Architectural and communications barriers to access to primary health care in Brazil: an analysis based on the first national census of primary health care centers, 2012. / Barreiras arquitetônicas e de comunicação no acesso à atenção básica em saúde no Brasil: uma análise a partir do primeiro Censo Nacional das Unidades Básicas de saúde, 2012.

OBJECTIVE: to analyze the results of the National Census of Primary Health Care Centers with regard to architectural and communication barriers in Primary Health Care throughout Brazil. METHODS: this was a cross-sectional study based on data from the first National Census of Primary Health Care Centers conducted between May and October 2012. RESULTS: the Northern region had the lowest rates of adequacy; although the Southeast region had the best rates when compared to the country's other regions, they were nevertheless unsatisfactory, since for many items adequacy was still below 50%; the items relating to accessibility by people with disabilities (5.7 to 34.2%) and/or the illiterate (0.1 to 27.4%) had very low scores. CONCLUSION: the majority of services evaluated had architectural and communication barriers, hindering access to health services by disabled, illiterate or elderly people; the importance of allocating resources to reduce iniquities and improve access is stressed.

Barreiras arquitetônicas e de comunicação no acesso à atenção básica em saúde no Brasil: uma análise a partir do primeiro Censo Nacional das Unidades Básicas de saúde, 2012 / Barreras arquitectónicas y de comunicación en el acceso a la Atención Básica de Salud en Brasil: Un análisis a partir del primer Censo Nacional de las Unidades Básicas de Salud, 2012 / Architectural and communications barriers to access to primary health care in Brazil: an analysis based on the first national census of primary health care centers, 2012

Resumo Objetivo: analisar os resultados do Censo Nacional das Unidades Básicas de Saúde no que se refere às barreiras arquitetônicas e de comunicação na Atenção Básica em Saúde em todo o território brasileiro. Métodos: estudo transversal com base nos dados do primeiro Censo Nacional das Unidades Básicas de Saúde, coletados de maio a outubro de 2012. Resultados: a região Norte apresentou menores índices de adequação, enquanto a Sudeste apresentou os melhores índices, comparados às demais regiões, porém insatisfatórios, pois muitos itens permaneceram abaixo de 50%; itens sobre acessibilidade por pessoas com deficiência (5,7 a 34,2%) e não alfabetizadas (0,1 a 27,4%) apresentaram pontuação muito baixa. Conclusão: a maioria das unidades avaliadas possuem barreiras arquitetônicas e de comunicação, prejudicando a acessibilidade aos serviços de saúde prestados às pessoas com deficiência, não alfabetizadas ou idosas; destaca-se a importância da alocação de recursos para redução de iniquidades e melhoria do acesso.

Resumen Objetivo: analizar la accesibilidad de los usuarios al Censo Nacional de las Unidades Básicas de Salud en lo referente a barreras arquitectónicas y de comunicaciones en todo Brasil. Métodos: estudio descriptivo analítico con base en los datos del primer Censo Nacional de las Unidades Básicas de Salud; la encuesta se realizó entre mayo y octubre de 2012. Resultados: la región Norte presentó menores índices de adecuación, mientras que el Sudeste presentó mejores índices comparados a las demás regiones, pero insatisfactorios, pues muchos ítems permanecieron por debajo del 50%; los ítems sobre accesibilidad por personas con discapacidad (5,7 a 34,2%) y no alfabetizadas (0,1 a 27,4%) presentaron una puntuación muy baja. Conclusión: los datos demuestran que la mayoría de los servicios evaluados poseen barreras arquitectónicas y de comunicación, perjudicando la accesibilidad a los servicios de salud prestados a las personas con discapacidad, no alfabetizadas o ancianas, y exalta la importancia de asignación de recursos para la reducción de iniquidades y mejoría del acceso.

Abstract Objective: to analyze the results of the National Census of Primary Health Care Centers with regard to architectural and communication barriers in Primary Health Care throughout Brazil. Methods: this was a cross-sectional study based on data from the first National Census of Primary Health Care Centers conducted between May and October 2012. Results: the Northern region had the lowest rates of adequacy; although the Southeast region had the best rates when compared to the country's other regions, they were nevertheless unsatisfactory, since for many items adequacy was still below 50%; the items relating to accessibility by people with disabilities (5.7 to 34.2%) and/or the illiterate (0.1 to 27.4%) had very low scores. Conclusion: the majority of services evaluated had architectural and communication barriers, hindering access to health services by disabled, illiterate or elderly people; the importance of allocating resources to reduce iniquities and improve access is stressed.

Access to dental public services by disabled persons.

BACKGROUND: According to the World Health Organization, one in every 10 people has a disability, and more than two-thirds of them do not receive any type of oral dental care. The Brazilian Constitution of 1988 guarantees all civilians including disabled people the right to healthcare, shaping the guidelines of the Brazilian National Health Care System (Sistema Único de Saúde--SUS). However, there is limited information about the true accessibility of dental services. This study evaluated the accessibility of public dental services to persons with disabilities in Fortaleza, Ceará, which has the third highest disability rate in Brazil. METHODS: A cross-sectional quantitative study using structured questionnaires was administered to dentists (n = 89) and people with disabilities (n = 204) to evaluate the geographical, architectural, and organizational accessibility of health facilities, the communication between professionals and patients with disabilities, the demand for dental services, and factors influencing the use of dental services by people with motor, visual, and hearing impairments. RESULTS: 43.1% of people with disabilities do not recognize their service as a priority of Basic Health Units (BHU), 52.5% do not usually seek dental care, and of those who do (n = 97), 76.3% find it difficult to receive care and 84.5% only seek care on an emergency basis. Forty-five percent are unaware of the services offered in the BHU. Of the dentists, 56.2% reported difficulty in communicating with deaf patients, and 97.8% desired interpreters stationed in the BHU. People with disabilities gave better accessibility ratings than dentists (p = 0.001). 37.3% of the patients and 43.8% of dentists reported inadequate physical access infrastructure (including doors, hallways, waiting rooms, and offices). Dentists (60%) reported unsafe environments and transportation difficulties as geographical barriers, while most people with disabilities did not report noticing these barriers. CONCLUSIONS: While access to dental services has increased in Fortaleza, the lack of accessibility of health units and their surroundings does not promote the treatment of people with disabilities. Cultural, organizational, architectural, geographical, and communication barriers constrain the demand for and use of oral dental care services by this social segment.

Barreiras arquitetônicas a idosos e portadores de deficiência física: um estudo epidemiológico da estrutura física das unidades básicas de saúde em sete estados do Brasil / Architectonic barriers for elderly and physically disabled people: an epidemiological study of the physical structure of health service units in seven Brazilian states

O estudo transversal, realizado em 41 municípios com mais de 100 mil habitantes, descreve as condições das unidades básicas de saúde (UBS) em relação às barreiras arquitetônicas. A amostra aleatória de 240 UBS foi sorteada com diferentes modalidades de atenção básica. Um questionário padronizado foi utilizado e perguntas sobre barreiras arquitetônicas foram respondidas por trabalhadores das UBS. Cerca de 60 por cento das UBS foram classificadas como inadequadas para o acesso de idosos e portadores de deficiências. A presença de degraus, a falta de corrimãos, rampas, banheiros adaptados para os cadeirantes e salas de espera inadequadas às necessidades foram uma constante.Concluiu-se que barreiras arquitetônicas dificultam o acesso aos serviços de saúde. O envelhecimento populacional, aumento da demanda de idosos, aumento das doenças crônicas e a utilização das UBS por pessoas com deficiência física tornam indispensável a intervenção institucional no sentido de qualificar e promover melhorias na estrutura das UBS.

This cross-sectional study, carried out in 41Brazilian cities, describes the conditions of the basic health units (UBS) in relation to architectural barriers. A sample of 240 UBS with different modalities of basic attention was selected at random. The professionals working in the UBS answered a standardized questionnaire about architectonic barriers in their units.Approximately 60 percent of the UBS were classified as inadequate in relation to easy access for the elderly and subjects with disabilities. The existence of steps, the lack of railings, the inexistence of slopes, the lack of bathrooms adapted for the users of wheelchairs, and the inadequate waiting rooms were a constant in the studied UBS. The conclusion is that many architectural barriers make the access to the health services difficult. The population aging and the consequent increasing demand for healthcare by the elderly, the increase of chronic diseases and use of UBS by disabled persons make an urgent institutional intervention for improving the physical the structure of the UBS indispensable.

[Architectonic barriers for elderly and physically disabled people: an epidemiological study of the physical structure of health service units in seven Brazilian states]. / Barreiras arquitetônicas a idosos e portadores de deficiência física: um estudo epidemiológico da estrutura física das unidades básicas de saúde em sete estados do Brasil.

This cross-sectional study, carried out in 41 Brazilian cities, describes the conditions of the basic health units (UBS) in relation to architectural barriers. A sample of 240 UBS with different modalities of basic attention was selected at random. The professionals working in the UBS answered a standardized questionnaire about architectonic barriers in their units.Approximately 60% of the UBS were classified as inadequate in relation to easy access for the elderly and subjects with disabilities. The existence of steps, the lack of railings, the inexistence of slopes, the lack of bathrooms adapted for the users of wheelchairs, and the inadequate waiting rooms were a constant in the studied UBS. The conclusion is that many architectural barriers make the access to the health services difficult. The population aging and the consequent increasing demand for healthcare by the elderly, the increase of chronic diseases and use of UBS by disabled persons make an urgent institutional intervention for improving the physical the structure of the UBS indispensable.