Access to healthcare for children with Congenital Zika Syndrome in Brazil: perspectives of mothers and health professionals.

Autor:	Albuquerque MSV; Department of Social Medicine, Federal University of Pernambuco, Avenida Rui Barbosa, 716 - Flamengo, Rio de Janeiro, RJ, Brazil., Lyra TM; Aggeu Magalhães Institute, FIOCRUZ/PE, Av. Professor Moraes Rego, s/n - Campus da UFPE, Cidade Universitária, Recife, PE, CEP:50.740-465, Brazil.; Public Health Department, Faculty of Medicine, University of Pernambuco, Avenida Rui Barbosa, 716 - Flamengo, Rio de Janeiro, RJ, Brazil., Melo APL; Aggeu Magalhães Institute, FIOCRUZ/PE, Av. Professor Moraes Rego, s/n - Campus da UFPE, Cidade Universitária, Recife, PE, CEP:50.740-465, Brazil.; Federal University of Pernambuco, Avenida Rui Barbosa, 716 - Flamengo, Rio de Janeiro, RJ, Brazil., Valongueiro SA; Postgraduate Programme in Public Health, Federal University of Pernambuco, Avenida Rui Barbosa, 716 - Flamengo, Rio de Janeiro, RJ, Brazil., Araújo TVB; Postgraduate Programme in Public Health, Federal University of Pernambuco, Avenida Rui Barbosa, 716 - Flamengo, Rio de Janeiro, RJ, Brazil., Pimentel C; Aggeu Magalhães Institute, FIOCRUZ/PE, Av. Professor Moraes Rego, s/n - Campus da UFPE, Cidade Universitária, Recife, PE, CEP:50.740-465, Brazil., Moreira MCN; National Institute of Women, Children and Adolescents Health Fernandes Figueira/Fiocruz, Avenida Rui Barbosa, 716 - Flamengo, Rio de Janeiro, RJ, Brazil., Mendes CHF; National Institute of Women, Children and Adolescents Health Fernandes Figueira/Fiocruz, Avenida Rui Barbosa, 716 - Flamengo, Rio de Janeiro, RJ, Brazil., Nascimento M; National Institute of Women, Children and Adolescents Health Fernandes Figueira/Fiocruz, Avenida Rui Barbosa, 716 - Flamengo, Rio de Janeiro, RJ, Brazil., Kuper H; Clinical Research Department, International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, Kepple Street, London, UK., Penn-Kekana L; Epidemiology and Public Health, Maternal and Neonatal Health Group, London School of Hygiene & Tropical Medicine, Kepple Street, London, UK.
Jazyk:	angličtina
Zdroj:	Health policy and planning [Health Policy Plan] 2019 Sep 01; Vol. 34 (7), pp. 499-507.
DOI:	10.1093/heapol/czz059
Abstrakt:	The Congenital Zika Syndrome (CZS) epidemic took place in Brazil between 2015 and 2017 and led to the emergence of at least 3194 children born with CZS. We explored access to healthcare services and activities in the Unified Health Service (Sistema Único de Saúde: SUS) from the perspective of mothers of children with CZS and professionals in the Public Healthcare Network. We carried out a qualitative, exploratory study, using semi-structured interviews, in two Brazilian states-Pernambuco, which was the epicentre of the epidemic in Brazil, and Rio de Janeiro, where the epidemic was less intense. The mothers and health professionals reported that healthcare provision was insufficient and fragmented and there were problems with follow-up care. There was a lack of co-ordination and an absence of communication between the various specialized services and between different levels of the health system. We also noted a public-private mixture in access to healthcare services, resulting from a segmented system and related to inequality of access. High reported household expenditure is an expression of the phenomenon of underfunding of the public system. The challenges that mothers and health professionals reported exposes contradictions in the health system which, although universal, does not guarantee equitable and comprehensive care. Other gaps were revealed through the outbreak. The epidemic provided visibility regarding difficulties of access for other children with disabilities determined by other causes. It also made explicit the gender inequalities that had an impact on the lives of mothers and other female caregivers, as well as an absence of the provision of care for these groups. In the face of an epidemic, the Brazilian State reproduced old fashioned forms of action-activities related to the transmitting mosquito and to prevention with an emphasis on the individual and no action related to social determinants. (© The Author(s) 2019. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.)
Databáze:	MEDLINE
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