sustentação 24 / revista do conselho das secretarias municipais de saúde do ceará

108
!"!#$%#&'() *+,-./ *12*3,45 6 7889 6 :*;+4 2</,=,+4 >*54?@<,/ +* A*1?./ 788BC788D

Upload: cosemsce-conselho-das-secretarias-de-saude-do-ceara

Post on 30-Mar-2016

213 views

Category:

Documents


0 download

DESCRIPTION

Relatório de Gestão 2007-2008

TRANSCRIPT

Page 1: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

!"!#$%#&'()*+,-./0*12*3,450607889060:*;+402</,=,+4

>*54?@<,/0+*0A*1?./788BC788D

Page 2: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará
Page 3: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

!

8E0000*+,?/<,4500

8F0000G45*<,4

8D0000*;?<*:,1?4!"#$%&"'()*+,"%-.%/+*01"%2*+3"#*

7H00000704;/10+*0G*1?./45%6"7"%89::;<:%,*+*%"%8.*+=%.%>5%6"7"%:4:%,*+*%"#%).*+.6#.#%

HB00000/2,;,./?+*6)(#)"%&.-+"%-*%:('7*%?('@"%%

IE0000/2,;,./

H9000034243,?4<024<40G*<,<

JI00003/;G<*11/10;43,/;4,1

IF0000K)!!$L!CK$/%@(#AB+(*%-*%.6A(-*-.%C>.%D*E%"%:4:%*)"6A.).+%6"%.#A*-"%-"%8.*+=%

FI00003/;G<*11/10+/0K)!!$L!CK$0

DE0000M*+45N41F.)"6@.)(5.6A"%,.'*%'>A*%.5%D*7"+%-"%:4:%

DJ0000K)!!$L!0*M024O?4

9B0000:,:P;3,410MO;,3,24,10Q03/;?</5*01/3,458*6(6-$:"3+*'2*+3*'@*:.)+.A*+(*%-.%:*0-.%-"%8.*+=<*+*)*6*0

I8700RO4501O40/2,;,./

I8J00/O?<4102454:<41

9I00002<*1?4-./0+*03/;?41

JH00000<*45,S4<T042/,4<0*024<?,3,24<G.+3"#%)"61>H*-"#%,.'*%-(+.A"+(*%-"%89::;<:%

I8E003O5?O<4

Page 4: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

89::;<:8"6#.'@"%-*#%:.)+.A*+(*#%.%:.)+.A=+("#<>6()(,*(#%-.%:*0-.%-"%8.*+=

IJF;K9FJ/%;L;84KJG/&+.#(-.6A.M%!"#$%&"'()*+,"%-.%/+*01"%2*+3"#*%N8*#)*7.'O

I(+.A"+%?(6*6).(+"M%?+*6)(#)"%&.-+"%-*%:('7*%?('@"%N8+>EO:.)+.A=+(*%P.+*'M%Q>E(*%Q>)$'(*%:*+*(7*%%F(3.(+"%N:.6*-"+%&"5,.>O

89R:;QS9%?J:8/QK(A>'*+M%<*6>.'%Q",.#%<*+A(6#%N&.6A.)"#A.O:>,'.6A.M%G*'$+(*%G(*6*%NP>*+*5(+*6H*OK(A>'*+M%9'T5,(*%<*+(*%?+.(+.%-.%/E.7.-"%N/+*A>3*O

<.53+"%R*A"K(A>'*+M%!"#$%/'.U*6-+.%<"6AV/'7.+6.%%N?"+A*'.E*O

P+*6-.%&"+A.K(A>'*+M%R(E.A.%K*7*+.#%/'7.#%N8+*A"O:>,'.6A.M%8*+'"#%S('A"6%/'3>C>.+C>.%:"*+.#%N:"3+*'O%

<$-("%&"+A.K(A>'*+M%<*6>.'%Q",.#%<*+A(6#%N&.6A.)"#A.O

&.C>.6"%&"+A.K(A>'*+M%!"#.A.%<*'@.(+"%K*7*+.#%NP>*(03*O:>,'.6A.M%Q>(E*%Q>)$'(*%:*+*(7*%F(3.(+"%N:.6*-"+%&"5,.>OK(A>'*+M%G*'$+(*%G(*6*%NP>*+*5(+*6H*O:>,'.6A.M%F"-+(H"%8*+7*'@"%R"H>.(+*%NI.,W%J+*,>*6%&(6@.(+"O

:>,'.6A.M%!"#$%&"'()*+,"%-.%/+*01"%2*+3"#*%N8*#)*7.'O

&F9I4XY9I(+.A"+*%-.%*+A.Z%?"ABH+*D*%.%I.#(H6.+M%!*6*T6*%K.'.#%;-(A"+*Z%F.-*A"+*%.%F.,B+A.+M%8'*+(##.%8*7*')*6A.%<K2%[\]^_8;

K(+*H.5M%`Waaa%.U.5,'*+.#

.#,.)(*'%W%`aabW%*6"[[

K)!!$L!/::;::9FJ/%I;%89<4RJ8/XY9%I9%89::;<:

K+*7.##*%-"#%&")(6@"#Zcc

:;I;%I9%89::;<:

%+.7(#A*#>#A.6A*)*"de*@""W)"5W3+fffW)"##.5#).W"+HW3+

*+,?/<,45"

!"#$%&$'()*

"

"

"

"

"

Page 5: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará
Page 6: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

UO*M0V0/0K)!!$L!CK$

Page 7: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará
Page 8: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

WX02<*3,1/0+4<042/,/0,;3/;+,3,/;4504/10MO;,3Y2,/16Z

;5% D.7.+.(+"%-.%`aa\%*%*A>*'%-(+.A"+(*%-"%89::;<:% A"5">%,"##.% '(-.+*-*%,.'"%.6A>

,+"5.A.>% '>A*+%,.'*%5.'@"+(*%-*%#*0-.%.5%A"-"#%"#%5>6()T,("#%-"%.#A*-"Z%*A+*7$#%-*%

+.#,.(A*+Z%)"5"%5$-()"%.%)"5"%H.#A"+%-.%#*0-.W%%

Page 9: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

!"#$%&"' ()*(++$),&' ,&-"'$)&"' ,&' %$),$#&' .+("-,-,&' .(/&' "+0' )&'1233!430'2'56('&'%&#-7&6'$'*$),-,$#$+8"(9' )$56(/(' %&%()#&9' :' .+("-,;)*-$' ,&'1233!43<

! #$! %&'($(&!

"

"

"

"

=6('$>?("'("#+$#@A-*$"'.&,(8%&"' *&)"-,(+$+' *&%&' %$+*$"' ,(""$' A("8#B&<'

""

"

"

"

"

"""

'!""$'("#+6#6+$>B&' C&-'$/@%',$' +(C&+%$' ,$' "(,(9' *&)#(%./$),&' (".(8*-$/%()#(' &"' +(*6+"&"' D6%$)&"' ,&' 12383!430' 3(%.+(' C&-' 6%$' .+(&*6.$>B&' "6$'A$+$)#-+' E&$"' *&),->?("' ,(' #+$E$/D&' :"'.(""&$"<

"

""

"

"

Page 10: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

=6('&6#+$"'%6,$)>$"'&'12383!43' .&,(' -%./(%()#$+' .$+$' *&)"(A6-+'"6E"-,-$+' *$,$' 7(F'%$-"' &"' A("#&+("' (' $"'"(*+(#$+-$"'%6)-*-.$-"',('"$G,(<

"

"

46-#&"'A("#&+("'#;%',-#&'56('$'$#6$/'A("#B&'-%.+-%-6'6%$'.+("()>$'%6-8#&'C&+#('H6)#&'$&"'%6)-*I.-&"')&"'.+-)*-.$-"'(".$>&"',(',-"*6""B&'(',(*-"B&',$'.&/I#-*$',('"$G,(0'J&*;'"('*&)"-,(+$'6%'%6)-*-.$8/-"#$')$#&'('$#(%.&+$/<

"

"

""

Page 11: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

3$E(%&"' 56(' "6$' +(/$>B&' *&%' &'"(*+(#K+-&'("#$,6$/',('"$G,(9'L+0'M&B&'$)$)-$"9'@'%6-#&'.&"-#-7$0'!'$' +(/$>B&',&'*&""(%"'*&%'&'("#$,&9'+(),(6'E&)"'C+6#&"',6+$)#('(""("',&-"'$)&"<'

"

"

"

!'$')I7(/' C(,(+$/9'D&67('6%$'E&$'.$+#-*-.$>B&',&'1233!43')$'#+-.$+#-#(<

"

""

"

!!"#$'(,->B&',$'+(7-"#$'"6"#()#$>B&'

C$F'6%'E$/$)>&',$"'*&)56-"#$"'&E#-,$"',6+$)#('(""("' ,&-"' $)&"9' #$-"' *&%&'$,("B&'$&'N$*#&' ('*+-#@+-&"',('$/&*$>B&',('+(*6+"&"9'()#+('&6#+$"'*&-"$"0'O&"#$+-$',('*&%()#$+'$/A6%',(""("'%&8%()#&"<

"

"

Page 12: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

!P-"#('6%'$*&)#(*-%()#&'56('*&)A+(A$'#&,&'&'.&#()*-$/'.&/I#-*&9'("#+$8#@A-*&' (' .$+#-*-.$#-7&' ,&'1233!439' 56('@'&' "(6'*&)A+(""&'("#$,6$/0'1&%&' C&-' +(8$/-F$+',&-"'*&)A+(""&"')&'-)#(+-&+'('56$-"'$"'(P.(*#$#-7$"'.$+$'&'QR'1&)A+(""&'!"#$8,6$/',$"'3(*+(#$+-$"'('3(*+(#K+-&"'46)-*-8.$-"',('3$G,(<

"

""

"

N&+' 56(' &' 1233!43' @' #B&'C6),$%()#$/'.$+$'&'3S3<

"

"

"

'T6%$'$)K/-"(' .(""&$/9' &' 56('

.+("-,;)*-$')&'1233!43<""

""

"

Page 13: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

[4S*;+/0/0!"!043/;?*3*<0;/0K*4<\]Conselho das Secretarias e

Secretários Municipais de Saúde-Ceará-

20COSSEMS

Page 14: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

^/<0RO*0_/<M4<0G*1?/<*1`

Page 15: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

&0N,1?@<,40+40*;?,+4+*0RO*0_4S0/0!"!043/;?*3*<0;/0*1?4+/0+/0K*4<\

Conselho das Secretarias eSecretários Municipais de Saúde

-Ceará-

20COSSEMS

C>*6-"%"%8"6#.'@"%;#A*->*'%-.%:.)+.A=+("#%<>6()(,*(#%-.%:*0-.%g%89R;:;<:%D"(%)+(*

C>.%,+.)(#*7*% (5,'.5.6A*+%*#% (6#Ah6)(*#%C>.%-*+(*5%#>,"+A.%*"%:4:W%9%8"6#.'@"%R*)("6*'%-*#%:.)+.A*+(*#%<>6()(,*(#%-.%:*0-.%g%89R/:;<:%.%"%8"6#.'@"%R*)("6*'%-"#%

+(*5%"#%H.#A"+.#%-"%:(#A.5*%6"#%5>6()T,("#W

Page 16: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará
Page 17: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

"

"

"

"

"

"

"

"

"

"

"

"

"

"

"

"

"

"

"

""

"

"

"

""

"

""

"

)

Page 18: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

"

"

"

"

""

"

"

"

""

""

"

Page 19: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

' U'*&%'A+$),('&+A6/D&'56('$""6%-%&"'$',-+(#&+-$',&'1233!430'VK'.&6*&'@+$%&"'$.()$"'1&)"(/D&',('3(*+(#K+-&"'46)-*-.$-"',('3$G,(0'T$' G/#-%$' $""(%E/@-$' ,$' ()#-,$,(9' "6$' ,()&%-)$>B&' C&-' $/#(+$,$' .$+$'1&)"(/D&',$"'3(*+(#$+-$"'('3(*+(#K+-&"'46)-*-.$-"',('3$G,(0'1&%'*(+#(F$9'

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̂ '+(".&"#$'@'"-%./("_$'*&)"#+6>B&',&'3-"#(%$'`)-*&',('3$G,(9')&'[+$"-/'('(".(*-$/%()#(')&'1($+K'0' T&""$'()#-,$,('C&-'*+-$,$'(%'XYZY0'T("#("'XZ'$)&"'#(%&"'%(8/D&+$,&',&'.&)#&',('7-"#$'&+A$)-F$*-&)$/'('*+("*-,&')$'*$.$*-,$,(',('%&8E-/-F$>B&0'^',-+(#&+-$'56('()*(++$'"(6'%$),$#&'*6%.+-6'*&%'A$/D$+,-$'(',(#(+%-)$>B&'"6$'%-""B&0'^'(/$9')$'.(""&$',('"(6'.+("-,()#('4K+-&'aG*-&'W$%$/D&'4$+#-/,("9'&')&""&'+(*&)D(*-%()#&'('A+$#-,B&0' ^""6%-%&"' )&""&' %$),$#&' "&E' $' @A-,(' ,$' (".(+$)>$0' T&7&"'#(%.&"9'(%')I7(/'("#$,6$/9'("#B&'$')&""$'C+()#(0'2'A&7(+)$,&+'1-,'O&%("'('"(6'"(*+(#K+-&',('"$G,(9'M&B&'^)$)-$"',('J$"*&)*(/&"9'C&+$%'.+(C(-#&"'

,$"')(*(""-,$,("',&"'%6)-*I.-&"0'J$%&"'.+(*-"$+',(""$'*&%.+(()"B&9'$"8"-%'*&%&'(/("9'*(+#$%()#(9'*&)#$+B&'*&%'&')&""&'$.&-&'(')&""$'.$+#-*-.$8>B&')$'-%./(%()#$>B&',('.&/I#-*$"',('"$G,('(%')&""&'("#$,&0'3&%&"'6%'

"$G,(',(')&""$'.&.6/$>B&0'1&)7-7(%&"'$-),$'*&%'-),-*$,&+("'-)*&%.$#I8

)b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b/&"9',$'-%./$)#$8>B&',&"'1()#+&"',('!".(*-$/-,$,("'2,&)#&/bA-*$"'(',&',()#-"#$',$'C$%I/-$'.$+$'%6)-*I.-&"'%()&"'C$7&+(*-,&"',('+(*6+"&"0'̂ '#+$)"C(+;)*-$',("#("'+(8*6+"&"',(7('"6"#()#$+'6%$'*$+#(-+$',('"(+7->&"'%$)#-,$'*&%'+(.$""('C6),&'$'C6),&9'&E(,(*(),&'*+-#@+-&"'#+$)".$+()#("9',-"*6#-,&"',('C&+%$'E-.$+#-#('('"(%'-)#(+C(+;)*-$',&'*/-()#(/-"%&0' =6$)#&' $&"' %(,-*$%()#&"' .$+$' $#()>B&' EK"-*$9' $.&-$%&"' $'*&%.+$'*()#+$/-F$,$'.(/&'TG*/(&',('^""-"#;)*-$'c$+%$*;6#-*$'d'TS^3c',$'3(*+(#$+-$',$'3$G,(',&'!"#$,&',&'1($+K'd'3!3^9'.+&*(""&'56('#(%'"('

,&"'%6)-*I.-&"0' ^.("$+',&"'$7$)>&"9'$/A6)"'.+&E/(%$"'"B&'$)#-A&"'('.+(*-"$%'"(+'()C+()#$,&"9'()#+('(/("'$'56("#B&',$'+(C(+;)*-$'$%E6/$#&+-$/0'1&"#6%&',-F(+'56('&'6"6K+-&'#(%'%$-"'C$*-/-,$,(',('$*(""&'$'6%$'-)#(+)$>B&'(%'SeQ9'56$),&'$*&%(#-,&'.&+'6%'-)C$+#&',&'%-&*K+,-&9',&'56('$'6%$'*&)8"6/#$'*&%'6%'*$+,-&/&A-"#$0'e(%'%$-"'$*(""&'$'D(%&,-K/-"(',&'56('$'6%$'

*&)"6/#$' *&%'6%')(C+&/&A-"#$0'!"#$' "-#6$>B&')B&'.&,(' *&)#-)6$+0'!/$' @'.+&,6#&',$'E$-P$'+(%6)(+$>B&'.(/&'3S3'$'("#("'"(+7->&"'(".(*-$/-F$,&"9'+("56I*-&"',$'7-"B&')(&/-E(+$/'.$+$'$'"$G,(9'&),('"('A$+$)#('6%$'*("#$'

8F$,$'.$+$' -)-*-$#-7$'.+-7$,$0'N$+$'"&/6*-&)$+'&'.+&E/(%$9' "6A(+-%&"'&'-)*()#-7&':'*+-$>B&',('6%$'+(,(',('.&/-*/I)-*$"9'*()#+&"',('(".(*-$/-,$,("'

' 2"'-)7("#-%()#&"',-+(#&"',&'!"#$,&')$"'*-,$,("',&'-)#(+-&+'"B&'$*$)D$,&"' (%' +(/$>B&' :56(/("' 56(' D-"#&+-*$%()#(' C&+$%' +($/-F$,&"' )$'*$.-#$/0'^'*&)"#+6>B&',(',&-"'A+$),("'D&".-#$-"'.GE/-*&"')$"'%$*+&++(8A-?("',&'T&+#('(',&'1$+-+-9'*&)#(%./$),&')&'.+&A+$%$',&')&7&'A&7(+)&'("#$,6$/9'*&)#$'*&%')&""&'$.&-&'-)#(A+$/0

3$G,(',$'c$%I/-$9'E$"('("#+6#6+$)#(',(')&""&'"-"#(%$',('"$G,(0'TB&'.&8,(%&"'%$-"'*&)7-7(+'*&%'$'.+(*$+-F$>B&',('S)-,$,("'[K"-*$"',('3$G,(0'[6"*$+(%&"'.$+*(+-$"'.$+$'A$+$)#-+'6%$'+(,('$""-"#()*-$/',-A)$'.$+$'&"')&""&"'#+$E$/D$,&+("'('.+-)*-.$/%()#('.$+$')&""&"'6"6K+-&"0

8>$,&"'.(/&'"-"#(%$'/&*$-"',('"$G,(0'!%')&""&'%$),$#&9')&"'&+-()#$%&"'

' ^'*&)"&/-,$>B&',('6%'"-"#(%$'C&+%$,&+',('(,6*$>B&'*&)#-)6$8,$'.$+$'&'"-"#(%$'.GE/-*&',('"$G,('@'C6),$%()#$/'.$+$'"(6'"6*(""&0'e(%&"'$""-%',(')&"'(%.()D$+%&"')$'*&)"&/-,$>B&',&"'Nb/&"',('1$.$*-#$>B&',&'!"#$,&'*&%'&'.$-&',$"'6)-7(+"-,$,("'.GE/-*$"_Sc19'S!1!9SJ^'SW1^9'$/@%',$'!"*&/$',('3$G,('NGE/-*$',&'1($+K'(',$'!"*&/$',('3$G,('NGE/-*$',('QA6$#60' 1&%&'%(%E+&',&'TG*/(&',('!"#6,&"'(%'3$G,('1&/(#-7$'fT!31g',$'S)-7(+"-,$,('c(,(+$/',&'1($+K9'()#-,$,('56('DK'%$-"',('hi'$)&"'C&+8%$' +(*6+"&"' D6%$)&"' .$+$'&' 3S39'%(' "-)#&' *&%.+&%(#-,&'$' *&)"#-#6-+'.$+*(+-$'*&%'("#$'("#+6#6+$'C&+%$,&+$0' =6(+-,&"'*&%.$)D(-+&"9'"(*+(#K+-&"'('"(*+(#K+-$"9'*&%.$+#-/D&'

(',(*(.>?("',(')&""$'/$E6#$9',("()D$%&"'6%'.$.(/'D-"#b+-*&')$'%(/D&+-$',$"'*&),->?("',('7-,$'(')$'*&)"#+6>B&',$'*-,$,$)-$',&'.&7&'E+$"-/(-+&0' 2E+-A$,&j

'M&"@'N&/-*$+.&',('^+$GH&'[$+E&"$h',('C(7(+(-+&',('hiik

Page 20: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

""

"

"

"

"

"

"

"

Page 21: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

""

*+!(&!&%&,-+.!($.!/$0.!(0%&'.$.!&,-0($(&.!(+!

"""

"

""

Page 22: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

"

"

""

"

""

"

Page 23: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

704;/10+*0G*1?./OM0;/:/0K)!!$L!024<40/0K*4<\0*0OM0;/:/0!"!024<40/103*4<*;1*1

Page 24: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

"

"""

"

""

"

"

($.!,+%0($(&.1!(+.!$%$,*+.!,+!2'32'0+!.0.-&/$!(&!"

"

Page 25: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

!

Page 26: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

K/;RO,1?41<*1O5?4;?*10+*1?*10

+,\5/G/1"

"

"

"

""

"

"

"

""

"

Page 27: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

"""

"

"

"

"

"""

"

"

"

"

"

"

"

""

"

Page 28: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

"""

"""

"

"

"

""

"

"""

""

"

"

"

"

"

"

"

"

"

"

""

"

"

"

""

"

""

"

"

"

Page 29: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

"

"

"

"

"

"

"

"

"

"

"

"

"

"

"

"

"

"

"

"

"

"

Page 30: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará
Page 31: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

!"#$%&%!'(')*+,%"'-.,/'0%(1%#)*'2101-.31/*,)%(1%$'4(1

! "! #$%$&'()! *$+,)-$.! %)&! /&'$012.2+,32-')&! %2! 4$5%2! 6),! ,-&','78%)! 92.$!:)('$(,$!;4<4=4!>?@A!%2!>!%2!)7'71()!%2!

%)! %,$! 9)&'2(,)(B!=9C&! $+)(%)! -$! #)3,&0

92(3$-2+27! 23! +)-&7.'$! 951.,+$! $'D! %20

0($.A!2%,')70&2!23!EF!%2!%2G231()!%2!EHHH!$!:)('$(,$!IJJ<4=4A!K72!9$&&$!$!-)(3$',G$(!)!9()+2&&)!%2!+$%$&'($32-')!23!')%)!'2((,0'C(,)!-$+,)-$.B!L2!$+)(%)!+)3!)!;,-,&'D(,)!%$!4$5%2A!M"!4,&'23$!(29(2&2-'$!73!%2&2N)!OP!37,')! $&9,($%)! 9)(! ')%)&! K72! 7',.,G$3!

0

)&! %$%)&! +$%$&'($,&! &2! +)-&','723!73!%)&!

0&,&'Q-+,$!O)&9,'$.$(!2!$317.$')(,$.!-)!9$8&A!

2-'(2!$!+$9$+,%$%2!)92($+,)-$.!%$&!2-',%$0

0

0

0

%2!='2-%,32-')B

0(,$.!+(7G$3!)&!%$%)&!+)3!)!#*/4B!"!$&&2&0

0

0

)!;,-,&'D(,)! $,-%$! 2&'P! $%2K7$-%)! $)!K72!

37-,+89,)! '2(P!K72! '2(!+7,%$%)!+)3!$!+$(0

00

! L,$-'2!%$!-2+2&&,%$%2!%2!2&+.$(20+2(! )&!37-,+89,)&! &)1(2! $! ,39)('R-+,$! %)!#$%$&'()A!)!#"44/;4A!23!9$(+2(,$!+)3!$!

0

00

00

Page 32: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

!"#$%&'"()*&+,%-."/&(

!"#$%!&%'!#'$%()*+,#'-*.'/+*0%..*.'-%'0*!&+*(%1'+%2

$*!,&*+#'*'.,.&%$#'-%'.#3-%4'5#+#',..*1'*'6,!,.&7+,*'

/+%0,.#'.%+'8*+&#(%0,-*'-%!&+*'-%'.%"'&%++,&9+,*1'-*':"%'

' ;*'-,#'<='-%'>"!)*'-%'<??@'*'6,!,.&7+,*'-#'

!,.&7+,*'-#'A#3-%1'$#.'"$'.,.&%$#'/+9/+,*1':"%'7'*'

$#'/#+#':"%'&*-*.'*.'$"!,0B/,*.'/"-%..%$',$/(#!&#+'

#' %:",/%' &70!,0#' -*' CDAAE6A' .%' $*F,(,G*"' /#+#'

Page 33: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

!

!"#$%&#$#%'()"*+)#$%,+-+%+%)+..+%.*.,/0#%-/%

!

12+-/0+.%'#3#$%-/%,$4.%&$*)"*&#*.%*0&#",+.%

!

!

"+0%-#,#%0#$"#-#5%6%+% ,/$"/*$+%&+),+% '+*%

!

(0% #)+% -/% '()"*+)#0/),+% 78% 0#$"#0+.%

!

!

!

9/$8%"$*#-#%(0#%"/),$#3%-/%3/*,+.%:+.&*,#3#!

!

"#-#.,$+%"+)"3(;-+%-/%<=>%0*3%&/..+#.%?(/%

!?(*.#@%-/%&#"*/),/.%-/%+(,$+.%0()*";&*+.5% A+.% &/?(/)+.% 0()*";&*+.@% #%

0()*";&*+.%,*):#0%(0@%-+*.%"+0&(,#-+!$/.%&#$#%#%9/"$/,#$*#%*),/*$#@%+)-/%'#B*#0%

!

!

&#$#%+%&$*0/*$+%./0/.,$/%-/%C>>D5

!"#$%&'()*+*'(,'(-#.$/01$,'(%$.2&-(#-3(4,$'(/,-1#%&4,5*'(1&5&(&(6*/5*7%&5$&($.%*$5&3(,.4*(8&+$&-(%#4,9(:,-(&(/2*;&4&(4,'(5*/#5','(*(&(4$)$'<,3(/&4&(-#.$/01$,(5*/*=*#(,('*#(>$%(*(?@(%*-(#-&(*'%5#%#5&(=@'$/&(*A/B#'$)&(1&5&(*A*/#%&5('*#(:,-1B*A,(C*;#B&4,5D(

E"F.$/&(6,#'&G

Page 34: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

!"#$%

!

"#$%&'()*+,"-(),"$")./*)(+)0/&%12,%(+)*&1"0%!

!

!!

!

!3%4"'")5)6"7'*)&()*+8"'()'()9*"$:);3*++"&'$")

!!

8%&<"0) 1(0() '"$) /0) +/,($8*)0"%($) 1(0) $*3"!

1(0()*'/1"'($*+)=2+%1(+>)&/8$%1%(&%+8"+>)="$0"!

!

!

0"&*%$")8*0)/0)%0,"18()0"%($>)*0)8*$0(+)'*)

!

!8%")*)"1/,/&8/$"),"$")")0*3<($%")'")./"3%'"'*)

!!

?($8"$%") ./*) &($0"8%4") +*/) =/&1%(&"0*&8(>) ()

&'(&)(##*+#&,-&)./01&2-3&43-,.30-&,-&%.,536-&6.&%.&40.-784/0&.9&40.4/0/0&-%&98,37:43-%&4/0/&;8.&.%5.%&.</=-0/%%.9&-%&40->.5-%&6.&394</,5/?@-&6-&!"#$A&-&;8.&2.B&7-9&;8.&-&.%5/6-&6-&)./01&2-%%.&89&6-%&;8.A&40-4-073-,/<9.,5.A&9/3%&.,CD3-8&40->.5-%&4/0/&-&+3,3%5E03-&6/&#/F6.G

H"<.%%/,60/&I39.,5.<J

Page 35: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

!"#$%&'()"&*"+,(&#%-./.$(&-"&'%../0/)/,",(&1

11

1

1$2"-$(&,(&3%4(/3%.&,(&52"6(/3%&,%&7%3$(&(&,(&8"-/-,9:&;2(&2$/)/6"4&$(4'%3"3/"4(-$(&

,(&3(#23.%.&<24"-%.&'"3"&%.&./.$(4".&)%1#"/.& ,(& ."+,(&,(&42-/#='/%.& ,/.$"-$(.& ,(&

1

1

1$93/%&,"&*"+,(&/-.$/$2/2:&(4&>?&,(&@"-(/3%&

;2(& "'3(.(-$"..(4& -(#(../,",(.& )%#"/.&,($(34/-"-$(.A

1#/"4(-$%&(&"&$3"-.B(3C-#/"&,%.&3(#23.%.&B(1

,%/.& #%4'%-(-$(.D& #%4'%-(-$(& !/.%& ,"&1

111

(-$3(&%2$3".&#%/.".A&E.&3(#23.%.&,(.$/-",%.&1

%&"-%&,(&>FFG:&"&$3"-.B(3C-#/"&,%.&/-#(-$/1

11

B2-,"4(-$")&/4'%3$H-#/"&'"3"&,($(34/-"3&(&(-#"4/-<"3&"%&I/-/.$93/%&,"&*"+,(&".&3("/.&-(#(../,",(.&,(&#","&42-/#='/%A&JK&,/.#2.1

11

1

Page 36: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

!"#$%&'(")*+,-+.%/0#1-'(02(20#+,#+3(-%45*+67'")#+%*+8'(#,*+,*+9-#07

!!

"#$%"&'()"#'"'*+,+--$.".+'*/'+-0"./'./'1+!

!

!

.+2"*."' +-0&)0)&"."3' &+"#$%"."' ,/2'4"-+3'5"&"'+*,"2$*6"&'7-'5+--/"-'()+'082'5/.+&'

!

!*9&$/' +*,"2$*6"./' "/-'2)*$,:5$/-'5"&"' "'

' ;' ()+-0$/*9&$/' </$' +#"4/&"./' .+'!

!

!

&+</&2"&' /)' "25#$"&3' 2"-' ,/*-0&)$&' )2"'!

!-9&$"-'5"&"',/4&$&'/'2)*$,:5$/='>?2+&/'.+'+()$5+-'$25#"*0"."-'+',"."-0&"."-3'0"*0/'.+'

!./-'/-'2)*$,:5$/-3',/2'0/."-'"-'/&$+*0"!

!

./-'2)*$,:5$/-='@' 5"&0$&' .+--"-' $*</&2"!!!

0+&&$0A&$/-'+'()"#'"'*+,+--$.".+'.+'"25#$"!

B"&"'/'5&+-$.+*0+'./'1;CCDEC'B/#$,"&5/'

+' F)2'5/.+&/-/' $*-0&)2+*0/' .+' 0&"*-</&!

!

-$-0+2"'#/,"#'.+'-"?.+3'.+',"."'2)*$,:5$/'

)2"'#)0"'5"&"'0/./-'/-'.$"-'+'2)$0"-'/)0&"-'

./,)2+*0"./-',/2/'5"&0+'.+')2"'6$-0A&$"'!

Page 37: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

!"#"$#%&'%()#

!"#$%&$'"()#$%$*&+,-.+"/0%$!%'$'"&'$,-./*1,.%'$23'.*%'$*%/'0.0&*.%/).'4

5)'$%$6&"$-")7+"/0"$"'03$8)70)/!%$,)-)$0"-+%'$%$)0"/!.+"/0%$6&"$6&"-"9

/)/*.)+"/0%$:$0-.,)-0.0"$"$%'$+&/.*1,.%'$"+$'&)$+).%-.)$*&+,-"+$%$6&"$

;&+)/%$2-)'.7".-%4

!"#$%&'%()*+,"(),#)-&./#)!&.0(-+%"+12"&(),#)-#3,+),+)4"56

7&"+1(")!&$#$%+&"(),()48--9:-;49-+%"+12"&(),#)-#3,+),+)4"56

7&"+1(")!&$#$%+&"(),()48--9:-;49

Page 38: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

!"#$%&'('()*)("+'%,$+$-(%'(.$"-/0Conselho das Secretarias e

Secretários Municipais de Saúde-Ceará-

20COSSEMS

Page 39: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

!"#"$%&"'(#"'"()*'%'(!+,+(+(!-../0.("&1+1(#*2"(31"2%4%$"56+(7+8()*8&+'*8(7+(.9.

!"#$%#&$'()#&$%)$"#*+($#,-#./+$%#$#,-#0$%*(),+(*#$%+$1233453$ 6+*$ #$ 7#8#7*,#./+$%)$9)&,+:()&$)$,;7<*7+&=$4"$7+<7+"*,><7*#$7+"$+&$*<?)&,*")<,+&$()#0*@#%+&$8)0+$5*<*&,;(*+$%#$3#A%)$)"$*<6(#:)&,(-,-(#B$)"$()7-(&+&$C-"#<+&$+-$)"$#0,)(#.D)&$<#&$<+("#,*@#.D)&$%+$3!3B$+$1233453$

"#&B$)$#09-"#&$?)@)&$,(#@*%+&$%)$+-,(+&$)&,#%+&$+-$%+$8(E8(*+$5*<*&,;(*+$%#$3#A%)=$F1#8#7*,#($+&$"-<*7G8*+&$8#(#$H-)$)0)&$8+&&#"$()&8+<%)($I&$%)"#<%#&$<#7*+<#*&B$&)J#$<#$+K,)<./+$%)$*<?)&:

*<?)&,*")<,+$%#$#,-#0$9)&,/+$%+$1233453LB$%*@$+$8()&*%)<,)$%#$)<,*%#%)B$M+0*7#(8+$N(#AJ+=$N$

Page 40: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

!"#$%&'$(#%$&)#*(+,(-%)#*.'-%/+0-1+%+,(-*$#*%-23(+4+%&'$(#%5#,6'2+%788898%:#;-%<%'&+%/+0-1+%0-&%5#&)1-=+>%0-&%?-(+1@+?+%-%+('+1$A+?+%#,%1$,-B8%

7C$5+,#*%D'*E-19

C#4+%/+0-1+%?-%F*#5-?$&-,(#2%?#%GHG

!!

"# $%&'()# *#+,-,./01,*# '%# $%&'(# 2345,6*3#

!6%'%7# 8# '*639(-/*# :*,# 6*-./13;'*# %2<.#

!1,%.#=1(%.#/06-,6%.#'*#+$)#(-/1(#(5%.#$>$)#

!

!

!

!2,/%5%1#(#%9435%/*1,%5)# ,-./,/3,#%/1,43/*.#'(#,-61(9(-/*.#2%1%#21*6(',9(-/*.#'(#2%1/*#(#

!

!

'*.#'*,.#.,./(9%.)#6*9#%#93'%-?%#'*#6*-!6(,/*#'(#6*41%-?%)#'(#21*6(',9(-/*.)#6*9#

!1(-/%#2(..*%.)#'31%-/(#/*'*#*#',%7#>21(.(-!/%9*.# *#$,./(9%)# (-.,-%9*.# 6*9*#*2(1%!

@3(# /(1# 39%#A*1/%1,%)# (# :*1%9# /%-/*.# 21*!

Page 41: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

!"#$%&'('#)%*+(&,-&.,(/(/0&1+(&-23)#/.4%$-15-0&$%/&-/'-63.%)$-15-0&5-$(/&7#-&,%8&#$%&%5-1*+(&'%8%&(&

3#.,%,(0&7#%1,(&9(8&.$'(//:4-)&3#8%8;&<(/'.5%)&1+(&=&)#>%8&'%8%&3#.,%80&7#-$&3#.,%&=&%&9%$:).%?

@A%83(/&B#-.8(CD

E//./5F13.%&G($.3.).%8

!

!

!

!

!

!

!

!

!!!

!

!!!

Page 42: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

!"#$%#&'$%()

*"+,-.+.-+,-./"+0+,-.+1"2()+()+3.))"()+)($(4+2(,-$+5"6.+)(7.'2"+%"4"+8./.'%$(/+-4(+!"#$%#&'$%(+'"+).-+4-'$%&3$"+"-+.4+,-(#,-./+"-1/"9+

:;/'(#2"+<")1(+=$4(>

Page 43: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

!"#$#%"$&'#()*+$,*-./',*'*0'12".),*+'*0$3+'

!

!!

!

!

!

Page 44: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

!"#$%#%$&'()*+)"*,%-+)"*.%-/0/1&/"*+2*3&4+2

!!

!

!!

!

!

!

!

!!!

!

!

!

!

56*7&/)$/&*+)"*,%-+)"*+2*3&4+2*-()*8*92$/+&*12:)"*"20$2#;$/)"*+2*"&4+2<*2:2"*-()*#=7*&%#)-)7/&*1:2-&<*#=7*>%2*&""/-&$*0?2>%2"*@%-#)*0)7*)"*"20$2#;$/)"*+&*A&B2-+&<*7%/#&"*C2B2"*0)7*)*1$2A2/#)<*2*/"")*+27)$&<*#)$-&*)*1$)02"")*1)%0)*#$&-"1&$2-#2*2*&*1$/)$/*-()*+;*&*

&%#)-)7/&*:29&:*>%2*)*"20$2#;$/)*#27DEFG2-/*H)I$2J

Page 45: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

!"#$%&'%$()"!

"

""

""

"

"

"

"""

""

"

Page 46: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

!"#$%&'$()*+),(-%*

!

!

!!

!!

!

!

!

!

.('()/*')(0*11&)(&)1*'#$2&)%*)&"#$%&'$(3).&'4"*).'(/$0(5+*6/*)/&%(1)*1/7&)0&60*6/'(%(1)6()0(.$/(8)*)&)*19&'2&)%()!"#$%&'$():*'(8)%(),;,<)*)%&)=!,,;>,)/*+)1$%&)6&)1*6/$%&)%*)4"*)*8(1)1*?(+)$+.8(6/(%(1)6&1)+"6$0@.$&13)

A<6()B("8():$'7&C

Page 47: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

!"#$%

Page 48: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

!"#$%&%'"()*+

,-.%/01"/*2'*#%34&%"/5*/6%5"7/'.#80*/./.9:*$%6./5./&0#+./;/<.#1"#/=*+$.#*+/'"#"/$#"9">?"#/4./@A@B/CD./+*/$#"$.0/"'*4"+/5*/<.#1"#/+*&#*$E#%.+7/1"+/

>?"45./4"/E#*"/5"/+"F5*/'F9>%&"BBBGHI>9*#$./J">$"/K#L

Page 49: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará
Page 50: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

!"#$%&'('()*)("+'%,$+$-(%'(.$"-/0Conselho das Secretarias e

Secretários Municipais de Saúde-Ceará-

20COSSEMS

Page 51: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

!"#$"%&'()*+(,-"-!",.$'(&*+(,-.#-!"/(&"#-#./'"-0"#&1.

2.%0'"##.#-!.2344564725

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

Page 52: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

!"#$$%&'%(&)%*+,-,&-#&,.%"-%&.%)&,$&/"%0

!""#$%&'()**%+#$,(-(-#().)/)#0%1%#%#)*0,1%

Page 53: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

!

!

!

!

!!!

!

Page 54: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

! !"#$#%&'()*"+,-#.'()/')011)2'/3"+(('

456789

!8:;

<:81=68

Page 55: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

!"#$"%&'%("#)"*+"

!"#$%&'%()'*+"#,-.*&*/0*"#1%#$021%#1+#3"(01+#1+#4%0')#'%-.*1+"#%5#6""%5789*0#1+#4!$:

$3,$#.+#1*0#;<#1%#50*+#1%#;==>#.+#?+(%8#40810"@#%5#A0'708B0@#.-50#0(*C*101%#*.(%D'0.(%#

1+#EFF#4+.D'%""+#1%#$%&'%(0'*0"#%#$%&'%()'*+"#,-.*&*/0*"#1%#$021%#1+#3"(01+#1+#4%0')#

0/'+C0'05#0"#"%D-*.(%"#1*'%('*G%"#/0'0#0#&+.1-HI+#1+#$J$#%5#.+""+#%"(01+#.+"#/'KL*5+"#

M;#5%"%"N

MO35#'%80HI+#0+#P0&(+#/%80#$021%N

O#$-7"*1*0'#+"#5-.*&Q/*+"#R-%#0*.10#.I+#01%'*'05#0+#P0&(+#/0'0#R-%#+"#5%"5+"#&+.&8-05#"%-#

/'+&%""+@#0(*.D*.1+#M==S#1%#01%"I+#.+#%"(01+T

O#P'+5+C%'#%C%.(+"#(9&.*&+"#/0'0#+'*%.(0'#+#/80.%U05%.(+#10"#0HV%"#%#0/8*&0HI+#1%#'%&-'"+"@#

W'%.(%#X#.+C0#'%08*101%#0/'%"%.(010#.+#P0&(+T

O#Y+'(08%&%'#%"('0(9D*0"#1%#*5/80.(0HI+#1%#.+C+"#"%'C*H+"#R-%#C%.B05#/'%%.&B%'#0#80&-.0#1%#

.%&%""*101%"#*5/+"(0"#/%80"#5%(0"#%#'%"/+."07*8*101%"#01C*.10"#1%"(%#&%.)'*+T

O#Z%"%.C+8C%'#-50#/+8Q(*&0#1%#0'(*&-80HI+#*.(%'*."(*(-&*+.08@#7-"&0.1+#/0'&%'*0"#.+"#1*C%'"+"#

"%D5%.(+"#"+&*0*"#&+5+#W+'50#1%#D0'0.(*'#0#%W%(*C0HI+#1+"#P0&(+"#1%#[%"(I+@#/%80#E*10#%#%5#

Z%W%"0#1+#$J$O

;O#35#'%80HI+#0+#Y*.0.&*05%.(+N

O#Z%"%.C+8C%'#-5#/'+&%""+#1%#0'(*&-80HI+#/+8Q(*&0#/0'0#0#'%D-805%.(0HI+#-'D%.(%#10#P34#.\#;]T

:

O#^-(0'#/0'0#%W%(*C0HI+#1+#'%/0""%#W-.1+#0#W-.1+#1+"#'%&-'"+"#%"(01-0*"#/0'0#+"#Y-.1+"#

,-.*&*/0*"#1%#$021%T

E*D*8_.&*0#%5#$021%T

O#F.&%.(*C0'#%"('0(9D*0"#1%#W+'(08%&*5%.(+#1+"#Y-.1+"#,-.*&*/0*"#1%#$021%#.0#7-"&0#1%#50*+'#

O#P'+5+C%'#-50#0'(*&-80HI+#/+8Q(*&0#/%'50.%.(%#U-.(+#0+#D+C%'.+#%"(01-08@#,*.*"(9'*+#10#

3"(01+#1+#4%0')O

`O#35#'%80HI+#0+"#a%&-'"+"#?-50.+"N

O#P'+5+C%'#/+8Q(*&0#1%#W+'50HI+#%#0/%'W%*H+05%.(+#1+"#D%"(+'%"#1+#$J$#.+#.+""+#%"(01+T

O#A-"&0'#/0'&%'*0"#&+5#*."(*(-*HV%"#1%#%."*.+#/0'0#%1-&0HI+#/%'50.%.(%#1%#0&+'1+#&+5#0"#

1*'%('*G%"#1+#$J$#%#.%&%""*101%"#1+#$*"(%50#^+&08#1%#$021%T

O#6/+*0'#*.*&*0(*C0"#1%#1%"/'%&0'*G0HI+#10"#'%80HV%"#1%#('0708B+@#W+'(08%&%.1+#+"#CQ.&-8+"#

O#P'+/+'#0#&'*0HI+#1%#-5#$*"(%50#3"(01-08#1%#$021%#3"&+80#&+5#0#/0'(*&*/0HI+#%W%(*C0#1+"#

5-.*&Q/*+"T

O#4+."('-*'#-5#1*0D.K"(*&+#10"#.%&%""*101%"#'%0*"#1%#a%&-'"+"#?-50.+"#%5#"021%#.+#4%0')T

O#Y+'(08%&%'#+#1%"%.C+8C*5%.(+#10#P+8Q(*&0#1%#?-50.*G0HI+@#0('0C9"#1+"#/'+&%""+"#1%#

bO#35#'%80HI+#X#6(%.HI+#A)"*&0N

6(%.HI+#A)"*&0#W+'(08%&%.1+#+"#5-.*&Q/*+"#/0'0#+#&-5/'*5%.(+#1+"#'%R-*"*(+"#10#P+'(0'*0#

,*.*"(%'*08#.\#cbde;==c@#R-%#'%D-805%.(0#0#6(%.HI+#A)"*&0T

W%1%'0*"#%#0#&'*0HI+#1+#P6A#%"(01-08T

O#4++'1%.0'#+#/'+&%""+#1%#0'(*&-80HI+#/+8Q(*&0#.+#"%.(*1+#1%#1%"0('%80'#+#'%/0""%#*.&%.(*C+#

1+"#'%&-'"+"#10"#%R-*/%"#1%#$021%#A-&08#0+#W-.&*+.05%.(+#*.(%D'08#10"#%R-*/%"#1%#3R-*/%"#

1%#$021%#Y05Q8*0T

O#4+.('*7-*'#/0'0#+#1%"%.C+8C*5%.(+#1%#/+8Q(*&0"#R-%#*.&+'/+'%5#%#D0'0.(05#0#"021%#

1+#('0708B01+'T

6(%.HI+#A)"*&0O

<O#35#'%80HI+#X#,91*0#%#68(0#4+5/8%L*101%N

#O#6/+*0'#0#/+8Q(*&0#%"(01-08#1%#&+."('-HI+#1%#1+*"#B+"/*(0*"#(%'&*)'*+"#.+#*.(%'*+'#1+#

%"(01+@#8+&08*G01+"#.0"#50&'+''%D*V%"#1%#$+7'08#%#1+#40'*'*T

O#3"(*5-80'#0#&'*0HI+#1%#-50#/+8Q(*&0#f'*/0'(*(%#/0'0#0#D0'0.(*0#10#*.(%D'08*101%#10"#0HV%"#

+1+.(+8+D*0T

05/8*0HI+#1%#C0D0"#%#&'*0HI+#1%#.+C+"#&-'"+"#1%"(0"#.%&%""*101%"#1+#$*"(%50T

1%#0&+'1+#&+5#0#/0&(-010#('*/0'(*(%T

D0'0.(*.1+#0#0C08*0HI+#1+"#/'%"(01+'%"#1%#"%'C*H+"T

O#4+."+8*10'#%"('0(9D*0"#1%#&'*0HI+#1%#.+C+"#"%'C*H+"#0('0C9"#1%#/0'&%'*0"#*.(%'5-.*&*/0*"@#

W0&*8*(0.1+#+#0&%""+T

cO#35#'%80HI+#X"#0(*C*101%"#1%#4+.('+8%@#6C08*0HI+@#a%D-80HI+#%#6-1*(+'*0#g46a6hN

O#6'(*&-80'#+"#5-.*&Q/*+"#.+#/'+&%""+#1%#*5/80.(0HI+#1%#"%'C*H+"#1%#46a6#/0'0#+#&-5/'*:

5%.(+#10"#'%"/+."07*8*101%"#1+#P0&(+#/%80#$021%T

:

/'*5%.(+#1+"#'%R-*"*(+"#8%D0*"#%#.+#G%8+#.0#0/8*&0HI+#1+"#'%&-'"+"#/278*&+"T

O#3"(*5-80'#/+8Q(*&0"#5-.*&*/0*"#1%#&+.('+8%#%#0C08*0HI+#1+"#$*"(%50"#1%#$021%#&+5+#W+'50#

O#[0'0.(*'#0#*5/80.(0HI+#1+#"%'C*H+#1%#46a6#%5#(+1+"#+"#5-.*&Q/*+"#&%0'%."%"#&+5#+#

"-/+'(%#(9&.*&+#3"(01-08#%#Y%1%'08O

>O#35#'%80HI+#X#E*D*8_.&*0#%5#$021%N

O#[0'0.(*'#0#%W%(*C0HI+#1+#,+1%8+#1%#E*D*8_.&*0#%5#$021%#"-/%'0.1+#0#8KD*&0#1%/0'(05%.:

(08#1*""+&*010#1%#0(-0HI+#.+"#W+&+"#"0.*()'*+@#%/*1%5*+8KD*&+#%#057*%.(08T

O#3"(*5-80'#+#1%"%.C+8C*5%.(+#1%#/+8Q(*&0"#5-.*&*/0*"#1%#%1-&0HI+#/%'50.%.(%#%5#"021%#

/0'0#0#%W%(*C0HI+#1+#5+1%8+#1%#E*D*8_.&*0#%5#$021%T

dO#35#'%80HI+#0+#4+.('+8%#$+&*08N

#O#Y+'(08%&%'#/0'&%'*0"#/0'0#0#%"('-(-'0HI+#1+"#4+."%8B+"#,-.*&*/0*"#1%#$021%T

O#F.&%.(*C0'#/+8Q(*&0"#5-.*&*/0*"#1%#%1-&0HI+#/%'50.%.(%#%5#"021%#/0'0#&+."%8B%*'+"T

O#6/+*0'#0#*5/80.(0HI+#1+"#WK'-."#/%'50.%.(%"#'%D*+.0*"#1%#4+."%8B%*'+"#,-.*&*/0*"#

1%#$021%T

O#3"(*5-80'#0#*5/80.(0HI+#1+"#"%'C*H+"#1%#+-C*1+'*0#5-.*&*/08#%5#"021%O

]O#35#'%80HI+#0+"#4+."K'&*+"#,-.*&*/0*"N

O#a%&+.B%&%'#R-%#0#0(-08#8%D*"80HI+#W0C+'%&%#0#/+""*7*8*101%#1%#&'*0HI+#1%#&+."K'&*+"#%.('%#

%.(%"#W%1%'0(*C+"#.+#4%0')#%#R-%#0#5%"50#.I+#9#&+.&+''%.(%#&+5#0#8KD*&0#10#'%D*+.08*G0:

HI+#"+8*1)'*0#/'%&+.*G010#.+#P0&(+#1%#[%"(I+T

O#4++'1%.0'#+#1%70(%#%5#(+'.+#1%#&'*0HI+#1%#4+."K'&*+"@#U-.(+#0+"#5-.*&Q/*+"T

O#67'*D0'#0#/'+/+"(0#1%#$3$6#%5#%"(*5-80'#+"#&+."K'&*+"#*.(%'5-.*&*/0*"#1%#"021%#%#8-(0'#

/0'0#0#05/8*0HI+#1%#.+C+"#'%&-'"+"#/0'0#W+5%.(0'#C*07*8*G0HI+#1%""0#%"('0(9D*0O

F57-Q1+"#.+#"%.(*5%.(+#&+8%(*C+#1%#&+."('-HI+#%#0/%'W%*H+05%.(+#1+#$J$@#+"#"%&'%()'*+"#

5-.*&*/0*"#1%#"021%#%.1+""05#0"#*19*0"#%L/+"(0"#.%"(%#1+&-5%.(+#%#'%W+'H05#"-0#5+7*8*:

G0HI+#/%80#5%8B+'*0#10#R-08*101%#1%#C*10#1+#/+C+#&%0'%."%O

#################################################A0'708B0@#;>#1%#50*+#1%#;==>O

Page 56: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

!"""#$%&'()**%+#*,-.)#)#/0120(,#30&2,*#&%#$%&'()**%#4*2,.0,1!

Page 57: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

!

!!

"#"$%&'%"$(#)$'%*+&*&')&'%*$,&%-&./+$''&0!

!

!

!

Page 58: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

! !"#$#%&'()*"+,-#.'()/')0111)2'/3"+(('

456789

:87828;8<

!18;=>?

!"#$#"

Page 59: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

!"#$"%&'%()"*+,"

! "#!$%&'%()'*+#!,-.*&*/0*#!1%!$021%!1+!3#(01+!1+!

4%0')!'%-.*1+#!%5!0##%5678*09!'%##07(0.1+!:-%!%5!;<<=!#%!

+!>?.+!10!?(%.@A+!B)#*&0!.+!4%0')C9!1%7*6%'0'05!+#!

#%D-*.(%#!(E/*&+#!:-%!1%F%'A+!.+'(%0'!0#!/+7G(*&0#!1%!#021%!

%5!.+##+!3#(01+H

! I%F*#0'!+#!&'*(8'*+#!%!F07+'%#!1%#(*.01+#!0+!

&-#(%*+!%!50.-(%.@A+!10!?(%.@A+!J'*5)'*0!&+5!+!+6K%L

(*F+!1%!D0'0.(*'!0!5%7M+'*0!10!:-07*101%!%!%N/0.#A+!

10!&+6%'(-'0O

! 3N*D*'!:-%!+!J'+D'050!$021%!10!P05G7*0!#%K0!

('0.#Q+'501+!%5!/+7G(*&0!/267*&0!1%!%#(01+9!D0'0.(*.1+!

%N%&-@A+O!

! I%*(%'0'!0!.%&%##*101%!1%!'%F%'!+#!/0'R5%('+#!1%!

&+6%'(-'0!%!1%!/'+/+'&*+.07*101%!%.('%!Q05G7*0#!0##*#(*10#!

! S*#&-(*'!&+5!/'+Q-.1*101%!0!/+7G(*&0!1%!*.Q'0L%#L

('-(-'0!.0!?(%.@A+!J'*5)'*09!6-#&0.1+!0(%.1%'!+#!&'*(8'*+#!

! 3N*D*'!0!*5%1*0(0!'%D-705%.(0@A+!10!35%.10!

F*#0.1+!0##%D-'0'!0!*.(%D'07*101%T

! I%*(%'0'!0!.%&%##*101%!10!*5%1*0(0!1%#Q'0D5%.L

+#!F07+'%#!'%/0##01+#!/%7+!,*.*#(8'*+!10!$021%!'%Q%'%.(%#!

0!0@U%#!%!#%'F*@+#!1%!#021%!#+6!D%#(A+!10#!$%&'%(0'*0#!

0-(+5)(*&0!/0'0!+#!P-.1+#!,-.*&*/0*#!1%!$021%!L!$*#(%50!

V.*&+9!&+.(0!2.*&0O

! W0'0.(*'!+!'%/0##%!Q-.1+!X!Q-.1+!1+#!'%&-'#+#!

%#(01-0*#!/0'0!+!P-.1+!,-.*&*/07!1%!$021%T

-.*F%'#079!*.(%D'07!%!%:-R.*5%!8!-50!'%#/+.#06*7*101%!

! Y5/-7#*+.0'!0!Q+'50@A+!1%!'%1%#!1%!0(%.@A+!

'%D*+.07*Z010#9!&+5!/'*+'*101%!/0'0!0#!7*.M0#!1%!&-*101+!

'%70&*+.010#!0+#!0D'0F+#!50*#!/'%F07%.(%#!%!0+#!D'-/+#!

/+/-70&*+.0*#!50*#!F-7.%')F%*#9!#+6'%(-1+!X:-%7%#!D'-/+#!

%!0D'0F+#!/'%F*#(+#!.+!J0&(+!1%!$021%O

! 3706+'0'!%#('0(8D*0#!%!*.#('-5%.(+#!1%!0F07*0L

@A+!.+!&-5/'*5%.(+!1+#!'%:-*#*(+#!%!'%#/+.#06*7*101%#!

/'%F*#(+#!.+![%'5+!1%!4+5/'+5*##+!10!W%#(A+!,-.*&*/079!

1*0.(%!10!01%#A+!50&*@0!%5!.+##+!3#(01+O

&+.&%*(+#!1%!'%1%!1%!0(%.@A+!X!#021%!&+5!50*+'!+'D0.*L

&*101%!%!#%D-'0.@0!K-'G1*&0!\4Y[9!4YB9!J?4["9![3I,"!

S3!4",JI",Y$$"9!4"]?$$9!4"]?$3,$9!4"$3,$^9!

D0'0.(*.1+!0!*.+F0@A+!10!D%#(A+!%!+!Q+'(07%&*5%.(+!1+#!

&+.#%.#+#!*.(%'Q%1%'0(*F+#T

! ]%#(%!&+.(%N(+!+#!$%&'%()'*+#!,-.*&*/0*#!1%!$02L

1%!0:-*!'%-.*1+#!'%*(%'05!0!*5/+'(R.&*0!1+!4"$$3,$L43!

.+!0##%##+'05%.(+!(8&.*&+!0+#!5-.*&G/*+#9!&+5+!.0!&+.#L

('-@A+!#+7*1)'*0!10#!/+7G(*&0#!1%!#021%9!6-#&0.1+!1%!Q+'50!

*.&0.#)F%7!+!Q+'(07%&*5%.(+!1+!$_$!%5!.+##+!3#(01+T!

W-0*2609!`a!1%!50'@+!1%!;<<=T

Page 60: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

!"#$%&'()**%+#,)#-%./0#1#2%(/0.)3040(0#()4)&*0(#0#')*/5%#,%#$677897#)#0#')*/5%#)*/(0/:';<0#)#40(/;<;40/;-0#40(0#%#7=7

!"#$%&''"( '&%)( &*&+,-( -( #".-( /+%&,"%+-( /"(

""!!!#$%&'()**%#>0<;%&0.#,0*#7)<()/0(;0*

Page 61: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

!"#$%&'!"&'%'(%)$*!*(%+,"'-"."#/)011"1'2%!*"#%*1

.3445647.5

!!"""#$%&'()**%#+,-.%&,/#0,*#1)-()2,(.,*

34&.-.5,.*#0)#1,60)#

! "#$%! &'(()*(+! ',-.'! '/*(! #%0! ('1

2.'-3.4)(! '! ('2.'-3.4*(! 56,424&*4(! 7'! (*81

7'+! &*.-424&*.*5+! ,)! &'.9)7)! 7'! :$! *! ;0!

7'! <6,=)+! 7)! >>???! @),A.'(()! B*24),*/!

7'! C'2.'-*.4*(!D6,424&*4(! 7'! C*87'! '! ?E!

@),A.'(()!F.*(4/'4.)!7'!C*87'+!@6/-6.*!7'!

G*H!'!BI)1E4)/J,24*+!'5!K)4,L4//'!MC@NO!P!

'L',-)!.'6,46!45&).-*,-'(!,)5'(!7*!&)/9-41

2*!,*24),*/!7'!C*87'!&*.*!74(26-4.!)(!*L*,1

2',-.*/!7)!@),A.'(()O

! P! &.45'4.)! 74*! 7'! *-4L47*7'(! Q)4!

1

7)/)A4*! 7)(! -.*R*/=)(! Q)4! 74L4747*! ',-.'! *!

*&.'(',-*SI)!7)(! 'T&)(4-).'(! '! *! -.)2*!7'!

'T&'.4J,24*(! ',-.'! *(! C'2.'-*.4*(! D6,4241

&*4(!7'!C*87'!7)!&*9(O!P!74*!26/54,)6!2)5!

2)5!*!&*.-424&*SI)!7)!54,4(-.)!7*!C*87'+!

! U5!('6!74(26.()+!)!&.'(47',-'!7)!

*! 45&).-V,24*! '(-.*-WA42*! 7)(! ('2.'-3.4)(!

'! ('2.'-3.4*(! 56,424&*4(! 7'! C*87'! &*.*! *!

2),(-.6SI)! 7*! .'Q).5*! (*,4-3.4*! R.*(4/'4.*!

1

7)(!74*.4*5',-'!&*.*!*!'Q'-4L*SI)!7)!CXCO!

1

45&).-V,24*!7*!.'A6/*5',-*SI)!7*!U5',7*!

:Y+! 65*! 7*(! R*,7'4.*(! &)/9-42*(! 7'!5*4).!

>>???!@),A.'(()!Q)4!',2'..*7*!2)5!*!*&.'1

1

-'/!&*.*!2'.2*!7'!:!54/!2),L47*7)(O

! P(! ('2.'-3.4)(! '! ('2.'-3.4*(! 561

,424&*4(!7'!(*87'+!.'6,47)(!,)!>>???!@),1

A.'(()!.'4-'.*.*5!('6!2)5&.)54(()!2)5!*!

-)7)(!)(!R.*(4/'4.)(!'!2)5!*!2),()/47*SI)!'!

7'Q'(*!7)!C4(-'5*!Z,42)!7'!C*87'! MCXCN!

2)5)! &)/9-42*! 7'! U(-*7)O! G.)&6('.*5! *!

2),(-.6SI)!7'!65*!*A',7*!&*.*!*!['Q).5*!

C*,4-3.4*! F.*(4/'4.*! &*6-*7*! ,)! &.)2'(()!

&'/)! G*2-)! &'/*! C*87'+! 2)5! 7'/4R'.*S\'(!

7)(!@PCUDC!'!7*(!C'2.'-*.4*(!D6,424&*4(!

7'!C*87'O

! ])!@'*.3+!'(-'L'!&.'(',-'! -)7*!*!

74.'-).4*! 7)! @PCCUDC+! 2)5! 'T2'SI)! 7)!

1

2.'-3.4*! 'T'26-4L*! K)('*,*! ^45*+! '! L3.4)(!

-W2,42)(!'!('2.'-3.4)(!56,424&*4(!7'!(*87'O!

B*! )2*(4I)+! Q).*5! 74L6/A*7*(! *(! 74L'.(*(!

*-4L47*7'(!7'(',L)/L47*(!&'/)!@PCCUDC1

@U+! *-.*LW(! 7*! &.'(',S*! 7*! 2)54-4L*! '5!

-.*R*/=)(!L',2'7).'(!,)!E??!@),A.'(()+!7'!

Page 62: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

!!"7#$%&'()**%#+,-.%&,/#0,*#1)-()2,(.,*

34&.-.5,.*#0)#1,60)

>>?E!@),A.'(()!B*24),*/!7*(!C'2.'-*.4*(!

D6,424&*4(!7'!C*87'O!P(!:0!*,)(!7'!CXC!

Q).*5! 2)5'5).*7)(! *)! ()5! 7)! 2*.45R_!

'! -'(-'56,=*7)(! &'/*(! R'/'H*(! -9&42*(! 7*!

1

1

7'`+!Q)4!.'*/4H*7)!,)(!74*(!%!*!""!7'!*R.4/+!

1

5)!&'.9)7)!Q)4!.'*/4H*7)!-*5RW5!)!E!@),1

A.'(()!F.*(4/'4.)!7'!C*87'+!@6/-6.*!7'!G*H!

'!,I)1E4)/J,24*O

! B*!)2*(4I)+! Q)4!5),-*7*!*!ab'4.*!

'(-*,7'(! 'T&'.4J,24*(! (62'(()! ,I)! *&',*(!

7'!C'2.'-*.4*(!D6,424&*4(!7'!C*87'+!5*(!7'!

@PCUDC!7'!-)7)!)!F.*(4/+!7'!@),('/=)(!7'!

1

-).'(1Q).,'2'7).'(!7'!&.)76-)(O!U,-.'!'(('(!

'(-*,-'(! '(-*L*!)! 7)!@PCCUDC1@U+!5641

-)! &.)26.*7)! &'/*! 74(-.4R64SI)! 7'! .'L4(-*(+!

Q)/7'.(+!<).,*4(+!*/W5!7'!564-*!2*(-*,=*!7'!

7'! ',-.*7*! 7)! @',-.)! 7'! @),L',S\'(! Q)4!

)26&*7)!&).!65*!(W.4'!7'!)6-.)(!*-.*-4L)(O!

7)!-'5&)!7)(!:0!*,)(!7'!CXC!()R!*!_-42*!

2='4*!7'!A.*,7'(!&.)-*A),4(-*(+!',-.'!'/'(!)!

)!@),('/=)!B*24),*/O

Q).*5! 7'742*7*(! c! .'*/4H*SI)! 7*(! *-4L47*1

1

()(O!@)5!65!&8R/42)!5W74)!L*.4*,7)!',-.'!

L*.4*7)(+! -*4(! 2)5)d!@)/'A4*7)!7'!e'(-I)!

['A4),*/+!f'/'((*87'+!C*87'!?,79A',*+!',1

-.'!)6-.)(O!P(!&*4,W4(!*&.'(',-*.*5!74(26(1

(\'(!()R.'!C*87'!C6&/'5',-*.+!X.AJ,24*!'!

-4L'.*5!Q)2)!,*!A'(-I)d!'/*R).*SI)!7'!).1

S*5',-)(+!&.)<'-)(!7'!4,L'(-45',-)(+!.'/*1

7)!'L',-)+!,*!,)4-'!7)!74*!Y+!Q)4!5*.2*7*!

&'/*!2)5'5).*SI)!7*!*&.)L*SI)!&'/)!C'1

1

/*5',-*! *! U5',7*! :Y+! *((6,-)! 7'R*-47)!

76.*,-'!-)7)!)!74*O

! B*! 5'(5*! ,)4-'! Q)4! ',-.'A6'! *!

1

1

1

C*,-*.W5O!U!&*.*!2)5'5).*.!)(!:0!*,)(!7'!

1

*7*(! 74L'.(*(! &'.(),*/47*7'(+! ',-.'! '/*(! )!

&.)A.*5*SI)!7)(!74*(!"0!'!""!Q)4!Q).5*7*!

1

)(!4,-'.L*/)(+!*/A65*(!('S\'(!7)!@*QW!2)5!

?7W4*(+!),7'!Q)4!&)((9L'/!/*,2=*.!('5!&*.*.!

! X5!7)(!L4,-'! -.*R*/=)(!L',2'7)1

.'(! 7)!>>?E!@),A.'(()!B*24),*/! Q)4! 65!

7)(!L4-).4)()(!7)!,)(()!E??!@),A.'(()!U(1

-*76*/d!aB82/')!7'!G.'L',SI)!7*(!E4)/J,1

24*(!'!G.)5)SI)!7*!C*87'`+!7)!56,429&4)!

7'!C)R.*/O!P!@),A.'(()!Q)4!',2'..*7)!2)5!

1

76H46!'!'/*R).)6!*!@*.-*!7'!F'/W5O!!!

!

"

:

;

g

Page 63: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

80%9*:%);'%("*%)'0'(%)$*!*(%)'<0)="1'!"#>?/%-"1'(09%'-*)0$")*%'-"'.344564

89#0.:.,#;,4/#1).<,*#&,#-%=5%*.>?%#@A()/60.%BC#*%&D%#E4)#*)#*%&D,#*F#G#*F#4=#*%&D%#E4)#*)#*%&D,#*FH#1%I

&D%#E4)#*)#*%&D,#J4&2%#G#(),/.0,0)H#K%.#J4&2%#,#'(,&0)*#5,(-).(%*#E4)#%#$L11M31#5(%=%N)4#04(,&2)#)**,#

')*2?%#4=,#*G(.)#0)#,-%&2)-.=)&2%*#E4)#-%&-()2.:,(,=#%*#*%&D%*#0,#0.()2%(.,C#0)#.=5(.=.(#5()*)&>,#)O)2.N,#

&%#-)&9(.%#0)#5%/P2.-,*#56Q/.-,*#&,#*,60)#0%#)*2,0%H#A,(,#.**%R#&,0,#=)/D%(#0%#E4)#(),/.:,(#)#5,(2.-.5,(#0)#

)N)&2%*H#S/G=#0%*#$%&'()**%*#)*2,04,.*R#)=#0%.*#,&%*#,#,24,/#')*2?%#5(%=%N)4#2(T*#'(,&0)*#KF(4&*R#/,&>%4#

E4,2(%#54Q/.-,>U)*#)#)*2)N)#5()*)&2)#)=#=,.*#0)#*)**)&2,#)N)&2%*H#+)*2,#=,2G(.,R#,#14*2)&2,>?%#O,:#4=#

5,**).%#&%#2)=5%#)#()/)=Q(,#Q%,#5,(2)#0)*2)*#=%=)&2%*H

Page 64: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

SQ(.(#)*5,>%*#5,(,#%#0)Q,2)#O%.#4=,#0,*#-,I

(,-2)(P*2.-,*#0,#,24,/#')*2?%#0%#$L11M31H#S#

-%=)>,(#5)/,*#()4&.U)*#,=5/.,0,*R#*)'4.&I

0%#5)/%*#OF(4&*#)#-D)',&0%#&%*#-%&'()**%*R#

O%(,=#0%.*#,&%*#0)#.=5%(2,&2)*#5,-24,>U)*#

)&2()# ')*2%()*# 0)# *,60)# )R# ,/G=# 0.**%R# 0)#

.&*)(>?%#0)#5,42,*#&,#*%-.)0,0)#-.N./#,2(,I

NG*# 0,# =P0.,H# +?%# D9# 4=# 6&.-%# *)-()29(.%#

0)# *,60)# E4)# &?%# 2)&D,# *.0%# -%&N.0,0%# ,#

)&2(,(#&,*#0.*-4**U)*R#)<5%(#*4,*#%5.&.U)*#)#

%4N.(#,*#%5.&.U)*#0%*#%42(%*H#M*5)-.,/=)&2)#

E4,&0%# %#=%=)&2%# 5)0.,# E4)# %# $L11M31#

2.N)**)#4=,#5%*.>?%R# -,*%#0%# "# KF(4=#$),I

()&*)#0)#M<5)(.T&-.,*#M<.2%*,*#0)#$%=Q,2)#

V#W)&'4)R#E4,&0%#%#$),(9#N.N.,#4=,#0)#*4,*#

=,.%()*#)5.0)=.,*

KF(4=R#0%#X,2.=#forumR#

Page 65: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

(',-*SI)! 7*! 58(42*! a]',A6'`+! 2)5&)(-*!

1

(',-*SI)! 7*! D'(*+! )! ('2.'-3.4)! 56,424&*/!

7'! C*87'! 7'! b).-*/'H*! P7).42)! D),-'4.)!

)!2),-.)/'!7*!7',A6'!'5!A.*,7'(!5'-._&)1

-.*R*/=*,7)! 2)5!*!5)R4/4H*SI)!7*(! &'(()1

L3!/3!'!-*5&'!*!2*4T*!7h3A6*!7*(!&'(()*(`O!

U5!('A647*!)(!,)L'!56,429&4)(!('/'24),*1

'T'5&/)+! ('! 7'(-*2)6! &'/*! 45&/*,-*SI)! 7)!

',7'54*(! 56,424&*4(O! @*62*4*! *&.'(',-)6!

&/*,4/=*!2)5&.)L*,7)!)(!'Q'4-)(!7*!4,(-*/*1

SI)!7)!@',-.)!7'!D),4-).*5',-)!'!@),-.)/'!

c!]',A6'O!]'(-*2)61('!-*5RW5!)!56,429&4)!

7'!K*A6*.4R'+!2)5!)!G.)<'-)!i64,-*/!^45&)+!

1

,4(-W.4)!7*!C*87'+!)!-W2,42)!7*!@)).7',*SI)!

B*24),*/!7)!G.)A.*5*!7'!@),-.)/'!c!]',1

(4-6*SI)!7*!7)',S*!'5!-)7)!)!&*9(O

KF(4=#$),()&*)#0)#M<5)(.T&-.,*#M<.2%*,*#

0)#$%=Q,2)#V#W)&'4)

1

-WA4*(! 56,424&*4(! 7'! 2)5R*-'! c! 7',A6'+!

*-.*LW(! 7)! ?! b_.65! 7'! UT&'.4J,24*(! UT41

-)(*(!&.)5)L47)!&'/)!@PCCUDC+!Q)4!R'5!

.'2'R47*!&'/)(!A'(-).'(!7'!(*87'+!6(63.4)(!

'! -W2,42)(! '5! '&47'54)/)A4*! 7)! U(-*7)O!

1

R*-'!.'*/4H*7)!,)!*674-_.4)!@4.)!e)5'(+!7*!

U(2)/*!7'!C*87'!G8R/42*!7)!U(-*7)!7)!@'1

1

.4J,24*(! *&.'(',-*7*(! Q).*5! ('/'24),*7*(!

&).!&*.'2'.!-W2,42)!7*!C'2.'-*.4*!U(-*76*/!

7'! C*87'+! ,)(! 2.4-W.4)(! 7'! 2.4*-4L47*7'! '!

(6(-',-*R4/47*7'!7*(!4,424*-4L*(O!G*.*!)!&.'1

a*!7',A6'!&'.-',2'!c!()24'7*7'+!Q)4!=4(-)1

.42*5',-'! 2.4*7*! '! ,I)! -'.3! 2)5R*-'! &)(1

(9L'/!('5!*!2),(24J,24*!74(()`O!P!)R<'-4L)!

7)!'L',-)!Q)4!7'5)2.*-4H*.!*(!'T&'.4J,24*(!

,I)!'(-*L*5!*A4,7)!&*.*!'..*742*.!*!'&47'1

1

247*7'! '! &.)*-4L47*7'+! L3.4)(! 56,429&4)(!

&.)L*.*5! =*R4/47*7'! '! .'()/6R4/47*7'! ,)!

',Q.',-*5',-)!7)!&.)R/'5*O

! P!'L',-)!Q)4!4,424*7)!2)5!*!*&.'1

b)-)(j!UT&)(4-).'(!7*(!'T&'.4J,24*(!'T4-)(*(

Page 66: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

"#KF(4=#M*2,04,/#0)#Y)*2%()*#)#

$%&*)/D).(%*#0)#1,60)

! aP! @),-.)/'! C)24*/! ,)! &.)2'(()!

7'!-.*,(4SI)!7*!A'(-I)!7)(!56,429&4)(`!Q)4!

)! -'5*! 7)! ?! b_.65! U(-*76*/! 7'! e'(-).'(!

'! @),('/='4.)(! 7'! C*87'+! .'*/4H*7)! &'/)!

,)(! 74*(! :0! '! :"! 7'! ,)L'5R.)! 7'! :00%+!

7'! e'(-I)! U(-.*-WA42*! '! G*.-424&*-4L*! 7)!

1

G.'Q'4-)(!D6,424&*4(! 7)! U(-*7)! 7)! @'*.3!

1

&'2-)(!/'A*4(!'!*!/'A4-4547*7'!7*(!7'24(\'(!

,*!-.*,(4SI)!7'!A)L'.,)+!*/W5!7'!2)5&*.1

-4/=*.!'T&'.4J,24*(!'T4-)(*(!7'!A'(-I)!&*.-41

24&*-4L*!,)(!56,429&4)(O

! ]6.*,-'!-)7)!)!74*!:0!=)6L'!*&.'1

(',-*SI)!7*(!'T&'.4J,24*(!56,424&*4(!('/'1

1

.*,-'!-)7)!)!b_.65O!E4,-'!'!,)L'!-.*R*/=)(!

'!e'(-I)!G*.-424&*-4L*! Q).*5!('/'24),*7)(!

&*.*! &*.-424&*SI)! ,)! b_.65O! b).*5! *&.'1

(',-*S\'(!).*4(+!2)5!)!4,-64-)!7'!&*.-4/=*.!

Q).-*/'2'5!*!&*.2'.4*!',-.'!A'(-).'(!'!()24'1

1

7*7'(! 4,'.',-'(! *)!5)5',-)! 7'! -.*,(4SI)!

7'!A'(-I)O!P(! -.*R*/=)(!Q).*5!(6R5'-47)(!

*)!<6/A*5',-)!7'!65*!@)54((I)!2)5&)(-*!

&).! .'&.'(',-*,-'(! 7)! @PCCUDC1@U+! 7)!

,'(-*!'74SI)O

! U,-.'! *(! 'T&'.4J,24*(! 2*5&'I(!

D6,424&*4(!7'!C*87'`+!;k!@[UC+!'!aP6L41

7).4*!D6,424&*/!7)!CXC!2)5)!4,(-.65',-)!

7'! A'(-I)! &8R/42*! 7*! (*87'! l! *! 'T&'.4J,1

24*!7'!C)R.*/`O!G*.*!*!2)).7',*7).*!7*!;k!

@[UC!^',4!B)R.'+!)!b_.65!Q)4!a65*!)&).1

-6,47*7'!7'!5)(-.*.+!*-.*LW(!7*(!'T&'.4J,1

1

&)7'5!('.! -.*76H47*(!7'!5*,'4.*!5*4(!Q*1

Page 67: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

54/4*.! &*.*! )(! &*.-424&*,-'(`O! G*.*! KV,7'.!

D*A*/=I'(+!*6-).!7)! -.*R*/=)!()R.'!P6L41

7).4*+! a*! 'T&'.4J,24*!7'!C)R.*/! '5!)Q'.'1

247*7I)(!W!)!4,742*-4L)!7'!-.*,(&*.J,24*!,*!

A'(-I)O!G*.-424&*.!7'!65!'L',-)!7'(-*!5*A1

,4-67'!<3!W!65!A.*,7'!&.4L4/WA4)!'!-'.!,)(()!

-.*R*/=)!.'2),='247)!2)5!65*!&.'54*SI)+!

*/W5!7'!,)(!7'4T*.!*/'A.'(!&).!'(-*.5)(!,)!

2*54,=)!2'.-)+! -*5RW5!,)(!',2='!7'! .'(1

&),(*R4/47*7'`O!

! m!,)4-'!*2),-'2'6!*!*R'.-6.*!()/'1

,'!2)5!*!@),Q'.J,24*!ae'(-I)!G*.-424&*-41

CXC`+!&.)Q'.47*!&'/)!2)).7',*7).!A'.*/!7'!

C)24*/!7*!C'2.'-*.4*!7'!e'(-I)!U(-.*-WA42*!

'!G*.-424&*-4L*!7)!D4,4(-W.4)!7*!C*87'!?L)!

G'7.)(*O!D4/4-*,-'!7)!CXC!7'(7'!)!('6!4,91

24)+!?L)!Q*/)6!7*!*/'A.4*!7'!&*.-424&*.!7'!65!

1

7*!2)5)!&*.-'!Q6,7*5',-*/!7*!2),(-.6SI)!

7)!CXC`O!G*.*!)!&.'(47',-'!7)!@PCCUDC+!

1

747)! 2)5)! 65! a5*.2)! =4(-_.42)+! &).! ('.!

.'*/4H*7)!,65!5)5',-)! -I)!2.9-42)+!),7'!

2*7*! 65+! A'(-).! )6! 2),('/='4.)+! &.'24(*!

',-',7'.!)!('6!&*&'/O!P(!A'(-).'(!&.'24(*5!

1

-)(!45&.'(24,79L'4(!7'!A'(-I)`O!

,)!74*! :"! 2)5!*!5'(*1.'7),7*! a@),-.)/'!

C)24*/! ,)! CXC! '! *! -.*,(4SI)! 7'! A)L'.,)d!

*(&'2-)(! /'A*4(! '! W-42)(`+! 2)5! *! &.'(',1

S*! 7)! ]'&6-*7)! U(-*76*/! ^6/*! D).*4(+!

)! .'&.'(',-*,-'! 7*! X,4I)! 7)(! E'.'*7).'(!

2)5)! -'5*! a@),-*(! 7'! A)L'.,)! '! *! A'(1

-I)! l! )! 5)5',-)! 7*! -.*,(4SI)`+! 5'74*7)!

7)!f.4R6,*/!7'!@),-*(!7)(!D6,429&4)(!^69(!

D3.4)!E4'4.*!'!&'/)!(6R1!('2.'-3.4)!7'!(*81

C)R.*/+!;O!^89(!D3.4)!E4'4.*+!gO!G*.-424&*,-'(!7'!@*,4,7W!

"

:

;

g

Page 68: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

aU(-)6!'5!54,=*!-'.2'4.*!A'(-I)!'!&'/*!&.45'4.*!L'H!

-4L'!65*!).4',-*SI)!-I)!2/*.*!()R.'!)(!&.'2'4-)(!7)!

CXC+!()R.'!)!&._&.4)!@PCCUDCO!b)4!65!5)5',-)!

'T-.'5*5',-'!&.)L'4-)()+!'(&'24*/5',-'!&*.*!)(!,)1

L)(!A'(-).'(+!&'/*!_-45*!)&).-6,47*7'!7'! 4,Q).5*1

1

-'`O!MD*.4*!7)!@*.5)!>*L4'.+!('2.'-3.4*!7'!

C*87'!7'!?.*2'5*NO

aX5!5)5',-)!564-)!&.)L'4-)()!,)!

(',-47)!7'!-.*H'.!2),='245',-)!&*.*!-W2,41

2)(!'!A'(-).'(+!4,2/6(4L'!*-.*LW(!7*!&*.2'1

.4*!2)5!*!C'2.'-*.4*!U(-*76*/!7'!C*87'`O!

-W2,42*!7'!F'/*[email protected]

aD64-)!).A*,4H*7)O!C6.&.'',7'6!&)(41

-4L*5',-'!&'/)(!'(2/*.'245',-)(!()R.'!

)!Q6,24),*5',-)!7)!@PCCUDC+!()R.'!

7'R*-'+!2)5!*!L4(I)!A'.*/!7*!2),<6,-6.*!

56,74*/!7*!C*87'+!-*5RW5!Q)4!564-)!

&)(4-4L)`O!MU5'.(),!f'/'(+!('2.'-3.4)!7'!

C*87'!7'!C*,-*!i64-W.4*NO

ab)4!65!',2),-.)!7'!Q6,7*5',-*/!45&).1

-V,24*!&'/*(!2),-.4R64S\'(!7'!).4',-*SI)!

&*.*!4,424*.!)!-.*R*/=)!2)5)!A'(-).!'!&*.*!

K8,4).+!('2.'-3.4)!7'!C*87'!7'!X54.45NO

KF(4=#0)#S-%/D.=)&2%#G#()-%(0)#0)#

56Q/.-%#)#0)#5,(2.-.5,>?%#

! ]6.*,-'!)(!74*(!:Y!'!;0!7'! <*,'41

.)+!7'H',*(!7'!&*.-424&*,-'(+!',-.'!A'(-).'(!

1

@PCCUDC!5)5',-)(!7'!'(&'24*/!2),Q.*-'.1

,4H*SI)!'!-.)2*!7'!'T&'.4J,24*(O!f.*-*1('!7)!

.'*/4H*7)!'5!&*.2'.4*!2)5!*!C'2.'-*.4*!U(-*1

! P!b_.65! -'L'! )! )R<'-4L)! 7'! *2)1

/='.! )(! ('2.'-3.4)(!56,424&*4(! 7'!C*87'! '!

).4',-31/)(! ()R.'! */A6,(! *(&'2-)(! '(-.*-W1

A42)(! 7'! A'(-I)d! )! 2),-'T-)! =4(-_.42)! 7)!

CXC+! *! 45&).-V,24*! 7'! 2),(-.64.! )! G/*,)!

D6,424&*/! 7'!C*87'! '! )! &*&'/! '(-.*-WA42)!

7)!@PCCUDC! ,*! Q).56/*SI)! '! 'T'26SI)!

7*!&)/9-42*!7'! (*87'O!@'.2*!7'!":0! ('2.'1

-3.4)(!56,424&*4(! .'(&),7'.*5! *)! 2),L4-'!

'! 2)5&*.'2'.*5!*)! 'L',-)+! */A6,(! *2)51

&*,=*7)(!7'!('6(! -W2,42)(+!2)5&),7)!65!

1

,*7).'(!7*(!@[UC+!2)5!.'&.'(',-*,-'(!7*!

C'2.'-*.4*!U(-*76*/!7'!C*87'+!',-.'!)6-.)(+!

7'!&.)A.*5*SI)O!X5*!5*.2*!=4(-_.42*O

! P!b_.65!-'L'!4,924)!,*!5*,=I!7)!

74*!:%+!2)5!)!2.'7',24*5',-)!'!',-.'A*!7'!

5*-'.4*/O!m(!Y=(+!)!&.'(47',-'!7)!@PCCU1

1

5*SI)!2)5!*!*&.'(',-*SI)!7)(!('2.'-3.4)(!

7'!(*87'!*-W!',-I)!4,(2.4-)(O!B'(-'!5)5',1

-)+! .'L'/)61('! *! ',).5'! 74L'.(47*7'! 7)(!

*!&)/9-42*!56,424&*/!7'!(*87'd!&'7*A)A)(+!

*754,4(-.*7).'(+! *7L)A*7)(+! ',Q'.5'4.)(+!

1

-.'! )6-.)(O! U5! ('A647*+! K6.*,74! b.6-6)()+!

65*!&*/'(-.*!()R.'!)!CXC!,)!F.*(4/+!.'/'51

R.*,7)! 45&).-*,-'(!5)5',-)(!7*! .'Q).5*!

(*,4-3.4*! '! -'2',7)! 2),(47'.*S\'(! ()R.'! )!

*-6*/! '(-3A4)! 7)! C4(-'5*! '5! ,)(()! &*9(O!

Page 69: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

aU,2),-.*.! '(-'! *674-_.4)! /)-*7)! W! 65*!

A.*-*! (6.&.'(*O! BI)! =3! (*87'! ('5! &*.1

2'4.)(! Q).-'(O! @PCCUDC! Q.*2)! '! U(-*1

7)! Q).-'! W! 7)54,*SI)O! @PCCUDC! Q).-'!

7'5)2.3-42*!(_!*2),-'2'!',-.'!&*.2'4.)(!

74(('!b.6-6)()O

1

&.)Q'.46!*!('A6,7*!&*/'(-.*!&.)A.*5*7*d!

)!CXC!,)!@'*.3O!B*!)2*(4I)+!*&.'(',-)6!

)(!,)L)(!4,L'(-45',-)(!'(-.6-6.*4(!7*!G)1

/9-42*!U(-*76*/!7'!C*87'O!ai6'5!2),-4,61

*.!A'(-).!&)7'.3!Q*H'.!=4(-_.4*!,)!@'*.3+!

45',()!4,L'(-45',-)!'!Q).-*/'245',-)!4,(1

-4-624),*/!7*!G)/9-42*!U(-*76*/!7'!C*87'`+!

7'2/*.)6!F*(-)(O!B)!&'.9)7)!7*! -*.7'!)(!

&*.-424&*,-'(!&67'.*5!',-',7'.!5'/=).!)!

&*&'/!7)!@PCCUDC+!2)5!*&.'(',-*S\'(!

7'!-)7)(!)(!('6(!('-).'(d! <6.9742)+!*7541

,4(-.*-4L)!'!7'!2)56,42*SI)O!['2'R'.*5!

4,Q).5*S\'(! *! .'(&'4-)! 7)(! R','Q924)(! '!

7*(!5*,'4.*(!7'!*(()24*.1('!c!',-47*7'O

! ]6.*,-'! -)7)! )! 74*! :Y! =)6L'! *!

7)!G/*,)!D6,424&*/!7'!C*87'O!B)!&.45'4.)!

5)5',-)+! )! 2)).7',*7).! 7'! &/*,'<*5',-)!

1

,'('(!54,4(-.)6!65*!&*/'(-.*!()R.'!)!G/*,'1

<*!CXC+!2)5!'/'5',-)(!,).-'*7).'(!&*.*!*!

'/*R).*SI)!7)(!G/*,)(!D6,424&*4(!7'!C*87'O!

1

c! -*.7'+! )! 2),(6/-).! 7)!B82/')!7'!U(-67)(!

1

A'(-).'(!'!-W2,42)(!&67'.*5!2),-.4R64.!2)5!

(6A'(-\'(! ()R.'! &/*,'<*5',-)+! 'T&),7)! '!

Q).*5! ',2'..*7*(! 2)5! &.),6,24*5',-)! 7)!

&.'(47',-'! 7)! @PCCUDCO! aB6,2*! ,*! =4(1

-_.4*! 7)! @PCCUDC! -9,=*5)(! 2),('A647)!

.'6,4.! -*,-)(! ('2.'-3.4)(O! U(-'! 'L',-)! ,)(!

*65',-*.5)(!)!2)5&.)54(()!7'!.'*/4H*.!65!

" :

; g

Page 70: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

X.N(%*R#0%#X,2.=#libruR#

M&2)&0)&0%#,#.=5%(2Z&-.,#0)#.&-)&2.N,(#)#5(%=%N)(#,#)<I

2)&*?%#0,*#54Q/.-,>U)*#0)#()/)NZ&-.,#()/,2.N,*#,%#1[1R#%#

$L11M31#O%.#5,(-).(%#0%#/,&>,=)&2%#0)#2(T*#/.N(%*#0)#=GI

0.-%*#*,&.2,(.*2,*#0%#)*2,0%C#\)=5%#0)#+,*-)(R#0)#3,&4)/#

K%&*)-,]#1[1#^#L#)*5,>%#0,#')*2?%#.&%N,0,#)#0%*#-%&*)&I

*%*#.&2)(O)0)(,2.N%*R#0)#L0%(.-%#3%&2).(%#)#X)&.(#1,&2%*]#

)#M&2()#;.*-%*#)#;,Q.*-%*R#0)#X4.:#W)#S(,6J%#_,(Q%*,H#

\)=5%#0)#+,*-)(C#L#$4.0,0%#`4=,&%#&%#A,(2%#)#&%#+,*-.=)&2%

! f'5&)!7'!B*(2'.+!'(2.4-)!&'/)!5W742)!D*,)'/!b),('2*+!W!65!

/6H!'5!2*(*+!2)5!-)7)(!7*!Q*59/4*!).A*,4H*,7)1('!'5!Q6,SI)!7)!&*.-)!

&*.-'4.*+! 65*!56/='.! 7*! 2)56,47*7'! 2),='247*! 7'! -)7)(O!P(! 8/-45)(!

#0!*,)(!-'(-'56,=*.*5!65*!-.*,(Q).5*SI)!7'((*!.'*/47*7'+!&'/)!5',)(!

,*(!A.*,7'(!247*7'(!7)(!'(-*7)(!7)!,).7'(-'!R.*(4/'4.)O!b)4!65*!567*,1

7'4T*L*!7'!('.!&4,-*7)!,)(!/*.'(!'!&*((*L*!*!*2),-'2'.!7',-.)!7)!=)(&41

*,'(-'(4(-*(!2),()/47)61('!,)!2',3.4)O!P!&*.-)!'!)!,*(245',-)!()Q.'.*5!

74.'SI)!7'(('!5)L45',-)!7'!5'742*/4H*.!)!&*.-)!'!)!,*(245',-)!Q)4!Q'4-*!

5),(-.*!65*!'T6R'.*,-'!&.3-42*!7'(('!,)L)!&*.*74A5*!7'!2647*7)!2)5!

-'5&)!7'!,*(2'.!7'!Q).5*!=65*,*O!

Page 71: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

M&2()#(.*-%*#)#(,Q.*-%*

! U,-.'!.4(2)(!'!.*R4(2)(!(6.A46!7)!,*7*n!X5!-.*1

R*/=)!.'*/4H*7)!,)(!&/*,-\'(!,)-6.,)(!7*!'5'.AJ,24*!7)!

C'5&.'+! ',-.'! 65! *-',745',-)! '! )6-.)+! =3! 65! -'5&)!

()R.'!-'/*+!7'(',=)O!P(!.4(2)(!'5!A'.*/!(6.A'5!*)!*2*()+!

7)! ('! -.*,(Q).5)6O! f)7*L4*! 5'! 2=*5*! *-',SI)! ,*!

.'/*SI)!5W742)1&*24',-'+! *! (6*! 7'-'.4).*SI)O!@'.-)(!

7*! 2),(6/-*+! Q)A'5!7)!2),-'T-)O!G).-*,-)+! W!&.'24()!

'5! ,_(+! <3! ,*(2'5)(! *.-4(-*(+! '! W! 65*! ,'2'((47*7'O!

F'.,*.7!^)o,O!@*7*!&/*,-I)!-'5!(6*!=4(-_.4*O!B'(-'!

-.*R*/=)!2),-)!*!7'!65+!5*(!2='4*!7'!.4(2)(O!M^64H!]'!

1[1C#L#)*5,>%#0,#')*2?%#.&%N,0,#)#

0%*#-%&*)&*%*#.&2)(O)0)(,2.N%*

! P!CXC+!*)!/),A)!7'!('6(!:0!*,)(+!-'L'!(6*!).A*1

,4H*SI)!'!Q6,24),*5',-)!&*6-*7)(!&).!,).5*(!)&'.*24)1

Q)4!)!A.*,7'!5)-4L*7).!7*!).A*,4H*SI)!*754,4(-.*-4L*!'!

CXC!W!2)/)231/)!*!('.L4S)!7)(!4,-'.'(('(!'!7*(!,'2'((41

7*7'(!7'!(*87'!7*!&)&6/*SI)O!U!(',7)!)!CXC!65!(4(-'5*!

*754,4(-.*-4L)!2)5&/'T)+!)(!&*.*74A5*(!7*!*-6*/!*7541

! G).!4(()!*!&.'5',-'!,'2'((47*7'!7)!CXC!*/2*,1

S*.!5*-6.47*7'! &)/9-42*! '! &*6-*.1('! &).! *..*,<)(! *7541

-)7)! )! (4(-'5*! 7'! (*87'+! *! 4,-'A.*/47*7'! 7*! *-',SI)! c!

.'7'!4,-'.Q'7'.*-4L*N!()5',-'!&)7'.3!('.!()/624),*7)!('!

)&'.*7)!,65*!*754,4(-.*SI)!&8R/42*!2),2'.-*7*+!,'A)1

24*/12),(',(6*/O

2)5)! )(! 2),(',()(! '! )(! 2)/'A4*7)(! 4,-'.Q'7'.*-4L)(+!

*/W5!7'!,'2'((4-*.!7'! 4,(-.65',-)(+!2)5)!)(!2),-.*-)(!

7'!).A*,4H*.! *! *SI)!&8R/42*!7*! (*87'O!C'5!65! 4,(-.61

*!A'(-I)!&8R/42*+!,I)!('.3!&)((9L'/!)&'.31/)!'5!Q*L).!7)!

&)(-*(!4,)L*7).*(!&*.*!*!(6*!A'(-I)+!2)5)!*!&)/9-42*!7'!

2),-.*-6*/4H*SI)!',-.'!',-'(!&8R/42)(O!MP(!*6-).'(NO

Page 72: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

K%(,=#=,.*#0)#ab#%*#)N)&2%*#E4)#%#$L11M31#5,(2.-.5%4#-%=%#-%&N.0,0%#,%#

/%&'%#0)**)*#0%.*#,&%*#0)#')*2?%H#M=#,/'4=,*#%-,*.U)*R#-%=%#5,/)*2(,&2)H#

L#0,0%#G#()/)N,&2)#5%(E4)#()N)/,#,/'4&*#.&0.-,2.N%*C#()5()*)&2,2.N.0,0)R#-()I

0.Q./.0,0)R#,42)&2.-.0,0)R#)&2()#%42(,*#-%.*,*H#1)=5()#,Q)(2,#,%#0.9/%'%R#,#

0.()2%(.,#)*2)&0)4#*4,*#,>U)*#%&0)#5c0)#-D)',(R#%&0)#)(,#&)-)**9(.%#O,/,(#0)#

')*2?%#=4&.-.5,/#0%#1[1H#S#*)'4.(R#()-,5.24/,=%*#,/'4=,*#0)**,*#5,(2.-.5,I

>U)*R#()'.*2(,0,*#&%*#N)P-4/%*#0)#-%=4&.-,>?%#0%#$L11M31H#

MN)&2%*R#0%#X,2.=#eventuR#,-%&2)-.=)&2%

3,(>%

SQ(./

3,.%

84&D%

84/D%

O!>???!U,2),-.)!['A4),*/!7)(!U(-67*,-'(!7'!D'7424,*!7)!@*.4.4

O!@*&*24-*SI)!7*!B)L*!f*R'/*!7'!G.)2'745',-)(+!D'742*5',-)(!'!PGD!7)!CXC

O!C'54,3.4)!@),='2'.!)!C4(-'5*!7'!C*87'!l!CI)!^69(

O!?!b_.65!U(-*76*/!7'!G/*,'<*5',-)!G*.-424&*-4L)!'!['A4),*/4H*7)

O!?!U,2),-.)!7)(!@)).7',*7).'(!D6,424&*4(!7'!C*87'!7*!b*59/4*

O!U,2),-.)!P6L4,7)!)!@47*7I)!1!D*,*6(

dbbe

Page 73: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

1)=.&9(.%#"&2)(&,-.%&,/#0.*-42)#)&*.&%#

5,(,#S2)&>?%#_9*.-,#&%#_(,*./

! P!@PCCUDC+!*-.*LW(!7'!('6!G.'1

F.*(9/4*+! 7)! C'54,3.4)! ?,-'.,*24),*/! aP(!

e.*76*SI)!'5!D'7424,*`+!&.)5)L47)!&'/*!

C*87'! '! &'/)!D4,4(-W.4)!7*!C*87'+! 2)5!*!

&.'(',S*!7)(!54,4(-.)(!7*!C*87'+!K)(W!e)1

5'(!f'5&).I)+! '! 7*! U762*SI)+! b'.,*,7)!

1

R*/=)!'!U762*SI)!'5!C*87'!7)!D4,4(-W.4)!

7*!C*87'+!b.*,24(2)!@*5&)(+!,)(!74*(!"%!*!

:"!7'!<6/=)!7'!:00$O!P!)R<'-4L)!7)!'L',-)!

CXC+!,*!'(-.*-WA4*!7'!('.L4S)(!7*!(*87'!,*!

! P! ('54,3.4)! -'L'! *! &*.-424&*SI)!

7'!;%!4,(-4-64S\'(!7'!',(4,)!(6&'.4).!4,2).1

1

()*(+!',-.'!A'(-).'(!'(-*76*4(!'!56,424&*4(+!

7)2',-'(! 7'!5'7424,*+! '(-67*,-'(+! ',-47*1

U(-.*-WA4*!C*87'!7*!b*59/4*+!.'&.'(',-*,-'(!

1

'L',-)!&*9('(!2)5)!*!B).6'A*+!*!@=4,*+!*!

1

/'2'.!&),-)(! 45&).-*,-'(!()R.'!)!&*&'/!7*!

6,4L'.(47*7'!,)!*&.45).*5',-)!7)!',(4,)!

1

.)! 56,7)! 'T4(-'! 65! 4,L'(-45',-)! 564-)!

A.*,7'! ,*! Q).5*SI)! 7'(('(! '(&'24*/4(-*(d!

5W742)(! 7'! (*87'! 7*! Q*59/4*O! ?,2/6(4L'!

&*A*51('! (*/3.4)(!5*4(! */-)(!7)!

'(&'24*/4(-*(O! f)7*! *! R*('! 7)(!

(4(-'5*(! 7'! (*87'! 7'(('(! &*9('(!

W!*!5'7424,*!Q*54/4*.`+!7'2/*.)6!

1

&'.4J,24*(! '! '(-.*-WA4*(! 4,-'.,*1

24),*4(! L)/-*7*(! &*.*! )! ',(4,)!

2)5!*!4,-',SI)!7'!*5&/4*.!)!7'1

R*-'! ()R.'! *! ).4',-*SI)! ,*! Q).1

,)!*-',745',-)!*)(!&*24',-'(!,*!U(-.*-WA4*!

C*87'!7*!b*59/4*O

! ]'! *2).7)! 2)5! )!D4,4(-W.4)! 7*!

,'2'((47*7'(!7)!CXC!*2),-'2'6!*!*((4,*1

-6.*+!'5!:0!7'!<6,=)+!7*!G).-*.4*!2),<6,-*!

4,(-4-64!)!G.)A.*5*!7'!U762*SI)!&'/)!f.*1

1

59/4*!'!*/6,)(!7'!A.*76*SI)!'!&_(1A.*761

*SI)O!P!)R<'-4L)!W!*5&/4*.!)!743/)A)!',-.'!

*(!74L'.(*(!4,(-4-64S\'(!7'!',(4,)!'!_.AI)(!

1

(4),*/!'5!C*87'!2)5!*(!,'2'((47*7'(!L)/1

-*7*(!&*.*!)!CXCO

S'%*2%

O!C)/',47*7'!7'!/*,S*5',-)!7)!G.)<'-)!G4/)-)!B*24),*/!7'!

Page 74: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

$L11M31I$M#5,(2.-.5,#0,#5%**)#0,#&%N,#

W.()2%(.,#0%#$L+S1M31

)2)..47)!,*!,)4-'!7'!:Y!7'!*A)(-)!,)!D'1

1

/4*+!2),-)6!2)5!*!&*.-424&*SI)!7'!2'.2*!7'!

',-47*7'+!&.'(4747)(!&'/)! ('2.'-3.4)!56,41

1

24)!D4.*,7*!D*A*/=I'(! K8,4).+! '(-4L'.*5!

&.'(',-'(!)!54,4(-.)!7*!C*87'+!K)(W!e)5'(!

f'5&).I)+!)!&.'(47',-'!7*!@V1

@=4,*A/4*+! )! &.'(47',-'! 7*!

b.',-'!G*./*5',-*.! 7'!C*87'+!

]*.29(4)!G'.),74+!)!&.'(47',-'!

&.'(47',-'! 7)! @),('/=)! B*1

24),*/! 7'! C*87'+! b.*,24(2)!

F*-4(-*! K8,4).+! '! 7'5*4(! 451

&).-*,-'(!,)5'(!7*!G)/9-42*!7*!

C*87'!7)!F.*(4/O!

2)5&.)54(()! &)/9-42)! &'/)!

Q).-*/'245',-)! 7)! C4(-'5*!

1)2)=Q(%

L424Q(%

+%N)=Q(%

O!C)/',47*7'!7'!G)(('!7)!@)54-J!@'*.',('!7'!G.'L',SI)!c!D).-*/47*7'!D*-'.,*

O!Yk!@*5&*,=*!B*24),*/!7'!])*SI)!7'!p.AI)(!'!f'247)(

O!@),Q'.J,24*!U(-*76*/!7'!C*87'!7)!@'*.3

O!@),Q'.J,24*!B*24),*/!7'!C*87'

O!$k!U>GPUG?!1!F.*(9/4*

Z,42)! 7'! C*87'+! '(&'24*/5',-'! *-.*LW(!

7*! 74(26((I)! ()R.'! *! .'A6/*5',-*SI)! 7*!

U5',7*!@),(-4-624),*/!:Y+!65*!7*(!&.4,241

1

()+! )(! 74(26.()(! &),-6*.*5! *! 45&).-V,24*!

7*!A'(-I)!56,424&*/!&*.*!)!CXC+!'/)A4*.*5!

*!*-6*SI)!7)!&.'(47',-'!'5&)((*7)!,*!C'1

1

5',-*.*5!*!2)R'.-6.*!'T-.'5*5',-'!,'A*1

-4L*!Q'4-*!&'/*!5974*!R.*(4/'4.*!7)(!*((6,-)(!

7)!CXC!'!*!6.AJ,24*!,*!.'A6/*5',-*SI)!7*!

U@!:Y!Q).*5!*/A6,(!7)(!&),-)(!2.9-42)(!241

1

('O! U5! (6*! L4(I)+! '(('(! &),-)(! 7'L'.4*5!

,).-'*.! *! *A',7*!7)!CXC!2),-'5&).V,')O!

C'A6,7)!'/'+!*!74(26((I)!7*!&.)..)A*SI)!7*!

1

24)!2),2/646!('6!74(26.()!&),-6*,7)!)6-.)(!

7)4(!&),-)(!2.9-42)(!7)!C4(-'5*d!)!-'5*!7)(!

.'26.()(! =65*,)(! '! *! ,'2'((47*7'! 7'! ('!

.'-)5*.!*!74(26((I)!7)!5)7'/)!7'!*-',SI)!

Page 75: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

$,(.(.#*)0.,#%#"#$%&'()**%#M*2,04,/#

0)#S2)&>?%#_9*.-,

! C'!'T4(-'!,)!CXC!65*!.'/*SI)!741

.'-*!7'!5W.4-)! ',-.'!C4(-'5*!'!56,429&4)+!

56,424&*/4H*SI)+!5'/=).!)! Q6,24),*5',-)!

1

1

24*/4H*7)!*(!74(26((\'(!()R.'!(*87'!,)!@'1

7)!@PCCUDC+!7)!e)L'.,)!7)!U(-*7)!7)!

@'*.3!'!7*!X,4L'.(47*7'!b'7'.*/!7)!@'*.3+!

*2),-'2'6!',-.'!)(!74*(!$!'!Y!7'!,)L'5R.)!

,*! b*26/7*7'! 7'! D'7424,*! 7'! F*.R*/=*+!

2)5!;%%!4,(2.4-)(O

! E3.4)(! 2)).7',*7).'(! 7*(! 541

2.)..'A4),*4(!7'!(*87'!'(-4L'.*5!&.'(',-'(!

1

F3(42*O!]6.*,-'!*!*R'.-6.*!7)!U,2),-.)!Q)1

.*5! =)5',*A'*7*(! */A65*(! &'(()*(! &'/)!

-.*R*/=)! .'*/4H*7)!,)!CXCd!@*./4/'!^*L).+!

e*.24*+!.'&.'(',-*,-'!7)!]'&*.-*5',-)!7'!

1

/4H*.! 65! ',2),-.)! 7'((*! ).7'5! ,)!@'*.3+!

*)!CXCO!X5!U(-*7)!.'Q'.',24*/!'!&4),'4.)!

2)5&)(-*! &).! B'o-),! CW.A4)! ^)&'(+! 7)!

*&.'(',-)6!65!G*,).*5*!7*!U(-.*-WA4*!7'!

C*87'!7*!b*59/4*!,)!CXC+!'!&'/*!2)).7'1

1

5'(*!.'7),7*+!)!&.'(47',-'!7)!@PCCUDC!

1

,4(-W.4)! 7*! C*87'! (6R5'-'! )(! 56,429&4)(!

,*!R6(2*!7'!.'26.()(!&*.*!)!A'.',24*5',-)!

1

7)+!'!Q*/)6!()R.'!*!*-6*SI)!7)!@PCCUDC!

,)!(',-47)!7'!74(26-4.!'((*(!74(2.'&V,24*(O

! b).*5!7'R*-47)(! *((6,-)(! 2)5)d!

]4.'-.4H'(! 7*! G)/9-42*! B*24),*/! 7'! C*81

1

1

@*&*247*7'! fW2,42*! 7)(! C'2.'-3.4)(!D61

,424&*4(! 7'! C*87'! '5! D),4-).*5',-)! '!

*&.'(',-*7)(!;#!-.*R*/=)(!()R.'!'T&'.4J,1

1

/=)! L',2'7).! l! P! ?5&*2-)! 7*! E4A4/V,24*!

U&47'54)/_A42*!<6,-)!*)!G.)A.*5*!C*87'!

7*! b*59/4*! 7'!@.*-'8(! l! Q.',-'! c! 4,L'(-41

2)1*6-).4*! 7'! D*.4*! 7)! C)2)..)! G'.'4.*!

C4/LW.4)! '![)(V,A'/*!7'!C)6(*!@*L*/2*,1

-'+!7*!C'2.'-*.4*!7'!C*87'!7'!@.*-'8(!1!Q)4!

('/'24),*7)! &*.*! *! U>GPUG?! l! D)(-.*!

B*24),*/!7'!UT&'.4J,24*(!F'51C62'747*(!

'5!U&47'54)/)A4*+! G.'L',SI)! '!@),-.)/'!

'!:;!7'!,)L'5R.)+!'5!F.*(9/4*O

W):)=Q(%

O!f.'4,*5',-)!7)!C?C[Ue!l!F.*(9/4*

O!f.'4,*5',-)!7)!C?PGC!l!F.*(9/4*

Page 76: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

8,&).(%

K)N)().(%

3,(>%

O!['6,4I)!P.74,3.4*!7*!D'(*!U(-*76*/!7'!B'A)24*SI)!7)!CXC

O!G)(('!7*!]4.'-).4*!7)!@),('/=)!7'!b*.5324*

O!@*QW!2)5!@6/-6.*!'!2),<6,-6.*!'(&'24*/!7'!G)(('!7*!B)L*!]4.'-).4*!7)!@[UCC

O!C)/',47*7'!7'!G)(('!7)(!@)54-J(!['A4),*4(!7'!G.'L',SI)!c!D).-*/47*7'!D*-'.,*

O!U,2),-.)!7)!C4(-'5*!B*24),*/!7'!E4A4/V,24*!C*,4-3.4*!1!F.*(9/4*

O!['6,4I)!&.'(47',-'(!7)(!@PCUDC!7*!.'A4I)!,).7'(-'

O!U,2),-.)!U(-*76*/!7'!@),-.)/'+!i6*/47*7'!'!D),4-).*5',-)!7)!^'4-'

O!['6,4I)!7'!)&'.*24),*/4H*SI)!7*!G)/9-42*!U(-*76*/!7'!U762*SI)!G'.5*,',-'!'5!C*87'

O!C)/',47*7'!7'!G)(('!7)(!D'5R.)(!7*!@)54((I)!()R.'!]'-'.54,*,-'(!

!!C)24*4(!7*!C*87'!,)!U(-*7)!7)!@'*.3

dbbf

$L11M31#)#1M1S#)=#A,(-)(.,#&%#1"LA1H

&*.-424&*.*5!'5!F.*(9/4*!7'!-.'4,*5',-)!7)!

C?PGC!l!C4(-'5*!7'!?,Q).5*S\'(!()R.'!P.1

S*5',-)!G8R/42)!'5!C*87'+!',-.'!)(!74*(!""!

'!"g!7'!7'H'5R.)!7'!:00$+!2)5!)!)R<'-4L)!

7'!).4',-*.!'!2*&*24-*.!)(!5'5R.)(!

c(!567*,S*(!A'.*7*(!*-.*LW(!7)!

1

24*5',-)! '5! R/)2)+! .',4L'/*1

5',-)!7*(!2),-*(+!',-.'!)6-.)(O!

P!'L',-)!Q)4!-*5RW5!65*!)&).1

-6,47*7'!7'!-.)2*.!'T&'.4J,24*(+!

*L*/4*.!)!7'('5&',=)!7)!*,)!7'!

:00$+! -.*S*.!5'-*(!&*.*!:00%!'!

L4(6*/4H*.! '(-.*-WA4*(O!U,-.'! '(1

(*(! 5'-*(! '(-3! *! 7'! Q*H'.! 2)5!

1

&4)(!2'*.',('(!'!)!&._&.4)!U(-*1

7)!',-',7*5!*!45&).-V,24*!7'!(4(-'5*-4H*.!

'!74(&),4R4/4H*.!)(!7*7)(!()R.'!('6(!4,L'(-41

5',-)(!'5!(*87'O

! U5!:000+!)!C?PGC!Q)4!45&/'5',1

-*7)! '! Q).5*/4H*7)! ,)! V5R4-)! 7)!D4,4(1

-W.4)!7*!C*87'+!*-.*LW(!7*!G).-*.4*!"O"#;+!

4,2/64,7)! *! 2.4*SI)! 7*! @V5*.*! fW2,42*!

'! 7)(! B82/')(! U(-*76*4(+! '5R).*! 7'(7'!

"YY%! <3! 'T4(-4(('! 65*! ).A*,4H*SI)!59,41

5*! 7)! ).S*5',-)! '(-.6-6.*7*! '5! .'/*-_1

Q).5*7)(!&).!65!e.6&)!UT'26-4L)!'!65!

e.6&)! @),(6/-4L)+! 4,(-4-697)! &).! G).-*1

.4*! 7)! C'2.'-3.4)! U(-*76*/! 7*! C*87'O! B)!

@'*.3+! )! &.45'4.)! W! 2)5&)(-)! &).! .'&.'1

]*-*CXC+!'!-'5!)!)R<'-4L)!7'!(',(4R4/4H*.+!

-.'4,*.+!74L6/A*.!'!*,*/4(*.!7*7)(!7)!U(-*1

7)!'!56,429&4)(O!P!('A6,7)!73!(6&).-'!c(!

74(26((\'(!'!7'24(\'(!7)!UT'26-4L)+!(',7)!

56,429&4)!'!U(-*7)!4,L'(-'5!(*87'O

! P!C4(-'5*!7'L'!('.!*/45',-*7)!('1

5'(-.*/5',-'!'!-)7*(!*(!).4',-*S\'(!,'2'(1

(3.4*(!'(-I)!74(&),9L'4(!,)!(4-'!7)!C?PGC!

MoooO(4)&(O7*-*(6(OA)LOR.NO!B)!'L',-)!.'1

*/4H*7)!'5!F.*(9/4*+!)!@'*.3+!G'.,*5R62)!

'!D*-)!e.)(()!Q).*5!=)5',*A'*7)(!&'/)!

7'('5&',=)! ,*! (4(-'5*-4H*SI)! '! *7'(I)!

('!7'L'6!*)!Q*-)!7)(!56,429&4)(!2'*.',('(!

-'.'5!)!C?PGC!*/45',-*7)!"00q!7'!:000!

*!:00#!*,6*/O!

b)-)j!K)('*,*!^45*!'!&*.-424&*,-'(!7)!-.'4,*5',-)!7)!C?PGC

Page 77: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

SQ(./

O!C'54,3.4)!B*24),*/!l!E4)/J,24*d!65*!'&47'54*!(4/',24)(*

$L11M31#-%&D)-)#%#1.*2)=,#0)

1,60)#0)#3.&,*#Y)(,.*

7)4(!)R<'-4L)(d!L4(4-*.!)!4,-'.,*-)!.6.*/!7*!b*26/7*7'!7'!

D'7424,*! 7*! X,4L'.(47*7'! b'7'.*/! 7'! D4,*(! e'.*4(+!

2)5)!.'Q'.J,24*!&*.*!)!.'1).7',*5',-)!7)!4,-'.,*-)!7*!

)Q'.'2'.!65*!U(&'24*/4H*SI)!7'!C*87'!7*!b*59/4*O!aU((*!

'(&'24*/4H*SI)! ('.3!564-)! 45&).-*,-'! &*.*! *! Q).5*SI)!

=)<'!*-6*5!2)5!2),='245',-)!564-)!4,24&4',-'!()R.'!*(!

7)!f'/'((*87'!7)!@'*.3!^64H![)R'.-)O!

! UT4(-'! 65*! &.)&)(-*! 7)! e)L'.,)! b'7'.*/! 7'!

(I)!,'2'((3.4)(! -*5RW5!'(Q).S)(!'5!&.)/!7'!65*! Q).1

1

G).! 4(()! '((*! 2)54-4L*! L4(4-)6! -*5RW5! 'T'5&/)(! 7'!

&_(1A.*76*SI)! c! 74(-V,24*+! <3! )Q'.-*7*! &'/*! b*26/7*7'!

7'!D'7424,*!7*!X,4L'.(47*7'!b'7'.*/!7'!D4,*(!e'.*4(!1!

&*.-424&*.*5!*4,7*!)!('2.'-3.4)!'(-*76*/!7'!(*87'!7)!@'1

b)-)j!@)54-4L*!7)!@'*.3!'5!P6.)!G.'-)1De

Page 78: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

3,.%

84&D%

O!?>!@),A.'(()!F.*(4/'4.)!7'!D'7424,*!7*!b*59/4*!'!@)56,47*7'

O!???!U,2),-.)!7)(!C'2.'-3.4)(!U(-*76*4(!7'!C*87'!7*!.'A4I)!,).7'(-'

!!&*.*!'..*742*SI)!7)!-.*R*/=)!4,Q*,-4/

O!C'54,3.4)!&*.*![''(-.6-6.*SI)!7)(!@)54-J(!7'!5).-*/47*7'!

!!5*-'.,*!'5!C)R.*/

O!f.'4,*5',-)!C?PGC!l!F.*(9/4*

O!?!@),A.'(()!@'*.',('!7'!C*87'!D',-*/!1!?A6*-6

'(-*7)!r'7*[email protected](46(O!G*.-424&*.*5!-*5RW5!

)(!.'&.'(',-*,-'(!7*!X,'(2)!,)!F.*(4/+!E41

1

2),-.*[email protected]'!'!].)A*(!1XBP]@+!e4)L*,4!

1

)! .'&.'(',-*,-'!7)!@),('/=)!B*24),*/! 7'!

1

CUDC+!b.*,24(2)!@*.7)()O!['&.'(',-*.*5!

)! @PCCUDC1@U! *! ('2.'-3.4*! 'T'26-4L*!

K)('*,*!^45*+!*!',-I)!('2.'-3.4*!7'!*.-4261

1)=.&9(.%#+,-.%&,/I

7.%/T&-.,C#4=,#)5.0)=.,#*./)&-.%*,#

! ]6.*,-'!)(!74*(!:Y!'!;0!7'!*R.4/+!

*! 2*&4-*/! A*82=*! ('74)6! )! C'54,3.4)!B*1

24),*/!l!E4)/J,24*d!65*!'&47'54*!(4/',24)1

7)!',2),-.)!Q)4!74(26-4.!*!L4)/J,24*!2)5)!

65! &.)R/'5*! 7'! (*87'! &8R/42*+! *&.)Q6,1

1

*! &.'L',SI)! 7)(! (642974)(O! b)4! .'((*/-*7*!

*4,7*! *! 45&).-V,24*!7*! *-6*SI)! 4,-'.('-)1

.4*/!'!7*!*SI)!&)/9-42*!&*.*!)!',Q.',-*5',-)!

1

1

<'-_.4*(!7'!*A.'((I)!Q9(42*!,*!4,QV,24*d!Q*1

-).'(!7'!.4(2)!'!&.)A.*5*(!7'!&.'L',SI)`O!

P!'L',-)!&.)5)L47)!&'/)!@),('/=)!B*24)1

&'/*!C'2.'-*.4*!7'!U(-*7)!7*!C*87'!7)![4)!

e.*,7'!7)!C6/!.'2'R'6!'5!(6*!

*R'.-6.*!*6-).47*7'(!2)5!)!541

,4(-.)! 7*! C*87'+! K)(W! e)5'(!

f'5&).I)!'!*!A)L'.,*7).*!7)!

"""#M&-%&2(%#0%*#1)-()29(.%*#M*2,04,.*#

0)#1,60)#,-%&2)-)4#)=#K%(2,/):,#

! b).-*/'H*! .'2'R'6! ,)! 74*! %! 7'!

5*4)!A'(-).'(!7'!(*87'!7'!74L'.()(!'(-*7)(!

7)!,).7'(-'!&*.*!)!???!U,2),-.)!7)(!

C'2.'-3.4)(! U(-*76*4(! 7'! C*87'+!

1

1

C'2.'-3.4)!7'!C*87'!7)![4)!e.*,1

1

)! @PCCUDC+! )! C'2.'-3.4)! 7'! C*87'! 7'!

A'(-).'(+!.'&.'(',-*,-'(!7'!(4,742*-)(!'!*(1

()24*S\'(!5W742*(!'!7'!2)54((\'(!7'!.'(41

7J,24*!5W742*!7)!,).7'(-'O!P!)R<'-4L)!7)!

U,2),-.)! Q)4!74(26-4.! ()R.'! *! .''(-.6-6.*1

SI)!'!*5&/4*SI)!7*(!.'(47J,24*(!5W742*(+!

*!).A*,4H*SI)!7'!26.()(!&*.*!)R-',SI)!7'!

-9-6/)(! 7'! '(&'24*/4(-*(! '! )(! 5'742*5',1

-)(!7'!*/-)!26(-)O!G*.*!:00%+!*!['(47J,24*!

L*A*(!Q).*5!'Q'-4L*5',-'!&.'',2=47*(O!P!

U,2),-.)!Q)4!',2'..*7)!2)5!*!'/*R).*SI)!

7*!@*.-*!7'!b).-*/'H*+!74(&),9L'/!,)!(4-'d!

oooO2),*((O).AOR.O

Page 79: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

+%N,#0.()2%(.,#0%#$M1S[#2%=,#5%**)#&,#1M1S#

1

1

&)(-*! &'/)! ('2.'-3.4)! '(-*76*/!

1

-3.4)!'(-*76*/!7'!(*87'!D*.2'/)!

C)R.'4.*+! &'/*! &.)26.*7).*! 7)!

D4,4(-W.4)! G8R/42)! ?(*R'/! G).1

'! 7*! ]'Q',().4*! G8R/42*! K)I)! [42*.7)+! '!

&'/)! &.'(47',-'! 7)! @PCCUDC! G)/42*.&)!

1

1

26()6! '((*! &.'..)A*-4L*! '5! Q*L).! 7'! 65*!

'/'4SI)!74.'-*!7*!74.'-).4*!&'/)(!2),('/='41

65!7)(!2),('/='4.)(!-'5!74.'4-)!7'!74.4A4.!)!

L)-)(! &'/*! D'(*! ]4.'-).*! 2)5&)(-*! &'/)!

! G*.*! )! &.'(47',-'! 7)! @PCCUDC!

&*(()!Q6,7*5',-*/!&*.*!)!'Q'-4L)!@),-.)/'!

C)24*/`O! U! 2)5&/'-*d! aP! A'(-)! (4,A'/)! 7'!

].O! K)I)!,)(!5)(-.*! )! 2*.3-'.! '! *! 2*&*241

1

-',2'!*)!6(63.4)`O!P!&.'(47',-'!'5&)((*7)!

7'742)6!)!5)5',-)!c(!56/='.'(!7'!(6*!Q*1

1

X,&>,=)&2%#0%#A(%'(,=,#7.0,#+%N,

'!)!()Q.45',-)!7*!'(&'.*!&).!65*!24.6.A4*!

'/'-4L*+!)!A)L'.,*7).!@47!b'..'4.*!e)5'(!'!

1

,4*(+!/*,S*.*5!)!aG.)A.*5*!E47*!B)L*`!,)!

74*! :0!7'! <6,=)+! ,)! *674-_.4)!G*6/)!D*.1

2'/)+! 7*! b*26/7*7'! 7'!D'7424,*! 7*!Xb@O!

P!G.)A.*5*!W!65! 4,L'(-45',-)!7'![s!:0!

54/=\'(O!i6*-.)!=)(&4-*4(!7*!.'7'!'(-*76*/!

1

1

&'(()*(+!-*5RW5!('.I)!.'*/4H*7*(!24.6.A4*(!

@*,-974)!'!'5!=)(&4-*4(!&*.-426/*.'(+!*-.*1

LW(!7'!2),LJ,4)(!2)5!*!C'2.'-*.4*!7*!C*81

Page 80: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

1)=.&9(.%# 0)Q,2)4# 5(%'()**%# 0,*# 5)*E4.*,*#

5,(,#%#1.*2)=,#g&.-%#0)#1,60)#

&*.*! )!CXC! Q).*5!*&.'(',-*7)(! '! *L*/4*1

1

(*(!&*.*!)!CXC+!.'*/4H*7)!,)(!74*(!"%!'!"Y!

1

(*(!&*.*!)!CXC!Q)4!&.)&)(-)!&'/*!C'2.'-*1

.4*!7'!@4J,24*!'!f'2,)/)A4*!7)!D4,4(-W.4)!

7*!C*87'+! 2)5!)!)R<'-4L)!7'!&.)5)L'.! *!

A'(-I)! 2)5&*.-4/=*7*! ',-.'! ('2.'-*.4*(! 7'!

.'(&)(-*(!&*.*!)(!&.)R/'5*(!5*4(!&.'5',1

-'(!*&.'(',-*7)(!&'/)(!)&'.*7).'(!7)!CXCO!

P! &.)Q'(().! 7*! X,4L'.(47*7'! b'7'.*/! 7*!

7)(! &.)<'-)(+! 5*,4Q'(-)6! (*-4(Q*SI)! 2)5!

)(! .'(6/-*7)(d! ae)(-'4! 564-)! 7)(! -.*R*1

/=)(! *&.'(',-*7)(+! '(&'24*/5',-'! &'/*!

&*.-424&*SI)! 7)(! */6,)(! 7'! A.*76*SI)! '!

1

1

S\'(!'(-*.I)!c!74(&)(4SI)!7)(!4,-'.'((*7)(!

,*!b6,2*&O

A%(2,(.,#0)#M04-,>?%#A)(=,&)&2)#G#,**.&,0,#

&,#M*-%/,#0)#1,60)#A6Q/.-,

! P! ('2.'-3.4)! '(-*76*/! 7'! C*87'!

1

-*76*/!7'!U762*SI)!G'.5*,',-'!'5!C*87'+!

,*!U(2)/*!7'!C*87'!G8R/42*!7)!U(-*7)!7)!

@'*.3O!P!'L',-)!.'6,46!.'&.'(',-*,-'(!7*(!

3.'*(!7'!'762*SI)+!(*87'!'!2),-.)/'!()24*/O!

G*.*! )! ('2.'-3.4)! 7'! (*87'! 7'! b).-*/'H*!

P7).42)! D),-'4.)+! W! Q6,7*5',-*/! &',(*.!

*! '762*SI)! &*.*!

)! CXCd! aU(-*1

5)(! 2),(-.64,7)!

65! (4(-'5*! ,)L)!

,65*! 2*(*! L'/=*O!

f)7*!*!26/-6.*!7)!

CXC+! 2).&).*-4L*!

'! 7'! '762*SI)+!

W! L)/-*7*! &*.*! )!

84/D%

O!^*,S*5',-)!7*!G)/9-42*!U(-*76*/!7'!U762*SI)!G'.5*,',-'

S'%*2%

O!?!C'54,3.4)!7*!e'(-I)!U(-.*-WA42*!'!G*.-424&*-4L*!7*!['A4I)!B).7'(-'

O!???!D)(-.*!B*24),*/!7'!C*87'!7*!b*59/4*!l!F.*(9/4*

O!C'54,3.4)!@),='2'.!)!C4(-'5*!7'!C*87'!l!CI)!G*6/)

O!b_.65!7'!U762*SI)!G'.5*,',-'

5'.2*7)O!P!5*4).!'T'5&/)!74(()!W!*!.'(41

1

-*,-'! 7*! C'2.'-*.4*! U(-*76*/! 7'! @4J,24*! '!

4,424*-4L*! 7)!e)L'.,)!b'7'.*/! .'&.'(',-*1

'!*!2),(),V,24*!2)5!*(!&)/9-42*(!'(-*76*4(!

7'!7'(',L)/L45',-)O!aB_(!.'6,45)(!2'.2*!

7'!;:!4,(-4-64S\'(!*!,9L'/!'(-*76*/!'!'/*R)1

.*5)(!)!G/*,)!U(-*76*/!7'!U762*SI)!G.)1

()R.'!)! -'5*O!C'-).'(!&8R/42)(!'!&.4L*7)(!

&*.-424&*5!7'(('!&/*,)+!'!'((*!G).-*.4*!Q).1

-*/'2'!,)((*(!4,424*-4L*(`+!74(('O!P!(6&'.4,1

1

7)!G),-'(!Q*/)6!()R.'!)!&*&'/!7*!UCGO!aU6!

1

-)! 7)!CXC!'! 7'&)4(!5'! 4,2)5)7'4! 74*,-'!

R6(2*.!*!'762*SI)!&*.*!)!

CXC!&'.5*,',-'5',-'`+!

1

CUDC! Q)4! .'&.'(',-*7)!

&'/*!('2.'-3.4*!A'.*/!^61

2W/4*!C*.*4L*O

Page 81: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

$L11M31# 5,(2.-.5,# 0,# 7"# A/)&9(.,# M*2,04,/#

0)#$%&*)/D%*#0)#1,60)#0%#$),(9H#

! P! @),('/=)! U(-*76*/! 7'! C*87'!

7'!@),('/=)(!7'!C*87'!7)!@'*.3O!@'.2*!7'!

2),('/='4.)(+!5'5R.)(!7'!)6-.*(!&/',3.4*(!

P! &.'(47',-'! 7)! @PCCUDC+! G)/42*.&)!

54,4(-.)6!65*!&*/'(-.*!2)5!)!-'5*!aG*2-)!

7'!e'(-I)! '! )! b).-*/'245',-)! 7)!@),-.)1

/'! C)24*/`O! ]'! *2).7)! 2)5! G)/42*.&)+! a*!

&*.2'.4*! 7)(! A'(-).'(! 56,424&*4(! 2)5! )(!

@),('/=)(!7'!C*87'!W!Q6,7*5',-*/!&*.*!)!

R)5!Q6,24),*5',-)!7)!CXC+!&)4(!(_!A'(1

-).'(! .64,(! -J5!5'7)!7)! 2),-.)/'! ()24*/`O!

f*5RW5! &.)Q'.4.*5! &*/'(-.*! )! &.'(47',-'!

1

*!'/'4SI)!7)(!.'&.'(',-*,-'(!&*.*!*!@)).7'1

,*SI)!7'!G/',3.4*(!7'!@),('/=)(!7'!C*87'!

1)2)=Q(%

O!C)/',47*7'!7'!G)(('!7*!@)54((I)!?,-'.('-).4*/!7'!C*87'!7)!f.*R*/=*7).!!!!!!!!!!!!

'!7*!@)54((I)!7'!G.)<'-)(!E47*(!G*.*/'/*(

O!?E!U,2),-.)!B*24),*/!7)!D4,4(-W.4)!G8R/42)!'5!]'Q'(*!7*!C*87'

L424Q(%

O!E?!G/',3.4*!U(-*76*/!7'!@),('/=)(!7'!C*87'

!!"""#L424Q(%#3G0.-%

c!(*87'!'!*!4,-'.Q*2'!2)5!*(!'(&'24*/47*7'(!

.'*/4H)6!,)!&'.9)7)!7'!"%!*!:0!7'!('-'5R.)!

@'*.3+!)!>>???!P6-6R.)!DW742)O!P!'L',-)!

W!*,6*/!'!4,-'A.*!)!G.)A.*5*!7'!U762*SI)!

1

7'(!5W742*(! ('! .'6,4.*5! &*.*! 74(26-4.! -'1

1

,9*('+! 74*R'-'(+! (9,7.)5'(! 5'-*R_/42*(+!

)6-.)(O!]6.*,-'! )!>>???!P6-6R.)!DW742)!

)2)..'.*5!*4,7*!*!???!K).,*7*!7'!D'7424,*!

7'!b*59/4*!'!@)56,47*7'+!)!b_.65!7'!['1

(47',-'(!7*!D'7424,*!7'!b*59/4*!'!@)56,41

b)-)j!G)/42*.&)!F*.R)(*+!P7).42)!D),-'4.)!'!f*/'(!@)'/=)!

+%N)=Q(%

O!%k!U>GPUG?

O!"t!b_.65!U(-*76*/!7)(!e'(-).'(

O!!['6,4I)!7*(!@*5*.*(!fW2,42*(!7'!G/*,'<*5',-)!'!e'(-I)

O!!UL',-)!C?PGC

O!!['6,4I)!@V5*.*!fW2,42*!b*.5*2'6-42*!!!!!

W):)=Q(%

!!!@),('/=)!U(-*76*/!7'!C*87'!'!(6*!.'/*SI)!2)5!)(!@),('/=)(!D6,424&*4(

Page 82: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

S**)=Q/G.,#X)'.*/,2.N,

$Z=,(,#0%*#7)(),0%()*#0)#;)0)&>?%

O!D).-*/47*7'!D*-'.,*!1!*R.4/!7'!:00$

O!C'.L4S)(!'5!X,47*7'(!7)!C4(-'5*!Z,42)!7'!C*87'!'!@),(-4-64SI)!U(-*76*/!7'!C*87'!1!5*4)!7'!:00$

O!@V,2'.!?,Q*,-4/!1!*R.4/!7'!:00%

O!C4(-'5*!^)2*/!7'!C*87'!1!<*,'4.)!7'!:00%

A(%=%2%(.,#0,#1,60)##h#3.&.*2G(.%#A6Q/.-%

@)5R*-'!c!7',A6'!l!*R.4/!7'!:00%

f'.*&4*![',*/!C6R(-4-6-4L*!l!<6/=)!7'!:00%

! @)5)! ',-47*7'! .'&.'(',-*-4L*!

7)(!56,429&4)(+!)!@PCCUDC!'(-'L'!&.'1

(',-'! ),7'! ('! Q'H! ,'2'((3.4)! .'(&),7'.!

&'/*!A'(-I)!56,424&*/!7'!(*87'+!7'R*-',1

7)!()R.'!*((6,-)(!2)5)!5).-*/47*7'!5*1

-'.,*+! ('.L4S)(! 7'! (*87'+! 2)5R*-'! c! 7',1

A6'+! 2V,2'.! 4,Q*,-4/+! ',-.'! )6-.)(O! G*.*! )!

b.'4.'+!*!&*.-424&*SI)!7)!@),('/=)!'5!*61

W! )! _.AI)! .'&.'(',-*-4L)! 7*(! C'2.'-*.4*(!

'!7)(!('2.'-3.4)(!7'!C*87'+!'!2)5!4(()!=3!

65!Q).-*/'245',-)!'!65*!.'(&'4-*R4/47*7'!

5*4).!7)!@),('/=)!2)5)!',-'! Q'7'.*-4L)!

7'!7'Q'(*!7)!CXC`O!U!2)5&/'-*d!aK3!()5)(!

L4(-)(! 2)5)! 7'Q',().'(! 7)(! 56,429&4)(+!

7*(!7'5*,7*(+!'!,_(!Q*H'5)(!564-)!'(Q).1

S40.T&-.,*#A6Q/.-,*

L#$L11M31#5,(2.-.5%4#,.&0,R#04(,&2)#)**)*#0%.*#,&%*#

0)# ')*2?%R# 0)# N9(.,*# ,40.T&-.,*# 56Q/.-,*# *%/.-.2,0,*#

%(,# 5)/,# S**)=Q/G.,# X)'.*/,2.N,R# %(,# 5%(# $Z=,(,*# 0)#

7)(),0%()*R#%(,#5)/%#3.&.*2G(.%#A6Q/.-%H#

Page 83: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

1)(N.>%*#)=#[&.0,0)*#0%#1.*2)=,#g&.-%#0)#

1,60)#)#$%&*2.24.>?%#M*2,04,/#0)#1,60)

=,.%#0)#dbbe

7'!C*87'!7*!b*59/4*+!*(!2),74S\'(!'(-.6-61

.*4(! 7'((*(!X,47*7'(!F3(42*(! 7'!C*87'+! '!

/=).'(! 2),74S\'(! 7'! -.*R*/=)!&*.*! )(! &.)1

7'!*-',745',-)!*)(!6(63.4)(O!P!@PCCUDC!

X,47*7'(+!5*(! ,I)! 74(&\'5! 7)(! .'26.()(!

,'2'((3.4)(!&*.*!.'*/4H*.! 4(()O!B*!)2*(4I)+!

)!@PCCUDC!()/424-)6!7)!U(-*7)!65*!&)1

/9-42*! 7'! 4,L'(-45',-)(! ,*! 2),(-.6SI)! 7'!

1.*2)=,#X%-,/#0)#1,60)#

J,&).(%#0)#dbbf

! P!@PCCUDC!Q)4!2),L47*7)!&'/*!

',-I)! ('2.'-3.4*! 7'! (*87'! 7'! ['7',SI)+!

(',-'! ,*! 74(26((I)! 7)! C4(-'5*! 7'! C*87'!

^)2*/O!aB_(!,)(!(',-45)(!564-)!=),.*7)(!

@PCCUDC!2)5)!.'Q'.',24*/!-W2,42)!'!&)/91

-42)!&*.*!)!7'(',L)/L45',-)!7*(!*S\'(!561

2'7).!),7'!)!@PCCUDC!-'L'!2),74S\'(!7'!

2)/*R).*.!2)5!)!('6!2),='245',-)+!2)5!*(!

'T&'.4J,24*(!'T4-)(*(+!2)5!)!Q).-*/'245',1

-)!7)!(4(-'5*!7'!(*87'`+!.'/'5R.)6!*!',-I)!

&*.-424&)6!7*!5'(*!'!-'L'!)&).-6,47*7'!7'!

.'(&),7'.! &'.A6,-*(! '/*R).*7*(!&'/)(! -W21

,42)(+!&'/*!&._&.4*!&)&6/*SI)!'!2),-.4R64.!

2)5! *(! 74(26((\'(O! b)4! 65!5*.2)! &*.*! )!

.'2),='245',-)!&'/)(!56,429&4)(!7)!-.*R*1

/=)!7)!@PCCUDCO!

U(-*76*/!7*!C*87'+!7'!*2.'(2',-*.!*/A65*(!

6(63.4)(! '! ()R.'! )! &*&'/! 7)! '(-*7)O! ab)4!

&6-*7)(!*!7'(R6.)2.*-4H*SI)!&*.*!5'/=).'(!

2),74S\'(! 7'! *2'(()! *)(! .'26.()(! &'/)(!

*(!&)/9-42*(+!'!)!U(-*7)!,I)!-'5!2),74S\'(!

7'! .'&*((*.!'(('(! .'26.()(!*)(!56,429&4)(!

Page 84: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

60-%9@%1)0!"#@0!*&0#$"'(09%'9?$%'0&'A%<")'-"'4B4

K%.#-%=#'(,&0)#,/)'(.,#E4)#%#$L11M31#)#%#*)4#5()*.0)&2)#A%/.-,(5%#S(,6J%#()I

-)Q)(,=#%#()-%&D)-.=)&2%#0)#,/'4=,*#)&2.0,0)*#.=5%(2,&2)*#0%#1[1#&%#$),(9#

5)/%#2(,Q,/D%#(),/.:,0%#)=#5(%/#0,#*,60)#56Q/.-,#&%*#=4&.-P5.%*H#S*#D%=)&,')&*R#

2(,04:.0,*#)=#=)0,/D,*R#()5()*)&2,=#%#()*4/2,0%#0)#4=,#/42,#-%&*2,&2)#)#N.2%I

(.%*,#E4)#,#)&2.0,0)R#5()*.0.0,#5)/%#=G0.-%#*,&.2,(.*2,R#-%&04:#0.,#,#0.,#&%#-)&9I

(.%#5%/P2.-%#)#.0)%/F'.-%#0%#5,P*H#

\.=)#0%*#3G0.-%*

! P! &.'(47',-'! 7)! @PCCUDC+! G)/42*.&)!

76.*,-'!)!>>???!P6-6R.)!DW742)+!,)!74*!"Y!7'!('1

@'*.',('!7'!D'7424,*!7*!b*59/4*!'!7*!@)56,47*7'!

1

L*/2*,-'+!b.*,24(2)!D),-'4.)!'-2O!G*.*!)!&.'(47',-'!

&.J54)(+!5*(!,6,2*!W!7'5*4(!.'2),='2'.!)!-.*R*/=)!

74(('O!]6.*,-'!*!',-.'A*+!G)/42*.&)!7'742)6!*!=)5'1

,*A'5!*!-)7)(!)(!('2.'-3.4)(!56,424&*4(!7'!(*87'!7)!

)!CXC!,)!4,-'.4).!7)!'(-*7)`O

Page 85: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

1

2'747*!*)!&.'(47',-'!7)!@PCCUDC+!G)/42*.&)!

,*!A'(-I)!7)!@),('/=)+!()5*7)!*!(6*!54/4-V,1

24*!2)5)!5W742)!(*,4-*.4(-*!7'(7'!*!Q6,7*SI)!

1

2.'-*.4*!U(-*76*/!7'!C*87'!'!&.'54)6+!*/W5!7'!

G)/42*.&)+!)6-.*(!"Y!&'.(),*/47*7'(+!'5!2)5'1

5).*SI)!*)(!:0!*,)(!7)!C4(-'5*O!P(!'(2)/=41

-J5!2),(-.697)!)!CXC+!',-.'!'/'(!*!5*4(!*,-4A*!

1

5'47*+! -.*R*/=*7).*!=3!76*(!7W2*7*(O!P6-.)(!

-)7)(!*-6*,-'(!-*5RW5!7'(7'!*!2),2'&SI)!7)!

D*5'7'+!*&/*6747)(!7'!&W!&'/)(!&.'(',-'(!,)!

a*!5'7*/=*!-'5!65!(45R)/4(5)!Q6,7*5',-*/+!

&.'(',-'(!&67'.*5!*((4(-4.! c! *&.'(',-*SI)!7)!

.'A47)!&'/)!5*'(-.)![)AW.4)!K*/'(O

1

1

5',*A'5! &'/*! ?5&/*,-*SI)! 7)! G.)A.*5*! 7'!

1

*.3+!'5!<6,=)!7'!:00%O!

Page 86: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

! U5! ,)L'5R.)! 7'! :00$+! )!@PC1

CUDC!45&/*,-)6!*!*(('(().4*!7'!2)56,41

U74Q924)! G*/324)! G.)A.'(()+! ,)! 2',-.)! 7'!

<).,*/4(-*+!@/*.4(('!@*L*/2*,-'+!'!65*!7'1

@)5! *! 54((I)! 7'! .',)L*.! '! Q).-*/'2'.! *!

1

<)6!'!'T'26-)6!74L'.(*(!*S\'(!,*!3.'*!7'!

1

1

1

5',-*SI)! 2),(-*,-'! 7)! (4-'! 7*! ',-47*7'+!

1

1

(9L'/!*(!*S\'(!7)!@PCCUDC!,*!5974*O

! P(! .'(6/-*7)(! */2*,S*7)(! Q).*5!

"0)&2.0,0)#7.*4,/

! @),(-.64.! 65*! ,)L*! 47',1

-47*7'!L4(6*/+!2)5!*!'/*R).*SI)!7'!

1

1

*/5',-'! *! 4,(-4-64SI)+! Q)4! 65*! 7*(!

'(-.*-WA4*(! 7*! *(('(().4*! 7'! 2)561

,42*SI)!&*.*!Q).-*/'2'.!*!47',-47*7'!

7)!_.AI)O!U(('!2),<6,-)!7'!'/'5',1

-)(!W!2)5&)(-)!7)!/)A)-4&)+!7'!65!

2),<6,-)!7'!2).'(+!'!7'!65!(/)A*,O!

G*.*! .'2),(-.64.! '(-*! 47',-47*7'!

',-47*7'!Q)4!.'Q'4-)d!',L'/)&'(+!R).1

.\'(+! 2*.-\'(! 7'! L4(4-*+! &*(-*(O! f)1

7)(!)(! 'L',-)(!A*,=*.*5! Q).5*-)(!

&._&.4)(+!2)5!*!2.4*SI)!7'!2*.-*H'(+!

Q)/7'.(+! R*,,'.(+! &*4,W4(+! 2.*2=3(+!

.344564'0&'(%?$%!"&"'$)%=%9@"?'%'%11011")*%'-0'!"&?#*!%+,"

L4(6*/+! *! 47',-47*7'! 7)! _.AI)! Q)4! .'2),(1

1

,42*(! 7'! *(('(().4*! 7'! 2)56,42*SI)+! Q)4!

&)((9L'/!2),(-.64.!65!*5&/)!5*-'.4*/!<).1

1

(4R4/47*7'!*)!@),('/=)+!*&.)T45)61)!7)(!

56,429&4)(! '! 7)(! A'(-).'(!56,424&*4(! 7'!

(*87'+!2)5!74(-.4R64SI)!Q)2*7*!,)(!'(&*1

S)(! '(-.*-WA42)(! 7'! &)/9-42*(! &8R/42*(! '5!

1

1

-4L)!W!5*,-'.1('! ('5&.'!2)5)! .'Q'.J,24*!

7'! 4,Q).5*SI)! '! 2.'74R4/47*7'!74*,-'!7)(!

56,429&4)(! '! 74*,-'! 7)(! L'926/)(! 7'! 2)1

56,42*SI)O!B'(-'!.'/*-_.4)+!65*!*,3/4('!'!

.'-.)(&'2-4L*!7)!-.*R*/=)!.'*/4H*7)O

Page 87: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

7)P-4/%*#0)#$%=4&.-,>?%

! !"#$%&' ()$*%&+! P! K).,*/! 7)! @PC1CUDC!'(-3!'5!(6*!":k!'74SI)O!P!4,Q).5*-4L)!

Q)4!2.4*7)!&*.*!&.)76H4.!'!74L6/A*.!,)-924*(!7'!

4,-'.'(('!7)(!56,429&4)(+!-*4(!2)5)!*&.)L*SI)!

7'!.'26.()(+!/*,S*5',-)!7'!G).-*.4*(+!2)R'.-61

L*4!&*.*!*!2)/6,*!D6,429&4)(+!&.)76H47*!*-.*1

LW(!7)!2),-*-)!74.'-)!2)5!A'(-).'(!'!-W2,42)(!

7'!(*87'+!2)5!)R<'-4L)!7'!74L6/A*.!*S\'(!'T41

-)(*(!7'(',L)/L47*(!,)!4,-'.4).!'!,*!2*&4-*/O

! ,)-.*/%' 01*/)$/%23"+! W! 65*! .'11

-.*/+!2)5!'74-).4*(!.''/*R).*7*(!*!&*.-4.!7'!

2.4-W.4)(!<).,*/9(-42)(!M4,-'.'(('!&8R/42)+!.'1

1

CUDC!7)!F.*(4/!'(-3!'5!(6*!:gk!'74SI)+!*(!

7'! 2)56,42*SI)O! U5! (6*! 2),(-.6SI)! '741

-).4*/+!7'24745)(!&'/*!'(2)/=*!7'!65!-'5*!

7'!(*87'!&8R/42*!*!('.!*&.)Q6,7*7)!*-.*LW(!

7'!A.*,7'(! .'&).-*A',(! *! 2*7*! '74SI)O!P(!

D',-*/!M:"N+!:0!*,)(!7'!CXC!M::N!'!C*87'!

F62*/!M:;N!-.)6T'.*5!',-.'L4(-*(!2)5!&.)1

&.)76H47*(! 2)5! *! 2)/*R).*SI)! 7'! 45&).1

-*,-'(!'(&'24*/4(-*(!'!2)R'.-6.*(!7'!A.*,7'(!

'L',-)(!.'*/4H*7)(!,)(!56,41

29&4)(O!C'6!A.*,7'!5W.4-)+!

*/W5!7'!-'.!('!-).,*7)!5*1

74L6/A*SI)+! Q)4! 45&/*,-*.!

,)(! 56,429&4)(! 65*! 26/1

-6.*!7'!74L6/A*SI)!7'!&'(1

7'! &.)5)SI)! '! *-',SI)! c!

(*87'+!,*!('SI)!aE4LJ,24*(!

D6,424&*4(`+! 26<)! 5*-'1

.4*/!W!-)7)!&.)76H47)!&'/)(!

56,429&4)(O!

! 4.*/#.51.23"+' -I)! 45&).-*,-'!

,)(! /)2*4(! 2)..'-)(O!B)((*! /4(-*!7'! 2),1

-*-)(+!2)5&)(-*!7)(!',7'.'S)(!7)(!5*4(!

.'/'L*,-'(!_.AI)(!7'!(*87'!7)!&*9(+!&'.1

/)2*4(!),7'!('!Q*H!5*4(!45&).-*,-'!'!,'1

-)7*(!*(!G.'Q'4-6.*(!'!C'2.'-*.4*(!D6,41

24&*4(!7'!C*87'+!C'2.'-*.4*(!U(-*76*4(!7'!

^'A4(/*-4L*+!@V5*.*+!@PCUDC!7'! -)7)!

! 0./)+!76.*,-'!-)7)!)!*,)!7'!:00%!)!(4-'!7)!@PCCUDC!&'.5*,'2'6!=)(&'1

45',(*!,'2'((47*7'!7'!2.4*.!65!(4-'!2)5!

5*4(! &)-',24*/47*7'! 7'! *R*(-'245',-)+!

2)5!65*!A*5*!5*4).!7'!.'26.()(!7'!741

L6/A*SI)+!65!,)L)! (4-'! Q)4! .'Q).56/*7)O!

1

&.4)+! 'T2/6(4L)+! 7)-*7)!7'! Q'..*5',-*(! '!

1

/*SI)+!*6T4/4*,7)!,)(!)R<'-4L)(!7*!*(('(1

().4*!7'!2)56,42*SI)O!P!,)L)!',7'.'S)!W!

66678"**)9*8)7"#:75#

Page 88: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

! ;**)**"#.%' <)' .9=#)$*%+! *! &.)176SI)! 7'! 2),-'87)! <).,*/9(-42)! ()R.'! *(!

*-4L47*7'(!7'(',L)/L47*(!&'/*!',-47*7'!Q)4!

)! &.45'4.)! A.*,7'! 45&*2-)! 7*! *(('(().4*!

7'!45&.',(*O!C'5!65!R)5!5*-'.4*/!'(2.4-)!

'! (6A'.47)! ('.4*! &.*-42*5',-'! 45&)((9L'/!

45&/'5',-*.!65*!26/-6.*!7'!-.)2*!'!',L4)!

7'! 4,Q).5*S\'(O! G*.-'! 7'(-'! 5*-'.4*/! Q)4!

74.'-*5',-'!6-4/4H*7)!&'/)(!L'926/)(!7'!2)1

56,42*SI)+!*-.*LW(!7)!',L4)!7'!(6A'(-\'(!

7'! &*6-*+! '(&'24*/5',-'! 76.*,-'! )(! 'L',1

*R*4T)!65!.'(65)!7)!'(&*S)!7'(-4,*7)!,)(!

5'4)(!7'!2)56,42*SI)!*)!@PCCUDC!761

.*,-'!)!*,)!24-*7)d

!"#$%&'>'?"-"

7'7'7'7'7'7'7'7'7'7'

!"#$%&'4.@#."'<"'A"#<)*/)

7'7'7'7'7'7'

,@<."*')'/)&)-.*B)*

7'7'()R.'!b_.65!7'!e'(-).'(7'fE!E'.7'(!D*.'(!M:00%Nd!]'R*-'!()R.'!

7'7'fE!@47*7'!M:00%Nd!D*-W.4*!()R.'!b_1.65!7'!@)5R*-'!c!]',A6'7'fE!]43.4)!M:00%Nd!D*-W.4*!()R.'!/*,S*15',-)!/4L.)!P7).42)!D),-'4.)7'b_.65!7'!e'(-).'(!l!*)!L4L)7'fE!@'*.3!M:00%Nd!D*-W.4*!()R.'!*!7',A6'

Page 89: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

W)Q,2)*#\)/)N.*.N%*

! b*H! &*.-'! *4,7*! 7*(! *-4L47*1

7'(! 7)!@PCCUDC!*! &*.-424&*SI)! '5!

7'R*-'(! &8R/42)(+! 2)5)! ',-47*7'! .'1

&.'(',-*-4L*!7)(!('2.'-3.4)(!'!7*(!C'1

2.'-*.4*(!D6,424&*4(!7'!C*87'+! ('<*5!

1

R/W4*+! ,)!D4,4(-W.4)! G8R/42)! '-2O!X5!

7'(-'(! 7'R*-'(! Q)4! &.)5)L47)! &'/*!

*,)(!7)!CXC+!'5!('-'5R.)!7'!:00%O!P!

&.'(47',-'! 7)! @PCCUDC+! G)/42*.&)!

1

A.*5*! 2),-)6! *4,7*! 2)5! )6-.)(! 7)4(!

&*.-424&*,-'(d!)!('2.'-3.4)!'(-*76*/!7'!

1

F3(42*+!*!56,424&*/4H*SI)!7*!(*87'+!*!

A)(*5)-2.N,*

1

/=)! 2)5! *(('(().4*! 7'! 2)56,42*SI)! W!

2),(-.697)! ,65! &'.5*,',-'! &.)2'(()!

7'! 567*,S*O! f'(-*,7)! &)((4R4/47*7'(+!

1

1

-',(\'(!7)!@PCCUDC+!7'!('.!65!_.AI)!

1

74L6/A*.!'5!('6(!L'926/)(!-)7*(!*(!2),1

1

.'2'.! &*.*! ('6(! 6(63.4)(O! f.*R*/=*,7)!

7'5)2.*-42*5',-'+! &.'-',7'5)(! Q*H'.!

1

1

-4L)(! &*.*! ('.! 2),(47'.*7)! 65! A.*,7'!

(4(-'5*! 7'! (*87'+! 2.'(S*! *! 2*7*! ,)L)!

&.)76-)!L'426/*7)O!G).!'(('(!:0!*,)(!'!

C)R.'! *(! 567*,S*(! *&.'(',-*7*(! *)!

/),A)!7)(!:0!*,)(!7)!CXC+!G)/42*.&)!

1

ai6*,7)! '6! '.*! A*.)-)+! 5'6! &*4! 5'!

5*,7)6!&*.*!*! ('..*!7'!F*-6.4-W!&).1

G)/4)54'/4-'O! D64-*! A',-'! 5)..'6! ,*!

4(()!,I)!*2),-'2'!5*4(+!&).!5W.4-)!7)!

1

&*9(!)Q'.-*!5'742*5',-)!A.*-64-)!&*.*!

Page 90: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

C%:0#-"'"'4B4'%!"#$0!0)'#"'.0%)DEConselho das Secretarias e

Secretários Municipais de Saúde-Ceará-

20COSSEMS

Page 91: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

!"#$$%&""'"()*+'",-.-,-/0-")'"1)*',"+-",2"%345$67687"9',,-(:'/+-")",2"83485675%""""""""""""/'";)/9'"+'";,)(<*"-",2"=>7%$"/'";,)+-(9'!"#$$3"&"'"()*+'",-.-,-/0-")'"1)*',-",2"5=4$%678?7"9',,-(:'/+-/0-")",2">4?#%78?""""""""""/'";)/9'"+'";,)(<*"-"",2"6=4%6%7$$"/'";,)+-(9'

!"#$%&'()*+#*,)-%&$

.//01.//2

Page 92: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará
Page 93: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará
Page 94: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará
Page 95: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

!"#$%&'()"*+'($,()-./"0"1+)2#&3$'(#)4"5/3"2&'(#&6+&-./"7/#"(/2/"/"($##&(8#&/",)5&/,)49":"+3)"#$%&'()"1+$"3$'54)"5&$,;

Faça parte do COSSEMS e comunique-se!

Page 96: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

!"#$%&'()"*+'($,()-./"0"

!"#$%&'('()*)("+'%,$+$-(%'(.$"-/0Conselho das Secretarias e

Secretários Municipais de Saúde-Ceará-

20COSSEMS

Page 97: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

!"#$%"&'()"*+,&

!"#$%&'()*+,-'.'/",012'3/&4/

Page 98: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

!"#$#%&

!"'"($)"*+,-(,.,-/0)1")&2$"-%3-4,1)"53($.3#),-'"1"-,-!,#)1,53-6,($"5-#"-6"7%3

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

$-($3(/!4+.!(+3./-C/'%+.!/0!./,!(+&'4'$3+?!@+3C/(/34+!&+4$!/..$!.'&,$)*+!4/!#/%&+!/!$#J.!$-A,3.!#%+(/..+.!4/!($#$('&$)*+!/38'$4+.!$+!0,3'(7#'+<!D,/!

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

$#%/./3&$4$.!#/-+.!(+3./-C/'%+.!/!&/8/!./,!'37('+!0$%($4+!(+0!,0!/3(+3&%+!4/!4+'.!4'$.!PTU!4/!0$%)+!/!MV!4/!$F%'-WTMMX!Y!#$%&'('#$)*+!4/!VZ!(+3./-C/';

!"#$%&'()*$*+$%,)-

4+!565<!(+3&%+-/!.+('$-<!+%A$3'I$)*+!/!/1/(,)*+!4+.!./%8')+.!4/!.$94/<!4';

./0&1,0(2$)*0&)3(/4'$&)*3,2,*1,2,1%$2&5,2*,*)&%6,78(*",)$-Q0F+%$!./K$!3+&J%'$!$!($%S3('$!4/!($#$('&$)*+!#$%$!+!#-/3+!/1/%(7('+!4+.!(+3./-C/'%+.! 4/! .$94/! 4/! ,0!0+4+! A/%$-<! (+3.&$&$0+.! /..$! %/$-'4$4/! 3+!

./!4/.&$($8$!(+0+!(+3./-C+!#$%&'('#$&'8+!./!(+0#$%$4+!(+0!+.!4/0$'.!4$!

.*+!4+!&%$F$-C+!B!4/!D,/!./K$!'3.&$,%$4+!,0!#%+(/..+!(+3&73,+!4/!/4,($)*+!#/%0$3/3&/<!D,/!#+..$!$F%$3A/%!&+4+.!+.!(+3./-C/'%+.?!O$!0/4'4$!/0!D,/!+!(+3./-C+!./!%/3+8$!B!#+..78/-!/8'&$%!+!/32%$D,/('0/3&+!4+!(+-/A'$4+!/!$!

0,3'(7#'+.<!.+F%/&,4+!3+!'3&/%'+%?

9&/:;&1,*0$*<6/1&(/,;$/%(*=*$)%2,%>?&,)*0(*32(?2,;,*=*32(#$%(*$*2$162@)()*$;32$?,0()-

4+.<!F/0!(+0+!+!#-/3+!/1/%(7('+!4+.!(+3C/('0/3&+.!$4D,'%'4+.<!3+!($.+!4$!@$#$('&$)*+!/0!D,/.&*+!2+'!+%A$3'I$4+!,0!/8/3&+!D,/!0$%(+,!$!$F/%;&,%$!4/../!#%+(/..+<!,0!5/0'3E%'+!4/!@$#$('&$)*+!%/$-'I$4+!/0!4+'.!4'$.<!#$%$!+!D,$-!2+%$0!(+38'4$4+.!&+4+.!+.!(+3./-C/'%+.!PTU!4/!0$%)+!/!MV!4/!

4/!4+!0,3'(7#'+!$&%$8B.!4/!&/0$.!(+0+[!\/A'.-$)*+!/0!5$94/<!@$%&'-C$!4+.!

0+0/3&+.!4,%$3&/!$.!%/,3'>/.!4+!@+3./-C+<!#$..$34+!$!(+3.&$%!3$!$A/34$!4/!$&'8'4$4/.!4+!@+3./-C+!(+0+!#%'+%'4$4/?!"!#/%.#/(&'8$!B!D,/!/0!($4$!%/,3'*+!4+!@+3./-C+!$(+3&/)$!,0!0+0/3&+!4/!($#$('&$)*+!P$#%/./3&$)*+!

4/!5$94/<! '3(-,.*+!4'A'&$-!;!(%'$)*+!4/!/;0$'-.!#$%$!+.!(+3./-C/'%+.<!/3&%/!

4+!#%+K/&+<! .+0/3&/!+.! 4'.#+378/'.! 3+!#%J#%'+!0,3'(7#'+<! (+0+! &B(3'(+.<!

/3(+3&%+.!/.&*+!./34+!A$%$3&'4$.!#/-$!5/(%/&E%'$!4/!5$94/?!H%$&$;./!4/!$)>/.!

(+3&73,+!/!$!($4$!/3(+3&%+!3+8$.!0/&$.!$!./%/0!$-($3)$4$.!.*+!/.&$F/-/(';4$.<!F/0!(+0+!$!#%/#$%$)*+!4+.!3+8+.!(+3./-C/'%+.!D,/!(C/A$%*+?

A$)6B%,0()*$*&;3,1%(*("%&0(*1(;*2$)3$1%&'()*&/0&1,0(2$)-"#J.!$!/&$#$!#%'3('#$-!4$!@$#$('&$)*+<!0,'&+.!KE!2+%$0!+.!$8$3)+.!$-($3)$;4+.[!%/,3'>/.!%/A,-$%/.!/!(+0!D,+%,0!Y!+!D,/!3/0!./0#%/!+(+%%/!D,$34+!./! &S0!,0!390/%+!(+3.'4/%E8/-!4/!(+3./-C/'%+.!#%+8/3'/3&/.!4$!I+3$!%,;

A$&+%'$0/3&/!+!5/(%/&E%'+!4/!5$94/!Y!$8$3)+!/.&/!'3.&'&,74+!$&%$8B.!4/!\/'!

A$%$3&'$!4/!,0$!/.&%,&,%$!073'0$!#$%$!./,!2,3('+3$0/3&+!#/%0$3/3&/<!(+0!

F/0!(+0+!$!#$%&'('#$)*+!/2/&'8$!4/!(+3./-C/'%+.!/0!/8/3&+.!$!378/-!/.&$4,$-!

".! &%S.! (+0'..>/.! KE! /1'.&/3&/.! %/$&'8$%$0!./,! &%$F$-C+!$&%$8B.!4/!8'.'&$.!$+.!#%/.&$4+%/.!4/!./%8')+<!#%+4,I'%$0!%/-$&J%'+.<!/2/&,$%$0!$#%/('$)*+!4$.!(+3&$.!%/2/%/3&/.!$+!$3+!4/!TMMU!4/!2+%0$!4/&$-C$4$!D,/!$&B!/3&*+!3*+!C$;

2+%0$4$!3$!+($.'*+!4/!0,4$3)$!4+!A/.&+%!4/! .$94/<!D,/! 2/I!,0$!$3E-'./!('%(,3.&$3('$4$!4$!.'&,$)*+!4/!.$94/!4+!0,3'(7#'+!#%+#+34+!$-&/%$)>/.!D,/!

(+3C/('0/3&+! $&%$8B.!4+.!8/7(,-+.!4/! (+0,3'($)*+! PK+%3$-! -+($-<!]/8'.&$!

)+!0$'.!'0#+%&$3&/!+F./%8$4+!2+'!$!(+3.&$&$)*+!4/!D,/!+.!(+3./-C/'%+.!/.&*+!/.(-$%/('4+.!/!/1/%(/34+!4/3&%+!4/!.,$.!#+..'F'-'4$4/.!/!4/!2+%0$!$,&^3+0$!+!./,!#$#/-!#$%$!$!(+3.+-'4$)*+!$!565?

!!!!!!!,#0358,-9:#$($'"5-%3-6"7%3------9$(;355$#3-!8"<30-%3-=1$),->3230------?,0&-@"1(&5$,-93#%,#*"-%"-6$5<"-

@3$-%3-A5(B#)"1"-A1"7C,/5$0DEF$,-=1$),-G:"1)3

-----(.0("#$#%3H8,)."$5I(,.

Page 99: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

!"#$%&

'$"()*"+,)+-"$*%&)./0)1*"+)+2)%*/3%45"+,"6+7"16)&8"6+9".%/6+,)+:)6)13"&3/0)1*"+!"./%&+)+!%;,)+)0+!"#$%&<7=

! "#$%&'(#%! )#*+,%! -&! .+/-&! 0#1+2! ,23'+$4+-#%! &2! .#51+'6

7+28',+9! +! :;+'! -&%&$*+-&#;!;2+! %<1,&!-&! 1&;$,=&%! *#2!+! *#2;$,-+-&!3+1+!%&$%,5,',>+?@#!-+!3#3;'+?@#!&!*#$%&:A&$4&!&%*#'(+!-#%!"#$%&'(&,1#%!

6

*#$*&3?@#!;'41+3+%%+1!#!2#-&'#!(&B&2C$,*#!41+-,*,#$+'!-&!+*#23+$(+6

*#4,-,+$#!-#!%&1D,?#!&!-+!%#*,&-+-&9!&! 4#1$E6'#%!&%3+?#%!-&! ,$4&1+?@#!&!$&B#*,+?@#!&$41&!#%!-,D&1%#%!+4#1&%!&$D#'D,-#%!$+:;&'&!4&11,4F1,#G

6

*#$%4+4+$-#!+! &H,%4I$*,+!-&!J!"#$%&'(#%! 0;$*,#$+$-#! 1&B;'+12&$4&9!KL!

7#14+'&*,2&$4#!&!M&D,4+',>+?@#!-#%!"#$%&'(#%!)#*+,%9!:;&!0#1+!&$*+2,6

!"#$%&'()*$*+$%,)-M&'+4+1! +%! +?=&%! -&%&$D#'D,-+%! +41+D<%! -#! 31#N&4#! -&! 7#14+'&*,2&$4#! &!!M&D,4+',>+?@#!-#%!"#$%&'(#%!)#*+,%G

./0&1,0(2$)*0&)3(/4'$&)*3,2,*1,2,1%$2&5,2*,*)&%6,78(*0$*",)$-

6

.+/-&!&!O?@#!.#*,+'!-&!;2+!3#'84,*+! ,$%4,4;*,#$+'!-&!&-;*+?@#!3#3;'+1!&2!%+/-&9!5+,H+!*+3+*,4+?@#!-#%!*#$%&'(&,1#%9!31&*E1,#!+*#23+$(+2&$4#!

7#14+'&*,2&$4#!&!1&+4,D+?@#!-&!"#$%&'(#%!)#*+,%!3+1+!3#4&$*,+',>+1&2!+!3+14,*,3+?@#!3#3;'+1!$#%!KP!5+,11#%!&!KQ!-,%41,4#%!-&!.#51+'9!#$-&!&$*#$641+6%&!&%41;4;1+-+!+!R%41+4<B,+!-&!.+/-&!-+!7+28',+G

9&/:+&1,*0(*;6/1&(/,+$/%(<$)%2,%=>&,)*0(*32(>2,+,<32(#$%(*$*2$162)()*$+32$>,0()-"#2!+!+31#D+?@#!-#!31#N&4#9!&2!+B#%4#!-&!STTL9!3+1+!*#$%41;,1!+!&H&6

666

3+4,D+9!5;%*+$-#!B+1+$4,1!#!+4&$-,2&$4#!-+%!$&*&%%,-+-&%!&!&H3&*4+4,D+%!-#!B1;3#9!+%%,2!*#2#!#3#14;$,>+1!%;3#14&! 4&F1,*#62&4#-#'FB,*#!3+1+!#!1&0&1,-#!B1;3#9!*#2!D,%4+%!+!2&'(#1+1!+!+4;+?@#!-&%%+%!,$%4U$*,+%!-&!3+14,6

-&%4,$+-#!+#!3+B+2&$4#!-&!0+*,',4+-#1&%9!&'+5#1+?@#!-#!2+4&1,+'!-,-E4,*#!

31#*&-,2&$4#%G

?$)6@%,0()*$*&+3,1%(*("%&0(*1(+*2$)3$1%&'()*&/0&1,0(2$)-

6?@#!&!0#12+?@#!-&!JT!',-&1+$?+%!3+1+!+4;+1&2!*#2#!*#$%&'(&,1#%!'#*+,%!&V#;! ',-&1+$?+%! *#2;$,4E1,+%! 3+1+! %&1&2!2#5,',>+-#1&%! '#*+,%9! D,%+$-#!

6

3+1+!+23',+1!&!-+1!*#$4,$;,-+-&!+!&%%+!3#'84,*+G!O'<2!-&%%&%!&H31&%%,D#%!1&%;'4+-#%!:;&!#54,D&2#%9!*#$%4+4+2#%!+,$-+W!*,$*#!*#2;$,-+-&%!&2!31#6

6'(&,1#%!&23#%%+-#%!&!1&;$,=&%!*#2!3+;4+%!&$D#'D&$-#!#%!-&2+,%!%&4#1&%!

-&!2#5,',>+-#1&%9!41#*+!-&!&H3&1,I$*,+9!&!+*#23+$(+2&$4#!2+41,*,+'!-&!+?=&%!'#*+,%G

!).$)*%$/%+,)+!%;,)+)+>45"+!"./%&+,)+!"#$%&?)$0@1/%+A%$/%+!"B6%+,%+'"1*)7%$&"6+?/&*"1+>&#BCB)$CB)+!"%$)6

D"6E+F*%3/%1"+9"G)6+-/&8"-$%1./6.%+9"G)6+

D"6E+2)H/1%&,"+'%$)1*)+-)/(5"8)$0/1/%G"1*)IJ%8""K."0K#$

Page 100: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

!"#$"%&"

'(#)"*+(,-.*/"0.1#(/,+",2"3,*"/,4/5(%"/,+.,!"#$"%&"674

!"#$%&$'()!*+,!%&-.&%$-*+'.&'$&/.0+1+2!3&!&%.)+$'!'$&4!3!&.&43.01$/!&'!&

!53$%%#$%& !.%& (%(63+.%& $& 7(-)+.-63+.%8& !/$!"!%& $*)9&:1;/&'+%%.8& 61)..1&

43+-)+4!1&$%*3!*;5+!&4!3!&+%%.&;&(*+1+2!3&!&)(1*(3!&'.&*$!*3.&4!3!&/.0+1+2!3&.%&!1(-.%&$&*.3-6<1.%&3$%4.-%6,$+%&4$1!&).-%*3("=.&'!&/$-%!5$/&'!&)(1<*(3!&'$&4!29&:&/.%*3!&'$&*$!*3.&,$/&%$&3$!1+2!-'.&'$%'$&>??@8&0(%)!-'.&$-,.1,$3&.%& A.,$-%&!*3!,;%&'!&3$!1+2!"=.&'$&!43$%$-*!"#$%&$/&$%).1!%&$&

'$2&A.,$-%&$&!&/+%%=.&'.&-B)1$.&;&!4.+!3&!%&!*+,+'!'$%&'$&%$-%+0+1+2!"=.&'!&4.4(1!"=.8&,+%!-'.&(/!&-.,!&7.3/!&'$&)(1*(3!&'$&4!2&$&-=.&,+.1C-)+!9

!"#$%&'()*$*+$%,)-:/41+!3&.&-B/$3.&'$&$%).1!%&$-,.1,+'!%&-!%&!*+,+'!'$%&'$&43./."=.&'!&%!B'$&$&43$,$-"=.&'!%&,+.1C-)+!%9

./0&1,0(2$)*0&)3(/4'$&)*3,2,*1,2,1%$2&5,2*,*)&%6,78(*0$*",)$-D.&+-E)+.&'.&!-.&'$&>??@&F!,+!&G(!*3.&$%).1!%&4!3*+)+4!-'.&'!%&!*+,+'!<'$%8&+-)1(%+,$&3$)$0$-'.&/!*$3+!+%&+/43$%%.%&$&4!1$%*3!%9

9&/:+&1,* 0(* ;6/1&(/,+$/%(<$)%2,%=>&,)* 0(* 32(>2,+,<32(#$%(* $* 2$?162)()*$+32$>,0()-D.&!-.&'$&>??H&7.+&4.%%E,$1&!/41+!3&.&-B/$3.&'$&$%).1!%&,+%+*!'!%&4!3!&

53(4.&'$&*$!*3.&7!2+!&!&!43$%$-*!"=.&'!&4$"!&I3!,+'$2&'!&!'.1$%)C-)+!&$&

3$!1+2!'!&-.&%$5(-'.&%$/$%*3$&'$&>??H9&:%& +-%)3+"#$%& 7.3!/&3$!1+2!'!%&'(3!-*$&G(!*3.&/$%$%9&J$+%&$%).1!%&%$& +-%)3$,$3!/8&/!%&!4$-!%&'(!%&%$&

<)+!8&43.%*+*(+"=.&+-7!-*+18&,+.1C-)+!&'./;%*+)!&$&,+.1C-)+!&%$K(!1&+-7!-*+19&&:%&$%).1!%&G($&4!3*+)+4!3!/&3$)$0$3!/&03+-'$%&'.!'.%&4.3&$/43$%!%&'.&

<*3.&'.&L!-).&'.&D.3'$%*$&$&'$,$&3$43.'(2+3&!&4$"!&$/&.(*3!%&$%).1!%&-.&43MK+/.&!-.9

@$)6A%,0()*$*&+3,1%(*("%&0(*1(+*2$)3$1%&'()*&/0&1,0(2$)-

</$3.&'$&!1(-.%&$&.&*3!0!1F.&*$/&!&4$3%4$)*+,!&'$&).-*3+0(+3&)!'!&,$2&/!+%&

43./.,$3&!"#$%&).-*3!&!&,+.1C-)+!&$&!&7.3/!"=.&'$&A.,$-%&)+'!'=.%9&N($&$%*$%&A.,$-%&%$A!/&!*+,.%&$&3$%4.-%6,$+%&4$1!&).-%*3("=.&'$&(/!&%.)+$'!<'$&/$1F.39

8.5#.9"#1",-:*151;"%,+",8"<+.,=1%1"*.,-"#1",8"#"1>"

?9"%(,@.A,!.3.##",2":%1*(B%$.#9(,-"%9",C<*1(#D

,0"$/)/D$"#$"%&"E&(9)"1%D5()

8.5#.9"#1",+",8"<+.,+(,4/9"+(,+(,7."#F

'G#:),2.#)"*.*9.,+.,H:>1+(#1",+(,8I8,+(,7."#F

& O3+!'.& $/& %$*$/03.& '$& >??@8& 4.3& +-+)+!*+,!& '!& J$)3$*!3+!& '!&J!B'$&'.&P%*!'.&'.&O$!368&.&QM3(/&).-%*+*(+<%$&-(/&$%4!".&4$3/!-$-*$&'$&'+%)(%%#$%&%.03$&!%&.(,+'.3+!%&'.&JRJ&-.&$%*!'.8&%$-'.&(/!&+-+)+!*+,!&

<<

O!()!+!&$&Q.3*!1$2!& S/(-+)E4+.%&G($& A6&4.%%($/&(/!&$K4$3+C-)+!&/!+%&

!"#$%&'()*$*+$%,)*0,*$B3$2&C/1&,*0$)$/'(A'&0,-

<

-!&63$!&'$&.(,+'.3+!%9

./0&1,0(2$)*0&)3(/4'$&)*3,2,*1,2,1%$2&5,2*,*)&%6,78(*0$*",)$-

<

THU&/(-+)E4+.%&'.&$%*!'.8&)./&.%&%$5(+-*$%&3$%(1*!'.%V

<

9&/:+&1,* 0(* ;6/1&(/,+$/%(<$)%2,%=>&,)* 0(* 32(>2,+,<32(#$%(* $* 2$?162)()*$+32$>,0()-

<"=.&'.%&$,$-*.%&)./&0!%$&-!&!-61+%$&'!&%+*(!"=.&$&-$)$%%+'!'$%&*;)-+).<!'/+-%*3!*+,!%9&

@$)6A%,0()*$*&+3,1%(*("%&0(*1(+*2$)3$1%&'()*&/0&1,0(2$)-

<

<

<

H:>1+(#1",+",848BJ74B*",2":%",K1#L(,=.//"CM*+.#,-"0"%&L./,N(##./,,

Page 101: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

!"#$%&

'%()"*+,)-$.-)"$/%&*0%*1$-%2*34*%5%,6"*,%*73%&/0%0-*0%*%)-,68"*,%.*("43,/0%0-.*0".*#%/$$".*9/&%*:,/8";*<-$$-,".*="5".*-*>3,("

!"#$"%!&#!'#"!'(&$)&*+&,#-.$+'#/0&#&$$&$#1".22'$#+34#"(+'$#5*!.)&$#!&#"!'6

6(&$)&*+&$#&#7'-&*$8#9#.!:."#;2.*).;"(#&2"#+2"1"(<"2#"=>&$#!&#$"%!&#-'(+"!"$#;"2"#&$$&#;%1(.)',#&*-'(-&*!'#'$#?@A8#B'#&*+"*+',#*"#10$)"#;&("#/0"(.!"6!&#!"$#"=>&$,#"#;2';'$+"#.*.)."(#C'.#"4;(."!"#&#C'2"4#.*+2'!0D.!"$#'0+2"$#&*+.!"!&$# !'# 1".22',# '.+'# &$)'("$# !'# &$+"!'# &#40*.)5;.',# "$$')."=E'# !&#

@"%!&#!"#A"45(."#&#;2.*).;"(4&*+&#"#;"2+.).;"=E'#)'40*.+F2.",#"4;(."*6

.*$+204&*+'#!&#0*.E',#C'2="#&#;'$$.1.(.!"!&#!&#40!"*="#!&#04"#2&"(.!"!&#6

4&*+'#!"#.*+&2$&+'2."(.!"!&8

!"#$%&'()*$*+$%,)-

6

./0&1,0(2$)*0&)3(/4'$&)*3,2,*1,2,1%$2&5,2*,*)&%6,78(*0$*",)$-

9&/:+&1,* 0(* ;6/1&(/,+$/%(<$)%2,%=>&,)* 0(* 32(>2,+,<32(#$%(* $* 2$?162)()*$+32$>,0()-

6

@$)6A%,0()*$*&+3,1%(*("%&0(*1(+*2$)3$1%&'()*&/0&1,0(2$)-

6

?-,)$"*0-*!%@0-*0%*A%4B&/%*0%*9/&%*:,/8"C,%*D%$/,%*E%$#".%*9%.(",(-&".A$%,(/.("*0-*'%3&"*F3/4%$8-.

%G5%&5-.HI%J""K("4K#$

L%$%(%,%@

C*'$-.)%68"*0-*?",)%.*0".*!/.)-4%.*L3,/(/M%/.*0-*!%@0-

"+&*+'$#G#)'22&+"#0+.(.D"=E'#!'$#2&)02$'$#7F#/0&#"#$0"#4F#0+.(.D"=E'#2&+2"+"#"#;'$$.1.(.!"!&#!&#!&$;&2!5).',#"0$3*)."#!&#04"#;'(5+.)"#4".$#)("2"#)'4#2.$)'#.*)(0$.-&#!&#.4;0+"=E'#!&#!:1.+'$#'0#40(+"$#;"2"#'#H&$+'2#!"#$"%!&8#9#'12.H"+'2.&!"!&#!'#0$'#!'$#2&)02$'$#&#!"#;2&$+"=E'#!&#)'*+"$#!"$#!&$;&6$"$#&I&)0+"!"$#&4#)'*C'24.!"!&#)'4#'$#!.$;'$.+.-'$#(&H".$#)'*$+.+0.#04#

6!"$#*"#;2&$+"=E'#!&#)'*+"$8

!"#$%&'()*$*+$%,)-9;2&$&*+"2#'$#!"!'$#;"2).".$#!"#;&$/0.$"#/0&#)"2")+&2.D"#"$#)"0$"$#!"$#!&6

;2')&$$'$#;&("$#.22&H0("2.!"!&$#&*)'*+2"!"$#*"#;2&$+"=E'#!&#)'*+"$8

./0&1,0(2$)*0&)3(/4'$&)*3,2,*1,2,1%$2&5,2*,*)&%6,78(*0$*",)$-B'#;&25'!'#&4#"*F(.$&#JKL#!'$#40*.)5;.'$#!'#?&"2F#+.-&2"4#$0"$#)'*+"$#

C'2"46(<&$#.4;0+"!'$#40(+"#;&('#70(H"4&*+'#!&#+'4"!"#!&#)'*+"$8

9&/:+&1,* 0(* ;6/1&(/,+$/%(<$)%2,%=>&,)* 0(* 32(>2,+,<32(#$%(* $* 2$?162)()*$+32$>,0()-

)'*+"$#!&#H&$+E'#&# +'4"!"#!&#)'*+"$#!&#H&$+E'#!&#0*.!"!&$#H&$+'2"$#!"#

@$)6A%,0()*$*&+3,1%(*("%&0(*1(+*2$)3$1%&'()*&/0&1,0(2$)-9$#C"(<"$#4".$#C2&/M&*+&$#/0&#)"0$"4#"#!&$";2'-"=E'#!"$#)'*+"$#!"#H&$6+E'#!"#$"%!&#$E'N#'#*E'#&*-.',#&*-.'#.*+&4;&$+.-'#'0#*E'#2&4&$$"#!&#;&="$#

6

OB@@,#;&*$E'#"(.4&*+5).",#$"(F2.'#C"45(.",#$&H02'#!&#-.!",#.*!&*.D"=>&$,#

.*+&2*'#!&#)'410$+5-&(,#(')"=E'#&#C2&+&#!&#-&5)0(',#$0;2.4&*+'#!&#C0*!'$,#

!&#*'4&"=E'#!"#;&$$'"#2&$;'*$F-&(#;&('#"(4'I"2.C"!'#;"2"#!&$&4;&*<"2#

6

!N!C*?""$0-,%0"$/%*O-P/",%&*0-*!%@0-

Q-,/*Q@(/%*Q-%&*="#$-&-,/,"#$-H.%30-K(-KP"5K#$

Page 102: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

!"#$%&%'()#$*#+,!-'#$-#.%'/0)%-#$(#

1*2!3%-)%$-$*'#.%'/0)%2-'4#5(#6%75%(#899:;899<# ('# '*2)*/+)%('# "!5%2%;1-%'#$*#'-=$*#$(#>*-)+#*?1*)%*52%-;

)-"#!"-#%"1()/-5/*#*'/)-/@,%-#$*#A()/-3*2%"*5/(#$(#$*;6-/*#$*"(2)+/%2(4#A)-52(#*#-6*)/(#'(6)*#-#2(5'/)!BC(#$(#

-/)-&@'#$-'#)*!5%D*'#-"13%-$-'#$('#,*'/()*'#"!5%2%1-%'#$-#'-=$*#E#6("#-2(3.%"*5/(4#6("#5F&*3#$('#$*6-/*'# 4##1('/!)-# $*"(2)+/%2-4# *'/F"!3(# -# 1-)/%2%1-BC(4# %5/*)%(;)%G-BC(# $('# *&*5/('4# %5/*)3(2!BC(# *H!%3%6)-$-# 2("# -#

I3%-$-#-#"%3%/J52%-4#"*)*2*#*'1*2%-3#$*'/-H!*#-#(!'-$%-#

'!-#,*'/C(K#H!*)#5(#-'1*2/(#AF'%2(#E#*'/)!/!)-BC(#$*#!"-#

$-#*5/%$-$*#E#H!*)#1*3-'#%"1()/-5/*'#2(5H!%'/-'#-!A*)%;$-'#1-)-#(#2(5L!5/(#$('#"!5%2F1%('#2*-)*5'*'#5(#'*/()#

;)%(#"!5%2%1-3#H!*#&*5.-#-#!"-#$-'#5(''-'#)*!5%D*'#-";13%-$-'#H!*#5C(# 3*&*#2(5'%,(#!"#5(&%$-$*# %"1()/-5/*#1-)-#(#'*!#"!5%2F1%(MN

'*2)*/+)%(#$*#O-=$*#$*#P!-%=6-

(6)%,-BC(#$(#'*2)*/+)%(#H!*#/*"#2(5'2%752%-#$-#5*2*''%$-$*#$*#

;

;$*#*"#5(''(#*'/-$(M#Q'1*2%-3"*5/*#5('#$(%'#=3/%"('#-5('4#2("#

;

'*$*4#-#(A*)/-#2(5'/-5/*#$*#2-1-2%/-BC(#1-)-#('#,*'/()*'4#-'#)*!;5%D*'#-"13%-$-'#1)("(&*5$(#-#-1)(?%"-BC(#$('#'*2)*/+)%('#2("#$%'2!''D*'#$('#/*"-'#"-%'#'%"13*'#-('#"-%'#1(37"%2('4#2("(#-#-3(2-BC(#$*#)*2!)'('#1-)-#('#"!5%2F1%('4#$-5$(#"-%'#H!-3%$-$*#

;

;/!5%$-$*#-('#,*'/()*'#$*#"('/)-)*"#'!-'#*?;

/*5.(#2(5&%2BC(#$*#H!*##/*"('#!"#>(5'*3.(#$*#O*2)*/+)%('#)*2(5.*2%$-"*5/*#A()/-3*2%$(#*#)*'1*%/-$(MN

'*2)*/+)%-#$*#O-=$*#$*#P!-)-"%)-5,-

5(#'*5/%$(#$*#2(5'/)!%)4#*"#2(5L!5/(#2("#-#OQOI4#!"-#"*3.()#1(3F/%2-#$*#'-=$*#1-)-#(#>*-)+4#3*&-5$(#'*"1)*#-'#$%'2!''D*'#1-)-#-#>RS4#$*#"-5*%)-#6-'/-5/*#1-)/%2%1-/%&-MN

1)%"*%)(#1()H!*#'(!#"!5%2%1-3%'/-#*#*5/*5$(#H!*#H!-5/(#"-%'#A()/*4#"-%'#1)0$%,-4#@#-#(),-5%G-BC(#$('#"!5%2F1%('4#)*1)*'*5/-)+#"*3.()*'#)*'!3/-$('4#1()H!*#@#(5$*#(#1(&(#&%&*4#(5$*#-'#5*2*''%$-$*'#*#$*"-5;$-'#-2(5/*2*"#*#'*)C(#-/*5$%$-'M#R''(#5C(#@#5*5.!"#$(,"-4#@#!"-#H!*'/C(#1)+/%2-4#13-!'F&*3#*#*5/*5$F&*3#1()#/($('M#O*,!5$(#1()H!*#(#

;;

$('#"!5%2F1%('4#'*L-"#*3*'#1*H!*5('4#"@$%('#(!#,)-5$*'#*#*''*#@#(#1-1*3#A!5$-"*5/-3#$(#

5-#T5%C(M#I#1-)/%)#$*''-#3!/-#1(''(#/*'/*"!5.-)4#1()H!*#1-)/%2%1(#H!-'*#'*"-5-3"*5/*#$*#;

/!$(#5(#H!*#$%G#)*'1*%/(#-('#)*2!)'('4#H!*#@#(#1(5/(#A)-2(#$-'#,*'/D*'4#*#50'#*52(5/)-"('#

H!*# 2(5/*"13-''*# ('#"!5%2F1%('4# H!*# )*A()B-''*# (# OTO#5('#"!5%2F1%('4# (# H!*# $*# A-/(#-2(5/*2*!4#*#/($-'#-'#6-5$*%)-'#*"#/()5(#$*#-BD*'#*#%5&*'/%"*5/('#5('#"!5%2F1%('#/*"('#(#

('#"!5%2F1%('MN

'*2)*/+)%(#*'/-$!-3#$*#O-=$*

$(#"!5%2F1%(#$*#U*)%!/-6-#1()H!*#A(%#3+#(5$*#)*2*6*"('#%5A()"-BD*'4#

('#/@25%2('#$*#'-=$*4#(5$*#1!$*"('#"*3.()-)#5(''(#/)-6-3.(#*#%52)*;"*5/-)#2("#/@25%2-#*#)*'1(5'-6%3%;

$-$*#5(''-'#"*/-'MN

'*2)*/+)%-#$*#O-=$*#$*#U*)%!/-6-

!"#$%&"#%'()*)+'%&',-.%#%/$0)1#%2.&0+'%3'%4566786947:

Page 103: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

!

!

"#$%&'&"#()*+,-&%*+ ./.%&0#+ 1#+ '*12-&3!

'&$-$4&#3+.5.%&0#3+6*-0.+4$#17.+#%-#()*+

!

5*$+".$+'#"&%#+"#$#+*3+,-1&'8"&*39+2-.+#1%.3+.$#+"*$+-,#+3:$&.+

6&3%;$&'#9+ ".5#+ 2-.3%)*+ 7#+ .3%$-%-$#+ 7.+ "$.3%#7*$.39+ .+ 1#7#+

,#&3+ <-3%*+ 2-.+ 3.<#+ ".$+ '#"&%#=+ >*&+ %)*+ &,"*$%#1%.+ #+ "#$%&!

,#3+".$'#"&%#+"*$+,-1&'8"&*9+$."#33#7*+/-17*+#+/-17*9+3*?+

#+'**$7.1#()*+7#3+'**$7.1#7*$&#3+$.4&*1#&3+7.+3#@7.=+A1%)*+

"$#+,&,+#+4$#17.+,#$'#+/*&+#+7.3'.1%$#5&B#()*+"#$#+*+'&7#!

7)*9+".$+'#"&%#+.,+'#7#+,-1&'8"&*9+2-.$+3.<#+1#3+'&$-$4&#3+

.5.%&0#39+2-.$+3.<#+1#+"#$%&'&"#()*+7*+.3%#7*9+1#+%$#13/.$C1'&#+

.3/.$#3+ 7.+ 4.3%)*+ '*,+ $.5#()*+ $.3*5-?&5&7#7.+ 1#+D%.1()*+

EF3&'#9+&1'5-3&0.+1*+.1%.17&,.1%*+7*+2-.+:+-,+,*7.5*+7.+

#%.1()*+G+3#@7.=H

I.1&+J*?$.9+

*$&.1%#7*$#+KL+MNAO

,.56*$.3+ &13%&%-&(P.3+

'$&#7#3+ "#$#+ #<-7#$+ *3+

3.'$.%F$&*3+,-1&'&"#&3+7.+

3#@7.=+ J&14-:,+ "*7.+ 7&!

,&1-&$+#+&,"*$%Q1'&#+7*3+7.,#&3+"$.3&7.1%.3+

#%-#5+#7,&1&3%$#()*+%.,+3&7*+7.+3-,#+&,"*$!

%Q1'&#9+3*?$.%-7*+'*,+$.5#()*+G+'$&#()*+7#+&1!

/$#.3%$-%-$#+"#$#+$.'.?&,.1%*+7*3+'*5.4#3+2-.+

0C,+7*+&1%.$&*$9+,-&%#3+0.B.3+7.3*$&.1%#7*39+

.+#3+ $.-1&P.3+#,"5&#7#3+ %$#B.,+&1/*$,#(P.3+

"$#+2-.+.5.3+'*13&4#,+$.'-$3*3+1)*+3;+#+180.5+

!

'#$"*+%.,+/.&%*+-,+%$#?#56*+.R'.5.1%.9+'*,+#+

.3%$-%-$#+.+'*,+3-#+"$.3.1(#+,#$'#1%.+<-1%*+

#3+"$./.&%*39+'*,+.33#+,#1.&$#+3&,"5.3+.+6-!

,&57.+7.+.3%#$+#*+ 5#7*+7*3+'*5.4#3+.+7.+1*3+

7#$+#"*&*+&1%.4$#59+*+2-.+0.,+,.56*$#17*+#3+

'*17&(P.3+7.+%$#?#56*+7*3+4.3%*$.39+#+*?%.1!

./.%&0*-+#+#"$*R&,#()*+'*,+*+.3%#7*+.+ %.,+

%$#?#56#7*+'*1<-1%#,.1%.=H

,#&3+<-1%*39+3.+5&4#,+,#&39+/#B.,+"$*<.%*3+

!

%#,?:,+'*,+#"*&*+7*+3.'$.%F$&*+.3%#7-#59+

"$.3.1%.+1*3+.0.1%*39+,.56*$*-+,-&%*+#+

3#@7.+7*+,-1&'8"&*=H

!

$.3+.+.3%F+3.,"$.+#+/$.1%.+7#3+"$&1'&"#&3+,-7#1(#3+1#+F$.#+7#+3#@7.+.+%*7#3+

#3+7.'&3P.3+"*58%&'#3+"#33#,+%#,?:,+".5#+"#$%&'&"#()*+7*3+3.'$.%F$&*39+".5#+

*"&1&)*+7.5.39+".5#+$.#5&7#7.+.,+2-.+.5.3+%$#?#56#,+1*3+,-1&'8"&*39+.+,#&3+

2-.+1&14-:,9+2-.,+%.,+#+3#?.7*$&#+7.+7&B.$+*+2-.+:+?*,+:+2-.,+.3%F+5F+1*+

!

7#7.+2-.+$."$.3.1%#+*3+#13.&*3+7*3+3.'$.%F$&*3+.+&17&$.%#!

,.1%.+*3+#13.&*3+7#+"*"-5#()*9+2-.+"$*'-$#+1*3+4.3%*$.3+

&,"*$%#1%.+"*$2-.+'*14$.4#9+.3%&,-5#9+,*%&0#+.+#";&#+*3+

3.'$.%F$&*39+/#B.17*+'*,+2-.+.5.3+1)*+3.+3&1%#,+3*B&16*3+

.+#%-.,+'*,+,#&3+/*$(#=H

S,#'-5#7#+>.$$.&$#9+

'**$7.1#7*$#+7.+D%.1()*+EF3&'#+7#+OAOD

.3%*-+1#+%.$'.&$#+4.3%)*9+3.4-17#+'*13.'-%&0#+1*+,-1&'8"&*+

7.+N.7.1()*9+.+3&1%*+-,+#"*&*+,-&%*+4$#17.9+1#3+#33.33*$&#3+

%:'1&'#9+<-$87&'#9+7.+'*,-1&'#()*=+O.,"$.+

2-.+%&0.+#54-,#+7@0&7#+/-&+"$*1%#,.1%.+

#%.17&7#=+D'6*+2-.+*+"$.3&7.1%.+7.0.$&#+

3.$+$..5.&%*=H

>F%&,#+M#$0#56*9+

3.'$.%F$&#+7.+O#@7.+7.+N.7.1()*

*3+3.'$.%F$&*3+,-1&'&"#&3+.,+%*$1*+7.+7&3'-33P.39+"$*!

/*$%#5.'.$+.3%.+,*0&,.1%*9+%*$1#17*+*+M*13.56*+'#7#+

7&#+,#&3+*-3#7*+1#+7./.3#+7*3+&1%.$.33.3+7*3+'&7#7)*3+

#%$#0:3+7*+/*$%#5.'&,.1%*+7#3+"*58%&'#3+,-1&'&"#&3=+

.R!"$.3&7.1%.+.+

Page 104: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

!"#$%&'()*+,-.-()/.-(01(2134/5,3(2*66-37(

8,+19:-;(8/<,0(!,3)=1+

!"#$%"&"#'()*&#*%"#%#*%+,%#-&#."#/&0$%#-&#12#('%)3#4+(-.(0"&'5&6#*%"&7(#(#+&8./&'&)*&+6#/9/&'-%#:.&)5;&)#*%"%#(#,())(<&"#-%#5&",%6#(#-&)*%=&+5(#-%#("%+#

9'5&9+("&'5&#'%/(3#>5&'7?%#@#&),0A'-9-(#

*&'(6#/9/&'-%#5%-()#()#9-(-&)#-&#)&.#,&+)%'(<&"3#B))&#5+(=(0$%#C#D+.5%#-&#."(#&:.9,&#).,&+/9)9%'(-(#,%+#E+9('#F9,&#

!"#"$%&# !"#"$'&# !"#"$()%*#

!"#$%&>,[email protected](!1@,A7("3B@/61++/C(DEEFG(H=IFG(J-5K0,/8,+19:-(1(+-61,+-;($,L1(#1,B=

G%'-+&)#:.&#/9/&#"%-&)5("&'5&6#"()#&'D+&'5(#*(-(#."#-%)#,+%=0&"()#-%#*%59-9('%#*%"#."#9'/&'*H/&0#=%"#$."%+3#B0(#(*$(#."#(-/&+)I+9%#'%#9')5+.5%+#-&#(.5%J&)*%0(#:.&#*%'5+(5(6#."#$%"&"#%=*&*(-%#&#D&+%K3

J8&>-@(M1B+-7N,+BO3,/(P-0+,B*1.

('%)#*('5('-%#&"#*%+%)#-&#9<+&8()#*(5L09*()#&#,+%5&)5('5&)6#&0(#$(/9(#

&#0H+9*()#-%#:.&#%./9.#'(#9'DM'*9(#&#

,+9"&9+%#-9)*%#D%9#,+%-.K9-%#,%+#N&0)%#O%')&*(#&#5&/&#(++('8%)#-&#B-.(+-%#F%.5%#P&5%3#>)#"Q)9*()#D%+("#

&#N&0)%#O%')&*(6#&#9'*0.9#*('7;&)#

P()*9"&'5%3#

Page 105: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

!"#"$%&'(# !"#"$)*# !"#"$)*#

!"#$%"&'()*+),-&.+)/01+/2345+6)"(+780)/008&*8))))))))))))))))))))))))))))

!""#$%#&'(')*'+,*-$.#'(/0.,'$,'1)-"','-"#$2,'%,'-*,+'.,$.#%#')*-'2+(3)-'4'+)%#5-&'4'60,"7$.0-'#'4'.+)#"%-%#'%#')*'*,*#$2,'8092:+0.,'0$#91)#.;6#"<'

#'8)*0"%#'.,92)+#0+-'1)#'#*=-+.-'%-'

9#)'*-+0%,&'1)#'%#9-/-+#.#)'>)$2,'%#'9#)9'9,$8,9'%#'3":+0-'%,',)2+,'"-%,'%,'!2"?$20.,&'#'-.-=-'9#'2,+$-$%,')*'%,9'/+0$.0/-09'$,*#9'%-'.,$1)092-'%,'@80"#<'!2+-6(9'%-'/#$-'%-'*-09'A-*,9-'#9.+02,+-'"-20$,B-*#+0.-$-'%-'

/,%#'9#+'2C,'9)+/+##$%#$2#'1)-$2,'-'

!"#$%94&34()941:0834(/2345+6)#-5;-&-+)<440=

D#)$0$%,'/#"-'/+0*#0+-'6#5',9'.,$2,9'

2+-%)EC,&'/#",'/,#2-'F#,$-+%,'G+:#9&'#92#'6,")*#'9#'%#92-.-'/,+'2+-5#+'4'2,$-'-'+0.-'2#9902)+-'"02#+H+0-'%#')*-'%-9'*-0,+#9'-)2,+-9'0$3"#9-9'%,'9(.)",'

+#0$6#$2-'-'$-++-206-'%#'A,+*-'-'1)-9#'9#*/+#'A)30+'%-'%#9.+0EC,'%#')*-'-EC,'"0$#-+<'!9'A-"-9&',9'/#$9-*#$2,9'#'-9'-EI#9'%#'9#)9'/#+9,$-3#$9'9C,'+##*=-+-"8-%,9&'#'%092+0=);%,9'%#'A,+*-',+030$-"&'*)02-9'6#5#9'

#J#*/",&'$,'1)-"'$C,'8H'9#1)#+')*-'-EC,'/+,/+0-*#$2#'%02-&'2,%,'#"#'9#'/-99-$%,'%)+-$2#')*-'.-*0$8-%-'/#",9'>-+%0$9'/K="0.,9&'/+##$.80%-'/,+'

%#9/+#5-%,9'/#"-'$-++-206-'2+-%0.0,$-"&'.,*,','90*/"#9'-$%-+'%#')*'.-+-*)>,'/#",'.8C,<

9>!-3308)?4@$4*5-;4)/1+5+&38)))))))))))))))))))))))))))

.,*/+,6-'9#+')*'%,9'*#"8,+#9'*K90.,9'=+-90"#0+,9'%,9'K"20*,9'LM'

N2+-$3#+9O&'-"(*'%#',)2+-&'.8-*-%-'

9#+'.,$90%#+-%-')*-'%-9'*#"8,+#9'*K90.-9'%,'-$,<'P#*'/#3-%-'+#33-#'#'

#$.,$2+-99#'-'P+,/0.H"0-<'!9',)2+-9'Q'9#3)#*')*-'"0$8-'/,/'9#99#$2092-'#&'9#'/,+')*'"-%,'9C,'*-09')9)-09&'>H'9#'*,92+-*'*-09'-.#02-9'/#",',+R)2'

Page 106: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará

!"#$%&

Page 107: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará
Page 108: Sustentação 24 / Revista do Conselho das Secretarias Municipais de Saúde do Ceará