Acesso aos serviços de saúde para o controle do câncer do colo do útero em duas regiões de saúde da Bahia

Abstract

In this dissertation, access to health services for cervical cancer (CC) control was analyzed in two articles. The first article is a review entitled “Control of cervical cancer in primary health care in South American countries: a systematic review”, which involved two stages: a document review on government websites and a systematic review of the literature on the following databases: LILACS, MEDLINE, Scopus, SciELO and Science Direct. The results of this systematic review showed that there were high rates of morbidity and mortality due to CC and that opportunistic screening prevailed in primary health care (PHC) in the countries surveyed. All investigated countries adopted a comprehensive conception of PHC, although the implementation process was in heterogeneous stages and with a predominance of focus and selectivity. Worse access to screening is evidenced for women from rural or remote regions and for indigenous peoples, and the unavailability of PHC services close to homes/community was an important barrier to CC screening. In this context, the fragmentation of health systems and the segmentation in the supply of services proved to be obstacles for the prevention and control of CC in South America, highlighting the need for organized CC screening programs and the incorporation of an active search for performing the Papanicolaou exam via PHC. The second article is a case study with a qualitative approach entitled “Experiences and perceptions of SUS gynecologists in assistance for CC control in two health regions of Bahia”. To obtain data from this case study, eight semi-structured interviews were carried out with three gynecologists in the health region of Juazeiro and five gynecologists in the health region of Vitória da Conquista. Empirical data were interpreted in the light of Thematic Content Analysis. The results of the analysis of empirical data revealed the disarticulation between gynecologists and the CC control network. In the experience of gynecologists, the extended times between the collection of the Papanicolaou test by the PHC and the release of the result, as well as the histopathological results of the biopsies, compromised timely outpatient follow-up. In this sense, commonly, women resorted to the private network through the direct disbursement of expenses to advance installments of the assistance path in the SUS. Access to outpatient clinics was diverse and, routinely, women sought the service for gynecological complaints, instead of specific consultations for CC control, even when referred by the PHC. In summary, even though they have technical competence for diagnosing CC in the early stages, the gynecologists were positioned to focus their practices without being integrated into the network and, in this sense, there was difficulty in sharing care and in understanding the material and symbolic conditions that contribute to the persistence of CC cases, even in the presence of technologies for prevention and control.