Política de vigilância em saúde: avaliação do processo de gestão e execução das atividades de implementação em território da amazônia paraense

Abstract

This research evaluated the degree of action of the National Health Surveillance Policy (PNVSA) in a medium-sized municipality in Baixo Tocantins, Pará State, Brazil. The project of this research was approved by the Ethics and Research Committee of the Institute of Health Sciences (UFPA) with the number of opinions: 4,440,439 and was developed based on quantitative and qualitative approaches, based on methodological procedures: bibliographic, documentary and empirical research, with the collection of field data that occurred in December 2020 and January 2021. As instruments in the data collection, three (03) distinct questionnaires were used, addressed to: Municipal Health Secretary, Health Surveillance Coordinator and a common to the coordinators of the different Surveillance, involving the dimension of the management and execution of the activities of implementation of the Sanitary Surveillance (VISA), Epidemiological Surveillance (VE), Environmental Health Surveillance (VSA) and Health Surveillance of the Worker (VISAT), using for the field data the methods and techniques adopted by Donateli, et. Al. (2017) and Donabedian (2005), in addition to participant observation, and for bibliographic and documentary research, triangulation of methods was used. The results indicate that the degree of action of VISA in the municipality of study was classified as intermediate, while the VE and VSA was unsatisfactory, and VISAT performance was nonexistent. Among the critical points for both, the sub-dimensions stand out: material and technological resources; information management, implementation of actions; monitoring and resolution by goals, and process management is the best evaluated indicator. The weaknesses observed are related to the lack of physical resources for administrative and field work, challenges in relation to the municipal SV database, the periodicity of mandatory actions and health promotion occurs according to the conditions of the service, the internal evaluation of VS does not always happen, there are no channels of direct communication with the population, in addition, the professionals were dissatisfied with the work. The data also show that there is a great technical and managerial challenge to conduct the policy and articulate with the different territories in the implementation of actions, and there is a need for multiple initiatives to enable it, such as the training of agents that allows a more adequate understanding of the policy, because there are several knowledges inherent to health surveillance that need to be worked on a logic of integration of these knowledges; more financial investments; elaboration and discussion of the goals together with the population so that they meet their longings and the real needs of the current context, monitoring and continuous evaluation to improve the effectiveness of the policy and ensure a more effective performance in the dynamic and heterogeneous context that are the territories of the Amazônia, being crucial the effective support of the public power local and state so that actions and transformations happen in practice.