Municipal Health Secretariat Research Articles

The use of blogs as health management supporting tool at the local level.

In public health, blogs as data communication and dissemination tools have been widely used since the mid-2010s. This study aimed to describe the implementation of the blog tool by the Family Health Teams (ESF) of the municipality of Rio de Janeiro, which received the support of a Network of Local Observatories of the Municipal Health Secretariat, as a health communication and information vehicle for managers, health professionals and the population of Rio de Janeiro. We opted for a qualitative, descriptive and exploratory approach, with data and information collected directly from the media objects, as well as the literature review. Concerning total access to blogs of the Family Health Clinics and Municipal Health Centers, a total of almost seven million views were achieved. Finally, it should be emphasized that initiatives such as the ESF blogs' network should increasingly be analyzed, disseminated and known to understand, among other factors, the propensity of users, workers, and managers regarding the availability of channels of interaction and communication between them, their scope and their significance. After all, the power of a network is directly related to how it is being used.

Organização Intermunicipal: estudo de caso do Consórcio Público de Saúde na Região Fronteira Noroeste do Rio Grande do Sul

O artigo busca compreender a organização intermunicipal do Consórcio Público de Saúde Fronteira Noroeste do Rio Grande do Sul, tendo como meta pesquisar os serviços de saúde de média e alta complexidade, em 25 municípios, ao trilhar os caminhos da abordagem qualitativa, análise de conteúdo, interpretando os dados coletados pelo questionário, os documentos acessados e as verificações teóricas. Isso significa identificar e analisar as relações entre a saúde e as estruturas de saúde que possam contribuir no desenvolvimento da região, onde as dimensões da saúde se apresentam como um direito e com capacidade de mobilizar recursos para o desenvolvimento do ambiente de saúde nos municípios e qualificar a área na busca de melhores condições de vida da população. Para responder aos desafios propostos, utilizamos a coleta de dados, por um questionário com questões abertas, enviado para o gestor do consórcio e para três secretários municipais de saúde consorciadas. As respostas apresentam a importância do consórcio, com a ampliação dos serviços, a presença de profissionais para responder aos serviços de média e alta complexidade, bem como a redução dos custos em 25%. Como desafios a serem superados, destacamos a qualificação da estrutura funcional do consórcio, especialmente a matriz administrativa. Por fim, a pesquisa aponta uma experiência rica do consórcio, ao ampliar o atendimento das necessidades na área da saúde nos 25 municípios, ao promover um ambiente de cooperação e ao potencializar as políticas públicas na região Fronteira Noroeste.

Access to information for evidence-based decision-making from the perspective of Municipal Health Secretaries in the State of Paraná, Brazil, 2014

The study aimed to identify information sources for decision-making and barriers to access in the use of scientific journals by Municipal Health Secretaries in the State of Paraná, Brazil. Study participants included Secretaries of Health from 181 municipalities in the year 2014. Interviews focused on the frequency of consultation of resources for obtaining evidence, including from scientific journals. 40.9% of the participants were 18 to 39 years of age (mean age was 43±10.2 years; median 42 years). More than two-thirds (69.1%) had held the office of health secretary for less than five years. The majority were males (56.4%), and only one in three had a graduate degree in public health. The main sources of information were "non-scientific periodicals" (76.2%), "print/online journals" (71.4%), and "Ministry of Health guidelines" (71.3%). The main barriers to use of scientific journals were "lack of time for reading" (72.9%), "periodical's high cost" (69.1%), and "difficulty in identifying the best periodicals" (63.5%). The main information sources were non-scientific periodicals and Ministry of Health guidelines. The use of scientific journals is hindered by lack of time and limited familiarity with scientific language. Access to scientific information should be facilitated by the use of more accessible sources and training for municipal administrators in the use of open-access periodicals. Such measures can foster knowledge of current evidence among municipal health secretaries.

Spatial distribution and seasonality of Biomphalaria spp. in São Luís (Maranhão, Brazil).

Two of the three vector species of Schistosoma mansoni Sambon, 1907 in Brazil occur in the state of Maranhao: Biomphalaria glabrata (Say, 1818) and Biomphalaria straminea (Dunker, 1848). For the implementation of effective measures to combat schistosomiasis, it is necessary to identify the spatial and seasonal dynamics of these snails. Therefore, this work brought together information from malacological survey carried out in Sao Luis (Maranhao, Brazil) to identify the spatial and seasonal distribution patterns of Biomphalaria spp. snails. We used data from malacological surveys of the Municipal Health Secretary of Sao Luis, conducted between 2006 and 2013 in 23 neighborhoods. We also used data from the mollusk surveys that we conducted for 2 years (2012–2014) in four of these neighborhoods. During the 8-year period (2006–2013), 15,990 specimens of Biomphalaria spp. were collected. There was a positive association between precipitation and the abundance of mollusks of the genus Biomphalaria. During 2012–2014, a total of 2487 snail specimens were obtained (B. glabrata: 1046 specimens; B. straminea: 1426 specimens). There was a positive correlation between precipitation and B. straminea abundance. High density of human occupation and high precipitation are two factors that affect the distribution and density of Biomphalaria spp. populations.

Hidden Suicides of the Indigenous People of the Brazilian Amazon: Gender, Alcohol and Familial Clustering

ObjectiveTo evaluate the coverage, characteristics and the risk of suicide in the indigenous people of Tabatinga in the Brazilian Amazon. MethodsAn active surveillance strategy for suicide cases was used: records of the Ministry of Health, the Municipal Health Secretariat, the Special Indigenous Health District of the Upper River Solimões (Distrito Sanitario Especial Indígena Alto Río Solimões), the Military Hospital of Tabatinga, the National Indian Foundation (Fundación Nacional del Indio) and the civil registry offices were examined from 2007 to 2011 for individuals over 9 years of age. Adjusted rates were estimated using the direct method and according to age. A descriptive analysis was performed and the hypothesis tests were considered significant if p-values were <0.05. ResultsThe coverage of indigenous suicide was 82.8%, since 11 (17.2%) were classified as hidden suicides. For men between 15 and 29 years of age, and for women aged from 12 to 20 years, the probability of suicide was around 70.0%. In 17.2% of the sample there was a record of alcohol consumption before death and relationship between victims. The corrected adjusted mortality rate was 111.7/100,000 (95% CI, 84.6–148.6). ConclusionsThe risk of suicide in the indigenous people of the Tabatinga is very high. Coping strategies should consider the complex relationship between suicide and alcohol consumption, gender differences and the existence of vulnerable groups, such as young people, especially those with close relatives who have committed suicide.

The National Health Promotion Policy: an evaluability assessment in a health region in Brazil

The National Health Promotion Policy (PNPS) is based on the broadened concept of health and presents the promotion of health as a set of strategies and ways of promoting health, both individually and collectively with responsibilities for the three federated entities. The scope of this study was to develop an evaluability assessment of the PNPS. It is a qualitative-based evaluability assessment conducted in a health region in the Brazilian Northeast in the year 2013. Participants in the study were 18 key informants directly involved in PNPS implementation, of which eight are municipal health secretaries, six are coordinators of primary health care, two are coordinators of epidemiological surveillance, a general regional coordinator and a regional primary care coordinator. The semi-structured interview and the legal documents of the policy were used for gathering information from 2006 to 2012. The construction of the logical model made it possible to reflect on the possible influences of the context on the PNPS implementation. The results showed that PNPS is not yet sufficiently established in the health region and pointed to the need to incorporate specific monitoring and evaluation instruments for this policy.

Social Thermalism in Brazilian Public Health: perception of the public health secretaries from municipalities with thermal water sources

Given the immense Brazilian potential, social thermalism are little explored practice as a factor for health promotion. In 2006, the National Policy on Integrative and Complementary Practices was created in Brazil, where the Social Thermalism was included as observatories in public health. However, there are still no results materialized in social thermalism in the country, which means that there is a need for more research, not only about the mineralogical characteristics of mineralmedicinal and thermal water sources, but also public management mechanisms for that thermalism is incorporated into the national health system as a structured practice and beneficial to the quality of community life. Within this scenario, the objective of this study was focused on identifying the perception of members of the Municipal Health Secretaries in ten municipalities, in Santa Catarina estate - south of Brazil, thermal source retainers. The present investigation was done in a qualitative and descriptive way by means of surveys recorded and later transcribed. This initiative was approved by the Ethics Committee of the State Secretariat of Health of Santa Catarina. In the ten cities, two managers in charge of primary health care and ten municipal health secretaries were interviewed about their level of knowledge about balneoterapy, the probability of developing the activity in their region and the possible challenges for implementing social thermalism as an local activity. The data obtained through the surveys were worked through the content analysis and the results were segregated into three categories: (1) General knowledge of managers and secretaries of health about social hydrotherapy; (2) potential for insertion / development of social thermalism in the local public health system; and (3) Difficulties in the implementation of social thermalism as a structured practice in the public health system. With that, it was diagnosed that even if there is a lack of known about this practice, all the interviewees agree that the inclusion of thermalism in the structure of public health will be able to provide preventive and strengthening treatment to the quality of life of citizens. However, the constant change of the Municipal Health Secretaries in the ten municipalities was identified as the main weakness for the continuous structuring and financial contribution of the state in the potential projects.

Educação permanente em saúde: uma experiência do projeto “Bioética pelas Lentes do Cinema”

Este trabalho objetivou refletir e compartilhar a experiência de educação permanente com estudantes da Residência Multiprofissional em Saúde da Família da Prefeitura Municipal de Florianópolis, por meio da Bioética Narrativa. O Núcleo de Pesquisa e Extensão em Bioética e Saúde Coletiva/UFSC realizou no segundo semestre de 2016 o projeto de extensão “Bioética pelas Lentes do Cinema”, em parceria com a Secretaria de Saúde Municipal, ofertando-o para 47 profissionais residentes. Utilizou-se o cinema como recurso pedagógico para disparar a problematização da realidade e ancoragem dos argumentos de reflexão, construindo-se um espaço pedagógico de ensino-aprendizagem na aproximação do vivenciado no filme e o racionalizado em conjunto. Considerou-se que o projeto contribuiu significativamente para formação dos residentes e membros do Núcleo, especificamente, no desenvolvimento de sua capacidade crítica e reflexiva. Também permitiu evidenciar como a racionalidade narrativa auxilia a tomada de decisão frente às problemáticas éticas presentes no cotidiano do trabalho em saúde.

Conceptions on pharmaceutical services in Brazilian primary health care.

ABSTRACTOBJECTIVE To identify and discuss the conceptions of pharmaceutical services in Brazilian Primary Health Care, according to different subjects.METHODS This study is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services, 2015), which is composed of an information survey in a representative sample of cities, stratified according to Brazilian regions, and a subsample of primary health care services. Municipal secretaries of health, those responsible for pharmaceutical services, and those responsible for medicine delivery in pharmacies/dispensing units of the selected services were interviewed. The questionnaires included one question about the understanding of the interviewee regarding pharmaceutical services. The content analysis technique was used to apprehend, in the statements, the meanings attributed to pharmaceutical services, which were subsequently classified into categories according to their main conceptions.RESULTS Among the wide diversity of conceptions on pharmaceutical services (PS), we highlight the ones focused on 1) logistic control of medicines with activities concerning guidance or information on their use and 2) guidance or information to users on the use of medicine. The findings reveal a shifting tendency from a medicine-focused conception to one that considers the users and their needs as the final recipient of these actions. However, the lack of references to conceptions regarding care management and integrality point out the slowness of this change; after all, this is a social and historical process that comprises the production of meanings that transcend legal, logistic, and technical arrangements in pharmaceutical services.CONCLUSIONS The diversity of conceptions expresses the several meanings attributed to pharmaceutical services; we also identified, in their reorientation process, a movement that reflects a gradual shift in the technical paradigm, from the focus on medicine logistics to a user-oriented approach of health services.

Financing of Pharmaceutical Services in the municipal management of the Brazilian Unified Health System.

ABSTRACTOBJECTIVE To discuss factors related to the financing of the Basic Component of Pharmaceutical Services within the municipal management of the Brazilian Unified Health System.METHODS The Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil – Serviços (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services) is a cross-sectional, exploratory, and evaluative study that performed an information survey in a representative sample, stratified by Brazilian regions It considered different study populations in the sampling plan, which represent primary health care services in the cities. Data were collected in 2015 by two methods: in person, by applying direct observation scripts and interviews with users, physicians, and professionals responsible for the dispensing of medicines in primary care services; by telephone interviews with municipal health managers and municipal professionals responsible for Pharmaceutical Services. The results were extracted from the questionnaires applied by telephone.RESULTS Of the sample of 600 eligible cities, we collected 369 interviews (61.5%) with secretaries and 507 (84.5%) with pharmaceutical services managers. 70.8% of the cities have a computerized management system; and 11.9% have qualification/training of professionals. More than half (51.3%) of the cities received funds for the structuring of pharmaceutical services, and almost 60% of these cities performed this type of spending. In 35.4% of cases, municipal secretaries of health said that they use resources of medicines from the Componente Básico da Assistência Farmacêutica (CBAF – Basic Component of Pharmaceutical Services) to cover demands of other medicines, but only 9.7% believed that these funds were sufficient to cover the demands. The existence of a permanent bidding committee exclusively for acquiring medicines was reported in 40.0% of the cities.CONCLUSIONS We found serious deficiencies in the public financing of medicines, as well as little concern about the formality in the use of public resources, expenses that meet individual demands to the detriment of the community, insufficient resources allocated to the Basic Component of Pharmaceutical Services, and exhaustion of the financing model.

National Survey on Access, Use and Promotion of Rational Use of Medicines: methods.

ABSTRACTThe Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos –Serviços (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services) aimed to characterize the organization of pharmaceutical services in the Primary Health Care of the Brazilian Unified Health System (SUS). PNAUM – Services is a cross-sectional and evaluative study, with planned sample of 600 cities, held between 2014 and 2015, composed of a remote phase, with telephone interviews with health managers. Of these 600 cities, 300 were selected for a survey on health services. We selected the 27 capitals, the 0.5% largest cities of each region, and the remaining cities were drawn. The estimate of the representative national sample size considered three levels: cities, medicine dispensing services, and patients. The interviews were carried out with a structured questionnaire specific for: municipal secretaries of health, professionals responsible for pharmaceutical services in the city, professionals responsible for the dispensing of medicines, physicians, and patients. The secondary data were obtained in official databases, in the latest update date. PNAUM – Services was the first nationwide research aimed at the assessment and acquisition of national and regional indicators on access to medicines, as well as use and rational use, from the perspective of various social subjects.

Characterization of the institutionalization of pharmaceutical services in Brazilian primary health care.

ABSTRACTOBJECTIVE To characterize the current stage of the institutionalization of pharmaceutical services in Brazilian cities.METHODS This study is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines), a cross-sectional, exploratory, and evaluative study composed by an information survey in a representative sample of cities, stratified by Brazilian regions. We interviewed municipal secretaries of health, responsible for pharmaceutical services, and pharmacists responsible for the dispensing of medicines. The variables selected from the interviews were grouped into five dimensions that defined three stages of pharmaceutical services institutionalization: incipient (0%-34.0%), partial (35.0%-69.0%), and advanced (70.0%-100%), estimated based on the interviewees’ answers. Frequencies were estimated with 95% confidence intervals. For the statistical association analysis, the Chi-square test was applied, with significance level of p<0.05.RESULTS Our results show a partial and heterogeneous process of institutionalization of pharmaceutical services in Brazil, and an advanced stage in formal structures, such as the municipal health plans and the existence of a standardized list of medicines. The analysed variables in the “organization, structure, and financing” dimension configured stages that range from partial to advanced. The management presented partial institutionalization, positively showing the existence of computerized system, but also disparate results regarding the autonomy in the management of financial resources. Indispensable items related to the structure expressed disparities between the regions, with statistically significant differences.CONCLUSION The study showed a partial and heterogeneous process of institutionalization of pharmaceutical services in Brazilian cities, showing regional disparities. Variables related to the normative aspects of institutionalization were positively highlighted in all dimensions; however, it is necessary to conduct new studies to evaluate the institutionalization of pharmaceutical services’ finalistic activities.

Management of pharmaceutical services in the Brazilian primary health care.

ABSTRACTOBJECTIVE To identify limiting factors in the management of pharmaceutical services in the primary health care provided by the Brazilian Unified Health System (SUS).METHODS This study was based on the data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines), and it was conducted by interviews with professionals responsible for pharmaceutical services in Brazilian cities, in 2015. To identify the management limiting factors, we considered the organizational, operational, and sustainability indicators of the management. For the analyses, we included the weights and structure of analysis plan for complex samples. The results were expressed by frequencies and measures of central tendency with 95% confidence interval, considering the Brazilian geographic regions.RESULTS We identified the following limiting factors: lack of pharmaceutical services in the Municipal Health Secretariat organization chart (24%) and in the health plan (18%); lack of participation of managers in the Health Board and the absence of reference to this topic in the agenda of meetings (58.4%); lack of financial autonomy (61.5%) and lack of knowledge on the available values (81.7%); lack of adoption of operational procedures (about 50%) for selection, scheduling, and acquisition; and the fact that most professionals evaluate the organization of pharmaceutical services as good and great (58.8%), despite the worrisome indicators.CONCLUSIONS Pharmaceutical services management is currently supported by a legal and political framework that should guide and contribute to improve the pharmaceutical services in the Brazilian Unified Health System primary health care. However, there is a mismatch between the goals established by these guidelines and what is actually happening.

Policy of Labor Management and Health Education: a ProgeSUS experience.

To evaluate the stage of labor management and education policies in municipal and state health secretariats (SMS and SES, respectively), having as reference the adherence to a qualification and structuring program of work management and education in the Unified Health System. A descriptive and quantitative study, developed with 519 representatives from the Human Resources (HR) area of SMS and SES, through a survey composed of 56 questions, via a computer-assisted telephone interview in 2012. Responses were processed in a computerized database and the data treated by descriptive statistics. Changes in professional qualification, the establishment of job and salary plans and negotiation processes were identified; on the other hand, there was no progress related to the financial and budgetary autonomy of the area of work management and health education. It is observed progress in the incorporation of innovations in the management in SES and SMS from the process of training of managers and financial induction. It is necessary to monitor and periodically evaluate the operationalization of labor and education policies aimed at strengthening them, correcting directions and implementing innovative actions.

The prominent role of Councils of Municipal Health Secretariats in the regional governance process.

This study aims to analyze the perception of managers of the Councils of Municipal Health Secretariats (COSEMS) and their contributions to the health regionalization process. We conducted thorough interviews with presidents of COSEMS of the states of Mato Grosso do Sul, Paraná, Ceará, Tocantins and Minas Gerais. Data were analyzed with Iramuteq software, which generated a dendrogram with three themes: The first thematic axis: the prominent role of COSEMS in the regional governance process, which includes class 1 - COSEMS' leadership in the process of regionalization, and class 3 - The strategic experience of the regional agreement process. The second thematic axis includes the challenges to the provision of health care in the regions, consisting of class 2, which shows how to meet community needs, and class 4, which shows the local support carried out by COSEMS' teams. The third thematic axis consists of class 5, which describes the operational aspects of the provision of health care in the region. COSEMS play an important role in the regionalization process, especially because they have an organic performance and leadership. Its organic performance in these areas has ensured its legitimacy and leadership. It is a daily construction that ensures the advancement of collaborative governance in health regions.

Political Obstacles to Regionalization of the SUS: perceptions of Municipal Health Secretaries with seat in the Bipartite Interagency Commissions.

This paper aims to identify and analyze the political obstacles to the implementation of Organizational Contract of Public Action (COAP) based on the perceptions of municipal health secretaries of Bipartite Interagency Commissions (CIB). For this purpose, we interviewed 195 secretaries (92% of the total) from October 2015 to August 2016. Based on the approach of policy analysis, the main hurdles identified were, in short, a traditional obstacle (lack of resources), one that has been gaining strength in recent years (judicialization of politics) and another, perhaps unheard of: the party-political system and the State Executive Branch are the great absentees in the coalitions in support of SUS regionalization policies. We can conclude that such obstacles indicate an extremely negative setting for the implementation of the COAP and other SUS regionalization policies. Thus, it is incumbent upon those involved to reflect, negotiate and build consensus on improving the health of the population and overcome such obstacles if, of course, they embrace the authors' concept that regionalization is fundamental for the SUS.

Preceptorship in Family and Community Medicine: challenges and achievements in a Primary Health Care in progress.

Strengthening Primary Health Care (PHC) relies directly on training medical specialists in primary care. This text aims to report the Family Medicine training experiences in Rio de Janeiro between 2008 and 2016. It brings to reflection the development of preceptors in medical specialization through an experience report on three Family Medicine medical residency programs, namely, the Municipal Health Secretariat program, the Federal University of Rio de Janeiro program and the National School of Public Health program. The PHC reform in Rio de Janeiro created a demand for medical specialists working in networks, leading to the expansion of already established medical residency programs and the establishment of a new program sponsored by the Municipal Health Secretariat, providing new teaching positions in several health facilities within the municipal network. These three residency programs progressed through different paths to provide training to their preceptors, offering permanent courses and local actions seeking higher professional qualification and better balance between care and education responsibilities. Permanent investments to strengthen medical residency programs and preceptors training are essential to consolidate the PHC reform nationwide.

Analysis of the attributes of primary health care using the electronic medical records in the city of Rio de Janeiro.

Epidemiology plays a strategic role at this stage of the policy cycle, contributing to goal setting, resource allocation and use of information systems. In 2009, the Municipal Health Secretariat of Rio de Janeiro initiated a reform of the health care model under the main influence the Primary Health Care concept. This study evaluates the trend of selected pay-for-performance indicators that measure the health care process in the city's PHC. This a study on repeated panels, from the administrative and clinical records of electronic medical records in the period from 2012 to 2016. We selected seven indicators that analyzed longitudinal performance within the established goal, among those that represent access, longitudinality, coordination of care - APS attributes, as well as other characteristics of the services, such as care performance and economic efficiency. This study demonstrated that management decentralization to levels closer to the user is potentially successful for the recording of clinical data under an adequate monitoring of indicators, regular clinical audits and feedback to health professionals, along with data and indicators monitoring.

A web-based information system for a regional public mental healthcare service network in Brazil

BackgroundRegional networking between services that provide mental health care in Brazil’s decentralized public health system is challenging, partly due to the simultaneous existence of services managed by municipal and state authorities and a lack of efficient and transparent mechanisms for continuous and updated communication between them. Since 2011, the Ribeirao Preto Medical School and the XIII Regional Health Department of the Sao Paulo state, Brazil, have been developing and implementing a web-based information system to facilitate an integrated care throughout a public regional mental health care network.Case presentationAfter a profound on-site analysis, the structure of the network was identified and a web-based information system for psychiatric admissions and discharges was developed and implemented using a socio-technical approach. An information technology team liaised with mental health professionals, health-service managers, municipal and state health secretariats and judicial authorities. Primary care, specialized community services, general emergency and psychiatric wards services, that comprise the regional mental healthcare network, were identified and the system flow was delineated. The web-based system overcame the fragmentation of the healthcare system and addressed service specific needs, enabling: detailed patient information sharing; active coordination of the processes of psychiatric admissions and discharges; real-time monitoring; the patients’ status reports; the evaluation of the performance of each service and the whole network. During a 2-year period of operation, it registered 137 services, 480 health care professionals and 4271 patients, with a mean number of 2835 accesses per month. To date the system is successfully operating and further expanding.ConclusionWe have successfully developed and implemented an acceptable, useful and transparent web-based information system for a regional mental healthcare service network in a medium-income country with a decentralized public health system. Systematic collaboration between an information technology team and a wide range of stakeholders is essential for the system development and implementation.

Avaliação dos usuários crianças e adultos quanto ao grau de orientação para Atenção Primária à Saúde na cidade do Rio de Janeiro, Brasil

In the first half of 2014, 6,675 adults and caregivers of children using Primary Care (PC) services in Rio de Janeiro were interviewed using the Primary Care Assessment Tool - PCATool-Brazil. The aim was to arrive at an accurate overview of the extent to which PC services in all of the Planning Areas (PA) of the Rio de Janeiro City Health Department (CHD) - Municipal Health Secretariat have the essential and derivative attributes. This was a cross-sectional study of random, independent samples of the service users (children and adults). Results were measured using the scores assigned to PC attributes. In the opinion of adults and children using PC services, Type A Units - Municipal Healthcare Centers and Family Clinics staffed only with Family Health Teams, performed better than Type B units. The scores for the attributes "first contact accessibility", "comprehensive service - services provided", "community orientation" and "family orientation" still need to be improved. On the other hand "coordinated care" and "continuity" are on their way to quality scores, being always rated at around 6.0 or even higher.