Escorel Sarah, Giovanella Ligia, Magalhães de Mendonça Maria Helena, de Castro Maia Senna Mônica
Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública, Rio de Janeiro (RJ), Brasil.
Rev Panam Salud Publica. 2007 Feb-Mar;21(2-3):164-76. doi: 10.1590/s1020-49892007000200011.
As part of the implementation of the country's Unified Health System (Sistema Unico de Saúde), the Brazilian Government created, in the second half of the 1990s, the Family Health Program (FHP) (Programa de Saúde da Família), based on community-oriented, multidisciplinary care serving people organized into small groups. For this study, we evaluated the implementation of the FHP, based on three criteria: (1) the construction of the program as an entry point for most health needs and for access to specialized care, (2) the program's linkages with a comprehensive network of health services, and (3) the incorporation of new care practices into the health system. We found that the implementation of the FHP was far from uniform. In some municipalities the FHP is a focused program that runs in parallel with other primary care efforts. However, in other municipalities the FHP is viewed as a strategy aimed at changing the primary care model, and it partially or completely replaces preexisting primary care health units. Our research confirms a trend toward incremental change in the primary care model in Brazil. However, the expansion of the FHP in large urban areas faces several obstacles to guaranteeing all individuals access to comprehensive care with adequate clinical and collective health services, including secondary and tertiary care. The positive results that we found with some of the experiences with the FHP indicate that, in addition to increased federal financial incentives, the success of the FHP depends on creative local strategies to deal with Brazil's diversity.
作为该国统一卫生系统（Sistema Unico de Saúde）实施工作的一部分，巴西政府于20世纪90年代后半期设立了家庭健康计划（FHP）（Programa de Saúde da Família），该计划以社区为导向，提供多学科护理，服务对象是组织成小群体的人群。在本研究中，我们基于三个标准对家庭健康计划的实施情况进行了评估：（1）将该计划构建为满足大多数健康需求和获得专科护理的切入点；（2）该计划与全面的卫生服务网络的联系；（3）将新的护理实践纳入卫生系统。我们发现，家庭健康计划的实施情况远非统一。在一些城市，家庭健康计划是一个重点突出的计划，与其他初级保健工作并行开展。然而，在其他城市，家庭健康计划被视为旨在改变初级保健模式的一项战略，它部分或完全取代了原有的初级保健卫生单位。我们的研究证实了巴西初级保健模式逐步变革的趋势。然而，在大城市地区扩大家庭健康计划在保障所有人获得包括二级和三级护理在内的全面临床和集体卫生服务方面面临若干障碍。我们在家庭健康计划的一些经验中发现的积极成果表明，除了增加联邦财政激励措施外，家庭健康计划的成功还取决于应对巴西多样性的创造性地方战略。
