Department of Social Medicine, Federal University of Pernambuco, Avenida Rui Barbosa, 716 - Flamengo, Rio de Janeiro, RJ, Brazil.
Aggeu Magalhães Institute, FIOCRUZ/PE, Av. Professor Moraes Rego, s/n - Campus da UFPE, Cidade Universitária, Recife, PE, CEP:50.740-465, Brazil.
Health Policy Plan. 2019 Sep 1;34(7):499-507. doi: 10.1093/heapol/czz059.
The Congenital Zika Syndrome (CZS) epidemic took place in Brazil between 2015 and 2017 and led to the emergence of at least 3194 children born with CZS. We explored access to healthcare services and activities in the Unified Health Service (Sistema Único de Saúde: SUS) from the perspective of mothers of children with CZS and professionals in the Public Healthcare Network. We carried out a qualitative, exploratory study, using semi-structured interviews, in two Brazilian states-Pernambuco, which was the epicentre of the epidemic in Brazil, and Rio de Janeiro, where the epidemic was less intense. The mothers and health professionals reported that healthcare provision was insufficient and fragmented and there were problems with follow-up care. There was a lack of co-ordination and an absence of communication between the various specialized services and between different levels of the health system. We also noted a public-private mixture in access to healthcare services, resulting from a segmented system and related to inequality of access. High reported household expenditure is an expression of the phenomenon of underfunding of the public system. The challenges that mothers and health professionals reported exposes contradictions in the health system which, although universal, does not guarantee equitable and comprehensive care. Other gaps were revealed through the outbreak. The epidemic provided visibility regarding difficulties of access for other children with disabilities determined by other causes. It also made explicit the gender inequalities that had an impact on the lives of mothers and other female caregivers, as well as an absence of the provision of care for these groups. In the face of an epidemic, the Brazilian State reproduced old fashioned forms of action-activities related to the transmitting mosquito and to prevention with an emphasis on the individual and no action related to social determinants.
先天性寨卡综合征（CZS）疫情于 2015 年至 2017 年在巴西爆发，导致至少 3194 名患有 CZS 的儿童出生。我们从患有 CZS 的儿童的母亲和公共医疗网络的专业人员的角度探讨了获得统一卫生服务系统（Sistema Único de Saúde：SUS）医疗服务和活动的情况。我们在巴西的两个州（巴西寨卡疫情的中心——伯南布哥州和疫情不太严重的里约热内卢州）进行了一项定性探索性研究，使用半结构化访谈。母亲和卫生专业人员报告称，医疗服务提供不足且分散，并且存在后续护理问题。各个专业服务之间以及不同卫生系统层次之间缺乏协调和沟通。我们还注意到，由于系统分割和获得服务的不平等，公私混合现象影响了医疗服务的获取。高报告的家庭支出是公共系统资金不足的表现。母亲和卫生专业人员报告的挑战揭示了卫生系统中的矛盾，尽管该系统是普及的，但不能保证公平和全面的护理。通过此次疫情还发现了其他差距。该疫情使人们注意到其他因其他原因而残疾的儿童在获得医疗服务方面所面临的困难。它还明确了对母亲和其他女性照顾者生活产生影响的性别不平等，以及对这些群体缺乏护理的情况。在疫情面前，巴西国家再现了陈旧的行动形式，这些行动与传播寨卡病毒的蚊子有关，并且侧重于个人，而没有采取与社会决定因素有关的行动。
