Cecilio Luiz Carlos de Oliveira, Reis Ademar Arthur Chioro Dos
Universidade Federal de São Paulo, São Paulo, Brasil.
Cad Saude Publica. 2018 Aug 20;34(8):e00056917. doi: 10.1590/0102-311X00056917.
In recent decades, Brazil has witnessed a proposal to create an extensive basic health care network as the main portal of entry to a universal public health system. Based on the recognition of consistent strides in that direction, the article addresses four issues on some important challenges for the consolidation of the basic health care proposal: (1) the use of the term "basic health care" as opposed to the usual, hegemonic concept of "primary health care"; (2) the disconnect or mismatch between the policy's wording and its real-life implementation, underscoring the need for a review of the Brazilian National Basic Health Care Policy (PNAB), which centralizes and standardizes rules and routines for the entire country while overlooking Brazil's continental dimensions, heterogeneity, and wide local diversity; (3) the isolation of basic health care and its peripheral position in the health system, pointing to the need for more complex arrangements in the coordination of care, not left merely under the organization and responsibility of basic health care; and (4) the lack of health policymakers, administrators, and professionals who are prepared and aligned with a project aimed at transforming the country's prevailing health care model.
近几十年来，巴西见证了一项创建广泛基础医疗保健网络的提议，该网络将作为通向全民公共卫生系统的主要入口。基于对在这一方向上取得的持续进展的认可，本文探讨了巩固基础医疗保健提议面临的一些重要挑战的四个问题：（1）使用“基础医疗保健”一词，而非通常占主导地位的“初级卫生保健”概念；（2）政策措辞与实际实施之间的脱节或不匹配，强调需要对巴西国家基础医疗保健政策（PNAB）进行审查，该政策集中并规范了全国的规则和程序，却忽视了巴西的广袤地域、异质性以及广泛的地方差异；（3）基础医疗保健的孤立及其在卫生系统中的边缘地位，表明在医疗协调方面需要更复杂的安排，而不仅仅将其置于基础医疗保健的组织和责任之下；（4）缺乏为旨在转变该国现行医疗保健模式的项目做好准备并与之保持一致的卫生政策制定者、管理人员和专业人员。
