Portal de Periódicos da CAPES

Artigo Produção Nacional

BIBTEX RIS

Diversity in provision and utilization of maternal and child health care in an urban area of Brazil

1986; Maney Publishing; Volume: 6; Issue: 3 Linguagem: Inglês

10.1080/02724936.1986.11748432

1465-3281

Chester Luiz Galvão César, Godfrey JA Walker,

Maternal and Neonatal Healthcare

Health services in Brazil are characterized by a multiplicity of providers. While many are ultimately funded from public sources, notably the National Social Security Scheme, a large proportion are provided by the private sector. This variety of providers of health care has hindered the development of comprehensive care and the coverage of those in greatest need. In recent years increasing attention has been given to ways of reducing the undesirable aspects of this situation. The Federal and State Governments have established committees to improve coordination between services and set up several pilot programmes. One concerned with improving the effective coverage of maternal and child services has been established in Sorocaba. Sorocaba is a medium-sized city which is typical of the many urban centres in the state of São Paulo. This paper describes a study which has provided information from a representative sample of women, who had recently had a baby, on their eligibility for care from the various health services available in the city and on their actual use of those services. This information has been used in the implementation of a pilot programme. Most mothers attended some service for antenatal care. Almost 20% used several services because their entitlement varied from scheme to scheme and some services provided only specific components of care. This applied also to preventive and curative infant care.A survey of 296 mothers, with children born in March 1979, was conducted in Sorocaba, Sao Paulo State, Brazil, to describe the use and payment of health care, for baseline data for a maternal-child health program. Sorocaba, 96 km northwest of Sao Paulo, has 260,000 people and an infant mortality of 70/1000. Health care is dominated by private physicians and hospitals, and is largely reimbursed by public sources through the INAMPS social security payroll taxes, federal, state and municipal funds. There are also organized physician co-ops, and prepaid health plans. Because of diversity funding and services, there is an emphasis on curative medicine, duplication, and inequity of care. Extensive information is included in tables on socioeconomic, education, medical, insurance coverage, type of care received and residence characteristics of the subjects, expressed as percentages. Most (83%) mothers belonged to the Federal Social Security plan, and a third also belonged to a private insurance plan, usually through the husband's employment. Only 4% were not covered, except State and Municipal providers. Only 1.7% had no prenatal care. Any drugs needed were paid in part, although 17% had to go to more than one provider to get them. 98% were delivered in hospitals, 30% by Cesarean section, for which doctors receive higher fees. Many (62%) took their children for care by 2 months of age. Equal numbers used private or state health centers, while 14% used several sources. For infants' curative services 56% used private physicians or hospitals, 17% paid for care and 86% paid for drugs. Women in lower socioeconomic groups or with less education began prenatal care later and made significantly fewer visits for prenatal or infant care (p.001). The study has prompted discussions on coordination of outpatient services and identification of high risk patients.