Building a "Smiling Brazil"? Implementation of the Brazilian National Oral Health Policy in a health region in the State of São Paulo

Abstract

This paper is a case study on the implementation of the Brazilian National Oral Health Policy (PNSB), known as "Smiling Brazil", in the cities of the Regional Health Department of Araraquara (DRS III) in São Paulo State. A structured questionnaire was given to the municipal oral health coordinators, an interview with oral health care professionals and managers was conducted, and the official data provided by the Brazilian Ministry of Health were coded to assess the policy's scope: (i) expansion and qualification of actions; (ii) work conditions; (iii) care; (iv) access; and (v) planning and management. The quantitative and qualitative analyses were linked by methods triangulation. In terms of PNSB implementation, the majority of the cities (52.6%) were classified as "good", with 42.1% classified as "bad". Approximately 10 years after launching the PNSB, despite strides in oral health care and access to different levels of care, the cities still experience difficulties in implementing the policy's principles.

From theoretical concepts to policies and applied programmes: the landscape of integration of oral health in primary care

“…The main limitation of population-based models is their considerable cost, which often makes their implementation difficult or unlikely [ 80 ]. Several Brazilian publications [ 81 , 82 ] show that despite the effectiveness of PNSB in terms of oral health care and access, implementation of the principles of the policy continue to encounter difficulties in some cities even 10 years after its adoption.…”

What we know about management and organisation of primary dental care in Brazil

“…The Oral Health Teams (OHTs) were only included in the FHS teams in 2000, restructuring the PHC model. In 2004, the National Oral Health Policy guidelines, called the “Smiling Brazil” Program ( Programa Brasil Sorridente in Portuguese) was created with actions to reorganise basic health care and the expansion and qualification of specialised care, to improve the oral health problems that had been uncovered in the epidemiological survey SB Brasil 2003 [5, 6]. After a decade of the “Smiling Brazil” Program, advances in oral health work were observed focusing on educational and permanent education actions; welcoming, bonding and accountability.…”

Saúde Bucal em sistemas universais de saúde: análise comparativa do Brasil e Reino Unido

“…Apesar da expansão dos serviços, ainda há muito a ser feito no Brasil. Verificam-se insuficiências na oferta, barreiras de acesso, desigualdades regionais, problemas na implementação como baixo financiamento, gestão inadequada, falta de manutenção dos insumos e equipamentos odontológicos, além de muitos locais manterem a perspectiva da odontologia curativa e tradicional, com alta prevalência de exodontias (Aquilante & Aciole, 2015;Scarparo et al, 2015). Contudo, o reconhecimento da saúde como direito e expansão dos serviços públicos representam avanços, principalmente considerando que o Brasil é o único país capitalista periférico da América Latina que adotou um modelo de sistema público universal, e cerca de 75 % da população depende do sistema público (Giovanella et al, 2018;Santos, 2018).…”