Evaluation of Health Surveillance in the Zona da Mata Mineira: from standards to practice

Donateli, Cíntia Pereira; Avelar, Patrícia Silva; Einloft, Ariadne Barbosa do Nascimento; Cotta, Rosângela Minardi Mitre; Costa, Glauce Dias da

doi:10.1590/1413-812320172210.18252017

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ARTICLE • Ciênc. saúde colet. 22 (10) • Oct 2017 • https://doi.org/10.1590/1413-812320172210.18252017 copy

Evaluation of Health Surveillance in the Zona da Mata Mineira: from standards to practice

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Health Surveillance is of paramount importance when confronted with the current Brazilian epidemiological setting. This study aims to evaluate the level of Health Surveillance in the Zona da Mata Mineira region. This is an evaluative study, and data were collected in the first half of 2016. The research universe consisted of seven municipalities in the Zona da Mata Mineira complex. Municipalities were selected with reference to available operational epidemiological, environmental and sanitary surveillance. The subjects under analysis were the Surveillance coordinators (n = 21), Health Surveillance coordinators (n = 7) and Health secretaries (n = 7). We conducted interviews using a semi-structured and elaborated questionnaire based on the Donabedian triad: Structure, Process and Outcome. A score system was established in order to obtain the classification of performance, realm and sub-realms, in which a score was assigned for each criterion. We used incipient, intermediate or advanced cutoff points to classify the level of Health Surveillance of scores were below 5.99 points, between 6.0 and 7.99 points and between 8 and 10 points, respectively. The level of regional Health Surveillance performance level was classified as an intermediate.

Health assessment; Health Surveillance; Health management and health services

Realms	Sub-realms	Criteria	Surveillance sectors maximum score
Realms	Sub-realms	Criteria	Manager	Health Surveillance Coordinator	HS	EnvS	EpiS
Structure	Human Resources (10,0)	a) Adequacy of number of professionals - Inadequacy (0)	1,42	1,66	1,42	1,42	1,42
		b) Adequacy of professional education to the position held b1-Postgraduate in the area of health or management b2-Higher Education in the area of health b3-Higher Education b4-Technical b5-Secondary school	b1 - 1,42 b2 - 1,42 b3 - 1,1 b4 - 0	b1 - 1,66 b2 - 1,66 b3 - 1,06 b4 - 0	b1 - 1,42 b2 - 1,42 b3 - 0,82 b4 - 0,22 b5 - 0	b1 - 1,42 b2 - 1,42 b3 - 0,82 b4 - 0,22 b5 - 0	b1 - 1,42 b2 - 1,42 b3 - 0,82 b4 - 0,22 b5 - 0
		c) Duration of position held c1-Over 5 years c2-Between 1 and 5 years c3-Below 1 year	c1 - 1,42 c2 - 1,1 c3 - 0	c1 - 1,66 c2 - 1,36 c3 - 0	c1 - 1,42 c2 - 1,1 c3 - 0	c1 - 1,42 c2 - 1,1 c3 - 0	c1 - 1,42 c2 - 1,1 c3 - 0
		d) Professional relationship d1-Employee with position of trust or approved in public examination d2-Hired appointed in committee d3-Other	d1 - 1,42 d2 - 0,82 d3 - 0,22	d1 - 1,66 d2 - 1,06 d3 - 0,46	d1- 1,42 d2-0,82 d3-0,22	d1 - 1,42 d2 - 0,82 d3 - 0,22	d1 - 1,42 d2 - 0,82 d3 - 0,22
		e) Works in a 40-hour weekly workload - Lower workload (0)	1,42	1,66	1,42	1,42	1,42
		f) Defining and recognizing positions of team members - No (0)	1,42	*	1,42	1,42	1,42
		g) Recognizing targets - No (0)	1,42	1,66	1,42	1,42	1,42
	Infrastructure (10,0)	a) Adequacy of physical structure - No (0)	*	*	2,0	2,0	2,0
		b) Accessibility of physical structure - No (0)	*	*	2,0	2,0	2,0
		c) Hygiene of physical structure - No (0)	*	*	2,0	2,0	2,0
		d) Safety of surroundings of physical structure - No (0)	*	*	2,0	2,0	2,0
		e) Accommodation of surveillance sectors in the same physical structure - No (0)	*	*	2,0	2,0	2,0
	Material resources (10,0)	a) Vehicles a1-Own, exclusive use a2-Own, shared use a3-Other sector, shared use	*	*	a1 - 1.66 a2 - 1.04 a3 - 0.64	a1 - 1.66 a2 - 1.04 a3 - 0.64	a1 - 1.66 a2 - 1.04 a3 - 0.64
		b) Sufficient material for administrative work - Insufficient (0)	*	*	1.66	1.66	1.66
		c) Sufficient field material - Insufficient (0)	*	*	1.66	1.66	1.66
		d) Adequacy of work material quality - No (0)	*	*	1.66	1.66	1.66
		e) Adequacy of work material quantity - No (0)	*	*	1.66	1.66	1.66
		f) Adequacy of work material availability - No (0)	*	*	1.66	1.66	1.66
Structure	Technological resources (10,0)	a) Availability of technological resources for information organization and sharing - Poor (0) b) Municipal surveillance service database availability - No (0) c) Access to Information	* * *	* *	2.0 2.0	2.0 2.0	2.0 2.0
		Systems - No (0) d) Adequate functioning of	*	3.33	2.0	2.0	2.0
		information systems - Inadequate (0) e) Instrument for	*	3.33	2.0	2.0	2.0
		standardization of actions (Instructions) e1 - Agrees and implements e2 - Agrees and does not implement		el - 3.33 e2 - 0	e1 - 2.0 e2 - 0	e1 - 2.0 e2 - 0	e1 - 2.0 e2 - 0
		e3 - Disagrees and implements e4 - Disagrees and does not implement		e3 - 3.33 e4 - 0	e3 - 2.0 e4 - 0	e3 - 2.0 e4 - 0	e3 - 2.0 e4 - 0
	Administrative management (10,0)	a) SMS Action Plan available - No (0)	*	3.33	_*	_*	_*
Structure		b) Targets working at local reality - No (0)	10.0	3.33	5.0	5.0	5.0
		c) All surveillance areas operating c1 - All 6 c2 - Only 3 c3 - No	*	c1 - 3.33 c2 - 1.7 c3 - 0	c1 - 5.0 c2 - 3.37 c3 - 0	c1 - 5.0 c2 - 3.37 c3 - 0	c1 - 5.0 c2 - 3.37 c3 - 0
	Continuing education (10,0)	a) Training to work in the position after incorporation in the team - No (0)	*	*	2.0	2.0	2.0
		b) Adequacy of training themes and adequacy to professional demands - Inadequate (0)	3.33	3.33	2.0	2.0	2.0
Process		c) Responsible for the training c1-GRS c2-Professional from another institution c3-Professional from the municipal surveillance team d) Training frequency	cl - 3.33 c2 - 3.33 c3 - 2.83	c1 - 3.33 c2 - 3.33 c3 - 2.83	c1 - 2.0 c2 - 2.0 c3 - 1.5	c1 - 2.0 c2 - 2.0 c3 - 1.5	c1 - 2.0 c2 - 2.0 c3 - 1.5
		d1- According to the planning as per prerogatives of Instructions d2- Calling the GRS d3-According to work possibilities e) Training to use information systems - No (0)	d1 - 3.33 d2 - 1.66 d3 - 1.26 *	d1 - 3.33 d2 - 1.66 d3 - 1.26 _*	d1 - 2.0 d2 - 1.0 d3 - 0.6	d1 - 2.0 d2 - 1.0 d3 - 0.6	d1 - 2.0 d2 - 1.0 d3 - 0.6
					2.0	2.0	2.0
	Information management (10,0)	a) Feeding information systems a1- Timely as per prerogatives of Instructions a2- According to work possibilities	*	a1 - 3.33 a2 - 2.53	*	*	*
		b) Information systems feeding frequency b1- Daily b2- Weekly b3- Monthly	*	b1 - 3.33 b2 - 2.83 b3 - 2.33	*	*	*
Process		c) Sending of information systems spreadsheets c1 - Four-monthly c2 - Monthly c3 - Irregular	*	*	cl - 3.33 c2 - 2.83 c3 - 0	cl - 3.33 c2 - 2.83 c3 - 0	cl - 3.33 c2 - 2.83 c3 - 0
		d) Database is used for the following purposes d1- Planning actions and feeding information systems d2- Planning actions d3- Feeding information systems d4- Local database not available	*	*	d1 - 3.33 d2 - 2.83 d3 - 2.53 d4 - 0	d1 - 3.33 d2 - 2.83 d3 - 2.53 d4 - 0	d1 - 3.33 d2 - 2.83 d3 - 2.53 d4 - 0
		e) Communication channels with the population available - No (0)	*	3.33	3.33	3.33	3.33
	Implementation of actions (10,0)	a) Compulsory actions developed by each surveillance area with - Inadequate (0)	*	*	1.42	1.42	1.42
		b) Frequency of compulsory actions b1- Four-monthly targets b2- According to work conditions	*	*	b1 - 1.42 b2 - 0.8	b1 - 1.42 b2 - 0.8	b1 - 1.42 b2 - 0.8
		c) Performing health promotion actions - No (0)	*	*	1.42	1.42	1.42
		d) Frequency of health promotion actions d1- Four-monthly targets d2- According to work conditions	*	*	d1 - 1.42 d2 - 0.8	d1 - 1.42 d2 - 0.8	d1 - 1.42 d2 - 0.8
Process		e) Performing actions integrated with other surveillance areas e1- Health promotion e2- Vector control e3- Inspections e4- Environmental analysis e5- Investigation of outbreaks and diseases e6- No f)	*	*	e1 - 0.284 e2 - 0.284 e3 - 0.284 e4 - 0.284 e5 - 0.284 e6 - 0	e1 - 0.284 e2 - 0.284 e3 - 0.284 e4 - 0.284 e5 - 0.284 e6 - 0	e1 - 0.284 e2 - 0.284 e3 - 0.284 e4 - 0.284 e5 - 0.284 e6 - 0
		Performing actions in coordination with PHC - No (0)	*	*	1.42	1.42	1.42
		g) Performing actions in coordination with other bodies/institutions g1- Yes, working properly g2- Yes, but with restrictions g3- Yes, as a formality g4- No	*	*	g1 - 1.42 g2 - 1.0 g3 - 0 g4 - 0	g1 - 1.42 g2 - 1.0 g3 - 0 g4 - 0	g1 - 1.42 g2 - 1.0 g3 - 0 g4 - 0
	Monitoring (10,0)	a) Performing external evaluation - No (0)	*	5.0	1.42	1.42	1.42
		b) Types of external evaluation b1- Quantitative targets normative instrument + qualitative analysis of actions b2- Quantitative targets normative instrument	*	*	b1 - 1.42 b2 - 1.22	b1 - 1.42 b2 - 1.22	b1 - 1.42 b2 - 1.22
		c) External evaluation with * four-monthly frequency, according to normative instrument - Other (0)	*	*	1.42	1.42	1.42
		d) Performing internal evaluation - No (0)	*	5.0	1.42	1.42	1.42
Process		e) Internal evaluation protocol available - No (0)	*	*	1.42	1.42	1.42
		f)Types of internal evaluation f1- Quantitative targets according to planning + qualitative analysis of actions f2- Quantitative targets according to planning f3- Qualitative analysis of actions f4- None	*	*	f1 - 1.42 f2 - 1.22 f3 - 0.42 f4 - 0	f1 - 1.42 f2 - 1.22 f3 - 0.42 f4 - 0	f1 - 1.42 f2 - 1.22 f3 - 0.42 f4 - 0
		g) Frequency of internal evaluations g1- Monthly g2- Four-monthly g3- Annual g4- Other	*	*	g1 - 1.42 g2 - 1.42 g3 - 0.71 g4 - 0	g1 - 1.42 g2 - 1.42 g3 - 0.71 g4 - 0	g1 - 1.42 g2 - 1.42 g3 - 0.71 g4 - 0
	Process management (10,00)	a) Management of work processes carried out according to main diseases and strategies - No (0)	*	10	10	10	10
	Professional satisfaction (10,0)	a) Personal a1- Completely satisfied a2- Little satisfied a3- Satisfied a4- Very dissatisfied a5- Completely dissatisfied	a1 - 5.0 a2 - 3.75 a3 - 2.5 a4 - 1.25 a5 - 0	a1 - 5,0 a2 - 3.75 a3 - 2.5 a4 - 1.25 a5 - 0	a1 - 5.0 a2 - 3.75 a3 - 2.5 a4 - 1.25 a5 - 0	a1 - 5.0 a2 - 3.75 a3 - 2.5 a4 - 1.25 a5 - 0	a1 - 5.0 a2 - 3.75 a3 - 2.5 a4 - 1.25 a5 - 0
		b) With regard to work b1- Completely satisfied b2- Little satisfied b3- Satisfied b4- Very dissatisfied b5- Completely dissatisfied	b1 - 5.0 b2 - 3.75 b3 - 2.5 b4 - 1.25 b5 - 0	b1 - 5.0 b2 - 3.75 b3 - 2.5 b4 - 1.25 b5 - 0	b1 - 5.0 b2 - 3.75 b3 - 2.5 b4 - 1.25 b5 - 0	b1 - 5.0 b2 - 3.75 b3 - 2.5 b4 -1.25 b5 - 0	b1 - 5.0 b2 - 3.75 b3 - 2.5 b4 - 1.25 b5 - 0
Outcome	Resolubility by targets for Health Surveillance * (10,00)	a) Achieving targets of the normative instrument for Health Surveillance (items 1 to 6)	*	*	a1 a a6 - 1,66	*	*
	Resolubility by targets for Environmental Surveillance * (10,00)	a) Achieving targets of the normative instrument for Environmental Surveillance (items 1 to 10)	*	*	*	a1 a a10 - 1,0	*
	Resolubility by targets for Epidemiological Surveillance (10,0)	a) Achieving targets of the normative instrument for Epidemiological Surveillance (items 1 to 22)	*	*	*	*	a1 a a22 - 0.45

Municipalities	Work level	Structure				Process				Outcome

		HR	INF	REC TECNO MAT.	ADM MANAGEMENT	CONT EDUC	INF MANAGEMENT	IMPL. OF ACTIONS	PROC MANAGEMENT AND MONIT	PROF SATISF	RESOLUB
A	MANAGER	3.94	*	*	0	9.99	*	*	*	10	*
	COORD	8.3	*	4.99	5.03	8.32	9.19	*	7.5	7.5	*
	HS	6.18	10	7.64	8.37	4.6	9.19	7.1	7.03	6.25	6.64
	ENVS	7.32	8	9.67	8.37	9	9.99	8.8	7.03	7.5	7
	EPIS	9.94	4	6.15	3.37	7	9.19	8.8	8.7	7.5	2.7
	Sub-total	35.68	22	28.45	25.14	38.91	37.56	24.7	30.26	38.75	16.34
B	MANAGER	8.2	*	*	0	9.99	*	*	*	10	*
	COORD	7.4	*	3.33	6.66	9.99	8.69	*	10	10	*
	HS	7.32	10	9.98	10	8	9.99	3.12	9.06	6.25	6.64
	ENVS	7	10	7.47	5	7	6.66	5.96	7.03	10	6
	EPIS	8.42	10	7.98	5	7	6.66	8.18	8.7	8.75	1.35
	Sub-total	38.34	30	28.76	26.66	41.98	32	17.26	34.79	45	13.99
C	MANAGER	6.78	*	*	0	7.92	*	*	*	5	*
	COORD	8	*	4.99	1.7	8.32	9.19	*	7.5	8.75	*
	HS	7.1	8	4.52	8.37	9	9.19	8.18	7.03	6.25	8.3
	ENVS	6.5	6	5.66	10	9	9.99	8.8	9.97	10	6
	EPIS	7.1	6	9.15	8.37	7	9.19	8.8	7.03	10	4.05
	Sub-total	35.48	20	24.32	28.44	41.24	37.56	25.78	31.53	40	18.35
D	MANAGER	8.2	*	*	0	9.99	*	*	*	10	*
	COORD	8	*	3.33	3.33	8.32	9.99	*	7.5	8.75	*
	HS	6.5	6	4.83	5	5	9.99	6.764	7.03	2.5	3.32
	ENVS	5.9	6	4.66	5	7	9.49	8.8	9.06	10	8
	EPIS	7.1	8	5.66	5	9	9.19	8.8	8.7	10	4.05
	Sub-total	35.7	20	18.48	18.33	39.31	38.66	24.364	32.29	41.25	15.37
E	MANAGER	7.6	*	*	0		7.92	*	*	10	*
	COORD	8	*	4.99	5.03	9.99	9.99	*	7.5	10	*
	HS	7	0	4.15	3.37	7	9.19	6.96	7.03	6.25	3.32
	ENVS	6.18	2	4.32	3.37	7	9.19	8.18	8.35	6.25	4
	EPIS	6.78	6	7.01	3.37	9	9.19	8.8	8.7	10	4.05
	Sub-total	35.56	8	20.47	15.14	40.91	37.56	23.94	31.58	42.5	11.37
F	MANAGER	7.92	*	*	0	6.66	*	*	*	10	*
	COORD	7.4	*	4.99	1.7	8.32	9.99	*	7.5	8.75	*
	HS	7.1	0	8.98	8.37	5	9.99	8.18	7.03	10	4.98
	ENVS	9.62	2	7.49	3.37	9	9.19	5.96	8.35	7.5	0
	EPIS	9.94	4	6.49	3.37	7	9.49	5.96	8.7	6.25	3.6
	Sub-total	41.98	6	27.95	16.81	35.98	38.66	20.1	31.58	42.5	8.58
G	MANAGER	6.5	*	*	0	9.99	*	*	*	10	*
	COORD	7.4	*	4.99	9.99	8.32	9.99	*	7.5	8.75	*
	HS	7.6	6	9.67	10	5	9.19	6.76	7.03	7.5	4.98
	ENVS	7.1	4	6.18	5	7	9.19	7.38	9.06	10	5
	EPIS	7.1	2	5.18	5	5	9.19	8.8	9.06	10	3.6
	Sub-total	35.7	12	26.02	29.99	35.31	37.56	22.94	32.65	46.25	13.58

Surveillance areas	Municipalities	Structure	Process	Outcome	Realm performance score by municipality	Surveillance performance score in the seven municipalities	Regional surveillance performance score¹
HS	A	8.05	6.98	6.45	7.16^b	6.75^b	6.93 ^b
	B	9.33	7.54	6.45	7.77^b
	C	7.00	8.35	7.28	7.54^b
	D	5.58	7.20	2.91	5.23^a
	E	3.63	7.55	4.79	5.32^a
	F	6.11	7.55	7.49	7.05^b
	G	8.32	7.00	6.24	7.18^b
EnvS	A	8.34	8.71	7.25	8.10^c	7.13 ^b
	B	7.37	6.66	8.00	7.34^b
	C	7.04	9.44	8.00	8.16^c
	D	5.39	8.59	9.00	7.66^b
	E	3.97	8.18	5.13	5.76^a
	F	5.62	8.13	3.75	5.83^a
	G	5.57	8.16	7.50	7.08^b
EpiS	A	5.87	8.42	5.1	6.46^b	6.91 ^b
	B	7.85	7.64	5.05	6.85^b
	C	7.66	8.01	7.03	7.56^b
	D	6.44	8.92	7.03	7.46^b
	E	5.79	8.92	7.03	7.25^b
	F	5.95	7.79	4.93	6.22^b
	G	4.82	8.01	6.80	6.54^b

Municipalities	Structure	Process	Outcome	Performance score by municipality
A	7.42^b	8.04^c	6.27^b	7.24^b
B	8.18^c	7.28^b	6.50^b	7.32^b
C	7.23^b	8.60^c	7.44^b	7.76^b
D	5.80^a	8.24^c	6.31^b	6.78^b
E	4.46^a	8.22^c	5.65^a	6.11^b
F	5.89^a	7.82^b	5.39^a	6.37^b
G	6.24^b	7.72^b	6.85^b	6.94^b
Performance score by regional realm	6.46^b	7.99^b	6.34^b	6.93 ^b

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E-mail: cienciasaudecoletiva@fiocruz.br

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[1] Collaborations

CP Donateli contributed with design, outline and data review and interpretation, as well as paper writing. PS Avelar contributed with the outline and data review, as well as paper critical review. ABN Einloft and RMM Cotta contributed with data outline, as well as paper critical review. GD Costa contributed with the design and outline of the study, as well as paper critical reviewand approval of version to be published.