Proposta de metodologia de análise para a fase de avaliação externa do programa de melhoria do acesso e da qualidade da atenção básica (PMAQ-AB)

Abstract

The Program for the Improvement of Primary Healthcare Access and Quality (PMAQ – AB, Programa de Melhoria do Acesso e da Qualidade da Atenção Básica, in Portuguese) is designed to advance the population’s access to services, to improve the work conditions and the quality of services provided, as well as defray staff training. This work proposes creating a methodology of analysis for the External Assessment phase of the Program for the Improvement of Primary Healthcare Access and Quality (PMAQ – AB). This is a quantitative-approach ecologic, descriptive, inferential study. Data were collected and tabulated in 2016 and 2017 from all the healthcare teams that adhered to the program in Brazil. The variables concern the following: Municipal Management for the Development of Primary Healthcare, Employee Appreciation, and Healthcare Access and Quality and Work Process Organization of the PMAQ-AB. Information were standardized and submitted to the Principal Component Analysis (PCA) to reduce the dimensionality of data, with help from the R software and Excel spreadsheets. A total of 10,213 Family Health Teams (eSF, Equipes de Saúde da Família, in Portuguese) were assessed and 05 Principal Components (PC) were observed, among which the PC1 (0.65) had the highest relevance. Brazil’s Southeast region (n=4.770) had the highest number of teams assessed whereas the Central-Western region had the lowest number (n=545). The Dimension Municipal Management for the Development of Primary Healthcare had a positive result, especially due to managers’ support to the organization of the work process, as well as support provided by the institution and the head office to the teams; the dimension Employee Appreciation showed that professionals are financially undervalued and there is little investment in permanent training and incentive to career plan. Meanwhile, the results for the dimension Healthcare Access and Quality and Work Process Organization showed that the access and quality of healthcare and the organization of the work process are limited in most of the eSF, especially the Coordination of the healthcare network and problem solving, team action planning, organization of schedules, organization of patients’ records, taking in self-referrals, following up cases of Tuberculosis and Hansen’s disease, mental health, home care and visitations, promoting health, users’ participation, social control in the management of SUS (Sistema Único de Saúde, in Portuguese) and service to special populations, such as rural, Indian, Quilombo, and settlement populations. Evaluating a health system is a complex process which requires great effort to sensitize managers, professionals and users. The information obtained through the External Evaluation of the PMAQ-AB in Brazil, when analyzed through PCA, indicated weaknesses in essential areas for the healthcare policies, which may hinder improved access and the quality of primary healthcare.