Ramos André Luis Paes, Seta Marismary Horsth De
Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.
Hospital Universitário Gaffrée e Guinle, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brasil.
Cad Saude Publica. 2019;35(4):e00089118. doi: 10.1590/0102-311X00089118. Epub 2019 Apr 8.
This study focuses on the primary health care (PHC) performance of the four capitals of the Southeast Region of Brazil in the years 2009 and 2014 in terms of the indicators of the 2013-2015 Guidelines and Goals Pact (PDM, in Portuguese). Two capitals turned to Social Organizations (OS, in Portuguese) and two kept the provision and administration of PHC through Direct Administration (AD, in Portuguese), configuring distinct management models. Freely accessible secondary data and research on websites subsidized the characterization of the cities and their PHC performance. The characterization was based on demographic and socioeconomic data, PHC management model, health and PHC spending, importance of the Municipal Participation Fund for the budget and percentage of Executive Branch spending on personnel. In order to measure PHC performance, we calculated 13 indicators for 2009 and 2014, in three PDM guidelines: (i) access, (ii) integral care for women and children's health and (iii) reduction of health risks and harms. The comparative performance analysis considered the year 2014 and each capital's evolution during the period we analyzed. The capitals São Paulo and Rio de Janeiro, with OS management, did not have a better performance in the set of indicators than the capitals than maintained a direct administration. We highlight the rapid expansion in PHC coverage in Rio de Janeiro through OS. In the performance evolution, there was improvement in indicators such as child mortality and hospital admissions due to conditions sensible to PHC in all capitals. The cities are different with regard to many parameters that can influence PHC performance. We did not intend to establish a direct relationship between the administration model and performance.
本研究聚焦于巴西东南部地区四个首府在2009年和2014年的初级卫生保健（PHC）绩效，依据2013 - 2015年《指导方针与目标协议》（葡萄牙语为PDM）的指标进行评估。其中两个首府转向了社会组织（葡萄牙语为OS），另外两个则通过直接管理（葡萄牙语为AD）来提供和管理初级卫生保健，形成了不同的管理模式。通过网站上免费获取的二手数据和研究为城市及其初级卫生保健绩效的特征描述提供了支持。该特征描述基于人口和社会经济数据、初级卫生保健管理模式、卫生和初级卫生保健支出、市政参与基金对预算的重要性以及行政部门人员支出的百分比。为了衡量初级卫生保健绩效，我们在2009年和2014年依据三项PDM指导方针计算了13项指标：（i）可及性，（ii）妇女和儿童健康的综合护理，以及（iii）健康风险和危害的降低。比较绩效分析考虑了2014年以及我们所分析期间每个首府的发展情况。采用社会组织管理模式的圣保罗和里约热内卢在指标组方面的表现并不比维持直接管理模式的首府更好。我们强调里约热内卢通过社会组织实现了初级卫生保健覆盖范围的快速扩大。在绩效发展方面，所有首府在诸如儿童死亡率和因对初级卫生保健敏感的病症导致的住院率等指标上都有所改善。这些城市在许多可能影响初级卫生保健绩效的参数方面存在差异。我们并未打算在管理模式与绩效之间建立直接关系。
