7 out of 10 cities do not reach the target against hypertension – 02/23/2024 – Balance and Health

Seven out of ten Brazilian municipalities ended 2023 without achieving the minimum level of control for their diabetic and hypertensive patients, which is measuring glycated hemoglobin once a year and measuring blood pressure every six months for 50% of patients with these conditions.

Data from the last four months of 2023 from Previne Brasil, a federal program that links part of primary care resources to meeting care goals, show that these diseases are currently the worst performing in a list of seven indicators.

In addition to these, part of this relationship is the provision of six prenatal consultations for 60% of pregnant women, dental care and HIV and syphilis tests, in addition to preventive uterine cancer examinations for 40% of women between 25 and 64 years old, and vaccination coverage (polio and pentavalent) for 95% of children.

Created in the first year of Jair Bolsonaro’s (PL) administration, the indicators began to be measured in 2020, but, due to the Covid-19 pandemic, it was only in 2022 that municipalities that failed to meet the targets began to suffer discounts on federal health funds.

Analysis of the ImpulsoGov platform, a non-profit organization that promotes the use of data and technology in public management, shows that there was an improvement in the last year, but the majority of municipalities are still struggling to meet their goals.

In the first four months of 2022, the rate of municipalities that did not have minimum control of their diabetic and hypertensive patients was 97% and 95%, respectively. At the end of that year, it increased to 83% and 84%, and, in 2023, it closed at 74.8% and 72.8%.

The scenario is attributed to multiple factors. From the increase in these chronic diseases caused by population aging, combined with the lack of professionals in primary care, to methodology problems in the Ministry of Health’s information system.

According to Juliana Ramalho, project manager at ImpulsoGov, the first obstacle to meeting the goals is the large number of diabetics and hypertensive people. “Chronic diseases grow every year in the country, and the population to be monitored increases as well.”

Data from the Primary Care Observatory show, for example, that the prevalence of diabetes among the adult population in the city of São Paulo increased from 8.5% to 12.1% between 2020 and 2023. There are 1,083,135 diagnosed with the disease.

At the same time, many primary health care teams are lacking, which has negative impacts on assistance and data recording in information systems.

“If I don’t have a doctor and nurse on the team, I already lose [pontos] because these chronic conditions have criteria [do Previne Brasil] that only these professionals can fulfill.”

She states that failure to meet municipal targets is also linked to procedural problems. “Maybe this population is being monitored, but the information system is not being fed [com os dados da assistência prestada] as it should.”

For example, if a person with hypertension arrives at the health unit, the professional’s priority will be to measure blood pressure, and not necessarily fill the information system with data, in the exact fields that the Ministry of Health requests.

For Mauro Junqueira, executive secretary of Conasems (National Council of Municipal Health Secretaries), data from Previne Brasil do not match reality.

“For hypertension, it’s a medical consultation and a measurement every six months. Don’t we do it? We do it a lot every day, but the ministry’s system is fragile for this, we are discussing reformulating the calculation methodology.”

One of the issues is that, to calculate the program’s goals, the entire Brazilian population is considered without discounting the 25% that have a health plan and, probably, do not use the SUS to monitor chronic conditions.

“These 50 million [de usuários de planos] They use the SUS for urgency and emergencies, high complexity, to receive vaccines, but they do not directly use the basic health unit.”

Junqueira states, however, that controlling this high burden of chronic diseases also faces assistance obstacles caused by the very high turnover in health teams and the presence of recently graduated doctors at UBSs. “All of this impacts primary care at the end.”

According to him, the current team at the Ministry of Health, especially the Secretariat of Information and Digital Health, is working to ensure that the data fed into the health unit is transformed into information and reaches the teams in real time.

“We can’t wait a year for the ministry to process the databases and a year later say: ‘in January of last year, you stopped doing this here. I have to have this real information in hand to be able to map and act quickly.”

When contacted, the Ministry of Health reported that a new financing proposal for primary care is being discussed, which also involves changes to the Previne Brasil program, but that it could not provide any information at this time.

Folha learned that the proposal foresees, among other things, an increase in family health teams, a change in the methodology for transferring resources to municipalities and the inclusion of 15 new Previne Brasil indicators, including control of arboviruses and SUS user satisfaction. .

The change has come up against the lack of budgetary funds on the part of the ministry and the resistance of around 530 municipalities that would lose resources, around R$200 million, with the new calculation methodology.

So far, it has been agreed that municipalities will have one year to adapt to the new rules and that the new Previne Brasil indicators will only come into effect when the ministry’s information system is able to provide data to municipalities in real time.