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Introdução: Os Sistemas de Saúde podem ser analisados de forma sistemática de modo a ser possível avaliar a sua performance e os seus resultados em saúde, bem como a serem passíveis de comparação. O Brasil é um país caracterizado por heterogeneidade cultural, territorial, racial e política, tendo cada Estado uma realidade destinta. Recorrendo ao estágio hospitalar e em cuidados de saúde primários na cidade de Natal e ao contacto com uma nova realidade em saúde, pretendeu-se estudar o sistema de saúde brasileiro, nomeadamente no Rio Grande do Norte.
Objetivo: (I) analisar a organização do sistema de saúde brasileiro e do SUS, em específico no Rio Grande do Norte; (II) analisar a performance do sistema de saúde e do SUS no Rio Grande do Norte; (III) compreender a gestão do sistema de saúde e do SUS no Rio Grande do Norte; (IV) analisar o estado de saúde da população do Rio grande do Norte; (V) refletir sobre os obstáculos a uma melhor saúde existentes no Rio Grande do Norte e sobre os meios de superação dos mesmos.
Métodos: uso de duas estruturas teóricas: I) o Modelo de Avedis Donabedian para análise da organização e performance do sistema de saúde, através da sua divisão em “estrutura”, “processo” e “resultado”; II) o Modelo de Kelley and Hurst (2006), para análise das atividades e qualidade dos cuidados de saúde bem como o seu impacto no estado de saúde da população fazendo recurso, entre outras ferramentas, aos indicadores em estudo comparados com os valores médios da OCDE explicitados no relatório “Health at a Glance 2015”. Para recolha de dados foram utilizados: i) Recolha documental física e virtualmente; ii) Recolha de entrevistas; III) Processo mini-etnográfico de experiência pessoal com o sistema de saúde durante cinco meses no Brasil.
Resultados: O SUS é um sistema de saúde “tendencialmente” universal, já que na prática não tem capacidade de abranger toda a população do Rio Grande do Norte. Existem muitos fatores intrínsecos que têm impacto negativo no alcance da equidade em saúde no RN tais como a dimensão do território, o grau de pobreza e situação política instável e seu carater interventivo. A gestão do SUS no RN é frágil, existindo falhas na formação de gestores estaduais e municipais, o que pode tornar os cuidados de saúde menos efetivos e eficientes. A regionalização foi um processo que beneficiou o Rio Grande do Norte no que toca à distribuição mais equitativa dos cuidados de saúde e esforços continuam a ser feitos para melhorar esta estratégia. Existe subfinanciamento da saúde por, mais explicitamente pela União, o que propicia o “esgotamento” de recursos financeiros para investimento em saúde do RN e dos seus Municípios. Os cuidados de saúde primários têm evoluído positivamente ao longo dos anos, apresentando ótimos resultados de cobertura da ESF, que se refletem em vários indicadores como os internamentos evitáveis por causas sensíveis aos cuidados de saúde, cobertura de imunizações e TMI. Os cuidados de saúde terciários e secundários encontram-se mais atrasados quanto à sua performance já que os indicadores hospitalares e integrados refletem precaridade nos seus resultados. O estado de saúde da população do RN apresentou melhoria ao longo dos anos nomeadamente na EMV e perceção do estado de saúde. No entanto, os indicadores de mortalidade geral e mortalidade por causas selecionadas, apesar de apresentarem valores inferiores, acompanham a tendência crescente dos países da OCDE. A falta de médicos é uma realidade que o RN enfrenta historicamente, no entanto, mesmo com o aumento do seu número com o programa “Mais Médicos”, o rácio médico-doente continua a ser baixo e insuficiente. O RN tem-se empenhado na melhoria do acesso à saúde e no combate às iniquidades existentes na população. Para isso os gestores continuam a unir esforços, apostando na formação específica profissional, na implementação de políticas de saúde efetivas, no fortalecimento das redes de assistência e no fornecimento de meios para uma vida mais saudável da população.
Conclusão: O SUS é um sistema de saúde em evolução que enfrenta muitos obstáculos. O papel dos gestores de saúde é crucial para o atingimento das metas propostas. A saúde no Rio Grande do Norte apresenta resultados promissores e uma tendência positiva e as estratégias e políticas de saúde implementadas pelo SUS parecem ir de encontro à superação dos desafios que o Estado encara.
Introduction: Health care systems should be systematized so as to be possible to assess their performance and their health outcomes, as well as to be comparable. Brazil is a country characterized by cultural, territorial, racial and political diversity, each State having a distinct reality. Resorting to hospital and primary health care training in Natal associated with contact with a new reality in health, we intend to study the Brazilian Health Care System, especially in Rio Grande do Norte. Aim: (I) to analyze the organization of the Brazilian health care system and the SUS, specifically in Rio Grande do Norte; (II) to analyze the performance of the health care system and SUS in Rio Grande do Norte; (III) comprises the management of health care system and SUS in Rio Grande do Norte; (IV) to analyze the health state of Rio Grande do Norte population; (V) reflect on the obstacles existing to better health in Rio Grande do Norte and the means of overcoming them. Methods: use of two theoretical frameworks: I) the Avedis Donabedian model for analysis of the organization and performance of the health system, through its division in "structure", "process" and "result"; II) the Kelley and Hurst model (2006) for analysis of activities and quality of health care and its impact on the health status of the population making use of, among other tools, the indicators under study compared with the average values of OECD explained in the "Health at a Glance 2015". For data collection were used: i) physical document collection and virtually; ii) interviews collection; III) mini-ethnographic process with personal experience in the health system for five months in Brazil. Results: SUS is an health care system that "aims" be universal, since in practice is not able to cover all of Rio Grande do Norte population. There are many intrinsic factors that have a negative impact on health in achieving equity in RN such as the size of the territory, the degree of poverty and unstable political situation and its interventionist character. SUS management in RN is fragile and there are flaws in the formation of state and municipal managers, which can make health care less effective and efficient. Regionalization was a process that benefited the Rio Grande do Norte with regard to the more equitable distribution of health care and efforts continue to be made to improve this strategy. There is health underfunding, more explicitly by the Union, which provides the "depletion" of financial resources for investment in health care of RN and its municipalities. Primary health care has evolved positively over the years, presenting excellent results in the coverage of the ESF, which are reflected in various indicators such as avoidable hospitalizations for sensitive causes of health care, immunization coverage and TMI. Tertiary and secondary health care are behind performance wise as hospital and integrated indicators reflect precariousness in their results. The health status of the RN population has improved over the years especially in EMV and perception of health status. However, overall mortality indicators and mortality from selected causes, despite having lower values, follow the growing trend of OECD countries. The lack of doctors is a reality that the RN faces historically, however, even with the increase in their number with the "Mais Médicos" program, the doctor-patient ratio remains low and insufficient. The RN has been engaged in improving access to health and to combat existing inequalities in the population. For that managers continue to work together, focusing on specific professional training, implementation of effective health policies, strengthening of support networks and providing means for a healthier life of the population. Conclusion: SUS is an evolving health system facing many obstacles. The role of health managers is crucial to overcome them and to the achievement of the proposed targets. Health in Rio Grande do Norte shows promising results and a positive trend, and health policies implemented by the SUS, seem to have been instrumental in overcoming the healthcare challenges that the state faces.
Introduction: Health care systems should be systematized so as to be possible to assess their performance and their health outcomes, as well as to be comparable. Brazil is a country characterized by cultural, territorial, racial and political diversity, each State having a distinct reality. Resorting to hospital and primary health care training in Natal associated with contact with a new reality in health, we intend to study the Brazilian Health Care System, especially in Rio Grande do Norte. Aim: (I) to analyze the organization of the Brazilian health care system and the SUS, specifically in Rio Grande do Norte; (II) to analyze the performance of the health care system and SUS in Rio Grande do Norte; (III) comprises the management of health care system and SUS in Rio Grande do Norte; (IV) to analyze the health state of Rio Grande do Norte population; (V) reflect on the obstacles existing to better health in Rio Grande do Norte and the means of overcoming them. Methods: use of two theoretical frameworks: I) the Avedis Donabedian model for analysis of the organization and performance of the health system, through its division in "structure", "process" and "result"; II) the Kelley and Hurst model (2006) for analysis of activities and quality of health care and its impact on the health status of the population making use of, among other tools, the indicators under study compared with the average values of OECD explained in the "Health at a Glance 2015". For data collection were used: i) physical document collection and virtually; ii) interviews collection; III) mini-ethnographic process with personal experience in the health system for five months in Brazil. Results: SUS is an health care system that "aims" be universal, since in practice is not able to cover all of Rio Grande do Norte population. There are many intrinsic factors that have a negative impact on health in achieving equity in RN such as the size of the territory, the degree of poverty and unstable political situation and its interventionist character. SUS management in RN is fragile and there are flaws in the formation of state and municipal managers, which can make health care less effective and efficient. Regionalization was a process that benefited the Rio Grande do Norte with regard to the more equitable distribution of health care and efforts continue to be made to improve this strategy. There is health underfunding, more explicitly by the Union, which provides the "depletion" of financial resources for investment in health care of RN and its municipalities. Primary health care has evolved positively over the years, presenting excellent results in the coverage of the ESF, which are reflected in various indicators such as avoidable hospitalizations for sensitive causes of health care, immunization coverage and TMI. Tertiary and secondary health care are behind performance wise as hospital and integrated indicators reflect precariousness in their results. The health status of the RN population has improved over the years especially in EMV and perception of health status. However, overall mortality indicators and mortality from selected causes, despite having lower values, follow the growing trend of OECD countries. The lack of doctors is a reality that the RN faces historically, however, even with the increase in their number with the "Mais Médicos" program, the doctor-patient ratio remains low and insufficient. The RN has been engaged in improving access to health and to combat existing inequalities in the population. For that managers continue to work together, focusing on specific professional training, implementation of effective health policies, strengthening of support networks and providing means for a healthier life of the population. Conclusion: SUS is an evolving health system facing many obstacles. The role of health managers is crucial to overcome them and to the achievement of the proposed targets. Health in Rio Grande do Norte shows promising results and a positive trend, and health policies implemented by the SUS, seem to have been instrumental in overcoming the healthcare challenges that the state faces.
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Keywords
Brasil. Financiamento Gestão Em Saúde Planeamento Rio Grande do Norte Sistema de Saúde