Policies for Prevention and Control of Oral Cancer in the light of Giddens’ Structuration Theory

Lima, Fernando Lopes Tavares de; O’Dwyer, Gisele

doi:10.1590/1413-81232020258.17182018

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ARTICLE • Ciênc. saúde coletiva 25 (8) • Aug 2020 • https://doi.org/10.1590/1413-81232020258.17182018 copy

Policies for Prevention and Control of Oral Cancer in the light of Giddens’ Structuration Theory

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Challenges remain to ensure access to diagnosis and treatment ten years into continuous cancer prevention, control, and oral health policies. This study aims to analyze the oncology and oral health policies in force regarding the process of implanting oral cancer-related care components. Ten policies were analyzed under the lenses of the Structuration Theory, besides data on the supply of services between 2002 and 2017. Low coverage and inadequate regional distribution were highlighted in primary and secondary health care levels, despite increased funding and number of services. Unequal distribution of performed surgeries was identified in tertiary care. The limitation of home care services has hindered users’ access to palliative care. A convergence was identified between the analyzed policies and concern with the regulation of authoritative resources and the increase of allocative resources, which stirred the expansion of services. Investments should be made in the expansion, regionalization, and universalization of services. A possible setback in these policies could aggravate the situation and contribute to the increase in health inequalities.

Key words
Mouth Neoplasms; Health Policy; Oral Health

Year	Norms	Objective
2004	National Oral Health Policy Guidelines²³23 Brasil. Ministério da Saúde (MS). Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Diretrizes da Política Nacional de Saúde Bucal. Brasília: MS; 2004..	It presents the guidelines of the Ministry of Health for the organization of oral health care within the Unified Health System.
2012	Law nº 12.732 of November 22²⁵25 Brasil. Lei nº 12.732, de 22 de novembro de 2012. Dispõe sobre o primeiro tratamento de paciente com neoplasia maligna comprovada e estabelece prazo para seu início. Diário Oficial da União 2012; 23 nov..	Establishes a deadline for the start of treatment of a patient with proven malignancy.
2014	Ordinance MS/SAS nº 140 of February 2726.	Redefines the criteria and parameters for the organization, planning, monitoring, control and evaluation of health establishments qualified in specialized care in oncology and defines the structural, operating and human resources conditions for the qualification of these establishments within the Unified Health System.
2015	Ordinance MS/SAS nº 516 of June 17²⁷27 Brasil. Portaria nº 516, de 17 de junho de 2015. Aprova as Diretrizes Diagnósticas e Terapêuticas do Câncer de Cabeça e Pescoço. Diário Oficial da União 2015; 18 jun..	Approves the Head and Neck Cancer Diagnostic and Therapeutic Guidelines.
2017	Consolidation Ordinance MS/GM nº 2 (Annex XXII) of October 3²²22 Brasil. Portaria de Consolidação nº 2, de 28 de setembro de 2017. Consolidação das normas sobre as políticas nacionais de saúde do Sistema Único de Saúde. Diário Oficial da União 2017; 03 out..	Establishes the National Policy for the Prevention and Control of Cancer in the Health Care Network of People with Chronic Diseases within the Unified Health System.
2017	Consolidation Ordinance MS/GM nº 2 (Annex XXII) of October 3²²22 Brasil. Portaria de Consolidação nº 2, de 28 de setembro de 2017. Consolidação das normas sobre as políticas nacionais de saúde do Sistema Único de Saúde. Diário Oficial da União 2017; 03 out..	Approves the National Primary Care Policy to review the current implementation and operationalization regulations, within the Unified Health System, establishing guidelines for the organization of the Primary Care component in the Health Care Network.
2017	Consolidation Ordinance MS/GM nº 5 (Section I, Chapter V, Title IV) of October 3²⁴24 Brasil. Portaria de Consolidação nº 5, de 28 de setembro de 2017. Consolidação das normas sobre as políticas nacionais de saúde do Sistema Único de Saúde. Diário Oficial da União 2017; 03 out..	Establishes the Dental Specialties Centers and Regional Dental Prosthesis Laboratories, and with established criteria, norms and requirements for their accreditation.
2017	Consolidation Ordinance MS/GM nº 5 (Section II, Chapter I, Title IV) of October 3²⁴24 Brasil. Portaria de Consolidação nº 5, de 28 de setembro de 2017. Consolidação das normas sobre as políticas nacionais de saúde do Sistema Único de Saúde. Diário Oficial da União 2017; 03 out..	Establishes the National Program for Improving Access and Quality in Primary Care
2017	Consolidation Ordinance nº 5 (Section II, Chapter V, Title IV) of October 324.	Provides for the Program for Improving Access and Quality of Dental Specialty Centers
2017	Consolidation Ordinance MS/GM nº 6 of October 3²⁸28 Brasil. Portaria de Consolidação nº 6, de 28 de setembro de 2017. Consolidação das normas sobre o financiamento e a transferência dos recursos federais para as ações e os serviços de saúde do Sistema Único de Saúde. Diário Oficial da União 2017; 30 out..	Consolidates the rules on financing and transferring federal resources to the health actions and services of the Unified Health System.

	Midwest	Northeast	North	Southeast	South	Brazil
Population (N)
2002	11,883,997	48,328,769	13,243,229	73,469,982	25,454,344	172,358,700
2017	15,660,988	56,915,936	17,740,418	86,356,952	29,439,773	206,114,067
Variation	1.32	1.18	1.34	1.18	1.16	1.20
Teams (N)
ESF 2002	1,417	6,699	1,214	4,981	2,423	17,734
ESF 2017	2,745	14,757	3,271	13,300	5,799	39,782
Variation ESF	1.94	2.20	2.69	2.67	2.39	2.24
ESB 2002	534	2,134	242	705	464	4,261
ESB 2017	1,933	10,700	1,812	6,486	3,122	24,053
Variation ESB	3.62	5.01	7.49	9.20	6.73	5.64
Coverage (%)
ESF 2002	38.97	45.33	30.56	22.63	30.73	31.93
ESF 2017	55.70	75.13	57.97	49.93	61.95	59.74
Variation ESF	1.43	1.66	1.90	2.21	2.02	1.87
ESB 2002	26.00	28.00	11.00	6.00	14.00	15.00
ESB 2017	39.94	56.78	33.26	24.47	34.33	36.73
Variation ESB	1.54	2.03	3.02	4.08	2.45	2.45
Municipalities (N)
ESF 2002	439	1,408	328	1,171	817	4,163
ESF 2017	458	1,786	445	1,574	1,139	5,402
Variation ESF	1.04	1.27	1.36	1.34	1.39	1.30
ESB 2002	349	1,025	154	334	440	2,302
ESB 2017	448	1,755	420	1,329	981	4,933
Variation ESB	1.28	1.71	2.73	3.98	2.23	2.14

	Midwest	Northeast	North	Southeast	South	Brazil
Population
2004	12,270,694	49,890,217	14,130,131	78,211,800	25,991,388	174,443,248
2016	15,447,265	56,570,893	17,447,494	84,682,360	29,238,905	206,705,005
Variation	1.25	1.13	1.23	1.08	1.12	1.18
CEO
2004	15	25	6	39	15	100
2016	74	400	67	385	127	1,033
Variation	4.93	16	11.16	9.87	8.46	10.33
População/CEO
2004	818,046	1,995,608	2,355,021	2,005,430	1,732,759	1,744,432
2016	208,746	141,427	260,410	219,954	230,227	200,101
Variation	3.91	14.11	9.04	9.11	7.5	8.71
Municipalities
2004	9	21	4	13	13	60
2016	51	356	51	292	107	857
Variation	5.66	16.95	12.75	22.46	8.23	14.28

Units	Midwest	Northeast	North	Southeast	South	Brazil
Cacon	2	10	1	22	9	44
General Hospital with Oncological Surgery	0	0	1	7	0	8
Unacon	19	47	9	113	58	246
Total
Qualified units	21 (7%)	57 (19%)	11 (3%)	142 (48%)	67 (23%)	298
Habitants by unit	755,996	1,004,459	1,630,564	612,322	442,462	696,849
Cancer cases by unit^* * Cases estimated for 2018.	2,077	2,058	2,124	1,917	1,877	1,954
Oral cancer cases by unit^* * Cases estimated for 2018.	49	49	45	53	42	49

Units	Midwest	Northeast	North	Southeast	South	Brazil
Cacon
Units	2	10	1	22	9	44
Units with surgery records	2	9	1	21	9	42
% of units with surgery records	100	90	100	95	100	95
Number of surgeries	88	148	4	389	133	762
Number of surgeries by unit	44.0	16.4	4.0	18.5	14.7	18.14
General Hospital with Oncological Surgery
Units	0	0	1	7	0	8
Units with surgery records	0	0	0	2	0	2
% of units with surgery records	0	0	0	28	0	25
Number of surgeries	0	0	0	3	0	3
Number of surgeries by unit	0	0	0	1.5	0	1.5
Unacon
Units	19	47	9	113	58	246
Units with surgery records	13	25	8	79	50	175
% of units with surgery records	68	53	89	70	86	71
Number of surgeries	50	233	54	509	280	1,126
Number of surgeries by unit	3.8	9.3	6.8	6.4	5.6	6.4
Total
Units	21	57	11	142	67	298
Units with surgery records	15	34	9	102	59	219
% of units with surgery records	71	59	81	72	88	73
Number of surgeries	138	381	58	901	413	1,891
Number of surgeries by unit	9.2	11.2	6.4	8.8	7.0	8.6

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E-mail: cienciasaudecoletiva@fiocruz.br

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[1] Collaborations

FLT Lima participated in the conception and design of the study, collection and analysis of information, and writing of the paper. G O’Dwyer participated in the design of the study, the analysis of information, and the final review of the paper.