Análise do aceso das gestantes residente na RIDE-DF às maternidade públicas

Abstract

The reduction of maternal and child morbidity and mortality has been a national challenge and also to the managers and health professionals of the RIDE-DF – Integrated Region of Development of Federal District and Adjacencies in the search for strategies to qualify the care and improve the access of pregnant women in the region.This difficulty is intensified in a territory with disparate characteristics in the economic, social, political aspects and extreme inequality in the provision of health services.The proposition of a strategy for the organization of care flows by the State Health Secretariat of DF, from 2011, constitutes the object of this study, which had as objectives: to analyze if the implementation of the maternal and child care policy modified the access of pregnant women resident in RIDE-DF to public maternities of the region, from the examination of the flow of admissions of pregnant women for delivery; to demonstrate by means of maps of georeferencing flows envisaged by the Action Plans of the Network Stork of the states of Goiás, Minas Gerais and DF, as well as flows of pregnant women residing in RIDE-DF before (2011) and after (2014) of the deployment of Rede Cegonha (Network Stork), and; to analyze if the access of pregnant women to maternity hospitals of the region has changed and if it is in accordance with the relevant standards. Methods: descriptive and exploratory research using mixed methods of qualitative and quantitative research approaches. The following techniques were combined: documentary analysis of the state and federal standards regarding Maternal and Child Network in Brazil and its deployment in RIDE-DF; simplified statistical analysis of secondary data about production in the maternities of DF; preparation of maps by means of georeferencing to statement of cash flows, considering the years 2011 and 2014. Results: the spatial planning of flows for delivery care was implanted in RIDE-DF in an innovative way, extrapolating the geographical limits of the two states members and DF as a condition for the implementation of these actions. In addition to the efforts to qualify the attention given, there was an increase in the demand to maternity hospitals in DF by residents in RIDE-DF in 42%, totaling increase of 2,830 births in the period considered. The Surrounding South was identified as the most dependent region, responsible for 60% of the referrals to maternity hospitals of the DF. Among the municipalities, 68% have changed the flow of forwarding to the DF, and 72% of the flows of the municipalities of RIDE-DF are appropriate, according to the criteria set out in the existing rules. Conclusion: There have been advances in the deployment of an integrated policy in that territory, in so far as, from the organization of the flows of the pregnant women residing in RIDE-DF, the access to public maternities of the DF was modified, decreasing the pilgrimage for a bed in a maternity at the moment of birth.However, the overload on the health system of DFincreased, which signalizes the need for bilateralformal instruments, result of inter-federate pact, investments in the region and greater responsibility and role of municipalities, in overcoming the lack of assistance.