The Rede Governança Brasil (RGB) Health Management Committee, coordinated by the former Minister of Health, Nelson Teich, has prepared a document containing proposals for the Unified Health System (SUS).
The publication brings reflections on localization, based on an analysis of the indicators selected to characterize the effectiveness of primary health care (PHC) in the macro-districts of health in Brazil.
The study aims to make a diagnosis – based on analysis of secondary data and available evidence – that allows for the development of proposals with the aim of promoting regional and holistic health from a primary health care perspective.
methodology
As for the adopted methodology, an initial 60 indicators were identified, based on general data, to characterize the performance of primary health care from the perspective of macro regions. After rounds of consultations with specialists, those with excess or low priority content were discarded, leaving 33 indicators, which were then grouped into four dimensions: social and economic; structure of primary health care; APS procedures and services; Evidence for a Primary Care Solution.
consequences
The analysis of the results showed significant variance for all selected indicators and for all dimensions of the analysis, which was reflected in the final score for the overall areas. This variance was observed in all macro regions. When looking at the macro regions within the country’s five geographic regions – North, Northeast, Midwest, Southeast and South – one sees the challenge and urgent need to strengthen the model of care and management that is the foundation of the health system.
Proposals for SUS
The study made it possible to develop a set of eight proposals to be implemented in the unified health system:
1 – Define and monitor holistic areas of health in terms of physical structure and human resources, adopt minimum standards per 100,000 population and initiate immediate corrective action;
two – Increase federal investments in health promotion and prevention of chronic non-communicable diseases, while planning individual and group educational activities provided in primary health care;
3 – Develop metrics validation studies for assessment, monitoring and agreement on health outcomes at the macro health district level;
4 – Develop a study that aims to analyze heterogeneity between macro health districts, particularly with regard to socio-economic aspects, their impact on care (health processes and outcomes) and on perceived differences;
5 – Qualify the public administration, at the three levels of government, with regard to regionalization, identifying technical and structural weaknesses that must be addressed, as well as strengthening and expanding communication forums and regional governance mechanisms;
6 – Identification of the main actors in the regionalization process at the three levels of government, to discuss their roles and review their scope of action at the level of health macro-districts, while strengthening leadership;
7 – integration of national health information systems, with the goal of data interoperability between levels of care and the possibility of user monitoring from the perspective of longevity and comprehensive care;
8 – Studying the adoption of financial incentives capable of stimulating regionalization and combining the links in the chain of care in the health system.
Click here to access the full document
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Ascom Kaunas
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