Contrato organizativo da Ação Pública da saúde: instrumento de gestão administrativa em prol da responsabilidade sanitária / Organisational contract of Public Health Action: administrative management instrument for Health responsibility

A Reforma Sanitária Brasileira (RSB), consagrada como movimento de setores da sociedade, revela sua participação na elaboração do texto constitucional, que visou estabelecer a saúde como direito social. Posteriormente a esse processo, de forma contínua e concomitante, pode-se perceber que a RSB contribuiu com debates que culminaram na elaboração de leis que versam, em sua maioria, sobre a descentralização do SUS, enfatizando os instrumentos de gestão e promoção da saúde na União, nos Estados, no Distrito Federal e nos Municípios. Nesse contexto, surge como um elemento do Sistema Único de Saúde (SUS), o Contrato Organizativo da Ação Pública da Saúde (COAP), cujo objetivo é unificar e integrar as ações dos entes federativos, subsidiárias e complementares, levando em consideração as necessidades da região de saúde, dando ênfase à responsabilização dos gestores da saúde. Num panorama de fortalecimento da gestão da saúde, a responsabilidade sanitária, observada especialmente no COAP e no Projeto de Lei do Senado nº 174/2011, para alguns estudiosos, como expletiva, vistas a regulamentação vigente acerca da responsabilidade civil atribuída à atividade estatal e a repartição de competências dentre os entes federativos e por outros, é concebida como importante instituto em prol de maior efetividade na prestação da saúde, carecendo de especificidade na tipificação. O presente artigo explicita, acerca da responsabilidade sanitária, questões a serem consideradas em ambos os institutos (COAP e PLS) e indica que, em termos evolutivos, há muito a se caminhar, porém, é indiscutível o desenvolvimento social já alcançado, no tocante à gestão compartilhada na saúde brasileira.

The Brazilian Sanitary Reform (RSB), consecrated as a movement of sectors of society, can be clearly seen in its collaboration in the drafting of the constitutional text, which aimed to establish health as a social right. Subsequent to this process, continuously and concurrently, one can see that the RSB also contributed to debates that culminated in the drafting of laws that focused mostly on the decentralization of SUS, emphasizing management tools and health promotion in the Union, the states, the Federal District and the municipalities. In this context, as an element of the Unified Health System (SUS), the Organizational Agreement from the Public Health Action (COAP) arises, aiming to unify and integrate the actions of the federal entities, in a subsidiary and complementary manner, taking into consideration the needs of the health region, emphasizing accountability of managers. In a context of strengthening health management, the sanitary responsibility, together with COAP and Senate Bill nº 1, 742, 011, can both be seen as unnecessary by some scholars, considering the current regulations on the liability attributed to the state activity and the division of powers among the federal entities. For others, it is conceived as an important institution for the sake of greater effectiveness in the provision of health, and lack specificity in typification. This article explains about the sanitary responsibility, questions to be considered in both institutes (COAP and PLS) and indicates that, in evolutionary terms, there is much to work; however, it is undeniable the social development already achieved with regard to shared management in health.

La Reforma Sanitaria del Brasil, establecido como un movimiento con la participación de diversos sectores de la sociedad, reveló en su participación en la elaboración del texto constitucional, que tiene por objeto establecer la salud como un derecho social. Con posterioridad a este proceso, de forma continua y simultánea, se puede ver que la RSB también contribuyeron a los debates que culminaron en la elaboración de leyes que tienen que ver, sobre todo acerca de la necesaria descentralización del SUS, haciendo hincapié en herramientas de gestión y promoción de la salud en la Unión, los estados, el Distrito Federal y los municipios. En este contexto, surge el Acuerdo Organizacional de la Acción en Salud Pública, con el objetivo de unificar e integrar las acciones de todas las entidades federales, filial y de manera complementaria, teniendo en cuenta las necesidades de cada región del país. Por lo tanto, la responsabilidad sanitaria, como instituto específico para el fortalecimiento de la gestión de la salud, junto con el COAP, puede ser visto como innecesaria por algunos estudiosos, teniendo en cuenta las normas vigentes sobre la responsabilidad atribuida a la actividad del Estado y la división de poderes entre las entidades federales. Para otros, se concibe como una institución importante en aras de una mayor eficacia en la prestación de salud. En términos evolutivos, se entiende que aún hay mucho por conquistar; sin embargo, es innegable que parte del desarrollo social se ha logrado con respecto a la gestión compartida en la salud brasileña

On Health Responsibility / 中国医学伦理学

To differentiate health responsibilities in different circumstances should judge correctly the principle and conditions of responsibility division .It is deemed that the controllability view of responsibility provides the mor-al basis for health responsibility , which claims that the controllable causality is necessary condition for the judgment of responsibility .The construction of health responsibility is a multi -party participation .In face of the current re-ality of China , must build a diversified responsibility principle system: the responsibility of the government as the leading factor , the family and social responsibility as the backbone , and individual responsibility as base .

A instituição da responsabilidade sanitária pela via legal no Brasil / Health liability of state in Brazilian law

OBJETIVO: Caracterizar as proposições legislativas que objetivam instituir no Brasil instrumentos de responsabilidade sanitária dos gestores da saúde. Metodologia: Pesquisa documental. RESULTADOS: A responsabilidade sanitária é caracterizada quanto à natureza, esfera jurídica, tipificação dos atos ilícitos e sanções respectivas e o processo para o seu controle. CONCLUSÕES: A responsabilidade sanitária instituirá um novo paradigma na Administração Pública ao se caracterizar como responsabilidade subjetiva do gestor de saúde e incluir como obrigações, ademais do cumprimento de normas sanitárias configuradas em lei, os acordos entre os entes federados e os planos de saúde, vindo a constituir o conjunto de regras e mecanismos de cooperação e controle mútuo entre União, Estados e Municípios, essenciais para a construção e operação de um sistema unificado de saúde num estado federado com as características do Estado brasileiro.

OBJECTIVE: To characterize draft bills that aim at establishing State liability regarding health responsibility of healthcare managers. Methodology: Documental research.RESULTS: Health responsibility is defined in relation to its nature; legal sphere; essence of torts and penalties to which they are sanctioned and the process for its control.CONCLUSION: The institution of legal health responsibility creates a new paradigm when establishes, in addition to the objective liability of State, the tortious liability of the healthcare manager, and broaden the understanding of their traditional administrative civil liability: besides following healthcare rules set in laws, they have to incorporate the agreements between federative entities and health plan. The concept of 'health liability' is being shaped by the development and test of rules and mechanisms for cooperation and mutual control among the Union, states and municipalities, which are essential for the organization and management of a unified health system in a federate State with such characteristics as is Brazil's.

Estilo de Vida y Control Glucémico en pacientes con Diabetes Mellitus Tipo 2 de una Institución de Seguridad Social de Nuevo Laredo, Tamaulipas / Lifestyle and Glycemic Control in patients with Type 2 Diabetes Mellitus a Social Security Institution Nuevo Laredo, Tamaulipas

IIntroducción: El propósito del estudio fue determinar la relación entre los estilos de vida y el control metabólico del paciente medido a través del examen hemoglobina glucosilada. Metodología: Estudio descriptivo-correlacional. Muestreo por conveniencia. Muestra de 90 usuarios del programa de diabetes. Las mediciones fueron: Cuestionario de Responsabilidad en Salud y examen de hemoglobina glucosilada. Resultados: La responsabilidad en salud no se relacionó con el control metabólico de hemoglobina glucosilada del paciente (rs=.039, p=.719). La hemoglobina glucosilada reportó media de 13.32; observando que 95% de los pacientes tuvieron mal control metabólico. La evaluación de la responsabilidad en salud por medio de la hemoglobina glucosilada fue bajo (media= 49.71) y la media del examen fue de 13.32; 95% de los pacientes tuvieron mal control metabólico. La percepción de la calidad se relacionó significativamente con el control metabólico (rs=.282, p=.007). Se relacionó también positivamente la edad con la percepción de la calidad (rs=.260, p=.014). Conclusiones: Existe un bajo cumplimiento de la responsabilidad en salud del paciente para el control de la enfermedad, lo que es evidente con las altas cifras de hemoglobina glucosilada; la consistencia del instrumento fue aceptable, se recomienda ampliar la validez del mismo.

Introduction: The purpose of this study was to determinate the relationship among the life styles and metabolic control in the measured patient through the gloucosic hemoglobin test. Methodology: descriptive co-related study. Sample convenient, 90 users sample in the diabetes program. The measurements were: Responsibility questionnaire in health and glucose hemoglobin test. Results: Health responsibility not related with metabolic control of patient's glucose hemoglobin (rs=.039, p=.719). Glucose hemoglobin reported an average of 13.32; 95% of the patients with bad metabolic control. Health responsibility evaluation by glucose hemoglobin low (average= 49.71) and average test 13.32; 95% of the patients had bad metabolic control. The quality perception was significant related with metabolic control (rs=.282,p=.007). Was also positively related the age with quality perception (rs=.260,p=.014). Conclusions: There's a low accomplishment of patient's health responsibility to the disease control, what's evident with high rates of glucose hemoglobin; the instrument's consistency was acceptable, it's recommended to enlarge the validation itself.

Relación de los factores personales biológicos, socioculturales y apoyo social con la responsabilidad en salud a pacientes con Tuberculosis pulmonar / List of personal factors biological, cultural and social support with responsibility for health patients with pulmonary tuberculosis

Introducción: El propósito fue conocer la relación entre factores personales biológicos, socioculturales y el apoyo social con la conducta promotora de salud de responsabilidad en salud. Metodología: Diseño descriptivo-correlacional, muestreo no probabilístico, muestra de 80 sujetos que terminaron el tratamiento. Recolección de la información con una cédula y dos instrumentos de medición con Alpha de Cronbach aceptable. Resultados: Se observó correlación negativa y significativa entre la edad con el apoyo emocional (rs=-.426,p<.001), como con el apoyo tangible (rs=-.436,p<=.001). Se encontró correlación negativa y significativa del índice de masa corporal con el apoyo emocional (rs=-.27,p=.01), y el apoyo tangible (rs=-.22,p=.04). Se encontró correlación positiva y significativa de los años de escolaridad con el apoyo emocional (rs=.42,p=<.001), y el apoyo tangible (rs=.39,p=<.001). El modelo de regresión lineal múltiple de escolaridad, nivel socioeconómico y ocupación mostró efecto significativo sobre la responsabilidad en salud (Fc=2.83,p=.03) con una variación explicada del 13%. Conclusiones: Los factores personales biológicos y socioculturales tienen relación con las influencias interpersonales. Se encontró efecto significativo de los factores socioculturales con la responsabilidad en salud. No se encontró efecto significativo de los factores biológicos con el resultado conductual; y del apoyo social con la responsabilidad en salud.

Introduction: The purpose was to know the relationship among personal, biological and social-cultural factors and the social support with the promote behaviour of health responsibility. Methodology: Descriptive co-related design, non probabilistic sampler, 80 subjects finishing treatment, information collection with schedule and two measurement instruments with Cronbach's Alpha acceptable. Results: Co-relation negative observed and significant between the age with emotional support (rs=-.426,p<.001), as tangible support (rs=-.436,p<.001). Co-relation negative and significant observed with the corporal mass index with the emotional support (rs=-.27,p=.01) and tangible support (rs=-.22,p=.04). Found positive and significant co-relation of the scholarship with the emotional support (rs=.42,p=<.001), and tangible support (rs=.39,p=<.001). Multiple lineal regression of scholarship model, social-economiclevel and living showed significant effect over health responsibility (Fc=2.83,p=.03) with 13%explained variation. Conclusions: The personal, biological and social-cultural factors are related with the interpersonal influences. Significant effect found in social-cultural factors with health responsibility. Significant effect not found with biological factors with conduct result; and the social support with health responsibility.