Jatobá Alessandro, Castro-Nunes Paula, de Carvalho Paulo Victor Rodrigues
Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil.
Front Public Health. 2025 Jun 11;13:1613822. doi: 10.3389/fpubh.2025.1613822. eCollection 2025.
This study investigates the volatility in the outcomes of Essential Public Health Functions (EPHFs) and elaborates on its potential impacts on the operation of Brazil's Unified Health System (SUS). The research addresses the need to understand how performance variability in EPHFs affects health system stability, particularly during external shocks such as the COVID-19 pandemic, and its potential effects on the system's resilience.
Using cross-sectional data (2000-2023) from the Department of Informatics of the SUS (DATASUS), the study analyzes key indicators linked to two EPHFs: (1) Surveillance, control, and risk management (infant mortality) and (2) Equitable access to comprehensive and quality services (cytopathological tests and mammography screenings). Volatility was defined as deviations from central trends exceeding one standard deviation relative to prior years. These metrics were assessed to evaluate health system performance and resilience.
Significant volatility was observed across indicators, particularly during the COVID-19 pandemic, which disrupted service levels and exposed systemic vulnerabilities. Infant mortality declined by 60% since 2000 but exhibited persistent fluctuations. Cytopathological tests and mammography screenings saw sharp declines during the pandemic, reflecting systemic challenges in sustaining equitable access to care.
The study proposes a conceptual framework to analyze EPHF performance through a resilience lens, emphasizing the need to manage variability for stable, high-quality service delivery in the SUS. Recommendations include strengthening health data systems, integrating contextual factors into resilience planning, and enhancing institutional capacity. This work advances efforts to operationalize resilience assessments in universal health systems, offering actionable insights for policymakers and practitioners.
本研究调查基本公共卫生职能（EPHFs）成果的波动性，并阐述其对巴西统一卫生系统（SUS）运作的潜在影响。该研究满足了理解EPHFs绩效变异性如何影响卫生系统稳定性的需求，特别是在诸如新冠疫情等外部冲击期间，以及其对系统恢复力的潜在影响。
利用SUS信息部（DATASUS）的横断面数据（2000 - 2023年），该研究分析了与两项EPHFs相关的关键指标：（1）监测、控制和风险管理（婴儿死亡率）以及（2）公平获得全面优质服务（细胞病理学检测和乳房X光筛查）。波动性被定义为相对于前几年超过一个标准差的偏离中心趋势的情况。对这些指标进行评估以评价卫生系统的绩效和恢复力。
各指标均观察到显著的波动性，尤其是在新冠疫情期间，这扰乱了服务水平并暴露了系统漏洞。自2000年以来婴儿死亡率下降了60%，但仍呈现持续波动。细胞病理学检测和乳房X光筛查在疫情期间急剧下降，反映出在维持公平获得医疗服务方面存在的系统性挑战。
该研究提出了一个概念框架，通过恢复力视角分析EPHF绩效，强调在SUS中为实现稳定、高质量服务提供而管理变异性的必要性。建议包括加强卫生数据系统、将背景因素纳入恢复力规划以及提高机构能力。这项工作推进了在全民卫生系统中开展恢复力评估的努力，为政策制定者和从业者提供了可操作的见解。
