Modelo de gestão da atenção ao pré-natal no extremo-Norte do Brasil

Abstract

Retrospective study aiming to analyze the management model of Prenatal Care Primary Care System in the city of Boa Vista, capital of Roraima, with reference to the criteria and recommendations of the Health Ministry and based on the historical analysis of the indicators provided by the DATASUS database within the period from 2008 to 2013. The structure, the process and outcomes of prenatal care and the impact on quality of care offered to pregnant women in the municipality were contextualized. For analysis of the structure surveys were conducted in technical documents produced by local management and analysis of process and outcome indicators were analyzed related to the actions of prenatal and in accordance to the management. Data were collected in the month of June in 2014. The results were graphed and tabled and analyzed in the light of current literature. The results show the geographical distribution of health for the city in 06 macro areas where they are distributed 32 basic health units, 05 laboratory units and 55 teams from the family health strategy for serving an average population of 4,527.5 pregnant/year. Process indicators demonstrate that despite an average 53% of pregnant women begin prenatal care until the fourth month of pregnancy, when associated with other indicators of care quality such as basic tests, serology, vaccines and puerperal consultation only 3.2% finalize prenatal with all recommended procedures performed. Outcome indicators show an increase of 14% in the number of live births with low birth weight and 64% in the quantity of preterm births between the years 2010-2011, the average annual rate of normal births is 57.5%, the average quantity of maternal deaths was 2 every year, the simple average of cases of syphilis in pregnant women was 36 cases / year, 25%, of which occurred in neighborhoods with lower coverage of supply related to prenatal services, the average number congenital syphilis cases was 19 cases / year during the period reserved for the study. Out of total of R $ 1,140,930.00 provided for billing actions developed within prenatal, the City raised only R $ 37,140.00 during the reserved period for the study (2008-2013) period. These results reinforce the weakest features of the organization of actions oriented to maternal health in the city and reinforce the need for implementation of already existing for the quality assurance of prenatal policies. The analysis of the indicators show that the realization of the set of activities recommended for prenatal care is the biggest challenge for municipal management. We can verify that the greatest impacts of the paucity of the shares offered are prenatal inequity of service provision and the persistence of high rates of morbidity and mortality from preventable causes during pregnancy.