Construction and validation of a matrix for normative evaluation of the integrated health system of the borders

Fabriz, Luciana Aparecida; Oliveira, Valéria Conceição de; Zacharias, Fabiana Costa Machado; Valente, Silvia Helena; Ferro, Denise; Pinto, Ione Carvalho

doi:10.1590/1518-8345.4141.3433

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Revista Latino-Americana de Enfermagem

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Original Article • Rev. Latino-Am. Enfermagem 29 • 2021 • https://doi.org/10.1590/1518-8345.4141.3433 copy

Construction and validation of a matrix for normative evaluation of the integrated health system of the borders^* * Paper extracted from doctoral dissertation “Integrated Health System at the Border between Brazil and Paraguay, in the State of Paraná: an evaluative study”, presented to Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil. Supported by Fundação Araucária, Public call # 16/2017, Grant # 49036, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective:

to build and validate a matrix for normative evaluation of the Integrated Health System of Borders.

Method:

a methodological study, composed by the construction of an evaluation matrix elaborated in three stages: elaboration of the logical model, containing the triad of structure, process and result; definition of evaluative questions and appearance and content validation of the matrix. Appearance and content validation were performed simultaneously by seven judges. For data collection, an online questionnaire and the Delphi technique were used and, for analysis, the Content Validity Index and Content Validity Ratio.

Results:

the evaluation matrix containing 24 questions was submitted to two evaluations for its appearance and content validation. In the first, the overall mean Content Validity Index was 99.40% and the Content Validity Ratio was 0.90. In the second, the Content Validity Index was 100% and the Content Validity Ratio, 1.0; there were no new proposals and the matrix was made up of 24 questions. The matrix was considered intelligible in terms of appearance validation.

Conclusion:

the evaluation matrix of the Integrated Health System of the Borders is validated in terms of appearance and content for analyzing the performance of public actions and policies in border regions.

Descriptors:
Validation Studies; Program Evaluation; Public Health Policy; Health Systems; Border Areas; Border Health

Rounds	Suggestions and changes or justifications
Rounds	Structure
1^st	Here, in question 5, which refers to "room, equipment and materials for the first assistance of urgencies for 100% of the described population, contemplating", it was necessary to say where it is described and what should be contemplated.
2^nd	The question was revised and the information referring to the documents that should include the description of the population was included and the word "contemplating" was excluded, since it is already stated that it was equipment and materials.
1^st	In question 5, there is the word urgencies, I think it is not necessary, as it says that it is for first care.
2^nd	In this case, the word urgencies was maintained, for clarification to the reader, as the agreed service was for the first assistance of urgency cases.
	Process
1^st	In question 10, regarding the municipality to elaborate the client description, within 30 days from the Term of Adherence, I suggest extending the term to 30 to 40 days.
2^nd	The item was not changed, considering that the term of up to 30 days was established under Ordinance 1,189 of June 5th, 2006.
	Process
1^st	In question 15, which deals with the insertion of SIS Fronteiras in the Municipal Health Plan, it is necessary to clarify which period it refers to as, since the implementation of SIS Fronteiras in 2006, there are already at least four plans prepared in that period, with this, I suggest that they are in the Municipal Health Plans.
2^nd	Suggestion accepted, changing the text to: "The Municipal Health Plans, elaborated during the term and execution of SIS Fronteiras, contain the Local Diagnosis and the Operational Plan".
	Results
1^st	In question 23, there is a contingency plan for unusual events, but they were not exclusive to SIS Fronteiras, I think they could be removed.
2^nd	The contingency plan for unusual events is a requirement for the release of financial resources from SIS Fronteiras; therefore, it was maintained.

Structure
1. The Ministry of Health allocated financial resources for the development of SIS Fronteiras.
2. The municipality provided a room for the coordination of the project, containing 1 computer; 1 printer; 1 nobreak; 1 table; 1 typing chair and 1 cabinet.
3. The municipality provided infrastructure for the implementation of health networks, including: computers; information systems; primary and tertiary care points, to support primary health care, with specialized actions at outpatient and hospital levels, diagnostic and therapeutic support, meeting room and car for commuting.
4. The municipality provided offices, with equipment, furniture and materials for basic outpatient care.
5. The municipality provided a room, equipment and materials for first emergency care to 100% of the population described in the SIS Fronteiras Term of Adherence and Operational Plan.
6. Infrastructure, made available by the municipality, for new services proposed in the Local Health Diagnosis, which may include constructions; reforms; acquisition of equipment; vehicle purchase; consumables, etc.
7. Infrastructure, provided by the municipality, for qualification, contemplating the following: Physical space (available rooms for qualification), Computers and Bibliographic material.
8. Personnel, assigned and/or hired by the municipality for the activities inherent to SIS Fronteiras, with the possibility of hiring professionals and paying charges when provided for in the Operational Plan.
Process
9. The Municipality formalized a partnership with the Ministry of Health, through a contract called Term of Adherence to the Integrated Health System of the Borders, SIS Fronteiras, within the established term (April 2006).
10. The municipality prepared and presented the clientele description, within up to 30 days from the manager's signature on the Term of Adherence to SIS Fronteiras.
11. The municipality constituted a Local Health Commission in an integrated manner with the Municipal Health Council and with the participation of representatives of the health systems on both sides of the border, within 30 days of the manager's signature on the Term of Adherence to SIS Fronteiras.
12. The municipality presented an Operational Plan within 60 months from the manager's signature on the Term of Adherence to SIS Fronteiras.
13. The Municipal Health Council approved the Local Health Diagnosis and the Operational Plan.
14. The State Bipartite Inter-Management Commission approved the Local Health Diagnosis and the Operational Plan.
15. The Municipal Health Plans, elaborated during the validity and execution of SIS Fronteiras, include the Local Health Diagnosis and the Operational Plan.
16. Reports on the Phases of SIS Fronteiras were forwarded.
Results
17. Local Health Diagnosis complete, with qualitative and quantitative aspects, contemplating the identification of the population to be served in the health services; survey of existing demands; installed capacity; description of assistance flows; definition of the epidemiological, sanitary and environmental profile in health.
18. Qualified professionals in terms of management (economics, planning, organization of the health systems and supplementary health management), health care (protocols and specific border procedures), health surveillance, indigenous health, information systems and social control.
19. Health networks implemented, respecting the financial limits.
20. New services implemented according to demands surveyed in the Local Health Diagnosis.
21. Basic outpatient care available to 100% of the population described in the Local Health Diagnosis and Operational Plan.
22. Urgent care available to 100% of the population described in the Local Health Diagnosis and Operational Plan.
23. The municipality presented the Contingency Plan for Unusual Events.
24. The actions listed by the manager in the Local Health Diagnosis and Operational Plan were carried out.

Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo Av. Bandeirantes, 3900, 14040-902 Ribeirão Preto SP Brazil, Tel.: +55 (16) 3315-3451 / 3315-4407 - Ribeirão Preto - SP - Brazil
E-mail: rlae@eerp.usp.br

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[1] Corresponding author: Luciana Aparecida Fabriz E-mail: luciana.fabriz@gmail.com https://orcid.org/0000-0002-7633-0127