Neonatal malformations: organization of information flows in the S. Anna Hospital of Torino

Background Congenital malformations (CMs) represent a serious public health problem, both in terms of size (3% newborns/year) and severity of outcomes. The surveillance activity carried out by the Registers is an important tool for monitoring the frequency of events, to evaluate etiology, support research and public health actions. The aim is to evaluate the organization and the information network related to the diagnosis of malformation in the S. Anna presidium. Methods the retrospective study analyzed all newborns with one or more CM and all cases of TOPFA (Termination of Pregnancy for Fetal Anomaly) for CMs in the period 01/2020 - 01/2021. A forward-looking pilot study was then set up to assess the impact on the quality of data collection through the introduction of a MC sheet. Results 510 cases of CMs were found in live births, 180 in TOPFA for CMs and 4 in stillbirths. The duration of hospitalizations averaged 14.5 days (σ 36.56), with a median of 4 days. In the CMs group, an average maternal age of 33.40 years (σ 9.32), a median of 33 years and a mode of 33 years were calculated, in the TOPFA group an average maternal age of 34 years (σ 6.34), a median of 34 years and a mode of 32 years. In the live births group, 701 maternal diagnoses were detected, categorized and compared with the various national reports. The MC Sheet was compiled for 60 patients, 16 (4.30%) patients before the introduction of the sheet (01/2020 - 09/2020) and 44 (30.43%) after its introduction (10/2020 - 01/2021). Regarding the assessment of the proper use of ICD9CM an adequacy of 78% was observed in the first group vs one of 100% in the second. Conclusions Our preliminary data assess the need for a Regional registry, for a comparison with the main national and regional sources available (also with a view to possible participation in the EUROCAT and ICBDSR registers) and for regional health planning. Key messages The study underlines the need for a Regional Registry of congenital malformations. The clinical file is not always a complete source for analysing data on congenital malformations.

Regional inter-managers commission: local space for agreement and inter-federative articulation?

The Regional Intermanagers Commission (CIR) configures the space for agreement, articulation, cooperation and strengthening of the health region. The aim of this study was to reflect on the normative provisions that underlie the construction of the commission as a place of consolidation of regional management attenuating interfederative conflicts. Having as a guide question: how do the Regional Inter-Management Commissions provide local spaces of agreement and interfederative articulation? Qualitative study, based on documentary research, based on the analysis of the resolutions of the Regional Inter-Management Commissions of Alagoas, corresponding to the period from 2017 to 2019, using Decree 7.508/11 as a reference standard. The results were organized into four categories: Regional Health Planning; organization of health care actions and services: health region; Federalism, CIR and the financing of health services; governance and CIR: channel of negotiation and decision between municipal managers and the State within the Health Region. The Regional Inter-Management Commissions develop significant work in the discussions of regional policies, being a fundamental tool for strengthening governance in the territories, by negotiating the allocation and distribution of resources, essential for planning, interfederative pacts, and health financing, playing a key role for the regional health system of Alagoas, democratic, political and cooperative space.

Oferta assistencial de leitos de referência à covid-19 nas regiões de saúde de Pernambuco

Trata-se de um estudo descritivo que utilizou documentos e dados oficiais com objetivo de analisar a distribuição da oferta de leitos SUS para tratamento da infecção pelo covid-19 em Pernambuco, por região de saúde. Observa-se interiorização da doença com registro em todas as regiões de saúde, o que ocasionou diminuição da proporção de casos em residentes da Região Metropolitana do Recife, passando de 90,0% para 47,1%. Destaca-se ocorrência de SRAG em 22% dos casos. Quanto à oferta dos leitos, identificou-se crescimento de 1,29 para 4,74 leitos/10.000 habitantes, havendo distribuição homogênea entre as macrorregiões de saúde, condição relevante no enfrentamento à pandemia. Os registros de Autorização de Internação Hospitalar revelaram uma média de 7,05 dias de permanência no leito, aumentando para 9,97 dias nos internamentos em UTI. Por fim, destaca-se o importante legado deixado pela covid-19: o urgente e indispensável fortalecimento da saúde pública brasileira.Palavras-chave: Infecções por Coronavírus, Assistência à Saúde, Regionalização, Planos de Contingência The offer of reference hospital beds to treatment of covid-19 in the health regions of Pernambuco ABSTRACTThis is a descriptive study that used official documents and data in order to analyze the distribution of the supply of SUS hospital beds for the treatment of covid-19 infection in Pernambuco by health region. It been observed an internalization of the disease registrated in all health regions, which caused a decrease from 90.0% to 47.1% in the proportion of cases in residents of the metropolitan region of Recife. The occurrence of SARS stands out in 22% of cases. As for the supply of hospital beds, there was a growth from 1.29 to 4.74 beds per 10,000 inhabitants, with a homogeneous distribution among the health macro-regions, a relevant condition in facing the pandemic. Records of hospitalization authorization revealed an average of 7.05 days in bed, increasing to 9.97 days in ICU admissions. Finally, we highlight the important legacy left by covid-19: the urgent and indispensable strengthening of Brazilian public health.Keywords: Coronavirus Infections, Delivery of Health Care, Regional Health Planning, Contingency Plans

Regionalization and the federative crisis in the context of the Covid-19 pandemic: deadlocks and perspectives

ABSTRACT Regional health planning is a complex process conditioned by several factors, among which inequalities and federative relations stand out. In the context of the Covid-19 pandemic, these weaknesses in the federative and regional organization of the Unified Health System (SUS) have been acutely exposed, and accentuated by a scenario of incoordination and dismantlement of the institutional design conceived by the Federal Constitution of 1988. This essay aimed to draw reflections on some strategies built at the municipal, regional and state levels to tackle the pandemic, as a response to the political and institutional crisis, as well as to highlight current and future challenges. The work is based on syntheses of the discussions held during the preparatory workshop and the debate table of the IV Congress on Health Policies, Planning and Management of the Brazilian Association of Collective Health (Abrasco), on the theme of federative relations and regionalization in the scenario of the Covid-19 pandemic. The findings include: a lack of federal protagonism and the construction of delegated autonomy of subnational entities in the pandemic; the importance of some experiences of consortia and new partnerships with society; and the challenges and conditions of a new federative pact and new forms and designs to partner and support the organization of the SUS.

Status and Factors Associated with Healthcare Choices among Older Adults and Children in an Urbanized County: A Cross-Sectional Study in Kunshan, China

As important unit for regional health planning, urbanized counties are facing challenges because of internal migrants and aging. This study took urbanized counties in China as cases and two key populations as objects to understand different populations’ intentions of choosing corresponding health service resources and to provide support for resource allocation. A cross-sectional study was conducted in Kunshan, a highly urbanized county in China, in 2016, among older adults aged 60 or over and children aged 0–6. Multinomial logistics models were used to identify the factors associated with healthcare choices. In this study, we found that income, distance of the tertiary provider, and migrant status were not associated with choices of tertiary healthcare outside county for children, while parents’ education level was. The responsiveness of the tertiary provider inside the county was lower than primary and secondary providers inside the county, while respondents were dissatisfied with the medical technology and medical facility for the tertiary inside the county compared to those of the tertiary provider outside the county. Significant differences existed in terms of the perception of different categories of institutions. To conclude, local governments should particularly seek to strengthen pediatric primary health services and improve the responsiveness of healthcare facilities to treat geriatric and pediatric diseases, which also bring significance to the developing countries in the process of urbanization.

Brazilian especialized care: challenges and proposals to provide integrality on health assistance

The Brazilian health system has as principles the integrality of assistance and the regional health planning of services, organized through attention networks. In the constitution of this network, specialized care fraction, even though it concentrates a significant importance in citizens right of health guarantee, has represented a problem of great relevance, constituting a challenge for the organization of health care, whether in the field of management or assistance, in Brazil, as well as in other countries. In this perspective, this study aims to identify the challenges and propose strategies to effectuate the provision of specialized care fraction in the Brazilian health system. This is a qualitative and exploratory study, developed in the northern macro-region of the State of Paraná in Brazil. The data collection took place through semi-structured interviews, with the participation of public and private managers and other subjects that compose the assistance and management network of this region, between 2016 and 2017. The data were organized through discourse analysis, supported by policy analysis referential. The results show an expressive demand for this fraction of assistance in the analyzed territory, mostly offered by private institutions. The high demand is linked to the low resoluteness of primary health care and an ineffective communication system between different points of care. Other challenges highlighted in this phenomenon are: the lack of solidarity and the sharing of responsibilities between federal entities; the weakness of the counties; asymmetries of power between public and private managers; the fragile integrated and regionalized planning; the underfunding of the system; the fledgling regulatory system; the conflicts between governance actors; and political interferences. Key messages In order to overcome challenges to provise the specialized care fraction, is necessary to strength the cooperation between entities, making viable health policies coherent to collective needles. With the objective of organize the provision of integrality of health, one of the essential requirements would be qualify the assistance on the different points of care that compose the health network.

Measuring productivity of healthcare services under environmental constraints: Evidence from China

Background: Despite the growing literature on the efficiency and productivity of the Chinese healthcare system, less attention has been given to examining the undesirable outputs linked to healthcare services, including environmental pollution. Taking the atmospheric environmental pollution resulting from the incineration of medical waste as an undesirable output of the healthcare system, this study analyzed the growth and decomposition of Total Factor Productivity (TFP) of healthcare services across 31 Chinese provinces during the period 2005-2016. Methods: The Meta-frontier undesirable super-efficiency slack-based measure (SBM) model and the Global Malmquist-Luenberger (GML) Index were employed to analyze the growth and decomposition of TFP using the Max DEA software. Results: The results revealed that the years 2009 and 2015 marked significant changes in TFP of healthcare services in Chinese provinces. During the study period, the rate of technological change (TC) slowly declined, whereas the rate of efficiency change (EC) steadily increased. With the national average being the benchmark, the results indicated that: the TFP of 17 provinces and cities exceeded the average, the EC changes of 16 provinces and cities exceeded the average, the TC changes of 9 provinces and cities exceeded the average, and the in the Technology Gap Ratio (TGR) changes of 13 provinces and cities were above the national average. Conclusions: (1) The TFP of the healthcare services across China continued to decline slowly during the study period. (2) The effect of technical catch-up in the eastern, central, and western regions of China was significant across the three regions, whereas the effect of technical innovation was negative. (3) The TFP varied considerably among the Chinese provinces. These findings suggest that, under existing environmental constraints, relevant government departments should improve technical innovation in the supply of healthcare services and medical waste treatment, increase technical efficiency in the factor of healthcare production, strengthen regional health planning, and balance the development of regional healthcare.

Measuring productivity of healthcare services under environmental constraints: Evidence from China

Background: Despite the growing literature on the efficiency and productivity of the Chinese healthcare system, less attention has been given to examining the undesirable outputs linked to healthcare services, including environmental pollution. Taking the atmospheric environmental pollution resulting from the incineration of medical waste as an undesirable output of the healthcare system, this study analyzed the growth and decomposition of Total Factor Productivity (TFP) of healthcare services across 31 Chinese provinces during the period 2005-2016.Methods: The Meta-frontier undesirable super-efficiency slack-based measure (SBM) model and the Global Malmquist-Luenberger (GML) Index were employed to analyze the growth and decomposition of TFP using the Max DEA software. Results: The results revealed that the years 2009 and 2015 marked significant changes in TFP of healthcare services in Chinese provinces. During the study period, the rate of technological change (TC) slowly declined, whereas the rate of efficiency change (EC) steadily increased. With the national average being the benchmark, the results indicated that: the TFP of 17 provinces and cities exceeded the average, the EC changes of 16 provinces and cities exceeded the average, the TC changes of 9 provinces and cities exceeded the average, and the in the Technology Gap Ratio (TGR) changes of 13 provinces and cities were above the national average. Conclusions: (1) The TFP of the healthcare services across China continued to decline slowly during the study period. (2) The effect of technical catch-up in the eastern, central, and western regions of China was significant across the three regions, whereas the effect of technical innovation was negative. (3) The TFP varied considerably among the Chinese provinces. These findings suggest that, under existing environmental constraints, relevant government departments should improve technical innovation in the supply of healthcare services and medical waste treatment, increase technical efficiency in the factor of healthcare production, strengthen regional health planning, and balance the development of regional healthcare.

Managers' training as a strategy for strengthening regionalization of health

ABSTRACT Objective: to report on the experience of permanent education workshops with municipal health managers in the western region of Santa Catarina. These experiences were conducted in the search for strategies to strengthen management and the principle of regionalization. Method: a descriptive study, a type of experience report, using active methodologies for the development of workshops with 48 participants. Results: the main results point out the difficulties faced by managers in the articulation of public and private services, such as inter-municipal agreements, lack of involvement of health professionals in management qualification, chronic underfunding of SUS, and the lack of use of public management instruments. Conclusion: the outstanding advances for regionalization are related to the inter-municipal consortium, the proactive action of collegiate decision-making bodies and the carrying out of permanent education activities that strengthen relations among regional actors. Descriptors: Health Human Resource Training; Regional Health Planning; Health Planning; Public Health Policy; Unified Health System; Health Management.RESUMOObjetivo: relatar a experiência das oficinas de educação permanente com os gestores municipais de saúde da região oeste de Santa Catarina frente à conformação das redes de atenção à saúde, na busca por estratégias para o fortalecimento da gestão e do princípio da regionalização. Metódo: estudo descritivo, tipo relato de experiência, em que foram utilizadas metodologias ativas para o desenvolvimento das oficinas com 48 participantes. Resultados: os principais resultados apontam para as dificuldades dos gestores frente às articulações entre os serviços públicos e privados, as pactuações intermunicipais, a falta de engajamento dos profissionais de saúde na qualificação da gestão, o subfinanciamento crônico do SUS e o pouco uso dos instrumentos de gestão pública. Conclusão: os avanços destacados para regionalização estão relacionados ao consórcio intermunicipal, a atuação proativa das instâncias colegiadas de tomada de decisão e a realização de atividades de educação permanente que fortalecem as relações entre os atores regionais. Descritores: Formação Profissional em Saúde; Regionalização; Planejamento em Saúde; Políticas Públicas de Saúde; Sistema Único de Saúde; Gestão em Saúde. RESUMEN Objetivo: relatar la experiencia de talleres de formación permanente con los gestores municipales de sanidad de la región oeste de Santa Catarina frente a la conformación de las redes de atención sanitaria, en la búsqueda de estrategias para el fortalecimiento de la gestión y del principio de regionalización. Método: estudio descriptivo, tipo relato de experiencia, en el que se emplearon métodos activos para el desarrollo de talleres con 48 participantes. Resultados: los principales resultados señalan que las dificultades de los gestores frente a las relaciones entre servicios públicos y privados, los convenios intermunicipales, la falta de implicación de los profesionales sanitarios en la cualificación de la gestión, infra-financiación crónica del Sistema Único Sanitario y escaso uso de los instrumentos de gestión pública. Conclusión: los avances destacados para regionalización están relacionados con el consorcio intermunicipal, la actuación proactiva de las instancias colegiadas de tomada de decisión y la realización de actividades de formación permanente que fortalecen las relaciones entre los actores regionales. Descritores: Capacitación de Recursos Humanos en Salud; Regionalización; Planificación en Salud; Políticas Públicas de Salud; Sistema Único de Salud; Gestión en Salud.