O artigo (em inglês) está hospedado no portal da ScienceDirect, Dialogues in Health, Volume 1, dezembro de 2022. É possível realizar o acesso através do link. Abstract In Brazil, public hospitals…
Background: In Brazil, the Mobile Emergency Medical Service (SAMU) is a model of mobile assistance and care for emergencies standardized throughout the country. The water ambulance service within the SAMU operates in riverside and coastal areas, and faces challenges and peculiarities that increase the complexity of providing a high-quality and safe emergency care service. Objective: To develop organizational design guidelines aiming to improve resilient performance of complex systems, with an application to riverine and coastal mobile emergency care in Brazil. Methods: Data collection followed an ethnographic approach. Fieldwork was carried in a participatory way, based on worksite technical description, semi-structured interviews with managers and emergency care teams' professionals, and work observation whenever possible. Five regional SAMU coordinations were visited. Data coding employed content analysis and grouped data excerpts according to concepts of capacity and demand. Interfaces were identified between demand and capacity elements and adaptations led by system agents, orienting the proposal of guidelines for organizational design as solutions to face the verified gaps. Results: Design guidelines produced spanned composition and training of both intervention teams and dispatch central teams, uniforms and personal protective equipment (PPE), decentralized water bases, means of communication, intervention protocols, biosafety and inter-sector actions. Conclusion: The approach enabled framing and assessment of specific design elements according to resilience engineering concepts, which in turn showed paths for improving the service and reconciling work-as-imagined and actual system functioning.
Esta pesquisa teve como objetivo prospectar as condições de trabalho das equipes de socorro do Serviço de Atendimento Móvel de Urgência (SAMU-192) fluvial das áreas ribeirinhas e costeiras da região do Alto-Solimões, a partir da análise sistêmica das atividades no serviço de embarcações popularmente chamadas de “ambulanchas” durante os picos da COVID-19 no estado do Amazonas, quando o sistema de saúde funcionou sob o estresse provocado pela pandemia.
Essa pesquisa realizou uma análise do trabalho das equipes de saúde no serviço de embarcações do SAMU-192 em Regiões Fluviais, Ribeirinhas e Marítimas que estão habilitadas no Brasil e concordaram em participar da pesquisa. Para a realização do estudo foram visitados três estados onde está implementado este serviço, Bahia, Rio de Janeiro e Amazonas. Nestes três estados foram visitados 9 municípios que possuem serviço do SAMU fluvial atualmente habilitado e qualificados pelo Ministério da Saúde.
Relatório de coordenação da APS e das Redes de Urgência e Emergência para populações ribeirinhas e costeiras
Análise Situada do Funcionamento do Sistema de Regulação de Consultas e Exames descentralizado no Município do Rio de Janeiro. Aspectos da descentralização da regulação na atenção primária em saúde.
O artigo está hospedado no portal da Revista de Administração em Saúde, São Paulo, volume. 22, número 88, julho-setembro de 2022. É possível realizar o acesso através do link. Resumo…
This document is a consolidated, fit-for-purpose technical reference package to support countries in strengthening health systems resilience at national and subnational level from policy and planning, through operational and services delivery, to monitoring and evaluation. The Toolkit may be adapted to varying contexts and will also contribute to the dual agenda of universal health coverage (UHC) and global health security. The Toolkit serves as a compendium of technical resources to support countries in strengthening the resilience of their health systems and provides technical grounding and clarity on the conceptualization and operationalization of health systems resilience
As COVID-19 spread across Brazil, it quickly reached remote regions including Amazon's ultra-peripheral locations where patient transportation through rivers is added to the list of obstacles to overcome. This article analyses the pandemic's effects in the access of riverine communities to the prehospital emergency healthcare system in the Brazilian Upper Amazon River region. To do so, we present two studies that by using a Resilience Engineering approach aimed to predict the functioning of the Brazilian Mobile Emergency Medical Service (SAMU) for riverside and coastal areas during the COVID-19 pandemic, based on the normal system functioning. Study I, carried out before the pandemic, applied ethnographic methods for data collection and the Functional Resonance Analysis Method - FRAM for data analysis in order to develop a model of the mobile emergency care in the region during typical conditions of operation. Study II then estimated how changes in variability dynamics would alter system functioning during the pandemic, arriving at three trends that could lead the service to collapse. Finally, the accuracy of predictions is discussed after the pandemic first peaked in the region. Findings reveal that relatively small changes in variability dynamics can deliver strong implications to operating care and safety of expeditions aboard water ambulances. Also, important elements that add to the resilient capabilities of the system are extra-organizational, and thus during the pandemic safety became jeopardized as informal support networks grew fragile. Using FRAM for modelling regular operation enabled prospective scenario analysis that accurately predicted disruptions in providing emergency care to riverine population.
Countries worldwide are facing complex and diverse health challenges in 21st century, and usually there is one national health system for individual and population health outcomes. The COVID-19 pandemic and other emerging health challenges have exposed gaps and fragmentation in health systems with limited public health capacities and governance. In this context, “essential public health functions” (EPHFs) have been revitalized to support an integrated approach to sustainable health systems strengthening, complementary to primary health care, various programme-specific and health security approaches. Resolution WHA69.1 identified “public health functions as the most cost-effective, comprehensive and sustainable way to enhance the health of populations and individuals and to reduce the burden of disease”; operational framework for primary health care highlighted EPHFs as a key consideration to provide public health services; and WHO’s position paper on building health systems resilience towards universal health coverage (UHC) and health security recommended investing in EPHFs as a key mean for countries’ health systems recovery and transformation during COVID-19 and beyond.
resilisus@fiocruz.br
ResiliSUS - CEE/Fiocruz
@resilisus
