More than 80% of municipalities do not reach goals for diabetes – 04/17/2023 – Health

Three years after the beginning of a federal program that links part of the resources of primary care to the fulfillment of assistance goals, more than 80% of the municipalities still cannot measure the blood pressure of 50% of their hypertensive patients, every six months, and the glycated hemoglobin of half of their diabetics once a year.

At the same time, 848 cities (24% are in São Paulo) did not meet any of the program’s seven indicators, such as offering six prenatal consultations for 60% of pregnant women, dental care and HIV and syphilis tests, in addition to preventive exams. of uterine cancer for 40% of women between 25 and 64 years old, and vaccination coverage (poliomyelitis and pentavalent) for 95% of children.

The data are from the last quarter of 2022 of Previne Brasil, a program created in the first year of Jair Bolsonaro’s (PL) administration and which changed the way primary care is financed, and were compiled by Impulso Gov, a non-profit organization that supports free to municipalities for the intelligent use of data and technology in the SUS.

The indicators began to be measured in 2020, but, due to the Covid pandemic, it was only in 2022 that the reduction in transfers began to take effect. Last September, on the eve of the presidential elections, municipalities gained more time to adjust to meeting the goals of controlling hypertension and diabetes.

As of this year, if there are no new changes in the current management of the Ministry of Health, all program indicators will be linked to the transfer of resources to municipalities. The estimate calculated by Impulso is that in 2022 the municipalities will have lost at least BRL 315 million – the value can still change because the folder has not yet made the complete data available for the calculation.

In a note, the Ministry of Health said that it has resumed dialogue with state and municipal health managers for the construction of policies and actions aimed at strengthening the services provided to the population in primary care. “In this sense, some programs and strategies are undergoing revision, such as the Previne Brasil program.”

Last year’s assessment shows that the pressure exerted by the program on municipalities, linking funding to care performance, has already had a positive impact on some indicators. In the case of prenatal care, for example, meeting the goal of six consultations increased from 38% at the beginning of the year to 54% at the end of 2022.

“The challenge from now on will be huge. The main strategy is the active search, going after the people who need that care. But one thing is to do that for a hundred pregnant women, the other is for 15 thousand diabetics, hypertensives [em referência à situação de um município pequeno]”, says João Abreu, executive director of Impulso Gov.

Meeting the goal of polio and pentavalent vaccination coverage and cytopathological examination (papanicolaou) is also another obstacle: 85% and 83% of municipalities, respectively, failed to achieve this goal in the last four months of 2022.

“It is the first time that all the indicators will be valid and, as there was nothing extraordinary happening to change this scenario, these municipalities will certainly suffer a real big loss of resources”, says Érico Vasconcelos, founder of UniverSaúde, a startup that trains managers from SUS.

In the evaluation of Geraldo Reple Sobrinho, president of Cosems/SP (National Council of Municipal Health Secretariats), among the reasons for not meeting the targets are the difficulty in locating the users who need to be monitored, problems with the information systems, lack of doctors and understaffed family health teams.

“The municipalities’ data still have a ‘delay’ [atraso] to get to the ministry. Or because they have their own information systems and do not use e-SUS [sistema do Ministério da Saúde] or because it has a launch error [dos dados no e-SUS]”, it says.

He cites the example of São Bernardo do Campo (SP), where he is municipal secretary of health. “I have more than 83% of pregnant women with more than seven prenatal consultations. But, when I look at the ministry’s system, it gives 75%, 76%.”

Another problem at Previne Brasil, explains Reple, is that it only informs the municipality’s performance when the four-month period is already closed, that is, when there is no more time to try to correct assistance directions. “Ideally, we could monitor performance on a day-to-day basis in order to adjust the conduct.”

According to the secretary, there is also the obstacle of the lack of doctors, a problem faced by most Brazilian municipalities. He claims that there are 1,550 vacancies for doctors in 304 municipalities in São Paulo, and 1,351 primary care teams awaiting registration and funding from the federal government.

“The ministry charges a team [de saúde da família] complete. If the municipality does not have it, it loses a point and ends up being harmed [no repasse de recursos feito pelo Previne Brasil].”

A survey by Conasems-SP shows that, in 2021 alone, 129 São Paulo municipalities had losses of BRL 63.8 million due to failure to meet the program’s goals.

Family doctor Natália Araújo de Oliveira, president of the SBMFC (Brazilian Society of Family and Community Medicine) São Paulo regional office, says that the lack of doctors and the high turnover of professionals make it very difficult to register Previne Brasil’s care data. “With understaffed teams, it is very difficult to reconcile assistance with adequate data recording.”

Oliveira says that, in Praia Grande (SP), where she works as a medical residency supervisor, she only noticed progress in meeting Previne’s goals after the city hall trained the teams, in person, to correctly fill in the data and authorized that professionals to work on Saturdays to carry out this task exclusively.

For Érico Vasconcelos, founding director of UniverSUS, many municipalities have not been able to reach the program’s goals because they simply do not understand the guidelines of the Ministry of Health. “There were more than ten technical notes released at the touch of a button, in a short period of time, and changing the rules throughout the game, adapting the evaluation to the circumstances of the moment.”

Some municipalities also adopt erroneous strategies. For example, they run campaigns to increase the coverage of the Pap smear test, but, without planning and active search for women who are late, they always reach the same public.

In the opinion of João Abreu, from Impulso, this occurs because many of these cities do not know the basics: who they are and where they are, for example, unaccompanied diabetics and hypertensives or pregnant women with late prenatal appointments.

Impulso Gov offers an active nominal search tool for these patients, based on data from electronic medical records that many municipalities already have. Since 2021, it has already supported 130 municipalities and today there are 370 cities in the waiting list.

According to Abreu, it is important that the ministry’s current management signals what the program’s directions will be. Rumors circulate, for example, that it will end or that it will undergo profound changes. “It is necessary to increase funding for primary care regardless of anything, but we hope that the program’s positive points are not thrown away.”

He cites as one of the positive points the increase in people included in the SUS register. There are more than 168.5 million people identified with CPF and linked to a health team, against 74.6 million in 2018, before the start of Previne.

In addition to care indicators, the number of people registered under the responsibility of primary care teams is included in the composition of federal resources transferred to municipalities.