Authors
Aylene Bousquat (1), Ligia Giovanella (2), Luiz Facchini (3), Maria Helena Magalhães de Mendonça (2), Fulvio Borges Nedel (4), Geraldo Cury (5), Paulo Henrique dos Santos Mota (1), Simone Schenkman (1), Patricia Sampaio Chueiri (6) and Maria Cecilia Goi Porto Alves (7)
1 Department of Politics, Management, and Health, Faculty of Public Health, University of São Paulo, São Paulo, Brazil, 2 National School of Public Health (ENSP), Rio de Janeiro, Brazil, 3 Department of Social Medicine, Faculty of Medicine, Federal University of Pelotas, Pelotas, Brazil, 4 Department of Public Health, Federal University of Santa Catarina, Florianópolis, Brazil, 5 Department of Social and Preventive Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil, 6 Faculdade Israelita de Ciências da Saúde Albert Einstein Hospital Israelita Albert Einstein, São Paulo, Brazil, 7 Department of Health, Institute of Health, Government of the State of São Paulo, Institute of Health, São Paulo, Brazil
objectives
Brazil’s PHC wide coverage has a potential role in the fight against COVID, especially in less developed regions. PHC should deal with COVID-19 treatment, health surveillance, continuity of care, and social support. This article aims to analyze PHC performance profiles during the pandemic, in these axes, comparing the five Brazilian macro-regions.
methods
A cross-sectional survey study was carried out, using stratified probability sampling of PHC facilities (PHCF). A Composite Index was created, the Covid PHC Index (CPI). Factor analysis revealed that collective actions contrastingly behaved to individual actions. We verified differences in the distributions of CPI components between macro-regions and their associations with structural indicators.
results
Nine hundred and seven PHCF participated in the survey. The CPI and its axes did not exceed 70, with the highest value in surveillance (70) and the lowest in social support (59). The Individual dimension scored higher in the South, whereas the Collective dimension scored higher in the Northeast region. PHCF with the highest CPI belong to municipalities with lower HDI, GDP per capita, population, number of hospitals, and ICU beds.
conclusion
The observed profiles, individually and collectively-oriented, convey disputes on Brazilian health policies since 2016, and regional structural inequalities.
Frontiers in Public Health
The fight against the coronavirus disease (COVID-19) pandemic has been a task of enormous magnitude for all health systems, requiring a broad and articulated set of responses. Unfortunately, these were not observed in most countries at the beginning of 2020, which contributed to the high rates of morbidity and mortality (1). At first, the actions were almost exclusively directed to capacity expansion of hospital and intensive care beds. However, it quickly became clear that these actions would be insufficient to overcome the pandemic (2, 3). Robust intelligence systems with notifying actions; well-defined PHC services; social isolation measures and social support policies for vulnerable populations; strong health surveillance associated with community actions; and significant investments for vaccine development, were pointed out as essential to face the most dramatic health situation in the last 100 years (4, 5).
The first COVID-19 case was reported in Brazil on February 26, 2020, and on March 22 of the same year, reported cases were present in all Brazilian states. The pandemic led to a high number of deaths and cases, amounting to more than 600,000 deaths at the beginning of 2022, affecting especially the vulnerable population (6–9). The rates were higher and more accelerated in states with greater social inequality, such as in the black population, those with lower education levels and in the lowest income quintile, or living in the poorest city areas (10, 11). The dramatic scenario was partially relieved by the decentralized structure of the Brazilian health system, by which most state and municipal governments implemented actions to circumvent the obstacles imposed by the federal administration (12–15).
The Brazilian Unified Health System, called SUS (the acronym in Portuguese of Sistema Único de Saúde) has offered free and universal health care since 1990 (16). Despite its reduced funding, the SUS has improved the population’s health conditions and ensured the expansion of access to health services in general and particularly to primary health care (PHC). There are currently over 38,000 PHC facilities (PHCF) with strong capillarity throughout the territory (2020), which could play a central role in the fight against the COVID-19 pandemic. PHC strategies should be implemented in epidemic prevention, care, and control (17–20), especially when part of a global plan to face health emergencies, with better responses in some countries (21). The Brazilian PHC model until 2017, has been the Family Health Strategy (FHS), characterized by the combination of individual care with strong community and regional actions. Its coverage comprises over 130 million people (63% of the population). Currently, about 43,000 FHS multi-professional teams are the system’s gateway and source of continued care for defined populations in specific territories (2020). It integrates health promotion, disease prevention, surveillance, treatment, and rehabilitation, delivered by physicians, nurses, dentists, and more than 300,000 Community Health Workers-CHW. This combination of Primary Care and essential public health functions (22) may have played an important role in preventing more critical outcomes in Brazil.
Medina et al. (19), proposed four essential axes for the Brazilian PHC organization model’s performance during the pandemic: COVID-19 treatment; health surveillance; continuity of care; and social support. The authors point out that conducting activities in these axes would allow a better fight against the pandemic and reduce the impact of COVID-19 on other population health needs.
This article, therefore, aims to analyze the performance profiles of PHC services during the pandemic and to compare the role of these four axes in the five Brazilian macro-regions, focusing on how PHC services reorganized themselves to face the COVID-19 pandemic.