Indicadores de saúde no planejamento e avaliação da política pública

Abstract

The results of the investigation that are presented here consider health access a fundamental right, based on the 1988 Federal Constitution. It is universally enshrined in Article 25 of the UDHR. The Ministry of Health and its respective collegiate bodies (CNS, CIT, among others) have instituted a legal apparatus of instruments, aiming, besides health planning, to monitor and evaluate this access in the Unified Health System, in order to qualifying it. Brazil experienced a significant expansion in its list of health indicators in the initial period of the study, reaching its peak in 2013, when it strengthened its federative entities regarding the health evaluation tools, and then a much more expressive retraction followed, from 2016 onwards. The objective is to evaluate whether the changes that occurred in relation to the Ministry of Health's list of indicators in the period, especially those that make up the guidelines for access to PC and the reduction of risks and harm to the population's health through health surveillance actions, result in qualitative damage to health planning and evaluation, the guarantee of the right to health, relating the changes to health expenditures. The method used was the deductive one, with a qualitative approach, whose structural aspects are analyzed by a quantitative method. Descriptive research was carried out and extracted from an exploratory study, with secondary data analysis, through indirect data collection. The highlighted records correspond to the indicators defined by the Ministry of Health as inter-federative pact type, covering the period from 2012 to 2017, using the State of Bahia as a sample state entity, and health indicators as research variables. We observed that instead of enhancing, from 2016 onwards the indicators were being subtracted, or replaced, by others that “disguise” a precariousness of the right to health, through the amount of information that is far from their true primary objective. The suppression of mandatory monitoring and evaluation through indicators may imply a failure of health interventions, thus precarious access to health and increased damage and problems to public health. Despite current fiscal adjustment policies, there was no significant reduction in expenses spent on Primary Care and Health Surveillance. However, the guarantee of the right to health does not appear associated with the increased spending, which suggests greater effectiveness in the instances of evaluation, control, and inspection of public spending. We suggest greater institutional and civil society efforts in the process of monitoring and evaluating public policies, with the consolidation of evidence of morbidity and mortality, and active participation in coping strategies, in order to ensure universal access to health.