Universidade Federal da Bahia Instituto de Saúde Coletiva Programa de Pós-Graduação em Saúde Coletiva
PRIMARY HEALTHCARE EVALUATION Rosana Aquino Salvador, Bahia Julho de 2011
Memórias da Saúde da Família no Brasil
PHC evaluation, ISC-UFBA
PHC evaluation, ISC-UFBA
Observational studies Ecological design Household surveys Case studies
Randomized community trial
Ecological design ecological and longitudinal approach in which we used a panel data - observations on multiple entities (e.g., individuals, cities, counties), for which each entity is observed at 2 or more points in time. In our study, the municipality (county) was the unit of analysis, and time-series data were assembled from several databases.
Infant mortality and childhood mortality
Primary Health Care-sensitive Conditions
PHC and conditional cash transfer
Surveillance and health system organization
Surveys
a evaluative cross-sectional study in one sanitary district in the city of Salvador, Brazil
cross-sectional study in some municipalities - the physical environment, material resources, and staff
Accessibility, service organization and social participation
Conselhos Municipais de Saúde 5 4 3 2
Conselhos Locais de Saúde
1 0
12
1996
1997
1998
1999
2000
2001
2002
2003
2004 10
Grupo com PSF
Grupo de comparação
8
6
4
2
Fonte: LOPES, SM. A influência da implantação do PSF na criação de Conselhos Locais de Saúde nos municípios da Bahia, 2007.
0 19 9 6
19 9 7
19 9 8
19 9 9
G rup o c o m P S F
2000
2001
G rup o d e c o mp a ra ção
2002
2003
2004
Case studies
Mix approach - qualitative and quantitative study;
Deeply observation of an object (primary health care) and its interactions with the its context
Evaluation of the implementation of primary care in two municipalities of the state of Bahia Po pulação -alvo Equilíbrio nas relaçõ es de po der Repartição das respo nsabilidades Espaço s co mpartilhado s de decisão Discussão de caso s e atividades
100 80 60
Cadastramento das famílias M apeamento Ló gica do mapeamento
40
A nálise da situação de saúde
20
1 100
Circulação da info rmação
20 Ló gica da análise da situação de 19 saúde 80
0
2 3
18 Enfo que po r pro blemas60
P articipação po pular no PP LS
4
40
Princípio de respo nsabilidade
17 que de risco Enfo
5 20
Co mpreende co ntexto co munitário
Abo rdagem individual/co letiva 16
0
Co mpreede co ntexto familiar P arcerias co m instituiçõ es Co nhece po pulação e territó rio 15
7
Município A Município B Fonte: Medina MG e Hartz ZMA, The role of the Family Health Program in the organization of primary care in municipal health systems. Cad. Saúde Pública, 2009.2009.
14
8
13
9 12
10 11
Randomized community trial RCT – 10 municipalities – 5 with intervention and 5 controls; Municipalities of State of Bahia – according select criteria (size of population, coverage of PSF and PSE, NASF and public high school in urban area).
Prose Promovendo Saúde na Escola Ensaio comunitário para avaliação de uma intervenção de promoção de hábitos saudáveis de alimentação e atividade física
Assumptions Intervention interacts with implemented public policies versus pilot project; Relationship between research and management; Relevance of social and cultural context; Intervention is not isolated of its context development of articulated intervention improvement public policies.
Limitations
1. Ecological design - we cannot be certain that it was FHP users who experienced improved health conditions; 2. Source of the data - national health information systems (coverage, availability and quality of data).
Challenges
1. Independent variable o define a consistent and verifiable measure of primary health care;
2. Dependent variable o mortality; o list of primary health care–sensitive conditions o partnership with other stakeholders
o indirect measure of the effectiveness of PHC
3. Covariates o availability – interpolation/extrapolation; o covariate cutoff value.
4. Counterfactual
All photos used in this presentation were taken from the book: Memories of Health Family in Brazil Photography: Radilson Carlos Gomes
Rosana Aquino
[email protected]
