National Primary Health Care Policy Research Articles

Historical Perspective of Homeopathy in the Brazilian Public Health System.

Homeopathy was introduced in Brazil with the French doctor Benoît Jules Mure's arrival in 1840 and was officially recognised in 1980 as a medical specialty by Brazilian regulatory authorities. Public health policies played an important role in incorporating homeopathy into the Brazilian Unified Health System (SUS), emphasising homeopathy's coherence with SUS's fundamental principles and with other national health policies. Homeopathy is supported by the guidelines of the National Primary Health Care Policy and the National Policy on Integrative and Complementary Practices, and its offer in the SUS has been recognised since 2006. Challenges persist, however, such as the low prevalence of the use of homeopathy, lack of investment in professional training and under-reporting of homeopathy outpatient appointments. Investments in disseminating information on homeopathic philosophy and raising awareness among managers and health professionals are essential to strengthen its presence in the Brazilian public health system.

Temporal analysis of Family Health Strategy indicators from the perspective of the Brazilian National Primary Health Care Policy.

Throughout the three editions of the Brazilian National Primary Health Care Policy (PNAB), changes were made in relation to the structure of the Family Health Strategy (FHS), with emphasis on modifications concerning the priority nature of the FHS as an organization and care strategy in primary health care. The objective was to analyze temporal trends in indicators related to the FHS from the perspective of the three PNAB editions: 2006, 2011, and 2017. This is a descriptive study of the temporal trend of indicators selected from a logical model constructed by components related to the FHS in the three editions of the PNAB. The logical model was developed based on the components Territory/Enrollment, Teams, Work Process, Territory Planning and Management, and Care for Priority Groups by Family Health Teams, each one being represented by selected indicators. The construction of the national and regional time series between 2007 and 2020 was carried out using the Joinpoint software. Most of the indicators showed an upward trend in the first time segments identified by the models, followed by segments of stability or decrease, especially after the year 2017. The indicator Number of community health workers stands out, which decreased after 2017 in most geographical regions and in Brazil. The 2017 PNAB may have discouraged the continuation and expansion of the FHS as the priority model of primary health care, by allowing and financing new teamwork arrangements and processes.

Análise temporal de indicadores da Estratégia Saúde da Família sob o olhar da Política Nacional da Atenção Básica

Throughout the three editions of the Brazilian National Primary Health Care Policy (PNAB), changes were made in relation to the structure of the Family Health Strategy (FHS), with emphasis on modifications concerning the priority nature of the FHS as an organization and care strategy in primary health care. The objective was to analyze temporal trends in indicators related to the FHS from the perspective of the three PNAB editions: 2006, 2011, and 2017. This is a descriptive study of the temporal trend of indicators selected from a logical model constructed by components related to the FHS in the three editions of the PNAB. The logical model was developed based on the components Territory/Enrollment, Teams, Work Process, Territory Planning and Management, and Care for Priority Groups by Family Health Teams, each one being represented by selected indicators. The construction of the national and regional time series between 2007 and 2020 was carried out using the Joinpoint software. Most of the indicators showed an upward trend in the first time segments identified by the models, followed by segments of stability or decrease, especially after the year 2017. The indicator Number of community health workers stands out, which decreased after 2017 in most geographical regions and in Brazil. The 2017 PNAB may have discouraged the continuation and expansion of the FHS as the priority model of primary health care, by allowing and financing new teamwork arrangements and processes.

The effect of primary care policy changes on hospitalisation for ambulatory care sensitive conditions: notes from Brazil

Objectives: The aim of this study was to assess the effect of the Primary Health Care Reform and the impact of recent national policy changes on the trend in hospitalisation rates for Ambulatory Conditions Sensitive to Primary Care (ACSC) in the city of Rio de Janeiro, Brazil.Study design: Ecological study with data from the Brazilian National Health Information System.Methods: This study performed an interrupted time-series analysis, comparing three different time periods related to important changes in primary care policies in Brazil: Baseline (2008–2009); Primary Health Care Reform (RCAPS) (2010–2017); and National Primary Health Care Policy (PNAB) (2018–2019). Data included total monthly admissions for ACSC and rates for 19 groups of causes for hospitalisation.Results: There was a non-significant increasing trend in ACSC hospital admissions between January 2008 and December 2009 (β = 4.01, 95% confidence interval [CI] −12.14 to 20.15). The Primary Health Care Reform (RCAPS), which commenced in January 2010, resulted in a significant reduction in ACSC hospital admission trends during this time period (β = −7.97, 95% CI –9.78 to −6.16). Change in the PNAB did not change the declining ACSC hospital admission trend but it did reduce the rate of decline. In addition, the coefficient was no longer significant (β = −1.93, 95% CI –2.46 to 0.59), suggesting that monitoring of the historical series for a long time may show a reversal of the downward trend in some months. The most consistent change in ACSC hospital admission trend occurred between baseline and the RCAPS (β slope = −0.143, P < 0.001) and the level between the RCAPS period and the new PNAB (β step = 7.00, P = 0.008). Trends and differences in the time periods vary in the different ACSC hospitalisation-cause groups.Conclusion: Changes in public health policies impact ACSC hospitalisation rates, which can thus be used as an indicator for monitoring primary health care. We also recommend analysing admission rates by the individual ACSC hospitalisation-cause groups.

Gaining political will for actions to achieve health equity: lessons from Australia for advocates

Abstract Background There has been an accumulation of evidence on the importance of action on the social determinants of health to reduce global and national health equity. Yet there has been little effective systematic action by governments. This is commonly attributed to the absence of political will. Despite its importance, however, little research has examined how political will might be created or prevented. Methods This paper reports on the results of eight case studies of the extent to which Australian public policy is likely to contribute to reducing health inequities. 192 participants were interviewed including public servants, politicians and their staff, non-government organisation workers and community members. The transcripts were interrogated with the assistance of NVivo software to determine lessons about the creation or destruction of political will. The case studies were of: national primary health care policy, crucial determinants of health (work conditions, internet access, urban planning, social welfare, trade) and an automotive plant closure. Results We found the following factors to be important in determining the extent of political will for health equity, whether: path dependency was present; the issue would impact on staying in or winning government; political philosophies stressed collectivism or individualism; there were negative or positive social constructions of groups affected by the policies; economic and/or biomedical framings were dominant; elites (especially business interests) lobbied against the policies; and there was effective civil society and policy advocacy in favour of the policies. Conclusions Building on our insights from our case studies of action for political will, we conclude with a series of questions to guide the work of public health activists and policy advocates working to support existing and to create new political will in multiple contexts. Key messages The creation of political will is vital to the adoption of policies supportive of health equity. Analysis of 8 policy case studies points to how advocacy can most effectively create political will.

National Primary Care Policy 2017: analysis of teams composition and national coverage of Family Health.

The Family Health Strategy is the main form of organization of the Brazilian health system. However, the third edition of the National Primary Health Care Policy (PNAB) recognized other types of teams financially. A time series study was conducted from 2007 to 2019 using data from the National Register of Health Facilities (CNES) of jobs, teams and national coverage of Family Health to analyze the effects of the 2017 National Primary Health Care Policy (PNAB) on team composition. We observed the concentration of doctors in the Southeast and Northeast and variation of this professional category before the events of the "Mais Médicos" (More Doctors) Program. The number of nurses increased 5% and Community Health Workers (ACS) dropped 0.3% in the country. Despite the authorization and funding for the implementation of "Primary Care" teams (eAB), they correspond to less than 1% of the total teams. It is noteworthy that the municipal managers' preferred mode is the traditional Family Health Teams, equivalent to 75% of the total and growing. While the questionings and expectations generated by the 2017 PNAB in the context of Primary Health Care, we can conclude that, regarding the teams and their compositions, no significant change was identified two years into its coming into force.

Social participation in Primary Health Care towards the 2030 Agenda.

Listening to society is an ethical reference to respond to its legitimate needs and aspirations. Considering as presuppositions the social participation and the right to the city, which are part of the 2030 Agenda, this study sought to recognize the voice of users that evaluated PHC services and their attributes. This descriptive and cross-sectional study used national ministerial evaluation data, outlining a region with 323 teams in 80 municipalities in the state of São Paulo and 1,272 users heard by authors. Users were mostly female, over 51 years old, with low income and schooling, eliciting challenges to population aging and selective care. Around 93% were 20 minutes away from health services and opening on Saturdays (43%) and at night (38%) would facilitate access. Some 60% were received without scheduling and 62% did not consider services prepared for urgent care. Some 85% received Community Health Workers and 40% other professionals, suggesting disparities in the incorporation of the territory to the care production process. In line with National Primary Health Care Policy and what is recommended by international conferences, social participation was recognized as a way to address the multiple aspects in the construction of universal health.

Are changes in Australian national primary healthcare policy likely to promote or impede equity of access? A narrative review.

Significant changes have occurred in Australia's national primary healthcare (PHC) policy over the last decade, but little assessment has been made of implications for equity. This research aimed to identify key recent changes in national PHC policy and assess implications for equity of access to PHC. Academic literature was reviewed to identify issues affecting equity of access in national PHC policy, and grey literature was also reviewed to identify significant policy changes during 2005-16 with implications for equitable access. Equity implications of four areas of policy change, set against the existing Medicare system, were assessed. It was found that Medicare supports equitable access to general practice, but there is a risk of reduced equity under current policy settings. Four changes in PHC policy were selected as having particular implications for equity of access and these were assessed as follows: increased involvement of private health insurance presents risks for equity; equity implications of new models of coordinated care are unclear; and regional primary health organisations and current policy on Aboriginal and Torres Strait Islander health have potential equity benefits, but these will depend on further implementation.

The Mais Médicos (More Doctors) Program in Mato Grosso State, Brazil: implementation analysis.

Although the 224 health professionals engaged by the More Doctors for Brazil Project (Projeto Mais Médicos para o Brazil, PMMB) to strengthen the National Primary Health Care Policy (Política Nacional de Atenção Básica, PNab) in 104 municipalities of Mato Grosso (MT) State have encountered significant problems in the work process, important advances have resulted in the health of populations served by the More Doctors Programme (Programa Mais Médicos, PMM). This article analyses the implementation and development of the PMM in MT, from 2013 to 2015, on the basis of primary data from focus groups and interviews of social stakeholders at the institutions involved and secondary data from reports by supervisors, tutors, managers and institutions on the MT State Coordinating Committee (CCE) of the PMM. Despite political difficulties in managing implementation, the results show that the endeavour was beneficial in that it surmounted previous obstacles, afforded users greater access, prompted discussion of the problem and proposed and experimented with ways to strengthen primary health care. We conclude that there is a need for broader academic discussion of the provision and training of doctors, of the model of care and of human resource capacity-building by continuing professional development with integration among teaching, service and community.

Family health strategy: a technological innovation in health

The importance of the Family Health Strategy in the health sector in Brazil, and the debate on technology and technological innovation have led to the development of a theoretical reflection aiming to characterize the Family Health Strategy as a non-material technological innovation of the health field. In order to construct the text, the philosophical and sociological approach was used, as was the conceptualization of technological innovation, found in international documents and in Brazilian legislation and publications regarding technological innovation in health care. These references were used in order to analyze what is prescribed for the Family Health Strategy in the National Primary Healthcare Policy, emphasizing the innovative aspects in relation to biomedicine, which made it possible to support that the Family Health Strategy consists of a non-material technological innovation in health care, of the incremental type. It is concluded that the Family Health Strategy is a non-material technological innovation in health care, due to the principles which it anchors, and is incremental, as it does not completely break with the traditional model in health care.

Integrated primary health care in Australia.

To fulfil its role of coordinating health care, primary health care needs to be well integrated, internally and with other health and related services. In Australia, primary health care services are divided between public and private sectors, are responsible to different levels of government and work under a variety of funding arrangements, with no overarching policy to provide a common frame of reference for their activities. Over the past decade, coordination of service provision has been improved by changes to the funding of private medical and allied health services for chronic conditions, by the development in some states of voluntary networks of services and by local initiatives, although these have had little impact on coordination of planning. Integrated primary health care centres are being established nationally and in some states, but these are too recent for their impact to be assessed. Reforms being considered by the federal government include bringing primary health care under one level of government with a national primary health care policy, establishing regional organisations to coordinate health planning, trialling voluntary registration of patients with general practices and reforming funding systems. If adopted, these could greatly improve integration within primary health care. Careful change management and realistic expectations will be needed. Also other challenges remain, in particular the need for developing a more population and community oriented primary health care.

Village Health Worker Attrition and Function Levels in the ILE-IFE Area of Nigeria

Volunteer village health workers (VHWs) form the backbone of primary health care (PHC) from both philosophical and logistical perspectives. They represent an underlying PHC ethic of community involvement as well as a practical means for delivering health care at the grassroots. Although VHW recruitment and training does not rival the cost of training formal medical and health workers, the investment in not insubstantial. Thus when VHW dropout rates approach 50 percent in many countries, there is cause for alarm and for investigation into the possible causes of attrition. Nigeria embarked on a national PHC program in 1986, supported by national PHC policy in 1987. Nearly 1500 VHWs have been trained in model local government areas (LGAs) during the intervening years. Although there have been anecdotal reports of VHW attrition, little study into the reasons for drop-out from this large scale and expensive operation have been undertaken. This study looked at the former Oranmiyan LGA (now divided into three) where 115 VHWs had been trained. Only 79 percent of trainees took up PHC tasks, and another 7 percent left their villages shortly thereafter due to school admission or job opportunities. Two to three years after the initial training, 58 percent of the original trainees self-reported that they were still functioning as VHWs. A PHC function test, based on VHW job descriptions, was developed and administered within a questionnaire among the VHWs still living in their villages. Three factors were associated with function score: farming as an occupation, reported recent supervision and reported attendance at a continuing education activity. The results indicate two main points of intervention for preventing VHW attrition. During recruitment, effort should be made to explain the voluntary nature of the work and to encourage villagers to select people (like farmers) who will reside permanently in the village. After training, supervision and continuing education must be planned to maintain a high level of VHW functioning.