Enfrentamento da pandemia de covid-19 no estado do Maranhão: a reorganização da Rede de Atenção à Saúde na perspectiva dos municípios

Abstract

Introduction: The covid-19 pandemic originating in Wuhan, China in December 2019 has heavily impacted healthcare systems. Countries have adopted urgent measures to meet the demand for hospital beds, contain the speed of transmission of the SARS CoV-2 virus, in addition to discovering and producing immunizers in a timely manner to vaccinate the population. Brazil, which has a universal health system, the Unified Health System (SUS), was greatly affected. The state of Maranhão, one of the poorest in Brazil, was one of the first to adopt measures at all levels, from health to social, to control the pandemic. Objective: to analyze the reorganization of the Maranhão Health Care Network in coping with the covid-19 pandemic. Method: This is an ecological study, with an exploratory base, whose population was the 217 municipalities of the state. Data collection was carried out from June to August 2021 by sending the questionnaires to the electronic addresses of the municipal health departments. The platform used to apply the questionnaire was Google Forms®, where the instrument was typed and made available. The questionnaire had 87 questions formulated according to the components of the RAS operational structure: APS, secondary and tertiary care points, support system, logistics and governance. In addition, data on hospital and intensive care beds were collected in the database of the National Registry System of Health Establishments (SCNES) and information on the number of Family Health Teams in the SCNES base for the period December 2019 (pre pandemic) and August 2019 (pandemic). Results: 198 (91.2%) municipalities of the 217 that make up the state participated in the study, which corresponds to 94.5% of the total population of the state (6,760,979). The results showed that APS acted as a protagonist in terms of flows, guidance and follow-up of suspected and confirmed patients. With regard to secondary and tertiary care points, there was a significant increase in hospital and complementary beds. There was a positive correlation between HDI-M and services offered (r=0.293 p<0.001); eSF coverage and expansion of professionals (r=0.162 p<0.023); negative correlation between eSF coverage and consultations in primary care (r=-0.210 p<0.003). Vaccination took place with the participation of the CHA in carrying out registrations (73.2%) and communication about vaccination with the population (95.4%). There was variation in the macro-regions influenced by the HDI-M in strategies that require logistics. Municipalities with lower HDI had higher eSF coverage, with less use of means of communication. Conclusion: It can be concluded that PHC becomes essential for the control of epidemic situations. However, articulation with other points of care and support are equally important for strengthening actions aimed at responding to the population's health problems, especially in epidemic scenarios. Investing in communication strategies and logistical support and support, in addition to favoring population adherence and recording information, can contribute to effective vaccination campaigns.