Avaliação da Rede de Cuidados à Pessoa com Deficiência: avanços e desafios da implantação em cenários brasileiros.

Abstract

This thesis is based on the ethical, historical, and scientific premise that strengthening comprehensive care for people with disabilities is an urgent necessity, given the historical invisibility of this population in public health policies. The research is justified by the absence of specific instruments to assess the implementation of the Care Network for People with Disabilities (RCPD), the low quality of health information recorded in Specialized Rehabilitation Centers (CER), and the structural challenges of consolidating a truly equitable network, especially in the Amazon region. The central objective of this study was to analyze the implementation of the RCPD in Brazil, focusing on three main aspects: the degree of implementation of the Network in eight states representing the five regions of the country; the operationalization process of the RCPD in the state of Amazonas, based on the perspective of the State Steering Group (GCE); and the quality of medical records of users served at CERs, considering the inclusion of data on the International Classification of Functioning (ICF), Singular Therapeutic Project (PTS), and care management. A mixed-methods approach was adopted. To assess the implementation of the RCPD, a multiple case study was carried out, structured in five stages: analysis of the initial situation of the policy, development of a logical model, definition of evaluation criteria, scoring and percentage calculation, and final classification of the degree of implementation. In Amazonas, a qualitative case study was conducted through semi-structured interviews with GCE members in 2020, analyzed using content analysis with the support of the IRAMUTEQ software. In addition, a cross-sectional study was conducted focusing on the completeness of medical record information at CER. The results showed that, while most states achieved a moderate level of RCPD implementation, Amazonas was classified as incipient. This performance was attributed to factors such as lack of regionalization, absence of regional steering groups, high turnover of state managers, shortage of qualified professionals, and difficulties in contracting and accrediting new services. These weaknesses compromised intersectoral coordination and the continuity of public policies in the region. Regarding the quality of CER medical records, the analysis revealed significant gaps, particularly in the documentation of therapeutic goals, interventions, and coordination with the care network—factors that impact the continuity and personalization of care. The thesis concludes that, although the RCPD represents a strategic pillar of the Unified Health System (SUS), its consolidation requires strengthening governance, promoting regionalization, and valuing health information. The study recommends the creation of regional and municipal steering groups, expansion of services to inland areas, and implementation of regular evaluation mechanisms to ensure a more equitable, effective, and person-centered care network for people with disabilities.