Massuda Adriano, Fernandez Michelle, Paschoalotto Marco Antonio Catussi, Kemper Elisandréa Sguario
Fundação Getulio Vargas, Brazil.
Political Science Institute, University of Brasília, Brazil.
Health Policy Open. 2025 Aug 22;9:100147. doi: 10.1016/j.hpopen.2025.100147. eCollection 2025 Nov.
This study examines the policy investments in Primary Health Care (PHC) within the health systems of Brazil, Chile, and Colombia, highlighting their contributions toward achieving Universal Health Coverage (UHC). Employing a qualitative methodology, the research includes an institutional historical review and interviews with key stakeholders to analyze the development of PHC financing policies and practices in these countries. Brazil, with its Unified Health System (SUS), demonstrates federal leadership through initiatives like Requalifica UBS and the new PAC, albeit facing challenges in regional equity and monitoring. Chile emphasizes central governance but struggles with municipal funding capacity and infrastructure renewal. Colombia lacks targeted PHC investment policies but shows promise through emerging frameworks such as the Planes Maestros. The findings underline the critical role of integrated governance, sustainable funding, and advanced technological investment in strengthening PHC systems. Recommendations include enhancing territorial diagnostics, fostering public-private partnerships, and aligning investments with demographic and regional needs. Therefore, this research contributes to understanding PHC financing structures, offering actionable insights for improving equity and access. Limitations include the study's focus on three countries and qualitative scope, suggesting future research should adopt broader comparative frameworks and mixed methodologies to evaluate the long-term impacts of PHC investments globally.
本研究考察了巴西、智利和哥伦比亚卫生系统对初级卫生保健(PHC)的政策投入,强调了它们对实现全民健康覆盖(UHC)的贡献。该研究采用定性研究方法,包括机构历史回顾以及与关键利益相关者的访谈,以分析这些国家初级卫生保健融资政策及实践的发展情况。巴西的统一卫生系统(SUS)通过“重新调整基本卫生单位(Requalifica UBS)”和新的“加速增长计划(PAC)”等举措展现出联邦层面的领导力,不过在区域公平性和监测方面面临挑战。智利强调中央治理,但在市政资金能力和基础设施更新方面存在困难。哥伦比亚缺乏针对性的初级卫生保健投资政策,但通过诸如“总体规划(Planes Maestros)”等新兴框架展现出潜力。研究结果强调了综合治理、可持续资金投入和先进技术投资在加强初级卫生保健系统方面的关键作用。建议包括加强区域诊断、促进公私伙伴关系以及使投资与人口和区域需求相匹配。因此,本研究有助于理解初级卫生保健融资结构,为改善公平性和可及性提供了可操作的见解。局限性包括该研究仅聚焦于三个国家且研究范围为定性研究,这表明未来研究应采用更广泛的比较框架和混合研究方法,以评估全球初级卫生保健投资的长期影响。