An Evaluation of the Challenges of the Implementation of Programa de Saúde na Escola (PSE) in Camaçari

By Daniel Wilhite

PSE History + Background

Established by Ministry of Education in 2007 Mission: “contribute to the integral education of students

through health promotion, illness and disease prevention, and health care, aimed at addressing the vulnerabilities that compromise the full development of children, adolescents, and young people….”

Integrates public education and health systems Pesquisa Nacional de Saúde do Escolar (PeNSE) data

demonstrates need Started in Camaçari in 2013 (2 yrs. old) PSF + PSE partnerships

Implementation Challenges

PSF capacity Can only serve up to 1,000 students Many serving fewer than allotment

Staff discontinuity Medical professionals – 7 y contracts Administration shifts every 4 yrs.

PSF connectivity Difficulty in successful specialist referrals

Grupos Intersetoriais de Trabalho (GTIs) Team made up of Sec. Health, Sec. Education, local cultural, leisure, sport,

transport, urban planning, NGOs, civil society entities Reality: dominated by health sector

Ethical concerns Disclosure Parent tension

Study Aims

This research seeks to verify the extent to which these previously identified programmatic challenges are relevant to the experience of PSE in Camaçari, Brazil. The study, through qualitative methods, hopes to capture the state of PSE at a local municipal level and the primary concerns of all parties involved in its operation.

Study Hypotheses

1. There are not enough PSF health care worker teams to implement PSE at all public schools in Camaçari.

2. There are issues of programmatic continuity within PSE teams.

3. There are problems of connectivity to specialized care within the PSE system.

4. The Grupos Intersetoriais de Trabalho (GTIs) are underdeveloped and dominated by the health sector.

5. There are ethical concerns of parents about PSE medical care within public schools.

Data Analytic Sample + Analysis

Interviewees: PSE administrators PSF health care workers in a unit officially

affiliated with PSE Public school administrators, teachers, parents,

and students of schools affiliated with PSE Interview questionsAnalysis plan

Fieldwork

Interviews with administrators in Camaçari: Paula (Sec. of Health/DAB), Marieni (Sec. of Ed.), Lidiane, Ana

Interviews with health professionals and principal in Fonte das Aguas

PSE school visit in Fonte das AguasPSE administrator meeting observation

School Visit

Arembepe, Fonte das Aguas, Camaçari

Initial Findings PSE Administrators:

It’s a very young, new program – “a lot needs to be figured out” Lack of established GTIs, mostly run out of Sec. of Health -> lack of teamwork between educators

and medical teams Some PSF units are much more proactive than others Lots of discontinuity among medical teams, admins Hasn’t reached all schools, BUT has definitely expanded More conservative parents are resistant to sex ed (ex. pamphlets)

Health Professionals Some schools are more cooperative/welcoming than others Its sometimes hard to schedule and get to schools (transport) Root many problems in habits of parents Frustrated with specialist referral difficulties

Schools Love working with PSF team who they know them well Easy way to fast-track students to get appointments and parents are usually welcoming of this Teachers remain in classrooms and monitor children during information sessions, but don’t actively

lead Learned of other teachers who attend workshops to teach about health education Can be a bit disruptive to normal routine

Moving Forward

More interviews with principals, teachers, parents, and students

More observation of PSF work during PSE visits

Interview scripts + codingFinal analysis