Inequality in prehospital care in Brazil: Analysis of the efficiency and sufficiency of SAMU 192 coverage

Abstract

Objective: To analyze the evolution and coverage scenario of pre-hospital care in Brazil between 2015 and 2019, under the dimensions of efficiency and sufficiency, in all municipalities, according to macro-regions, population covered, coverage strategy, geographic area covered, modalities available and distributed mobile resources. Method: Census study, observational, quantitative, descriptive, and exploratory approach, performed with data on the Mobile Emergency Care Service (SAMU 192) provided by the Ministry of Health, complemented with geographic area and population, by municipality. Results: In the period, coverage grew 5.4%, reaching 85.0% of citizens in 3750 municipalities (67.3%), with an increase (0.6%) and predominance (83.0%) of the Support modality Basics of Life. There were variations in coverage efficiency between regions (between 77.2% in the northern region and 94.6% in the southern region) with inequality in the composition of the response forces (between 10.5% of advanced life support teams in the northern region to 18.3% in the southern region), markedly higher among capitals and municipalities in the interior. Capitals and municipalities with 10 thousand to 50 thousand inhabitants concentrate SAMU 192 resources. The most vulnerable face of coverage is in the 1938 municipalities covered regionally and in the 1820 municipalities without coverage (51.8% with <10 thousand inhabitants). Conclusion: Efficiency in coverage is consistent with the guideline of comprehensiveness of the health system, however, the small expansion and persistence of uncovered citizens and a scenario of inequality of resources and response forces in municipalities in different regions, corrupt the guideline of equality in access to health (sufficiency).