Managing Brazil’s Health System at municipal level against Covid-19: a preliminary analysis

Malik, Ana María; Schiesari, L; Tasca, Renato; Costa, Cinthia Ferreira; Massuda, Adriano

doi:10.1590/0103-11042022e101i

Saúde debate

2022

DOI: 10.1590/0103-11042022e101i

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Managing Brazil’s Health System at municipal level against Covid-19: a preliminary analysis

Ana María Malik

L Schiesari

Renato Tasca

et al.

Abstract: This qualitative, observational, and exploratory study was supported by quantitative data to analyze the Brazilian Unified Health System (SUS) response to Covid-19 in three Brazilian municipalities. We used semi-structured interviews to listen to and dialogue with managers of the cities analyzed, guided by a roadmap to explore the managers’ perception during the response to the pandemic, understand the motivations that guided their strategic choices, and visualize the weaknesses and potentials of the municipal… Show more

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2023

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Cited by 3 publications

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Maternal health during the COVID-19 pandemic: Experiences of health workers in three Brazilian municipalities

Carvalho,

Alves,

Silva-Junior

et al. 2023

PLoS ONE

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Objective To analyze the experiences of maternal health workers in three Brazilian cities, located in the Northeast (São Luís), Southeast (Niterói), and South (Pelotas) regions during the first year of the COVID-19 pandemic. Methods Qualitative research carried out between December 2020 and February 2021. Interviews were conducted, in person or remotely, with 30 health workers, doctors and nurses, working in maternity hospitals of different degrees of complexity. Results Sociodemographic characteristics, employment relationships and professional qualification of the interviewees were described. Two thematic axes were identified: 1) changes in hospital organization and dynamics in the pandemic; 2) Illness and suffering of health workers. The majority of respondents were women. Most physicians had work relationships in the public and private sectors. In Niterói, health workers had better professional qualifications and more precarious work relationships (as temporary hires), compared to São Luís and Pelotas. In the context of the uncertainties resulting from the pandemic, this situation generated even more insecurity for those workers. The statements at the beginning of the pandemic covered topics such as changes in the organizational dynamics of services, healthcare, telemedicine, and interaction between health workers and users. In the health workers’ perception, the initial period of the health emergency, which resulted in intense changes in the provision of services, was marked by an increase in preterm births, perinatal mortality, and fetal losses. Work overload, fear of contamination, concern for family members and uncertainties regarding the new disease caused intense suffering in health workers who had little institutional support in the cities studied. The suffering experienced by health workers went beyond the work dimension, reaching their private life. Conclusion Changes caused by the pandemic required immediate adjustments in professional practices, generating insecurities in healthcare regardless of the location studied. The method of hiring health workers remained the same as the previously practiced one in each city. Due to the risk of disease transmission, measures contrary to humanization practices, and more restrictive in São Luís, were reported as harmful to obstetric care. The Covid-19 pandemic was a huge challenge for the Brazilian health system, aggravating the working conditions experienced by health workers. In addition to the work environment, it was possible to briefly glimpse its effects on private life.

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Maternal health during the COVID-19 pandemic: Experiences of health workers in three Brazilian municipalities

Carvalho,

Alves,

Silva-Junior

et al. 2023

PLoS ONE

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Community health workers perspective on the COVID-19 impact on primary health care in Northeastern Brazil

et al. 2023

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This article evaluates the COVID-19 pandemic impacts on the Family Health Strategy (FHS) team’s work routines across a range of northeast Brazilian cities as perceived by community health workers (CHW). Data on COVID-19, CHW activities, and FHS teams were collected in 2021 by a structured questionnaire. A total of 1,935 CHWs from four state capitals (Fortaleza - Ceará State, João Pessoa - Paraíba State, Recife - Pernambuco State, Teresina - Piauí State) and four hinterland cities (Crato, Juazeiro do Norte, Barbalha, Sobral - Ceará State) participated in the study. Most CHWs were women (82.42%), with mean age 46.25±8.54 years. Many (39.92%) were infected with COVID-19, of which 70.78% believed they were infected in the workplace. A total of 77.82% defined their role as frontline in the fight against COVID-19, 16.07% reported receiving training for COVID-19, and 13.74% had access to sufficient protective equipment. Most (90.27%) believed their work routines were modified by the pandemic, either strengthening (41.46%) or weakening (44.41%) the team spirit. Home visits (60.55%), health promotion actions in schools (75.66%) and in specific community groups (93.96%), and other on-site community services (66.01%) showed a reduction in frequency. The sampled cities revealed a significant heterogeneity regarding responses to the COVID-19 pandemic, possibly associated with a lack of coordination by the Federal Government. Regardless of context, the pandemic led to a reconfiguration of local health systems, workflows, and primary care protocols for FHS teams. The importance of the Brazilian Unified National Health System (SUS) and its potential for reorganization during crisis should be acknowledged while preserving the headway made thus far.

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Eficiência administrativa dos municípios da região do Cariri Cearense no enfrentamento à pandemia de Covid-19

Oliveira¹,

Chagas²,

Leite³

et al. 2023

R. G. Secr.

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A pandemia de COVID-19 ficou marcada mundialmente, dentre outros fatores, pelo aumento dos gastos com saúde. O Brasil foi demasiadamente impactado, pois mesmo antes da confirmação do primeiro caso da doença o país enfrentava graves problemas socioeconômicos e fiscais. Assim, um dos maiores desafios para o gestor público, em especial de saúde, consiste em buscar ganhos de eficiência, já que os recursos são escassos, notadamente em tempos de crises. Nesse sentido, o presente estudo tem como objetivo avaliar a eficiência administrativa dos municípios da região do cariri cearense no enfrentamento à pandemia de Covid-19, utilizando a Análise Envoltória de Dados (DEA), no modelo Retornos Constantes à Escala, proposto por Charnes, Cooper e Rhodes (1978), CCR, e no modelo Retornos Variáveis à Escala, proposto por Banker, Charnes e Cooper (1984) o BCC, com orientação para outputs, para o cálculo da eficiência dos 26 municípios. Com base no CCR, em que considera a proporcionalidade entre inputs e outputs, houve maior número DMU’s eficientes. Em relação ao BCC, o qual admite que a eficiência máxima varie em função da economia de escala. Na média, os municípios obtiveram melhores escores médios de eficiência pelo método BCC em comparação ao CCR. Houve aumento de gastos com saúde, contudo houve desperdício de 3,48% nas análises pelo método BCC. O número de notificados e de confirmados foram as variáveis que apresentaram o maior potencial de melhoria indicando a necessidade de redução do contágio. Além disso, o melhor nível de eficiência não necessariamente ocorre naqueles que tiveram maiores gastos.

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Managing Brazil’s Health System at municipal level against Covid-19: a preliminary analysis

Cited by 3 publications

References 15 publications

Maternal health during the COVID-19 pandemic: Experiences of health workers in three Brazilian municipalities

Maternal health during the COVID-19 pandemic: Experiences of health workers in three Brazilian municipalities

Community health workers perspective on the COVID-19 impact on primary health care in Northeastern Brazil

Eficiência administrativa dos municípios da região do Cariri Cearense no enfrentamento à pandemia de Covid-19

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