The National Supplementary Health Agency (ANS) is going to launch this year a certification to recognize health plans that promote proper delivery and combat the high rate of unnecessary cesarean sections in the private health network.
The forecast is that the norm will be evaluated and approved by the collegiate board of the agency in the first meeting of the year, which will be held on Monday (16).
The Certification Manual for Good Practices in Proper Childbirth, which defines the criteria for recognition, has already undergone public consultation.
The certification is one of the results of the Movimento Parto Adequado, an ANS initiative in partnership with the Institute for Healthcare Improvement (IHI) in the United States and Hospital Israelita Albert Einstein.
The project started in 2015 with the aim of engaging health operators and hospitals in the adoption of care models that value normal delivery and reduce the number of cesarean sections without clinical indication.
Brazil has one of the highest cesarean rates in the world. In 2021, the overall index was 57%. If only births performed in the private network are analyzed, the percentage of cesarean sections exceeds 80%.
The World Health Organization (WHO) considers that the adequate rate of cesarean births is 10% to 15%.
In the eight years of the Movimento Parto Adequado, 125 hospitals and 68 operators participated in at least one of the phases of the project. According to Angélica Carvalho, deputy director of sectoral development at ANS, the idea is that the experience accumulated in the project will serve as a basis for other operators, whether or not participating in the movement, to be able, when seeking certification, to adopt better practices in care to the pregnant woman.
“In the project, we held tutorials with participating establishments and operators and built protocols.
The purpose of certification is for all operators to be able to consult these protocols and carry out their activities independently of tutoring”, he says.
She explains that the quest for accreditation will be voluntary, but says she hopes that companies seek the seal as it is an important indicator of quality for customers. “Companies that volunteer for certification will be verified by accrediting entities authorized by the ANS. Whoever adheres will earn a score on the IDSS (Supplementary Health Performance Index)”, says Angélica.
According to the certification manual, operators will be evaluated on seven requirements: planning and technical structuring, use and dissemination of evidence-based practices, interactions centered on women and children, monitoring of the gestational and puerperal cycle, integration between operator and hospital , quality monitoring and evaluation, and innovative value-based compensation models.
In each of the seven requirements, the operator will have a set of essential (mandatory) items for certification and other complementary and excellent ones. According to the level of compliance with these items, the operator can be certified at three levels: basic (level 3), intermediate (level 2) and full (level 1).
The essential items must be respected at all levels of certification. For basic certification, the company must also meet 20% of the excellence items, among other criteria. At the intermediate level of accreditation, it will be necessary to reach 50% of the excellence indicators and, for certification at the full level, this percentage must be 80%.
Among the dozens of items that will be checked are the operator’s conduct in cases of pregnant women who try to schedule a cesarean section without clinical indication before the 39th week of pregnancy, the provision of information to patients about normal delivery based on scientific evidence, the formalization, together with hospitals, of pain management protocols, and the guarantee of having, in its accredited network, hospitals with a minimum multidisciplinary team on duty for obstetric and neonatal care.
The certification will last for two years and, for its renewal, the operators will have to monitor three macro-indicators, with goals for each of them: increase by 6% the proportion of vaginal deliveries and reduce, also by 6%, the rates of women in potentially life-threatening conditions and admission of infants to the NICU.
If the operator does not reach these targets, it will not automatically lose certification, but the indicators will be used by ANS to monitor the company’s performance.
According to Angélica, the agency plans to expand, in 2024, the certification program to hospitals and other supplementary health service providers, such as doctors and clinics. With this, it will be possible to know if a maternity hospital or obstetrician follows the requirements for valuing normal childbirth.
Source: CNN Brasil
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