Changes in the primary care policy and the (un)sustainability of the Family Health Strategy

ABSTRACT Primary Health Care is a strategic level of care for forming a sustainable health system that responds to diverse needs. This article analyzed federal regulation and its implications for establishing primary care teams in Brazil. Exploratory mixed methods research involves analyzing 25 federal ordinances and secondary data of national scope referring to the teams approved in the National Register of Health Establishments from 2017 to 2021. The results indicate changes in the direction of the policy regarding the configuration, funding, and accreditation of teams. There was an expansion of primary care teams, a reduction in community health agents, and a weakening of the Family Health Support Center. The results suggest that the incentives for other team arrangements, the flexibility of the coverage of the community agent, and the multidisciplinary action compromise the sustainability of the Family Health model in the Unified Health System.

摘要：初级卫生保健（Primary Health Care）是构建可响应多元健康需求的可持续卫生系统的战略性照护层级。本文针对巴西基层医疗团队组建相关的联邦法规及其政策影响展开分析。本研究采用探索性混合研究方法，对2017至2021年间国家卫生机构注册簿（National Register of Health Establishments）中获批的基层医疗团队相关的25项联邦法令，以及国家级二手数据进行分析。研究结果显示，巴西在基层医疗团队的架构、经费支持与资质认定方面的政策导向发生了转变：基层医疗团队规模有所扩张，但社区卫生专员人数减少，家庭健康支持中心（Family Health Support Center）的职能也有所弱化。研究结果表明，针对其他团队组建模式的激励政策、社区卫生专员服务覆盖范围的灵活性调整，以及多学科协作模式，均对统一卫生系统（Unified Health System）下家庭健康模式的可持续性造成了负面影响。