Proposição de um índice de desempenho em saneamento e suas contribuições para o estudo da disseminação de doenças: uma abordagem em municípios do estado de Pernambuco, Brasil

Abstract

Environmental health is directly related to the integrality and maintenance of basic sanitation services, which can be included in four infrastructures: water distribution network, sewage sys-tem, solid waste management and urban drainage. Among the many benefits guaranteed by sanitation services, the decrease in the number of hospitalizations in health systems can be highlighted, opening precedents for conducting studies aimed at analyzing relationships between sanitation and the spread of diseases, such as diseases related to inadequate environ-mental sanitation (DRIES). Most municipalities in Pernambuco show low coverage rates of sanitation services, a situation found in the sanitation rankings prepared by the Instituto Trata Brasil (ITB) and the Brazilian Association of Sanitary Engineering (ABES). Given this perspective, this research aimed to use indicators and thus obtain a Sanitation Performance Index (IDS) capable of synthesizing information about the sanitation sector and helping to understand the dissemination of DRIES in municipalities in the State of Pernambuco. The methodology used involved the following steps: selection of sanitation indicators; data collection; application of criteria for filtering the municipalities analyzed; weighting of indicators; calculation of the index; classification; ranking of municipalities; and integration of health indicators (hospitalization rates) with the sanitation index in order to analyze possible relationships. Overall, the results showed that 70% of the municipalities analyzed were classified with critical and unsatisfactory performance indices; whereas, considering the share of municipalities in the total analyzed by mesoregion, the Sertão and the Metropolitan region of Recife had the largest number of municipalities within the critical and unsatisfactory classes; there was a trend of higher DRIES rates and lower IDS values in small municipalities compared to the others; and that municipalities with higher priorities in decision-making were characterized as small and disposed in regions that express climatic, social or political-administrative weaknesses. It is expected that the results generated through this research can contribute to the understanding of performance in municipal sanitation and DRIES in the different contexts explored, assisting in the planning of actions and decision-making processes aimed at priority municipalities or regions.