a programação pactuada e integrada da assistência à saúde no estado de Mato Grosso do Sul

Abstract

The objective of this research was to investigate the Agreed and Integrated Programming of health assistance (PPI) of the municipalities of the State Mato Grosso do Sul, Brazil, which integrated the Organizational Contract of Public Health Action (COAP), held from 2012 to 2015. The PPI is a planning instrument of the Unified Health System (SUS) and of agreement between municipalities, through which health actions to be performed are defined and quantified, seeking to adapt the demand the provision of health services, according to the local and regional health peculiarities, needs and realities. This instrument is inserted into the midst of the regionalization, proposed directive on the basic legislation of the SUS, which aims at guiding the decentralization of health actions and services and ensuring universal access and the fulfillment of the attention to health. To guide managers in the process of programming actions, the Ministry of health has set several strategic areas, being studied, specifically, the parameters agreed on strategic area “Adult Health - Hypertension”. Hypertension is a serious public health problem in Brazil and in the world and, besides being a direct cause of hypertensive heart disease, is a risk factor for diseases caused by atherosclerosis and thrombosis. In order to identify the parameters of assistance and the factors that influenced the agreement process in the municipalities secondary data from several sources of information were used, such as COAP, health plans, management reports, manuals, laws, decrees and ordinances of the Ministry of Health, as well as primary data obtained through interviews with managers/technicians of Municipal Health Bureaus. We analyzed the settlements of 78 municipalities in the State of Mato Grosso do Sul, identifying, among them, those municipalities whose parameters of coverage of the target population, concentration of procedures, and healthcare coverage, showed discrepancies in relation to what was established by the State Bipartite Management Committee (CIB), which were in the target population of the interviews. All municipalities surveyed elaborate formal planning instruments prescribed in legislation (Health Plan, Annual Program and Management Reports). The results reveal a high influence of financial resources on agreement of the municipalities, who are subject to the predefined financial ceilings, not reflecting, the settlements, the demands of the municipality, but an adaptation of procedures to resources available. The study made it possible to conclude, yet, that for the agreement concerning the hypertensive population coverage, the municipalities sought to maintain the percentage of coverage already practiced by for the population. For determining the concentration of parameters and procedures of healthcare coverage the historical series of actions and health services was taken into account, as well as the capacity and infrastructure of the municipalities, such as lack and/or turnover of personnel (administrative and professionals in the area of health care), the lack of qualification of staff, o accumulation of functions and poor organizational structure. The PPI turned out to be a regulatory document of the references, but does not guarantee the access to the various levels of assistance, once the referenced services may not be executed. The PPI is restricted to routine monitoring of financial implementation of the agreed actions and flows, being necessary to investigate the validity of keeping the program by strategic area, Once there is a mismatch between what is evaluated by indicators (COAP) and accompanied by PPI (per action).