Brazil's primary health care response to the COVID-19 pandemic
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Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
Ensp/FIOCRUZ, Brazil
FSP, Brazil
USP, Brazil
UFPel, Brazil
UFSC, Brazil
UFMG, Brazil
Publication date: 2023-04-27
Popul. Med. 2023;5(Supplement):A520
Background: Brazil has more than 33,000 primary health care facilities (PHCFs) which could have played an important role in combating the Covid-19 pandemic. This study examines PHC performance during the pandemic in the country’s five macro-regions. Methods: A cross-sectional study was carried out as a survey using probability sampling of PHCFs. A composite Covid PHC Index (CPI) was generated aggregating 26 variables along four axes: Covid-19 treatment, health surveillance, care continuity and social support. A CPI of 100 would represent best PHCF performance. Factor analysis revealed that the axes reflecting collective actions (health surveillance and social support) behaved similarly, in contrast with those focused on individual actions (Covid-19 care and care continuity). Differences between macro-regions in the CPI and the 4 axes were analysed. Associations between the CPIs and socioeconomic, political and health indicators were examined. Results: 907 PHCFs participated in the survey. The highest CPI value was observed in health surveillance (70) and the lowest, in social support (59). In the dimension expressing more individual care practices (care continuity and Covid-19 care), a higher value was found among South region PHCFs than among those of the Northeast. The relationship was reversed in the collective dimension: higher values were found in the Northeast. PHCFs with the highest CPIs belong to municipalities with lower per capita income, population and number of hospital beds. Conclusions: In the absence of national government coordination, PHC potential in the Unified Health System (SUS) was not fully realised. The two performance profiles, with their differing emphases on the individual and collective dimensions, reflect the political projects disputing PHC approaches in Brazil’s healthcare system since 2016, as well as structural inequalities between regions.