Situação da rêde pública de assistência médico-sanitária na área metropolitana da Grande São Paulo

Abstract

The situation of the Public Health Unit Centers care system is analysed by the "Great São Paulo" Metropolitan Area (Brazil) which contains 37 cities and 8 million inhabitants. There is a health unit center to every 101.025 inhabitants. There is no homogeneous proportion between the size of the population and the number of the health unit centers since there are regions of the Metropolitan area that have from 22.000 inhabitants (to every health center) to 136.142. The number of the Maternal and Child Health centers is 232 with 34400 inhabitants to every unit, and the variation by regions goes from 2444 inhabitants (to every unit) to 73500. There is a Tuberculosis Dispensary to every 380048 inhabitants. The Northern region of the Metropolitan Area with 67000 inhabitants does not have any Tuberculosis Dispensary. The proportion founded to the Leprosy Dispensaries is 570071 inhabitants to every unit. The Northern and Southwest region with 155000 inhabitants do not have any Leprosy Dispensary. There is no rational criteria to the geographical localization of the Health Unit Centers beside this occurs a poor quantitative and qualitative medical attendance. Among the main goals of the Administrative Reform of the Health State Department, São Paulo, Brazil we distinguished: normative centralization, executive descentralization and, in local level, integration of the health unit center. Only 25.6% of the Health Centers are integrated physically and functionally, 40.0% of the Subsidiary Centers, 42.8% of the Tuberculosis Dispensaries and 42.8% of the Leprosy Dispensaries. According to the new terminology 21 Health Centers were classified as being of type I, 10 of type II, 16 of type III, 26 of type IV and 138 of type V. This classification is concerned to the established health care programmes. According to the study carried on by the Health State Department, in 1970, only 4.7% of the attendance was considered excellent, 62.17% and 52.3% respectively of the Health Unit Centers did not have enough material and health manpower. Parallel to this poor situation there is a lack of the coordenation amog the state, municipal and private medical care organization, contributing to the concentration on some areas and its total absence on others. © 2006 Faculdade de Saúde Pública da Universidade de Sao Paulo.