Avaliação do grau de implantação do Programa de Humanização do Parto e Nascimento no Médio Vale do Jequitinhonha em Minas Gerais.

Abstract

Considering the relevance of the humanization of delivery and childbirth care in reducing maternal and perinatal mortality and the need for evaluation of health services and programs, this study aims to analyze the implementation of the Program for the Humanization of Childbirth (PHC) in hospitals that provide care to delivery and childbirth in the middle region of the Jequitinhonha Valley, Minas Gerais estate. This is an evaluative type survey, which incorporates normative evaluation into components of the structure and process of delivery and childbirth care to assess the degree of implementation of PHC. In each of the 10 hospitals surveyed the director/technical supervisor, a maternity nurse and the physician responsible for maternity or physician on duty were interviewed. Furthermore, an observation script was used to verify the physical and material resources, the register of maternity/neonatal and file of death declaration were used to collect information on health indicators. The logical model was developed to describe the PHC. To create the scoring system, used to assess the structure and process and used to estimate the degree of implementation (DI), we used matrices to elaborate judgment criteria of official standardization of PHC and organized according to each dimension and component of the program with subsequent application of the Delphi technique. From the scores achieved by hospitals, each dimension was classified as excellent (90-100 points), satisfactory (70-89), unsatisfactory (50-69) and critical (<50). The DI was classified as advanced (80-100% of points), intermediate (50-79%) and incipient (<50%). The 10 general hospitals investigated are low risk and accredited to the SUS, 7 being philanthropic and 3 with municipal management. In 2011 and 2012 there were 6,626 live births (LB) and 107 fetal deaths in these hospitals, and the perinatal mortality rate of 21.3 deaths/thousand LB ranging from 95.9 to 14.9 deaths/thousand LB. The cesarean rate ranged from 18.02% to 47%. Deficiencies were observed in the human, physical and material resources and internal aspects of the organization and structuring of work. Regarding the structure, five hospitals were negatively evaluated: 3 classified as unsatisfactory and 2 as critical. Regarding the process dimension 6 hospitals had critical level evaluation. There was a statistically significant correlation between total score attained by the structure and size dimension process, in other words, when the structure was evaluated positively, the process also acquired a positive rating. The DI of PHC was classified as advanced in one of the hospitals, 5 being classified as intermediate and 4 incipient. These results indicate that the investigated hospitals in PHC still has deficiency in its implementation, especially in the process component.