Equity and Primary Health Care: providing care to vulnerable populations, traditional peoples, and communities in Brazilian PHC facilities.
1
Politics, Health and Management, School of Public Health, University of Sao Paulo, Sao Paulo, Brazil
2
Brazilian Centre for Analysis and Planning-CEBRAP, Sao Paulo, Brazil
3
Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
4
Social Medicine, Faculty of Medicine, Federal University of Pelotas, Pelotas, Brazil
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
INTRODUCTION:
From the perspective of health equity¹, we analyzed the structural and contextual aspects of care provision and integration with the service network of Brazilian Primary Health Care facilitiess (UBS) that serve vulnerable populations, traditional peoples, and communities, with an emphasis on indigenous peoples not residing in their territories, ‘quilombolas’ (maroons), riverine populations, and agrarian reform settlers.
METHODS:
Data from the 2024 National Census of UBS were used, including all 44,938 UBS and considering the dimensions² of access, workforce, care qualification, territorial distribution, and community and territorial care model, as well as integration into the network, which was considered an important marker for equity. We tested their association using logistic regression models, overall and by care pathways for hypertension and diabetes.
RESULTS:
Of the total number of UBS, 25.9% served all of these populations,, and 15,0% served at least one of the four selected groups, with a predominance of UBS located in rural areas and in the North and Northeast regions. In comparison with Brazilian UBS as a whole, activities in the individual dimension, expressed in terms of structure, availability of equipment, and integration into the health system as a whole, were systematically worse. The importance of healthcare pathways and cardiovascular risk stratification stands out. On the other hand, actions more relevant to the collective, territorial, and community dimensions were more frequent.
CONCLUSIONS:
The more robust the collective variables are, with effects on the dimension of individual care, the better the navigation through the network. Distinct profiles were observed in the four highlighted groups, requiring customized policies to achieve equity, although existing policies have partially contributed to reducing inequalities. Shortening historical, geographical, and symbolic distances and ensuring the complete and decisive journey of these populations in the health system is still an unfinished task.
From the perspective of health equity¹, we analyzed the structural and contextual aspects of care provision and integration with the service network of Brazilian Primary Health Care facilitiess (UBS) that serve vulnerable populations, traditional peoples, and communities, with an emphasis on indigenous peoples not residing in their territories, ‘quilombolas’ (maroons), riverine populations, and agrarian reform settlers.
METHODS:
Data from the 2024 National Census of UBS were used, including all 44,938 UBS and considering the dimensions² of access, workforce, care qualification, territorial distribution, and community and territorial care model, as well as integration into the network, which was considered an important marker for equity. We tested their association using logistic regression models, overall and by care pathways for hypertension and diabetes.
RESULTS:
Of the total number of UBS, 25.9% served all of these populations,, and 15,0% served at least one of the four selected groups, with a predominance of UBS located in rural areas and in the North and Northeast regions. In comparison with Brazilian UBS as a whole, activities in the individual dimension, expressed in terms of structure, availability of equipment, and integration into the health system as a whole, were systematically worse. The importance of healthcare pathways and cardiovascular risk stratification stands out. On the other hand, actions more relevant to the collective, territorial, and community dimensions were more frequent.
CONCLUSIONS:
The more robust the collective variables are, with effects on the dimension of individual care, the better the navigation through the network. Distinct profiles were observed in the four highlighted groups, requiring customized policies to achieve equity, although existing policies have partially contributed to reducing inequalities. Shortening historical, geographical, and symbolic distances and ensuring the complete and decisive journey of these populations in the health system is still an unfinished task.
| eISSN: | 2654-1459 |
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