Analysis of problems associated with the quality standards of primary care in the Federal District

Scherer, Magda Duarte dos Anjos; Leite, Thaís Alessa; Santos, Ricardo Ramos dos; Prado, Nília Maria de Brito Lima

doi:10.1590/2358-289820241428607I

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ORIGINAL ARTICLE • Saúde debate 48 (142) • Jul-Sep 2024 • https://doi.org/10.1590/2358-289820241428607I copy

Analysis of problems associated with the quality standards of primary care in the Federal District

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

This article analyzes the priority problems established in the local management action plans within the scope of the Federal District’s Primary Health Care Qualification Program – QualisPHC. It is a descriptive study, with a qualitative approach, based on the self-assessment described in the Quality Action Plans drawn up by 100 managers of the Primary Health Care Service Departments in 2022. The results showed that of the five dimensions of the quality self-assessment instrument, user care and work organization are the key ones for improving Primary Health Care. In the thematic analysis of the problems, critical nodes were identified that indicate priorities for intervention by managers: territorialization; planning and monitoring; communication with users; work organization; structure; qualification of professionals; and the pandemic. The results show that the continuous process of identifying priorities is essential to support health planning by managers and teams, and the QualisPHC is a good step towards fostering experiences with a strategic planning approach in other local systems.

KEYWORDS
Quality ofhealth care; Primary Health Care; Family Health Strategy; Health planning; Health evaluation

Health Region	Administrative Region	UBS	eSF	eSB	GSAP
Central	Cruzeiro	2	10	3	2
	Lago Norte	1	4	1	1
	Plano Piloto	5	24	5	4
	Varjão	1	3	1	1
	Total	9	41	10	8
South central	Candangolândia	1	5	2	1
	Guará	5	23	11	4
	Núcleo Bandeirante	2	7	3	1
	Park Way	1	1	1	0
	Riacho Fundo I	2	10	4	2
	Riacho Fundo II	5	16	4	2
	Scia/Estrutural	2	12	6	1
	Total	18	74	31	11
North	Fercal	3	4	3	1
	Planaltina	20	48	20	9
	Sobradinho	6	24	14	3
	Sobradinho II	7	21	11	3
	Total	36	97	48	16
West	Brazlândia	9	16	8	3
	Ceilândia	18	80	36	18
	Total	27	96	44	21
Southwest	Águas Claras	2	7	4	1
	Recanto das Emas	9	36	21	5
	Samambaia	13	60	37	9
	Taguatinga	7	49	21	7
	Vicente Pires	1	8	3	1
	Total	32	160	86	23
South	Gama	10	39	20	7
	Santa Maria	8	28	14	5
	Total	18	67	34	12
Total		165	603	286	100

Dimensions	Dimensions	Nº of patterns
user care	Access	2
	Integral care	3
	Education and Communication in Health	1
	Participation and Social Control	3
Structure	Physical Structure and Equipment	2
	Materials, Inputs and Medicines	2
Work management	Work Force	3
	Permanent Qualification and Education	2
Care network organization	Integration to the network	5
	Teaching-Service Integration	2
Work organization	Actions in the territory	3
	Planning, Monitoring and Evaluation	8

RS	Pattern	Problems
Central	Information availability on UBS operation	Work overload of the health service; focus on pandemic actions; lack of updated information; non-standard mode of operation; divergences in information; inadequate communication with the population.
South-Central	Parameters for schedule arrangement	Weaknesses of records; difficulty in scheduling a programmed care; lack of service optimization at alternative work times.
South-Central	Provision of information on UBS operation	Lack of clear information; lack of materials; work overload of the health service.
East	Parameters for schedule arrangement	Programmed non-serviced demand due to the pandemic; difficulty in controlling agendas by managers; professional absenteeism
	Carrying out integrative health practices in PHC	Inadequate physical space; need for permanent education focused on integrative practices.
	Provision of information on UBS operation	Cease of meetings with local leaders; inadequate physical space; inadequate communication; lack of human resources.
North	Parameters for schedule arrangement	High spontaneous demand; parameters focused on the pandemic; difficulty in organizing the care schedule in cases of scheduled or unforeseen absence of professionals.
	Carrying out integrative health practices in PHC	Demobilization of collective activities during the pandemic; inadequate physical space for PIS; managers not qualified for the promotion or valorization of PHC’PIS; professionals without specific knowledge on PIS; difficulty to schedule protected time for carrying out PIS; lack of interest of professionals in training on this topic
	Provision of information on UBS operation	Focus on actions on the pandemic, ceasing some offers; lack of updated information on UBS available services; work overload of the health service
West	Carrying out integrative health practices in PHC	Lack of necessary material for PIS development; lack of financial resources; lack of clear information; lack of human resources; Inadequate unidentified physical space.
West	Provision of information on UBS operation
South-west	Provision of information on UBS operation	Absence of UBS territorialization tool maps; absence of reterritorialization tool; absence of updated information; lack of standard information; inconsistencies among information on the SES-DF website; absence of health education actions.
South	Parameters for schedule arrangement	Non-inclusion of PIS actions in the organization of the team or professional’s agenda; fear of resuming collective activities; work overload of professionals.
South	Provision of information on UBS operation	Lack of materials to carry out activities in the service; outdated information: health service overload; professional absenteeism

RS	Pattern	Problems
Central	Situational diagnosis	Recording deficit; absenteeism; inconsistency of records; work overload; lack of ACS institutional identification; deficit of human resources; e-SUS instability; difficulty in recording the floating population; maps outdating; deficit of ACSs.
Central	Monitoring and evaluation of the indicators provided for in the AGLs	E-SuS slowness of e-SuS; lack of permanent education recording; absenteeism; work overload; lack of planning; low quality of records; e-SUS instability; lack of permanent education recording; inconsistent records; difficulty in recording the floating population.
South central	Situational diagnosis	Deficit of records; incomplete and inconsistent records; need for permanent education recording; lack of recording due to non-visitation; residents’ turnover; lack of transportation for user recording; outdated recording; deficit of records; inconsistent recording; lack of prioritization of the territorialization tool by the team; territory of difficult access.
East	Monitoring and evaluation of the indicators provided for in the AGLs	Spontaneous demand without connection with the team; absence of protected hours for data analysis; absence of an instrument for data analysis; difficulty in accessing e-SUS reports; managers do not prioritize indicators; fluctuation of users in the territory.
East	Building of planning, monitoring and evaluation mechanisms	Ünstable internet and computer operation; work overload with administrative activities; inexistence of a schedule for the collegiate manager of units; lack of management devising; difficulty in following up the teams; professionals do not prioritize the evaluation of indicators; manager work overload; lack of e-SUS training; difficulty in accessing the territory.
North	Situational diagnosis	Low percentage of records; difficulty in recording during the pandemic; difficulty in collecting and updating data during the pandemic; changes in priorities due to the pandemic; human resources deficit; ACS deficit; difficulty in accessing the territory; work overload of professionals; inconsistencies in e-SUS recording; lack of information on the territory.
	Monitoring and evaluation of the indicators provided for in the AGLs	Lack of permanent education recording; absenteeism; work overload; outdated data; lack of planning; low quality of records; e-SuS instability; difficulty in recording the floating population.
	Implementation of guidelines, protocols, and flows to guide work processes	Low adherence to the spontaneous demand protocol; care weakness; focus on pandemic actions; work overload; turnover of managers.
West	Situational diagnosis	Need for permanent education; low quality of records; difficulty in accessing the territory and recording; difficulty in recording due to the floating population; data unavailability; fragility of records; non-prioritization of situational analysis; territory of difficult access.
	Monitoring and evaluation of the indicators provided for in the AGLs	Work overload; managers and professionals do not prioritize the evaluation of indicators; difficulties in systematizing information system data; unqualified managers
	Building of planning, monitoring and evaluation mechanisms	Non-prioritization of indicators; difficulties in holding a team meeting
Southwest	Situational diagnosis	Inconclusive recording; recording weakness; lack of interest from teams; reterritorialization; deficit of human resources/ACS; deviation of ACS attributions; non-compliance with actions by ACS and team coordinators; inappropriate use of information systems.
	Monitoring and evaluation of the indicators provided for in the AGLs	Difficulty in holding team meetings; absence of permanent education; managers work overload; system instability: e-SuS, Sisab, Auxílio Brasil and e-Gestor; difficulty in accessing data; lack of action plan.
	Building of planning, monitoring and evaluation mechanisms	Difficulty in prioritizing data planning and monitoring; difficulty in following recording; lack of knowledge of teams on number of records; low knowledge of the territory; lack of planning, monitoring and evaluation actions; lack of material resources; lack of integrated planning among teams; difficulty in adjusting records inconsistencies; lack of structural resources as for data monitoring; difficulty in improving local management tools.
	Implementation of guidelines, protocols, and flows to guide work processes	Permanent education; computer knowledge; deficit of human resources; recording inconsistencies; managers work overload; lack of material resources; lack of engagement; teams’ different ways of working; workflows and working processes without technical standardization; resistance to operational changes.
South	Situational diagnosis	Coverage area larger than recommended; ACS deficit; lack of team knowledge; lack of information on the territory; difficulty of recording in e-SUS; deficit of human resources; deviation of ACS function; change of assigned territory.
South	Monitoring and evaluation of the indicators provided for in the AGLs	Work overload; deficit of human resources; management unpreparedness; difficulty in monitoring teams by management.

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[1] Editor in charge: Sandro Rogerio Rodrigues Batista