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Item Análise da equidade da política nacional de medicamentos no período de 1998 a 2013(Fundação João Pinheiro, 2016-03-30) Lopes, Flávia Alice Dias; Fahel, Murilo Cássio Xavier; http://lattes.cnpq.br/8223101141977871; Ferreira Júnior, Sílvio; Salim, Celso AmorimEquitable access to medicines is a central strategy for reducing inequalities in healthcare systems, especially in developing countries that still face high levels of socioeconomic disparities such as Brazil. Considering that Brazil's 1988 Constitution defined health as a universal right and the legislation defined the goal to promote equitable access to drugs as a way to ensure a comprehensive healthcare in the public healthcare system, this study aimed to present an overview of equity in financing and access to medicines in Brazil. The literature review indicated that the vertical inequity remain relevant in medicine financing in Brazil, which is the main health expenditure among the poorest households. Moreover, it was found that out-of-pocket expenditure with medicines is strongly associated with the risk of catastrophic expenditure in Brazil. In this scenario, this study analyzed the distribution of access to prescribed drugs and drugs for chronic diseases between population groups with different socioeconomic and demographic characteristics in the period 1988-2013, based on national surveys conducted the Brazilian Institute of Geography and Statistics. Under this approach, it was observed that since the implementation of the National Medicine Policy, in 1998, there was a substantial expansion of the coverage of the free supply of medicines in Brazil, which went from 27.2% in 1998 to 46% in 2008. In addition, it was found that coverage of the free supply of prescribed drugs and drugs for chronic diseases was higher among population groups considered vulnerable, such as non-white, illiterate, living in the rural areas, without private health insurance and lower per capita income, especially among people with poorer health status. This finding indicates that the National Medicine Policy has significant potential to promote horizontal equity in access to medicines, acting as a counterweight to the existing socio-economic disparities in Brazilian society, in an attempt to alleviate the cycle of inequalities in health. com amostras mais amplas. Esse estudo de caso das AGEIs demonstrou que, segundo a percepção dos respondentes, as AGEIs possuem um conjunto de fatores condicionantes favoráveis ao ambiente inovador no setor público.Item Evolução da cobertura de médicos em estratégia saúde da família na atenção primária do SUS nos municípios de Minas Gerais: uma avaliação sob a ótica da equidade no contexto do Programa Mais Médicos(Fundação João Pinheiro, 2018-03-22) Morais, João Roberto Muzzi; Ferreira Júnior, Silvio; http://lattes.cnpq.br/7789533222493903; Fahel, Murilo Cássio Xavier; Pereira, Danielle Ramos de MirandaThe trajectory of public health policies demonstrates a continuous effort in opposition to health inequities, including new mechanisms that favor the attraction and fixation of medical professionals. Therefore, this dissertation had as main objective to analyze the evolution of the coverage of medical professionals in FHS, in the scope of the PHS of the SUS and of the implementation of the Program More Doctors. For this, we used descriptive and inferential statistics, as well as cartographic analysis, in an attempt to identify if there was a positive evolution of this coverage and to what extent economic, social, population and structural factors contributed to a greater or lesser increase in the quantitative of these professionals in the State of Minas Gerais. The descriptive analysis indicated an increase in the growth rate of physicians in ESF of 7.53 doctors / 100 thousand inhabitants, as well as in the median values, in absolute terms, comparing the years of 2012 and 2016, in addition to a positive evolution of the median, considering the expanded health regions. There was also a decrease in the coefficient of variation, considering the coverage of physicians in FHS. It is also worth mentioning the significant decrease in the number of municipalities with a FHP / inhabitants ratio equal to zero. From the health needs index, it was verified that the evolution of the growth rate of the enlarged health regions was more frequent in those that presented greater need. The descriptive analysis of the quality index of the BHUs suggested less heterogeneity, when compared to the INS analysis. The cartographic analysis suggested a relation, although not in its totality, between the quality of the BHUs and greater health needs. Regarding the regression analysis by population size, the results were significant for the less populous municipalities, with up to 10 thousand inhabitants. As for the regressions by extended health regions, the results reinforce the need to evaluate public policies at a more specific level. However, locations with lower rates of FHP / resident physicians appear to have been prioritized and had a more robust increase in FHP physicians' rates. Finally, the allocation of physicians, in the context of the PMM, seems to have been effective and equitable, since there was a positive evolution of the growth rate of physicians in FHT, being this evolution more robust in municipalities eligible to PMM. In addition, the study suggests a decrease in inter-municipal intra- and inter-regional inequalities of medical professionals in FHS, within the scope of PHC in MG.Item Protagonistas e coadjuvantes da vacinação no Brasil : lógicas e empreendedores institucionais da imunização brasileira(Fundação João Pinheiro, 2024) Teixeira, Flávia Avila; Batitucci, Eduardo Cerqueira; http://lattes.cnpq.br/9562452176702956; Cruz, Marcus Vinícius Gonçalves da; http://lattes.cnpq.br/3678172153181366; Cruz, Marcus Vinicius Gonçalves da; Batitucci, Eduardo Cerqueira; Carneiro, Ricardo; Domingues, Carla Magda Allan Santos; Matozinhos, Fernanda PenidoThis dissertation analyzes the configuration of institutional logics that mark the immunization process in Brazil, seeking to understand the reasons for the variation in vaccination coverage. It also identifies and analyzes the actions of the main institutional players involved in the field of vaccination, also known as institutional entrepreneurs. It uses the theoretical framework of institutional logics, from the perspective of Thornton and Ocasio (2008; 2012), in the context of institutionalism. The research adopted a qualitative, descriptive approach, through a literature review, documentary survey and semi-structured interviews with key players from various organizations in the organizational field. The findings revealed the National Immunization Program (PNI) as the main reference instrument. They showed the dynamism of institutional logics over time, which predominate to a lesser or greater degree, sometimes favoring or sometimes opposing vaccination. It was possible to identify at least eight major logics at work in this context: political; managerial; technical-operational; academic, scientific and professional; informational; industrial; supervisory and control; and individual or family. Practices and values in favor of vaccination predominated until the mid-2010s, but changed from 2015/2016 onwards, when vaccination coverage indicators began to fall. The drop in indicators is multicausal and requires a broader, multidisciplinary view of the vaccination context in order to identify bottlenecks. Currently, three logics predominate: the political logic, the managerial logic and the technical-operational logic, all of which are mutually influenced by the informational logic, which has been identified as on the rise. A misalignment was found between the managerial and technical logics of primary care and immunization. The connection and interdependence between the various logics underpins the PNI's resilience over the years, despite all its problems. The conclusion is that public managers involved in defining immunization policies, based on the institutional logics revealed by the study, should concentrate their efforts on strengthening the informational and technical-operational logics. The study contributes to broadening the debate on institutional logics and to strengthening Brazil's public immunization policy, by interpreting the logics in force in the field and guiding the actions of the players involved.Item Política de saúde mental no município de Belo Horizonte: o papel das ideias, dos atores e das instituições na construção de uma práxis de reforma psiquiátrica e desinstitucionalização(Fundação João Pinheiro, 2013-04-08) Moreira, Tábata Christie Freitas; Carneiro, Carla Bronzo Ladeira; http://lattes.cnpq.br/2040877413046909; Brasil, Flávia de Paula Duque; http://lattes.cnpq.br/4666930977365902; Lobosque, Ana Marta; http://lattes.cnpq.br/7313598096631432; Goulart, Maria Stella Brandão; http://lattes.cnpq.br/2033867522463148Item Crise, governança e capacidades : o enfrentamento da pandemia por COVID-19 no âmbito da política municipal de saúde de Belo Horizonte(Faculdade Estácio de Sá de Vila Velha, 2021) Magalhães, Bruno Dias; Neves, Laura Bastos Pimenta; Brasil, Flávia de Paula Duque; Carneiro, RicardoO artigo tem por objetivo abordar as respostas do município de Belo Horizonte à Covid-19, privilegiando analiticamente a área da saúde. A análise é balizada pela perspectiva de gestão de crises, destacando como principais chaves as capacidades e legitimidade governativas. A partir de levantamentos documentais e realização de entrevistas semiestruturadas com gestores municipais, destaca-se a celeridade das ações iniciais e a construção de um conjunto de respostas emergenciais articuladas em um processo de tomada de decisões adaptativas. O artigo contribui para o diálogo entre gestão de crises e governança em âmbito municipal, revelando que apontamentos desta literatura se mostraram adequados para a abordagem do caso local, bem como para a difusão de práticas de enfrentamento à pandemia.Item A contribuição do projeto apoiador do COSEMS/MG no espaço de gestão regional de saúde do estado de Minas Gerais no período de 2009 a 2011(Fundação João Pinheiro, 2012-04-26) Motta, Paola Soares; Carneiro, Ricardo; http://buscatextual.cnpq.br/buscatextual/visualizacv.do?id=K4735034Y6; Fortes, Fátima Beatriz Carneiro Teixeira Pereira; http://lattes.cnpq.br/8096452401595457; Machado, José ângelo; http://lattes.cnpq.br/9345341099863361Item O programa Mais Médicos na região de saúde do norte de Minas Gerais(Faculdade Adventista da Bahia, 2024) Freitas, Carina Silva de; Costa , Luis Felipe Marinho; Ferreira Júnior, Silvio; Anjos, Evandro Barbosa dos; Freitas, Daniel Antunes; Fahel, Murilo Cássio XavierO Programa Mais Médicos (PMM) foi lançado em resposta à carência significativa de médicos no Brasil, especialmente em áreas com altos níveis de vulnerabilidade sanitária. Um exemplo é a Regido de Saúde Norte de Minas Gerais (RSN), uma área de 86 municípios com conexão histórica com o programa. Esta pesquisa teve como objetivo analisar os resultados do PMM na RSN em relação ao fornecimento de profissionais médicos para a Atenção Primária à Saúde (APS). Dessa forma, foi avaliado se houve benefício do PMM aos municípios mais vulneráveis, com altos índices de população em extrema pobreza, e com menor cobertura de médicos nas áreas primárias do SUS. Trata-se de estudo de natureza exploratória, com abordagem descritiva quantitativa. Os dados foram coletados de um banco de acesso restrito aos tutores do PMM, denominado Plano de Trabalho, gentilmente cedido pelos mesmos. Realizou-se análise por meio das variáveis: médicos da APS; médicos do PMM; proporção de médicos PMM / APS. Para adesão de municípios, a análise foi feita baseada em municípios elegíveis e não elegíveis ao programa, conforme critérios dos editais. Como resultados, o PMM reduziu a falta de médicos na APS na RSN e melhorou a cobertura médica nos municípios. No entanto, os critérios de elegibilidade do programa deixaram de fora municípios com necessidades de saúde significativas, apontando uma falha de acurácia destes. Sobre a adesão de municípios, apenas 1/3 deles permaneceram durante todo o período, destacando irregularidades na continuidade. Apesar das dificuldades, o PMM teve impactos positivos na região, melhorando o acesso à saúde.Item Avaliação do Programa de Fortalecimento e Melhoria da Qualidade dos Hospitais - PRO-HOSP: alcance da regionalização da atenção hospitalar no estado de Minas Gerais(Fundação João Pinheiro, 2009-06-30) Lima, Marilene Fabri; Menicucci, Telma Maria Gonçalves; http://lattes.cnpq.br/8388652849956928; Fahel, Murilo Cássio Xavier; http://lattes.cnpq.br/8223101141977871; Mendes, Eugênio Vilaça; http://lattes.cnpq.br/1902100067164359Item A municipalização da saúde: Programas de Saúde da Família e Agente Comunitário de Saúde no Estado de Minas Gerais(Fundação João Pinheiro, 2002-07-29) Pereira, Marluci Moraes; Andrade, Mônica Viegas; http://lattes.cnpq.br/2085641989038025; Perpétuo, Ignez Helena Oliva; http://lattes.cnpq.br/4627037433746129; Andrade, Eli Iola Gurgel; http://lattes.cnpq.br/6869396953297183Item Avaliação de impacto do Programa de Fortalecimento e Melhoria da Qualidade dos Hospitais do SUS/Minas Gerais (Pro-Hosp)(2014) Noronha, Kenya Valeria Micaela de Souza; Fortes, Fátima Beatriz Carneiro Teixeira Pereira; Carmargos, Mirela Castro Santos; Pereira, Danielle Ramos de MirandaEste estudo avaliou o impacto do Programa de Fortalecimento e Melhoria da Qualidade dos Hospitais do SUS-MG (Pro-Hosp). Para tanto, foi empregado o método diferenças-em diferenças, que permite avaliar o impacto de políticas públicas quando o indicador avaliado é observado em mais de um período no tempo. Foram selecionados quatro indicadores de desempenho hospitalar: a proporção média de cesárea, a taxa média de ocupação, a taxa média de mortalidade e o tempo médio de permanência. Constatou-se que o Pro-Hosp teve impacto na proporção média de cesáreas no sentido esperado, ou seja, de reduzi-las.