"Saúde nos Bairros (Health in the Neighbourhoods)"

BASIC CITY DATA

• Population size: 2,418,005
• Population Growth Rate(%):0.98 
• Surface Area (sq.km): 693,442
• Population Density (people/sq.km): 3486.96
• GINI Index: 0.49
• Main Source of Prosperity: Services Sector

ABSTRACT

During the COVID-19 pandemic, the population was prevented from accessing health services on an elective basis, which led to a worsening of chronic health cases in the low-income population, causing an overload in the urgent/emergency network.

The“Saúde nos Bairros”(Health in the Neighborhoods) project takes free medical care and exams to communities in Salvador on an itinerant basis, as a way of meeting the pent-up demand caused by the pandemic that generated a backlog in the regulation queue for basic health access.

The project will cover all 12 of Salvador's Health Districts and offers the following services: dental consultations, X-rays, specialized medical consultations; transthoracic echocardiograms and electrocardiograms; ultrasounds (total abdomen, joint, obstetric, soft tissue, colour doppler vessels, thyroid, bilateral breast, pelvic (gynaecological); mammography; laboratory and vaccinations.

The necessity to provide comprehensive care underpins the project, which led the Municipal Health Secretariat to accompany the service provider, directing people to the services that the itinerant route wouldn´t be able to cover. The expressive quantitative results, the resoluteness and the embracement of the service created an expressive satisfaction within the population.

BACKGROUND INFORMATION

The Ministry of Health's Cabinet Order No. 90 of 02/03/2023 established the National Programme to Reduce Queues for Elective Surgeries, Examinations and Specialised Consultations, indicating that municipalities need to expand and organise access to meet the pent-up demand. Furthermore, the project supports the axis of the municipal strategic planning, "Salvador capital of quality of life”, aiming to make Salvador a reference for healthy living in an efficient, sustainable and equitable way. It also refers to goal 3.8 of SDG 3 and meets commitment 55 of the New Urban Agenda.

ORIGINS

With a population of 3,573,973 within a metropolitan area of 100 km, Salvador is the main city with the capacity to offer specialized public services. In addition, the city has the most complex health services in the state, covering all 417 municipalities. Finally, the city's location on a geological fault makes micromobility a challenge, impacting on access to public health services. Exacerbated by the pandemic, these challenges accumulated demand and requested a Municipal answer, which was provided through Saúde nos Bairros to reach all population equally, leaving no one behind.

Saúde nos Bairros aims to assist all Health Districts, providing care in remote locations of the city.

Nevertheless, the main objective is to provide a time-lapse for the restructuring of the primary attention strategy in Salvador. With that, the Health Secretariat can revise flows, protocols and communication in all dimensions, generating change in the entire chain, from management to the professional and to the population.

Besides that, Saúde nos Bairros can create capacities within the Secretariat to deal with crises and emergencies, creating a model to restart comprehensive care.

The Municipal Secretariat of Health (SMS) initially invited people who were booked on the Vida+ system to join Saúde nos Bairros, to reduce the queue, but reserved a quota for spontaneous demand. As a result, the project received other requests and directed them to care at units of the municipal network. It was innovative to have a regulation team on site during itinerant services providing access to basic healthcare by tying them up to the health network, in contrast with usual mobile units that provided care without a comprehensive approach.

The initiative required partnerships in different spheres:

(a) public-public: ensuring the necessary infrastructure to offer mobile services in the indicated neighbourhoods, such as the provision of electricity, urban cleaning, security and

water.

(b) public-private: provision of the mobile units and health teams, since the Municipal Secretariat of Health is unable to move the teams that work in its health units, as this would create a shortfall in the service offered by the municipal network.

(c) public-community: aims to ensure the mobilization of communities, through their leaders, identifying and prioritizing the most serious health cases and assisting in communication.

The Municipal Secretariat of Health (SMS) is using financial resources from the Municipality's treasury and from the Federal Ministry of Health to fund the initiative. The treasury resources are directed through public bidding to companies that can operationalize the project, which are responsible for providing their own human resources, the itinerant spaces and the services foreseen on the bidding.

Furthermore, SMS mobilizes over 200 professionals from the Secretariat to manage the initiative, which requires great organizational logistics, and invests in an infrastructure of its own in the location to be able to provide embracement and referral to the municipal

service.

INNOVATIVE ASPECTS

The initiative was revolutionary because, despite using specific aspects of other policies, such as the idea of mobile units, it brought about a comprehensive care approach where the Municipality continues to be involved throughout the entire service provision.

Usually in Brazil, public biddings result in the provision of service by the private company that wins it in an independent manner. Previous experiences with this type of project showed the municipal servers that, often, people had access to a specific service and any referral to complementary care, exams or parallel needs not covered by the public bidding would end up in a void of care. Lack of information and difficulties accessing public spaces can hinder the coverage of primary healthcare.

In Saúde nos Bairros, two neighbourhoods are attended simultaneously by both the contracted company and the Municipal Health Secretariat for fifteen days, reaching four places in a month. Besides that, and most revolutionary, there is a high number of case referrals for follow-up and/or high-complexity procedures that unfold into the health network. An example is the identification of considerable gaps in the coverage for Autistic Spectrum Disorders (ASD), which are being brought forward by caretakers, especially mothers, during the itinerant services. In specific cases, neighbourhoods had the addition of educational programs, responding to the population’s demand.

Finally, Saúde nos Bairros can be an opportunity to implement decision-making based on evidence, since the embracement of the population has shown these shortages that can be addressed in the following Municipal Strategic Planning.

DESIRED CHANGE OR OUTCOME

Over the last four months, the Saúde nos Bairros project has involved over 300 health workers, covering 14 neighbourhoods of Salvador and serving more than 70,000 people and over 300,000 procedures.

In addition, the project improves quality of life and health outcomes by working on prevention and early identification of diseases that need intervention and/or treatment. It also helped the Secretariat with a time-lapse to reorganize and implement an improved basic care strategy, as it gave evidence of the epidemiological profile and the highest care gaps.

Data collection encompasses the number of people assisted, number of appointments (which is a larger number, since people seek more than one service), requested sectors, age, gender and presence of disabilities. All stakeholders use the Vida+ System, which belongs to the Municipal Secretariat of Health, to collect the data, so information is unified. A specialist then uses Business intelligence (BI) to analyze, compile and propose improvements.

Although Saúde nos Bairros will cover all twelve Health Districts of Salvador, it has a greater impact on socioeconomically unequal regions, where settlements are denser. Thus, the project focuses on low-income neighbourhoods with low socioeconomic indicators (HDI, per capita income, unemployment rate, etc.), prioritizing areas of "care gaps" with low Primary Health Care coverage and high repressed demand. Fourteen neighbourhoods of the city have already been served, two are in implementation and 40 more are planned.

The project reached an average of 5,000 people per neighbourhood. Women composed 74% of the public attended, 2% of people had disabilities (4% didn’t inform) and, by age group, 3% was of youth, 6% of children, 28% of elders and 63% of adults. Considering this average, the two neighbourhoods being attended and the forty that will be until the end of next year can add up to 210,000 people directly cared for until December 2024.

RELEVANCE TO SUSTAINABLE DEVELOPMENT GOALS

Goal 1: End poverty in all of its forms 

Goal 3: Ensure healthy lives and promote well-being for all ages 

Goal 10: Reduce inequality within and among countries 

Goal 11: Make cities and human settlements inclusive, safe, resilient and sustainable 

Goal 16: Promote peaceful and inclusive societies for sustainable development, provide access to justice for all and build effective, accountable and inclusive institutions for all 

Goal 17: Strengthen the means of implementation and revitalize the Global Partnership for Sustainable Development