Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brasil.
Faculdade de Medicina, Universidade Federal de Pelotas, Pelotas, Brasil.
Cad Saude Publica. 2023 Sep 15;39(8):e00009123. doi: 10.1590/0102-311XPT009123. eCollection 2023.
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.
有效应对大流行需要初级卫生保健 (PHC) 和卫生监测之间的有效协调，确保关注急性和慢性需求，并与基本卫生单位 (UBS) 的社区层面保持联系。本研究旨在对比巴西在抗击 COVID-19 中 PHC 表现的两个极端标准，将它们与相应的城市特征和服务组织特点进行比较。基于对 UBS 进行的具有代表性的全国横断面调查结果，我们创建了一个综合指数来评估 PHC 对抗 COVID-19 的表现，称为 CPI，由卫生监测和社会支持（集体维度）以及 COVID-19 护理和护理连续性（个体维度）组成。在接受调查的 907 个 UBS 中，选择了 120 个，其中一半具有最高指数（完整标准），另一半则具有最低指数（限制标准）。具有完整标准的 UBS 所在的城市主要是农村，城市卫生发展指数 (MHDI) 较低，家庭健康战略 (FHS) 覆盖率较高，并且在集体维度上表现出色，而具有相同标准的城市 UBS 则具有较高的 MHDI、较低的 FHS 覆盖率，并且侧重于个体维度。在限制标准方面，我们强调社区卫生工作者在该地区的工作减少。在巴西东北部，具有完整标准的 UBS 占主导地位，而在东南部，具有限制标准的 UBS 占主导地位。该研究提出了一些问题，涉及在需要迅速应对卫生问题的情况下 PHC 在医疗保健网络中的作用和组织，并指出 FHS 计划在这种情况下具有更大的潜在能力。
