National Policy for Comprehensive Health Care for Adolescents Deprived of Liberty: an analysis of its implementation

Perminio, Henrique Bezerra; Silva, Juliana Rezende Melo; Serra, Ana Luísa Lemos; Oliveira, Bruna Gisele; Morais, Caroline Maria Arantes de; Silva, João Paulo Almeida Brito da; Franco Neto, Thereza de Lamare do

doi:10.1590/1413-81232018239.13162018

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ARTICLES • Ciênc. saúde colet. 23 (9) • Sept 2018 • https://doi.org/10.1590/1413-81232018239.13162018 copy

National Policy for Comprehensive Health Care for Adolescents Deprived of Liberty: an analysis of its implementation

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The realization of the right to health of adolescents and young people deprived of their liberty in Brazil is a complex task that places us before health inequities and interventions on their social determinants of health. Therefore, this study sought to contribute to a discussion about the right to health of this population, based on the analysis of the implementation of the Comprehensive Healthcare Policy for Adolescent Offenders (PNAISARI). This is an analytical approach, using documentary analysis of legal frameworks and policy monitoring and evaluation data. In short, the results suggest that the policy strengthens the realization of the right to health of this population. However, its implementation must be promoted and qualified so that access to health care is, in fact, a reality in all states and municipalities.

Institutionalized adolescent health; Health evaluation; Public health policies and intersectoral collaboration

Realm	Ordinance nº 647/2008	Ordinances nº 1082 and nº 1083/2014
Governance	It is the responsibility of the municipalities to establish their methods of policy governance.	The Inter-Sectoral Working Group (IWG), which is understood as an intersectoral mechanism for the negotiating table and decision-making, is expanded. States and municipalities qualified in the policy are responsible for its institutionalization.
Financing	Financing from the qualification of the states with transfers to either the state or municipal health fund, on a quarterly basis. Values based on the number of adolescents attended per month, per year: . > 40 = R$ 21.300,00 . 41 – 90 = R$ 51.120,00 . < 90 = R$ 85.300,00 . Semi-liberty = there was no incentive	Increased the incentive based on the parameters of the Family Health Strategy (ESF) team, transfer to the municipal/state fund as empowered, with monthly transfers and financial resources for semi-liberty houses. Values based on the number of adolescents attended per month, per year: . Up to 40 = R$ 89.838,00 . 41 - 90 = R$ 102.672,00 . < 90 = R$ 128.340,00 . Semi-liberty = R$ 38.502,00
Reference Team	Minimum team: . Doctor . Nurse . Dental surgeon . Psychologist or Social Worker Prioriza o atendimento pela Rede Local de Saúde, nos casos quando houver equipe de saúde dentro da unidade socioeducativa. Apresenta um anexo sobre como deve ser a estrutura física e de equipamentos.	Minimum team: . Doctor . Nurse . Dental surgeon . Mental health professional depending on the monthly number of adolescents attended at the facility. Prioritizes service in Primary Care, and in cases when there is a health team within the socio-educational facility, PHC reference health team should be articulated with the of the socio-educational health team. Does not mention the physical and equipmentstructure.
Architectural parameters of the health area in the socio-educational facility	Parameters defined as health area.	No description on parameters is available.
Modalities of socioeducational service	Internment and Provisional Internment	Internment and Provisional Internment, Semi-confinement and Open Environment Measures (Guidelines)
Interfederative articulation	Centralized State qualification.	Decentralization to municipalities with the possibility of state or local qualification.
Monitoring and Evaluation	State operational plan. State and regional seminars The State Health Secretariat must send to the Ministry of Health a copy of the chapter of the Management Report that includes POE’s actions, which will serve as a basis for monitoring and evaluation until the definition of indicators and monitoring procedures. Criteria for suspension of the incentive (financing): . Incomplete minimum team or team not updated in the SCNES.	Operational plan and state / municipal action plan. “In loco” technical visits Completion of the PNAISARI Follow-up and Monitoring Form (Form SUS) by the authorized subnational partners semiannually. Criteria for suspension of the incentive (financing): . Incomplete minimum team or team not updated in the SCNES. . Failure to submit the annual action plan . Identification of other irregularities in the implementation of the policy at the discretion of CGSAJ/DAPES/SAS/MS

Sphere	Area responsible for the implementation of the policy	N	%
State	Adolescent health	4	45
	Primary Healthcare	2	22
	Child and adolescent health	1	11
	Other	2	22
	Total	9	100
Municipal	Primary Healthcare	13	48
	Child and adolescent health	7	26
	Adolescent health	4	15
	Other areas	3	11
	Total	27	100

Data on the implementation of the policy	Nº of Municipalities	Nº of States
Federated units that held a meeting of SINASE’s Management Collegiate Body	8	3
Federated units that participated in a meeting of SINASE’s Management Collegiate Body	8	2
Federated units that held a meeting of the IWG	27	7
Federated units that participated in a meeting of the IWG	25	6
Federated units that co-finance PNAISARI	14	3
Follow-up the implementation of the PNAISARI	26	8
Health services improved after the implementation of the PNAISARI	24	7

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E-mail: cienciasaudecoletiva@fiocruz.br

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[1] Collaborations

All authors participated in the design and accomplishment of all stages of the research, as well as this paper’s design, elaboration, and review.