Assessment of the management of the Family Health Strategy via the tool Assessment for Quality Improvement in municipalities of Minas Gerais, Brazil

Cardoso, Andreza Viana Lopes; Chain, Ana Paula Nascimento; Mendes, Rafael Inácio Pompeu; Ferreira e Ferreira, Efigênia; Vargas, Andréa Maria Duarte; Martins, Andréa Maria Eleutério de Barros Lima; Ferreira, Raquel Conceição

doi:10.1590/1413-81232015204.01832014

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Free Themes • Ciênc. saúde coletiva 20 (4) • Apr 2015 • https://doi.org/10.1590/1413-81232015204.01832014 copy

Assessment of the management of the Family Health Strategy via the tool Assessment for Quality Improvement in municipalities of Minas Gerais, Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

The self-assessment of the quality ofthe Family Health Strategy(FHS) was assessed in the context ofmanagement and its correlation with characteristics of FHS and of the municipality. Managers, coordinators and Family Health Unit managers of municipalities in the Northeast region of Minas Gerais replied with tools 1, 2 and 3 of the Assessment for Improving the Quality of Family Health Strategy (AIQ). Scores were defined for each subdimension, according to the number of features compliant with the standards of the AIQ. We tested the correlation of this score with coverage and the deployment time of the FHS, with the municipal population and the HDI (Human Development Index). The lowest scores were for Work Management, Permanent Education and Inputs, Immunobiologicals and Medicines. There was a positive correlation between the municipal population and Strengthening of Coordination, Support for Teams, Permanent Education Management and Standardization and a negative one with Infrastructure and Equipment. The use of the AIQ tools permitted the identification of subdimensions and municipalities which will require greater attention and intervention by the municipal management.

Assessment of health services; Primary Healthcare; Health management; Family Health Program

		Maximum	Compliance scores
Dimension^*	Subdimension	compliance	Compliance scores
Dimension^*	Subdimension	compliance
		score	Minimum	Maximum	Average (SD)

Development	Installation/Implementation of FH	19	11	19	16.08	(2.01)
of the Family	within the municipality
Health Strategy	Integration of the services network	19	5	19	13.50 (13.80)
	Work Management	10	1	9	4.50	(1.88)
	Strengthening of Coordination	12	1	12	7.56	(2.58)
Technical	Planning and Integration	8	0	7	5.00	(1.52)
Coordination	Monitoring of the Teams	7	0	7	5.50	(1.52)
of Teams	Management of Permanent Education	6	0	6	3.54	(1.61)
	Management of Valuation	10	0	10	6.77	(2.22)
	Standardization	9	0	9	5.69	(2.23)
Family Health	Infrastructure and Equipment of the	24	8	22	14.42	(3.62)
Unit	Family Health Unit
	Inputs, Immunobiologicals and	16	6	16	13.23	(2.38)
	Medicines

		Population			Percentage		HDI of the			Installation
		of the			coverage by		HDI of the			Installation
Dimension	Subdimension	municipality			the FHS		municipality time of FHS
Dimension	Subdimension
			p			p		p			p
		r	value		r	value	r	value		r	value

Development	Installation/Implementation of FH	-0.09	0.55	0.10		0.49	0.17	0.23	0.10		0.55
of FHS	within the municipality
	Integration of the services network	0.10	0.51	0.02		0.89	0.04	0.79	0.14		0.34
	Work Management	0.07	0.65	0.01		0.94	0.10	0.50	0.09		0.52
	Strengthening of Coordination	0.29	0.04	0.15		0.30	0.02	0.91	0.13		0.38
	Planning and Integration	0.23	0.11	0.12		0.41	0.09	0.53	0.19		0.21
Technical	Monitoring of the Teams	0.29	0.04	0.05		0.74	0.14	0.35	0.01		0.99
Coordination	Management of Permanent	0.63	0.00	0.26		0.08	0.18	0.21	0.02		0.90
of Teams	Education
	Management of Valuation	0.18	0.22	0.20		0.18	0.03	0.87	0.01		0.94
	Standardization	0.38	0.01	0.09		0.55	0.08	0.61	0.08		0.57
	Infrastructure and Equipment of	-0.43	0.00	0.15		0.28	0.60	0.07	0.23		0.09
Family	the Family Health Unit
Health Unit	Inputs, Immunobiologicals and	-0.59	0.00	0.21		0.12	-0.27	0.04	0.22		0.11
	Medicines

		Municipalities
Subdimension	Standards	with positive	% of
		replies	municipalities
Installation/ Implementation of FH in the municipality	The Municipal Health Plan defines FH as a strategy for	49	98
	the reorganization of Basic Care
	The installation of FHS gives priority to the areas with	49	98
	less favorable socio-economic and health conditions and/
	or of social exclusion
	All of the teams are responsible for an attached	39	78
	population of up to 4,000 individuals
	Municipal health management supplies the Information	48	96
	Systems on a regular basis and within the established
	deadlines
	Municipal health management establishes OH teams	50	100
	The Municipal Health Plan details the guidelines and	47	94
	planning for the installation, implementation and
	consolidation of the FH
	Municipal health management carries out an analysis	35	70
	of the health situation of the municipality in order to
	support the installation of the FH
	The Municipal Health Secretariat maintains strategies for	44	88
	awareness raising and dissemination of FH among the
	population
	The directives and planning for the installation,	50	100
	implementation and consolidation of FH are agreed and
	approved with the CMS
	Municipal health management maintains analysis	41	82
	and monitoring of the health situation to support the
	implementation of FH
	The Municipal Health Secretariat maintains strategies	45	90
	for awareness raising and dissemination of FH among
	healthcare professionals of the municipal network
	Municipal health management develops actions in a form	45	90
	of articulated with other government sectors
	Municipal health management develops the FH strategy,	43	86
	installing OH in a proportion of at least one team for
	every two FHS
	The municipal management monitors supply and	43	86
	shortages of inputs in the FHU
	Municipal health management supports and legitimates	44	88
	popular participation and social control for FH
	FH strategy is institutionalized within the municipality	31	62
	through a legal instrument
	The organization of the teams in the UFH balances	43	86
	criteria of regionalization, comfort and sanitary safety for
	the development of activities
	The municipal health manager has agreements and/	21	42
	or partnerships formalized with organizations of civil
	society and/or social movements
	The municipal management develops the FH installing	37	74
	Oral Health in the proportion of one team for each FHS
Integration of the Service Network	Municipal health management expands and/or makes	45	90
	adaptations to the service network as a function of the
	installation of FH within the municipality
	Municipal health management expands and/or makes	36	72
	adaptations to the network of references, basing itself on
	studies of the demand verified and/or estimated in the FHS
	Planning exists for the supply of basic complimentary	45	90
	examinations for the FHS
	Municipal health management guarantees the collection and	47	94
	submission of all serology requests for diagnosing dengue
	fever
	Municipal health management develops strategies for	48	96
	ensuring a reference for the population attached to the FH
	teams for hospitalizations in the basic clinics
	Municipal health management guarantees the execution of	46	92
	high-risk prenatal tests for all referred pregnant women
	Planning exists for the supply of cardiology treatment for	29	58
	the FHS based on studies of demand
	Planning exists for the supply of orthopedic treatment for	30	60
	the FHS based on studies of demand
	The procedures of fixing tests, procedures and	42	84
	hospitalizations are carried out by a reservation center
	The municipal health manager monitors and specialized	41	82
	tests, requested by the FHS, which are not provided by the
	reference
	Planning of the supply of rehabilitation services for the FHS	33	66
	based on studies of demand
	Planning of the supply of ophthalmologist services for the	24	48
	FHS based on studies of demand
	Planning of the supply of a nose and throat treatment for	26	52
	the FHS based on studies of demand
	Planning of the supply of neurology treatment for the FHS	26	52
	based on studies of demand
	Municipal health management develops strategies for	30	60
	ensuring a reference for the population attached to the FH
	teams for dentistry specialties
	The health services network guarantees access to the dental	15	30
	prosthesis laboratory for the population attached to the FH
	teams
	Municipal health management develops integration	36	72
	strategies between the mental health service and the FHS
	Municipal health management monitors the use of urgent,	35	70
	emergency and first aid services of the public network for
	the population covered by the FH
	Support by other network professionals for the FH teams is	41	82
	provided systematically, on the basis of an established model
Work Management Strengthening of Coordination	Municipal health management develops strategies for	16	32
	ensuring that labor rights do not become precarious in the FH
	The criteria of the SMS for the selection and recruitment of	37	74
	FH professionals are described in an official document
	The criteria for selecting professionals for higher-level FH	18	36
	give value to Residential or Postgraduate Studies in Family
	Health
	The entry of high-level FH professionals is realized through	17	34
	a public competition to fill permanent positions or public
	sector jobs
	The entry of mid-level FH professionals is realized through	28	56
	a public competition to fill permanent positions or public
	sector jobs
	Higher-level FH professionals have been working in the	30	60
	municipality for more than two years
	The ACS have been working in the municipality for more	33	66
	than two years
	The municipal management has an incentive program for	13	26
	the FHS related to performance, meeting targets and results
	achieved
	Municipal health management has institutionalized career	11	22
	plans, positions and salaries regarding the FH
	80% of higher-level professionals in the teams have specific	22	44
	training in the area
	The SMS has a specific coordinating body for BH/FH	41	82
	The coordinating body of the BH/FH is formally included	32	64
	in the organizational structure of the Municipal Health
	Secretariat
	Municipal health management involves the coordination of	45	90
	the BH/FH in the process of agreeing on the BH indicators in
	the Health Pact
	Municipal management values the participation of the	43	86
	coordinating body of the BH/FH in congresses and meetings
	of the area
	The technician(s) responsible) for the coordination of the	31	62
	BH/FH has/have specific training in the area
	The coordinating body of the BH/FH consists of a multi-	25	50
	professional team for the support, supervision and technical
	monitoring work of FHS
	Decentralized coordination exists, which is responsible for	19	38
	the monitoring of at most 8 FH teams
	The SMS has a professional coordinator of the BH/FH,	32	64
	responsible for the area of OH
	Municipal health management and/or the coordinating body	17	34
	establish or use mechanisms for the monitoring of the degree
	of satisfaction of the users of the FH
	Technical areas work in an integrated manner with the	42	84
	coordination of the BH/FH
	The coordinating body of the BH/FH supports and promotes	19	38
	the training of Local Health Councils in the basic units
	Municipal health management develops a Humanization	32	64
	policy for the municipal network, in conjunction with the

Subdimension	Standard	n	%
			municípios

Planning and	The coordinating body of the BH/FH has a timetable of visits to the UFH and	43	89.6
Integration	meetings with the FHS
	The coordinating body of the BH/FH has a work plan which guides the	30	62.5
	activities to be developed
	The coordinating body of the BH/FH registers the monitoring of the	46	95.8
	situation of FH in the municipality, the number of teams, coverage,
	professionals and results
	The coordinating body of the BH/FH takes part regularly in the meetings of	39	81.3
	the Municipal Health Council
	The coordinating body of the BH/FH meets with the public and social sectors	35	72.9
	of the municipality
	The coordinating body of the BH/FH possesses and makes available to the	21	43.8
	FHS an updated register of the social resources of the municipality
	The municipal experiences with FH are presented at congresses and meetings	13	27.1
	in the area
	The coordinating body of the BH/FH develops initiatives for integration and	13	27.1
	partnership with academic institutions, making possible the realization of
	scientific production in the field of Basic Health Care
Monitoring of	The coordinating body of the BH/FH meets on a monthly basis with the FHS	44	91.7
the Teams	The coordinating body of the BH/FH guarantees a weekly shift to the FHS	34	70.8
	intended for a team meeting
	The coordinating body of the BH/FH uses instruments to monitor the	33	68.8
	actions and practices of the FH
	The coordinating body of the BH/FH develops strategies for administering	40	83.3
	conflicts between FH professionals
	The coordinating body of the BH/FH assesses the level of satisfaction of	33	68.8
	professionals with their work, taking into consideration criticisms and
	suggestions for planning actions
	The coordinating body of the BH/FH develops strategies with the teams for	43	89.6
	confronting problems encountered while providing care to the population
	The coordinating body of the BH/FH develops instruments for the	37	77.1
	organization and monitoring of FHS actions and practices in conjunction
	with the teams
Management	The coordinating body of the BH/FH ensures preparatory courses for FH	34	70.8
of Permanent	workers
Education	The coordinating body of the BH/FH takes part regularly and forums or	36	75.0
	meetings for the Development of the Permanent Education
	The coordinating body of the BH/FH decides, together with the FHS on the	34	70.8
	themes and activities to be developed in Permanent Education
	Theoretical and practical training is offered in basic areas for those	19	39.6
	higher-level FH professionals who require it
	Technical areas and FH develop Permanent Education activities in integrated	28	58.3
	fashion
	The coordinating body of the BH/FH ensures the execution of specializations	19	39.6
	in the area for FHS professionals
Subdimension	Standard	n	%
			municipalities

Management of	The coordination evaluates the output of FHS on a monthly basis	42	87.5
Assessment	The coordinating body of the BH/FH uses the information of	43	89.6
	the SIAB as a management instrument: assessment, planning and
	monitoring
	The coordinating body of the BH/FH analyses the reports of the SIAB	28	58.3
	on a monthly basis, in conjunction with the FHS
	The coordinating body of the BH/FH analyses data and reports of the	35	72.9
	SUS or health information system
	The coordinating body of the BH/FH chooses criteria and indicators	22	45.8
	for evaluating with the teams the impact on the health conditions of
	the population
	The coordinating body analyses the demand for FH tests and referrals,	27	56.3
	observing whether there is a match with the estimated requirement
	The coordinating body of the BH/FH debates the results and plans the	38	79.2
	objectives of FH with the teams
	The coordinating body of the BH/FH meets with the other areas of	26	54.2
	the SMS to discuss the results achieved in BH.
	The coordinating body of the BH/FH evaluates the established goals	44	91.7
	for the Basic Healthcare indicators of the Health Pact with the FHS
	Epidemiological surveys of Oral Health are carried out within the	20	41.7
	municipality
Standardization	The coordinating body of the BH/FH makes documents available to	32	66.7
	all of the FHS with the principles and guidelines of the FH strategy
	The coordinating body of the BH/FH uses a written standard with	28	58.3
	regard to the physical installation and equipment
	The BH/FH coordinating body makes updated information from the	32	66.7
	municipal reference and counter-reference system available to all of
	FHS units
	The coordinating body of the BH/FH provides a manual of basic	35	72.9
	pharmacy medicines
	The coordinating body of the BH/FH makes supporting technical-	37	77.1
	scientific material available to the teams on frequent situations in
	Basic Health Care
	The coordinating body of the BH/FH makes supporting technical-	44	91.7
	scientific material available to the teams on the most prevalent
	infectious and parasitic diseases in the country.
	The coordinating body of the BH/FH has documentation establishing	31	64.6
	the action of each FH professional
	The coordinating body of the BH/FH provides protocols and technical	21	43.8
	information to the FHS/OH on dealing with urgent situations
	The coordinating body of the BH/FH provides protocols and technical	13	27.1
	information to the FHS/OH on dealing with urgent situations in
	Mental Health

Subdimension	Standard	n	%
			Teams

FHU	Each FHS has a clinic with basic equipment for attending its population	174	82.9
Infrastructure	The UFH clinics permit the visual and auditory privacy of health care	181	86.2
and Equipment	Clinics where gynecological examinations are carried out have, as a	179	85.2
	minimum, screens for dressing and undressing
	The ACS have basic equipment for external work	113	53.8
	The FHS have complete equipment and orthodontic equipment for the	146	69.5
	regular performance of its activities
	Considering the physical installation, all areas of the UFH have adequate	118	56.2
	conditions for carrying out basic health actions
	The UFH has a covered space, exclusively for reception and waiting, with	164	78.1
	a number of seats compatible with the expected demand
	The UFH has an exclusive refrigerator for vaccines with temperature	118	56.2
	control for the preservation of immunobiologicals
	The UFH plans the use and adaptation of environments for applying	146	69.5
	bandages, inhalation, sutures and the observation of patients
	There are sufficient quantities of gynecological-obstetric equipment for	169	80.5
	the work of the FHS
	The number of clinics of the UFH allows doctors and nurses to provide	172	81.9
	outpatient FH treatment at the same time
	The tensiometers and scales of the UFH are measured in accordance	81	38.6
	with technical parameters
	The ACS have other items of equipment for external work	56	26.7
	The UFH has a telephone line	65	31.0
	The UFH has computer equipment	97	46.2
	The UFH has a room for holding team meetings, internal activities of	110	52.4
	the ACS and Permanent Education activities
	The UFH has other items of equipment for treatment by the teams	37	17.6
	The UFH has equipment recommended for first aid in urgent and	32	15.2
	emergency cases
	Travel by the FH professionals to carry out planned external activities is	162	77.1
	carried out in a SMS vehicle
	The UFH has electronic equipment for educational activities	105	50.0
	The dentistry clinics allow the provision of DHT treatment and dental	93	44.3
	surgery in an integrated manner
	The UFH is equipped to treat individuals with special needs: ramps,	76	36.2
	banisters, width of the doors, restrooms and wheelchairs
	The UFH has access to the Internet and makes it available to FH workers	53	25.2
	on the basis of defined criteria
	Clinics where gynecological examinations are carried out have their own	148	70.5
Subdimension	Standard	n	%
			Teams

Inputs,	The UFH provides all of the vaccines for the basic calendar of the	162	77.1
Imunobiologicals	National and State Immunization Programs on a routine basis
and Medicines	The UFH provides on a regular basis and in sufficient quantities the	174	82.9
	basic medicines prescribed for the treatment of the most frequent
	parasitic infections
	The FHS/OH have materials and inputs for carrying out educational	160	76.2
	activities with the population
	The UFH regularly dispenses medicines indicated for the prevention	179	85.2
	and treatment of deficiency anemias and hipovitaminoses in
	sufficient quantities
	The UFH has basic inputs in sufficient quantities for the regular	194	92.4
	performance of health actions
	The UFH has OH inputs in sufficient quantities for the regular	157	74.8
	performance of health actions
	The UFH has printed material in sufficient quantities for the regular	194	92.4
	performance of health actions
	The UFH has glucometers and supplies tapes in sufficient quantities	159	75.7
	The UFH regularly dispenses basic antibiotics indicated for the
	treatment of the most prevalent infectious diseases in sufficient	165	78.6
	quantities, with these appearing in the standardized list of antibiotics
	of the SMS
	The UFH regularly dispenses sufficient quantities of the basic	176	83.8
	medicines indicated for the treatment of Systemic Arterial
	Hypertension
	The UFH regularly dispenses regularly dispenses sufficient quantities	178	84.8
	of the basic oral medicines indicated for the treatment of Diabetes
	Mellitus
	The UFH regularly dispenses NPH insulin indicated for the	157	74.8
	treatment of diabetes mellitus in sufficient quantities, deriving from
	adequate storage in a refrigerator
	The UFH has basic medicines indicated for first aid for cases of	152	72.4
	hypertensive crisis, in accordance with local protocols, with these
	stored under adequate conditions
	The UFH has inhalatory medicines for asthma attacks, stored in an	151	71.9
	adequate location
	The UFH has medicines for the treatment of diseases of the	139	66.2
	gastrointestinal tract
	The UFH has basic medicines indicated for first aid for cases of	101	48.1
	grand mal epilepsy crises, in accordance with local protocols, with
	these stored under adequate conditions

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[1] Collaborators AVL Cardoso, APN Chain, RIP Mendes, EF Ferreira, AMD Vargas, AMEB Lima and RC Ferreira also took part in all of the stages of elaboration of this article.