Transition to universal primary health care coverage in Brazil: Analysis of uptake and expansion patterns of Brazil’s Family Health Strategy (1998-2012)

Abstract

Family Health Strategy, the primary health care program in Brazil, has been scaled up throughout the country, but its expansion has been heterogeneous across municipalities. We investigate if there are unique municipal characteristics that can explain the timing of uptake and the pattern of expansion of the Family Health Strategy from years 1998 to 2012. We categorized municipalities in six groups based on the relative speed of the Family Health Strategy uptake and the pattern of Family Health Strategy coverage expansion. We assembled data for 11 indicators for years 2000 and 2010, for 5,507 municipalities, and assessed differences in indicators across the six groups, which we mapped to examine spatial heterogeneities. Important factors differentiating early and late adopters of the Family Health Strategy were supply of doctors and population density. Sustained coverage expansion was related mainly to population size, marginal benefits of the program and doctors’ supply. The uptake was widespread nationwide with no distinct patterns among regions, but highly heterogeneous at the state and municipal level. The Brazilian experience of expanding primary health care offers three lessons in relation to factors influencing diffusion of primary health care. First, the funding mechanism is critical for program implementation, and must be accompanied by ways to support the supply of primary care physicians in low density areas. Second, in more developed and bigger areas the main challenge is lack of incentives to pursue universal coverage, especially due to the availability of private insurance. Third, population size is a crucial element to guarantee coverage sustainability over time.

Melhor no passado: a verdadeira saúde da família

“…When questioned, there were doubts as to the choice of building more health units with the strategy or of a hospital in the municipality, which reinforces the idea and valuation of the hospitalcentered model. Andrade et al (2018) shows practical evidence on the expansion of the FHS during the consolidation of PC. They emphasize the magnitude of this expansion in a country with inequalities, where often, in small municipalities, the provision of primary services constitutes the majority, if not the only way to have access to health.…”

Health Conditions Associated with Overweight in Climacteric Women

“…A cross-sectional and analytical study was carried out in the city of Montes Claros, Minas Gerais, Brazil, from August 2014 to August 2015, whose target population consisted of 30,801 climacteric women enrolled in 73 health care units, excluding pregnant, postpartum or bedridden women. This study was carried in the Family Health Strategy (FHS) that represents the mechanism of primary health care (PHC) on the public health system in Brazil 10 .…”

Mudanças no financiamento da Atenção Primária à Saúde no Sistema de Saúde Brasileiro: avanço ou retrocesso?

“…However, despite the advances achieved, the Brazilian PHC faces challenges and threats. Studies indicate that the expanded PHC coverage occurred in different patterns in the country, facing hurdles associated with structural weaknesses of the SUS, such as budget restrictions, fragile regional organization, and low capacity to allocate strategic resources, particularly for medical professionals 7 . Furthermore, disparities among the 5,570 municipalities (68.2% have less than 20,000 inhabitants, while 5.8% have more than 100,000 inhabitants) translate into varying levels of the quality of services provided, limiting the performance of strategic PHC functions, such as first contact access, care coordination, comprehensiveness and longitudinality 8 .…”