Indicadores básicos Argentina 2023

Esta es la vigésimo séptima publicación de la serie de indicadores básicos desde que en 1996 el Ministerio de Salud de la Nación y la Organización Panamericana de la Salud presentaron esta iniciativa. Indicadores Básicos 2023 recopila los últimos datos disponibles en el país provenientes de diversas fuentes oficiales. Continúan las ya clásicas secciones de indicadores demográficos, socioeconómicos, de recursos, acceso y cobertura, de morbilidad, de mortalidad y salud materno-infantil, indicadores generales del país y enfoque de género cuando está disponible. En esta ocasión, se han actualizado los indicadores socioeconómicos con información de la Encuesta Permanente de Hogares y se desagregan los indicadores de ocupación por período. También se incluye un apartado especial sobre las muertes por la Enfermedad por COVID-19 y las principales causas de muerte en el año 2021.

Casos, óbitos e letalidade por COVID-19: análise de dados sociais e assistenciais do Nordeste brasileiro / Cases, deaths and lethality due to COVID-19: analysis of social and assistance data from the Brazilian Northeast

Objetivo: Analisar o impacto da cobertura da Atenção Primária à Saúde, Índice de Desenvolvimento Humano e Bolsa Família na ocorrência de casos, óbitos e letalidade por COVID-19 no Nordeste brasileiro. Método: Estudo descritivo, de caráter transversal, com dados extraídos das plataformas estaduais da COVID-19, Sistema de Informação em Saúde para Atenção Básica e Instituto de Pesquisa Econômica Aplicada. Foram utilizados testes de correlação de Spearman e Kruskal-Wallis. Resultados:Verificou-se que foram notificados 483.793 casos confirmados de COVID-19 e 19.307 óbitos por esse agravo no Nordeste brasileiro. Com relação à ocorrência da COVID-19, o Estado do Ceará apresentou maior taxa de casos (1200,83/100.000 habitantes). Observou-se que quanto maior cobertura da ESF maior identificação da ocorrência de casos confirmados (r=0,855 e p-valor=0,002) e óbitos (r=0,818 e p-valor=0,004) por COVID-19. Conclusão: A Estratégia Saúde da Família é um modelo organizativo da Atenção Primária à Saúde potente para enfrentamento da pandemia, a partir da prevenção, rastreamento entre grupos mais vulneráveis, identificação e notificação dos casos e óbitos por COVID-19. Descritores: Atenção Primária à Saúde; Cobertura de Serviços de Saúde; Indicadores de Desenvolvimento; Infecções por Coronavírus; Programas Sociais.

Objective:To analyze the impact of the coverage of Primary Health Care, Human Development Index and Bolsa Família on the occurrence of cases, deaths and lethality due to COVID-19 in the Brazilian Northeast. Method:Descriptive, cross-sectional study, with data extracted from the state platforms for COVID-19, the Health Information System for Primary Care and the Institute for Applied Economic Research. Spearman and Kruskal-Wallis correlation tests were used. Results:It was found that 483,793 confirmed cases of COVID-19 and 19,307 deaths from this condition were reported in the Brazilian Northeast. Regarding the occurrence of COVID-19, the State of Ceará had the highest rate of cases (1200.83/100,000 inhabitants). It was observed that the greater the coverage of FHS, the greater the number of confirmed cases (r=0.855 and p-value=0.002) and deaths (r=0.818 and p-value=0.004) due to COVID-19. Conclusion:The Family Health Strategy is an organizational model of Primary Health Care powerful to cope with the pandemic, based on prevention, tracking among the most vulnerable groups, identification and notification of cases and deaths due to COVID-19.Descriptors:Primary Health Care; Health Services Coverage; Development Indicators; Coronavirus Infections; Social Programs.

Casos, óbitos e letalidade por COVID-19: análise de dados sociais e assistenciais do Nordeste brasileiro / Cases, deaths and lethality due to COVID-19: analysis of social and assistance data from the Brazilian Northeast

Objetivo: Analisar o impacto da cobertura da Atenção Primária à Saúde, Índice de Desenvolvimento Humano e Bolsa Família na ocorrência de casos, óbitos e letalidade por COVID-19 no Nordeste brasileiro. Método: Estudo descritivo, de caráter transversal, com dados extraídos das plataformas estaduais da COVID-19, Sistema de Informação em Saúde para Atenção Básica e Instituto de Pesquisa Econômica Aplicada. Foram utilizados testes de correlação de Spearman e Kruskal-Wallis. Resultados: Verificou-se que foram notificados 483.793 casos confirmados de COVID-19 e 19.307 óbitos por esse agravo no Nordeste brasileiro. Com relação à ocorrência da COVID-19, o Estado do Ceará apresentou maior taxa de casos (1200,83/100.000 habitantes). Observou-se que quanto maior cobertura da ESF maior identificação da ocorrência de casos confirmados (r=0,855 e p-valor=0,002) e óbitos (r=0,818 e p-valor=0,004) por COVID-19. Conclusão: A Estratégia Saúde da Família é um modelo organizativo da Atenção Primária à Saúde potente para enfrentamento da pandemia, a partir da prevenção, rastreamento entre grupos mais vulneráveis, identificação e notificação dos casos e óbitos por COVID-19. Descritores: Atenção Primária à Saúde; Cobertura de Serviços de Saúde; Indicadores de Desenvolvimento; Infecções por Coronavírus; Programas Sociais.

Objective:To analyze the impact of the coverage of Primary Health Care, Human Development Index and Bolsa Família on the occurrence of cases, deaths and lethality due to COVID-19 in the Brazilian Northeast. Method:Descriptive, cross-sectional study, with data extracted from the state platforms for COVID-19, the Health Information System for Primary Care and the Institute for Applied Economic Research. Spearman and Kruskal-Wallis correlation tests were used. Results:It was found that 483,793 confirmed cases of COVID-19 and 19,307 deaths from this condition were reported in the Brazilian Northeast. Regarding the occurrence of COVID-19, the State of Ceará had the highest rate of cases (1200.83/100,000 inhabitants). It was observed that the greater the coverage of FHS, the greater the number of confirmed cases (r=0.855 and p-value=0.002) and deaths (r=0.818 and p-value=0.004) due to COVID-19. Conclusion:The Family Health Strategy is an organizational model of Primary Health Care powerful to cope with the pandemic, based on prevention, tracking among the most vulnerable groups, identification and notification of cases and deaths due to COVID-19. Descriptors: Primary Health Care; Health Services Coverage; Development Indicators; Coronavirus Infections; Social Programs

Evaluación del cambio del algoritmo de diagnóstico serológico para la enfermedad de Chagas en Colombia / Evaluation of a change in the serological diagnostic algorithm for Chagas disease in Colombia / Avaliação da mudança do algoritmo de diagnóstico sorológico da doença de Chagas na Colômbia

[RESUMEN]. Objetivo. Evaluar los efectos del cambio del algoritmo de diagnóstico serológico para la infección por T. cruzi en los Laboratorios de Salud Pública Departamentales y en el Laboratorio Nacional de Referencia de Colombia, desde una perspectiva del acceso al diagnóstico. Métodos. Se realizó un estudio descriptivo, transversal, a partir de fuentes secundarias entre el 2015 y 2021, se consolidó el número de ensayos serológicos realizados por los laboratorios. Se elaboró una encuesta para identificar beneficios y limitaciones en la implementación del nuevo algoritmo de diagnóstico serológico. Se estimaron totales, proporciones y promedios del número de pruebas comparando dos periodos diferentes. Resultados. Se analizó la información de 33 Laboratorios de Salud Pública, encontrando que el 87,9% de ellos procesaron ensayos serológicos durante el periodo analizado. El uso de las pruebas serológicas aumentó después de la publicación del nuevo lineamiento en 2017 y la capacidad de realización de la segunda prueba paso de 4 a 33 Laboratorios de Salud Pública. La ELISA de antígenos totales y de antígenos recombinantes se consolidaron como las pruebas más realizadas en Colombia después del 2017. Conclusiones. El cambio del algoritmo de diagnóstico serológico para la enfermedad de Chagas en Colombia en 2017 tuvo efectos positivos en el acceso al diagnóstico ya que facilitó el uso de la segunda prueba, esta modificación se tradujo en aumento de la cobertura diagnóstica. Los laboratorios del país tienen disponible un algoritmo sencillo, oportuno, de calidad y que podría ser implementado en casi cualquier laboratorio clínico del país.

[ABSTRACT]. Objective. To evaluate the effects of changing the algorithm for serological diagnosis of T. cruzi infection in departmental-level public health laboratories and in the National Reference Laboratory of Colombia, from the perspective of access to diagnosis. Methods. A descriptive, cross-sectional study was carried out, based on secondary sources between 2015 and 2021, consolidating the number of serological tests carried out by the laboratories. A survey was developed to identify benefits and limitations in the implementation of the new algorithm for serological diagnosis. Totals, proportions, and averages of the number of tests were estimated by comparing two different periods. Results. Information from 33 public health laboratories was analyzed, 87.9% of which processed serological assays during the period under study. The use of serological tests increased after the publication of the new guideline in 2017, and the capacity to perform the second test increased from four to 33 public health laboratories. In absolute terms, ELISAs for antigens and recombinant antigens became the most performed tests in Colombia after 2017. Conclusions. The change in the algorithm for serological diagnosis of Chagas disease in Colombia in 2017 had positive effects on access to diagnosis since it facilitated the use of the second test. This change resulted in increased diagnostic coverage. The country's laboratories have access to a simple, timely, quality algorithm that could be implemented in almost any clinical laboratory in the country.

[RESUMO]. Objetivo. Avaliar os efeitos da mudança do algoritmo de diagnóstico sorológico da infecção por T. cruzi nos Laboratórios Departamentais de Saúde Pública e no Laboratório Nacional de Referência da Colômbia desde a perspectiva do acesso ao diagnóstico. Métodos. Foi realizado um estudo descritivo transversal a partir de fontes secundárias do período entre 2015 e 2021, consolidando-se o número de testes sorológicos realizados pelos laboratórios. Foi desenvolvido um questionário para identificar benefícios e limitações na implementação do novo algoritmo de diagnóstico sorológico. Os totais, as proporções e as médias do número de testes foram estimados pela comparação de dois períodos diferentes. Resultados. Dados de 33 laboratórios de saúde pública foram analisados, e constatou-se que 87,9% processaram testes sorológicos durante o período analisado. O uso de testes sorológicos aumentou após a publicação das novas diretrizes em 2017, e a capacidade de realizar um segundo teste aumentou de 4 para 33 laboratórios de saúde pública. O ELISA com antígeno total e o ELISA com antígeno recombinante se consolidaram como os testes mais realizados na Colômbia após 2017. Conclusões. A mudança no algoritmo de diagnóstico sorológico da doença de Chagas na Colômbia em 2017 teve efeitos positivos no acesso ao diagnóstico, facilitando o uso do segundo teste, o que resultou em maior cobertura diagnóstica. Os laboratórios do país têm à sua disposição um algoritmo simples, oportuno e de alta qualidade que poderia ser implementado em quase todos os laboratórios clínicos do país.

Indicadores básicos Argentina 2022

Esta es la vigésimo sexta publicación de la serie de indicadores básicos desde que en 1996 el Ministerio de Salud de la Nación y la Organización Panamericana de la Salud presentaron esta iniciativa. Indicadores Básicos 2022 recopila los últimos datos disponibles en el país provenientes de diversas fuentes oficiales. Continúan las ya clásicas secciones de indicadores demográficos, socioeconómicos, de recursos, acceso y cobertura, de morbilidad, de mortalidad y salud materno-infantil, indicadores generales del país y enfoque de género cuando está disponible. En esta ocasión, se han actualizado los indicadores socioeconómicos con información de la Encuesta Permanente de Hogares y se desagregan los indicadores de ocupación por sexo. También se incluye un apartado especial sobre las muertes por la Enfermedad por COVID-19 y las principales causas de muerte en el año 2020.

NPS (Net Promoter Score). Métrica de la experiencia del cliente: construcción y análisis del indicador de una cobertura médica privada / NPS (Net Promoter Score), Customer experience metrics.: construction and analysis of the indicator of private medical coverage

Introducción: el NPS (Net Promoter Score) es un indicador que se utiliza en los programas de experiencia del cliente para medir la satisfacción de dicho público objetivo y su lealtad. Nuestra finalidad fue consolidar el NPS por primera vez en una prepaga de un hospital de alta complejidad de Buenos Aires (PS-HIBA) en busca de establecer un indicador objetivo desde la perspectiva del cliente. Métodos: se realizó un estudio observacional analítico, de corte transversal. Se incluyeron en el estudio los datos obtenidos a partir de las respuestas de los afiliados al PS-HIBA. Resultados: se consolidó el primer indicador NPS del PS-HIBA: 22 puntos. Se visualizaron los tres perfiles de clientes, obteniendo un 45,7% promotores, 22,3% detractores y 32% pasivos o neutros. Complementariamente se identificaron los motivos de dichas calificaciones; las tres principales fueron: la problemática de accesibilidad a los turnos, la atención y los profesionales valorados positivamente. Conclusión: este estudio aporta un indicador objetivo, que facilita un lenguaje común en la organización y una comparación con el mercado desde la mirada del cliente. El NPS, como sistema, busca impulsar la construcción de una cultura centrada en el cliente, con el fin de mejorar su lealtad y permitir una retroalimentación donde se logra tener presente la voz del cliente, e identificar, priorizar y abordar los problemas percibidos. Nos permite establecer los lineamientos de oportunidades de mejora desde la perspectiva de los pacientes. (AU)

Introduction: the NPS (Net Promoter Score) is an indicator used in customer experience programs to measure the satisfaction of said target audience and their loyalty. Our purpose was to send the survey and consolidate the NPS for the first time in a high complexity prepaid hospital in Buenos Aires (PS-HIBA) in search of an objective indicator from the customer's perspective. Methods: an analytical, cross-sectional observational study was carried out. Data obtained from members' responses to the PS-HIBA were included in the study. Results: the first NPS indicator of PS-HIBA was consolidated: 22 points. The three customer profiles were displayed, obtaining 45.7% promoters, 22.3% detractors and 32% passive or neutral. Complementarily, the reasons for these qualifications were identified, being the three main ones: the problem of accessibility to medical appointments, the medical attention and the professionals valued positively. Conclusion: this study provides an objective indicator which facilitates a common language in the organization and a comparison with the market from the customer's point of view.The NPS as a system seeks to promote the construction of a customer-focused culture, in order to improve their loyalty and allow feedback. Thus, it is possible to keep the customer's voice in mind, identify, prioritize and address the perceived problems. It allows us to establish the guidelines for opportunities to improve from the patients' perspective. (AU)

Spatial-temporal analysis of hospitalizations with death caused by oral cancer in Brazil and its correlation with the expansion of healthcare coverage

Background: Oral cancer (OC) is a growing public health problem worldwide. In Brazil, the National Oral Health Policy, implemented in 2004, expanded access to oral health services and prioritized OC care. However, it is not known whether this expansion resulted in a reduction in hospital admissions with death. This study aimed to analyze the proportion of hospital admissions who progressed to death due to OC in Brazil from 2007 to 2019 and its correlation with the coverage of health services. Material and Methods: This study is an ecological, longitudinal, and analytical study of hospital admissions with death due to OC recorded in the Brazilian Hospital Information System. The following analyses were performed: descriptive, spatial (choropleth maps and Moran index), and negative binomial regression, with a hierarchical approach, estimating crude and adjusted regression coefficients (β) and respective 95% confidence intervals (95% CI) (alpha=5%). Results: In 2019, Moran's index (I) of spatial autocorrelation showed a negative association between hospital admissions with death and dentist surgeon/inhabitant rate (I=-0.176), physician/inhabitant rate (I=-0.157), family health strategy (FHS) coverage (I=-0.080), oral health team (OHT) coverage (I= -0.129), dental specialty centers (DSC)/inhabitant rate (I= -0.200), and oncology bed/inhabitant rate (I= -0.101). In the adjusted regression analysis, the proportion of hospitalizations with deaths caused by OC was higher in Brazilian states with a lower medical ̸inhabitant ratio (β= -0.014; p=0.040), a lower dentists/inhabitant ratio (β= -0.720; p=0.045), a lower number of DSC (β= -0.004; p<0.000), a lower amount paid per hospitalization (β= -10.350; p<0.001), and a lower number of biopsies (β= -0.00008; p=0.010). The proportion of hospitalizations that progressed to death showed a positive association with the number of days of hospitalization (β= 0.00002; p=0.002). (AU)

National Assessment of the Health Extension Program in Ethiopia: Study Protocol and Key Outputs

BACKGROUND: The Health Extension Program (HEP) was introduced in 2003 to extend primary health care services by institutionalizing the former volunteer-based village health services.However, this program is not comprehensively evaluated.MATERIALS AND METHODS: The 2019 comprehensive national assessment of HEP involved (1) assessment through quantitative and qualitative primary data, (2) a thorough systematic review of the HEP literature, and (3) a synthesis of evidence from the two sources. The assessment included household survey(n=7122), a survey of health extension workers (HEWs) (n=584)_, and an assessment of health posts (HPs)(n=343) and their supervising health centers (HCs)(n=179)from 62 randomly selected woredas. As part of the comprehensive assessment.OUTPUT AND RESULTS: The outputs were (a) full and abridged reports, (b) 40 posters, (c) seven published, three under review scientific papers and (d) seven papers in this special issue. During the one-year period preceding the study, 54.8% of women, 32.1% of men, and 21.9% of female youths had at least a one-time interaction with HEWs. HPs and HEWs were universally available. There were critical gaps in the skills and motivation of HEWs and fulfillment of HP standards: 57.3% of HEWs were certified, average satisfaction score of HEWs was 48.6%, and 5.4% of HPs fulfilled equipment standards. CONCLUSIONS: The findings informed policy and program decisions of the Ministry of Health, including the design of the HEP Optimization Roadmap 2020­2035 and the development Health Sector Transformation Plan II. It is also shared with global community through published papers

Ethiopian Health Extension Workers' Training Status and Perceived Competency

BACKGROUND: Training and work experience are critical inputs for delivering quality health services. However, no nationwide assessment has been conducted on the status of training and the competency of Health Extension Workers (HEWs). Therefore, this study aimed to assess HEWs' pre service training status and perceived competency in Ethiopia. METHODS: The study was conducted in all regions and all HEWs training institutions in Ethiopia. We used cross sectional study design with a mixed method approach that included 585 HEWs, 1,245 HEW trainees, 192 instructors, and 43 key informants. Descriptive statistics and thematic analysis were used to analyse quantitative and quantitative data respectively. RESULT: Twenty-six percent of the HEWs said that they were competent to deliver all the HEP activities, and 73% of the HEWs said that they could confidently deliver 75% of the HEP activities. Receiving in-service training and having level III/IV qualifications are positively associated with the competency of HEWs. Similarly, HEP trainees perceived themselves as highly competent in executing their professional work, except in using computer and mobile health technology. Both instructors and trainees rated the quality of the curriculum and course materials positively. However, basic services and facilities in most training institutions were perceived to be inadequate. Additionally, individual learning, problem-solving, case-analysis, and assessment methods such as project work and portfolios were rarely practiced. CONCLUSIONS: Although the perceived competence of HEW trainees is high, the HEWs' training is not provided as per the curriculum because of limited resources. All the necessary resources should be made available to produce competent HEWs

Depression and Burnout among Health Extension Workers in Ethiopia: A Cross-Sectional Study

BACKGROUND: Depression and burnout are common among healthcare workers (HCWs) and negatively affect their well being and the quality of the service they provide. However, the burden of depression and burnout among health extension workers (HEWs) in Ethiopia and their relationship has not been documented well. The objective of this study was to estimate the prevalence of depression and burnout among HEWs in Ethiopia and to investigate the relationship between these conditions. MATERIALS AND METHODS: We used a cross-sectional study design and collected data from 584 rural and 581 urban HEWs in Ethiopia, as part of the 2019 national health extension program assessment. The Patient Health Questionnaire (PHQ-9) and Burnout Self-Test were used to screen HEWs for depression and burnout, respectively. We used descriptive statistics to estimate the magnitude of depression and burnout, and logistic regression to examine their relationship. RESULT: Based on PHQ-9 cutoff scores of 10, the prevalence of major depression was 16.5% among rural and 8.9% among urban HEWs, whereas burnout risk was 39.8% among rural and 12.6% among urban HEWs. The odds of having depression among HEWs with burnout risk was relatively higher compared to those without burnout risk [For rural HEWs, the adjusted odds ratio (AOR) is 11.88 at a 95% confidence interval (CI; 5.27, 26.80), and for urban HEWs, the AOR is 11.49 at a 95% CI (5.35, 24.63)]. CONCLUSION: The prevalence of depression and burnout is high among HEWs in Ethiopia, with a significant rural­urban difference, and burnout is a significant predictor of depression. Mental health interventions that enable prevention, early detection, and management are needed especially for rural HEWs who are in charge of preventive health service delivery for the disadvantaged rural communities

Relevance of the Health Extension Program to the current Health Needs and Evolving Demands of Rural Ethiopia: A Mixed-Method Analysi

BACKGROUND: Ethiopia has been implementing a health extension program (HEP) to respond to the high maternal and child mortality in rural communities. HEP has brought tremendous contributions to improved access and coverage of primary healthcare in the last 15 years. Despite its attributions, attention to HEP has declined in recent years due to several reasons. This study is designed to explore HEP's relevance to the current healthcare needs of the rural communities. METHODS: This study is a nested cross-sectional mixed method to the overall HEP's evaluation between March and May 2019. Descriptive statistics were used on qualitative and quantitative assessment. A literature review supplemented the assessment. A representative quantitative sample of 11,746 women, men, and young girls; a qualitative sample of 268 key informants from Kebele administrators, HEWs, program people in the health system and focus groups from community leaders, men and women from 185 Kebeles in 62 woredas were selected. A thematic approach was used for qualitative analysis. RESULTS: Rural communities and program managers asserted that HEP's service packages with the existing service delivery modalities were relevant. Eighty-two percent of men and women and 77% of young girls confirmed this relevance. Besides the existing packages, additional curative services for adults and children were recommended with emphasis on the pastoralist community. HEP's service uptake has declined as over 86% of targeted rural communities bypassed HPs due to unavailability of services and capacity problems of HEWs. CONCLUSION: The current HEP packages with the existing service delivery modalities are still relevant to the rural communities' health needs. However, on-going changes to address the evolving demands of the targeted rural communities are crucial

Interações entre regulação sanitária e Avaliação de Tecnologias em Saúde para cobertura em sistemas de saúde e a integralidade do cuidado / Interactions between health regulation and Health Technology Assessment for coverage in health systems and comprehensive care

Resumo Este estudo analisa as interações entre os processos regulatórios e de avaliação de tecnologias de saúde (ATS) voltados para a cobertura dos sistemas de saúde. Foi realizada revisão em cinco bases de dados visando identificar experiências de articulação entre processos regulatórios e processos de ATS, sendo incluídas 19 publicações. Quanto ao tipo de processo, destacaram-se o early dialogue, scientific advice e parallel advice como forma de interação entre ATS e regulação. Os estudos abordaram a interação entre a ATS e a regulação sanitária para as políticas de cobertura de medicamentos em sistemas de saúde, sendo escassas as evidências em relação a outros produtos. Ademais, essa interação é descrita basicamente para o que se refere à entrada de novas tecnologias nos sistemas de saúde. A interação entre ATS e regulação sanitária resultou na redução de prazos para a comercialização e incorporação da tecnologia nos sistemas de saúde. Os tipos de processo de interação identificados podem apresentar benefícios para todo o sistema de saúde, aumentando a cobertura e a integralidade do cuidado, entretanto, apesar dos avanços, ainda persistem barreiras para a interação entre agências reguladoras e a gestão de sistemas de cobertura.

Abstract This study analyzes the interactions between regulatory and health technology assessment (HTA) processes aimed at health systems coverage. A review was carried out in five databases to identify experiences of articulation between regulatory processes and HTA processes, and 19 publications were selected. Regarding the type of process, early dialogue, scientific advice and parallel advice stood out as forms of interaction between HTA and regulation. The studies addressed the interaction between HTA and health regulation for medicines coverage policies in health systems, with scant evidence in relation to other products. Furthermore, this interaction is basically described according to the entry of new technologies into health systems. The interaction between HTA and health regulation resulted in reduced deadlines for the commercialization and incorporation of the technology into health systems. The types of interaction processes identified can benefit the entire health system, increasing coverage and comprehensiveness of care. However, despite advances, some barriers to interaction between regulatory agencies and the management of coverage systems still persist.

Adequacy of prenatal care and associated factors in the State of Rio Grande do Sul, Brazil

ABSTRACT OBJECTIVE This study aims to assess the degree of adequacy of prenatal care (PNC) in the state of Rio Grande do Sul (RS) and in its 7 macro-regions considering the time of PNC initiation and the number of appointments attended. It also aims to verify the mode of delivery prevalence and the factors associated with PNC adequacy by mode of delivery. METHODS Sub analysis from a cross-sectional study conducted among 13,432 childbearing women aged 15-49 years assisted in 66 maternity hospitals of the Unified Health System (SUS) and private associated facilities from September 2017 to October 2019. A standardized form was used to collect sociodemographic data, and information about PNC and delivery from the childbearing women's prenatal cards, hospital records, and medical reports. RESULTS The PNC coverage was (98.4%), but only 57.5% of the participants had an adequate PNC defined as the one initiated until the 12th gestational week, with attendance of at least 6 appointments. The cesarean rate was 57.2%. Among women who performed vaginal delivery, multivariate analysis showed that for each 1-year increase in the age of the parturient, the chance of having an adequate PNC increased by 5%. White parturients with higher education and fewer deliveries residing in the macro-region of Valleys were more likely to have an adequate PNC when compared with non-white parturients, who were illiterate and/or had incomplete elementary school, with 3 or more deliveries and who resided in other macro-regions. During pregnancy, 96.0% of the women performed at least one anti-HIV test, 55.8% a rapid test for syphilis, and 75.0% a Venereal Disease Research Laboratory test (VDRL). CONCLUSIONS Despite the almost universal PNC coverage in RS, the PNC offered by the SUS was adequate for just half of the population, therefore public health policies targeted at women receiving care in this setting shall be revisited.

Diretriz brasileira para detecção precoce do câncer de mama: desafios para implantação / Brazilian breast cancer early detection guideline: challenges for implementation

Objetivo: Avaliar o acesso e a adesão da população feminina, atendida pelo Sistema Único de Saúde (SUS), à Diretriz Brasileira de Detecção Precoce do Câncer de Mama, em duas cidades de médio porte de uma região metropolitana do estado de São Paulo, Brasil. Métodos: Estudo transversal. Os dados foram coletados no Sistema de Informação do Câncer (Siscan) e nas Secretarias Municipais de Saúde no período de 01/01 a 31/12 de 2017. Resultados: Em Santa Bárbara d'Oeste, foram realizadas 3.106 mamografias: 2.931 (94,4%) BI-RADS® 1-2; 21 (0,7%) BI-RADS® 3; 12 (0,4%) BI-RADS® 4-5; 142 (4,5%) BI-RADS® 0. A maioria dos exames (1.855 ­ 59,7%) foi realizada em mulheres de 50 a 69 anos. A cobertura mamográfica na população de risco foi de 11,2%. O envelhecimento foi relacionado ao BI-RADS® 4-5 (p = 0,005). A idade jovem esteve relacionada ao maior número de BI-RADS® 0 (p = 0,03). Em Vinhedo, foram realizadas 1.996 mamografias: 1.835 (91,9%) BI-RADS® 1-2; 9 (0,45%) BI-RADS® 3; 7 (0,35%) BI-RADS® 4-5; 145 (7,3%) BI-RADS® 0. A maioria dos exames (975 ­ 48,8%) foi realizada em mulheres de 50-69 anos. A população coberta pela mamografia foi de 17%. Reunindo ambas as análises populacionais, evidenciou-se que o envelhecimento esteve relacionado ao maior número de casos suspeitos (p = 0,007). Conclusão: A maioria das mamografias foi realizada em mulheres de 50-69 anos. A cobertura mamográfica ficou aquém da encontrada no Brasil e recomendada pela Organização Mundial da Saúde.

Objective: To evaluate the access and adherence of the female population, assisted by Health Unic System (SUS), to Brazilian Breast Cancer Early Detection Guideline in two medium-sized cities of a metropolitan region in the State of São Paulo, Brazil. Methods: Cross-sectional study. Data were collected from the Cancer Information System (Siscan) and from the Municipal Health Secretariats between 01/01 to 12/31, 2017. Results: In Santa Bárbara d'Oeste 3,106 mammograms were performed: 2,931 (94.4%) BI-RADS® 1-2; 21 (0.7%) BI-RADS® 3; 12 (0.4%) BI-RADS® 4-5; 142 (4.5%) BI-RADS® 0. Most of the exams (1,855 ­ 59.7%) among women aged 50-69 years. The mammographic coverage at risk population was 11.2%. Aging was related to BI-RADS® 4-5 (p = 0.005). The young age was related to the highest number of BI-RADS® 0 (p = 0.03). In Vinhedo 1,996 mammograms were performed: 1,835 (91.9%) BI-RADS® 1-2; 9 (0.45%) BI-RADS® 3; 7 (0.35%) BI-RADS® 4-5; 145 (7.3%) BI-RADS® 0. Most of the exams (975 ­ 48.8%) among women aged 50-69 years. The population covered by mammography was 17%. Gathering both population analysis, it was shown that aging was related to the highest number of suspected cases (p = 0.007). Conclusion: Most mammograms were performed between 50-69 years. Mammographic coverage fell short of that found in Brazil and recommended by the World Health Organization.

Association between socioeconomic factors and origin of hospital referrals among patients with oral cancer

Background: The Brazilian Unified Health System (SUS) is responsible for offering free assistance to more than100 million Brazilians, including treatment of oral cancer lesions. Considering that the Brazilian public systemaids the most vulnerable population, this study analyzed whether the origin of hospital referrals of patients withoral cancer is associated with socioeconomic factors.Material and Methods: A cross-sectional study was carried out from cancer hospital records of the National Cancer Institute (RHC-INCA), considering the primary locations (C00 to C06) diagnosed between 2016 and 2019.Data on gender, skin color (white and non-white), education (no schooling, incomplete or complete elementaryeducation; high school; incomplete and complete higher education) and origin of referral (SUS and non-SUS) wereanalyzed by multiple logistic regression (p<0.05).Results: Higher referral rates by the SUS were observed in 2017 (OR=1.27; 95% CI=1.098-1.480) and 2018(OR=1.28; 95% CI=1.101-1.490); no differences were found between the years 2016 and 2019. Regarding gender,men were 40% more likely to have the SUS as the source of referral (OR=1.40; 95% CI=1.233-1.600). Non-whiteindividuals were 34% more likely to have the SUS as the source of the referral (OR=1.34; 95% CI=1.190-1.512). Illiterate individuals or individuals who only attended elementary school were 6.38 times more likely to be referredby the SUS than individuals with higher education (OR=6.38; 95% CI=5.228-7.796).Conclusions: It is concluded that the origin of hospital referrals via SUS of patients with oral cancer is associatedwith socioeconomic factors. (AU)

Construir sistemas de salud resilientes para avanzar hacia la salud universal en la Región de las Américas. Enseñanzas de la COVID-19

En este folleto se resume la situación de los sistemas y servicios de salud en la Región de las Américas en su progreso hacia el acceso universal a la salud y la cobertura universal de salud (la “salud universal”). Se presenta la situación previa a la pandemia de COVID-19, el efecto que ha tenido en los sistemas de salud y las recomendaciones para encarar los retos actuales y futuros en la construcción de sistemas de salud resilientes que permitan seguir avanzando hacia la salud universal en la Región.

Judicialização da assistência hospitalar negada por planos e seguros de saúde no Estado de São Paulo / Litigation of hospital care denied by private health insurance and plans in the state of São Paulo

Este artigo sistematizou a legislação e as alterações da regulamentação das coberturas dos planos de saúde entre 1998 e 2020 e analisou 2.845 acórdãos do Tribunal de Justiça do Estado de São Paulo no ano de 2018, relacionados a negativas de coberturas reclamadas por consumidores de planos de saúde. As coberturas hospitalares, dentre as quais destacam-se as cirurgias e internações, foram o principal objeto das demandas, compondo 41% do total estudado. A maioria das coberturas hospitalares excluídas ou negadas não constavam no rol de procedimentos e eventos em saúde da Agência Nacional de Saúde Suplementar. A regulamentação dessa agência, com destaque para o rol de procedimentos e eventos em saúde, relaciona-se com a exclusão de coberturas hospitalares por planos de saúde, sendo utilizada como argumento para a defesa judicial da negativa de cobertura pelas operadoras de planos de saúde, em conjunto com as previsões contratuais. O Tribunal de Justiça do Estado de São Paulo, na maioria das vezes (80% dos casos estudados), garantiu a cobertura hospitalar demandada, fundamentando as decisões prioritariamente no Código de Defesa do Consumidor, na Jurisprudência do Tribunal de Justiça do Estado de São Paulo, nas súmulas do tribunal e na Lei n. 9.656/1998 (Lei dos Planos de Saúde). Conclui-se que o Poder Judiciário, quando provocado, tende a reconhecer o direito dos consumidores ao acesso às coberturas assistenciais, muitas vezes em contraposição à regulação setorial pela Agência Nacional de Saúde Suplementar.

This article revisited the legislation and changes in the sectorial regulation of healthcare coverage from 1998 to 2020, and analyzed 2,845 decisions issued by the São Paulo State Court of Justice in 2018 related to coverage denial against health insurance beneficiaries. Inpatient coverage, among which surgeries and hospitalizations stand out, was the main object of the claims, accounting for 41% of the analyzed decisions. Most of the denied inpatient coverage was not included on the list of health procedures and events of the Brazilian Regulatory Agency for Private Health Insurance and Plans. This agency's regulation, especially the List of Health Procedures and Events, is related to the exclusion of hospital coverage by private health insurance, and is used as an argument for the legal defense for coverage denial together with contractual provisions. The São Paulo State Court of Justice, in most cases (80%), guaranteed the inpatient coverage claims, basing such decisions on the Consumer Protection Code, on Jurisprudence, on the Court's precedents and on Law no. 9.656/1998 (Health Insurance Law). In conclusion, when upon, the Judiciary tends to recognize the right of consumers to access health care coverage, often in opposition to sectorial regulation by the Brazilian Regulatory Agency for Private Health Insurance and Plans.

Exame citopatológico do câncer de colo do útero: estratégias para ampliação da cobertura / Cytopathological examination of cervical cancer: strategies for expanding coverage

O câncer do colo do útero é o terceiro câncer mais incidente em mulheres no Brasil e no mundo. As alterações celulares que dão origem ao câncer do colo do útero podem ser visualizadas precocemente com o exame citopatológico do colo do útero. O indicador 11 da pactuação interfederativa se refere à razão entre o número de exames citopatológicos do colo do útero realizados em mulheres de 25 a 64 anos e o total de mulheres da faixa etária no município. Nos últimos dois anos, o indicador municipal não atingiu a meta pactuada em 2016, de 62%.

Cervical cancer is the third most common cancer in women in Brazil world. The cellular changes that give rise to cervical cancer may be visualized early with cytopathological examination of the cervix. The indicator 11 of the interfederative agreement refers to the ratio between the number of tests cervical cytopathology performed in women aged 25 to 64 years and the total age group in the city. In the last two years, the municipal indicator did not reached the agreed target in 2016 of 62%.

Utilização de atendimentos no serviço de atenção básica em um município do Espírito Santo segundo perfil sociodemográfico e de condições de saúde / Use of primary care services in a city of Espírito Santo according to sociodemographic profile and health conditions

A Atenção Básicaé a principal porta de entrada do Sistema Único de Saúde. O acesso efetivo a esse serviço pode ser avaliado pela utilização de atendimentos, e não apenas pela disponibilidade. O conhecimento do perfil populacional permite identificar grupos vulneráveis ànão utilização, assim como conhecer as morbidades mais prevalentes para promover melhor organização da oferta e utilização do serviço. Este trabalho trata-se de um estudo transversal, cujas fontes de dados foram registros das fichas do e-SUS de 8.390 indivíduos, cadastrados numa Unidade de Saúde da Família (USF). Foi analisada a prevalência de utilização de atendimentos na USF, nos quais se incluíram consultas médicas e de enfermagem. Foram comparados os perfis sociodemográfico e de morbidade referida dos utilizadores e não utilizadores da USF em 2019. O percentual de utilização de consultas foi de 50,1% dos cadastrados, sendo a média de 2,3 consultas por habitante ao ano. A maioria dos utilizadores fez até cinco consultas ao ano, porém aproximadamente um terço das consultas se referiram aos hiperutilizadores. Ser do sexo feminino, ser pardo ou negro, ter baixa escolaridade, idade mais avançada e não possuir plano de saúde privado foram condições associadas à maior utilização de consulta.

Primary care is the main entry point into the Brazilian public health system. Effective access to this service can be assessed not only by the quality of the healthcare assistance but also by its availability. Knowledge of the population's profile makes it possible to identify groups that are vulnerable to non-use of the service as well as to the most prevalent morbidities, so theservice can be better offered and organized. This is a cross-sectional study whose data source was records of 8,390 e-SUS files registered in a Family Health Unit (USF, in Portuguese). The prevalence of use of services at the USF was analyzed, which included medical and nursing consultations. The sociodemographic and reported morbidity profiles of users and non-users of the USF in 2019 were compared. The percentage of consultations was 50.1% of registered ones, with an average of 2.3 consultations per inhabitant per year. Most users have up to five consultations per year, but approximately a third of those consultations are referred to as hyper-users. Being female, being mixed-race or black, having low-level education, being older, and not having a private health plan were associated with greater use of consultations.

The Knowledge Dialogues Methodology

Knowledge dialogues, also called intercultural dialogues, are processes of communication and exchange between people, groups or communities that come from different backgrounds or cultures. In the case of the health sector, exchanges take place between certain groups or individuals and trained health personnel. Its objective is, among others, to improve access to health services and build intercultural health, with emphasis on solving previously raised problems and their causes, mutual understanding and the creation of solid links. This publication, which contains the methodology applicable to this field, is aimed at health personnel or other areas and sectors in order to contribute to the search for ways to know, share and build healthy practices. The groups considered in this case are the indigenous and Roma populations, and the Afro-descendants, although strictly speaking the methodology can be applied to working with any group (migrants, displaced persons, adolescents, the elderly, etc.) that presents problems of universal access to health and universal health coverage.