Potential access to primary health care: what does the National Program for Access and Quality Improvement data show?

Severina Alice Da Costa Uchôa,Claudia Santos Martiniano,Mellina Yamamura,Ricardo Alexandre Arcêncio,Renata Melo Maroto,Ardigleusa Alves Coêlho,Anny Karine Freire Da Silva,Inês Fronteira,Isabel Cristina Araújo Brandão

doi:10.1590/1518-8345.1069.2672

Abstract

Objective: to analyze the influence of contextual indicators on the performance of municipalities regarding potential access to primary health care in Brazil and to discuss the contribution from nurses working on this access. Method: a multicenter descriptive study based on secondary data from External Evaluation of the National Program for Access and Quality Improvement in Primary Care, with the participation of 17,202 primary care teams. The chi-square test of proportions was used to verify differences between the municipalities stratified based on size of the coverage area, supply, coordination, and integration; when necessary, the chi-square test with Yates correction or Fisher's exact test were employed. For the population variable, the Kruskal-Wallis test was used. Results: the majority of participants were nurses (n=15.876; 92,3%). Statistically significant differences were observed between the municipalities in terms of territory (p=0.0000), availability (p=0.0000), coordination of care (p=0.0000), integration (p=0.0000) and supply (p=0.0000), verifying that the municipalities that make up area 6 tend to have better performance in these dimensions. Conclusion: areas 4,5 and 6 performed better in every analyzed dimension, and the nurse had a leading role in the potential to access primary health care in Brazil.

Highlights

In 2005, members of the World Health Organization (WHO) committed to achieve the universal health coverage target provided by the Millennium Development Goals and post-2015 agenda, aiming to improve the health and welfare of the population
The adherence to PMAQ occurred with 17,202 Primary Care Teams (PCT)
The majority of participants were nurses (n =;%), and many of them had less than three years of experience after completing their education

Summary

Introduction

In 2005, members of the World Health Organization (WHO) committed to achieve the universal health coverage target provided by the Millennium Development Goals and post-2015 agenda, aiming to improve the health and welfare of the population. In Brazil, the issue of universal and equitable access has been a concern since the creation of the Unified Health System UHS (SUS) in 1988. This idea is reinforced by the National Policy of Primary Care BANP (PNAB), in which the potential for access to comprehensive care management through multidisciplinary, interdisciplinary team work is emphasized[3]. New forms of system organization, with real universal coverage has been envisioned to achieve equity and integrality of actions[4]. Another challenge is shortage in the distribution, composition and competence of human resources, especially physicians, nurses and midwives[5]. In response to the most critical component, physicians, incentive programs were adopted to supply and qualify these professional, through the Enhancement Program of Primary Care, and by importing foreign physicians with the More Medical Doctors Program[6]

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Conclusion