Performance patterns of primary health care in the face of COVID-19 in Brazil: characteristics and contrasts

Schenkman, Simone; Bousquat, Aylene Emilia Moraes; Facchini, Luiz Augusto; Gil, Célia Regina Rodrigues; Giovanella, Lígia

doi:10.1590/0102-311XEN009123

Acessibilidade / Reportar erro

Brasil

Cadernos de Saúde Pública

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

ARTICLE • Cad. Saúde Pública 39 (8) • 2023 • https://doi.org/10.1590/0102-311XEN009123 copy

Performance patterns of primary health care in the face of COVID-19 in Brazil: characteristics and contrasts

Authorship SCIMAGO INSTITUTIONS RANKINGS

The adequate fight against pandemics requires effective coordination between primary health care (PHC) and health surveillance, guaranteed attention to acute and chronic demands, and a bond with the community dimension in the scope of basic health units (UBS, acronym in Portuguese). This study aims to contrast two extreme standards of PHC performance in the fight against COVID-19 in Brazil, comparing them with the profiles of the corresponding municipalities and characteristics of the organization of services. Based on the results of a cross-sectional national survey with a representative sample of UBSs, we created a synthetic index to evaluate how PHC performs against COVID-19 called CPI, composed of axes of health surveillance and social support (collective dimension) and of COVID-19 care and continuity of care (individual dimension). Of the 907 surveyed UBSs, 120 were selected, half of which had the highest indexes (complete standard) and the other half, the lowest ones (restricted standard). The municipalities of the UBSs with a complete standard are predominantly rural, have low Municipal Health Development Index (MHDI), high Family Health Strategy (FHS) coverage, and stand out in the collective dimension, whereas the UBSs in urban municipalities with this same standard have high MHDI, low FHS coverage, and an emphasis on the individual dimension. In the restricted standard, we highlight community health workers’ reduced work in the territory. In the Brazilian Northeast, UBSs with complete standard predominate, whereas, in its Southeast, UBSs with restricted standard predominate. The study poses questions that refer to the role and organization of PHC in the health care network under situations that require prompt response to health issues and indicates the greater potential capacity of the FHS program in such situations.

Keywords:
Primary Health Care; Family Health Strategy; COVID-19; Public Health Surveillance; Health Services

Variables	UBSs with restricted response to the pandemic [38 (18-43)]	UBSs with complete response to the pandemic [89 (85-98)]	p-value *
Variables	Median (IQR)	Median (IQR)	p-value *
Individual dimensions (CPI)
Care for patient with COVID-19	39 (31-50)	93 (90-95)	< 0.0001 **
Continuity of care	44 (37-55)	84 (76-90)	< 0.0001 **
Collective dimensions (CPI)
Health surveillance	30 (20-42)	100 (90-100)	< 0.0001 **
Social support	31 (17-42)	92 (83-100)	< 0.0001 **
Socioeconomic, demographic and political variables
MHDI ***	75 (72-78)	66 (60-62)	< 0.0001 **
GDP per capita (BRL) ^#	36,278 (22,460-46,677)	18,399 (11,665-27,400)	< 0.0001 **
Estimated population ^#	121,426 (53,082-373,820)	14,600 (5,376-37,884)	< 0.0001 **
% of votes in jair Bolsonaro ^##	66 (57-77)	49 (28-61)	< 0.0001 **
Hospitals and equipment ^###
Hospitals (n)	4 (1.5-10)	1 (0-1)	< 0.0001 **
Respirators (n)	47.5 (12-237)	0.5 (0-6)	< 0.0001 **
ICU beds ^###
ICU beds ii adults - COVID-19 (n)	11 (0-35)	0 (0-0)	< 0.0001 **
ICU beds ii pediatric - COVID-19 (n)	0 (0-0)	0 (0-0)	0.6106
Total (n)	26 (10-85)	0 (0-0)	< 0.0001 **
Coverage
FHS ^§ (%)	63 (38-88)	100 (89-100)	< 0.0001 **
Primary care ^§ (%)	75 (58-100)	100 (96-100)	< 0.0001 **
COVID-19 - surveillance
Confirmed cases by municipality/100,000 ^§§	12,251 (8.,89-14,779)	8,550 (6,123-13,117)	0.0003 **
Municipal mortality rate ^§§	0.025 (0.019-0.033)	0.026 (0.017-0.036)	0.7648

Variables	UBSs with restricted response to the pandemic	UBSs with complete response to the pandemic	p-value *
Variables	n (%)	n (%)	p-value *
Region			0.030 **
North	6 (10)	8 (13)
Northeast	8 (13)	20 (33)
Southeast	23 (38)	13 (22)
South	16 (27)	9 (15)
Central-West	7 (12)	10 (17)
Rural-urban division			< 0.001 **
Adjacent intermediate	3 (5)	7 (12)
Remote intermediate	1 (2)	0 (0)
Adjacent rural	3 (5)	27 (45)
Remote rural	0 (0)	7 (12)
Urban	53 (88)	19 (32)
FHS teams (n)			< 0.001 **
None	17 (28)	0 (0)
1	27 (45)	37 (62)
2-6	16 (27)	21 (35)
More than 6	0 (0)	2 (3)
ICT structure
Existence of Internet	59 (98)	58 (97)	0.559
Electronic health record	47 (78)	48 (80)	0.822
Computer with camera and microphone	8 (13)	35 (58)	< 0.001 **
Activities of CHWs
CHWs in the territory	24 (40)	42 (70)	0.001 **
CHW care for patients with respiratory symptoms	7 (12)	33 (55)	< 0.001 **
Home visit by CHWs	15 (25)	58 (97)	< 0.001 **
Active search by CHWs	10 (17)	53 (88)	< 0.001 **
Active search by CHWs for vaccination of priority groups	26 (43)	57 (95)	< 0.001 **
Active search by CHWs for those not vaccinated with 2nd dose against COVID-19	20 (33)	56 (93)	< 0.001 **
Vaccination against COVID-19 at UBS	23 (38)	53 (88)	< 0.001 **
Human resources
Increased demand	49 (82)	57 (95)	0.023 **
Overload for health professionals	51 (85)	53 (88)	0.591
Psychological support for health professionals	26 (43)	44 (73)	0.001 **
Human resources turnover	24 (40)	23 (38)	0.852
Increased due to the pandemic	13 (22)	14 (23)	0.827
Increase - change of municipal management	9 (15)	9 (15)	1.000
Care for patients with COVID-19 sequelae	41 (68)	56 (93)	0.001 **
NCD (impact on care)			0.048 **
Improved	2 (3)	10 (17)
Maintained	6 (10)	6 (10)
Impaired	27 (45)	29 (48)
Very impaired	25 (42)	15 (25)

Performance standard with restricted response	OR	95%CI	p-value
Bivariate analysis
North Region	0.80	0.25-2.58	0.703
Northeast Region	0.28	0.11-0.73	0.009 *
Southeast Region	2.70	1.17-5.26	0.002 *
South Region	2.14	0.84-5.46	0.111
Central-west Region	0.74	0.25-2.17	0.578
Lack of Internet	0.60	0.05-6.75	0.673
Lack of electronic health record	1.27	0.49-3.29	0.617
Lack of computer with camera and microphone	6.90	2.62-18.19	< 0.001 *
CHWs are not predominantly in the territory	3.22	1.43-7.26	0.005 *
CHW care for patients w/ respiratory symptoms	0.10	0.04-0.28	< 0.001 *
Lack of home visit by CHWs	57.74	12.06-276.45	< 0.001*
Lack of active search by CHWs	39.38	12.77-121.40	< 0.001*
Lack of active search by CHWs, for vaccination of priority groups	19.39	5.17-72.70	< 0.0001 *
Lack of active search by CHWs, for vaccination of those not vaccinated with the 2nd dose against COVID-19	28.23	8.03-99.21	< 0.001 *
Lack of vaccination against COVID-19 at UBS	13.36	4.75-37.60	< 0.001 *
FHS teams (n)	0.85	0.73-0.98	0.021 *
Increased demand	0.20	0.04-0.88	0.033 *
Overload for health professionals	0.89	0.28-2.82	0.840
Lack of psychological support for health professionals	4.54	2.07-9.99	< 0.001 *
Human resources turnover	1.14	0.51-2.54	0.741
Increase due to the pandemic	0.96	0.38-2.41	0.924
Increase - change of municipal management	1.00	0.34-2.93	0.999
Care for patients with COVID-19 sequelae	0.19	0.06-0.62	0.006 *
NCD (positive impact)	0.19	0.05-0.77	0.002 *
Final model
Lack of home visit by CHWs	70.08	2.65-1,851.31	0.011 *
Lack of active search by CHWs	12.30	1.90-79.55	0.009 *
Lack of vaccination against COVID-19 at UBS	14.65	2.82-76.21	0.002 *
Lack of psychological support for health professionals	17.51	1.56-196.29	0.021 *
Care for patients with COVID-19 sequelae	0.03	0.01-0.20	< 0.001 *
Constant	0.16	0.04-0.71	0.016 *

Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz Rua Leopoldo Bulhões, 1480 , 21041-210 Rio de Janeiro RJ Brazil, Tel.:+55 21 2598-2511, Fax: +55 21 2598-2737 / +55 21 2598-2514 - Rio de Janeiro - RJ - Brazil
E-mail: cadernos@ensp.fiocruz.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Correspondence
S. Schenkman Faculdade de Saúde Pública, Universidade de São Paulo. Av. Dr. Arnaldo 715, São Paulo, SP 01246-904, Brasil. simoneschenkman@usp.br