Factors associated with conducting planning for secondary oral health care services in Brazil.

BACKGROUND: Planning in health services specifically aims to improve the health status of a given population, guaranteeing access with equity and justice, as well as streamlining the response of the health system to the needs perceived by the community. This research aims to identify the factors associated with planning Specialized Dental Clinics (SDCs). METHODS: Secondary data were used from the external evaluation of the database of the first National Program for Access and Quality Improvement of SDCs (NPAQI-SDCs) and the informed Outpatient Information System of the Unified Health System (OIS/UHS), which contains data on the specialized dental procedures performed at SDCs. It consisted of a quantitative study in which Pearson chi-square statistical tests (p < 0.05) and a multivariate logistic regression were applied with odds ratio (OR) estimate. RESULTS: The results indicated that the realization of planning in SDCs was associated with lower coverage of the Oral Health Team of the Familiy Health Strategy in a municipality (OR = 1.4; 95% CI: 1.0-1.9, p = 0.049), additional training for managers (p = 0.038), the practice of self-assessment (OR = 8.2; 95% CI: 5.8-11.6; p = 0.000) and meeting service production targets (OR = 1.9; 95% CI: 1.2-3.2; p = 0.011). CONCLUSION: The results indicate that the work processes of the SDCs, especially with regard to service management, are essential to the proper functioning of the service and the practice of planning is linked to the technical capacity and commitment of service managers.

[Universal health coverage and the More Doctors physician recruitment program (Programa Mais Médicos) in BrazilCobertura universal de salud y el programa Más Médicos (Programa Máis Médicos) en Brasil]. / Cobertura universal em saúde e o Programa Mais Médicos no Brasil.

Universal health coverage can be understood as a goal encompassing a series of structural measures that allow health care systems to enhance access to health care. Primary health care (PHC) should be seen as an essential component of this process, in charge of re-organizing services according to the health needs of the population. A Brazilian physician recruitment program, Programa Mais Médicos (More Doctors), has introduced a set of measures that strengthen PHC. Based on a conceptual review of universal health coverage and on an analysis of the More Doctor Program from the perspective of the results obtained in terms of strengthening PHC in the public Unified Health System (SUS), the aim of the present article was to discuss the potential contribution of the More Physicians Program to the progress towards universal coverage in the SUS. It is concluded that the More Doctors Programs is a driver of universal coverage in the public health care system in Brazil.

La cobertura universal de salud puede entenderse como una meta que abarca una serie de medidas estructurales que permiten a los sistemas de atención médica mejorar el acceso a la atención médica. La atención primaria de salud (APS) debe ser vista como un componente esencial de este proceso, responsable de la reorganización de los servicios, tomando en cuenta las necesidades de salud de la población. El programa Más Médicos, ha introducido en Brasil un conjunto de medidas que fortalecen la APS. Con base en una revisión conceptual de la cobertura universal de salud y de un análisis del programa Más Médicos desde la perspectiva de los resultados obtenidos en términos de fortalecimiento de la APS en el Sistema Único de Salud público (SUS), el objetivo del presente artículo fue analizar la contribución potencial del programa Más Médicos al progreso hacia la cobertura universal en el SUS. Se concluye que el programa Más Médicos es un motor de cobertura universal en el sistema de salud pública en Brasil.

[Green, healthy environments: training of community health agents in the city of São Paulo, Brazil]. / Ambientes verdes e saudáveis: formação dos agentes comunitários de saúde na Cidade de São Paulo, Brasil.

The aim of this article is to describe the training of community health agents (ACSs) in the context of an intersectorial initiative (Green, Healthy Environments Project: Building Integrated Public Policies in the City of São Paulo). The initiative was developed by four city departments--Environment, Health, Social Support and Development, and Education--in collaboration with the city's 31 superintendencies and five regional health administrations. In addition to these municipal bodies, a network of partners was established, including institutions involved in multilateral international technical cooperation and academic institutions. The training of ACSs and social support agents, and the development of community programs that take into account local potential and characteristics was the main objective of the network. The locally integrated management for the development of an agenda of protection and promotion of green, healthy environments was carried out inside the previously existing networks operating in the territories close to public primary care health units serving populations covered by the Family Health Strategy. There currently are 705 programs created by the Green, Healthy Environments Project. These programs serve as evidence of the positive results obtained locally through intersectorial management efforts.

[The Family Health Program in Brazil: analysis of access to basic care]. / O Programa Saúde da Família no Brasil: análise do acesso a atenção básica.

This article shows a research about the implantation of the Family Helath Program, carried through 12 pioneer cities, related to the access to the basic health services. It was based in the context of social sciences, in the method of the hermeneutics-dialectics. Scripts of interview and focal groups for data collection were used. The study highlights regarding to the primary care accessibility to health sercives, that the PSF has contributed on the reduction of inequalities. However, it faces a sort of social, political, institutional, economic and cultural challenges, that are materialized in the deficiencies of coordination, management, financing, and mainly in medical practical assistance, strongly present in the daily professional practice of the PSF's teams.

[Ongoing food and nutrition education within the family health strategy: points of agreement and disagreement in major Brazilian cities]. / Educação permanente em alimentação e nutrição na Estratégia Saúde da Família: encontros e desencontros em municípios brasileiros de grande porte.

This study sought to ascertain the facilitating and inhibiting factors and strategies used by 28 major Brazilian cities in conducting ongoing food and nutrition education within the Family Health Strategy. It involved a qualitative study of multiple cases. The data collection technique was conducted in interviews with municipal coordinators of food and nutrition campaigns from the five regions of the country. The study was conducted between 2009 and 2010. NVivo 10 software was used and content analysis was divided up into thematic categories. Forty-four professionals were interviewed, 19 of which were nutritionists. Most cities were from the Northeast and Southeast; 14 were capitals, 7 were metropolises and 14 had Family Health Suppor Units. The most frequently mentioned facilitating factors for Ongoing Education in Nutrition were partnerships and the availability of funds. The most frequent inhibiting factors were difficulty in scheduling and a lack of professionals in management of nutrition actions. The strategies most commonly used were conducting training at the local level, in groups and planning and programming. The conclusion drawn is that more investment is needed for Ongoing Education in Feeding and Nutrition to be effectively implemented.

[Community health workers: a health model without walls]. / Agents communautaires de santé : un modèle de santé sans murs.

The aim of this commentary is to respond to a published Canadian Journal of Public Health article on Brazil's family health strategy, in order to clarify some aspects - in particular, the work of community health workers - that make the strategy a unique experience. In the same vein, the authors explore the similarities, differences and peculiarities between Brazil and Québec with regard to the organizational model for primary health care.

[Food and nutrition in the Family Health Strategy in five Brazilian cities]. / Alimentação e nutrição na Estratégia Saúde da Família em cinco municípios brasileiros.

This work is part of a national study seeking to understand the difficulties and the potential for overcoming the challenges faced in the quest to improve food and nutrition campaigns developed under the aegis of the Family Health Strategy. It is examined from the standpoint of professional teams of the Family Health Strategy and Family Health Support Centers of five major Brazilian cities. A qualitative approach was used to design a multiple case approach and the technique of focus groups was conducted to collect data. The instrument used was a semi-structured pre-tested and validated script with two leading questions. The Collective Subject Discourse technique was used for data analysis, based on which the synthesized discourses were created using the Qualiquantisoft program. Sixty health professionals from various training areas were interviewed, including dietitians, nurses and physicians. The results showed that the difficulties encountered for the provision of food and nutrition campaigns and the lack of professionals in this area have hampered compliance with the principles of comprehensiveness, universality and resolubility of health care.

[Family Health Program in Brazil: an incomplete agenda?]. / Programa Saúde da Família no Brasil: uma agenda incompleta?

The present article is a longitudinal analysis of the Brazilian experience with the Family Health Program (PSF) throughout its 12 years of implementation. The article starts with the fundamental purpose of such strategy which is the reorganization of Basic Health Care, contextualizing in the light of this unique and peculiar experience to the Brazilian Unified Health System (SUS). It highlights the progresses and challenges of the PSF, indicating urgent needs regarding technological incorporation, formation of labor force, establishment of new mechanisms as well as agreements on basic care funds and the direction of new strategies and technologies in the process of monitoring and evaluation. To conclude, the article shows the elements to foster a debate about such questions, which must be permanent and lucid in the perspective of building the Brazilian Unified Health System and the right to health.