Between norms and practices: implementation and regional repercussions of changes in primary health care policies in Brazil

This article analyzes the implementation of changes in national primary health care (PHC) policies in Brazil, and their repercussions in the Metropolitan Health Region I of Rio de Janeiro and in the Northern MacroRregion of Paraná between 2017 and 2022. This multicenter study adopts a comparative approach and mixed methods to identify similarities and differences between cases in three analytical axes: profile, institutional positioning, and conceptions about PHC; organizational decisions related to the work process; coverage and composition of teams. A total of 44 interviews were conducted with managers in 14 selected municipalities and secondary data were analyzed. Higher degrees in health, introduction to Public Health and short time in office, due to municipal elections, were common characteristics of the interviewees. There was convergence in the conceptions of PHC and the Family Health Strategy, as well as tensions and favorable positions for the Prevent Brazil Program, which encouraged organizational changes in the registration of the population and in the fulfillment of goals. A diverse set of strategies for monitoring, evaluation and maintenance of programs and actions was identified, as well as a reduction in the number of community health agents per team and an increase in the number of teams per basic health unit. Despite the predominance of family health teams, there were differences between the proportion of the registered population and the number of teams in the Family Health Support Center. The analysis suggests that the implementation of PHC guidelines and their repercussions are influenced by complex and interdependent factors, such as municipal capacities, intergovernmental relations, and state action within the regional context.

Keywords:
Primary Health Care; Health Policy; National Health Strategies; Family Health; Unified Health System