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Architectonic barriers for elderly and physically
disable people: an epidemiological study of the
of PHC centers in seven Brazilian states
12th World Congress on Public Health
Istanbul, 27 April – 1st May, 2009
Federal University of Pelotas
Degree in Epidemiology
School of Medicine - Dept of Social Medicine
School of Nursing – Dept of Nursing
Authors
Siqueira FV, Silveira DS, Facchini LA, Piccini RX, Tomasi ET, Thumé E
Research staff
• Luiz Augusto Facchini
• Roberto Xavier Piccini
• Elaine Tomasi
• Elaine Thumé
• Denise Silveira
• Vanessa Andina Teixeira
• Maria de Fátima Maia
• Alessander Osório
• Mercedes Lucas
• Fernando V. Siqueira
• Vera Vieira Paniz
• Ma. Aparecida Rodrigues
Brazil - Location of the country of study
PELOTAS, RS (Southernmost state), BRAZIL
PELOTAS
Social Medicine Department, Federal University of Pelotas
Introduction
The study evaluates architectonic barriers in
the structures of Primary Health Care (PHC)
centers in two important regions of Brazil
(South and Northeast)
The study integrates the evaluation of the
Project of Extension and Consolidation of the Family Health Program (PROESF), carried
out by the Brazilian Ministry of Health
Introduction
The project studied two important regions of
Brazil – South and Northeast
Pernambuco
Santa Catarina
Rio Grande do Sul
Rio Grande do Norte
Paraíba
Alagoas
Piauí
RS
SC
AL
PE
PB
RN
PI
Northeast
South
States of Study
RATIONALE
Many Brazilians present restrictions related
to mobility and independence
About 23.1% of the population of Brazil is
composed for elderly or disabled people
RATIONALE
The architectonic barriers are defined as obstacles related to the urban constructions and public buildings
The barriers hinder the basic right of elderly and
disabled people regarding the serious difficulties of movement and inadequacy of the public spaces, particularly the health services
Steps, stairs, lack of slopes and irregular floor, bathrooms without adaptation for persons in wheelchairs, inadequate public transportation, sidewalk without conservation are examples of architectonic barriers
METHODOLOGY
Cross-sectional study carried out in 41 Brazilian cities over
than 100,000 inhabitants, in two regions: South and Northeast, describe the architectonic barriers of PHC centers
A sample of 240 PHC centers with two strategies of care
was selected randomly from list of services in the
municipalities Family Health Program
Traditional PHC
The sample was proportional to the number of PHC cnters
in each municipalities
The professionals working in the UBS answered
standardized questionnaire about architectonic barriers in
their units.
METHODOLOGY
Strategies of PHC
•Family Health Program (FHP, or PSF in Portuguese)
• It is the new strategy for PHC, launched in Brazil in 1994 – it
addresses poor urban & rural areas through multidisciplinary teams
(family doctors, nurses and home visitor, or community health
workers), defined population & coverage area, health promotion,
preventive and curative care, caring for the people in the health
center & at home
Traditional PHCIt was started in 1980 and centered in medical doctors, with
basic specialties (clinicians, pediatricians, G-O), without defined
population & coverage area, restricted to preventive & curative
care in the health center
RESULTS
236 Teams of workers answered the questionnaire
Non-respondents was four teams
- Two in south
- Two in northeast region
- The non-respondents had been of different cities
The sample included seven states in Brazil
- Two in South Region
- Five in Northeast Region
RESULTS
Prevalence of cities participating in the study from each
state enrolled in the south and in the northeast regions
41,4
9,84,9 7,3
24,4
4,9 7,3
0
10
20
30
40
50
60
70
80
90
100
RS SC AL PB PE PI RN
South - 51,2% Northeast - 48,8%
States of study according to regions
Pre
vale
nce
RESULTS
Prevalence of the architectonic barriers in accordance with the
strategy of PHC in the Brazilian South region
0 20 40 60 80 100
Inadequate building
Steps in UBS
Absence of slopes
Sidewalk inadequates
Absence of railings
Absence of bathroom with suitable doors
Wheelchairs unavailable
Va
ria
ble
s
Prevalence (%)
South Traditional
South PSF
P=0,03
P=0,05
SOUTH REGION
RESULTS
Prevalence of the architectonic barriers in accordance with the
strategy of PHC in the Brazilian Northeast region
NORTHEAST REGION
0 20 40 60 80 100
Inadequate building
Steps in UBS
Absence of slopes
Sidewalk inadequates
Absence of railings
Absence of bathroom with
suitable doors
Wheelchairs unavailable
Vari
able
s
Prevalence (%)
Northeast Traditional
Northeast PSF
P=0,02
RESULTS
Prevalence of the barriers architectural in accordance with the regions
of Brazil
0 20 40 60 80 100
Inadequate building
Steps in UBS
Absence of slopes
Sidewalk inadequates
Absence of railings
Absence of bathroom with
suitable doors
Wheelchairs unavailable
Vari
able
s
Prevalence (%)
Region Northeast
Region South
P=0,004
RESULTS
• Many PHC centers use common houses rented by the local government in poor neighborhoods, that do not meet the legal requirements to health services
• The PHC teams reported that about 2/3 of the facilities were inadequate to their professional needs and that of the users
• The Brazilian Health System do not have a strategy to construct PHC centers following a standard for the requirements of the model of care and the needs of elderly and disabled people
Conclusions
The architectonic barriers are frequent in both regions, and strategies of PHC services
The PHC centers do not follow architectonic standards regarding to health services and to disabled people
The increase of elderly people in the Brazilian population, most of them with chronic illnesses, requires better PHC services, that promote safe and
friendly access to frail and disabled users.
Conclusions
• Hopefully, we have some institutional initiatives, like the Project of Extension and Consolidation of the
Family Health Program (PROESF), carried out by the Brazilian Ministry of Health
• The PROESF is financing the improvement of the infrastructure, that will make ease the access of these population groups to PHC centers, but need to increase its capability to cross the barriers of the bureaucracy
Thanks !
www.epidemio-ufpel.org.br/proesf/index.htm
www.aquares.com.br
