Avaliação da atenção pré-natal na atenção básica por macrorregiões geográficas e por regiões de saúde

Abstract

Prenatal care has a relevant role in the search to promote the health of pregnant women, with the main objective being the reduction of maternal and infant morbidity and mortality. The objective of this study was to investigate the adequacy of prenatal care, under the inequalities approach, by the family health teams that joined the National Program for Improving Access and Quality of Basic Care in Brazil. This is a cross-sectional type of evaluation, based on secondary data, obtained from the database of theexternal evaluation of the second cycle of the said program, performed in 2014. The resulting informations brings data on prenatal care developed in 24,055 family health units and by 29,778 family health teams (89% of the total teams) that work in the public service of Brazil. The categories of analysis that guided the evaluation were Access and Quality of Care. The study subdimensions of Access were the availability of infrastructure and management actions. To evaluate the quality of care, the subdimensions analyzed were managerial actions and clinical actions. For these dimensions and subdimensions were evaluated for the following characteristics: Brazil and its geopolitical macro-regions (North, Northeast, Midwest, Southeast and South); Amazonas and its health regions; the average by geographic region of the: Municipal Human Development Index, population coverage of the basic care and per capita monthly household income. The evaluation of the prenatal adequacy percentage, for each dimension, obeyed the following, parameters: Adequate - the evaluated items reached 100% of positive responses for the evaluated items; Partially adequate - framed in the range of 80.1% to 99.9% positivity; Regular adequate - framed in the range of 50.1% to 80% of positive responses and Inadequate - reached the maximum of 50% positivity for the items evaluated. The results show inadequacy of the Basic Attention infrastructure in the country (26% adequate units and 31% partially adequate); low adequacy of clinical actions for quality of care (36% adequate or partially adequate) and low management capacity of the teams focused on ensuring access and quality of care. In the analysis of prenatal care adequacy by geopolitical regions of Brazil, the units' infrastructure findings pointed to a directly proportional relationship between infrastructure adequacy and higher income and HDI contexts. Whereas, for the clinical actions of care, the teams of the North and South regions obtained better results. In Amazonas the adequacy degree of prenatal care was much lower than that observed in Brazil as a total, revealing significant inequalities in access and quality of care among the nine health regions of the state. The results indicate important organizational difficulties both in access and in the quality of prenatal care offered by the teams throughout the Brazilian territory. In addition, there were significant regional and socioeconomic inequalities in the five geopolitical regions.. The management process approach allowed the apprehension of managerail aspects with explanatory power over several gaps in quality and effectiveness care, whose origin had not yet been explored in prenatal care studies.