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 1 Conselhos Locais de Saúde 0 1996 1997 1998 1999 2000 2001 2002 2003 2004 12 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 2 0 0 0 2 0 0 1 2 0 0 2 2 0 0 3 2 0 0 4 Grupo co m PS F Grupo de co mp aração
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 Equilíbrio nas relações de po der Repartição das respo nsabilidades Po pulação -alvo 100 Cadastramento das famílias 80 M apeamento Espaços compartilhados de decisão 60 Ló gica do mapeamento Discussão de caso s e atividades 40 Análise da situação de saúde Circulação da info rmação 20 0 20 100 Lógica da análise da situação de 19 saúde 80 1 2 3 Participação popular no PPLS 18 Enfoque por problemas 60 4 Princípio de respo nsabilidade Co mpreende co ntexto co munitário Enfoque 17 de risco Abo rdagem individual/co letiva Co mpreede co ntexto familiar Parcerias co m instituições Co nhece população e território 16 40 20 0 5 Município A 15 7 Município B 14 8 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. 13 12 11 10 9
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 aquino@ufba.br