Laqueadura tubária: redes de atenção à saúde no interior de São Paulo e Toronto
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Data
2016-09-01
Autores
Polido, Carolina Guizardi
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
A laqueadura tubária está dentro das ações preconizadas pela legislação vigente de planejamento familiar, e é parte das ações integradas em saúde, que visa atender à legislação tanto nacional como internacional que prevê o direito do ser humano de escolher quando e quantos filhos quer ter. Os serviços de planejamento familiar, junto com os serviços que atendem à maternidade, à concepção assistida, e à esterilização, constituem o atendimento integral à saúde reprodutiva e para isso são fundamentais as redes de atenção à saúde e sua adequada gestão. No Brasil, esse serviço é oferecido primordialmente dentro das Estratégias de Saúde da Família, e as mulheres acabam recorrendo a este método por falha/desconfiança dos métodos reversíveis ou pela indisposição do parceiro na contracepção. Dentro desta premissa, este estudo teve como objetivo avaliar a gestão e regulação do sistema de referência e contrarreferência das laqueaduras tubárias e seu público alvo em duas microrregiões de saúde do interior do Estado de São Paulo, estabelecendo um cenário de similaridades e diferenças comparativo com a situação encontrada na cidade de Toronto, Canadá. A abordagem dos resultados foi multimétodo, com análises descritiva, quantitativa e qualitativa quando pertinente, utilizando-se como base para a análise a avaliação de serviços e o arcabouço teórico-legal do SUS. Os resultados apontam para uma rede de atenção à laqueadura tubária com entraves na tríade estrutura, processo e resultado e repercussões nos sete pilares (eficácia, efetividade, eficiência, otimização, aceitabilidade, legitimidade e equidade). Como consequência, os princípios da universalidade, integralidade e equidade, como propostos pela legislação SUS estão sendo parcialmente cumpridos.
Female sterilization is among the actions advised by the current family planning legislation and it is part of the integrated actions in health that aim to comply with both the national and international legislation, which provide the human right of choosing when and how many children to have. The family planning services along with the maternity care services, the assisted conception and the sterilization constitute the integral assistance in the reproductive health, and to this end, the healthcare networks and their proper management are vital. In Brazil this service is offered primarily within the Family Health Strategies and the women end up using the definitive surgical method due to failure/mistrust of the reversible methods or because of the unwillingness of the partner in the contraception. Within this premise the present study aimed at evaluating the management and regulation of the tubal ligation’s reference and counter reference system and its target audience in two health micro regions in the inner part of the State of São Paulo establishing the similarities and differences with the situation encountered in the city of Toronto, Canada. A multimethod approach was employed with descriptive, quantitative and qualitative analyses. The theoretical reference for the analysis was the evaluation of services considering the theoretical legal framework of SUS. The findings pointed out a care network to the tubal ligation with hindrances in the structure, processes and results triad which compromises the pillars of efficacy, effectiveness, optimization, acceptability, legitimacy and equity. Some highlights are the organizational and communication flaws that undermine the regulation. As a consequence, the university principles of universality, integrity and equity as proposed by the SUS legislation are being partially fulfilled.
Female sterilization is among the actions advised by the current family planning legislation and it is part of the integrated actions in health that aim to comply with both the national and international legislation, which provide the human right of choosing when and how many children to have. The family planning services along with the maternity care services, the assisted conception and the sterilization constitute the integral assistance in the reproductive health, and to this end, the healthcare networks and their proper management are vital. In Brazil this service is offered primarily within the Family Health Strategies and the women end up using the definitive surgical method due to failure/mistrust of the reversible methods or because of the unwillingness of the partner in the contraception. Within this premise the present study aimed at evaluating the management and regulation of the tubal ligation’s reference and counter reference system and its target audience in two health micro regions in the inner part of the State of São Paulo establishing the similarities and differences with the situation encountered in the city of Toronto, Canada. A multimethod approach was employed with descriptive, quantitative and qualitative analyses. The theoretical reference for the analysis was the evaluation of services considering the theoretical legal framework of SUS. The findings pointed out a care network to the tubal ligation with hindrances in the structure, processes and results triad which compromises the pillars of efficacy, effectiveness, optimization, acceptability, legitimacy and equity. Some highlights are the organizational and communication flaws that undermine the regulation. As a consequence, the university principles of universality, integrity and equity as proposed by the SUS legislation are being partially fulfilled.
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Palavras-chave
Planejamento Familiar, Laqueadura Tubária, Saúde Coletiva, Saúde da Mulher, Sistemas de Saúde, Avaliação de Serviços