SN 37 - Part 1 - State - Plan - MG - 2018-1-150

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GOVERNMENT OF THE STATE OF MINAS GERAIS

STATE SECRETARIAT OF HEALTH
RESOLUTION CIB-SUS/MG No. 2,846, OF DECEMBER 5, 2018.
Approves the Care Network Plan in
Oncology - Diagnosis and Guidelines -
for the State of Minas Gerais.
The Bipartite Interagency Commission of the Unified Health System of the State of Minas Gerais - CIB
SUS/MG, in the use of its powers conferred on it by art. 14-A of Federal Law No. 8,080, of 19
September 1990, and art. 32 of Federal Decree No. 7,508, of June 28, 2011 and considering:
- Federal Law No. 8,080, of September 19, 1990, which provides for the conditions for promotion,
health protection and recovery, the organization and functioning of the corresponding services;
- Federal Law No. 8,142, of December 28, 1990, which provides for community participation in the management
of the Unified Health System/SUS and transfers
intergovernmental financial resources in the health area;
- Complementary Law No. 141, of January 13, 2012, which regulates § 3 of art. 198 of
Federal Constitution to provide for the minimum amounts to be applied annually by the
Union, States, Federal District and Municipalities in public health actions and services; establishes the
criteria for apportionment of funds from transfers to health and rules for inspection, evaluation
and control of health expenditures in the 3 (three) spheres of government; repeals provisions of the Laws in
8,080, of September 19, 1990, and 8,689, of July 27, 1993; and makes other arrangements;
- State Law No. 13,317, of September 24, 1999, which contains the Health Code of the State of
Miners General;
- Federal Decree No. 7,508, of June 28, 2011, which regulates Law No. 8,080, of September 19, 1990, to provide
for the organization of the Unified Health System - SUS, the
health planning, health care and inter-federative articulation;
- Ordinance GM/MS No. 2488, of October 24, 2011, which approves the National Care Policy
Primary Care, establishing the review of guidelines and norms for the organization of Primary Care,
for the Family Health Strategy/ESF and the Community Health Agents Program/PACS;
- Ordinance MS/GM nº 874, of May 16, 2013, which establishes the National Policy on Prevention and
Cancer Control in the Health Care Network for People with Chronic Diseases within the scope of the
SUS;
- Ordinance SAS/MS nº 140, of February 27, 2014, which redefines the criteria and parameters for
organization, planning, monitoring, control and evaluation of health facilities
1
qualified in specialized care in oncology and defines the structural conditions,
functioning and human resources for the qualification of these establishments within the scope of the
Unified Health System (SUS);
- Deliberation CIB-SUS/MG No. 2144, of July 15, 2015, which approves Diagnosis and
Guidelines for the Action Plan of the Oncology Care Network for the State of Minas Gerais;
- CES/MG Resolution No. 016, of December 12, 2016, which provides for the approval of the Plan
State of Health of Minas Gerais for the quadrennium 2016-2019;
- Official Letter No. 307/2015 - CGAPDC/DAET/SAS/MS, which analyzes the Oncological Action Plan of the
Minas Gerais state;
- the need to review the current action plan; and
- the approval of CIB-SUS/MG at its 248th Ordinary Meeting, held on December 5,

2018
RESOLVES:
Art. 1 - The Oncology Care Network Plan - Diagnosis and Guidelines - is approved for
the State of Minas Gerais, pursuant to Annex I and II of this Resolution.
Art. 2 - The already qualified health establishments that have not yet been rehabilitated will be
reassessed according to the deadlines and criteria set out in Ordinance SAS/MS No. 140/2014, in order to
be re-qualified within the scope of the Unified Health System.
Art. 3 - Resolution CIB-SUS/MG No. 2144, of July 15, 2015, is hereby revoked.
Art. 4 - This Resolution enters into force on the date of its publication.
Belo Horizonte, December 5, 2018.
NALTON SEBASTIÃO MOREIRA DA CRUZ

SECRETARY OF HEALTH AND
CIB-SUS/MG COORDINATOR
ANNEXES I and II OF RESOLUTION CIB-SUS/MG No. 2,846 OF DECEMBER 5, 2018 (available on the website
www.saude.mg.gov.br/cib).
two
ANNEX I OF RESOLUTION CIB-SUS/MG No. 2,846, OF DECEMBER 5, 2018.
ONCOLOGY CARE NETWORK PLAN
Diagnosis and Guidelines
STATE SECRETARIAT OF HEALTH OF MINAS GERAIS 2018
3
Nalton Sebastião Moreira da Cruz
SECRETARY OF HEALTH STATE
Daniel Guimaraes Medrado de Castro
ASSISTANT SECRETARY OF STATE FOR HEALTH
Lisandro Carvalho de Almeida Lima
OFFICE HEAD
Marcia Faria Moraes Silva
UNDER SECRETARY FOR HEALTH POLICIES AND ACTIONS
Rodrigo Fabiano do Carmo Said
UNDER SECRETARY FOR SURVEILLANCE AND HEALTH PROTECTION
Wandha Karine dos Santos
UNDER SECRETARY FOR HEALTH REGULATION
Karina Rocha de Oliveira Taranto
SUPERINTENDENCE OF HEALTH CARE NETWORKS
Daniela Aguiar Alberto

PHARMACEUTICAL ASSISTANCE SUPERINTENDENCE
Ana Paula Medrado de Barcellos
SUPERINTENDENCE OF PRIMARY HEALTH CARE
Rejane Balmant Lyrics
SUPERINTENDENCE OF EPIDEMIOLOGICAL, ENVIRONMENTAL AND SURVEILLANCE

WORKER'S HEALTH
Rilke Newbie Publius
HEALTH SURVEILLANCE SUPERINTENDENCE
Zeila de Fatima Abrao Marques
ASSISTANCE PROGRAMMING SUPERINTENDENCE
Driving group:
Berenice Navarro Antoniazzi (Coordinator of the Evaluation and Surveillance Program of the
Cancer - VAP
Cristiane Barbosa Marques (Specialized Actions Board)
Cynthia Helen de Lima Saúde (Specialist in Health Policy and Management
Health/CAC/SRAS/SUBAS)
4
Daiana de Carvalho Souza (Technical Advisor to the Thematic Actions and

strategies)
Galzuinda Maria Figueiredo Reis (Consultant physician)
Iveta Malachias (Director of Assistance Studies and Analysis/SUBGR/SES-MG)
Juliana Ávila Teixeira (High Complexity Coordination)
Valéria Batista da Silva (Specialist in Health Policy and Management/Technical Advisory)
CAC/SRAS/SUBAS)
Technical Support Team
Alcione Elaine Silva Campos (Director of Studies and Assistance Analysis/SUBGR/SES)

Alice Martino de Carvalho (Directorate of High Cost Medicines/SUBPAS)
Ana Paula Torres de Camargos (Coordination of Specialized Outpatient Care)
Camila Cátia Vilela (State Urgency and Emergency Coordination/SUBPAS)
Carolina Guimarães Marra Nascimento (Technical Reference of the
Health)
Daniela Souzalima Campos (Health Promotion Director)
Débora Cristina Lara Conrado (Coordination of Specialized Outpatient Care)
Denise Dutra (COSEMS)
Evandro Maranhão Fagundes (Consultant physician)
Fernanda Vilarino Jorge (Oral Health Coordination/SUBPAS)
Flávia Adriana dos Reis Silva (Health Services Surveillance Directorate/SVS)
Ingrid Melo Gonçalves (CERAC-MG/SUBREG)
Jacqueline Silva Santos (Oral Health Coordination/SUBPAS)
Joseane Mariluz Martins de Carvalho (Technical Reference of the Directorate of Health Promotion)
Layla Madureira Duarte (Coordination of Specialized Outpatient Care)
Leandro de Abreu Vieira (Health Services Surveillance Directorate/SVS)
Lidiane Geralda Costa Martins (Director of Programming and Integrated Agreement)
Marcela Augusta Teixeira (Health Information Directorate/SUBREG)
Marcelo Almeida Campos (SMSA-BH)
Márcia Dayrell (Manager of the High Complexity Municipal Center / SMS-BH)
Márcia Moreira Morais (COSEMS Technical Advisor)
Margarete Aparecida dos Santos (PAV/SVPS)
Maria Aparecida Rodrigues Soares (Technical Reference of the Directorate of Care Policies
Primary Health Care)
Maria Auxiliadora Da Silva Pinto (Director of Studies and Analysis
Assistance/SUBGR/SES-MG)
Maria Rita Pereira da Silva Lima (Technical Reference of the Care Policy Directorate
Primary Health Care)
Maurício Durval Sá (COSEMS)
Mayla Magalhães de Souza (Director of Primary Health Care Policies)
Michelle Souza Costa (Women's Health Care Coordination/SUBPAS)
Natália Paludeto Guerreiro (Technical Reference of the Directorate of Primary Health Care Policies)
Nathalia Ribeiro Mota Beltrão (Technical Reference of the Directorate of Health Promotion)
Nayara Resende Pena (Technical Reference of the Directorate of Health Promotion)
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Priscila de Faria Pereira (Technical Reference of the Directorate of Primary Care Policies to
Health)
Príscila Guedes Santana Ursine (State Urgency and Emergency Coordination/SUBPAS)
Rejane Valgas Oliveira Galvão (COSEMS)
Rodrigo Costa (SISCAN-WEB/SVPS)
Rosa Elstner (SRS Sete Lagoas)
Sílvia Marquez Henriques (High Complexity Coordination/SUBPAS)
Tatianna Mendes da Rocha (Coordination of Specialized Outpatient Care)
Wanda Taulois Braga (Oral Health Coordination/SUBPAS)
summary
1. PRESENTATION ..................................................... ................................................................ ................... 11
PART I: ............................................... ................................................................ ................................................ 13
CANCER SURVEILLANCE: CANCER SITUATION IN MINAS GERAIS............ 13
2. ONCOLOGICAL CARE PLAN OF MINAS GERAIS – CANCER

SURVEILLANCE ..................................... ................................................................ ................................................................ ..... 16
3. STATE PROFILE OF ONCOLOGICAL CARE ACCORDING TO 38 RHC MG

26
4. EFFECTIVENESS OF ASSISTANCE ACCORDING TO THE ORIGIN OF THE

REFERRAL.................................................... ................................................................ ......................... 33
5. COMMENTS AND FINAL CONSIDERATIONS ............................................ ................ 40
PART II: ..................................................... ................................................................ ................................................. 42
TERRITORIALIZATION OF ONCOLOGY ..................................................... ............................. 42
6. REGIONALIZATION OF SERVICES............................................. ................................ 43
7. CATEGORY 1 ................................................... ................................................................ .......................... 47
8. CATEGORY 2 ..................................................... ................................................................ .......................... 50
9. RADIOTHERAPY ................................................... ................................................................ ..................... 56
6
10. DEFICIT / SURPLUS .......................................... ................................................................ ....... 57
PART III: ..................................................... ................................................................ ................................................... 64
PRIMARY ATTENTION................................................ ................................................................ ................. 64
11. PRIMARY HEALTH CARE................................................... ................................................. 65
12. HEALTH PROMOTION................................................... ................................................................ .... 67
PART IV: ..................................................... ................................................................ ................................................... 69
WOMEN'S HEALTH ..................................................... ................................................................ ..................... 69
13. QUALIFYING THE NETWORK OF CYTOLOGY PROVIDERS IN THE STATE OF MINAS

GERAIS.................................... ................................................................ ................................... 70
14. CYTOPATHOLOGICAL EXAMINATION.............................................. ................................... 74
PART V: ..................................................... ................................................................ ................................................. 76
SPECIALIZED AMBULATORY ATTENTION .......................................... ................. 76
15. INSTALLED CAPACITY OF AVERAGE AMBULATORY COMPLEXITY

77
16. STATE CENTER FOR SPECIALIZED ATTENTION (CEAE) ....... 78
17. MEDICAL SPECIALTIES CENTER (CEM)................................................... ....... 80
18. HEALTH REGIONS WHICH HAVE CEAE/CEM COVERAGE ..................... 81
19. UTERINE CERVICAL BIOPSY ............................................ ..................................................... 82
20. COLPOSCOPY ................................................... ................................................................ ................... 88
21. BREAST PUNCTURE BY FINE NEEDLE ..................................... 93
22. BREAST PUNCTURE BY THICK NEEDLE.......................................... .............100
23. BILATERAL BREAST ULTRASOUND........................................... ....106

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24. BILATERAL SCREENING MAMMOGRAPHY ..........................................110
25. STRESS ECHOCARDIOGRAPHY............................................. ................................114
26. TRANSESOPHAGEAL ECHOCARDIOGRAPHY .............................................. .............115
27. TRANSTHORACIC ECHOCARDIOGRAPHY............................................ ................116
28. MAGNETIC RESONANCE................................................... .................................................123
29. COLONOSCOPY................................................. ................................................................ ...............129
30. VIDEOLARYNGOSCOPIC................................................. ...................................................134
31. RECTOSIGMOIDOSCOPY ................................................... ................................................139
32. LARYNGOSCOPE ................................................... ................................................................ ..........146
33. CYSTOSCOPY .......................................... ................................................................ ...................151
34. ESOPHAGOGASTRODUODENOCOSPIA................................................. ...................156
35. SCINTILOGRAPHY ................................................... ................................................................ .............161
36. TOMOGRAPHY ................................................... ................................................................ ...................168
37. ULTRASONOGRAPHY ................................................... ................................................................ ..174
PART VI: ..................................................... ................................................................ .................................................179
ORAL HEALTH ..................................................... ................................................................ .............................179
38. CANCER OF LIP AND ORAL CAVITY .......................................... .....................180
39. POINTS OF ATTENTION - SUS/MG ................................................... ...................................181
40. SPECIALIZED HOSPITAL CARE............................................. .............189
PART VII: ..................................................... ................................................................ ...................................196
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SURVEILLANCE IN HEALTH SERVICES (PECQMAMO) .......................................... ....196
41. STATE PROGRAM FOR QUALITY CONTROL IN MAMMOGRAPHY –

PECQMAMO ...................................... ................................................................ .......197
PART VIII: ..................................................... ................................................................ ...................................200
SPECIALIZED HOSPITAL ATTENTION ............................................... ......................200
42. SPECIALIZED HOSPITAL CARE............................................. .............201
43. CANCER TREATMENT ............................................. ................................................202
44. FORMS OF ORGANIZATION............................................. ...................................................216
45. DIAGNOSIS AND TREATMENT SUPPORT SERVICE (SADT) IN

HOSPITALS ................................................... ................................................................ ...................................240
46. TRANSPLANTATION HOSPITALS............................................ ................................246
47. REIMBURSEMENT OF ANTIFUNGALS................................................... .....................247
48. NATIONAL SUPPORT PROGRAM FOR ONCOLOGICAL CARE

(PRONON)................................................ ................................................................ ...................................................248
PART IX: ..................................................... ................................................................ ......................................250
REGULATION................................................. ................................................................ .....................................250
49. FINANCING ................................................... ................................................................ ...........251
50. TREATMENT OUTSIDE THE HOME ............................................ ......................255
51. ONCOLOGY AT CNRAC (NATIONAL CENTRAL FOR HIGH COMPLEXITY

REGULATION) .................................... ................................................................ .....................256
52. REGULATION OF ACCESS TO ONCOLOGY IN THE STATE OF MINAS GERAIS

257
PART X: ..................................................... ................................................................ ...................................................261
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INFORMATION SYSTEMS............................................... ................................................................ 261
53. INFORMATION SYSTEMS – REGISTRATION OF PROVIDERS AND PROCESSING OF THE

PRODUCTION OF MEDIUM AND HIGH COMPLEXITY SERVICES IN
ONCOLOGY. ................................................................ ................................262
54. SISCAN AND RHC............................................. ................................................................ .....................263
PART XI: ..................................................... ................................................................ ......................................267
PHARMACEUTICAL CARE................................................ .................................................267
55. OPIOID MEDICINES............................................ ...................................................268
56. ONCOLOGICAL MEDICINES (PURCHASE CENTRALIZED BY THE MINISTRY OF

HEALTH)...................................... ................................................................ ...................268
PART XII: ..................................................... ................................................................ .....................................270
PALLIATIVE CARE................................................ ................................................................ .........270
57. PALLIATIVE CARE................................................... ................................................................ ....271
PART XIII: ..................................................... ................................................................ ...................................283
ACTION PLANS............................................... ................................................................ ......................283
58. PRIMARY CARE AND HEALTH PROMOTION .......................................... .......284
59. SPECIALIZED AMBULATORY CARE............................................. .....286
60. ORAL HEALTH .................................................... ................................................................ ...................288
61. HIGH COMPLEXITY............................................. ................................................................ .291
62. GLOSSARY FOR THE ONCOLOGY NETWORK................................................ ...............297
63. BIBLIOGRAPHIC REFERENCES............................................ .............................298
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1. PRESENTATION
Health care networks are organizations formed by a set of

health, which allow offering continuous and comprehensive care to a given population,
coordinated by primary health care.
There is, in the international literature, good quality evidence that health care networks
health can improve clinical quality, health outcomes, user satisfaction and
reduce the costs of health care systems.
In Brazil, the issue of health care networks is recent and there are no experiences in scale,
nor robust assessments. However, case studies of experiences of health care networks
health indicate that they, similarly to what happens in developed countries, may have
significant impact on health levels, with costs supported by the SUS.
The National Oncology Care Policy started to treat cancer as a problem of

public health, as directed by the World Health Organization (WHO). The control of
disease should focus on early diagnosis and prevention rather than on
treatment of advanced stages. The Oncology Care Network aims to reduce the
cancer incidence and mortality and ensure quality of life for patients undergoing treatment.
The care network for people with chronic diseases in the cancer thematic axis is
made up of the following components:
• Primary Care: responsible for promotion, prevention, screening, diagnosis

care, support and palliative care.
• Specialized Outpatient Care: composed of a set of services that

characterize the second level of care, which is of medium complexity, and that perform the
specialized care, exams for the diagnosis of cancer, therapeutic support and the
treatment of precursor lesions.
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• Specialized Hospital Care: CACON (Discharge Assistance Center

Complexity in Oncology), UNACON (High Complexity Care Unit in
Oncology) and Complexes - General Hospital with Cancer Surgery in a Hospital Complex,
Hospital Complex Radiotherapy Service, responsible for the definitive diagnosis, the
extension of the neoplasm (staging), treatments, oncology emergency care and
palliative care.
• Support, Regulation, Logistics Systems and Governance Systems: in this

component, among the main functions is: register and insert the pertinent data in the
current information systems; provide pharmaceutical assistance necessary for the treatment of
cancer; regulation is responsible for organizing access to actions and services
specialists related to the care of people with cancer, acting in an integrated way,
ensuring transparency and equity in access; carry out elective health transport
for users with cancer, when necessary; agree on regional and local action plans
for cancer prevention and control; establish a mechanism to regulate access to
qualify the demand and assistance provided.
Considering the Official Letter No. 307/2015 of the Ministry of Health, which analyzes the Health Plan
Oncological Action of the State of Minas Gerais and the technical visits carried out in all
hospitals qualified in high complexity in oncology, there was a need to review
of the action plan published in 2015 through Deliberation CIB-SUS/MG No. 2,144, of 15
July 2015.
In the plan presented here, the diagnosis and guidelines of all areas of the
aforementioned components, including the epidemiological analysis of cancer and the
territorialization for oncology in Minas Gerais.
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ONCOLOGY NETWORK PLAN IN MINAS GERAIS

2018
PART I:
CANCER SURVEILLANCE: CANCER SITUATION IN MINAS GERAIS
13

STATE SECRETARIAT FOR HEALTH
1. INTRODUCTION
There are several types of diseases that encompass the word cancer and that are increasingly
gain space as a public health problem. According to the literature, cancers
indistinctly affect people of all ages, sex, race, cultures, countries and religions.
Regional differences are attributed to differences in population exposure to risk factors,
associated with lifestyle or directly related to genetic characteristics of the
population.
Information is the primary resource to get as close as possible to the
reality making it possible to trace its profile, detect problems and act towards their solution. How much
the more organized and standardized the process, the more suitable is the use of
information that can respond to the demands and needs for decision making.
In this way, the Cancer Assessment and Surveillance Program developed the analysis of
situation through the national mortality and morbidity systems of the
Population-Based Cancer – RCBP, for incidence data and the hospital records of
cancer - RHC for information on the care profile. These data are available
respectively at http://www.datasus.gov.br; http://www.inca.gov.br/cgi/sisbasepop.asp. and
http://irhc.inca.gov.br,.
The expectation is that the scenario presented by the Surveillance can subsidize the other
technical areas involved in the Oncological Care Plan with a view to prevention and control
of these diseases called “cancer” in the population of Minas Gerais
NUMBERING TABLES
Table 1 - Minas Gerais and its health macro-regions - resident population (IBGE 2015)
Table 2 - Relative percentage variation of crude mortality rates (100 thousand) according to all
neoplasms and sex - RPV% between the initial year (2007) and the final year (2016)
Table 3 - year 2017 - Minas Gerais - Mortality from neoplasm (Cause - ICD BR 10)
Table 4 - Crude mortality rate (100 thousand) according to primary location and health macro-region.
MG - year 2017
Table 5 - Estimated incidence of cancer, Minas Gerais - year 2018
Table 6 - Estimated gross incidence rate (100 thousand) by macro-region, year 2014
Table 7 - New cases estimated for the year 2018 according to the macro-region of Minas Gerais
Table 8 - indicators of cancer care in Minas Gerais - 38 RHC MG, year 2016 and others
14

Table 9 - Number of new hospital cases by macro-region of origin, 38 RHC MG, year 2016 and others - all
ages
Table 10 – Median interval (in days) between the date of diagnosis and the date of initiation of treatment
38 RHC MG, year 2016 and others - cases with previous diagnosis and without previous treatment, all
ages
Table 11 - Median range according to all neoplasms and ages according to the macro-region of health of
Minas Gerais, 38 RHC MG year 2016 and others
Table 12 - Hospital cases from SUS and Non-SUS who started treatment in the early stages of the disease
(TNM: in situ and Stage I) according to no evidence of the disease after the 1st cancer treatment, all ages,
38 RHC MG year 2016 and others
Table 13 – Hospital cases from the SUS and Non-SUS who started treatment in the advanced stages of
the disease (TNM: Stages III and IV) according to no evidence of the disease after the 1st cancer treatment,
all ages, 38 RHC MG year 2016 and others
Table 14 – Childhood and Youth Cancer - Number of new hospital cases 0-19 years old. 38 RHCMG, year
2016 and others
Table 15 - Exposure to alcohol and tobacco consumption of new hospital cases of all neoplasms according
to the macro-region of Minas Gerais, 38 RHCMG, year 2016 and others
FIGURE NUMBERING
Figure 1 - Age structure of the population of Minas Gerais - IBGE 2010

Figure 2 - Evolution of mortality rates (100 thousand) for all neoplasms according to sex.
Minas Gerais, years 2007 and 2016
Figure 3 - Proportional mortality (all ages) in the state of Minas Gerais, 2017
Figure 4 - Proportional mortality of cancers subject to preventive actions and/or early detection Minas
Gerais, year 2017
Figure 5 - Crude Mortality Rate (per 100 thousand) by type of neoplasms and sex, Minas Gerais - 2017
Figure 6 - Proportional distribution of deaths from neoplasms according to sex and age group, Minas
Gerais year 2017
Figure 7 - Number of new hospital cases of all neoplasms from Minas Gerais, 38 RHC-MG year 2016 and
others.
Figure 8 - Distribution of new hospital cases of all neoplasms according to the health macro-region of
Minas Gerais, 38 RHC-MG year 2016 and others
Figure 9 - Median interval (in days) between the date of diagnosis and the date of initiation of cancer
treatment of new hospital cases of all neoplasms that arrived at the hospital for the 1st time with previous
diagnosis and without previous treatment. 38 RHCMG, 2016 and others
Figure 10 - Condition of arrival at the 1st consultation according to clinical tumor staging (TNM), of new
hospital cases with previous diagnosis and without previous treatment coming from Minas Gerais. 38 RHC
MG, year 2016 and others
Figure 11 - Origin of referral of new hospital cases from Minas Gerais according to SUS or Non-SUS. 38
RHC-MG, 2016 and others.
Figure 12 – Childhood and Juvenile Cancer: Median interval (in days) between the date of previous
diagnosis and the date of initiation of treatment of new hospital cases aged 0-19 years who arrived with
previous diagnosis and without previous treatment, all cases neoplasms. 38 RHC -MG, 2016 and others
15

2. MINAS GERAIS ONCOLOGICAL CARE PLAN - SURVEILLANCE
OF CANCER
Minas Gerais has 853 municipalities with a total of 20,869,033

inhabitants, of which 10,375,840 are males and 10,493,193 are females
(IBGE, 2015). According to the Regionalization Master Plan, there are
13 health macro-regions in the State
(Table 1)
Table 1 - MINAS GERAIS AND ITS
HEALTH MACROREGIONS -
RESIDENT POPULATION (IBGE 2015) Male Female Total
1 - Center 3,179,335 3,349,384 6,528,719
2 - South 1,399,787 1,371,929 2,771,716
3 - North 842,651 827,610 1,670,261
4 - Southeast 820,323 840,522 1,660,845
5 - East 756,074 773,959 1,530,033
6 - Northern Triangle 638,038 633,421 1,271,459
7 - West 637,880 628,133 1,266,013
8 - Northeast 471,783 462,030 933,813
9 - South Center 388,923 395,368 784,291
10 - Southern Triangle 387,320 373,735 761,055
11 - East of the South 349,773 347,642 697,415
12 - Northwest 354,302 341,337 695,639
13 - Jequitinhonha 149,651 148,123 297,774
MINAS GERAIS 10,375,840 10,493,193 20,869,033
Source: IBGE, RIPSA/Datasus, year 2015 estimate
16

The age pyramid shows the highest concentration in the 15 to 29 age group
signals the aging of around 22% of the population aged 50 years and over (Figure 1).
2.1 MORTALITY FROM NEOPLASIA
In 10 years of follow-up (2007-2016), mortality from neoplasia
increasing in this population with a higher risk of death for males. for both
sexes, the crude mortality rate increased from 76.98 deaths/100,000 in 2007 to
107.64/100,000 in the year 2016 (Figure 2). Between the beginning year and the end of the analyzed period
there was an increase in mortality from neoplasia according to the Percent Variation calculation
Relative (VPR% 2007-2016), +38.2% for males, +40.0% for females and
+39.8% for both sexes. (Table 2).
17

Source: SIMMG/CID 10, PAV/DASS/SVEAST/SubVPS/SESMG - position on 12/19/2017
18

Table 2 - RELATIVE PERCENTAGE CHANGE IN MORTALITY RATES ACCORDING TO ALL NEOPLASMS AND
SEX - VPR% between the years 2007 and 2016
Table 2 - VPR% Gross Rate 2007 Gross rate 2016 (final Relative Percentage Variation between the
MINAS GERAIS (initial year) year) initial year and the final year - (VPR%, 2007 and 2016)
Male 85.41 118.98 + 38.2% (increase)
both sexes 76.98 107.64 + 39.8% (increase)
Women 68.63 96.37 + 40.0% (increase)
In 2017, neoplasms were the 2nd cause (16.8%) of all causes of death (Figure 3) with 20,260 deaths in both sexes.
(Table 3). Of these, approximately 44.4% of the deaths were due to seven neoplasms that could be taken preventively and/or early detected (Figure 4).
Attention is drawn to the high mortality rates in males (Figure 5) and that, in both sexes, mortality from neoplasms is higher.
accentuated after 49 years (Figure 6).
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Table 3 - YEAR 2017 - MINAS GERAIS Male Feminine Total

MORTALITY FROM NEOPLASIA coef. for Coef. for Coef.P/100
Cause - ICD-BR-10 No 100 thousand No 100 thousand No thousand
Lip, oral cavity and pharynx 642 6.19 136 1.30 778 3.73
Esophagus 890 8.58 268 2.55 1,158 5.55
Stomach 846 8.15 412 3.93 1,258 6.03
Colon, rectum and anus 761 7.33 746 7.11 1,507 7.22
Liver and intrahepatic bile ducts 475 4.58 314 2.99 789 3.78
pancreas 491 4.73 468 4.46 959 4.60
Larynx 432 4.16 55 0.52 487 2.33
Trachea, bronchi and lungs 1,350 13.01 898 8.56 2,249 10.78
Non Melanoma Skin 68 0.66 67 0.64 135 0.65
mama 16 0.15 1,430 13.63 1,446 6.93
cervix - - 400 3.81 400 1.92
- - 352 3.35 352 1.69
Body and parts n/esp uterus
Ovary - - 328 3.13 328 1.57
Prostate 1,348 12.99 - - 1,348 6.46
Bladder 257 2.48 145 1.38 402 1.93
Mening, brain and out parts SNC 414 3.99 352 3.35 766 3.67
non-Hodgkin's lymphoma 199 1.92 173 1.65 372 1.78
Multiple myeloma and plasma cell neopl malig 191 1.84 169 1.61 360 1.73
Leukemia 327 3.15 287 2.74 614 2.94
Neoplasms in situ, benig, behavior uncertain 296 2.85 254 2.42 550 2.64
Remaining malignant neoplasms 2,061 19.86 1,941 18.50 4,002 19.18
Total 11,064 106.63 9,195 87.63 20,260 97.08
Source: SIMMG/CID 10, PAV/DASS/SVEAST/SubVPS/SESMG, position in

12/19/2017
20

Crude mortality rates for ALL NEOPLASMS stood out in six macro-regions Southeast (113.62 deaths), South (110.11),
West (105.05), South Center (104.30), Southern Triangle (101.96) and Northern Triangle (100.28) per 100 thousand inhabitants, in Table 4.
Table 4
GROSS RATE OF
C00-10 C15
MORTALITY (100 C16 C18-21 C33-34 C50 C53 C61 C44
Cavity Esophagus
thousand) SECOND Stomach Colon, Trachea, mama cervix Prostate Skin No All
Oral Subtotal
LOCALIZATION rectum bronchus Melanoma neoplasms
PRIMARY AND and anus and lung
MACROREGION
HEALTH - 2017
center 5.09
3.71 5.88 10.34 2.14 8.06
5.36 5.36 12.11 2.55 1.68 4.37 5.71 0.67 4.51 6.14 9.02 3.078.88
2, 87 5.02 11.9 5.96 50.75 0.69 98.67
South Center 2.72 3.21 6.85 4.935.74
1.71 3.31 4.4613.97
10.781.93 3.118.16
1.153.72 7.65
5.6312.45
6.77 1.14
1.4413.80
4.03
3.93 51.71
5.03 11.37.78
.77 3.73
14.316.03
1.82
1.6510.78
3.61
4.076.44
1.92
5.91 8.54 55.97 0.38 104.30
Jequitinhonha 7.05 4.37 3.02 3.36 30.56 0.34 61.79
East 8.56 5.69 7.78 6.73 51.96 0.46 96.27
south east 7.60 5.69 5.59 6.17 48.46 0.72 95.50
North East 9.42 2.36 3.53 6.85 39.19 0.32 74.32
Northwest 3.02 4.74 3.59 5.89 37.66 0.72 70.87
North 6.47 4.13 4.13 4.67 36.34 0.30 69.93
West 4.42 7.74 7.58 6.32 49.92 0.95 105.05
Southeast 6.02 8.07 7.53 8.19 56.48 0.72 113.62
South 4.51 9.81 6.21 7.68 54.19 0.72 110.11
North Triangle 3.15 7.47 5.74 6.13 48.53 1.10 100.28
southern triangle 4.99 6.96 5.91 6.04 49.80 0.39 101.96
MINAS GERAIS 5.55 7.22 6.93 6.46 49.25 0.65 97.08
Seven macro-regions stood out for the highest gross mortality rates in specific primary locations - Center: breast
(8.88 deaths); South Center: oral cavity (5.36), colon/rectum/anus (8.16) and prostate (8.54); East: cervix (3.07); Northeast: esophagus (9.42);
Southeast: all neoplasms (113.62) except non-melanoma skin (56.48); South: stomach (7.65); Northern Triangle: trachea/br/lung
(14.31), per 100 thousand inhabitants, in Table 4.
21

2.2 ESTIMATED INCIDENCE
The José Alencar Gomes da Silva National Cancer Institute – INCA, estimates for the year
2018 (valid for 2019), the occurrence of 57,590 new cases for all neoplasms of both
the sexes (men: 29,010 and women: 28,580. The crude rates corresponded to 274.87 cases
new per 100,000 men and 267.56 per 100,000 women BY SEX, except non-skinned
melanoma, highlighted in males prostate cancer (63.80/100 thousand) and
trachea/bronchus/lung (15.01/100 thousand) and in females, breast cancer (50.15/100
thousand) and colorectal (15.49/100 thousand), in Table 5.
Table 5 ESTIMATED INCIDENCE OF CANCER - MINAS GERAIS, YEAR 2018
MALIGNANT NEOPLASMS MEN WOMEN

Primary Location New cases Gross Rate Adjusted Rate New cases Gross Rate Rate
(100 thousand) (100 thousand) (100 thousand) adjusted
(100 thousand)
Prostate 6,730 63.80 65.12 - -

female breast - - 5,360 50.15 45.02
cervix - - 890 8.37 7.20
Trachea, br and lung 1,580 15.01 14.14 990 9.29 7.71
colon and rectum 1,510 14.28 13.72 1,650 15.49 12.03

Stomach 1,410 13.37 7.41 760 7.15 2.92
Oral cavity 1,110 10.52 8.99 330 3.12 2.59
Larynx 540 5.10 4.84 140 1.29 0.83
Bladder 650 6.11 5.63 250 2.37 1.89
Esophagus 1,010 9.57 8.75 320 3.01 2.24
Ovary - - 560 5.20 4.42
Hodgkin's Lymphoma 200 1.93 1.64 110 1.63 1.07
Non-Hodgkin's Lymphoma 530 5.01 4.40 780 7.27 6.61
Thyroid gland 100 0.95 1.64 780 7.27 6.61

Nervous system 500 4.72 4.75 510 4.79 4.68
Central
leukemias 560 5.26 5.03 470 4.44 4.21
body of uterus - - 510 4.76 4.59
Melanoma skin 190 1.84 320 2.96 2.00
other locations 3,950 37.45 35.43 3,600 33.71 26.78
ALL LOCATIONS 20,570 192.85 - 18,890 176.32 -
EXCEPT C44
non-melanoma skin 8,440 79.95 - 10,560 98.86 -
ALL NEOPLASMS 29,010 274.87 - 28,580 267.56 -
Source: INCA 2017, 2018 Estimate: Cancer Incidence in Brazil

22

The publication Cancer Situation in Minas Gerais and its health macro-regions, volume I presented estimated cancer rates
for the year 2013 (valid for 2014) in the population of Minas Gerais (Table 6). The Southeast macro with the highest estimated incidence rate of all
neoplasms (330.35/100 thousand).
Table 6 - year 2014

C00-10 C18-21 C61
GROSS RATE C15 C16 C33-34 C50 C53 C44
cavity Colon/ prostate ALL
ESTIMATED OF Esophagus Stomach Trachea, mama cervix Subtotal Skin No
and Straight/ The NEOPLASIA
INCIDENCE (100 bronchus Melanoma
Oral Anus AT
thousand) PER and lung
MACROREGION
OF MINAS GERAIS
Center 7.38 6.99 11.40 201.56 9.91 17.14 65.14 16.87 90.97 64.39 265.95
South Center 9.45 10.31 11.98 219.71 14.92 15.16 56.35 13.68 91.22 62.58 282.28
Jequitinhonha 4.35 12.77 4.25 132.09 9.12 5.10 21.63 7.98 58.47 31.73 163.82
East 6.43 11.26 10.34 165.07 11.38 10.08 47.15 14.76 81.48 68.93 233.99
South East 7.71 11.40 10.64 157.91 10.92 9.98 42.49 11.92 76.39 85.72 243.63
Northeast 5.94 9.62 5.68 102.78 13.35 6.31 22.28 16.23 57.25 73.36 176.14
Northwest 3.77 4.01 9.44 151.71 6.08 10.16 34.67 13.20 66.12 39.75 191.46
North 4.76 7.70 6.56 145.56 9.05 7.28 27.44 10.53 52.08 26.66 172.22
West 6.36 6.28 13.22 181.43 9.90 16.06 60.79 15.27 91.93 94.72 276.14
Southeast 10.97 11.12 15.53 254.16 14.65 19.44 72.49 17.91 109.91 76.20 330.35
South 5.95 6.82 12.28 206.54 10.78 16.61 54.60 10.21 98.89 84.79 291.33
Northern Triangle 6.30 4.01 16.68 195.36 9.15 14.71 57.67 17.67 91.22 74.28 269.64
Southern Triangle 7.83 6.66 15.41 178.97 7.97 17.56 48.51 15.27 108.75 101.74 280.71
MINAS GERAIS 6.94 7.83 11.51 188.93 10.55 14.51 54.08 14.72 86.94 68.70 257.63
Source: RCBP– BH and Poços de Caldas, September 2012; MS/Datasus/Mortality Information System; 2010 Census and Projection
IBGE population; SESMG 2012
23

Five macro-regions stood out for the highest gross incidence rates in specific primary locations: Center-South:
stomach (10.97 new cases); Jequitinhonha: esophagus (12.77); West: non-melanoma skin (94.72); Southeast: oral cavity (10.97), colorectal
(19.44), breast (72.49), cervix (17.91), prostate (109.91), all (330.35); Northern Triangle: trachea/bronchi/lung (16.68), per 100
thousand inhabitants, in Table 6
Considering the urgent need for the absolute number of new cases estimated for the calculation of prevention and control actions
Oncology Care Plan, a calculation was made of the probable occurrence in the macro-regions (Table 7) from the total of new cases
estimated for Minas Gerais (INCA, 2017) and the percentage distribution of new cases from the publication SES MG, 2013, volume 1.
Table 7
C18-
NEW CASES C33- C50 C53
C00- 21 C61 ALL C44
ESTIMATED C15 34 BAD CO
10 C16 EXCEPT SKIN TOTAL
2018 BAD LO
COL PRO O NO L
ESOF TR FAITH UT
CAVI % % I'M % ON, % % % % s % SKIN % HONEY % GEN %
THE BR AND MI
DADE MAGE STRAIGHT TAT NO YEAR AL
MACROREGI GO PUL NIN ER
ORAL , THE MELA BAD
ION OF MINES HAND THE O
ANUS NAME
GENERAL
33 28 29 36 31 2.02 38 37 32 33 29
center 477 367 629 1,147 802 329 2,147 13,180 5,453 18,141 32%
% % % % % 1 % % % % %
South Center 71 5% 57 4% 111 5% 114 4% 98 4% 204 4% 29 3% 256 4% 1697 4% 627 3% 2,304 4%
Jequitinhonha 20 1% 41 3% 39 2% 22 1% 21 1% 38 1% 12 1% 81 1% 513 1% 152 1% 691 1%
11
East 101 7% 146 169 8% 167 5% 175 7% 343 6% 59 7% 464 7% 2,565 7% 1,387 7% 3,801 7%
%
south east 50 4% 65 5% 80 4% 73 2% 87 3% 139 3% 23 3% 209 3% 1,144 3% 798 4% 1,785 3%
North East 50 4% 65 5% 119 6% 54 2% 54 2% 91 2% 41 5% 182 3% 908 2% 836 4% 1,613 3%
Northwest 30 2% 24 2% 39 2% 73 2% 64 3% 113 2% 23 3% 175 3% 1,065 3% 361 2% 1,382 2%
North 81 6% 98 7% 150 7% 126 4% 118 5% 214 4% 53 6% 330 5% 2,447 6% 570 3% 3,052 5%
West 81 6% 65 5% 119 6% 218 7% 185 7% 354 7% 59 7% 431 6% 2,328 6% 1,558 8% 3,686 6%
24

13 11 11 11 11 11 10 10 11
Southeast 183 146 241 335 283 568 88 680 4,262 1,653 9% 6,853 12%
% % % % % % % % %
11 11 14 15 14 13 15 15 16
South 163 146 299 480 368 697 82 9% 1,036 5,761 3,078 8,523 15%
% % % % % % % % %
Northern Triang 81 6% 65 5% 119 6% 218 7% 185 7% 402 8% 59 7% 431 6% 2,328 6% 1,558 8% 3,686 6%
southern triangle 50 4% 41 3% 50 2% 136 4% 131 5% 166 3% 35 4% 303 5% 1,342 3% 988 5% 2,188 4%

MINES 100 100 100 10 10 5.36 100 100 10 10 10 100
1,440 1,330 2,170 3,160 2,570 890 6,730 39,460 19,000 57,590
GENERAL % % % 0% 0% 0 % % 0% 0% 0% %
Source: INCA estimates for the year 2018 (INCA, 2017), adapted for macro-regions by PAV MG, year 2018 according to distribution
percentage of 2014 estimates
It should be noted that the statistical calculations of the estimates for the year 2019 (valid for 2020) are being processed for the macro-regions of
Minas Gerais according to the methodology used by INCA (Black et al; 1999). Therefore, after official estimates are made available
the values shown in Table 7 must be readjusted.
25

3. STATE PROFILE OF ONCOLOGICAL ASSISTANCE ACCORDING TO RHC 38

MG
Ordinance SAS/MS nº 140 of 02/22/2014 provides for the hospital records of

cancer in SUS-enabled establishments. The RHC state network is made up of 38
records (35 RHC in SUS-enabled institutions and 3 voluntary RHC). The system of
information is the SIS RHC/Integrator of INCA. This analysis is based on the cases
cancer hospital patients who arrived at these institutions for the first time (Figure 7) in the year
2016 (35 RHC) or previous year (3 RHC).
Source: SIS RHC/38 RHCMG/PAV/DASS/SVEAST/SVPS/SESMG, position in

05/07/2018.
26

Table 8 shows that 40,614 new hospital cases from all

the neoplasms. Of these, 10,998 cases in advanced stages (Stages III and IV), but 16,339
cases without staging information. The median age at diagnosis was 63 years.
(men) and 62 years (women). The median interval between the diagnosis and start dates
of antineoplastic treatment was 67 days for cases that arrived with a previous diagnosis and
without previous treatment and 39.5 days of cases without diagnosis/without treatment. The data
vary between selected primary locations.
27

38 RHC MG – INDICATORS OF ONCOLOGICAL CARE OF MINAS GERAIS of selected neoplasms according to 38

RHCMG, year 2016 and others
Table 8 - Indicators of cancer care - 38 RHC
C00-10 C53 C18-21 C15 C16 C50 C44 C61 C33-34
MG, year 2016 and others Others TOTAL
Cavity cervix Colon/ Esophagus Stomach mama Skin No Prostate Tr/Br/
locations GENERAL
Oral rectum/anus Melanoma Lung
MINAS GERAIS
1 Total cases (N) 1,833 2,123 3,375 1,455 1,459 6,288 5,573 6,629 1,430 10,449 40,614
Total advanced cases (stage

two
(N) 1,138 585 1,456 685 697 1,654 162 1,242 908 2,471 10,998
III and IV)
male 58 - 63 61 66 62 69 68 66 60 63
Median age at diagnosis (in years)
3
female 59 47 62 64 65 57 70 - 64 60 62
Median* of the interval between the
date of diagnosis and the date of
4
initiation of treatment, of the cases
that arrived at the hospital:
Number of cases WITH diag/NO 816 655 461
4.1 933 1,434 890 1977 496 3,144 2,683 13,489
treatment calculated
Median of the range cases
WITH diag/NO treatment (in days) 73 84 58 64 68 66 96 90 51 63 67 days
Maximum value of days 240 238 237 237 236 240 233 240 233 239
Number of cases WITHOUT diag/ 228 113 302 104 465 468 211
4.2 77 764 1447 4,179
NO treatment calculated
Median of the range cases
WITHOUT diag/NO treatment (in days) 48 53 30 35 22 44 50 59 27 27 39.5 days
Maximum value in days 227 216 208 222 182 215 227 240 210 240
Number of cases with staging
5 (N) 447 418 997 469 546 1,414 3,631 2012 373 6,092 16,339
without information / not staging
Source: SIS RHC/38 RHCMG/PAV/DASS/SVEAST/SVPS/SESMG, position on 05/07/2018 – Note 1: 35 RHC with consolidated year 2016 and 3 RHC according to the last previous year consolidated;
Note 2: duplication of cases may occur between institutions if they were admitted for the first time to more than one institution in the analyzed year; Note 3: Negative values, zero and cases with more
than 240 days between diagnosis and initiation of treatment were excluded from the calculation of the medians. Note 4: The selected indicators were based on Ordinance SAS/MS nº 140 of 02/22/2014,
especially CAP II (VI); CAP III, Art. 18 (IV); CAP IV, Art. 33, III(a)(b).
28

38 RHC MG – NUMBER OF HOSPITAL CASES of cancer that arrived for the first time at the institution according to macro-
region and year, all ages.
There were 40,029 hospital cases that arrived for the first time at institutions with active RHC in the defined year, with information from
origin of municipalities in Minas Gerais that corresponded to the respective distribution in the macro-regions, in Table 9.
C33-34
Table 9 - Number C00-10 C53 C18-21 C15 C16 C50 C61 Trachea
of hospital cases by Oral cavity cervix Colon, rectum and anus Esophagus Stomach mama Prostate Bronchus Too much ALL
macro-region Lung NEOPLASMS
MG, 38 RHC MG, year
2016 and others all ,
ages
center 683 818 1,119 421 505 2,679 2,189 498 3,650 13,855
South Center 97 71 164 79 85 301 323 82 491 1,866
Jequitinhonha 21 31 18 40 22 48 66 10 98 368
East 115 210 243 133 107 441 437 95 779 3,083
south east 68 78 106 89 57 166 210 51 330 1,308
North East 79 89 68 84 67 140 244 26 243 1,123
Northwest 23 28 30 7 5 74 85 16 116 412
North 152 150 173 187 120 248 501 77 674 2,489
West 109 141 220 65 72 382 353 81 651 2,359
Southeast 146 188 336 146 109 592 736 136 923 3,743
South 213 189 599 136 214 803 905 200 1,495 6,383
northern triangle 54 49 146 26 42 156 270 57 402 1,515
southern triangle 51 69 116 34 37 164 212 68 424 1,525

Grand Total 1,447 Source: SIS RHC/38
1,811 RHCMG/PAV/DASS/SVEAST/SVPS/SESMG,
2,111 3,338 position on 1,442 6,194 6,531 1,397 10,276 40,029
05/07/2018 – Note 1: 35 RHC with consolidated year 2016 and 3 RHC according to the last previous consolidated year;
Note 2: Duplication of cases may occur between institutions if they were admitted for the first time to more than one institution in the analyzed year
29

38 RHC MG – Number of in-hospital cancer cases of all ages that arrived at the institution for the
first time, according to macro-region and year – ALL NEOPLASMS
In Figure 8, the distribution of new hospital cases by residence in13
health macro-regions. It should be noted that hospital data are not of incidence
populational.
Source: SIS RHC/38 RHCMG/PAV/DASS/SVEAST/SVPS/SESMG, position on 05/07/2018 –
Note 1: 35 RHC with the year 2016 consolidated and 3 RHC according to the last previous year consolidated;
Note 2: Duplication of cases may occur between institutions if they are admitted for the first time
in more than one institution in the year analyzed
38 RHC MG – Median interval (in days) between the date of diagnosis and the beginning of the
cancer treatment according to selected neoplasm, MG macro-region and year of cases
hospital patients who arrived at the institution for the first time with a previous diagnosis and without
previous treatment, ALL AGES.
The median intervals between diagnosis and initiation of treatment varied between
primary locations and health macro-regions. For all neoplasms from Minas Gerais
Gerais, the interval was 68 days), in Table 10.

30

Table 10– Median interval (in days) C33-34

between the date of diagnosis and C18-21 C16 C61 trachei C44
the start of treatment 38 RHC MG, C00-10 C53 Colon, C15 stomach C50 prostate The non- ALL
year 2016 and others - CASES WITH cavity cervix rectum Esophagus O mama The
bronchial melanom skinLOCATION
and oral and anus O The
ZATION
PREVIOUS DIAGNOSIS AND Lung s
NO TREATMENT
PREVIOUS, all ages
center 77 81 59 75 73 70 103 53 108 75
South Center 67 83 57 67 60 42 73 38 71 67
Jequitinhonha 95 108 75 88 49 58 107 111 106 95
East 89 84 77 70 83 81 95 64 80 81
south east 90 117 74 77 73 55 85 53 109 77
North East 65 89 57 70 95 77 111 54 113 77
Northwest 64 81 54 44 41 84 75 47 39 54
North 64 39 43 33 61 53 54 34 74 53
West 96 104 72 86 81 76 112 76 132 86
Southeast 58 104 47 64 55 58 82 49 108 58
South 63 83 59 54 61 60 74 51 93 61
Northern Triangle 57 63 49 61 59 60 86 31 98 60
southern triangle 61 68 41 56 104 52 94 32 68 61
66
MINAS GERAIS 73 days 84 days 58 days 64 days 68 days days 90 days 51 days 96 days 67 days
Source: SIS RHC/38 RHCMG/PAV/DASS/SVEAST/SVPS/SESMG, position on 05/07/2018. – Note: In the calculations of the medians were excluded
negative values, zero and cases above 240 days between diagnosis and the beginning of treatment.
The primary locations with higher intervals were - non-melanoma skin (132 days) and prostate cancer (112 days) in macro
West and cervical cancer in the South East macro (117 days), in Table 10.
31

38 RHC MG – MEDIAN INTERVAL (IN DAYS) BETWEEN THE DATES OF DIAGNOSIS

AND BEGINNING OF ONCOLOGICAL TREATMENT BY MACROREGION. 38 RHC-MG,
year 2016 and others
For all neoplasms, eight macro-regions (62%) did not reach the
median of 60 days between diagnosis and initiation of treatment (cases with
diagnosis/no treatment). The most critical macro-regions were Jequitinhonha (92
days), West (84 days) and East (82 days), in Figure 9.

05/07/2018. – Note: In the calculations of the medians, negative values were excluded,
zero and cases over 240 days between diagnosis and initiation of treatment.
32

38 RHC MG – CLINICAL STAGING OF THE TUMOR (TNM) IN THE 1st

CONSULTATION - hospital cases that arrived at the oncological institution with previous
diagnosis and without previous treatment according to selected neoplasm and year
Antineoplastic treatment in the early stages (in situ and Stage I) occurred in
13.8% of all neoplasms and 32.6% of them reached advanced stages of the disease
(Stages III and IV), that is, with an unfavorable prognosis at the beginning of treatment
oncological. The most critical percentages in the advanced stages of the disease were
lung (70.4%) and oral cavity (67.9%) cancers. The without information of
staging varied between 13.5% (oral cavity) and stomach (32.5%), in Figure 10.
05/07/2018. Note: 35 RHC with consolidated year 2016 and 3 RHC second last year
previous consolidated.
4. EFFECTIVENESS OF ASSISTANCE ACCORDING TO THE ORIGIN OF THE
REFERRAL
38 RHC MG - year 2016 and others -

ORIGIN OF
REFERRAL IN THE 1ST
CONSULTATION IN HIGH
COMPLEXITY ONCOLOGY
77.6% of hospital cases were referred by
SUS and 18.7% by 33
and by Non-SUS (Figure 11)
Source: SIS RHC/38 RHCMG/
PAV/DASS/SVEAST/SESMG, position on
05/07/2018.

38 RHC MG – Effectiveness of SUS and Non-SUS Oncological Care – MEDIAN INTERVAL BETWEEN DIAGNOSIS AND STARTING TREATMENT SECOND HEALTH
MACROREGION – ALL NEOPLASMS WITHOUT PREVIOUS TREATMENT (Table 11)
Table 11 shows that the SUS has more difficulty in the flow of patients to high complexity. However, SUS and Non-SUS presented worrying maximum individual values,
greater than 200 days, both in cases with a previous diagnosis and in those in which the diagnosis is made in the hospital.
Table 11 CASES WITH DIAGNOSIS / WITHOUT TREATMENT CASES WITHOUT DIAGNOSIS / WITHOUT TREATMENT
Median SUS no SUS SUS no SUS
range, year
2016 and others Median (in Median (in Median (in
ALL Number days) days) Number days) median
NEOPLASMS of Maximum in days number Maximum in days of Maximum in days number maximum
macro-region Cases of cases Cases of cases in days
Center 4,576 85 240 928 45 225 2,958 39 240 872 27.5 199
South Center 719 68 239 136 27 235 281 46 196 165 32 195
Jequitinhonha 185 95 232 12 35.5 213 62 23 117 9 44 73
East East South 1,342 83 237 226 76 237 639 45 216 214 43 146
Northeast 471 83 237 162 81 233 192 33 215 84 35 186
Northwest North 548 87 239 42 69 148 103 43 176 14 63 111
West Southeast 172 72 238 14 50 107 64 27.5 217 5 72 72
South Triang 1,142 47 240 155 44 209 610 35 224 119 23 142
North Triang 1,139 93 240 153 45 214 304 51 218 83 19 66
South Total 1,213 71 240 355 64 232 843 49 239 246 35 217
2,219 65 240 306 55.5 234 2,061 27 197 237 30 97
554 233 9 50 157 555 32 237 11 - -
64.5
317 70.5 230 86 43 194 749 41 240 144 41 113
14,597 - - 2,584 - - 9,421 - - 2,203 - -
Source: SIS RHC/PAV/DASS/SVEAST/SVPS/SESMG, position on 05/07/2018 – Note 1: In the calculations of the medians, the values were excluded
negative, zero and cases over 240 days between diagnosis and initiation of treatment. Note 2: underlined the median intervals above 60 days.
34

38 RHC MG – EFFECTIVENESS OF SUS AND NON-SUS ONCOLOGICAL CARE – % of cases of selected neoplasms diagnosed/untreated from
SUS and Non-SUS in the early stages of the disease (IN SITU/STAGE I) according to no evidence of the disease after the 1st treatment, year
2016 and others
For new hospital cases that started oncological treatment in the early stages of the disease, it can be said that the results are not satisfactory
since the percentages of several primary locations are below 70% in the Non-SUS and markedly in the SUS, in the Table 12.
WITHOUT EVIDENCE OF THE DISEASE AFTER THE 1ST TREATMENT - CASES THAT STARTED TREATMENT WITH
Table 12 - Hospital STAYING IN SITU/I
cases from the
NOT SUS SUS BOTH 9SUS AND NOT SUS0
SUS and non-SUS
who started treatment in the number of cases
Number of cases number of cases Number of cases Number of cases
WITHOUT
STADIUMS IN SITU EI Number of cases WITHOUT
with information from the WITHOUT with information from the with DO information
EVIDENCE
second no evidence of disease STATUS OF EVIDENCE STATUS OF EVIDENCE OF STATUS OF
% % GIVES %
after 1st treatment, year 2016 DISEASE TO OF THE DISEASE DISEASE TO DISEASE after the DISEASE TO
and others, all ages DISEASE
END OF THE 1st after the 1st END OF THE 1st 1st treatment END OF THE 1st
TREATMENT treatment TREATMENT TREATMENT after the
1st treatment
Oral cavity 4 4 100.0% 27 14 51.9% 31 18 58.1%

cervix 16 9 56.3% 207 163 78.7% 223 172 77.1%
Colon, rectum and anus 15 11 73.3% 51 20 39.2% 66 31 47.0%
Esophagus 1 0 0.0% 31 6 19.4% 32 6 18.8%
Stomach 6 5 83.3% 18 6 33.3% 24 11 45.8%
mama 95 57 60.0% 188 47 25.0% 283 104 36.7%
non-melanoma skin 6 5 83.3% 67 44 65.7% 73 49 67.1%
Prostate 61 30 49.2% 310 131 42.3% 371 161 43.4%
Lung 1 0 0.0% 6 0 0.0% 7 0 0.0%
Other neoplasms 37 20 54.1% 167 70 41.9% 204 90 44.1%
TOTAL 242 48.9% 141 58.3% 1072 501 46.7% 1314 642
Source: SIS RHC/PAV/DASS/SVEAST/SVPS/SESMG, position on 05/07/2018 – Grade 1: 0% = no case without evidence of the disease after the 1st treatment – Grade 2: SIS RHC presents seven
categories of variable Disease status at the end of the 1st treatment: disease in progression, stable disease, death, partial remission, no evidence of disease and therapeutic support. As it is a complex
variable, table 12 only shows NO EVIDENCE OF THE DISEASE, considering that this is the best result that can be obtained.
35

38 RHC MG – EFFECTIVENESS OF SUS AND NON-SUS ONCOLOGICAL CARE – % of cases of selected neoplasms diagnosed/untreated
from SUS and Non-SUS in advanced stages of the disease (STAGE III and IV) according to no evidence of the disease after the 1st
treatment , year 2016 and others
The low percentages without evidence of the disease after the 1st oncological treatment of advanced cases justify the prevention and
early detection.
Table 13 - Cases NO EVIDENCE OF DISEASE AFTER 1ST TREATMENT STAGING III and IV
hospitals from the NOT SUS SUS SUS AND NOT SUS
SUS and not SUS that Number of cases Number of cases Number of cases number of cases
started treatment in number of cases
with information from the with information from the with information from the WITHOUT
STAGES III and IV) WITHOUT Number of cases WITHOUT
STATUS OF STATUS OF STATUS OF EVIDENCE
according to no EVIDENCE EVIDENCE OF
DISEASE TO % DISEASE TO % DISEASE TO DA %
evidence of disease after 1st OF THE DISEASE DISEASE after the
END OF THE 1st END OF THE 1st END OF THE 1st DISEASE
treatment, year 2016 and others, after the 1st 1st treatment
TREATMENT TREATMENT TREATMENT after the
all ages treatment
O O O 1st treatment
Oral cavity 25 11 44.0% 296 51 17.2% 321 62 19.3%

cervix 15 4 26.7% 119 30 25.2% 134 34 25.4%
Colon, rectum and anus 56 15 26.8% 367 37 10.1% 423 52 12.3%
Esophagus 28 5 17.9% 247 35 14.2% 275 40 14.5%
Stomach 29 1 3.4% 199 17 8.5% 228 18 7.9%
mama 64 12 18.8% 355 38 10.7% 419 50 11.9%
non-melanoma skin 3 0 0.0% 30 6 20.0% 33 6 18.2%
Prostate 77 11 14.3% 315 45 14.3% 392 56 14.3%
Lung 53 1 1.9% 186 1 0.5% 239 two
0.8%
Other neoplasms 93 17 18.3% 416 49 11.8% 509 66 13.0%
ALL NEOPLASMS 443 12.2% 13.0% 77 17.4% 2530 309 2973 386
Source: SIS RHC/PAV/DASS/SVEAST/SVPS/SESMG, position on 05/07/2018 – Grade 1: 0% = no case without evidence of disease after the 1st treatment – Grade 2: SIS RHC has seven
categories of the variable Disease status at the end of the 1st treatment: disease in progression, stable disease, death, partial remission, no evidence of disease and therapeutic support. As it is a complex
variable, Table 13 only shows NO EVIDENCE OF THE DISEASE, considering that this is the best result that can be obtained.
36

38 RHC-MG: JUVENILE CHILDHOOD CANCER: NUMBER OF HOSPITAL CASES OF CANCER 0-19 YEARS OLD who arrived for the first time at the institution
according to the international classification for children and adolescents (Cici)¹ and the International Classification of
Diseases for Oncology (ICD 03)² according to MG macro-region and defined year - (Table 13)
Table 14 - Group
Group Group Group Group Group Group Group Group X Group Group TOTAL
Number of hospital I II III IV V SAW
Group VII IX XI XII
VII
cases Cell 0-19
0-19 yearsleuce lymph CNS neuro retina Renal bones sarcom car, in Others
Hepatic Gen. YEARS OLD
38 RHCMG, 2016 and more But blast blast
others bad bad .
center 32 28 17 5 3 11 0 11 24 7 19 6 163
South Center 3 3 3 0 0 0 0 1 two 0 3 0 15
Jequitinhonha 3 1 0 0 0 0 0 1 0 0 0 0 5
East 11 7 6 1 0 1 1 0 two 3 7 0 39
south east 4 two 0 1 0 0 0 0 0 two two 0 11
North East 3 1 0 two 0 0 0 0 0 1 0 0 7
Northwest two two 1 1 0 0 0 0 0 0 0 0 6
North 13 8 4 0 0 two 0 5 7 two 4 3 48
West 7 6 two 0 0 4 0 3 3 3 4 1 33
Southeast 9 3 3 0 0 3 0 4 5 two 5 3 37
South 6 9 0 0 1 1 0 6 two 12 4 0 41
Northern Triangle 3 1 0 1 0 0 0 1 0 1 4 0 11
southern triangle 7 3 1 0 0 1 0 0 1 0 4 1 18
No information / 3 0 0 0 0 1 0 0 0 0 1 0 5
Another state
TOTAL 24 46 106 74 37 11 4 1 32 33 57 14 439
Source: SIS RHC/38 RHCMG/PAV/DASS/SVEAST/SVPS/SESMG, on 05/07/2018 - Note: 35 RHC with consolidated year 2016 and 3 RHC according to the last previous year
consolidated; ¹WHO/IARC, 1996 and Brazil, INCA, 1999 ²WHO, 3rd edition, year 2000
37
38 RHC MG – JUVENILE CHILD CANCER - Median interval (in days) between the date of diagnosis
and the start of oncological treatment, all neoplasms up to 19 years of age according to MG macro-
region and year of diagnosed/untreated cases.
In childhood cancer, the high median intervals between diagnosis and
the start of treatment in the Jequitinhonha (92 days), Oeste (76 days) and South (69 days) macroregions,
for all neoplasms up to 19 years of age, in Figure 12.
Source: SIS RHC/38 RHCMG/PAV/DASS/SVEAST/SVPS/SESMG, position on 05/07/2018 – Note 1: 35 RHC with year
2016 consolidated and 3 RHC second last year consolidated; Note 2: duplication of cases may occur between
the institutions joined more than one institution for the first time in the analyzed year.
38
38 RHC MG – EXPOSURE TO RISK FACTORS, ALL AGES, 38 RHC-MG, year 2016 and others
In the history of hospital cancer cases, there is a worrying exposure to the

risk of alcohol and tobacco consumption. The North macro-region presented
higher percentages in both factors (53.0% each). Other macro-regions
highlighted with percentages above 40% of consumption, in Table 15.
Table 15 Consumption of Alcoholic Beverages Tobacco Consumption
Exposure of cases
hospital to factors
risky
Total Cases
ALCOHOLIC BEVERAGE Total Cases
with information No. of No. of
AND TOBACCO % with with information % with
of consumption cases with cases with
38 RHCMG, year 2016 and exposure¹ of consumption exposure²
DRINK exposure¹ exposure²
others TOBACCO
ALCOHOLIC
ALL
NEOPLASMS
macro-region
center 10,919 4,539 41.6% 10,967 4,865 44.4%

South Center 1,321 489 37.0% 1,386 650 46.9%
Jequitinhonha 323 155 48.0% 322 142 44.1%

East 2,506 737 29.4% 2,580 935 36.2%
south east 1,048 447 42.7% 1,086 561 51.7%
North East 997 353 35.4% 1,002 441 44.0%
Northwest 337 156 46.3% 343 179 52.2%
North 2,148 1,142 53.2% 2,162 1,145 53.0%
West 1,630 650 39.9% 1,730 779 45.0%
Southeast 2,827 1,148 40.6% 2,914 1,364 46.8%
South 5,227 1,608 30.8% 5,320 2,306 43.3%
Northern Triangle 1,404 461 32.8% 1,412 620 43.9%
southern triangle 1,000 423 42.3% 1,145 606 52.9%
SUB TOTAL 31,687 12,308 38.8% 32,369 14,593 44.8%
No Information/ Other State 465 184 39.6% 473 206 43.6%
32,152 12,492 38.9% 32,842 14,799 45.1%
Source: SIS RHC/PAV/DASS/SVEAST/SVPS/SESMG, position on 05/07/2018 - Note: ¹consumes

alcoholic beverage/former consumer; ²smoker/ex-smoker.
39
5. FINAL COMMENTS AND CONSIDERATIONS
Mortality from cancer is increasing (Figure 2) and the burden of cancer is also significant.
incidence (Table 5) that characterize it as a public health problem in the State of Minas
General. Not all of these so-called “cancer” diseases are controllable due to
causal influence of non-preventable risk factors, among them, population aging. THE
possibility to minimize the current load is to invest in seven primary locations capable of
preventive and/or control actions, responsible for 44% of cancer mortality (Figure 4). THE
The present analysis sought in the hospital information (HRC) to signal the weaknesses of the line of
care and health macro-regions that may be hampering cancer control in the
mining population, including:
• Exposure to risk factors: high percentages of patient exposure history
alcohol and smoking (Table 15) that show the need to intensify
prevention actions in the population vulnerable to the initiation of these habits, such as young people and
teenagers;
• Delay time to start cancer treatment: critical median intervals between
diagnosis and initiation of treatment after 60 days in macroregions (Table 10 and
Figure 9). This situation was found in SUS and Non-SUS, including maximum values
individual over 200 days (Table 11). Efforts are needed to improve the flow
of the referral of patients in the “problem” territories come from the SUS
or Not SUS;
• Early detection: high percentages of advanced cases at the beginning of treatment
cancer, that is, with an unfavorable prognosis (Figure 10), and if the
current conditions, it will be inevitable that this type of mortality will continue to increase. There is
imminent need to strengthen suspicion and early detection actions;
• Effectiveness of cancer care: the discrete percentages of “no evidence of the disease”
after the 1st treatment” of several neoplasms that started treatment in the early stages of
disease when better values would be expected (Table 13) indicate that there is a need
to invest in the qualification of cancer care for better results, in the SUS and
Not SUS.
40
Therefore, the situation analysis provided by the Cancer Surveillance is an important
tool for planning strategic actions of the Oncological Care Plan of Minas
General with a view to changing the current scenario and which can be used in the future in the evaluation
impact of the actions that will be adopted by the plan.
41

2018
PART II:
TERRITORIALIZATION OF ONCOLOGY
42
6. REGIONALIZATION OF SERVICES
6.1 THE REGIONALIZATION MODEL - THE PDR SUS/MG
The PDR is the guiding basis for the organization and decentralization of health services,
having been designed in order to promote more rational flows for populations in their various
spaces, intra and inter-regional. In the network planning processes, it is one of the guidelines
to assess greater accessibility and regional solvability. The PDR also aims,
pursuant to Law 8080 and Decree 7508, promote economies of scale and scope and greater equity
between regions, which is evaluated annually.
For spatial planning, geographic extension, differences in
demographic density and possibilities of urban facilities. The PDR in Minas Gerais
was structured in order to meet, in its references, the design of care models for
health: primary, secondary, tertiary. The first level of care is the responsibility of the
counties. The second level is the responsibility of the pole municipalities of the Health Regions (the
microregion). The third level, which assumes more rarefied demand and higher density
technology, is the responsibility of the hub municipality of the Expanded Health Regions (the
macro-region), conceptually defined as a set of surrounding Health Regions
that refer to their demand for tertiary care for that center.
Thus, the PDR makes it possible to estimate care gaps and direct, at different levels,
investments that make viable the networks or the physical and assistance structure for the lines of
care, as it establishes criteria and general principles that relate to the needs
demand in terms of access and scale.
The table below cites some examples of the proposed organization of levels of
attention/regionalization, citing procedures that are guiding and not mandatory. There is
possibility of the existence of other nearby municipalities that already offer part of the
procedures expected for a hub city and level of care.
43
Table 1- Relationship between the levels of care and regionalization according to the PDR-MG.
Outpatient actions and services and (2)

Attention responsibility
hospital
Levels (Cast of sanitary
Acronym) (2)
(Examples)
PSF, UBS; clinical admissions for treatment of infections,

Primary County
first aid, childbirth at usual risk, etc.
(MCHB)
It is the 1st level of reference. Mammography, ultrasound,

Pole in tomography, hospitalizations for pregnancy complications,
secondary microregion adult and neonatal ICU, medium complexity urology
(MCH1 and 2) (about 100,000 surgeries, vascular, small and medium trauma, treatment
of cardiovascular diseases.
inhabitants,
distance The
Medium-sized hospitals and specialty outpatient services,
fence in from MC. TRS, Coverage of micro municipalities.
1h30min)
It is the 2nd level of referral, generally more specialized

Pole gives AC and MC services, such as spine surgeries. They must
macro-region attend to major trauma, surgeries and treatment in Onco,
(about 1,000,000 Cardiovascular Surgeries, transplants, etc.
tertiary
inhab.,
(AC-MCHE) with They must have services of Core Medicine, magnetic
subsets of about resonance imaging and highly specialized diagnostic and
500,000 inhabitants; therapeutic services. Large hospitals offer more than 70%
distance is not The
of the expected cast and reference or coverage of the
entire macro.
relevant
According to installed capacity and different demographic sizes by municipality, or by
health region, the responsibilities outlined in the table above may be appropriate to the
specific realities. Thus, a municipality of the population size of a health region can
assume secondary care services. It will not be characterized as a region because it does not absorb
coverage responsibilities and inter-municipal coverage.
44
The Service Portfolio (Typology)/PDR-SUS/MG, which details according to Table SIAH the
actions and services by level of care and regionalization, was designed with a view to
need and the potential installed capacities of the services mapped in the State, according to
the principles of SUS. These, in addition to the purposes of decentralization/regionalization, point to
for the observance of equity, economies of scale and scope and are quality inducers
SUS services and sustainability.
Given the logic and motivations described above, the PDR-SUS/MG prepared and approved
by CES/MG, CIB-SUS/MG and CIT, in 2002, has been, over the years, discussed and
adjusted by SES/MG and COSEMS/MG. The PDR-SUS/MG has 13 Expanded Regions of
Health and 77 Health Regions.
Oncological, cardiovascular, endovascular and interventional surgeries are
planned to be offered at the centers of the Expanded Health Region, generally located
in municipalities that ensure the establishment of teams of specialists and support for populations
higher in several Health Regions in the surroundings. Most such procedures are elective and
programmable. The Urgency/Emergency Network provides, when necessary, other resources to
access (Ambulances with ICU, etc.).
6.2 THE PDR-SUS/MG AND THE SPATIAL DISTRIBUTION OF THE UNITS

ENABLED
In the case of Oncology, in previous administrations, services were enabled in disagreement with the
scale proposals from the PDR and from the ministerial norms that provide for a service for about
500,000 inhabitants. There are some differences in production and atypical access in services
enabled to date, to be detailed in this document in due course. It is evident
also the low coverage of extensive and populous regions such as the Northeast. The correction of these
questions is being proposed by the plan presented here.
As is well known, supply conditions demand. In these terms, there is great
concentration of supply and access/coverage for certain regions, evidenced from
of this study. Enabling services in geographically more suitable points guarantees the
greater access by region and state. In MG there are some units that the qualification was motivated
45
to care for residents in Health Regions with low population density and without
need to cover surrounding populations (example: Cataguases and São
Joao del Rei). On the other hand, there are Extended Health Regions with large deficits in relation to
population in their territories, making adequate coverage impossible, as can be seen in the
Expanded Health Regions West and North (in the West Region there is a provider in the process of
license – Itaúna).
The spatial difficulties of coverage and distribution of UNACON and CACON in MG,
considering the 13 Expanded Health Regions, imply planning for the future of new
facilities, in addition to the expansion and rehiring of the current ones. In this action plan that will guide the
line of oncology care, it is also necessary to promote adjustments to the PDR-SUS/MG
in order to ensure better identification of the responsible territory, either by contributing with
Primary in the identification and monitoring of new cases, whether in the orientation of flows to
Secondary and Tertiary Care, the closest to the residence.
Thus, it is proposed that the 13 Expanded Health Regions are, when necessary,
subdivided. In other words, each Expanded Health Region is a set of Health Regions
Surrounding health even if distant. For the oncology care line it becomes
necessary to identify the Aggregate Health Region belonging to the same Expanded Region
of Health, making it important to observe that they are closer, surrounding, with
population estimated at around 500,000 inhabitants and who already have a tradition of referring to part of
demand for municipalities with providers already qualified to provide assistance in
oncology. Such characteristics allow a better definition of the coverage areas, where the
services qualified for tertiary care, under the coordination of Primary Care, will guarantee the
development of the line of care to be implemented, mainly for the attention of
patients affected by the most prevalent cancers.
6.3 CRITERIA FOR ADEQUACY
The Expanded Health Regions were adequate in view of the need to
implementation of the line of care in oncology, in territories called “Regions of
Aggregate Health” to define specific responsibilities, considering:
46
1st) Existence of units enabled by territory;
2nd) Predominant flow of demand in oncology to attend to patients

most prevalent cancers
3rd) Population scale of the health regions of the aggregates around 500,000 inhabitants.
4th) Surroundings of health regions.
It was identified within some Aggregate Health Regions, establishments

located in different municipalities and Health Regions, which implied the subdivision
of these Aggregate Health Regions, motivated by the need for contractualization and
monitoring of the various providers. As evidenced in the maps below.
7. CATEGORY 1
Maps 1 and 2 illustrate oncological surgery hospitalization flows and the proposed territories
of care for Category 1 (most prevalent cancers).
Map 1- Flow of admissions for Oncological Surgery (Category 1 total) by RS of

residence and RS of occurrence in 2017.
47
Mapa2 - Service territories for Category 1 (2019)
The description of this territorialization can be found in Annex 2, item 2.
It is possible to verify Expanded Health Regions with gaps, deficits, imbalances in the
supply and/or production and others with supply surpluses, as shown below:
• RAS with “voids:” Jequitinhonha;
• RAS with production or resolution deficits:
- Of Units or Services and of production: Northwest, Northeast, East of South and East;
- Solving or producing, but with a surplus of Units in the territory:

South Center;
• RAS with imbalances in supply or/and production:
- In the offer or distribution in the space with concentration in a single municipality in a
large territory and difficulty in decentralization: North, Northeast, Northwest, 48

Northern Triangle, Southern and Western Triangle;
- With good spatial distribution of Units, but with production and/or resolvability
very different: Center;
• RAS with good spatial distribution and resolution: South and Southeast.
The Expanded Health Regions still without qualified units remain as
“territory”, territory with a “care void” to be overcome. And the regions with units
enabled with low solvability and reduced potential for immediate expansion of the offer,
as needed, remains considered a territory, but its population will be
referred to until the deficit is overcome.
7.1 Evolution of territorialization according to proposals from 2015/2016 to 2018.
ONCOLOGY NETWORK - EVOLUTION OF TERRITORIALIZATION ACCORDING TO PROPOSALS(1) FROM 2015/2016 TO 2018 - CATEGORY 1
PERIODS NO. OF TERRITORIES
2015 to 2016 12, with % of reference differentiated by territories.
2017 13, with % of reference differentiated by territories.
2018/2019 17(2) = 16 “effective” and 1 “empty” (this one with total reference to the headquarters of another territory); different territories with inter-regional references.
2019 to 2020 17 (ideal formatting, see map 2); or 18 Territories(3)
2020 to 2021 20 Territories (4) if in the future considered Curvelo and Sete Lagoas Territory
(1) CIB-SUS/MG Resolution No. 2144, of July 15, 2015
(2) See attached Map 2, proposal 2018/2019
(3) If the unit is enabled in the Jequitinhonha macro, 18 territories if with effective implementation of the division in Itabira
(4)See Annex: Map 3
Source:Coordination Center for Regionalization, Assistance Studies and Analysis/SUBGR. –IM/FS/AE
49
Mapa3 - Service territories for Category 1 - Future forecast (19 or 20

territories)
Note: Enabling territories 7, 8, 19 and 20 in progress.
8 CATEGORY 2
Below are the maps that illustrate the oncological surgery hospitalization flows and the
proposal of service territories for Category 2 (less prevalent cancers).
50
8.1 Head and neck
51
8.2 Bones and soft parts
52
8.3 Neurology
53
8.4 Thoracic Surgery
54
8.5 Pediatric oncology
8.6 Hematology
55
9 RADIOTHERAPY
56
10 DEFICIT / SURPLUS
The Aggregate Health Regions, then, comprise the 13 Expanded Health Regions. They
regroup the surrounding Health Regions, in order to guarantee better use of the
services and equipment, but also allow adequate demographic coverage.
Thus, they provide greater coverage and compliance with the rules, in addition to better guiding
agreements and references between Expanded Health Regions.
The following Tables indicate, name and detail these Aggregate Health Regions,
informing the health regions and population.
Some Aggregate Health Regions needed, due to the proximity of two units
enabled, be divided (or “subdivided”), as already clarified. Tables 1, 2, 3 and 4,
in addition to quantitatively and nominally identifying the Aggregate Health Regions with
their Health Regions, also inform the number and location of the service providers
enabled. In addition, it also assesses whether the number of qualified units is below or beyond
57
than expected for a population of around 500,000 inhabitants or 1,300,000 in the case of
pediatric oncology and hematology services (Ordinance nº140/2014) to assist in the evaluation
of qualifications.
Table 1 - Number of Qualified and Necessary Units for Oncology Assistance by population in the PDR-SUS/MG regions
Number of
Units
Population Required
Number of
Expanded Health Region/Municipality of Dear (based on Deficit/
Units
Attendance (IBGE/TCU a parameter of Surplus
Enabled
2016) 1 Unit for
500,000 inhab)
I) RAS (MACRO) CENTER

1 - BELO HORIZONTE: RS Belo
Horizonte/ N Lima/Caeté, Vespasiano, Ouro 4,754,658 7 9.5
black, count -2.5
RS Betim 699,742 1 1.4 -0.4
ITABIRA: RS Itabira, Guanhães and João
492,014 1 1
Monlevade 0
RS Sete Lagoas 443,100 1 1 0
RS Curvelo 185,454 1 0.4 0.6
II) RAS (MACRO) JEQUITINHOnha
2 - RS Diamantina, Minas
389,978 0 0.8
Novas/Tourmaline/Capelinha and Araçuaí -0.8
Total of the Belo Horizonte Subset and 5,144,636 7 10.3
Diamond Subset -3.3
III) RAS (MACRO) SOUTH CENTER
3 - BARBACENA: RS Barbacena,
Councilor Lafaiete/Congonhas and São João del 788,353 two
1.6
Rei 0.4
• Barbacena: RS Barbacena and Cons.
547,693 1 1.1
Lafaiete/Congonhas -0.1
• São João del Rei: RS São João del Rei 240,660 1 0.5 0.5
IV) RAS (MACRO) EAST
4 - GOVERNOR VALADARES: RS
Governador Valadares, Mantena, Resplendor and 697,988 1 1.4
Santa Maria do Suaçuí
-0.4
5 - IPATINGA: RS Ipatinga, Caratinga and 838,603 1 1.7
Colonel Fabriciano -0.7
V) MACRO (RAS) EASTERN SOUTH
6 - BRIDGE NOVA: RS Ponte Nova and Viçosa 355,269 1 0.7 0.3
VI) RAS (MACRO) NORTHEAST
7 - TEÓFILO OTONI: RS Águas Formosas,
Almenara, Itaobim, Nanuque, Padre Paraíso, 844,254 1 1.7 -0.7
Blue Stone and Theophilus
Otoni/ Malacacheta/ Itambacuri
58
VII) RAS (MACRO) NORTHWEST

8 - DUCKS OF MINAS: RS João Pinheiro,
699,974 1 1.4
Ducks from Minas and Unai -0.4
VII) RAS (MACRO) NORTH
9 - MONTES CLAROS: RS Montes Claros/
Bocaiúva, Brasília de Minas/S.Francisco/
Coração de Jesus, Francisco Sá, Janaúba/ 1,678,958 two
3.4 -1.4
Monte Azul, Januária, Manga, Pirapora and Salinas/
Taiobeiras
VIII) RAS (MACRO) WEST
10 - DIVINÓPOLIS: RS Divinópolis/ Santo Antônio
do Monte, Formiga, Itaúna, Bom Despacho, Pará 1,276,557 1 2.6
de Minas and Santo Antônio do Amparo/Campo Belo
-1.6
IX) RAS (MACRO) SOUTHEAST
11 - JUIZ DE FORA: RS Juiz de Fora, Além Paraíba,
Santos Dumont and São J. 868,612 3 1.7
Nepomucene/Bicas 1.3
12 - MURIAÉ: RS Muriaé, Manhuaçu,
961,970 1 1.9
Carangola and Ubá • RS Leopoldina / -0.9
Cataguases X) RAS (MACRO) SOUTH 183,702 1 0.4 0.6
13 - STEPS: RS Passos/ Piumhi,

Alfenas/ Machado, Guaxupé and São Sebastião do 903,947 two
1.8
Paraíso 0.2
• Passos: RS Passos and São Sebastião do
418,088 1 0.8
Paraíso 0.2
• Alfenas: RS Alfenas/Machado and
485,859 1 1
Guaxupé 0
14 - POUSO ALEGRE: RS Pouso Alegre, 979,458 two two
Poços de Caldas and Itajubá 0
• Poços de Caldas: RS Pouso Alegre • 540,701 1 1.1 -0.1

Poços de Caldas: RS Poços de Caldas and
438,757 1 0.9
itajubá 0.1
15 - VARGINHA: RS Varginha, Lavras, São 904,209 1 1.8
Lourenço, Três Corações and Três Pontas -0.8
XI) RAS (MACRO) TRIANGLE OF
NORTH
16 - UBERLAND: RS
Uberlândia/Araguari, Ituiutaba and 1,281,989 1 2.6
Sponsorship/Mount Carmel -1.6
XII) RAS (MACRO) SOUTHERN TRIANGLE
17 - UBERABA: RS Uberaba, Araxá and
768,771 two
1.5
Fruity/Iturama 0.5
Total Minas Gerais 21,055,628 34 42 -8
Denomination of the Subset in Bold and Provider Municipality in Bold and Italics
59
Table 2 - Number of Qualified and Necessary Units for Radiotherapy Assistance by population in the PDR-SUS/MG regions
Number of
Units
Population Required
Number of
Expanded Health Region/Municipality of Dear (based on Deficit/
Units
Attendance (IBGE/TCU parameter of Surplus
Enabled
2016) 1 unit
for 500,000
inhab)
I) RAS (MACRO) CENTER
1 - BELO HORIZONTE: RS Belo
Horizonte/ N Lima/Caeté, Vespasiano, Ouro 4,754,658 6 9.5
black, count -3.5
RS Betim 699,742 1 1.4 -0.4
ITABIRA: RS Itabira, Guanhães and João
492,014 0 1.0
Monlevade -1
RS Sete Lagoas 443,100 0 0.9 -0.9
RS Curvelo 185,454 0 0.4 -0.4
II) RAS (MACRO) JEQUITINHOnha
2 - RS Diamantina, Minas
389,978 0 0.8
Novas/Tourmaline/Capelinha and Araçuaí -0.8
Total of the Belo Horizonte Subset and 5,144,636 6 10.3
Diamond Subset -4.3
III) RAS (MACRO) SOUTH CENTER
3 - BARBACENA: RS Barbacena,
Councilor Lafaiete/Congonhas and São João del 788,353 1 1.6
Rei 0.4
• Barbacena: RS Barbacena and Cons.
547,693 0 1.1
Lafaiete/Congonhas -1.1
• São João del Rei: RS São João del Rei 240,660 1 0.5 0.5
IV) RAS (MACRO) EAST
4 - GOVERNOR VALADARES: RS
Governador Valadares, Mantena, Resplendor and 697,988 1 1.4 -0.4
Santa Maria do Suaçuí
5 - IPATINGA: RS Ipatinga, Caratinga and 838,603 1 1.7 -0.7

Colonel Fabriciano
V) MACRO (RAS) EASTERN SOUTH

6 - BRIDGE NOVA: RS Ponte Nova and Viçosa 355,269 0 0.7 -0.7
VI) RAS (MACRO) NORTHEAST
7 - TEÓFILO OTONI: RS Águas Formosas,
Almenara, Itaobim, Nanuque, Padre Paraíso, 844,254 0 1.7 -1.7
Blue Stone and Theophilus
Otoni/Malacacheta/Itambacuri
VII) RAS (MACRO) NORTHWEST
8 - DUCKS OF MINAS: RS João Pinheiro,
699,974 1 1.4
Ducks from Minas and Unai -0.4
VII) RAS (MACRO) NORTH
60
9 - MONTES CLAROS: RS Montes Claros/

Bocaiúva, Brasília de Minas/S.Francisco/
Coração de Jesus, Francisco Sá, Janaúba/ 1,678,958 two
3.4 -1.4
Monte Azul, Januária, Manga, Pirapora and Salinas/
Taiobeiras
VIII) RAS (MACRO) WEST
10 - DIVINÓPOLIS: RS Divinópolis/ Santo Antônio
do Monte, Formiga, Itaúna, Bom Despacho, Pará 1,276,557 1 2.6 -1.6
de Minas and Santo Antônio do Amparo/Campo Belo
IX) RAS (MACRO) SOUTHEAST

11 - JUIZ DE FORA: RS Juiz de Fora, Além Paraíba,
Santos Dumont and São J. 868,612 3 1.7 1.3
Nepomucene/Bicas
12 - MURIAÉ: RS Muriaé, Manhuaçu,
961,970 1 1.9 -0.9
Carangola and Ubá • RS Leopoldina /
Cataguases X) RAS (MACRO) SOUTH 183,702 0 0.4 -0.4
13 - STEPS: RS Passos/ Piumhi,

Alfenas/ Machado, Guaxupé and São Sebastião do 903,947 two
1.8 0.2
Paraíso
• Passos: RS Passos and São Sebastião do
418,088 1 0.8
Paraíso 0.2
• Alfenas: RS Alfenas/Machado and
485,859 1 1.0
Guaxupé 0
14 - POUSO ALEGRE: RS Pouso Alegre, 979,458 two
2.0
Poços de Caldas and Itajubá 0
• Poços de Caldas: RS Pouso Alegre • 540,701 1 1.1 -0.1

Poços de Caldas: RS Poços de Caldas and
438,757 1 0.9
itajubá 0.1
15 - VARGINHA: RS Varginha, Lavras, São 904,209 1 1.8 -0.8
Lourenço, Três Corações and Três Pontas
XI) RAS (MACRO) TRIANGLE OF
NORTH
16 - UBERLAND: RS
Uberlândia/Araguari, Ituiutaba and 1,281,989 1 2.6 -1.6
Sponsorship/Mount Carmel
XII) RAS (MACRO) SOUTHERN TRIANGLE

17 - UBERABA: RS Uberaba, Araxá and
768,771 two
1.5
Fruity/Iturama 0.5
Denomination of the Subset in Bold and Provider Municipality in Bold and Italics
61
Table 3- Number of Qualified and Necessary Units for Hematology Assistance by population in the PDR-SUS/MG regions
Number of Units
Population Number of Required (based on a
Extended Region of Dear Deficit/
Units parameter of 1 Unit for
Health/Service Municipality (IBGE/TCU Surplus
Enabled 1,300,000 inhab)
2016)
1- CENTER 6,574,968 5 5 0
2- JEQUITINHOnha 389,978 0 0.3 -0.3
Total of the Center Subset and 6,964,946 5 5.4 -0.4

Jequitinhonha Subset
3- EAST 1,536,591 1 1.2 -0.2
4- NORTHEAST 935,587 0 0.7 -0.7
East Subset Total and 2,472,178 1 1.9 -0.9

Northeast Subset
5- NORTH 1,678,958 1 1.3 -0.3
6- WEST 1,276,557 1 1 0
7- Southeast
RSA JUIZ DE FORA: RS Juiz de Fora,

Além Paraíba, Santos Dumont and São J. 868,612 3 0.7 2.3
Nepomuceno/Bicas
Total of the Central South Subset and 1,656,965 3 1.3 1.7

RSA Juiz de Fora (SUDESTE)
RSA Muriaé: Muriaé,

Leopoldina/Cataguases, Carangola and 801,190 1 0.6 0.4
Uba
Total of the South East Subset and 1,500,941 1 1.2 -0.2

RSA Muriaé (SOUTHEAST)
9- SOUTH 2,787,614 4 2.1 1.9
•STEPS: RS Passos/Piumhi,
Alfenas/Machado, Guaxupé and São 903,947 two
0.7 1.3
Sebastião do Paraíso
•POUSO ALEGRE: RS Pouso

979,458 1 0.8 0.2
Alegre, Poços de Caldas and Itajubá
•VARGINHA: RS Varginha,
Lavras, São Lourenço, Three 904,209 1 0.7 0.3
Hearts and Three Points
10- NORTHERN TRIANGLE 1,281,989 1 1 0
62
11- SOUTHERN TRIANGLE 768,771 two

0.6 1.4
12- NORTHWEST 699,974 0 0.5 -0.5
Total Triangle Subset of

1,468,745 two
1.1 0.9
South and Northwest Subset
Total Minas Gerais 20,997,560 19 16 3
Table 4- Number of Qualified and Necessary Units for Pediatric Oncology Assistance by population in the PDR-SUS/MG regions
Number of
Units
Number of
Extended Region of Estimated Population Required (based Deficit/
Units
Health/Service Municipality (IBGE/TCU 2016) Enabled on a parameter of Surplus
1 Unit for
1,300,000 inhab)
1-CENTER 6,574,968 -two
2-JEQUITINHOnha 389,978 30 5 0.3 -0.3
Total of the Center Subset and

6,964,946 3 5.4 -2.4
Jequitinhonha Subset
3-EAST 4- 1,536,591 1.2 -0.2

NORTHEAST Total 935,587 10 0.7 -0.7
of the East Subset and Northeast
2,472,178 1 1.9 -0.9
Subset 5-NORTH 6-WEST 7-
Southeast 1,678,958 0 1.3 -1.3
1,276,557 0 1 -1
RSA JUIZ DE FORA: RS Juiz de Fora,

Além Paraíba, Santos Dumont and São J.
868,612 0 0.7 -0.7
Nepomucene/Bicas
Total Center South and RSA Juiz de Fora
1,656,965 0 1.3 -1.3
(SUDESTE) Subset
RSA Muriaé: Muriaé,
Leopoldina/Cataguases, Carangola and Ubá 801,190 0 0.6 -0.6
Total of the South East Subset and RSA

1,500,941 0 1.2 -1.2
Muriaé (SUDESTE)
9- 2,787,614 two
2.1 -0.1
SOUTH •STEPS: RS Passos/Piumhi,
Alfenas/Machado, Guaxupé and São 903,947 1 0.7 0.3
Sebastião do Paraíso
•POUSO ALEGRE: RS Pouso
Alegre, Poços de Caldas, Itajubá,
1,883,667 1 1.4 -0.4
Varginha, Lavras, São Lourenço,
Three Hearts and Three Points
10-NORTHERN TRIANGLE 1,281,989 1 1 0
11-SOUTHERN TRIANGLE 768,771 0 0.6 -0.6
12-NORTHWEST 699,974 0 0.5 -0.5
Total of the Southern Triangle Subset
1,468,745 0 1.1 -1.1
and Northwest Subset
63


2018
PART III:
PRIMARY ATTENTION
64

11 PRIMARY HEALTH CARE
11.1 Introduction
The process of comprehensive health care is one of the premises of the Unified Health System
(SUS) and Primary Health Care (APS) and involves health promotion, risk reduction
or maintenance of low risk, early detection and screening of diseases, as well as the
treatment and rehabilitation.
As described in the National Primary Care Policy - PNAB (2017), Care
Primary Health Care (PHC) is characterized by a set of health actions, within the scope of
individual, family and collective, which covers the promotion and protection of health, the prevention of
injuries, diagnosis, treatment, rehabilitation, harm reduction, palliative care
and health surveillance.
Primary Care has, among its attributions, the role of care coordinator and
organizer of health care networks. In this sense, it accompanies users
longitudinally, even when it demands a specialized service or a
hospitalization, and is responsible for coordinating the actions of the various services on the
professionals. It is also responsible for the articulation of the different services and units of
that make up the networks, participating in the definition of flows and a list of health needs.
health of a given population.
Considering the organization of management and care in Primary Health Care, it is
the following advances are mentioned:
11.2 National Program for Improving Access and Quality of Primary Care
(PMAQ-AB)
The Ministry of Health has a program called the National Program for the Improvement of
Access and Quality of Primary Care (PMAQ-AB) whose main objective is to induce
expanding access and improving the quality of primary care and producing greater
transparency and effectiveness of government actions aimed at Primary Health Care.
To this end, it proposes a set of qualification, monitoring and evaluation strategies for the
work of the Primary Care health teams.
65

The evaluation of the program's results allows professionals and managers to make a
critical analysis of the services offered and seek intervention strategies that contribute to the
effectiveness and improvement of Primary Care.
The 3rd Cycle of the PMAQ had the participation of 99% of the municipalities, totaling 846
municipalities, 2,983 Primary Care teams with Oral Health, 2,145 Care teams
Basic without Oral Health and 712 NASF. In this Cycle, the PMAQ-AB is organized into three phases:
Adhesion/Contracting, Certification and Recontracting, as well as an Axis
Transversal Strategic Development that make up a continuous cycle of improvement of the

access and quality of Primary Care.
11.3 Primary Care Information System: E-SUS/SISAB AB
The e-SUS Primary Care system (e-SUS AB) is a public and free software,
developed by the Department of Primary Care/Ministry of Health (DAB/MS) to
meet the work processes of Primary Care, promoting the management of health care and qualified
computerization in the registration of teams. It consists of two systems of
software that instrumentalize the collection of data that will be inserted in the Information System
in Health for Primary Care (SISAB), the official DAB/MS database. They are: Collection
Data Center (CDS) and Citizen's Electronic Health Record (PEC).
Regarding oncology and cancer prevention actions, the e-SUS AB system

allows professionals in the primary care team to record:
- Register of users of the territory with neoplasms or risk factors.
- Monitoring of users of the territory who are carriers of neoplasms or risk factors
risk.
- Record of screening procedures (breast, cervix and mouth cancer),

excision/biopsy/puncture of superficial skin tumors and oral soft tissue biopsy
carried out in the Basic Health Units.
- Screening record (breast, cervix and mouth cancer).
- Registration of oncological palliative care performed in home care.
- Record of referral of cancer patients for follow-up and

examinations in specialized care.
66

The records made by Primary Care professionals can be monitored

through the Reports made available by the PEC and SISAB, such as the
Procedures, Follow-up, Monitoring, Conduct and Health Reports. O
state does not have access to municipal registration/procedure data.
11.4 Integrative and Complementary Practices (PICS) in Primary Health Care
The National Policy on Integrative and Complementary Practices (PNPIC) has

since 2006, social demands through the institutionalization of the offer of 29 PICS in the territory
national. In the state of Minas Gerais, PICS are offered mainly by the Strategy
Family Health, in 59.5% of the municipalities (Source: SISAB AB/2017).
The therapeutic services of practices comprise individuals in contexts

outpatient, home and community facilities, as well as families and users who suffer
together the processes of cancer and palliative individuals.
12 HEALTH PROMOTION
Currently, 852 municipalities in the state of Minas Gerais have joined the State Policy for
Health Promotion according to data from the health promotion indicators evaluated in the
State Health Plan (PES), in 2017, a percentage of 1.19% of the SUS population
exclusively participated regularly in actions of body practices and physical activity offered
by the municipalities, with 90.26% of Minas Gerais municipalities, in the same year, offering
body practices and physical activities. PES results also indicate that 79% of
municipalities that adhered to the State Health Promotion Policy carried out
collective activities of Health Education, for Health Promotion, together with the community. O
PES also points out that the coverage of monitoring the nutritional status of the population
monitored on SISVAN Web was 17% in 2017.
The National Tobacco Control Program (PNCT) aims to prevent

smoking initiation, protection of the population against environmental exposure to
tobacco, the promotion and support of smoking cessation through the cognitive behavioral approach
and drug support, in addition to the regulation of tobacco products through actions
67

education and mobilization of legislative and economic policies and initiatives. the PES
monitors the proportion of municipalities that adhere to the cycles of the Control Program for
Smoking (PNCT) in Minas Gerais, it is noted that, in 2017, there were 3 cycles of adherence: 10th
Cycle: With 80% of the municipalities adhered; 11th Cycle with 83% and 1st SES/MG Distribution with
87% of the participating municipalities. Regarding the proportion of smokers who quit smoking, in
2017, it was 44.31%. Being considered effective, since studies show that a
A smoking cessation program is considered effective when the smoking cessation rate is reached.
smoking equal to or greater than 30% after 12 months.
The Academia da Saúde Program was established in 2011 by the Ministry of Health and
represents a health promotion and care production strategy that consists of
implementation of public spaces called Poles of the Academia da Saúde Program that
infrastructure, equipment and qualified professionals to carry out the actions of
Health promotion. Currently, the state has 511 qualified centers in 376 municipalities,
and, of the qualified centers, about 59% (302) have completed works. the state of
Minas Gerais also has 75 centers that were qualified by the Ministry of Health as
being similar to the Program, and, therefore, are able to develop actions to promote
of health. The Ministry of Health also enables municipalities to receive incentives
funding to support the health promotion actions to be developed. Of the total
of poles with the construction completed, 231 (75%) were qualified to receive the
funding incentive.
As for the School Health Program (PSE), which aims to “contribute to the
integral formation of students through actions of promotion, prevention and health care,
with a view to tackling the vulnerabilities that compromise the full development
of children and young people in the public school system” data from the 2017-2018 cycle indicate that 804
municipalities joined the Program, which represents 94% of municipalities in Minas Gerais
General.
68


2018
PART IV:
PRIMARY ATTENTION
WOMEN'S HEALTH
69

13 QUALIFYING THE NETWORK OF CYTOLOGY PROVIDERS IN THE STATE OF

MINAS GERAIS
Periodic cytopathological examination continues to be the most

widely adopted for cervical cancer screening. Achieve high coverage of
target population (women aged 25 to 64) is the most important component in the
scope of primary care, in order to obtain a significant reduction in the incidence and
mortality from cervical cancer (BRASIL, 2016).
Currently, the uterine cytology network in Minas Gerais is composed of 89 laboratories

enabled and distributed in the Expanded Health Regions (RAS) as follows:
70

Subtitle:
The National Policy for Cancer Prevention and Control in the Health Care Network
of People with Chronic Diseases within the scope of the SUS, published in 2013 (Ordinance nº 874/13),
highlights, among the guidelines related to cancer prevention, the “structuring of actions of
monitoring and quality control of screening tests” (art. 9, item V).
The quality of cytopathological exams is based on a set of measures aimed at
to detect, correct and reduce deficiencies in the production process within the laboratory. Of that
way provides the improvement of laboratory procedures and minimizes the occurrence
diagnostic errors, also serving as a guideline for the improvement of material collection,
as an educational tool. The performance of the cytopathological examination presents difficulties
not only of an interpretive nature, but also of conditions for carrying out the exams that,
71

in the case of the cervix, it involves professionals with different qualifications, experiences and
degrees of responsibility (COLLAÇO et al., 2005).
The cytopathological examination is part of the screening process, and there are several factors that
may be related to the failure of a program as a whole. However, the

improvement of cytopathological examination reinforces the role of this method in cancer prevention
of the cervix, and every effort to reduce the likelihood of erroneous results
should be stimulated, thus contributing to the improvement of health conditions (BRASIL,
2016).
Monitoring the quality of cytopathological examinations aims to produce

most reliable results possible while maintaining good material condition and reliability
of cytopathological exams in the laboratories that provide services to the SUS.
Operationally, to verify the quality of the exams, it was implemented in

Mines the quality certification policy of the cytopathology laboratories in the SUS, through
review of exams released by these laboratories. Quality assessment involves
also local technical visit. For guidance on such guidelines, SES-MG, in partnership with the
Quality Monitoring Unit (UMEQ) in the state of Minas Gerais, built and
published the Instruction on Good Practices for Quality Control in Cervical Cytopathology, which
defines quality parameters and work processes that should guide the
qualified laboratories that provide services to the SUS.
In the period from 2013 to June 2018, 92.13% of the services were monitored and the
other laboratories that are in operation were included in the monitoring process
external quality. Since the quality monitoring process must be carried out
continuously, it is highlighted that several laboratories have already been monitored repeatedly. In
In order to exemplify the monitoring process, the results of the 1st
network monitoring:
72

Source: own database – Coordination of Health Care for Women and
Children
Based on the results of each laboratory, specific and new interventions are carried out.
evaluations, which subsidizes the management regarding the permanence or not of the laboratory in the
network.
In view of the above, in 2014, supported by Ordinance GM/MS No. 3,388 of December
2013 (Qualicito), and in the Quality Management Manual for Cytopathology Laboratories
published in 2012, the Minas Gerais State Health Department (SES-MG) started the
qualification process of the network of cervical cytology providers, with a view to structuring the State
Policy for the Prevention and Control of Cervical Cancer.
With the publication of DELIBERATION CIB-SUS/MG No. 2291, OF MARCH 16,
2016, which provides for the criteria for reassessment of Type I and Type II Qualified Laboratories
by Qualicito and approves the disabling of providers that do not meet the criteria described in
Ordinance GM/MS No. 3388, of December 30, 2013, SES/MG approved criteria for
maintenance of services enabled in the cervical cancer prevention and control network.
In this sense, aiming at the regionalization of assistance and the strengthening of networks of
health care, municipalities must agree to carry out the exams within their own
Expanded Health Region.
In addition to the reorganization of the network of cervical cytology providers, the state of
Minas Gerais established a policy of decentralization of the Cancer Information System
73

- SISCAN, recognizing it as a management tool, to strengthen control and

cancer prevention. The mandatory registration of the cervical cytology procedure through SISCAN
was established in DELIBERATION CIB-SUS/MG No. 2,379, OF 17 DE
AUGUST 2016.
14 CYTOPATHOLOGICAL EXAMS
Coverage of cervical cytopathological exams by RAS in the years 2015 to 2017.
percentage
percentage
population there
production percentage
macro-region Goal Production production there
O reached O Reached
of health Yearly 2015 the 2016 Reached
target the da 2017 of the goal
of the goal
goal
South 697229 232410 170119 73.2 143230 61.6 140418 60.4
South Center 203058 67686 41832 61.8 34706 51.3 37116 54.8
center 1727947 575982 259305 45.0 243829 42.3 229599 39.9
Jequitinhonha 64438 21479 18266 85.0 13635 63.5 15151 70.5
West 319675 106558 65599 61.6 61340 57.6 57952 54.4
East 380614 126871 67332 53.1 65179 51.4 65638 51.7
Southeast 431738 143913 84030 58.4 74080 51.5 77785 54.1
North 373122 124374 81210 65.3 53210 42.8 65856 52.9
Northwest 166856 55619 31668 56.9 26634 47.9 22277 40.1
south east 169705 56568 33415 59.1 28481 50.3 32266 57.0
North East 205959 68653 53258 77.6 42823 62.4 42901 62.5
Southern Triangle 191251 63750 23525 36.9 27284 42.8 19049 29.9
triangle of
North 327451 109150 68380 62.6 66454 60.9 66490 60.9
Total 5259043 1753014 997939 56.9 880885 50.2 872498 49.8
Source: SIA/SUS. Accessed in March/2018
The Ministry of Health recommends that 1/3 of women aged between 25 and 64 years,
are screened through the cytopathological examination of the cervix, considering the orientation of
triennial screening for cervical cancer.
74

The State of MG agreed on the target of 51% of the MS recommendation, which refers to 1/3 of the
population for the year 2017 in the State Health Plan to perform cytopathological tests.
In view of what is presented in the spreadsheet above, we found that 3 RAS did not reach the goal
proposed in the State Health Plan, interfering with the overall result of the State.
75

2018
PART V:
AMBULATORY SPECIALIZED ATTENTION
76

15 INSTALLED CAPACITY OF AVERAGE AMBULATORY COMPLEXITY
The average outpatient complexity (MC) is composed of a set of actions and

services that aim to address the main health problems and problems of the population, whose
level of complexity of clinical practice demands the availability of professionals
specialists and the use of technological resources for diagnostic and therapeutic support that
imply more intensive use to achieve some degree of economy of scale, which entails no
be carried out in all municipalities, most of which are very small.
Considering its role in the care scope and its organizational power in relation to the actions
that transcend the competences of primary care, CM is defined as a true protection
for the good performance of the health system. In this way, you can improve the quality of
attention, as it can be one of the most complex critical nodes. The majority of
procedures classified by the Ministry of Health in the MC subsidize the clarification of the
diagnosis of diseases, which justifies its strategic character both to increase the
resolution of Primary Care (AB), as well as to enable and guarantee the integrality of the
attention in services with specialization and technologies of high density in the system.
The state of Minas Gerais has a wide territorial extension whose scenery and
configuration of the offer and access to specialized consultations and diagnostic methods
present different biases due to the different and distinct specificities in each of the 77
Existing Health Regions (RS). In this sense, for the analysis of the diagnostic capacity in
average outpatient complexity of the SUS in the State, a data collection was carried out
assistance from all its Health Regions in order to enable a global assessment of the
strengths and weaknesses of the assistance network in the state territory.
As an initial action, the main procedures related to the actions were identified
diagnoses by types of cancer, and from that reports were extracted based on the selection
of the production variables presented and the value presented from the Information System
Outpatient Clinic (SIA/SUS) of the year 2017. Under analysis of the Agreed Agreement database and
Integrated Program (PPI), quantitative data were collected, by RS, of existing agreements, value
programmed and SADT (which is configured as a financial complement linked to some
procedures referring to the competence of August 2018). To this end, they were used as
filters the procedure, the form of organization and/or the subgroup, based on the SIGTAP code
(SUS Procedures, Medicines and OPM Table Management System).
77

It is noteworthy that the referral flow for diagnostic access and consultations is guided by the
Integrated Pact Programming (PPI) and regulated by the Municipal Health Departments.
Concomitant to this, there was a measurement of the SUS equipment available that
are registered in the National Registry of Health Establishments (CNES), for each RS.
With this information base, a comparison was made between the estimated need
defined by Ordinance GM/MS 1,631 of 2015, the existing quantity and installed capacity of
each one.
To analyze the parameters of need, the guidelines presented in the
Ordinance GM/MS 1,631 of 2015 that defines the parameters for the needs of the main
procedures and exams. It should be noted, however, that there are no parameters for all
procedures that were considered for this study, making it impossible to fully assess
of the assistance need through the existing offer.
As a basis for the estimated population, the source IBGE/TCU/MG 2016 was used, however
the RIPSA 2015 font was also used, due to the need presented by some É
procedures to stratify the target population by sex and age group.
It is important to emphasize that it is not possible to carry out an exclusive survey of the diagnostic network
in the MC for the detection of cancer, since the existing records mostly registered in the
SIA-SUS do not have the requirement to link the CID, which makes it difficult to know if patients
who are undergoing tests are for suspicion of cancer, or related to other pathologies.
Furthermore, it should be noted that in Minas Gerais the Intermunicipal Health Consortia, if
constitute an important instrument for local and regional planning in health and
perform an important offer of assistance services, in particular consultations and exams
of MC. However, there is no full presentation of production in official billing systems.
of the SUS by these providers, thus making a full and reliable analysis of the network unfeasible.
assistance of medium complexity. This reality tends to change after the publication of the
SES /MG Resolution No. 5,819, of July 19, 2017, which establishes the Methodology of
Feeding care production in the Outpatient Information System - SIA/SUS by
Intermunicipal Health Consortia of the State of Minas Gerais.
Through the form of organization and structuring used in the study, the following are
individual analyzes and situational diagnosis by health region are presented, based on the
verification and consolidation of data obtained from the medium complexity care network.
16 STATE CENTER FOR SPECIALIZED CARE (CEAE)

78

The CEAE are configured as micro-regional attention points distributed in the State
Minas Gerais that offer specialized outpatient care services for the
risk pregnant women; at risk children who have repeated complications with repercussions
clinic; propaedeutics for breast and uterine cervix cancer; users with arterial hypertension
High-risk systemic (SAH), users with high-risk Diabetes Mellitus (DM) and users
with high-risk Chronic Kidney Disease (CKD). These services work in an integrated manner with the
primary and tertiary care, articulated with the territory covered, whose base
organizational structure follows care guidelines and protocols defined by SES/MG.
The stratification and referencing of users to the center occurs through the
regulation carried out by AB, by evaluating the referral criteria provided for in the
resolutions that guide these services. Therefore, the proper functioning of the centers
depends primarily on the existence of a shared work between the professionals of the
primary care and specialized care, with effective matrix support and
continuous use of reference and counter-reference guides.
This assistance network is distributed in the State through 26 services that provide
an assistance coverage to 51 Health Regions, with 428 referenced municipalities. These
centers are subdivided into two forms of organization, which are classified into:
- Integrated CEAE: they comprise 13 centers that offer health care for the
women and children, hypertension, diabetes and chronic kidney disease.
- Non-integrated CEAE: they comprise 13 centers that only offer assistance to the
health of women and children at high risk.
The portfolio of services offered by CEAE includes the offer of medical consultations and
multiprofessional team and the following tests and procedures: echocardiogram, doppler
portable vascular, exercise stress test, obstetric flow doppler ultrasound, obstetric ultrasound,
tococardiography, colposcopy, colon biopsy, electrocauterization, laser photocoagulation,
electrocardiogram, map, holter, bilateral screening mammography, unilateral mammography
diagnosis, breast biopsy – core biopsy and FNA, bilateral breast US, EZT, retinography
without and with contrast. It should be noted that the availability of these procedures follows the
organization of each center (integrated and non-integrated).
79

17 MEDICAL SPECIALTIES CENTER (CEM)
The CEM is an articulation of health care points, of regional scope, that
offer specialized outpatient care, organized through different models
organizational structures, according to lines of care and care networks, ordered by PHC and
with access regulation based on clinical protocols.
CEM Pirapora/Coração de Jesus covers the health regions of Pirapora and Coração de Jesus.
Jesus, totaling 12 municipalities benefited and offering the specialties of angiology,
endocrinology, cardiology, gynecology/obstetrics, mastology, nephrology, ophthalmology,
pediatrics and urology.
The table below shows the municipalities where each service is located and the regions that are
covered by CEAE/CEM.
CEAE/CEM - Municipality Coverage

Thirst Health Region - RS
Brasilia de Minas RS from Brasilia de Minas/San Francisco
Beautiful field RS of Santo Antônio do Amparo/ Campo Belo
little chapel RS of Minas Novas/Tourmaline/Capelinha
diamond RS of Diamantina
fruity RS of Frutal/Iturama
Valadares Governor RS of Governador Valadares
Itabira RS of Itabira
itabirito RS of Ouro Preto
Janaúba RS of Janaúba/Monte Azul
January RS of Januária and Mango
Jequitinhonha RS from Almenara, Pedra Azul and Itaobim
Juiz de Fora RS from Juiz de Fora/Lima Duarte/Bom Jardim de Minas, São João
Nepomuceno/Bicas and Santos Dumont
workings RS de Lavras
Leopoldine RS of Leopoldina/Cataguases and Beyond Paraíba
manhuaçu RS of Manhuaçu
muriaé RS of Muriaé
Mine Ducks RS from Patos de Minas and João Pinheiro
80

Sponsorship Sponsorship RS/Monte Carmelo
stream of snow Municipality of Ribeirão das Neves

San Antonio do Monte RS from Divinópolis/Santo Antônio do Monte
São João del Rei RS of Sao Joao del Rei
St. Lawrence RS of Sao Lourenco
Seven lagoons RS of Sete Lagoas
Taiobeiras RS of Salinas/Taiobeiras
Teófilo Otoni RS by Teófilo Otoni/Malacacheta/Itambacuri, Águas Formosas,
Nanuque and Father Paraíso
Viçosa RS Viçosa
Pirapora - CEM RS Pirapora and Heart of Jesus
18 HEALTH REGIONS THAT HAVE CEAE/CEM COVERAGE
81

It is worth noting that, once the CEAE/CEM fulfill the objectives of
contribute to the reduction of morbidity and mortality from breast and cervical cancer through
the provision of services aimed at women's health, an evaluative study of the
assistance coverage offered by these services from the completion of the procedures
present in your service portfolio (Colon Biopsy, Screening Bilateral Mammography,
Core biopsy, PAAF and Bilateral Breast Ultrasound).
It is noteworthy that there are no parameters in Ordinance GM/MS 1,631 of 2015 that define the
assistance need for the aforementioned procedures. This Ordinance presents in its
Chapter 2 a collection of norms, criteria and parameters in force extracted from the Policies already
regulated by the Ministry of Health that have a normative character for qualification and/or
accreditation. Among the Ordinances specified, there is Ordinance No. 189 of January 31,
2014, which includes these procedures in its scope, but the parameters presented are
regarding the minimum production for qualification according to the population size, not being able,
therefore, be used as a parameter for estimating care needs.
It is important to point out that in some CEAE there was no record of production due to
organizational problems, inoperative or obsolete equipment and the difficulties of
launch of the procedures performed in the official database (SIA).
19 Cervical Biopsy
For situational analysis of the installed capacity of the offer, this procedure was used
RIPSA 2015 as a population base, due to the need to stratify the
target audience (women from 25 to 64 years old). Another peculiar point in relation to this exam occurs
due to the fact that there are no parameters for estimating the need in Ordinance GM/MS 1631,
having used the data of need presented by the National Cancer Institute
(INCA) for the year 2018.
The estimated amount of assistance need for all 77 SRs is equivalent to 18,292
procedures. In consultation with the PPI database, there is an agreement of 22,141 biopsies
of cervix, leading to the inference that there is sufficient financial resources to cover the network.
However, when evaluating the production presented in the SIA/SUS, there is a low production that
corresponds to only 5,229 exams, configuring, therefore, an assistance deficiency. 82


Correlating the PPI data with the estimated need for each SR, it appears that the
agreement intended for this procedure is sufficient to cover the assistance need of 76
Health Regions and in Juiz de Fora/Lima Duarte/Bom Jardim de Minas provides a
coverage of 98% of the recommended total. However, evaluating the production data, it
if that in none of the SRs the PPI was used in its entirety, and in 24 SRs there is no
no production records in the SIA/SUS in the period stipulated for this study and only the
regions of Pouso Alegre, Itaúna and Pará de Minas presented a production of more than 50% of
your agreement.
When evaluating the production carried out by CEAE/CEM, it appears that in many territories
that these state services cover cervical biopsy procedures
were carried out practically in their entirety in these centers, among them: Governador
Valadares, Brasília de Minas/São Francisco, Janaúba/Monte Azul, Januária and Manga, Patos de
Minas and João Pinheiro, Almenara, Pedra Azul, Itaobim, Manhuaçu, Frutal/Iturama,
Sponsorship/Monte Carmelo, Ouro Preto, São Lourenço, São João del Rei, Teófilo
Otoni/Malacacheta/Itambacuri, Pirapora and Lavras.
The only RS whose production reached the estimate of need were in:
- Mining, whose procedures, registered in the SIA/SUS, were in their entirety
carried out at CEAE, providing coverage of more than twice the need
advocated.
- Salinas/Taiobeiras, whose production carried out by CEAE is equivalent to 48% of the total
presented in SIA/SUS.
Table 1 presents the details of the data that were analyzed for this
procedure, by health region. It is worth mentioning that the item referring to the values presented
in SIA/SUS should not be considered in their entirety, since they are included in this
total production values performed by CEAE and CEM and these, in turn, are offered
through an annual amount of assistance quotas that do not encumber the PPI values. Being
thus, of the total of R$ 95,847.57 included in the SIA/SUS as the amount presented, it must be
considered as a financial impact of the PPI the total of R$ 67,124.46.
83

Table 1 - Cervical Biopsy Analysis
Production
presented Estimated Value
Health Region Colon biopsy need for exams - PPI presented
programmed value
Uterine-SIA INCA SIA/SUS
2017
Belo Horizonte/Nova Lima/Caeté 1,470 3499 3,770 BRL 69,104.10 BRL 26,945.10
betim 86 651 757 BRL 13,875.81 BRL 1,576.38
Score 133 853 910 BRL 16,680.30 BRL 2,437.89
Itabira two 225 248 BRL 4,545.84 BRL 36.66
Black gold 36 176 190 BRL 3,482.70 BRL 659.88
João Monlevade 26 138 155 BRL 2,841.15 BRL 476.58
Seven lagoons 194 424 482 BRL 8,835.06 BRL 3,556.02
Vespasian 7 303 309 BRL 5,663.97 BRL 128.31
curve 0 170 198 R$ 3,629.34 R$ R$ -
Guanhães 0 101 134 2,456.22 R$ R$ 4,747.47

R$ -
Barbacena 66 177 259 R$ 6,030.57 R$ R$ 1,209.78
Counselor Lafaiete/Congonhas 135 226 329 4,802.46 R$ R$ 8,926.71
R$ 2,474.55
São João del Rei 23 177 262 R$ 2,712.84 R$ R$ BRL 421.59
Divinópolis/San Antonio do Monte 53 443 487 2,401.23 BRL BRL 971.49
0 126 148 4,142.58 BRL BRL -
Ant
Itaúna 74 115 131 4,160.91 BRL 1,356.42
Pará de Minas 132 207 226 2,419.56
Santo Antônio do Amparo/Campo Belo 64 190 227 1,173.12
84

good order 24 99 113 R$ 2,071.29 R$ R$ 439.92

Valadares Governor 106 472 330 8,651.76 R$ R$ 1,942.98
ipatinga 98 428 319 7,845.24 R$ R$ 1,796.34
radiance two 102 68 1,869.66 R$ R$ 36.66
caratinga 0 220 153 4,032.60 R$ R$ -
Colonel Fabriciano/Timoteo 0 248 186 4,545.84 R$ R$ -
keep 0 79 55 1,448.07 R$ -
Santa Maria do Suaçuí/São João 0 123 70
Evangelist R$ 2,254.59 R$ R$ -
manhuaçu 7 218 360 6,598.80 R$ R$ 128.31

new bridge two 145 250 4,582.50 R$ R$ 36.66
Viçosa 0 96 152 2,786.16 R$ R$ -
Beyond Paraíba two 60 64 1,173.12 R$ R$ 36.66
Juiz de Fora/LD/BJ de Minas 95 753 736 13,490.88 R$ R$ 1741.35
Leopoldina/Cataguases 1 192 199 3,647.67 R$ R R$ 18.33
muriaé 15 181 185 3,391.05 R$ R$ 274.95
Carangola 0 127 142 2,602.86 R$ R$ -
Santos Dumont 0 55 58 1,063.14 R$ R$ -
São João Nepomuceno/Bicas 0 76 81 1,484.73 R$ R$ -

Uba 0 317 330 6,048.90 R$ R$ -
Brasilia de Minas/San Francisco 60 143 274 5,022.42 R$ R$ 1,099.80
Janaúba/Monte Azul 85 177 307 5,627.31 R$ R$ 1,558.05
January 13 68 128 2,346.24 R$ R$ 238.29
Montes Claros/Bocaiuva 118 342 516 9,458.28 R$ R$ 2,162.94
Pirapora 40 95 160 2,932.80 R$ R$ 733.20
Salinas/Taiobeiras 226 128 231 4,234.23 R$ R$ 4,142.58
Jesus' heart 0 30 56 1,026.48 R$ -
85

Francisco Sá 0 43 83 BRL 1,521.39 BRL BRL -
0 33 69 1,264.77 BRL BRL -

Aguas
0 50 68 1,246.44 BRL -
Formosa mango
Almenara 19 157 202 R$ 3,702.66 R$ R$ 348.27

araçuaí 0 80 106 1,942.98 R$ R$ 1,741.35 -
Itaobim 0 70 95 R$ R$ 1,484.73 R$ R$ -
nanuque 0 66 81 1,246.44 R$ R$ -
Father Paradise 0 52 68 1,136.46 R$ R$ -
Blue stone 0 47 62 6,635.46 R$ R$ R$ -
Teófilo Otoni/Malacacheta/Itambacuri 19 298 362 7,020.39 R$ R$ 5,205.72 348.27
Mine Ducks 62 243 383 R$ R$ 1,393.08 R$ R$ 1,136.46
Unai 13 172 284 3,666.00 R$ R$ 2,511.21 238.29
João Pinheiro 0 45 76 R$ R$ 3,464.37 R$ R$ -
diamond 96 141 200 3,336.06 R$ R$ 7,588.62
R$ 1,759.68
Minas Novas/Tourmaline/Capelinha 43 99 137 R$ 3,812.64 R$ R$ 788.19
araxá 22 168 189 3,885.96 R$ R$ 17,340.18
R$ 403.26
Fruity/Iturama 75 155 182 R$ 6,488.82 R$ R$ 1,374.75
uberaba 31 377 414 3,171.09 R$ R$ 4,087.59
R$ 568.23
Ituiutaba 19 173 208 R$ 3,556 .02 BRL 348.27
Sponsorship/Mount Carmel 232 173 212 4,252.56
Uberlândia / Araguari 458 834 946 8,395.14
Privet/Ax 77 187 354 1,411.41
Guaxupé 7 93 173 128.31
0 120 223 -
itajubá
workings 190 110 194 3,482.70
86

Passos/Piumhi 89 170 311 R$ 5,700.63 R$ R$ 1,631.37

Poços de Caldas 13 144 244 4,472.52 R$ R$ 238.29
Happy landing 281 318 554 10,154.82 R$ R$ 5,150.73
St. Lawrence 36 156 291 5,334.03 R$ R$ 659.88
Sao Sebastiao do Paraíso 11 74 136 2,492.88 R$ R$ 201.63
three hearts 0 76 145 2,657.85 R$ R$ -
three points 26 74 138 2,529.54 R$ R $ 476.58
varginha 15 120 207 3,794.31 BRL 274.95
87

20 COLPOSCOPY
The production data presented in the SIA/SUS demonstrate that there was
of this procedure in 58 RS in 2017, totaling 24,109 procedures. In
consultation of the PPI database, it was found that there is an agreement of 27,347
colposcopy for the 77 RS, but as there are no parameters to estimate the need
assistance of this procedure in Ordinance GM/MS 1631, an analysis is not possible
relevant information about the sufficiency or not of the coverage that was offered and the schedule of
agreement intended for this purpose.
In an individualized analysis of these SRs that presented production in the period
delimited for this study, it was found that in 20 there was a production with extrapolation
MAC ceiling, with the highest percentages in the RS of Varginha, Conselheiro
Lafaiete/Congonhas, Salinas/Taiobeiras, Nanuque, Uberaba and Montes Claros/Bocaiúva. In
29 regions production was below 50% of the existing agreement and in the other regions the
production was equivalent to using 66-98% of PPI.
It should be noted that this procedure is part of the care scope intended for the
cervical cancer workup offered by CEAE/CEM, with 5,673
procedures in 2017 in these centers. In the RS of Lavras, São João Del Rei, Ouro
Preto, Minas Novas/Turmalina/Capelinha, Governador Valadares, Leopoldina/Cataguases,
Brasília de Minas/São Francisco, Janaúba/Monte Azul, Januária, Viçosa, Jequitinhonha,
Teófilo Otoni/Malacacheta/Itambacuri, Patrocínio/Monte Carmelo, colposcopy exams
registered in the SIA/SUS were carried out in their entirety in the CEAE/CEM.
When performing the consolidation of the data presented, it appears that the value
programmed in the PPI database of the 77 RS is equivalent to R$ 92,432.86 and that was
presented in the SIA/SUS an amount corresponding to R$ 81,488.42. However, it is worth emphasizing that
the production carried out by CEAE/CEM is equivalent to a total of R$ 19,174.74, and as this
production does not generate a burden to PPI, this amount must be deducted from the value presented and consider
as a financial impact of the PPI the total of R$ 62,313.68.
88

Table 2 - Colposcopy Analysis
Region
Production PPI Value presented
enlarged from Health Region SIA/SUS 2017
Health presented programmed value
Belo Horizonte / Nova
Lima / Caeté 6614 5,000 BRL 16,900.00 BRL 22,355.32
betim 705 881 BRL 2,977.78 BRL 2,382.90
Score 781 6 1153 BRL 3,897.14 BRL 2,639.78
Itabira 80 0 300 BRL 1,014.00 BRL 20.28
center Black gold 952 233 BRL 787.54 BRL 270.40
João Monlevade 12 0 199 BRL 672.62 BRL BRL -
Seven lagoons 0 135 583 1,970.54 BRL 3,217.76

Vespasian 368 BRL 1,243.84 BRL 40.56
curve 231 BRL 780.78 BRL BRL -
Guanhães 136 459.68 BRL BRL -
Barbacena 326 1,101.88 BRL 456.30
counselor
South Center 941 407
Lafaiete/Congonhas BRL 1,375.66 BRL 3,180.58
São João del Rei 95 329 BRL 1,112.02 BRL 321.10
Divinopolis/San Antonio do
mount 165 617 R$ 2,085.46 R$ R$ 557.70
0 185 625.30 R$ R$ 544.18
R$ -
Ant
West Itaúna 260 161 R$ 902.46 R$ 878.80
Pará de Minas 38 267 128.44
Saint Anthony of
Amparo/Campo Belo 267 272 BRL 919.36 R$ 902.46
89

Good Dispatch 158 140 BRL 473.20 BRL 534.04

Governador Valadares 570 557 BRL 1,882.66 BRL 1,926.60
Ipatinga Resplendor 1020 523 BRL 1,767.74 BRL 3,447.60
2 65 122 BRL 412.36 BRL 6.76
Caratinga 00 245 BRL 828.10 BRL 219.70
East
Coronel Fabriciano/Timoteo 312 BRL 1,054.56 BRL BRL -
keep 92 310.96 BRL -
Santa Maria do Suaçuí/São João

0 121
R$ 408.98 R$ R$ -
Evangelista
Manhuaçu 180 402 1,358.76 R$ R$ 1,007.24 608.40
south east Ponte Nov a 1 47 298 R$ R$ 608.40 R$ R$ 3.38
Viçosa 0 180 270.40 R$ R$ 3,292.12
R$ 158.86
Beyond Paraíba 80 3,494.92 -
Juiz de Fora/LD/BJ de Minas 1034 Leopoldina/ 974
13
Cataguases Muriaé Carangola Santos Dumont 251 BRL 848.38 BRL 43.94
43 229 BRL 774.02 BRL 145.34
Southeast
22 161 BRL 544.18 BRL 74.36
0 73 BRL 246.74 BRL BRL -
São João Nepomuceno/Bicas 24 Ubá 98 331.24 BRL BRL 81.12

1 394 1,331.72 BRL 3.38
Brasília de Minas/São
Francisco Janaúba/Monte 195 249 BRL 841.62 BRL 659.10
Azul Januária 377 323 BRL 1,091.74 BRL 1,274.26
2 122 BRL 412.36 BRL 6.76
North Montes Claros/Bocaiúva 1358 610 BRL 2,061.80 BRL 4,590.04
Pirapora Salinas/Taiobeiras 145 172 BRL 581.36 BRL 490.10
Coração de Jesus 727 0 232 BRL 784.16 BRL 2,457.26
0 54 BRL 182.52 BRL BRL
-
Francisco Sá 78 263.64 BRL
-
90

0 62 BRL 209.56 R$ -
Mango
beautiful waters 4 65 BRL 219.70 R$ 13.52
Almenara 256 208 BRL 703.04 R$ 865.28
00 105 BRL 354.90 R$ -
araçuaí
Itaobim 339 93 BRL 314.34 R$ -
North East nanuque 00 93 BRL 314.34 R$ 1,145.82
Father Paradise 63 BRL 212.94 R$ -
Blue stone 63 BRL 212.94 R$ -
theophilus
344 383
Otoni/Malacacheta/Itambacuri BRL 1,294.54 BRL 1,162.72
Mine Ducks 167 460 BRL 1,554.80 BRL 564.46
Northwest Unai 96 303 BRL 1,024.14 BRL 324.48
João Pinheiro 0 83 BRL 280.54 BRL BRL
-
diamond 365 204 689.52 BRL 1,233.70
Jequitinhonha Mines
58 130
New / Tourmaline / Chapel BRL 439.40 BRL 196.04
araxá 71 233 BRL 787.54 BRL 239.98
southern triangle Fruity/Iturama 147 223 BRL 753.74 BRL 496.86
uberaba 1529 532 BRL 1,798.16 BRL 5,168.02
Ituiutaba 57 261 BRL 882.18 BRL 192.66
triangle of
Sponsorship/Mount Carmel 265 253 BRL 855.14 BRL 895.70
North
Uberlândia / Araguari 406 1220 BRL 4,123.60 BRL 1,372.28
Privet/Ax 650 414 BRL 1,399.32 BRL 2,197.00
Guaxupé 189 0 203 BRL 686.14 BRL 638.82
463 264 BRL 892.32 BRL BRL -
itajubá
South workings 119 239 807.82 BRL 1,564.94
Passos/Piumhi 31 372 BRL 1,257.36 BRL 402.22
Poços de Caldas 779 314 BRL 1,061.32 BRL 104.78
Happy landing 668 BRL 2,257.84 BRL 2,633.02
91

St. Lawrence 78 352 BRL 1,189.76 BRL BRL 263.64

Sao Sebastiao do Paraíso 113 161 544.18 BRL BRL 567.84 381.94
0 15 168 BRL BRL 537.42 BRL -
three hearts
three points 533 159 50.70
varginha 256 BRL 865.28 BRL 1,801.54
92

21 BREAST PUNCTURE BY FINE NEEDLE
The Fine Needle Aspiration of the Breast (FNAB) is a procedure that is
included in the CEAE/CEM service portfolio in breast cancer workup, aimed at
for diagnostic workup.
For the survey of the situational diagnosis related to this exam, the
production carried out by CEAE/CEM and that of other providers, the physical goal of the PPI, the value
programmed and agreed and the value presented in the SIA/SUS of the 77 RS.
In the production data presented, it appears that 45 RS performed this exam, however
in quantities far below the programmed agreements, with the highest percentage of
PPI use was in the João Monlevade Region (45%). In 27 of these regions, production was
below 22% of the existing agreement and in 17 the production presented was carried out in its
fully in the CEAE.
The amount programmed and agreed to carry out the PAAF of the 77 RS is equivalent to R$
705,751.68, which corresponds to a physical goal of 21,232 procedures. A total of
of 1,916 procedures (presented amount of R$ 71,499.24), but must be deducted from this total
the values from production in the CEAE, since as mentioned above,
does not generate PPI burden, therefore the value presented must be considered in relation to the impact
financial contribution of PPI corresponds to R$ 43,647.62.
93

Table 3 - Fine Needle Aspiration Puncture Data
Production
Extended Region of PPI Value presented
Health Region presented
Health programmed value SIA/SUS 2017
PAAF
Belo Horizonte/Nova Lima/Caeté 723 BRL 3535 BRL 117,503.40 26,459.04
betim 11 711 BRL BRL 23,633.64

598.32
Score 157 BRL 854 BRL 28,386.96 5,351.64
Itabira 12 234 398.88

BRL BRL 7,778.16
Black gold 70 178 2,725.68

BRL BRL 5,916.72
center
João Monlevade 65 146 2,459.76

BRL BRL 4,853.04
R$
0 455 BRL 15,124.20 -
Seven lagoons
Vespasian two 289 66.48

BRL BRL 9,606.36
R$
curve 0 187 BRL 6,215.88 -
R$
Guanhães 0 126 BRL 4,188.24 -
South Center Barbacena 0 245 BRL 8,143.80 BRL
94

-
R$
Counselor Lafaiete/Congonhas 0 -
306 BRL 10,171.44
São João del Rei 1

244 33.24
BRL BRL 8,110.56
Divinópolis/San Antonio do Monte 19 BRL 457 BRL 15,190.68 930.72
Ant 10 138 332.40

BRL BRL 4,587.12
R$
Itaúna 0 122 BRL 4,055.28 -
West
Pará de Minas 16 212 664.80

BRL BRL 7,046.88
Santo Antonio do Amparo/Campo
Beautiful 5 212 BRL 7,046.88 BRL 166.20
good order 15 106 565.08

BRL BRL 3,523.44
Valadares Governor 99 441

3,423.72
BRL BRL 14,658.84
ipatinga 51 402
BRL 13,362.48 BRL 1,861.44
R$
radiance 0 95
BRL 3,157.80 -
East
R$
caratinga 0 205
BRL 6,814.20 -
R$
Colonel Fabriciano/Timoteo 0 232
BRL 7,711.68 -
R$
keep 0 72
BRL 2,393.28 -
95

Santa Maria do Suaçuí/São João R$

0 115
BRL 3,822.60 -
Evangelist
manhuaçu 3 340 BRL BRL 11,301.60

99.72
BRL
south east
new bridge 38 238 BRL 7,911.12 1,396.08
BRL
0 143 BRL 4,753.32 -
Viçosa
R$
Beyond Paraíba 0 61
BRL 2,027.64 -
Juiz de Fora/LD/BJ de Minas 201 691

BRL BRL 22,968.84
7,744.92
BRL
Leopoldina/Cataguases 0 186
BRL 6,182.64 -
muriaé 11 174
BRL BRL 5,783.76
598.32
Southeast
BRL
Carangola 0 131
BRL 4,354.44 -
R$
Santos Dumont 0 55
BRL 1,828.20 -
R$
São João Nepomuceno/Bicas 0 74
BRL 2,459.76 -
R$
Uba 0 311
BRL 10,337.64 -
R$
Brasilia de Minas/San Francisco 0 256 BRL 8,509.44 -
North
Janaúba/Monte Azul 32 292 BRL 9,706.08 BRL 1,362.84
96

January 5 120 BRL 3,988.80 BRL

166.20
Montes Claros/Bocaiuva two 483 BRL BRL 16,054.9266.48
BRL
Pirapora 1 148 BRL 4,919.52 33.24
BRL
Salinas/Taiobeiras 11 218 BRL 7,246.32 498.60
BRL
0 52 BRL 1,728.48 -
Jesus' heart
R$
Francisco Sá 0 78 BRL 2,592.72 -
R$
0 64 BRL 2,127.36 -
Mango
R$
beautiful waters 0
65 BRL 2,160.60 -
Almenara 1
190 BRL BRL 6,315.60
33.24
BRL
araçuaí 13
100 BRL 3,324.00 432.12
BRL
Itaobim 0
North East 88 BRL 2,925.12 -
R$
nanuque 0
76 BRL 2,526.24 -
R$
Father Paradise 0
64 BRL 2,127.36 -
R$
Blue stone 0
59 BRL 1,961.16 -
theophilus 56 337 BRL 11,201.88 BRL
97

Otoni/Malacacheta/Itambacuri 2,060.88
BRL BRL
Mine Ducks 1 358 11,899.92 33.24
BRL
Northwest
Unai two 267 BRL 8,875.08 66.48
BRL
João Pinheiro 0 72 -
BRL 2,393.28
diamond 11 185
BRL BRL 6,149.40565.08
Jequitinhonha
BRL
Minas Novas/Tourmaline/Capelinha 8 128
BRL 4,254.72 265.92
BRL
araxá 13 178 BRL 5,916.72 664.80
BRL
southern triangle
Fruity/Iturama 19 172 BRL 5,717.28 631.56
BRL
uberaba 10 389 BRL 12,930.36 332.40
BRL
Ituiutaba 0 197
-
BRL 6,548.28
Northern Triangle Sponsorship/Mount Carmel 31 200

BRL 6,648.00 BRL
1,229.88
Uberlândia / Araguari 10 887
BRL BRL 29,483.88332.40
BRL
Privet/Ax 0 -
330 BRL 10,969.20
South
Guaxupé two 164 BRL BRL 5,451.3666.48
BRL
itajubá two 210 BRL 6,980.40 66.48
98

workings 31 181 BRL 6,016.44 BRL

1,229.88
Passos/Piumhi 60 292 BRL BRL 9,706.082,293.56
BRL
Poços de Caldas 4 230 BRL 7,645.20 132.96
BRL
Happy landing 51 519 BRL 17,251.56 1,861.44
BRL BRL
St. Lawrence 8 272 9,041.28 332.40
BRL
Sao Sebastiao do Paraíso 1 128 BRL 4,254.72 33.24
BRL
0 136 -
three hearts BRL 4,520.64
three points 22 131 BRL BRL 4,354.44831.00

BRL
0 193 -
varginha BRL 6,415.32
99

22 BREAST PUNCTURE BY THICK NEEDLE
The Breast Puncture by Coarse Needle (Core Biopsy) is indicated for the diagnosis of
impalpable or palpable breast lesion larger than 2 cm.
Evaluating the production data presented in the SIA/SUS, in the year 2017,
It is clear that only 31 Health Regions performed this procedure, and in 27 the
production was less than 24% of the existing agreement, 3 had a production between 29-
42% of the PPI and only the RS of Ipatinga produced above 50% of its agreement. Fits
It should be noted that in the Northwest RAS there was no record of production and in the South Central RAS
and Jequitinhonha the tests carried out do not generate a significant impact on the percentages of
pact.
Regarding the production of CEAE, in 12 RS the Core Biopsy exams registered
were entirely carried out in these centers.
When performing the consolidated of the programmed amount, there is a total of R$ 1,746,333.60 and
the amount presented which corresponds to R$ 204,719.72, after deducting the amounts from
of CEAE, the value presented that must be considered in relation to the financial impact of the
PPI corresponds to BRL 153,136.65.
100

Table 4 - Coarse Needle Breast Puncture Data (Core Biopsy)
Production
Value
Extended Region of presented PPI
Health Health Region core presented
programmed value SIA/SUS 2017
biopsy
Belo Horizonte/Nova Lima/Caeté 742 4247 BRL 290,622.21 BRL 63,085.10
R$
betim 0 853 BRL 58,370.79 -
Score 84 1026 BRL 70,209.18 BRL 5,819.69

R$
Itabira 0 280 BRL 19,160.40 -
Black gold 61 214 BRL 14,644.02 BRL 5,176.21
center R$
João Monlevade 0 175 BRL 11,975.25 -
Seven lagoons 17 544 BRL 37,225.92 BRL 1,234.88

R$
0 347 BRL 23,745.21 -
Vespasian
curve 92 225 BRL 15,396.75 BRL 7,512.25
R$
Guanhães 0 151 BRL 10,332.93 -
R$
Barbacena -
0 296 BRL 20,255.28
South Center R$
Counselor Lafaiete/Congonhas 0 372 -
BRL 25,455.96
São João del Rei 1 295 BRL 20,186.85 BRL 68.43
West Divinópolis/San Antonio do Monte 13 548 1,319.01

BRL BRL 37,499.64
Ant 1 165 BRL 11,290.95 BRL
101

68.43
R$
Itaúna 0 146 BRL 9,990.78 -
Pará de Minas 19 254 BRL 17,381.22 BRL

Santo Antonio do Amparo/Campo 1,944.30
Beautiful 53 254 4,342.49
BRL BRL 17,381.22
BRL
0 128 BRL 8,759.04 -
good order
Valadares Governor 220 530 BRL 36,267.90 BRL 17,130.13
ipatinga 244 483 BRL 33,051.69 BRL 17,770.47
radiance two 115 BRL 7,869.45 BRL 136.86
R$
caratinga 0 248 -
East BRL 16,970.64
Colonel Fabriciano/Timoteo 5 280 BRL 19,160.40 BRL 556.86
R$
keep
0 90 BRL 6,158.70 -
0 138 BRL 9,443.34 -
Evangelist
R$
0 407 BRL 27,851.01 -
manhuaçu
south east new bridge 58 281 BRL 19,228.83 BRL 4,613.07
R$
0 172 BRL 11,769.96 -
Viçosa
R$
Beyond Paraíba -
0 73 BRL 4,995.39
Southeast Juiz de Fora/LD/BJ de Minas 144 830 BRL 56,796.90 BRL 11,070.61
R$
Leopoldina/Cataguases 224 -
0 BRL 15,328.32
102

R$
muriaé -
0 211 BRL 14,438.73
R$
Carangola 0 161 -
BRL 11,017.23
R$
Santos Dumont -
0 66 BRL 4,516.38
R$
São João Nepomuceno/Bicas 0 92 -
BRL 6,295.56
R$
Uba -
0 373 BRL 25,524.39
R$
Brasilia de Minas/San Francisco 0 306 BRL 20,939.58 -
Janaúba/Monte Azul 17 348 BRL 23,813.64 BRL 1,735.87
January 8 144 BRL 9,853.92 BRL 547.44
Montes Claros/Bocaiuva 8 579 BRL 39,620.97 BRL 1,120.00
R$
0 179 BRL 12,248.97 -
Pirapora
North R$
Salinas/Taiobeiras 0 262 BRL 17,928.66 -
R$
Jesus' heart 0 63 BRL 4,311.09 -
R$
Francisco Sá 0 93 BRL 6,363.99 -
R$
0 77 BRL 5,269.11 -
Mango
R$
beautiful waters 0 78 -
BRL 5,337.54
North East
Almenara 32 229 BRL 15,670.47 BRL 2,189.76
araçuaí 0 120 BRL 8,211.60 BRL
103

R$
Itaobim -
0 106 BRL 7,253.58
R$
nanuque 0 91 -
BRL 6,227.13
R$
Father Paradise -
0 77 BRL 5,269.11
R$
Blue stone -
0 70 BRL 4,790.10
theophilus
Otoni/Malacacheta/Itambacuri 29 408 BRL 27,919.44 BRL 2,199.18
R$
Mine Ducks 0 432 BRL 29,561.76 -
R$
Northwest -
Unai 0 320 BRL 21,897.60
R$
João Pinheiro 0 87 BRL 5,953.41 -
diamond 0 225 BRL 15,396.75 BRL 15,396.75
Jequitinhonha
Minas Novas/Tourmaline/Capelinha two
157 BRL 10,743.51 BRL 10,743.51
R$
araxá 0 212 BRL 14,507.16 -
southern triangle Fruity/Iturama 15 207 BRL 14,165.01 BRL 1,026.45
uberaba 1 469 BRL 32,093.67 BRL 68.43
R$
Ituiutaba
0 235 BRL 16,081.05 -
Northern Triangle Sponsorship/Mount Carmel 41 241 BRL 16,491.63 BRL 3,449.76
R$
South
Privet/Ax 0 397 BRL 27,166.71 -
104

R$
0 197 BRL 13,480.71 -
Guaxupé
R$
0 251 BRL 17,175.93 -
itajubá
workings 33 217 BRL 14,849.31 BRL 2,973.89
Passos/Piumhi 83 351 BRL 24,018.93 BRL 7,111.09
Poços de Caldas 3 275 BRL 18,818.25 BRL 276.86
Happy landing 28 624 BRL 42,700.32 BRL 2,202.32
St. Lawrence 38 328 BRL 22,445.04 BRL 3,244.47
R$
Sao Sebastiao do Paraíso 0 153 BRL 10,469.79 -
R$
three hearts 0 163 BRL 11,154.09 -
R$
three points 0 156 BRL 10,675.08 -
R$
0 232 BRL 15,875.76 -
varginha
105

23 BILATERAL BREAST ULTRASOUND
In consultation with the PPI database, it was found that there is a physical agreement
equivalent to 49,066 procedures distributed in the 77 RS, having been presented in the
SIA/SUS produced 60,205 exams in 2017, which corresponds to a
extrapolation of 11,139 exams.
There was a record of production in the SIA/SUS in 72 RS, when individually evaluating each
one, it appears that in 42 there was extra-ceiling production, in 20 the production was less than 49% of the
agreement and in the remaining 10 the productivity was relevant to a percentage of 58-98% of the PPI.
Regarding the production carried out by CEAE and CEM, it appears that they were
a total of 10,919 procedures were performed, and in the RS of Brasília de Minas/São
Francisco and Leopoldina/Cataguases the production shown corresponds to the production carried out
by these centers.
106

Table 5 - Bilateral Breast Ultrasound Data
Production Value
Extended Region of presented PPI
Health Health Region US presented
programmed value
SIA/SUS 2017
BREAST
betim 1900 1643 BRL 39,760.60 BRL 45,980.00
Score 2069 1972 BRL 47,722.40 BRL 76,894.00
Itabira 430 539 BRL 13,043.80 BRL 10,406.00
Black gold 1166 411 BRL 9,946.20 BRL 28,217.20
center
João Monlevade 837 336 BRL 8,131.20 BRL 20,255.40
Seven lagoons 483 1047 BRL 25,337.40 BRL 11,688.60
Vespasian 139,667 BRL 16,141.40 BRL 5,178.50
curve 613 429 BRL 10,381.80 BRL 14,834.60
Guanhães 103 291 BRL 7,042.20 BRL 2,492.60
Barbacena 789 566 BRL 13,697.20 BRL 19,093.80
South Center Counselor Lafaiete/Congonhas 1457 713 BRL 17,254.60 BRL 35,259.40
São João del Rei 843 567 BRL 13,721.40 BRL 20,400.60
Divinópolis/San Antonio do Monte 1129 1056 BRL 25,555.20 BRL 27,321.80
Ant 119 319 BRL 7,719.80 BRL 2,879.80
Itaúna 190 282 BRL 6,824.40 BRL 4,598.00
West Pará de Minas 584 490 BRL 11,858.00 BRL 14,132.80
Beautiful 1101 493 BRL 11,930.60 BRL 26,644.20
good order 143 248 BRL 6,001.60 BRL 3,460.60
Valadares Governor 2833 1016 BRL 24,587.20 BRL 68,558.60
East ipatinga 2077 927 BRL 22,433.40 BRL 50,263.40
radiance 0 219 BRL 5,299.80 BRL -
107

Caratinga 528 477 228 BRL 11,543.40 BRL 12,777.60

Coronel Fabriciano/Timóteo 538 55 172 BRL 13,019.60 BRL 5,517.60
Mantena Santa Maria do Suaçuí/ BRL 4,162.40 BRL 1,331.00
São João Evangelista Manhuaçu
Ponte Nova Viçosa Beyond Paraíba 113 267 BRL 6,461.40 BRL 2,734.60
Juiz de Fora/LD/BJ de Minas 1676 782 553 BRL 18,924.40 BRL 40,559.20
south east Leopoldina/Cataguases Muriaé 543 938 330 BRL 13,140.60 BRL 13,382.60
Carangola Santos Dumont São João 6 139 BRL 7,986.00 BRL 22,699.60
Nepomuceno/Bicas Ubá BRL 3,363.80 BRL 145.20
2687 1594 BRL 38,574.80 BRL 65,025.40
446 430 BRL 10,406.00 BRL 10,793.20
1135 405 BRL BRL 9,801.00 BRL 27,467.00
Southeast
381 305 157 7,381.00 BRL 9,220.20
127 BRL 3,073.40 BRL 3,799.40
404 176 BRL 4,259.20 BRL 9,776.80
522 721 BRL BRL 17,448.20 BRL 12,632.40
Brasília de Minas/São Francisco 14,374.80 BRL 48.40
Janaúba/Monte Azul Januária 2,594,324,671 BRL 16,238.20 BRL 7,840.80
335 279 461 BRL 6,751.80 BRL 8,107.00
Montes Claros/Bocaiuva 1117 BRL 27,031.40 BRL 11,156.20
North Pirapora 5 343 609 BRL 8,300.60 BRL 121.00
Salinas/Taiobeiras 502 0 120 0 BRL 12,148.40 BRL 14,737.80
Jesus' heart 179 0 149 BRL 2,904.00 BRL -
Francisco Sá 93 148 BRL 4,331.80 BRL -
Aguas 189 439 BRL 3,605.80 BRL -
Formosa mango 418 229 8 BRL 3,581.60 BRL 2,250.60
Almenara 204 BRL 10,623.80 BRL 4,573.80
North East
araçuaí BRL 5,541.80 BRL 10,115.60
Itaobim BRL 4,936.80 BRL 193.60
108

R$
nanuque 0 176 4 -
BRL 4,259.20
Father Paradise 148 BRL 3,581.60 BRL 96.80
Blue stone 132 135 BRL 3,267.00 BRL 3,194.40
theophilus
Otoni/Malacacheta/Itambacuri 2036 783 879 BRL 18,948.60 BRL 49,271.20
Mine Ducks 830 BRL 20,086.00 BRL 21,271.80
Northwest Unai 273 617 BRL 14,931.40 BRL 6,606.60
João Pinheiro 1,166 BRL 4,017.20 BRL 24.20
diamond 278 429 284
BRL 10,381.80 BRL 6,727.60
Jequitinhonha
Minas Novas/Tourmaline/Capelinha 299 BRL 7,235.80 BRL 6,872.80
araxá 134 408 BRL 9,873.60 BRL 3,242.80
southern triangle Fruity/Iturama 991 398 BRL 9,631.60 BRL 23,982.20
uberaba 1565 899 BRL 21,755.80 BRL 60,580.52
Ituiutaba 213 451 BRL 10,914.20 BRL 5,154.60
Northern Triangle Sponsorship/Mount Carmel 1058 463 BRL 11,204.60 BRL 25,603.60
Privet/Ax 1609 762 BRL 18,440.40 BRL 38,937.80
Guaxupé 444 376 BRL BRL 9,099.20 BRL 10,744.80
itajubá 174 483 930 11,688.60 BRL 4,210.80
workings 419 BRL 10,139.80 BRL 22,506.00
Passos/Piumhi 1120 676 BRL 16,359.20 BRL 27,104.00
Poços de Caldas 367 529 BRL 12,801.80 BRL 8,881.40
South
Happy landing 1306 1197 BRL 28,967.40 BRL 31,605.20
St. Lawrence 1169 631 BRL 15,270.20 BRL 28,289.80
Sao Sebastiao do Paraíso 1005 296 264 BRL 7,163.20 BRL 24,321.00
three hearts 314 BRL 7,598.80 BRL 6,388.80
three points 265 301 BRL 7,284.20 BRL 7,643.23
varginha 893 446 BRL 10,793.20 BRL 21,610.60
109

24 BILATERAL SCREENING MAMMOGRAPHY
In January/2018, Ordinance GM/MS No. 15 was published by the Ministry of Health (MS)
in which there was migration of funding for bilateral screening mammography from the
Strategic Actions and Compensation (FAEC) for the Medium and High Complexity Ceiling (MAC).
Through the Ordinance, the MS transferred to the state of MG an annual resource of R$
15,184,395.00 to finance this exam, which added to other funding sources, the
annual resource is currently R$ 16,932,060.00, which is equivalent to 376,268 procedures. That
number of exams in the PPI is equivalent to about 37.4% of the annual need of women of
50 to 69 years old since the population estimate is 2,011,224 (RIPSA, 2015) generating a
demand of 1,005,612 mammograms/year. It should be noted that INCA recommends the
performance of screening bilateral mammography examination by women aged 35 years and over
of age who have a personal or first-degree family history of breast cancer.
When evaluating the production in the 2017 SIA/SUS, 348,313 exams were performed
for the 50 to 69 age group, which is equivalent to a coverage of 34.6%. only the regions
Itaobim, Manga, Pedra Azul, Santa Maria do Suaçuí / São João Evangelista and São
Sebastião do Paraíso had a coverage greater than or equal to 70%, as recommended
by INCA. With the exception of São Sebastião do Paraíso, these other health regions were
covered by the Mobile Mammography Unit of SES/MG in 2017.
In 2017, 166 providers presented production for the mammography exam. if
considering the population parameter of Ordinance GM/MS 1,631/2015, it would be necessary
147 providers. However, it is important to carry out an analysis regarding the parameter of
distance and/or travel time (60 km or 60 minutes) from this Ordinance, since there is
health regions that do not need equipment as a result of the criterion
populational.
The CEAE and CEM in 2017 produced a total of 74,921 exams. Only the CEAE of
Januária, Muriaé and Santo Antônio do Monte did not show production since in Muriaé
and Santo Antônio Monte the services outsource the exam and in Januária the equipment was
dead.
110

Table 6 - Screening Bilateral Mammography Data
% of PPI in
health need
Extended Region of Production Coverage relation to
Health Region PPI
Health presented 2017 annual health
Yearly
need
B.Horizonte/N.Lima/Caeté 178118 45890 26% 53536 30%
Betim Contagem Curvelo 28715 10682 37% 8733 30%
Guanhães Itabira João 38706 10136 26% 10465 27%
Monlevade Ouro Preto Sete 8684 3800 44% 4113 47%
Lagoas Vespasiano Barbacena 5153 279 5% 3042 59%
center
Cons.Lafaiete/Congonhas São 10979 4956 45% 6176 56%
João del Rei Bom Despacho 7716 3898 51% 4560 59%
Divinópolis/S.Antº.Monte 8391 3391 40% 2575 31%
Formiga Itaúna Pará de Minas 21328 4980 23% 4875 23%
S.Antôn.Amparo /Cpo.Belo 13822 2077 15% 2239 16%
Caratinga Cel.Fabriciano/ 12855 4661 36% 4969 39%
South Center Timóteo Governador Valadares 15427 7762 50% 9015 58%
Ipatinga 12936 3819 30% 4438 34%
5449 2874 53% 2191 40%
23126 7425 32% 6957 30%
7196 1923 27% 3479 48%
West
6159 2899 47% 3451 56%
8864 3208 36% 3909 44%
10653 5790 54% 2405 23%
9162 4193 46% 4257 46%
11580 2607 23% 3666 32%
East
20406 5473 27% 9588 47%
19068 6919 36% 8436 44%
111

Mantena 3384 1192 35% 1116 33%

Resplendor 4587 2599 57% 1707 37%
S.Maria Suaçuí/S.João Ev 4359 3996 92% 1587 36%
Manhuaçu Ponte Nova Viçosa 14808 5288 36% 6131 41%
south east Beyond Paraíba Carangola 11405 4494 39% 4669 41%
J.Fora/L.Duarte/B.Jardim 6964 3713 53% 3553 51%
Leopoldina Cataguases Muriaé 3129 1191 38% 132 42%
5980 2777 46% 3 53%
39764 13655 34% 3185 38%
10064 4181 42% 15088 29%
Southeast
8902 4174 47% 2921 4550 51%
Santos Dumont 2985 1375 46% 1613 54%
S.João Nepomuceno/Bicas Ubá 3993 1911 48% 228 57%
15208 6381 42% 1 47%
Brasília MG/S.Francisco 9106 5285 58% 7170 14%
Heart of Jesus Francisco Sá 2019 831 41% 39%
2707 376 14% 13%
Janaúba Monte Azul 11235 1006 9% 1309 46%
North Januária Manga Montes 4505 2127 47% 789 33%
Claros Bocaiúva Pirapora 2290 2681 117% 357 123%
Salinas Taiobeiras 20372 7298 36% 5172 50%
5912 2975 50% 1475 57%
8507 2982 35% 2820 38%
beautiful waters 2464 626 25% 10185 104%
Almenara 7817 4725 60% 3371 15%
araçuaí 3748 617 16% 21%
North East
Itaobim 3372 2350 70% 3267 78%
nanuque 3297 2051 62% 2566 66%
Father Paradise 2352 1558 66% 1146 792 2632 2162 1677
71%
112

Blue Stone 2194 1556 71% 1648 75%

T.Otoni/Malacac/Itambac. 13982 2172 16% 4173 30%
João Pinheiro 2692 494 18% 755 28%
Northwest Patos de Minas 17075 4601 27% 9825 58%
Unai Diamantina 10373 5828 56% 5829 56%
M.Novas/Turmalin/ 7087 2046 29% 2368 33%
Jequitinhonha
Capelin Araxá 4496 789 18% 1413 31%
8517 1273 15% 1773 21%
southern triangle Fruity Iturama 7474 849 11% 553 7%
Uberaba Ituiutaba 19939 7620 38% 7398 37%
Sponsorship 9719 4616 47% 4288 44%
Northern Triangle Monte Carmelo Uberlândia 8979 5220 58% 4553 51%
Araguari Alfenas Machado 42971 15731 37% 15718 37%
Guaxupé Itajubá 15971 6084 38% 6123 38%
7990 3564 45% 3136 39%
10463 3250 31% 3589 34%
Lavras 9463 2300 24% 2802 30%
Passos Piumhi 14613 8914 61% 6639 45%
Poços de Caldas 12549 4031 32% 4367 35%
South
Pouso Alegre São 26233 9470 36% 9473 36%
Lourenço São 14100 4015 28% 5851 41%
Sebastião do Paraíso Três 6595 4600 70% 4420 67%
Corações Três Pontas 6288 382 6% 1170 19%
Varginha 6210 2108 34% 1832 30%
9929 2743 28% 2883 29%
113

25 STRESS ECHOCARDIOGRAPHY
According to Ordinance GM/MS 1631 of 2015, which defines the parameters for
need, 4,200 stress echocardiography exams per year are needed to meet the
assistance needs of all 77 health regions.
In analyzing the PPI database, it was found that there is no
agreement for this procedure, but even without having a financial ceiling, nine health regions
presented production of this exam in SIA/SUS in the period defined for this study, being
them: Barbacena, Belo Horizonte/Nova Lima/Caeté, Ouro Preto, Bom Despacho, Ipatinga, Juiz de
Fora/Lima Duarte/Bom Jardim de Minas, Teófilo Otoni/Malacacheta/Itambacuri and
Uberlândia/Araguari.
Performing a percentage comparison of the production presented and the estimate of
need, it was observed that five of these RS produced above 50% of the recommended, with
highlighting the Teófilo Otoni/Malacacheta/Itambacuri region whose productivity exceeds by more than
than six times the need for assistance.
The table below shows the production presented by the nine health regions in the
SIA/SUS and the estimated need for each one.
Health Region Production presented Need estimate
SIA/ SUS 2017 – Ordinance GM/ MS 1631
Barbacena 30 48
Belo Horizonte / Nova 221 679
Lima / Caeté
Black gold 8 37
good order 19 21
ipatinga 1 81
Juiz de Fora/Lima Duarte/Bom 124 137
Mine Garden
Teófilo Otoni 406 66
João Pinheiro 10 15
Source: SIA-SUS, 2017
114

26 TRANSESOPHAGEAL ECHOCARDIOGRAPHY
According to Ordinance GM/MS 1631 of 2015, which defines the parameters for
need, 4,200 transesophageal echocardiography exams/year are needed to meet the
assistance needs of all 77 health regions.
In analyzing the PPI database, it was found that there is no
agreement for this procedure, but even without having a financial ceiling on the PPI, ten regions of
presented production of this exam in the SIA/SUS in the period defined for this study,
being: Belo Horizonte/Nova Lima/Caeté, Betim, Contagem, Bom Despacho, Coronel
Fabriciano/Timóteo, Ipatinga, Juiz de Fora/Lima Duarte/Bom Jardim de Minas, Ponte Nova,
Uberaba, Uberlândia/Araguari.
As shown in the table below, production in some regions is negligible
when compared to the recommended estimate of need, with the exception of Coronel's SR
Fabriciano/Timóteo whose productivity reported in the SIA/SUS exceeds by almost three times the
need, and Bom Despacho with coverage of 75% of the assistance need.
Health Region Production presented Need estimate
SIA/ SUS 2017 – Ordinance GM/ MS 1631
Belo Horizonte / Nova 97 679
Lima / Caeté
betim 6 140
Score 1 172
good order 16 21
Colonel Fabriciano/Timoteo 137 46
Juiz de Fora/Lima Duarte/Bom 43 137
Mine Garden
ipatinga 1 81
new bridge 1 43
uberaba 13 82
Source: SIA-SUS, 2017.
115

27 TRANSTHORACIC ECHOCARDIOGRAPHY
To carry out the analysis of the assistance coverage of this procedure, a

tabulation of data linked to the SIGTAP code 02.05.01.00-32. According to the parameters of
Ordinance GM/MS 1,631 of 2015, 335,955 exams are needed per year to meet the
assistance need of the 77 RS.
In consultation with the PPI database, it appears that the physical goal made available to
this procedure (35,544) provides coverage of the estimated need that oscillates between
percentages of 9-12% of the total recommended for all SRs, thus generating a deficit
assistance and finance.
The production presented, like other analyzed procedures, has

different scenarios in health regions. In 26 RS there was no record of production in the SIA/SUS in the
delimited period for this study, in 25 RS there was MAC ceiling extrapolation, and the
largest in Uberlândia/Araguari, Uberaba, São João Nepomuceno/Bicas and Juiz de Fora/Lima
Duarte/Bom Jardim de Minas. It should be noted that the estimate of need was not reached.
recommended in none of the 77 RS.
116

Table 7 - Transthoracic Echocardiography Data
Production
PT.1631-
presented Estimated
Region PPI Value presented
Health Region transthoracic need for
enlarged echocardiography programmed value SIA/SUS 2017
exams
SIA 2017
54328
Belo Horizonte/Nova Lima/Caeté 33,119 5919 BRL 236,404.86 BRL 1,322,772.86
BRL 178,771.44
11196
betim 4,476 1189 BRL 47,488.66 BRL 21,727.36
BRL 8,467.28
13760
Score 544 1429 BRL 57,074.26 BRL 55,516.60
BRL 15,177.20
3755
Itabira 212 390 BRL 15,576.60 BRL 4,553.16
BRL 16,852.71
center 2944
Black gold 1,390 299 BRL 11,942.06 BRL 25,521.66
2238
João Monlevade 380 243 BRL 9,705.42
7090
Seven lagoons 114 759 BRL 30,314.46
5043
Vespasian 237 483 BRL 19,291.02
2967
curve 639 311 BRL 12,421.34
117

R$
1878 -
Guanhães 0 209 BRL 8,347.46
Barbacena 648 3818 408

BRL BRL
16,295.52 25,881.12
South Center Counselor Lafaiete/Congonhas 207 4945 514
BRL BRL 8,267.58
20,529.16 BRL
São João del Rei 155 3851 410
BRL 16,375.40 6,190.70
BRL
7511
Divinópolis/San Antonio do Monte 272 767 BRL 30,633.98 10,863.68
BRL
2123 -
Ant 0 230 BRL 9,186.20
1965
Itaúna 92 204 BRL 8,147.76 BRL
West
3,674.48
382 3
Pará de Minas 96 355 BRL 14,178.70 BRL
Santo Antonio do Amparo/Campo 3,834.24
3287
Beautiful 135 355 BRL 14,178.70 BRL
5,391.90
1716
good order 51 182 BRL 7,269.08 BRL
2,036.94
Valadares Governor 240 6915 736
BRL BRL
29,395.84 9,585.60
ipatinga 949 6463 671
BRL BRL 37,903.06
East 26,799.74
radiance 0 1455 159
BRL R$ -
6,350.46
caratinga 17 3255 345
BRL BRL 678.98
Colonel Fabriciano/Timoteo 0 3700 13,779.30 390 BRL R$
118

15,576.60 -
BRL R$
keep 0 1135 122
4,872.68 -
Santa Maria do Suaçuí/São João BRL R$

0 1662 194 -
Evangelist 7,748.36
BRL R$
5512 568
0 22,685.92 -
manhuaçu
BRL
south east 3473 395
new bridge 1,659 15,776.30 BRL
BRL 66,260.46
2211 240
Viçosa 1,146 9,585.60 BRL
BRL 45,771.24 BRL
Beyond Paraíba 0 929 102
4,073.88 -
BRL
Juiz de Fora/LD/BJ de Minas 7517 10968 1156
46,170.64 BRL
BRL 300,228.98 BRL
Leopoldina/Cataguases 0 2939 312 -
12,461.28
BRL
muriaé 711 2787 293
11,702.42 BRL
Southeast
BRL 28,397.34
Carangola 683 2070 222
8,866.68 BRL
BRL 27,279.02
Santos Dumont 133 830 92
3,674.48 BRL
BRL 5,312.02
São João Nepomuceno/Bicas 930 1171 128
5,112.32 BRL
BRL 37,144.20
Uba 73 5016 519
20,728.86 BRL
BRL 2,915.62
North 3972 426
Brasilia de Minas/San Francisco 203 17,014.44 BRL 8,107.82
119

4476 485
Janaúba/Monte Azul 985 BRL BRL
19,370.90 39,340.90
1865 202
January 29 BRL BRL
8,067.88 1,158.26
7950 807
Montes Claros/Bocaiuva 1,572 BRL BRL
32,231.58 62,785.68
2349 249
Pirapora 343 BRL BRL
9,945.06 13,699.42
3340 366
Salinas/Taiobeiras 189 BRL BRL 7,548.66
14,618.04 BRL
776 87
0 BRL -
Jesus' heart
3,474.78 R$
1197 130
Francisco Sá 0 BRL -
5,192.20 R$
939 107
0 BRL -
Mango
4,273.58 R$
beautiful waters 0 967 108
BRL -
4,313.52
Almenara 375 2940 320
BRL BRL
12,780.80 14,977.50 BRL
araçuaí 0 1461 166
BRL -
North East 6,630.04 R$
Itaobim 0 1325 149
BRL -
5,951.06 R$
nanuque 0 1127 127
BRL -
5,072.38 R$
Father Paradise 0 1009 107
BRL -
Blue stone 0 868 4,273.58 98 BRL R$
120

3,914.12 -
theophilus BRL
361 5273 567
Otoni/Malacacheta/Itambacuri 22,645.98 BRL
BRL 14,418.34
5677
Mine Ducks 767 604 24,123.76 BRL
BRL 30,633.98 BRL
Northwest 4342 -
Unai 0 447 17,853.18
BRL R$
1180 -
João Pinheiro 0 120 4,792.80
BRL
diamond 840 2772 311
12,421.34 BRL
Jequitinhonha
BRL 33,549.60 BRL
Minas Novas/Tourmaline/Capelinha 0 2007 217 -
8,666.98
R$
2948 -
araxá 0 294 BRL 11,742.36
triangle of 2826
South Fruity/Iturama 1 287 BRL 11,462.78 BRL
39.94
6526
uberaba 4,385 652 BRL 26,040.88 BRL 208,169.90
BRL
Ituiutaba 0 3125 326 -
BRL 13,020.44
triangle of Sponsorship/Mount Carmel 67 3117 336
North BRL 13,419.84 BRL
2,675.98
Uberlândia / Araguari 10265 14270 1488
BRL 59,430.72 BRL
409,984.10
Privet/Ax 335 5175 550 BRL 21,967.00 BRL 13,379.90
South
BRL 34,268.52
Guaxupé 858 2599 273 BRL 10,903.62
121

itajubá 289 3300 351 BRL 14,018.94 BRL

11,542.66 BRL
workings 0 2921 304 BRL 12,141.76 -
Passos/Piumhi 355 4666 490 BRL 19,570.60 BRL

14,178.70
Poços de Caldas 874 3720 383 BRL 15,297.02 BRL
34,907.56
Happy landing 2,624 8651 868 BRL 34,667.92 BRL
104,802.56
St. Lawrence 1 4227 459 BRL 18,332.46 BRL 39.94
BRL 7,388.90
Sao Sebastiao do Paraíso 185 2023 214 BRL 8,547.16 BRL
0 2121 227 BRL 9,066.38 -

three hearts
R$
three points 0 2022 218 BRL 8,706.92 -
varginha 189 3177 324 BRL 12,940.56 BRL 7,548.66
122

28 MAGNETIC RESONANCE
The organizational basis for evaluating the offer of magnetic resonance care
(RM) took into account the tabulation of data linked to the following codes
present in SIGTAP: 0207010030, 0207010048, 0207010056, 0207010064, 0207010072,

0207020027, 0207020035, 0207030014, 0207030022, 0207030030, 020703004. Under analysis
to the PPI database, it was found that these procedures have linked to them
a value of SADT and that present different forms of organization among themselves, being that
its agreement is based on the following groupings: MRI of the head, neck and spine
spine, MRI of the abdomen, pelvis, and lower limbs, and MRI of the chest and limbs
superiors. Due to this peculiarity, the survey of the amount of the agreement
existing, the programmed value and the SADT of the 77 RS were tabulated based on the subgroup
207, which encompasses all the aforementioned forms of organization. The PPI made available
for this procedure provides coverage of only 2-3% of the estimated need
recommended by Ordinance GM/MS 1631, thus generating a coverage deficit
assistance in all health regions. The programmed and agreed value in the database
of the PPI is BRL 4,128,899.98 with a SADT of BRL 185,800.45 and the amount presented in the
SIA/SUS in 2017 was R$12,291,866.29.
Ordinance GM/MS 1,631 also presents parameters related to the quantity
of necessary equipment and the installed capacity of each one. In this sense, it was
A survey was carried out at the CNES of the SUS equipment existing in each RS and the
From this, a cross-reference of these data was carried out with the estimate of the need
advocated. It was found that only 33 RS have MRI equipment registered in the
CNES, 14 of which have a greater amount of equipment than the estimated
recommended need, especially the RS of Ipatinga, 11 RS have equipment in
amount lower than recommended. The biggest care void is found in the RAS
Northwest, which does not have any SUS MR equipment and according to the parameters
needs 4 to meet the recommended need. In 8 regions, the amount of
equipment is compatible with the estimate of need and 13 RS do not fit the
population criteria for having MRI equipment.
It is noteworthy that none of the equipment that is available in the SUS network
123

presented a production compatible with their installed capacity recommended by the
Ordinance GM/MS 1,631 (5,000 exams/year). Another point to be highlighted is the
production by region that does not present the equipment registration in its CNES. it is believed
that this occurs due to the fact that it is not mandatory to have the registration to have the production,
and, therefore, the information of lack of equipment may not be true, a situation that
makes a reliable analysis of the existing network difficult.
The consolidated estimate of the need for the 77 SRs defines it as ideal quantitative
to supply the care demand 629,916 procedures/year, through a quantity of
MRI scans scheduled in the PPI database equivalent to 15,363 procedures.
Analyzing the production data, the total number of exams registered in SIA/SUS in 2017
corresponds to 45,452. Among the SRs that presented production, in 31 one was covered
percentage lower than 10% of the recommended need, in 06 this percentage ranges from 11-
23% coverage of need. There was extrapolation of the MAC ceiling in 26 RS, and
the highest percentages were in: Alfenas/Machado, Belo Horizonte/Nova Lima/Caeté, Juiz
de Fora/Lima Duarte/Bom Jardim de Minas, Caratinga and Uberaba.
MAP 1: MRI equipment available at SUS in Minas

General.
Source: Ministry of Health - National Registry of Health Establishments in Brazil - CNES
124

Table 8 - Magnetic Resonance Data
PT.1631- Equipment
Production Estimate s SUS
Region presented The
Value presented Esteem
Health Region PPI SADT
enlarged the RM-SIA need programmed value SIA/SUS 2017 exist need
2017 from from beings
exams ty
Belo Horizonte / Nova
101865 2,558
Lima / Caeté 23,482 BRL 687,478.12 BRL 30,936.52 BRL 6,310,787.50 20992 515 21 20
betim 0 BRL 138,409.37 BRL 6,228.42 BRL - 25800 617 BRL 165,822.50 BRL 7,462.01 4
Score 1,725 BRL 527,728.79 7 BRL 45,419.77 BRL 2,043.89 BRL 3,225.00 BRL 34,669.53 BRL 1 5
Itabira 12 1,560.13 BRL 3,493.7588,152,
169 5520 BRL 28,219.37
03 BRL BRLBRL
3,966.84 1,269.87 BRL
- 9,455 - 4197
BRL 13293BRL
56,170.00 BRL 51 1
center Black gold 13 - 5,564 3,522129
BRL 24,456.80
2,527.65
BRLBRL
1,100.56
44,343.75
BRLBRL
- 7158
36,282.11
BRL 47,569.84
BRL 1,632.69
BRL BRL 0 1
João Monlevade 0 105 2,140.64 BRL 1 1
Seven lagoons 0 328 2 3
Vespasian 165 209 1 two
curve 00 135 1 1
Guanhães 3 91 0 1
Barbacena 177 806.25 0 1
counselor
South Center 149 9273 222 1 two
Lafaiete/Congonhas BRL 59,663.83 BRL 2,684.87 BRL 40,043.75 BRL

São João del Rei 247 7220 178 47,838.59 BRL 2,152.74 BRL 66,381.25 two 1
Divinopolis/San Antonio do 14083
mount 669 331 BRL 88,958.28 BRL 4,003.12 BRL 179,793.75 1 3
West
3981
Ant 107 100 BRL BRL 26,875.63 BRL 1,209.40 28,756.25 1 1
125

Itaúna 0 3684 88 BRL 23,650.55 BRL 1,064.27 BRL - BRL 41,119.69 0 1

Pará de Minas 0 7169 153 BRL 1,850.39 BRL - 0 1
Santo Antônio do
6164
Amparo/Campo Belo Bom 31 154 BRL 41,388.44 BRL 1,862.48 BRL 8,331.25 BRL 20,694.22 BRL 0 1
Dispatch Governor Valadares 54 3217 77 931.24 BRL 14,512.50 BRL

133,837.50
85,733.20BRL
BRL78,208.05
3,857.99 BRL
3,519.36 0 1
Ipatinga Resplendor Caratinga 498 12966 319 12117 BRL 211,506.25 BRL 18,275.39 BRL 40,044.69 BRL 1,802.01
226,018.75
BRL 1 3
Colonel Fabriciano/Timóteo 787 291 2728 68 6103 BRL 45,419.77 BRL 2,043.89 BRL 49,987.50 BRL 14,244.06 BRL 6 two
0 149 6938 169 - 0 1

Mantena Santa Maria do 640.98 BRL - BRL 822.39 BRL
Suaçuí/São João Evangelista 841 2128 53 2 1
East
Manhuaçu Ponte Nova Viçosa Beyond 186 1 1
Paraíba Juiz de Fora/LD/BJ de Minas 0 0 0
Leopoldina/Cataguases Muriaé
0 3117 84 0 1
Carangola Santos Dumont São João BRL 22,575.55 BRL 1,015.90 BRL - BRL 65,845.23
Nepomuceno/Bicas Ubá 619 10334 245 170 BRL 2,963.04 BRL 166,356.25 BRL 45,688.52 BRL 2,055.98 BRL two
east of
501 6512 104 134,643.75 BRL 27,950.62 BRL 1,257.78 BRL 92,450.00
11,825.23
BRL 1 1
South
344 4146 44 BRL 532.14 BRL - 2 1
0 1742 20 0
3487 20565 500 6 4

BRL 134,378.05 BRL 6,047.01 BRL 937,131.25 BRL 36,282.11 BRL
5511 135 1,632.69 BRL - BRL 33,863.28 BRL 1,523.85 BRL 123,356.25 BRL 1
Southeast 0 5226 126 25,800.55 BRL 1,161.02 BRL 40,850.00 BRL 10,750.23 BRL 483.76 1 1
459 3882 96 BRL 14,781.56 BRL 665.17 BRL 60,738.91 BRL 2,733.25 BRL 2 1
1556 40 - 0 0
2196 55 - 0 0
152 0 0 229 9405 226 61,543.75 01 two
Brasília de Minas/São
0 7447 184 0 1
Francisco Janaúba/Monte -
BRL 49,451.09 BRL 2,225.30 BRL 56,170.00
North
Azul Januária 0 8393 209 - 0
BRL 2,527.65 BRL 23,650.55 BRL 1,064.27 two
0 3496 88 - 0 1
BRL
126

Montes Claros/Bocaiuva 978 14907 350 4404 BRL 94,064.61 BRL 4,232.91 BRL 262,837.50 BRL 29,025.62 4 3
Pirapora 00 108 6263 157 BRL 1,306.15 BRL - BRL 42,194.69 BRL 1,898.76 BRL - BRL 0 1
Salinas/Taiobeiras 00 1455 37 2244 56 9,943.98 BRL 447, 48 BRL - BRL 15,050.31 BRL 677.26 BRL - 0 1
Jesus' heart 00 1760 47 1812 47 BRL 12,631.56 BRL 568.42
BRL BRL
- BRL- BRL
36,819.62
12,631.57
BRL BRL
1,656.88
568.42
R$ 0 0
Francisco Sá 00 5512 137 274072 - R$ 19,350.47 R$ 870.77
14,781.57
R$ R$ 17,200.40
R$ 665.17
R$R$
774.02
- R$ 12,362.82
R$ - R$ 0 0
Aguas 00 2484 64 2114 55 R BRL 556.33 BRL - BRL 11,018.99 BRL 495.85 BRL - 0 0
Formosa mango 0 0
Almenara 0 1
- 0 1
araçuaí
Itaobim 0 0
North East nanuque 0 0
Father Paradise 0 1892 46 0 0
Blue stone 0 1627 41 0 0
Teófilo Otoni/
706 9887 245 3 two
Malacacheta/Itambacuri R$ 65,845.26 R$ 2,963.04 R$ R$ 69,876.56 189,737.50

Mine Ducks 0 10645 260 R$ 3,144.45 R$ R$ 51,869.92 R$ 2,334.15 - 0 two
Northwest Unai 0 8141 193 R$ R$ 13,975.31 R$ 628.89 R$ R$ 36,282.11 - 0 two
João Pinheiro 0 2213 52 BRL 1,632.69 BRL - 0 0

diamond 144 5197 135 38,700.00 3 1
Jequitinho
Mines
nah 0 3763 93 0 1
BRL 24,994.30 BRL 1,124.74 BRL 34,400.78 -
New / Tourmaline / Chapel
araxá 5528 128 BRL 1,548.04 BRL 33,594.53 BRL 1,511.75 537.50 0 1
southern
Fruity/Iturama 5299 125 BRL - BRL 75,789.22 BRL 3,410.51 BRL 598,650 0 1
triangle
uberaba 20 12236 282 141 .00 BRL 37,894.61 BRL 1,705.26 BRL 38,969.61 BRL 1,753.63 4 two
Ituiutaba 5860 - BRL

BRL 145 56,437.50 642 BRL 172,541.41 BRL 7,764.36 0 1
Northern
Sponsorship/Mount Carmel 2181 5844 BRL 31,444.45
792,275.00
BRL 1,415.00
239 BRL
BRL
64,232
117 .73 BRL 2,890.47 BRL 474,075.00 1 1
Triangle
Uberlândia / Araguari 0 210 26755 4 5
Privet/Ax 2948 9702 3 two
South
1,764 0 4873 - 0 1
Guaxupé
127

itajubá 163 6187 152 BRL 40,850.94 BRL 1,838.29 BRL 131 BRL 43,806.25 0 1
workings 0 5478 35,207.03 BRL 1,584.32
2,576.03 BRL BRL 57,245.08
213 165 BRL
BRL 44,344.77 - 0 1
Passos/Piumhi 414 8749 BRL 4,535.26
BRLBRL
1,995.51
BRL 53,482.50
BRL 375 BRL 100,783.51
2,406.71 111,262.50 1 two
Poços de Caldas 140 6976 BRL 199 BRL

BRL24,725.55
26,338.12BRL
BRL1,112.65 BRL
1,185 .22 92BRL
BRL 98 37,625.00 2 1
Happy landing 370 16221 24,994.30 BRL 1,124.74 BRL 93 BRL 37,625.86 99,437.50 2 3
St. Lawrence 0 7925 BRL 1,693.16 BRL 140 - 0 two
Sao Sebastiao do Paraíso 121 3794 32,518.75 0 1

three hearts 0 3976 - 0 1
three points 0 3791 - 0 1
varginha 551 5956 148,081.25 0 1
128

29 COLONOSCOPY
According to the parameters of Ordinance GM/MS 1631 of 2015,
73,490 colonoscopy exams per year, to meet the needs of the population of the State,
however, the programmed agreement of the 77 RS is equivalent to 7,620 procedures. Evaluating the
coverage of the estimated need provided by the PPI, it is inferred that there is an offer
insufficient assistance to meet the demand in the State, since it meets a
percentage of 9-12% of the recommended exams.
Analyzing the production data, it is possible to verify that 38 RS presented
production record in SIA/SUS in the period defined for this study. Of this total, there were
extrapolation of the financial ceiling in 23 RS, in 6 regions there was the use of a
percentage lower than 12% of the agreement, in 5 the use of PPI ranged between 21-43% and in
other production was equivalent to a percentage of 67-99% of the existing PPI. RAS
Jequitinhonha did not register any production of colonoscopy in the SIA/SUS in the period
delimited for this study.
It is noteworthy that in no SR there was a productivity compatible with the
estimate of need, and only Juiz de Fora/Lima Duarte/Bom Jardim de Minas
reached an approximate value (95%) by extrapolating the MAC ceiling equivalent to
924%. In 28 RS, coverage of less than 25% of the care estimate was provided and in
9, a percentage of 32-76% of the recommended need was reached.
Table 9 presents the details and values of the PPI, the programmed value, and the
value presented in the SIA/SUS as well as the estimate of need according to the Ordinance
GM/MS 1631, for each of the 77 RS.
129

Table 9 - Colonoscopy Data
Production PT.1631-
Region presented Estimated Value presented
Health Region PPI
enlarged from colonoscopy need for programmed value SIA/SUS 2017
Health SIA 2017 exams
Belo Horizonte/Nova Lima/Caeté 6,740 11884 1,265 BRL 142,514.90 BRL 759,328.40 BRL
betim 1,247 2449 256 28,840.96 BRL 140,487.02 BRL
Score 590 3010 306 34,473.96 BRL 66,469.40 BRL 9,463.44
Itabira 142 821 84 BRL 15,997.72 BRL 7,322.90 BRL BRL
Black gold 644 65 5,970 .98 R$ 28,502.98 R$ 18,363.58 -
center
João Monlevade 0 253 490 53 R$ 58,357.88 R$ 11,491.32 R$
Seven lagoons 518 1551 163 3,492.46 R$ 7,548.22 R$ R$ 5,069.70
Vespasian 31 1103 102 R$ R$ 9,914.08 R$ 450, 64 BRL
12,279.94
curve 0 649 67 BRL 12,167.28 BRL 10,026.74 BRL -
Guanhães 0 411 45 -
4,281.08 BRL 18,588.90 BRL 12,730.58
Barbacena 4 835 88 BRL 5,520.34 BRL BRL 5,069.70
BRL
BRL
South Center Counselor Lafaiete/Congonhas 108 1082 109 8,562.16 BRL BRL 8,336.84 BRL
Divinópolis/San Antonio do Monte 113 1643 165

0 464 49 -
Ant
West Itaúna 0 430 45 -
Pará de Minas 0 836 76 -
0 719 74 -
Santo Antônio do Amparo/Campo Belo
130

good order 8 375 39 BRL 4,393.74 BRL 901.28 BRL 17,800.28

Valadares Governor 38 1513 158 BRL 4,281.08 BRL 16,223.04 BRL
51,710.94
ipatinga 459 1414 144 BRL 3,943.10 BRL 5,520.34 BRL
radiance 0 318 35 13,969.84 BRL 9,350 .78 BRL 10,702.70-
caratinga 124 712 75 BRL 3,041.82 BRL
East
Colonel Fabriciano/Timoteo 95 809 83
keep 0 248 27 -

0 364 42
BRL 4,731.72 BRL -
Evangelist
manhuaçu 170 1206 121 13,631.86 BRL 19,152.20 BRL 9,576.10
south east new bridge 193 760 85 BRL 21,743.38 BRL 5,858.32 BRL
Viçosa 73 484 52 8,224.18 BRL 2,365.86 BRL BRL
27,827.02
Beyond Paraíba 0 203 21 R$ 257,090.12 R$ 7,548.22 R$ R$ -
Juiz de Fora/LD/BJ de Minas 2282 2399 247 6,984.92 R$ R$ 5,520.34 R$ R$ 2,253.20
Leopoldina/Cataguases 0 643 67 R$ R$ 3,041.82 R$ R$ 12,617.92 R$ R$-
muriaé 6 610 62 10,364, 72 R$ R$ 11,603.98 R$ R$
675.96
Southeast
Carangola 0 453 49 4,844.38 R$ R$ 19,602.84 R$ 47,655.18-
Santos Dumont 0 181 20 R$ 6,083.64 R$ R$ 8,787.48 R$ R$ -
São João Nepomuceno/Bicas 0 256 27 2,140.54 R$ -

Uba 0 1097 112 -
Brasilia de Minas/San Francisco 0 869 92 -
Janaúba/Monte Azul 40 979 103 4,506.40
January 0 408 43 -
North Montes Claros/Bocaiuva 423 1739 174
0 514 54 -
Pirapora
Salinas/Taiobeiras 0 731 78 -
Jesus' heart 0 170 19 -
131

Francisco Sá 0 262 29 R$ 3,267.14 R$ R$ -

0 205 22 2,478.52 R$ R$ 2,591.18 -
Aguas
Formosa mango 0 211 23 R$ R$ 7,773.54 R$ R$ -
Almenara 0 643 69 4,055.76 R$ R$ 3,492.46 -
araçuaí 24 320 36 R$ R$ 3,041.82 R$ R$ 2,703.84

Itaobim 0 290 31 BRL 2,703.84 BRL BRL -
North East
nanuque 0 247 27 2,365.86 BRL 13,744.52 -
Father Paradise 0 221 24 BRL 17,236.98 BRL -
Blue stone 0 190 21 14,307.82 BRL 12,730.58 -
Teófilo Otoni/Malacacheta/Itambacuri 153 1154 122 BRL 10,815.36 BRL 225.32 BRL 2,816.50
Mine Ducks 113 1242 127 BRL R$ 7,548.22 R$ R$ 5,182.36 R$ R$
Northwest Unai two 950 96 6,984.92 R$ R$ 7,097.58 R$ 15,209.10 R$
João Pinheiro 0 258 25 15,772.40 R$ 109,208.30 R$ 7,886.20 -
diamond 0 606 67 R$ R$ 8,336.84 BRL 35,713.22 BRL -
Jequitinhonha -
Minas Novas/Tourmaline/Capelinha 0 439 46 267,342.18 BRL 13,406.54 BRL 81,340.52
araxá 0 645 62 BRL 6,534.28 BRL 8,449.50 BRL BRL -
southern triangle Fruity/Iturama 135 618 63 7,435.56 BRL BRL 12,054, 62 BRL
uberaba 823 1428 140 45,176.66
Ituiutaba 0 684 70 -
triangle of Sponsorship/Mount Carmel 0 682 74 -
North
Privet/Ax 722 1132 119
0 569 58 -
Guaxupé
South 0 722 75 -
itajubá
workings 0 639 66 -
Passos/Piumhi 401 1021 107
132

Poços de Caldas 10 814 82 BRL 9,238.12 BRL 1,126.60 BRL

Happy landing 409 1892 184 20,729.44 BRL 46,077.94 BRL 10,815.36
St. Lawrence 6 925 96 BRL 675.96 BRL 5,182.36 BRL 8,562.16
BRL
Sao Sebastiao do Paraíso 76 443 46 5,633.00 BRL 675.96 BRL 5,295.02
BRL BRL
three hearts 6 464 50 7,773.54 BRL 15,096.44
three points 0 442 47 -
varginha 134 695 69
133

30 VIDEOLARYNGOSCOPE
Evaluating the production data in the year 2017, it appears that only 17 RS performed
this procedure, and in 11 regions there was extrapolation of the MAC ceiling, with the largest
in the RS of Formiga and Betim, in 5 the production was below 29% of the agreement and in 1 it was
equivalent to 79% PPI utilization. It is worth mentioning that the Northeast, Northwest and
Jequitinhonha showed no production record in the period defined for this study.
In analyzing the PPI database, it is inferred that there is a deficiency in network coverage, a
since the existing agreement, if executed in its entirety, provides coverage of the estimate
need of only 5-6% of the recommended total of all 77 RS.
When comparing the production presented with the estimate of need,
it appears that only the RS of Betim reached the coverage of the recommended need through a
extrapolation of its MAC ceiling of 1,917%, in 13 the coverage was less than 30% and in 3 there was
coverage of the need in percentages that ranged between 46-60%.
Table 10 presents the data that were considered for the analysis of the
assistance coverage of the videolaryngoscopy procedure by RS.
134

Table 10 - Videolaryngoscopy data
Production PT.1631-
Value
Extended Region of presented Need
Health Region PPI presented
Health videolaryngoscopy estimate programmed value
SIA/SUS 2017
SIA 2017 of exams
15619
Belo Horizonte/Nova Lima/Caeté 7,220 BRL 855 38,902.50 BRL 328,510.00 172
betim 3,297 3219 BRL 7,826.00 BRL 150,013.50 206 BRL
Score 306 3956 9,373.00 BRL 13,923.00 54 BRL 2,457.00
Itabira 0 1080 BRL 43 BRL 1,956.50 BRL 36 BRL 1,638 -
center Black gold 0 846 .00 BRL 108 BRL 4,914.00 BRL 70 BRL -
João Monlevade 173 644 3,185.00 BRL 46 BRL 2,093.00 BRL
7,871.50
30 BRL
Seven lagoons 0 2038 -
1,365.00 BRL 59 BRL 2,684.50 BRL 76 BRL
Vespasian 1 1450 3,458.00 BRL 60 BRL 2,730.00 BRL 110
45.50
curve 0 853 -
BRL 5,005.00 BRL 864.50 33 BRL 1,501.50
Guanhães 0 540 BRL 16,698.50 29 BRL 1,319.50 BRL 52 -
Barbacena 0 1098 BRL 2,366.00 BRL -
South Center Counselor Lafaiete/Congonhas 60 1422 2,730.00
São João del Rei 0 1107 -
Divinópolis/San Antonio do Monte 19 2159

Ant 367 610
West
Itaúna 0 565 -
Pará de Minas 0 1099 -
135


945 -
Beautiful 0 52 R$ 2,366.00 R$ 26 R$
0 493 1,183.00 R$ 107 R$ 4,868.50 -
good order
Valadares Governor 0 1988 R$ 97 R$ 4,413.50 R$ -
ipatinga 279 1858 12,694.50 23 R$ 1,046.50 R$ 49 R$ 2,229.50 R

radiance 0 418 $56 BRL 2,548.00 BRL 18 BRL 819.00 BRL -
caratinga 7 936 318.50
East
Colonel Fabriciano/Timoteo 0 1064 -
keep 0 326 -

0 478 28 -
Evangelist BRL 1,274.00 BRL
0 1585 82 BRL 3,731.00 BRL 55 BRL -
manhuaçu
south east new bridge 16 998 2,502.50 BRL 34 BRL 728.00
0 636 3,185.00 BRL 15 BRL 682.50 -
Viçosa
Beyond Paraíba 0 267 BRL 169 BRL 7,689.50
35,035.00 45BRL
BRL -
Juiz de Fora/LD/BJ de Minas 770 3153 2,047.50 BRL 42 BRL 1,911.00 BRL 33 BRL
Leopoldina/Cataguases 0 845 1,501.50 BRL 13 BRL 591.50 BRL 910.00 BRL-
muriaé 0 801 -
76 BRL 3,458.00 BRL 60 BRL 2,730.00 BRL 70
Southeast
Carangola 0 595 BRL 3,185.00 BRL 29 BRL 1,319.50 BRL 116 -
Santos Dumont 0 239 BRL 5,278.00 -
BRLBRL 30,030.00 36 BRL 1,638.00
São João Nepomuceno/Bicas 0 337 20 -
Uba 0 1442 -
Brasilia de Minas/San Francisco 0 1142 -
Janaúba/Monte Azul 0 1287 -

North January 0 536 -
Montes Claros/Bocaiuva 660 2286
0 675 -
Pirapora
136

Salinas/Taiobeiras 0 960 53 R$ 2,411.50 R$ 12 R$ -
0 223 546.00 R$ R$ 910.00

728.00 R$ R$
R$ R$ -
Jesus' heart
Francisco Sá 0 344 20 728.00 R$ 46 R$ -
0 270 16 2,093.00 R$ 25 -
Aguas
Formosa mango 0 278 16 R$ 1,137, 50 R$ -
Almenara 0 845 21 R$ 955.50 R$ R$ 864.50 -
araçuaí 0 420 R$ R$ 728.00 R$ R$ 637.00 -

Itaobim 0 381 R$ -
North East nanuque 0 324 19 -
Father Paradise 0 290 16 -
Blue stone 0 249 14 -
theophilus
0 1516 82
Otoni/Malacacheta/Itambacuri R$ 3,731.00 R$ 88 -
Mine Ducks 0 1632 R$ 4,004.00 R$ 66 R$

Northwest Unai 0 1248 3,003.00 R$ R$ 773.50 R$ 17 -
João Pinheiro 0 339 R$ 31 R$ 1,410.50

45 R$ 2,047.50
R$ 44 R$ -
diamond 0 797 2,002.00 BRL 42 BRL 1,911.00 -
Jequitinhonha -
Minas Novas/Tourmaline/Capelinha 0 577 BRL 96 BRL 4,368.00
22,534.00 48 BRL
BRL
araxá 0 848 2,184.00 BRL 48 BRL -
southern triangle Fruity/Iturama 0 812 2,184.00 BRL 216 BRL -
uberaba 306 1876 9,828.00 BRL 94,731, 00 80 R$ 3,640.00 R$ 39

Ituiutaba 0 899 R$ 1,774.50 R$ R$ 2,320.50 R$ 51 -
Northern Triangle Sponsorship/Mount Carmel 0 896 -

Privet/Ax 0 1488 -
South 0 747 -
Guaxupé
itajubá 3 949 136.50
137

workings 0 840 45 R$ 2,047.50 R$ 72 R$ -

Passos/Piumhi 0 1342 3,276.00 R$ 55 R$ 2,502.50 -
0 1070 R$ 126 R$ 5,733.00 R$ 68 -
Poços de Caldas
0 2487 R$ 3,094.00 R$ R$ 1,410.50 -
Happy landing
0 1215 R$ 31 32 R BRL 1,456.00 -
St. Lawrence
Sao Sebastiao do Paraíso 0 582 BRL 47 BRL
BRL2,138.50
32 BRL 1,456.00
BRL -
0 610 -
three hearts
three points 0 581 -
varginha 162 913 7,371.00
138

31 RETOSIGMOIDOSCOPY
According to the parameters of Ordinance GM/MS 1631 of 2015,
62,992 sigmoidoscopy exams per year to meet the needs of the population of
State, but the existing agreement in the 77 RS is equivalent to a physical goal of 8,555
procedures and a total of 7,865 exams were registered in the SIA/SUS.
Production data present values lower than the estimated need and the PPI
existing. In total, 22 RS performed this procedure in the delimited period, and in
5 RS there was an extrapolation of the financial ceiling,12 they produced below 17% of the PPI and in 5
47-83% of the agreement were used. The RAS Jequitinhonha and Triângulo do Sul do not
showed production in the SIA/SUS in the period defined for this study and in the RAS
Triangle of the North, Southeast and Northeast the production presented did not have an impact on the
coverage of the recommended care needs, as well as in the agreed values.

By crossing the PPI data with the estimated need for all SRs,
a percentage of assistance coverage that varies between 12-15% of the recommended amount.
Table 11 presents the details and values of the PPI, the programmed value, the
production presented, the value presented in the SIA/SUS as well as the estimated
need according to Ordinance GM/MS 1631, for each of the 77 RS.
139

Table 11 - Sigmoidoscopy Data
Production PT.1631-
Value
Extended Region of presented Need
Health Region PPI presented
Health rectosigmoidoscopy estimate programmed value
SIA/SUS 2017
SIA 2017 of exams
10186
Belo Horizonte/Nova Lima/Caeté 5,670 1419 BRL 32,821.47 BRL 131,147.10
BRL 23.13
2099
betim 1 284 BRL 6,568.92 BRL 23.13 BRL
2580
Score 1 343 BRL 7,933.59
704 -
Itabira 0 95 BRL 2,197.35
R$
552 -
Black gold 0 72 BRL 1,665.36
center
420
João Monlevade 27 58 BRL 1,341.54 BRL 624.51
R$
1329 -
Seven lagoons 0 182 BRL 4,209.66
R$
945 -
Vespasian 0 116 BRL 2,683.08
R$
556 -
curve 0 75 BRL 1,734.75
R$
352 -
Guanhães 0 51 BRL 1,179.63
South Center Barbacena 194 716 100 BRL 2,313.00 BRL
140

4,487.22
BRL
Counselor Lafaiete/Congonhas 0 927 127 -
BRL 2,937.51

BRL 2,266.74 BRL
138.78
1408
Divinópolis/San Antonio do Monte 105 BRL 184 BRL 4,255.92 2,428.65
BRL
398
0 57 BRL 1,318.41 -
Ant
R$
368
Itaúna 0 49 BRL 1,133.37 -
West
R$
717
Pará de Minas 0 85 BRL 1,966.05 -
Santo Antonio do Amparo/Campo R$

616
Beautiful 0 87 BRL 2,012.31 -
R$
322 -
good order 0 43 BRL 994.59
R$
Valadares Governor 0 1297 176 -
BRL 4,070.88
ipatinga 362 1212 162

BRL 3,747.06 BRL
8,373.06 BRL
radiance 0 273 39
BRL 902.07 -
East
caratinga 65 610 82
BRL 1,896.66 BRL
1,503.45
Colonel Fabriciano/Timoteo 8 694 94
BRL 2,174.22 BRL 185.04
BRL
keep 0 213 30
BRL 693.90 -
141


0 312 46
BRL 1,063.98 -
Evangelist
R$
1033
0 137 BRL 3,168.81 -
manhuaçu
south east 651

new bridge 79 95 BRL 2,197.35 BRL
1,827.27 BRL
415
0 58 BRL 1,341.54 -
Viçosa
R$
Beyond Paraíba 174 25
0 BRL 578.25 -
Juiz de Fora/LD/BJ de Minas 2057 275

3 BRL 6,360.75 BRL 69.39
R$
Leopoldina/Cataguases 551 76
0 BRL 1,757.88 -
R$
muriaé 523 70
0 BRL 1,619.10 -
Southeast
R$
Carangola 388 54
0 BRL 1,249.02 -
R$
Santos Dumont 156 22
0 BRL 508.86 -
R$
São João Nepomuceno/Bicas 220 30
0 BRL 693.90 -
R$
Uba 941 125
0 BRL 2,891.25 -
R$
745 104
Brasilia de Minas/San Francisco 0 BRL 2,405.52 -
North
839 117
Janaúba/Monte Azul 20 BRL BRL 2,706.21
462.60
January 0 350 49 BRL 1,133.37 BRL
142

1491 194
Montes Claros/Bocaiuva 14 BRL BRL 4,487.22
323.82
BRL
440 60
0 BRL 1,387.80 -
Pirapora
R$
626 88
Salinas/Taiobeiras 0 BRL 2,035.44 -
R$
145 22
0 BRL 508.86 -
Jesus' heart
R$
224 31
Francisco Sá 0 BRL 717.03 -
R$
176 26
0 BRL 601.38 -
Mango
R$
beautiful waters 0 181 26
BRL 601.38 -
R$
Almenara 0 551 77
BRL 1,781.01 -
R$
araçuaí two 274 40
BRL 925.20 46.26
R$
Itaobim 0 248 35
BRL 809.55 -
North East
R$
nanuque 0 211 31
BRL 717.03 -
R$
Father Paradise 0 189 26
BRL 601.38 -
R$
Blue stone 0 163 24
BRL 555.12 -
theophilus
1 989 138
Otoni/Malacacheta/Itambacuri BRL BRL 3,191.94
23.13
143

1064
Mine Ducks 622 145 BRL 3,353.85 BRL
14,386.86 BRL
Northwest 814 -
Unai 0 109 BRL 2,521.17
R$
221 -
João Pinheiro 0 29 BRL 670.77
R$
diamond 0 520 74 -
BRL 1,711.62
Jequitinhonha
R$
Minas Novas/Tourmaline/Capelinha 0 376 53
BRL 1,225.89 -
R$
araxá 0 553 71 BRL 1,642.23 -
R$
southern triangle Fruity/Iturama 0 530 -
68 BRL 1,572.84
R$
uberaba 0 1224 156 BRL 3,608.28 -
R$
Ituiutaba 0 586 79
BRL 1,827.27 -
R$
Northern Triangle Sponsorship/Mount Carmel 0 584 82
BRL 1,896.66 -

BRL BRL 8,211.15
23.13
BRL
Privet/Ax 77 970 133 BRL 3,076.29 1,781.01
BRL
South Guaxupé 0 487 66 BRL 1,526.58 -
R$
itajubá 0 619 84 BRL 1,942.92 -
workings 0 548 74 BRL 1,711.62 BRL
144

R$
Passos/Piumhi 0 875 119 BRL 1,966.05 -
R$
0 698 92 BRL 2,127.96 -
Poços de Caldas
Happy landing 592 1622 210 BRL 4,857.30 BRL

13,692.96 BRL
0 793 110 BRL 2,544.30 -
St. Lawrence
Sao Sebastiao do Paraíso 3 379 52 BRL BRL 1,202.76

69.39
BRL
0 398 55 BRL 1,272.15 -
three hearts
R$
three points 0 379 52 BRL 1,202.76 -
varginha 12 596 78 BRL BRL 1,804.14

277.56
145

32 LARYNGOSCOPE
Evaluating the production data presented in the SIA/SUS, in the year 2017,
it appears that only 16 Health Regions performed this procedure, of which 10
produced with extrapolation of the MAC ceiling, with the highest rates in the regions of
Muriaé and Governador Valadares. The other SRs presented production below 50% of the
pact. The Northwest, West and Jequitinhonha RAS did not present production in the period
stipulated for this study.
It should be noted that when carrying out an evaluation of the agreement of this procedure,
it was found that the physical goal of the PPI available for 68 RS is not more than 10
procedures per year.
There are no need estimation parameters in Ordinance GM/MS 1631 for this
examination, making it impossible to quantify the real care need and delimit the greatest
agreement deficits and care void.
The table below presents the production data presented, physical value and
financial contribution of the PPI and the presented value of the SRs that presented production in the SIA/SUS, in the
year 2017.
Production
Value
Health Region presented
PPI programmed value presented
SIA/ SUS 2017
Happy landing 14 11 BRL 518.54 BRL 659.96
varginha 24 6 BRL 282.84 BRL 1,131.36
Counselor Lafaiete/Congonhas 3 6 BRL 282.84 BRL 141.42
Score 25 BRL 1,178.50 BRL 47.14

Itabira 1 5 BRL 235.70 BRL 282.84
Seven lagoons 6 10 BRL 471.40 BRL 94.28
Valadares Governor 2 8 BRL 377.12 BRL 26,539.82
ipatinga 9 BRL 424.26 BRL 188.56
muriaé 563 3 BRL 141.42 BRL 10,842.20
Montes Claros/Bocaiuva 4 12 BRL 565.68 BRL 4,572.58
new bridge 230 97 2 3 BRL 141.42 BRL 94.28
theophilus
95 8 BRL 377.12 BRL 4,478.30
Otoni/Malacacheta/Itambacuri
Fruity/Iturama 15 3 BRL 141.42 BRL 707.10
uberaba 128 11 BRL 518.54 BRL 11,637.08
Uberlândia/Araguari 9 25 BRL 1,178.50 BRL 424.26
Source: SIA-SUS, 2017.
146

Table 12 - Laryngoscopy Data
Region
Production PPI Value presented
enlarged from Health Region
Health presented programmed value SIA/SUS 2017

betim 0 20 BRL 942.80 BRL -
Score 1 25 BRL 1,178.50 BRL 47.14
Itabira 6 5 BRL BRL 235.70

282.84
center Black gold 0 5 R$ 235.70 R$ R$ -
João Monlevade 0 4 188.56 R$ R$ 471.40 -
Seven lagoons two 10 R$ R$ 377.12 R$ R$ 94.28

0 8 188.56 R$ R$ 94.28 -
Vespasian
curve 0 4 R$ R$ 235.70 BRL -
Guanhães 0 two
BRL 282.84 BRL -
Barbacena 0 5 BRL 235.70 BRL -
South Center Counselor Lafaiete/Congonhas 3 6 141.42
São João del Rei 0 5 -
Divinopolis/San Antonio do
mount 0 12 BRL 565.68 BRL -
0 3 BRL 141.42 BRL -
Ant
Itaúna 0 3 BRL 141.42 BRL -
West
Pará de Minas 0 6 BRL 282.84 BRL -

Beautiful 0 4 BRL 188.56 BRL -
0 BRL 94.28 BRL -
good order two
147

Valadares Governor
563 8 26,539.82
BRL BRL 377.12
ipatinga 4 9 R$ 424.26 R$ R$ 141.42 188.56
radiance 0 3 R$ R$ 188.56 R$ R$ -
East caratinga 0 4 235.70 R$ R$ 47.14 R$ -
Colonel Fabriciano/Timoteo 0 5 -
keep 0 1 -

0 BRL 94.28 BRL -
Evangelist two
manhuaçu 0 8 BRL 377.12 BRL -

south east new bridge two 3 BRL 141.42 BRL 94.28
Viçosa 0 two
BRL 94.28 BRL -
Beyond Paraíba 0 1 BRL 47.14 BRL -
Juiz de Fora/LD/BJ de Minas 0 16 BRL 754.24 BRL -
Leopoldina/Cataguases Muriaé 0 4 BRL 188.56 BRL -

Carangola Santos Dumont São 230 3 BRL 141.42 BRL 10,842.20
Southeast
João Nepomuceno/Bicas Ubá 0 3 BRL 141.42 BRL -
0 1 BRL 47.14 BRL -
0 1 BRL 47.14 BRL -
0 6 BRL 282.84 BRL -
Brasilia de Minas/San Francisco 0 5 BRL 235.70 BRL -
Janaúba/Monte Azul 0 6 BRL 282.84 BRL -
January 0 3 BRL 141.42 BRL -
North Montes Claros/Bocaiuva 97 12 BRL 565.68 BRL 4,572.58
0 4 BRL 188.56 BRL -
Pirapora
Salinas/Taiobeiras 0 4 BRL 188.56 BRL -
Jesus' heart 0 1 BRL 47.14 BRL -
148

Francisco Sá 0 1 R$ 47.14 R$ R$ -
0 1 47.14 R$ R$ -
Aguas
Formosa mango 0 1 47.14 R$ R$ -
Almenara 0 two
94.28 R$ R$ -
araçuaí 0 1 47.14 R$ R$ -
Itaobim 0 two
94.28 R$ R$ -
North East nanuque 0 two
94.28 R$ R BRL -
Father Paradise 0 two
94.28 BRL BRL -
Blue stone 0 1 47.14 BRL BRL -
theophilus
95 8
Otoni/Malacacheta/Itambacuri BRL 377.12 4,478.30
Mine Ducks 0 9 R$ 424.26 R$ R$ 329.98 -
Northwest Unai 0 7 R$ R$ 47.14 R$ R$ -
João Pinheiro 0 1 141.42 R$ R$ 141.42 -
diamond 0 3 R$ R$ 188.56 R$ R$ -
Jequitinhonha -
Minas Novas/Tourmaline/Capelinha 0 3 141.42 R$ R$ 11,637.08
araxá 0 4 R$ 188.56 R$ R$ 235.70 -
triangle of Fruity/Iturama 15 3 R$ R$ 1,178.50 R$ R$ 707.10

South 329.98
BRL 518.54
uberaba 128 11 R$ R$
Ituiutaba 0 4 188.56 R$ R$ 188.56 R$ -
triangle of Sponsorship/Mount Carmel 0 5 -
R $ 235.70 R$
North
Uberlândia / Araguari 9 25 424.26
Privet/Ax 0 7 -
0 4 -
Guaxupé
South
0 4 -
itajubá
workings 0 5 -
149

Passos/Piumhi 0 6 BRL 282.84 BRL -
Poços de Caldas 0 6 BRL 282.84 BRL -

R$
Happy landing 14 11 BRL 518.54 659.96
St. Lawrence 0 4 BRL 188.56 BRL -
Sao Sebastiao do Paraíso 0 3 BRL 141.42 BRL -
three hearts 0 two

BRL 94.28 BRL -
three points 0 3 BRL 141.42 BRL -
varginha 24 6 BRL 282.84 BRL 1,131.36
150

SN 37 - Part 1 - State - Plan - MG - 2018-1-150

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SN 37 - Part 1 - State - Plan - MG - 2018-1-150

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GOVERNMENT OF THE STATE OF MINAS GERAIS

RESOLUTION CIB-SUS/MG No. 2,846, OF DECEMBER 5, 2018.

Approves the Care Network Plan in

Oncology - Diagnosis and Guidelines -

for the State of Minas Gerais.

of the Unified Health System/SUS and transfers

intergovernmental financial resources in the health area;

for the organization of the Unified Health System - SUS, the

health planning, health care and inter-federative articulation;

organization, planning, monitoring, control and evaluation of health facilities

qualified in specialized care in oncology and defines the structural conditions,

Unified Health System (SUS);

State of Health of Minas Gerais for the quadrennium 2016-2019;

- the need to review the current action plan; and

- the approval of CIB-SUS/MG at its 248th Ordinary Meeting, held on December 5,

the State of Minas Gerais, pursuant to Annex I and II of this Resolution.

Belo Horizonte, December 5, 2018.

NALTON SEBASTIÃO MOREIRA DA CRUZ

ANNEX I OF RESOLUTION CIB-SUS/MG No. 2,846, OF DECEMBER 5, 2018.

ONCOLOGY CARE NETWORK PLAN

Diagnosis and Guidelines

STATE SECRETARIAT OF HEALTH OF MINAS GERAIS 2018

Nalton Sebastião Moreira da Cruz

SECRETARY OF HEALTH STATE

Daniel Guimaraes Medrado de Castro

ASSISTANT SECRETARY OF STATE FOR HEALTH

Lisandro Carvalho de Almeida Lima

Marcia Faria Moraes Silva

UNDER SECRETARY FOR HEALTH POLICIES AND ACTIONS

Rodrigo Fabiano do Carmo Said

UNDER SECRETARY FOR SURVEILLANCE AND HEALTH PROTECTION

Wandha Karine dos Santos

UNDER SECRETARY FOR HEALTH REGULATION

Karina Rocha de Oliveira Taranto

SUPERINTENDENCE OF HEALTH CARE NETWORKS

Daniela Aguiar Alberto

Ana Paula Medrado de Barcellos

SUPERINTENDENCE OF PRIMARY HEALTH CARE

Rejane Balmant Lyrics

SUPERINTENDENCE OF EPIDEMIOLOGICAL, ENVIRONMENTAL AND SURVEILLANCE

Rilke Newbie Publius

HEALTH SURVEILLANCE SUPERINTENDENCE

Zeila de Fatima Abrao Marques

ASSISTANCE PROGRAMMING SUPERINTENDENCE

Daiana de Carvalho Souza (Technical Advisor to the Thematic Actions and

Technical Support Team

Alcione Elaine Silva Campos (Director of Studies and Assistance Analysis/SUBGR/SES)

1. PRESENTATION ..................................................... ................................................................ ................... 11

PART I: ............................................... ................................................................ ................................................ 13

CANCER SURVEILLANCE: CANCER SITUATION IN MINAS GERAIS............ 13

2. ONCOLOGICAL CARE PLAN OF MINAS GERAIS – CANCER

3. STATE PROFILE OF ONCOLOGICAL CARE ACCORDING TO 38 RHC MG

4. EFFECTIVENESS OF ASSISTANCE ACCORDING TO THE ORIGIN OF THE

5. COMMENTS AND FINAL CONSIDERATIONS ............................................ ................ 40

PART II: ..................................................... ................................................................ ................................................. 42

TERRITORIALIZATION OF ONCOLOGY ..................................................... ............................. 42

6. REGIONALIZATION OF SERVICES............................................. ................................ 43

7. CATEGORY 1 ................................................... ................................................................ .......................... 47

8. CATEGORY 2 ..................................................... ................................................................ .......................... 50

9. RADIOTHERAPY ................................................... ................................................................ ..................... 56

10. DEFICIT / SURPLUS .......................................... ................................................................ ....... 57