The Brazilian PHC response to the COVID-19 pandemic: individual and collective comprehensiveness and performance profiles

Abstract

Background Brazil has more than 33,000 primary health care facilities (PHCF) which could have played an important role in the fight against the COVID. Brazilian primary health care(PHC) should deal with the following axes to reduce the impact of COVID-19 on health needs: COVID-19 treatment; health surveillance; continuity of care; and social support. This article aims to analyze the performance profile of PHC during the pandemic in the five Brazilian macroregions. Methods A cross-sectional study was carried out as a survey format, using probability sampling of PHCF. A Composite Index was created, the Covid PHC Index(CPI). The process of creating the CPI started with the selection of the 59 most relevant questions, which were aggregated into 26 variables distributed in axes. CPI with a value equal to 100 would represent a more complete performance of the PHCF. Factor analysis revealed that the axes that encompass collective actions (Health Surveillance and Social Support) behaved in a similar manner and in contrast to those focused on individual actions (COVID-19 Treatment and Continuity of Care). Differences in the distributions of CPI components between macroregions were verified. Associations between the CPI and socioeconomic, political and health indicators of the PHCF localities were also verified. Results 907 PHCFs participated in the survey. The PCI and its axes didn’t exceed 70, with the highest value being observed in the surveillance axis(70) and the lowest in the social support axis(59). When analyzing the dimension that articulates the practices more focused on individual care (Continuity of Care and COVID-19 Treatment), a greater value is observed in the units of the South region, when compared to those of the Northeast, and the relationship is exactly the opposite in the Collective Dimension. PHCF with the highest CPI belong to municipalities with the lowest MHDI, GDP per capita, population, number of hospitals, and ICU beds. Conclusions The two observed performance profiles, with different emphasis on the individual and collective dimensions, convey not only the clash of political projects that dispute the Brazilian PHC since 2016, but also the structural inequalities that exist between the different regions