Hospitais de pequeno porte: relevância da implementação da política pública na Bahia

Abstract

The municipalization resulting from the process of decentralization of the Unified Health System (SUS) has made the municipality the main space for the implementation of different health policies. The Ministry of Health, aiming at strengthening small hospitals and understanding their performance as a strategic element for comprehensive health care, instituted the National Policy for Small-sized Hospitals (PNHPP). In order to promote the regionalization of health services, Bahia sought to expand its scope. Thus, in addition to the perception that such measures promote greater security for the population and easier access to health services, this study aimed to demonstrate the level of implementation of the State Policy of Small-sized Hospitals (PEHPP) in eight municipalities of the state, considering the context experienced in the period 2014-2020. To carry out the research, analysis of documents was used and questionnaires were applied with users of these services, in order to obtain the necessary elements to answer the research question, using the content analysis based on the categories of the evaluation model focused on the objectives of the public policy. The results of the work point to an intermediate level of implementation of such policy, with emphasis on the back-up actions of the Family Health Strategy, care to emergencies with the guarantee of continuity of care through referral to units of greater complexity. It is also noteworthy that 75% of the evaluated municipalities are responsible for most of the hospitalizations of their population. The main weaknesses found refer mainly to the managers' lack of responsibility in the implementation of the policy, neglecting the environment, the supply of equipment, and of adequate human resources. Similarly, it was found a great vulnerability in the guideline linked to the model of care to natural birth, a priority for the policy, as well as the total absence of acting as a back-up for regional reference hospitals, in the counter-reference of stabilized patients, whose relevance has been greater during the pandemic. In this context, knowledge of the degree of implementation of the PEHPP can determine inconsistencies in the process and the necessary corrections in the course of the program. Thus, with this purpose in mind, we have as a product of this work, the proposal of a matrix to evaluate the degree of implementation of this policy. This matrix was applied to the hospitals that were the object of this research, and may be replicated and expanded for the evaluation of other hospital units, both in Bahia and in other Brazilian states. The main limitation of this dissertation is the number of questionnaires answered, which was impacted by the pandemic context that made it difficult for the researcher to access users and municipal managers. In order to overcome these limitations, we suggest the development of new studies investigating a larger number of users, as well as including municipal managers from different levels, thus contributing to the improvement of the matrix proposed here.