Planejamento em saúde em municípios brasileiros: situação cadastral e a convergência com o plano ações estratégicas (2021-2030)

Abstract

Health planning is crucial for the organization and management of services, ensuring continuous improvement in public healthcare delivery. In Brazil, the Unified Health System (SUS) requires specific instruments, such as the Municipal Health Plan (PMS) and management reports, to monitor and plan municipal actions. This study employed both quantitative and qualitative approaches. It investigated the status of health planning instruments in Brazilian municipalities and analyzed the alignment of PMS in Brazilian capitals with the goals of the National Action Plan for the Prevention and Control of Chronic Non-Communicable Diseases (DANT Plan) 2021-2030. The quantitative analysis, based on data from 5,563 municipalities collected by the Strategic Management Support Room (SAGE), identified two clusters: Cluster 1, which included 60.6% of municipalities, demonstrated better performance regarding the status of planning instruments; and Cluster 2, which encompassed 39.4% of municipalities, showed lower performance in this regard. Both clusters revealed that monitoring-related documents had approval rates lower than those for more propositional documents. Specifically, 65.1% of municipalities in Cluster 2 did not approve any of the Detailed Reports for the Previous Quarter, as required for the period. Municipal typology and urbanization level were not associated with any of the identified clusters; however, geographical macroregions were. The qualitative analysis examined the PMS of 24 Brazilian capitals for the 2022-2025 period. This assessment was conducted in light of the "DANT goals" selected from the DANT Plan. Among the nine goals investigated, three were not addressed (either as a goal or objective), highlighting significant gaps in the alignment between planning and practice. The most addressed DANT goal in the PMS was the reduction of premature mortality, suggesting greater alignment with national priorities. However, the absence of clear goals related to improving dietary habits limits municipalities' ability to effectively address key risk factors for chronic non-communicable diseases (CCNTs), such as poor diet. Additionally, the apparent disconnect between the situational diagnosis in the PMS and the proposed goals/targets reveals a gap that may hinder the translation of the situational diagnosis into concrete actions, undermining the implementation of strategies aligned with the DANT Plan and reducing their effectiveness in mitigating the burden of CCNTs. These deficiencies in municipal health planning compromise the ability to address risk factors and health inequities in an integrated manner, which are essential for tackling CCNTs. More broadly, this situation is exacerbated by political-party influences, governance challenges, regional disparities, and socio-economic inequalities, which often misguided priorities and resource allocation, deviating from the actual health needs of the population. Therefore, initiatives to strengthen technical capacity, promote greater management stability, and enhance social control are critical to ensure a more effective and sustainable approach to public health.