Hemorredes estaduais no contexto de expansão das redes de atenção à saúde.

Abstract

The implementation of the Unified Health System (SUS) since the 1990s has favored expanded access to health care through a network of services at different levels of complexity. For the provision of health care, blood and its components are strategic products or resources. Therefore, this study aims to analyze the potential, limitations, and challenges of state blood networks in meeting the needs of the health system, considering the expansion of the health service network in the respective states. The specific objectives are: a) to characterize the expansion of the care network (2011-2023) in states representing three regions of Brazil; b) to identify the potential, limitations, and challenges for blood therapy services in the public blood network, given the expansion of the Health Care Network; c) to produce recommendations based on a synthesis of the potential, limitations, and challenges of state blood networks in meeting the needs of the health system, considering the expansion of the health service network. This is a descriptive and exploratory study, using documentary analysis and a qualitative approach, developed from public blood networks and health care networks in the states of Mato Grosso, Paraná, and Minas Gerais, across three different Brazilian regions. Data collection and production were conducted over the period 2011 to 2023. A documentary survey was conducted including the State Health Plan, the Blood Master Plan, the Annual Management Report of the State Health Departments and Blood Networks, as well as access to/consultation of information systems such as the National Registry of Health Establishments (CNES), the National Health Surveillance Agency (Anvisa), and the Brazilian Institute of Geography and Statistics (IBGE). To guide the collection and analysis of results, the components of the health services system according to Souza and Bahia (2023) and the elements of the health care network (RAS) according to Mendes (2011) were considered as references. Thus, the findings were analyzed and discussed based on the territory/population, infrastructure, organization and layout of services and actions, management, and financing. Data collection from the information systems involved the support of a data scientist, and Excel software was used. Content analysis and descriptive analysis of statistical data were employed. The results of this study highlighted a set of limitations, challenges, and potentialities relevant to the organization and strengthening of state blood networks. Among the limitations identified are the lack of physical infrastructure and qualified human resources, insufficient or obsolete equipment, the fragility of blood component transportation logistics, and the increased demand for blood components due to the expansion of RAS. Added to these aspects are the fragmentation of management models, underfunding of initiatives, and the lack of integration and updating of information systems. Challenges include strengthening the infrastructure and installed capacity of blood network units, improving transportation logistics, overcoming weaknesses in contracting models, expanding blood therapy coverage, integrating state and regional planning, updating and reconciling databases, and ensuring adequate and stable funding. Potential opportunities include expanding blood networks inland, developing regional integration and inter-institutional collaboration, strengthening continuing education initiatives, partnering with universities, and integrating teaching and research initiatives. Also noteworthy are the consolidation of public structures, expanding Patient Blood Management (PBM), and adopting strategies to restructure blood networks aimed at improving specialized care and effectively integrating them into the HCN. The recommendations resulting from this study have the potential to support managers and technicians of blood therapy services and healthcare networks, in the various states of the federation, in the decision-making process aimed at meeting and covering health needs.