O campo da saúde no Brasil constituiu-se como um terreno de intensos debates quando toma por foco a organização das políticas públicas para esta área. São muitos os sujeitos políticos que, com distintas inserções institucionais, constroem formulações no intuito de disputar nessa arena. Entretanto, em relação à maneira como se posicionam e no modo como são construídas as formulações, muitas vezes essas disputas ficam relativamente veladas. Por um lado, o fato de a saúde coletiva brasileira ter se fortalecido como área de produção acadêmica, com diversos grupos de pesquisa vinculados a conceituadas instituições formadoras, leva a que os debates tomem um caráter mais "científico". Nesse sentido, a dimensão política inerente às proposições que são realizadas se limita a uma "honestidade" teórica em que se reconhece a "parcialidade" do conhecimento produzido. De certo modo, assumidas como perspectivas teóricas, as distintas formulações políticas se isolam entre as escolas, fomentando discussões que ficam no campo epistêmi-co em torno de aspectos metodológicos.Na produção científica em geral, mas no campo da saúde em especial, as produções acadêmi-cas não apenas estão se assentando em métodos que têm relação com a concepção de mundo dos seus pesquisadores; as escolhas dos autores, de certa forma, delimitam o campo político no qual eles pretendem debater. Não há delimitação de objeto de pesquisa, há sempre definição políti-ca em torno de saber em que disputas estamos REVISÃO REVIEW

Objective: To analyze the influence of socioeconomic, demographic, epidemiological factors, and the health system structure in the evolution of the COVID-19 pandemic in Brazil. Methods: Ecological study with variables extracted from databases, having the incidence and mortality by COVID-19 until August 23, 2020, in Brazilian states, as response variables. The magnitude of the associations was estimated using Spearman's correlation coefficient and multiple regression analysis. Results: In the Brazilian states, 59.8% of variation in the incidence of COVID-19 was justified by income inequality, significant home densification, and higher mortality. In the case of mortality, those same variables explained 57.9% of the country's variations in federal units. Conclusion: Our results indicate that socioeconomic factors influenced the evolution and impact of COVID-19 in Brazil. Thus, we suggest comprehensive actions to ensure economic conditions and strengthening of health networks for populations with socioeconomic vulnerability.

The National Program for Access and Quality Improvement in Primary

O artigo traz algumas problematizações sobre os desafios da desinstitucionalização no cuidado em saúde mental a partir de um Centro de Atenção Psicossocial (CAPS) de João Pessoa, Brasil. O percurso metodológico se deu no cotidiano do serviço, no qual os pesquisadores participavam das reuniões de equipe e acompanhavam a produção do cuidado dentro e fora do CAPS. No processo de educação permanente junto à equipe do CAPS, foi possível produzir visibilidade a três movimentos: a invisibilidade do território vivo na produção das redes de cuidado; a necessidade do matriciamento como articulador das ações do CAPS e a atenção básica; e os impasses para a desinstitucionalização da vida. No entanto, apostamos que, no movimento de abrir-se ao mundo vivo da cidade, a saúde mental consiga produzir cuidados para além do sofrimento psíquico, se ocupando com a produção de vida das pessoas.

No abstract

The Program for Access and Quality Improvement in Primary Care (PMAQ-AB) aimed to improve healthcare public service quality. The purpose of this study was to identify the main factors that influence user satisfaction in Brazilian primary health care services. This research was carried out using secondary data from the first cycle of the PMAQ-AB. A cluster analysis was carried out to find the dependent variable of user satisfaction; and logistic regression was applied in order to obtain the decision model. From the resulting regression model, two factors can be highlighted as regards influencing user satisfaction in Brazil: the user's perception that the team did not attempt to address their needs/problems within the health unit; and the user not feeling respected by the professionals in relation to cultural habits, customs, and religion or only sometimes feeling so. This study revealed the importance of continued commitment of teams and managers to improving care access, meeting user needs, and improving organizational aspects and the health professional-user relationship.

Background Many governments have introduced pay-for-performance programmes to incentivise health providers to improve quality of care. Evidence on whether these programmes reduce or exacerbate disparities in health care is scarce. In this study, we aimed to assess socioeconomic inequalities in the performance of family health teams under Brazil's National Programme for Improving Primary Care Access and Quality (PMAQ). Methods For this longitudinal study, we analysed data on the quality of care delivered by family health teams participating in PMAQ over three rounds of implementation: round 1 (November, 2011, to March, 2013), round 2 (April, 2013, to September, 2015), and round 3 (October, 2015, to December, 2019). The primary outcome was the percentage of the maximum performance score obtainable by family health teams (the PMAQ score), based on several hundred (ranging from 598 to 914) indicators of health-care delivery. Using census data on household income of local areas, we examined the PMAQ score by income ventile. We used ordinary least squares regressions to examine the association between PMAQ scores and the income of each local area across implementation rounds, and we did an analysis of variance to assess geographical variation in PMAQ score. Findings Of the 40 361 family health teams that were registered as ever participating in PMAQ, we included 13 934 teams that participated in the three rounds of PMAQ in our analysis. These teams were located in 11 472 census areas and served approximately 48 million people. The mean PMAQ score was 61•0% (median 61•8, IQR 55•3-67•9) in round 1, 55•3% (median 56•0, IQR 47•6-63•4) in round 2, and 61•6% (median 62•7, IQR 54•4-69•9) in round 3. In round 1, we observed a positive socioeconomic gradient, with the mean PMAQ score ranging from 56•6% in the poorest group to 64•1% in the richest group. Between rounds 1 and 3, mean PMAQ performance increased by 7•1 percentage points for the poorest group and decreased by 0•8 percentage points for the richest group (p<0•0001), with the gap between richest and poorest narrowing from 7•5 percentage points (95% CI 6•5 to 8•5) to-0•4 percentage points over the same period (-1•6 to 0•8). Interpretation Existing income inequalities in the delivery of primary health care were eliminated during the three rounds of PMAQ, plausibly due to a design feature of PMAQ that adjusted financial payments for socioeconomic inequalities. However, there remains an important policy agenda in Brazil to address the large inequities in health.

The study's aim was to analyze primary health care delivered to people with tuberculosis on a national level, based on the information collected by an external assessment implemented by the Programa de Melhoria do Acesso e da Qualidade da Atenção Básica. This cross-sectional study with a quantitative approach used data from the 2 nd cycle external assessment of the Programa de Melhoria do Acesso e da Qualidade da Atenção Básica conducted in 2014. The Statistical Package for Social Sciences was used to establish frequencies and check for associations using the Chi-square test. The percentage of Family Health Strategy units recording the annual number of confirmed tuberculosis cases and respiratory symptoms was high for the entire country (81.1%). In contrast, the recording of follow-up of tuberculosis cases was performed by only 48.3% of the facilities, while only 48% of the health basic unites units implemented directly observed treatment. The findings reveal barriers in the structure of health basic unites units regarding the operationalization and sustainability of care provided to individuals with tuberculosis, including directly observed treatment. Directamente Observado en el 48% de las unidades básicas de salud. Los datos indicaron la presencia de barreras en la estructuración de las unidades básicas de salud cuanto a la operacionalización y sustentabilidad de la asistencia al portador de tuberculosis, incluyendo la estrategia Tratamiento Directamente Observado. DESCRIPTORS: DESCRIPTORES:Tuberculosis. Evaluación en salud. Atención primaria a la salud.