Relação entre oferta de força de trabalho, serviços e indicadores de saúde: uma análise para o estado do Tocantins

Abstract

Introduction: For health planning, it is necessary to recognize, monitor and assess the dynamics of territories, the health production process and the social health needs of the population. Health indicators constitute one of the references for analyzing the health situation in a given territory and can be used as an instrument in favor of work management, as they are the result of the workforce available in the territory. Objective: to analyze the relationship between the supply of workforce, services and health indicators for the state of Tocantins. Methods: This is a quantitative research with a descriptive character of secondary data from the agreement system of the Unified Health System of Tocantins. The analysis period comprises January 2014 to December 2017. Two axes were analyzed: Axis 1 – Workforce and Assistance Coverage and Axis 2 – Attention and Service Offer. The indicators included in this research were: 1) Population Coverage – Primary Care Team; 2) Population Coverage – Estimated by Oral Health teams. 3) Proportion of admissions for sensitive primary care conditions; 4) Average supervised toothbrushing collective action; 5) Proportion of tooth extractions in relation to preventive procedures; 6) Proportion of live births to mothers with 7 or more prenatal visits; 7) Infant Mortality; 8) Maternal Mortality; 9) Ratio of cervical cytopathological tests in women aged 25 to 64 years and the same age group. For the analysis of municipal indicators, choroleptic maps were produced indicating the distribution of indicators according to the intensity of the colors. To analyze the spatial bivariate relationship between the indicators, the local Bivariate Moran test was applied and to analyze this relationship in a multivariate analysis, the Skater technique or regionalization method was applied. Results: Regarding Oral Health Team Coverage, there was no change in the offer in the state of Tocantins, with few cities in critical condition (with less than 49.99%). The supervised brushing actions, on the other hand, undergo a reduction of actions over four years in part of the state's municipalities. Regarding the proportion of tooth extractions, there were 28 municipalities in 2014 and it rose to 26 in 2017 in the red classification. Regarding family health care coverage in Tocantins, 127 municipalities in 2014 and 126 municipalities in 2017 had 100% coverage. And in relation to the proportion of Hospitalization for Sensitive Conditions to Primary Care, over the four years there was a reduction in the number of cities in the red and orange classification. From 2015 onwards, there was a collapse of the analysis network of the materials collected to carry out the screening for cervical cancer, showing that the availability of the workforce does not translate into guaranteeing access to the exam in a timely manner. Over the four years, there was an improvement in prenatal care, but there was an increase in the number of municipalities that registered maternal deaths. In MoranMap, the overlap between the high coverage of primary care and the low number of maternal deaths stands out. This finding was corroborated in the Scater map, where cluster 1 shows the municipalities with high coverage of AB, high proportion of prenatal care and the lowest rates of maternal death. Conclusions: it was shown that the supply of the workforce and services is related to health outcomes. With this, the Regulation and Work Management can use these indicators for technical support with the creation of alert panels, for the discussion on work management and organization.