A oferta de cuidados à saúde das pessoas com deficiência em municipios brasileiros de pequeno e medio porte

Abstract

This thesis aimed to analyze the provision of health care for persons with disabilities in smalland medium-sized Brazilian municipalities, addressing the following guiding question: how have these municipalities organized care for persons with disabilities to meet their health needs? It is a mixed-method study with a descriptive, exploratory, and cross-sectional design, developed using data from the national project “Evaluation of the Comprehensive Care Network for Persons with Disabilities in the SUS – Redecin Brasil”, which covered 50 municipalities distributed across the five geographic regions of the country. In the quantitative stage, 1,555 Primary Health Care (PHC) professionals participated through stratified sampling, responding to a structured questionnaire on health actions aimed at persons with disabilities. The internal consistency of the questions related to specific actions was assessed using Cronbach’s Alpha (α = 0.809), resulting in the Primary Health Care Action Score for Persons with Disabilities (EAS/PHC-PwD). Statistical analysis included comparative tests and multiple linear regressions, stratified according to the population size of the municipalities. The results revealed that knowledge about the Care Network for Persons with Disabilities (RCPD), perception of the adequacy of care provided to persons with disabilities, team composition, and the number of available services showed statistically significant evidence of being associated with an increase in the EAS/PHC-PwD. Additionally, small and medium-sized municipalities demonstrated better performance in implementing actions compared to large municipalities, highlighting the importance of differentiated approaches according to local specificities. The qualitative stage, conducted with 16 managers (PHC coordinators and municipal health secretaries) from municipalities with lower densities of health services, analyzed perceptions and experiences related to the organization of the RCPD and care for persons with disabilities through interviews and content analysis, systematized using the SWOT Matrix. Identified Strengths included physical accessibility, management strategies, and specific PHC actions; Weaknesses involved the absence of clinical protocols, inadequate infrastructure, and limited professional training; Opportunities were represented by state-level support and strengthened communication in small municipalities; while Threats referred to underfunding, political instability, pandemic impacts, and limited access to specialized services. The findings demonstrate that team qualification, knowledge of the RCPD, and the strengthening of PHC structure and actions are central elements for ensuring comprehensive care for persons with disabilities. The final proposal of the thesis included decision-support models sensitive to territorial particularities, with the potential to guide managers and professionals in developing more effective and equitable practices within the PHC context.