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PEN ITS/HIV/SIDA - sector saúde 2004-2008 1

PEN ITS/HIV/SIDA - sector saúde 2004-2008

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PEN ITS/HIV/SIDA - sector saúde 2004-2008

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PEN ITS/HIV/SIDA - sector saúde 2004-2008

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PEN ITS/HIV/SIDA - sector saúde 2004-2008

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3 Num recente exercício, a DPS de Gaza projectou uma necessidade de preservativos para 2004 de mais de 90 milhões de unidades, várias vezes o consumo de todo o País. 4 O custo estimado dos medicamentos - excluindo preservativos - para o tratamento das ITS em 2002 foi ligeiramente superior aos 2 milhões de US$, quase o mesmo que o valor total das importações de antibióticos em 2001.

PEN ITS/HIV/SIDA - sector saúde 2004-2008

16

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5 O Departamento Farmacêutico estimou que, para o tratamento das infecções oportunistas, a importação de antibióticos devia aumentar em 40%. Porém, este exercício resulta apenas numa expressão de necessidades já que não há alocação de fundos adicionais para cobrir esta demanda.

Fonte: Impacto demográfico do HIV/SIDA

PEN ITS/HIV/SIDA - sector saúde 2004-2008

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POPULAÇÃO 2006

Prevalência HIV 15-49 2001

Total HIV +Distribuição%

total HIVDoentes 2006

Grávidas infectadas

Doentes 0-14 anos

Niassa 1.019.818 5,9% 32.521 2,3% 2.602 2.708 401 C Delgado 1.655.333 5,0% 44.735 3,2% 3.579 3.724 551 Nampula 3.727.143 7,9% 159.147 11,4% 12.732 13.250 1.961 Zambézia 3.824.117 15,4% 318.308 22,8% 25.465 26.501 3.922 Tete 1.540.775 16,7% 139.076 10,0% 11.126 11.579 1.713 Manica 1.357.996 18,8% 137.991 9,9% 11.039 11.489 1.700 Sofala 1.652.137 18,7% 166.987 12,0% 13.359 13.903 2.057 Inhambane 1.479.133 7,9% 63.158 4,5% 5.053 5.258 778 Gaza 1.404.358 19,4% 147.257 10,6% 11.781 12.260 1.814 Maputo P 1.146.124 14,9% 92.303 6,6% 7.384 7.685 1.137 Maputo C 1.106.843 15,5% 92.729 6,7% 7.418 7.720 1.142 TOTAL 19.913.777 13,0% 1.394.213 100,0% 111.537 116.077 17.177 �

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6 Ligeiramente inferior ao número estimado no “Impacto demográfico do HIV/SIDA em Moçambique” devido à utilização da prevalência de 2001. 7 12 consultas externas e 30 dias de internamento por ano (no último ano de vida) para doentes com SIDA

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8 Comparado com 1996, o volume de actividades produzido pelo SNS aumentou em 35% até o ano 2002. Entre 1993 e 2001, tinha-se registado um crescimento de 69%, especialmente em Consultas Externas e Contactos de SMI.

PEN ITS/HIV/SIDA - sector saúde 2004-2008

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7 - Análise de custo-eficácia DPC/Agosto 2003 8 - Plano de Acção para a Redução da Pobreza Absoluta, MPF, 2000

- PESS, Plano Estratégico do Sector de Saúde, Abril de 2001 - Compromisso de Kaya Kwanga (código de Conduta), Junho de 2003 - Memorando de Entendimento, MISAU, Novembro 2003

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9 Ver o ponto 5 dos princípios de base

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10 A interacção entre PTV e programas de redução da mortalidade materna pode servir como exemplo.

PEN ITS/HIV/SIDA - sector saúde 2004-2008

29

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INFORMAÇÃO, EDUCAÇÃO ECOMUNICAÇÃO •Informar•Despertara consciencialização

GABINETE DE ACONSELHAMENTO ETESTAGEM VOLUNTÁRIA •Aconselhamentopré-teste•TesteHIV •Aconselhamentopós-teste•ReferênciaaoHospital Dia

HOSPITAL DIA•Tratamentode doençasoportunistas•TARV•Referencia aos Cuidados Domiciliários

PNCTL•Melhoraro tratamentode IOdos pacienteshospitalizados•Continuaro tratamentoanti-tuberculosodos pacientesdo HDD•Encorajaro ATV

SMI/MATERNIDADE•Reduçãodatransmissãovertical•Encorajaro ATV

MEDICINA INTERNA PEDIATRIA•Melhoraro tratamentode IO•Encorajaro ATV

TRIAGENS E CONSULTA DE MEDICINA•Melhoraro diagnosticoe tratamentodas ITS e IO•Encorajaro ATV

CENTRO DE TRANSFUSÃO DE SANGUE•Melhoraro aconselhamentopré-teste•Melhoraro aconselhamentopós-teste•ReferênciaaoHDD

LABORATÓRIO•TesteHIV paracentrode transfusãode sangue•Melhorara capacidadediagnósticado Hospital Dia•Contagemde CD4 e CargaViral

Encorajar

Referência

EntradaNormal

Cooperação

REDE INTEGRADA

SECÇÃO DE SAÚDE MENTAL•Apoiopsicológicoaosaconselhadores•ApoiopsicológicoaosPVHS•Apoionaformaçãodos aconselhadores

CUIDADOS DOMICILIÁRIOS•Cuidadosde enfermagemem casa•ReferênciaHD, Consultade Medicina•EncorajarGATV•Aderênciaaosmedicamentos•Referênciasocio-economica

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11 Para uma descrição completa, veja o Manual Operacional do PEN IITS/HIV/SIDA-sector saúde

PEN ITS/HIV/SIDA - sector saúde 2004-2008

30

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12 Não há metas quantitativas para as componentes de nutrição, saúde mental, intervenção comunitária, medicina tradicional; estas acompanham a expansão das componentes de GATV e CD e a implementação das RI. 13 Inclui um total de 128 hospitais: 45 hospitais atuais e 83 CS de tipo I que passaram a Hospitais Distritais (ver a Tabela 6: Rede sanitária do SNS em 2002) 14 Com a excepção do diagnóstico e tratamento das infecções oportunistas complexas que precisam ser diagnosticadas e tratadas pelo um médico num HDD e com um laboratório mais sofisticado (Referir ao Manual Operacional)

PEN ITS/HIV/SIDA - sector saúde 2004-2008

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2004 2005 2006 2007 2008Preservativos distribuidos 25,360,000 31,600,000 35,400,000 43,400,000 50,400,000

� < B 0 =< �� /���0 9 2 5 =2 3@ < 6 �; 5 1�39 80 1 2 0 9 4 D 5 ,�� � � ��� � � & �Intervenção 2004 2005 2006 2007 2008Diagnóstico e tratamento ITS 1,000 1,000 1,000 1,000 1,000Transfusões seguras 111 111 111 111 111SAAJ 104 150 200 250 300GATV clássicos 50 76 192 260 315Prevenção Transmissão Vertical 60 120 200 250 258Tratamento IO e Quimioprofilaxia 60 120 200 250 250Cuidados Domiciliares 60 120 200 250 250TARV - HD - REDES INTEGRADAS 17 24 112 112 129

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Intervenção 2004 2005 2006 2007 2008Diagnóstico e tratamento ITS 684,828 818,592 958,410 1,104,795 1,275,964Transfusões seguras 80,000 85,000 90,000 95,000 100,000 SAAJ 104,000 160,000 220,000 270,000 330,000 GATV 72,000 135,000 384,000 540,000 945,000 Prevenção Transmissão Vertical 35,858 50,734 67,209 85,394 90,333 Tratamento IO e Quimioprofilaxia 34,311 67,779 94,178 108,207 114,965 Cuidados Domicilários 11,355 27,582 67,371 107,238 143,776 TARV - HD - REDES INTEGRADAS 7,924 20,805 57,954 96,418 132,280

15 Classificação da OMS 16 Para a componente de CD, assumiu-se que todos os doentes com TARV, a maioria dos doentes na fase IV, um terço dos doentes na fase III, bem como os grupos vulneráveis nas fases I e II vão entrar no programa de CD (segundo a classificação da OMS).

PEN ITS/HIV/SIDA - sector saúde 2004-2008

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17 Nota: O MISAU está a participar activamente na elaboração da estratégia de comunicação HIV/SIDA desenvolvido sob liderança do CNCS a ser disseminado brevemente. Particular atenção está sendo dada na colaboração para o desenvolvimento dos planos, harmonização de objectivos e na padronização de mensagens. O IEC do PEN ITS/HIV/SIDA-sector saúde ir-se-à integrar na política de intervenção comunitária (ver componente 13 “Intervenção comunitária”), que será desenvolvida pelo MISAU.

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PEN ITS/HIV/SIDA - sector saúde 2004-2008

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18 Existe um Plano Nacional Quinquenal (2003-2008) de Controlo da tuberculose e lepra, MISAU, Março 2003

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19 Ver o Manual Operacional – Tratamento das infecções oportunistas

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21 O Plano Quinquenal de TB e lepra elaborado em Março 2003 preconiza o desenvolvimento de actividades extra-hospitalar (DOTS) para aumentar a aderência ao tratamento

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22 Isto inclui: modos de transmissão e de prevenção do HIV/SIDA; educação nutricional; programas de planeamento familiar; terapia de rehidratação oral; aconselhamento sobre sexo mais seguro com abordagem cultural; reconhecer sintomas/suspeitar/diagnosticar HIV/TB/DTS, Malária, IRA, incluindo aspectos como, tratamento de sintomas simples através de um guião padronizado e quando referir ao SNS; biossegurança; sistema de referência

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23 Artigo 94 da Constituição da República do Moçambique

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24 Outras situações não legisladas, que não são da responsabilidade do MISAU e incluem:

• Direitos da mulher e da criança • Proibição da promoção do preservativo nas prisões • Discriminação e estigmatização das PVHS

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• Direitos de sucessão e propriedade sobre os bens dos órfãos • Descriminalização da prostituição • Violência sexual contra a mulher e a criança • Organização do apoio jurídico às PVHS

25 A legislação em vigor protege (lei nº 2/77, lei nº 4/87 de 19 de Janeiro e Diploma Ministerial nº 38/87) o acesso gratuito aos testes laboratórios no contexto do tratamento do HIV/SIDA

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26 (Grupo inter-departamental formada por todos os departamentos com competências na execução (DEE, DAM, DSC, DF, Recursos Humanos, DIS, etc.). Ver as estrutura de gestão – capítulo VI. 27 As projecções de carga de trabalho derivadas das estimativas de prevalência utilizadas para a elaboração do PEN ITS/HIV/SIDA-sector saúde têm claras implicações sobre o tipo, tamanho, e distribuição da rede sanitária. Na altura da elaboração do Plano de Investimento Sectorial (PIS) estes aspectos não podiam nem foram totalmente considerados.

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28 Duma forma simplificada, pode-se escolher entre um modelo de US mais “sofisticado”, incorporando melhorias tecnológicas no laboratório, por exemplo, que seria caracterizado por menor capacidade hoteleira e maior qualidade de atendimento. No extremo oposto estão US com maior capacidade hoteleira e menor capacidade para resolver problemas complexos e agudos, que actualmente caracteriza a totalidade da rede rural e uma parte importante da urbana. Entre as considerações a tomar em conta está o tipo de “serviço SIDA” a ser oferecido: o TARV implica mudanças que, teoricamente, permitem também tratar outras doenças como diabetes ou cardiopatias que actualmente ficam além das possibilidades mesmo de HP. O tratamento das infecções oportunistas, por outro lado, pode ser feito com o nível de desenvolvimento tecnológico actual (basicamente mini-laboratório) mas precisa maior capacidade de internamento. Outro aspecto a considerar é o perfil epidemiológico - até, do SIDA - projectado para o futuro. 29 Do estilo “dois técnicos para gestão do TARV em cada DPS”, por exemplo 30 Ver a composição deste grupo no capítulo VI – Estrutura de Gestão

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31 Iniciativas foram ocorrendo depois da finalização do PDRH 2001-2010 e incluem: MAP, GFATM e FBC 32 Por decisão do Ministro as Saúde, será preparado nas próximas semanas um plano de formação nestas áreas.

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34 PEN ITS/HIV/SIDA-sector saúde 2004-2008 DRH. Plano Operacional 01/10/2003-31/12/2004, Doc. Interno do MISAU, 2003. 35 Está em curso um estudo que deveria proporcionar dados mais completos e precisos 36 Assistência Técnica e Incentivos para o pessoal de saúde: análise das propostas e cálculo de custos, MISAU, DRH, 2002

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37 Proposta de critérios de atribuição do subsídio de almoço. MISAU, DRH/GD 2003. 38 Revisão e actualização do Guião para a prevenção dos profissionais de saúde sobre acidentes por exposição ao HIV, MISAU, 2002

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39 São exemplos de estudos já previstos: - Magnitude da mortalidade por SIDA ao nível da comunidade na população sexualmente activa - Estudo sobre a incidência, prevalência e etiologia das ITS – síndromes em subgrupos populacionais de risco - Estudo de sensibilidade e resistência dos agentes das ITS aos fármacos de uso corrente

PEN ITS/HIV/SIDA - sector saúde 2004-2008

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40 Documentos de base:

Manuais de gestão do aprovisionamento Proposta de acções estratégicas do Departamento de Logística Manual de procura (versão preliminar) Proposta de indicadores do sub-sistema de aprovisionamento geral

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41 O levantamento completo das necessidades em recursos humanos para o MISAU e o nível regional e provincial dentro do contexto do ITS/HIV/SIDA, bem como a elaboração dos Termos de referência de cada uma das posições identificadas e a definição do processo de seleção e contratação do pessoal identificado como necessário, esta em curso.

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42 Ver lista de composição de cada grupo, no Manual Operacional 43 Este Grupo de Trabalho ainda esta em curso de definição

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47 Está prevista uma consultoria brevemente de modo a definir os tipos de contractos e prestação de serviços das ONG, não só para o PEN ITS/HIV/SIDA-sector saúde, mas também para as actividades de saúde em geral.

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Custo per capita 2.64 4.27 5.92 6.02 5.98

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