Avaliação da qualidade da Atenção Pré-Natal no Brasil

Abstract

RESUMO O objetivo do estudo foi investigar características da estrutura das unidades de saúde e dos processos gerenciais e assistenciais da Atenção Pré-Natal (APN) no âmbito da Atenção Primária à Saúde (APS) no Brasil, em municípios que aderiram ao Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB). Trata-se de avaliação normativa com dados de 16.566 equipes de saúde da família que aderiram ao PMAQ-AB. Foi elaborado um modelo lógico dos componentes da APN, composto pelas dimensões de análise, gerencial e assistencial, e de 42 critérios de estrutura e processo e seus respectivos padrões. A estrutura das unidades básicas e as ações prestadas pelas equipes não obedeciam à maioria dos padrões, destacando-se a existência de barreiras estruturais, indisponibilidade de medicamentos e exames essenciais, problemas na oferta do elenco de ações assistenciais, envolvendo a atenção individual e o cuidado clínico, bem como de promoção da saúde e ações coletivas e domiciliares ofertadas. Conclui-se que, apesar da alta cobertura da APN e da sua institucionalização nos serviços de APS, persistem problemas que devem ser alvo de iniciativas governamentais que garantam atenção integral e de qualidade no ciclo gravídico-puerperal e que repercutam na melhoria dos indicadores de saúde materno-infantil.

Management of syphilis in pregnancy: Knowledge and practices of health care providers and barriers to the control of disease in Teresina, Brazil

“…In addition to insufficient knowledge regarding RST, the results of this study showed low use of this test in the Teresina FHS teams. Only 3.8% of the professionals reported using the RST to diagnose syphilis, a result similar to that found in a national study evaluating the quality of FHS PNC in Brazil, which observed the availability of RST and HIV rapid tests in only 1.6% of the evaluated teams . These data indicate failures in the implementation of RST in the country and low availability of RST in primary care units.…”

Evaluation of prenatal care in Primary Health Care in Brazil

“…These are extremely important factors in ensuring that the demands of the population are met without increased workload and with a satisfactory teampopulation relationship. 14 In the subdimension of standardization of care, most municipalities were inadequate, differing from the findings of Luz et al 6 . It is worth mentioning that the authors analyzed the availability of protocols, unlike the measure adopted in this study that included the information of its use.…”

“…3 The inadequacy of prenatal care actions is associated with negative effects such as prematurity and low birth weight, in addition to increased risk of fetal and maternal death, hospitalizations in intensive care units, postpartum depression and anxiety, and successive pregnancies in a short time. 4,5 In Brazil, there has been an increase in coverage of prenatal care in the last years in most of the country, 6,7 coinciding with the institutionalization of actions aimed at the comprehensiveness of care, proposed from different national programs in the period from 1984 to 2011. Despite this, the challenges persist with a high level of inadequacy of actions, endangering maternal and child health.…”

“…Despite this, the challenges persist with a high level of inadequacy of actions, endangering maternal and child health. 6 High child mortality rates, with a higher concentration of deaths in the early neonatal components, 2,8 and the still high maternal mortality rate (58 maternal deaths out of 100 thousand live births), with expressive disparities in the country, reinforce the existence of failures in the care provided.…”

“…The institutionalization of prenatal care evaluation is a fundamental strategy for the improvement of quality with consequent reduction of maternal and infant morbimortality, 10 since it reveals and produces subsidies for awareness and confrontation with failures, reviewing public policies and managerial and procedural adaptations, in order to respond more adequately and with immediate solution the needs of this population group. Studies that evaluated prenatal care with national coverage observed inadequacies in relation to the recommended 6,10,11 and had as a unit of analysis users 11 and PC 6,10 teams, and it was necessary to advance in the aspects of municipal management responsibility.…”