Abstract
BackgroundBrazil has the largest public health-system in the world, with 120 million people covered by its free primary care services. The Family Health Strategy (FHS) is the main primary care model, but there is no consensus on its impact on health outcomes. We systematically reviewed published evidence regarding the impact of the Brazilian FHS on selective primary care sensitive conditions (PCSC).MethodsWe searched Medline, Web of Science and Lilacs in May 2016 using key words in Portuguese and English, without language restriction. We included studies if intervention was the FHS; comparison was either different levels of FHS coverage or other primary health care service models; outcomes were the selected PCSC; and results were adjusted for relevant sanitary and socioeconomic variables, including the national conditional cash transfer program (Bolsa Familia). Due to differences in methods and outcomes reported, pooling of results was not possible.ResultsOf 1831 records found, 31 met our inclusion criteria. Of these, 25 were ecological studies. Twenty-one employed longitudinal quasi-experimental methods, 27 compared different levels the FHS coverage, whilst four compared the FHS versus other models of primary care. Fourteen studies found an association between higher FHS coverage and lower post-neonatal and child mortality. When the effect of Bolsa Familia was accounted for, the effect of the FHS on child mortality was greater. In 13 studies about hospitalizations due to PCSC, no clear pattern of association was found. In four studies, there was no effect on child and elderly vaccination or low-birth weight. No included studies addressed breast-feeding, dengue, HIV/AIDS and other neglected infectious diseases.ConclusionsAmong these ecological studies with limited quality evidence, increasing coverage by the FHS was consistently associated with improvements in child mortality. Scarce evidence on other health outcomes, hospitalization and synergies with cash transfer was found.
Highlights
Primary healthcare is essential for progress towards Universal Health Coverage [1], a key Sustainable Development Goal [2], which includes the provision of promotion, prevention, treatment, rehabilitation and palliative care to all citizens without significant financial burden [3]
We systematically reviewed published evidence regarding the impact of the Brazilian Family Health Strategy (FHS) on selective primary care sensitive conditions (PCSC)
Fourteen studies found an association between higher FHS coverage and lower post-neonatal and child mortality
Summary
Primary healthcare is essential for progress towards Universal Health Coverage [1], a key Sustainable Development Goal [2], which includes the provision of promotion, prevention, treatment, rehabilitation and palliative care to all citizens without significant financial burden [3]. Primary healthcare can contribute to Universal Health Coverage through expanding access to cost-effective, population-based healthcare and addressing the wider social determinants of health [4]. Further understanding of the impact of primary healthcare is essential to convincing policy-makers to invest in and expand it. Brazil is an excellent setting for evaluating the impact of primary healthcare and Universal Health Coverage. The SUS can be considered the largest, universal, free-of-charge public health system in the world. 160 million people (76% of the Brazilian population) [7] depend exclusively on SUS services. Brazil has the largest public health-system in the world, with 120 million people covered by its free primary care services. We systematically reviewed published evidence regarding the impact of the Brazilian FHS on selective primary care sensitive conditions (PCSC)
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