Controle de qualidade nas ações de vigilância em saúde: análise de melhorias e incentivos financeiros em um quadriênio de gestão municipal

Abstract

Introduction: Health surveillance actions in Brazil have been the target of a national quality management program that includes setting targets, indicators, annual evaluation and performance-based financial incentive. However, there are many challenges regarding the timely monitoring of indicators during the year, making it difficult to make a decision to reach the goals proposed and consequent loss of the associated financial incentive.Objectives: To evaluate the quality of health surveillance actions in a Brazilian municipality under the perspective of the Program for Qualification of Health Surveillance Actions (PQA-VS), as well as to analyze the annual goal achievement and improvement in the four-year period; analyze the feasibility of using run charts to identify improvement trends in monthly monitoring and analyze the gain of financial incentives associated with performance in the program.Methodology: Ecological study of a time series, retrospective, descriptive and analytical. The results of the 14 indicators of the PQA-VS predicted for the city of Natal, Rio Grande do Norte, based on the official information systems, were analyzed. The absolute improvement achieved during the four-year period 2014- 2017 was calculated and trend charts were also constructed by monthly monitoring of the indicators. In addition, we analyzed the fixed financial resources and annual variables for health surveillance actions, estimating the cost of poor quality related to the loss of possible financial incentives focused on the quality of health surveillance actions. Results: After four years, the quality is still unsatisfactory, since only six out of 14 indicators reached the annual target. The indicators that showed improvements were timely feeding of information systems on deaths, births and vaccination, timely closure of immediate notification diseases, in addition to the number of HIV tests carried out per year and filling of the occupational field in the reports of diseases and (DART). Significant patterns of variation (p <0.05) were identified in nine indicators, which define the processes related to it as unstable and targets for diagnosis and intervention. In 2014, 40% of the incentive was received and in 2017 60% of this resource was incorporated. The municipality stopped earning in the four-year period R $ 1,566,255.63 in variable incentives aimed at the qualification of Health Surveillance Conclusions: The evolution in the quality of VS actions in Natal has been slow, despite the national program and financial incentives for performance. The methodologies available for monitoring and evaluation of VS practices have proved to be insufficient, which is why the implementation of monitoring with monthly run charts can allow decision making in a more timely manner during the year to guide the projects and actions of improvements developed by VS.