Financiamento, medidas de enfrentamento e mortalidade por Covid-19 em municípios de fronteira internacional do Paraná

Abstract

The Covid-19 pandemic, an infection caused by the Sars-Cov-2 coronavirus, was declared a global emergency by the World Health Organization (WHO) in January 2020, constituting the largest and most significant epidemiological event of the last 100 years. In Brazil, there were over 700,000 deaths, many of which could have been avoided if the federal sphere had acted to coordinate its containment. This present study, of a cross-sectional nature with a quantitative approach, aimed to analyze the funding, containment actions, and mortality due to Covid-19 in the nine municipalities that are part of the 9th Health Regional of Paraná (Foz do Iguaçu, Medianeira, Matelândia, Missal, Itaipulândia, Ramilândia, Santa Terezinha de Itaipu, São Miguel do Iguaçu, and Serranópolis do Iguaçu). The research was conducted based on data obtained from public access information systems such as the System of Information on Public Health Budgets (SIOPS), the National Health Fund (FNS), the Transparency Portal, and the websites of the municipalities' local health departments within the study area, the National Register of Health Establishments (CNES), and the Paraná State Health Department (SESA). The results showed significant federal and state resource allocation to the nine municipalities in the years 2020 and 2021, with a notable per capita variation. Regarding the use of local resources in healthcare, all municipalities met the minimum required by law, but except for Medianeira and Itaipulândia, which increased resource allocation during the pandemic, the others decreased the volume of their own resources invested in healthcare, and few returned to the pre-pandemic level in the years following it. Regarding containment actions, there was a certain uniformity among the municipalities, as all of them devised contingency plans, established mechanisms to monitor the pandemic's progression, and took measures to ensure social distancing and prevent disease spread. However, due to the autonomy of municipal leaders to decree measures within their territories, these measures were not always implemented simultaneously, potentially reducing their effectiveness given the proximity between the municipalities. Foz do Iguaçu, as an international border city,implemented sanitary barriers at specific points, such as the airport, bus terminals, tourist spots, and bridges connecting neighboring countries. The Covid-19 mortality in the 9th Health Regional was 4.60 per thousand inhabitants, higher than the state average of 4.08 per thousand inhabitants and the national average of 3.36 per thousand inhabitants. Among the studied municipalities, the highest mortality and lethality rates occurred in Santa Terezinha de Itaipu. Thus, it is concluded that the amount of resources provided by the state and national spheres allowed municipalities to reduce their own financial contributions during the pandemic. However, the higher mortality rate in the 9th Health Regional of Paraná might be related to its status as a border region. Therefore, it is suggested to have clearer criteria for resource allocation to municipalities and information systems that enable better monitoring of the use of public funds in healthcare.