Mortalidade infantil evitavel e barreiras de acesso a atencao basica no Recife, Brasil

Abstract

OBJECTIVE:Analyze the factors infl uencing avoidable infant mortality from the perspective of the protagonists involved. METHODS:Qualitative study with a critical-constructivist approach, examining children's access to health care and avoiding preventable infant mortality through health care campaigns and services in Health District I of Recife, Northeastern Brazil, between February 2007 and February 2008. The theoretical sample was designed in two stages: I) institutions providing health services to children; II) interviewees: managers (11) (20), with sample size defi ned by "saturation of the speeches". Data was collected using individual semistructured interviews and case studies of avoidable infant death. Thematic content analysis was used, generating mixed categories (emerging and scripted). RESULTS:There were perceived to be confl icting positions between different stakeholder groups refl ecting their role in the care network. All institutional participants related infant deaths to the absence/poor dissemination of child health policies and inter-sectoral actions; professionals and mothers highlighted diffi culties in accessing health care due to insuffi cient global resources, especially the lack of doctorsinFamily Health Strategy, shifting health care to nurses. Lack ofdoctors,acutediseases rejection, and dehumanized and/or poortechnical quality carewere the mainfactors which the mothers relatedto deaths. Family Health Strategy participants from the Programme of Community Health Workers and mothers identifi ed thecondition ofsocial exclusionand maternal neglectwith deaths, but the case studyof deathrevealedthe association withlowerquality of care offered. CONCLUSIONS: Numerous barriers to access indicate insuffi cient BrazilianUnifi ed Health System implementation and lack of resolution of the main access route, the Family Health Strategy. The results indicate the need for improvement of structural and organizational factors of supply, with emphasis on mechanisms to stimulate the recruitment of doctors for the Family Health Strategy professional training of all staff consistent with the model of care to comply with health care policies for children and avoiding preventable infant mortality.

Práticas profissionais de saúde diante da linha cuidado à criança

“…Accessibility also presents difficulties when dealing with children with special needs, negatively affecting the quality of care and impairing the development of their potential. 9,10,14,29,34 The guarantee of access to health services is still a constant challenge to the Brazilian health system. Due to the slowness in obtaining resoluteness and the imposition of organizational barriers to the care provided by families, emergency care services to solve the children's health problem are sought.…”

Inequities in access to health care in different health systems: a study in municipalities of central Colombia and north-eastern Brazil

“…Based on the Behavioral Model of Health Services Use [53] and previous qualitative research [54-58], dimensions and variables were identified. In addition, systematic reviews were conducted of studies on access and equity of access to health care and of available tools in order to identify additional variables.…”

Percepções de urgência e emergência pediátrica entre quilombolas: uma abordagem à luz de Leininger [Quilombo women’s perceptions of acute and emergency pediatric care: an approach in the light of Leininger] [Percepciones de urgencia y emergencia pediátrica entre quilombolas: un enfoque a la luz de Leininger]

“…Considerando que nas situações emergenciais o fator tempo é preditor na tomada de decisões e no desfecho do caso 2 -sobretudo em locais geograficamente isolados, onde serviços de maior complexidade são inexistentes -esse elemento é importante, principalmente quando os agravos acometem crianças, visto que há uma relação próxima entre mortalidade infantil por causas preveníveis e acesso aos serviços de saúde, sendo necessário ampliar o acesso ao setor secundário ou terciário das Redes de Atenção à Saúde (RAS) 3 .…”