Abstract
This study aimed to identify the provision of actions and procedures by family health teams (FHSt), based on Rio de Janeiro Municipality's (MRJ) Health Services Portfolio (HSP) and the main factors associated with this provision, in the different population strata. Data from the National Program for Improving Access and Quality of Primary Healthcare were used and implemented at the national level into 17,202 FHSts from June to September 2012. Outcome variables were "FHSt belonging to MRJ" and "FHSt providing all nine CS-MRJ procedures". Uni-, bi- and multivariate analysis were performed. A better performance of the MRJ in relation to other major urban centers (EP6#) (p<5%) was noted in 10 of the 14 health actions analyzed. The electronic medical record showed a level of deployment in MRJ's FHSts of 96%, contrasting with 34% in the EP6# and 14% in Brazil. Both the MRJ and EP6# evidenced low supply of mental health services (about 56%). While the supply of low-complexity procedures was a major problem in large cities, the supply of health actions in the different health care lines was a larger problem in small municipalities. Overall, the MRJ showed better performance when compared to the average of large municipalities. The health service portfolio appeared to be an important management tool.
Highlights
The expansion of primary health care (PHC) through municipalization was a priority of the Brazilian Ministry of Health (MoH)
This study aimed to identify the provision of actions and procedures by family health teams (FHSt), based on Rio de Janeiro Municipality’s (MRJ) Health Services Portfolio (HSP) and the main factors associated with this provision, in the different population strata
With the exception of the provision of mental health services, with a national average of 44.3%, there was generally a good supply of health actions performed by the family health strategy team (FHSt) in all population strata, reaching 97%
Summary
The expansion of primary health care (PHC) through municipalization was a priority of the Brazilian Ministry of Health (MoH). The implementation of new practices to ensure the principles of the Primary Health Care National Policy[1] (PNAB) – universal access to services at all levels of care, comprehensive care, with a network of resolutive services, equity and community participation – is a challenge for many Brazilian municipalities. Since the end of 1990, the Family Health Strategy (FHS) and its financing policy have been assumed by the MoH as the main strategy to reorganize PHC, generating major changes in the care model[3]. After two decades of FHS implementation, improving the quality of care provided to the population is still a challenge for its sustainability. It is necessary to develop and implement tools that allow their continuous evaluation, enabling timely decision-making toward desired results
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