Programa Saúde da Família: ampliando a cobertura para consolidar a mudança do modelo de Atenção Básica

doi:10.1590/s1519-38292003000100013

Cited by 25 publications

(3 citation statements)

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“…The data was also supplemented from information on the number of Mais Médicos doctors in Brazilian municipalities obtained from the Brazilian Office of the Pan American Health Organization/World Health Organization. The density of Mais Médicos doctors in each municipality was used to calculate the programme’s contribution to the municipal ESF coverage (one doctor per 3450 inhabitants as defined by the Brazilian Ministry of Health [42]).…”

Section: Methodsmentioning

confidence: 99%

Mortality associated with alternative primary healthcare policies: a nationwide microsimulation modelling study in Brazil

Rasella

Hone

Souza

et al. 2019

BMC Med

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Background Brazil’s Estratégia Saúde da Família (ESF) is one of the largest and most robustly evaluated primary healthcare programmes of the world, but it could be affected by fiscal austerity measures and by the possible end of the Mais Médicos programme (MMP)—a major intervention to increase primary care doctors in underserved areas. We forecast the impact of alternative scenarios of ESF coverage changes on under-70 mortality from ambulatory care-sensitive conditions (ACSCs) until 2030, the date for achievement of the Sustainable Development Goals (SDGs). Method A synthetic cohort of 5507 Brazilian municipalities was created for the period 2017–2030. A municipal-level microsimulation model was developed and validated using longitudinal data and estimates from a previous retrospective study evaluating the effects of municipal ESF coverage on mortality rates. Reductions in ESF coverage, and its effects on ACSC mortality, were forecast based on two probable austerity scenarios, compared with the maintenance of the current coverage or the expansion to 100%. Fixed effects longitudinal regression models were employed to account for secular trends, demographic and socioeconomic changes, healthcare-related variables, and programme duration effects. Results Under austerity scenarios of decreasing ESF coverage with and without the MMP termination, mean ACSC mortality rates would be 8.60% (95% CI 7.03–10.21%; 48,546 excess premature/under-70 deaths along 2017–2030) and 5.80% (95% CI 4.23–7.35%; 27,685 excess premature deaths) higher respectively in 2030 compared to maintaining the current ESF coverage. Comparing decreasing ESF coverage and MMP termination with achieving 100% ESF coverage (Universal Health Coverage scenario) in 2030, mortality rates would be 11.12% higher (95% CI 9.47–12.76%; 83,937 premature deaths). Reductions in ESF coverage would have stronger effects on mortality from infectious diseases and nutritional deficiencies and would disproportionately impact poorer municipalities, with the concentration index for ACSC mortality 11.77% higher (95% CI 0.31–22.32%) and also ending historical declines in racial health inequalities between white and black/pardo Brazilians. Conclusions Reductions in primary healthcare coverage due to austerity measures are likely to be responsible for many avoidable deaths and may preclude achievement of SDGs for health and inequality in Brazil and in other low- and middle-income countries. Electronic supplementary material The online version of this article (10.1186/s12916-019-1316-7) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

Mortality associated with alternative primary healthcare policies: a nationwide microsimulation modelling study in Brazil

Rasella

Hone

Souza

et al. 2019

BMC Med

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“…3 Despite the legal basis for the activities of the ACS, your job depends on where it is inserted, since the actions of the ESF, despite regulations, redefine from the realities and local needs. With this, you can't say that the ACS has stable working conditions.…”

Section: 3mentioning

confidence: 99%

“…With this, you can't say that the ACS has stable working conditions. 3 The structural difficulties and the nature of the work of the ACS should be considered when to evaluate its impact on the health of these workers, as well as in the intervention and health protection. Among the difficulties include exposure to environmental and climatic factors, diseases/contagious, long walks in adverse situations, as well as urban violence.…”

Section: 3mentioning

confidence: 99%

Occupational hazards and health problems: perceptions of community health workers

Andrade

Gomes

Lima

et al. 2015

R. pesq. cuid. fundam. online

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Objective: to describe the perception of community health workers about risks and injuries related to their occupational activities. Method: This is a qualitative research, descriptive and exploratory, developed in basic health units in Recife (PE), Brazil. The Bardin's content analysis was used for the systematization and analysis of data. Results: The results show that community health workers perceive their exposure to occupational risks and health problems. Direct sunlight can contribute to the emergence of health problems, which were perceived as musculoskeletal, cardiovascular, dermatological and psychological. Conclusion: The working conditions may pose an obstacle to the profession and deserve special attention in the adoption of health promotion measures

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The quality of alternative models of primary health care and morbidity and mortality in Brazil: a national longitudinal analysis

Mrejen

Rocha

Millett

et al. 2021

The Lancet Regional Health - Americas

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Programa Saúde da Família: ampliando a cobertura para consolidar a mudança do modelo de Atenção Básica

Cited by 25 publications

References 0 publications

Mortality associated with alternative primary healthcare policies: a nationwide microsimulation modelling study in Brazil

Mortality associated with alternative primary healthcare policies: a nationwide microsimulation modelling study in Brazil

Occupational hazards and health problems: perceptions of community health workers

The quality of alternative models of primary health care and morbidity and mortality in Brazil: a national longitudinal analysis

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