Vulnerabilidade programática da atenção à saúde da criança xavante no polo base Marãiwatsédé

Abstract

Introduction - The concept of vulnerability makes it possible to overcome the difficulties and problems encountered in the health-disease process, facilitating the understanding of life and its determinants. The programmatic dimension of vulnerability presupposes the existence of key elements to analyze how is the government's political commitment across the health needs of the population, the definition of specific policies and the conditions of their governance and social control. Objective - To assess the vulnerability of the health care of Xavante children under five years old, in the Marãiwatsédé base pole.. Methods - Case study with data collection in documentary research (laws, ordinances, notebooks); semi-structured interviews with indigenous leaders, local health counselors, teachers, health professionals, residents of the village Marãiwatsédé and non-governmental workers. The information and observations were recorded in the field diary. Results and analysis: The organization of health care at the pole base Marãiwatsédé presented low resolution and ethnic discrimination in medium complexity services by municipal references in the region; District Plan for Xavante Indigenous Health 2012-2015 followed the upward logic in its preparation; Actions to increase the value of culture and traditional healing practices not included in plan. Work management with outsourced employment and professional category number and fallen short; the medical professional performance in precarious base polo and not contractual compliance; the need of nurses to leave to meet the needs of patients in referral centers, committed to solving the health care and reinforces the institutional vulnerability of the pole base. Professional qualification gives priority attention to children's health; cultural approach and traditional healing practices not inserted in the skills; relationship of commitment observed in the base pole health professionals, who work in an atmosphere of mutual collaboration. Low resolution rates of the base pole provide the leadership with misinterpretation of the situation, transferring the cause of problems to the base pole in the village. Proper attention to newborn as provided in the district plan: 90.9% natural deliveries; 70.0% in the village; 93.2% of live births with adequate weight for age, no weight lower than expected. Newborn screening held in the village. Coverage monitoring the weight of children < 5 years, in 2013 more than in 2012. Of the children, 79.5 % had adequate weight for age and 21.1 % of children aged 0 <6 months had very low weight for age in 2012 and in 2013, 90.0 % had adequate weight for age. Low vaccination coverage regarding the parameters established by the Ministry of Health. Individual vulnerability marked by high rates of infant mortality, Perinatal and children 1-5 years. Social vulnerability based on the territorial conflict and environmental degradation compromising fundamental aspects for the maintenance of life