19 th Wonca World Conference - 2012 - Apresentação Dra. Catherine Moura - Family Health Strategy in the National Health System in Brazil (SUS): social, epidemiological and clinical context analysis for the cardiovascular risk intervention

1. Family Health Strategy in the National Health System in
Brazil (SUS):
social, epidemiological and clinical context analysis for the
cardiovascular risk intervention
19 th WONCAWORLD CONFERENCE
19 – 23 May, 2010, Cancun - Mexico
Authors: Catherine M. F. Pinto (Gesaworld), Diego da Silveira, Roberson J.
Kanamura, Juliana Vasconcelos, Gisele C. M. Sugai, Rosimeire R. Oliveira, Dalia
A. Nogueira, Angela M. B. de Oliveira, Rodrigo F. M. Leite (OS ACSC)
Speaker: Catherine M. F. Pinto
cmoura@gesaworld.com.br

2. Family Health Strategy: PHC
BRAZIL
STATE OF SÃO PAULO
CITY OF SÃO
PAULO
ESF/ACS/SB
ESF/ACS
ACS
SEM ESF, ACS E ESB
0% 0 a 25% 25 a 50% 50 a 75%75 a 100%
Population : 10.940.311 inhabitants
•Area – 1.523 km²
•Population density– 7.113 inhabitants/km²

3. City of São Paulo: South Side
Municipality of São Paulo, South side
• Population 2.486.258 inhabitants
• Largest population living in substandard residences (slum) 21,4%
•Largest cluster of children under 10 years old -19%
•Second cluster in numbers of teenage pregnancies - 16,2%
•Fountainhead area with two Indian villages
• Highest rate of homicides in Sao Paulo (25,4 deaths/1000.00
inhabitants)
Management Contract: Public sector + Social
Health Organizations
• Jointly responsible for managing health services
in many territories of the city of São Paulo
(hospitals,
emergency
services,
primary
healthcare services and specialized healthcare
services)

4. Local scenarium – Partnership Model
 In the management model adopted by the municipality is the partnership model with
Social Health Organizations (OS), nonprofit organizations - that meets the
requirements of municipal legislation for this purpose, which requires its rules and
qualifications to manage health care services.
 The management model determines territorial integration between the different
levels of care.
 The work is developed on the basis on the health needs of the population in a
given area and observing the relationship between the different health care services.
 The focus is the effectiveness of public health policies to expand access,
resolution and quality of services and health actions.
 The model is regulated and controlled by a “Management Agreement” outlining the
commitments of partnership between the government (municipality or state) and the
OS.

5. Cidade Ademar - Microregion

20 Primary Health Care services, with 11
services
with
the
Family
Health
Strategy
implemented

06 Emergency services

01 Psychosocial support centers

01 Home Care

01 Specialist support team to family healthcare
strategy

02 Support services of diagnostic imaging

01 Dentistry specialized service

02 Medical specialized services

6. Hypertension and Diabetes Mellitus 
Cardiovascular Risk

7. Hypertension and Diabetes mellitus 
Cardiovascular Risk

8. Hypertension and Diabetes mellitus 
Cardiovascular Risk

9. Project: Cardiovascular Risk Guideline
An approach for the
identification of cardiovascular
Identification and classification
risk parameters based on
flowchart with cardiovascular risk
epidemiological, clinical and
parameters based on social,
social factors.
epidemiological and clinical studies
(Framingham scale).
Consider cardiovascular risk through programs of diagnosis
and treatment of hypertension and diabetes mellitus using
clinical, epidemiological and social data.

10. Cardiovascular Risk Guideline

11. Family Health Workers Team
 Interface between population and health system

12. FAMILY SOCIAL RISK RATING
Escore -6 a < 6
Low risk
Escore ≥ 6 a < 12
Moderate risk
Escore ≥ 12 a 18
High risk

15. Example of Therapeutic Plan

16. Expected Results

17. Conclusions
 Greater identification of high risk cases influenced by the social factor
 Provide a greater treatment for patients with cardiovascular risk, according to the
level of social, epidemiological and clinical risks
 Promote a holistic care of patients covering the social, epidemiological and clinical
parameters
 Organize the services (PHC) and the family health workers teams in order to
increase the quality of the assistance to the population in this micro region of the
city of São Paulo
 Contribute for the family health development