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The community health agents (CHAs) comprised the workforce at the forefront of health systems in the fight against COVID-19. The study identified the structural conditions for organizing and characterizing the work of CHAs in three municipalities of northeastern Brazil during the pandemic period. A qualitative study of multiple cases was carried out. Twenty-eight subjects were interviewed, including community agents and municipal managers. Data production assessed the interviews with document analysis. The operational categories that emerged from the data analysis were: structural conditions and characteristics of the activities. The results of this study disclosed the scarcity of the structural conditions in the health units, which during the pandemic made improvised adaptations of the internal spaces. As for the work characteristics, actions permeated by bureaucratic aspects of an administrative nature were evidenced in the health units, resulting in the elimination of their binding function of territorial articulation and community mobilization. Thus, changes in their work can be seen as signs of the fragility of the health system and, especially, of primary health care. [ABSTRACT FROM AUTHOR]

The aim of this study was to analyze the organization and development of primary health care and surveillance, including normative frameworks and the implementation of local health actions. Qualitative descriptive multiple-case study involving three municipalities in the state of Bahia. We conducted 75 interviews and a document analysis. The results were categorized into the following two dimensions: approach to the organization of the pandemic response; and development of care and surveillance actions at local level. Municipality 1 was found to have a well-defined concept of the integration of health and surveillance with a view to organizing team work processes. However, the municipality did not strengthen the technical capacity of health districts to support surveillance actions. In M2 and M3, delays in defining PHC as the entry point for the health system and the prioritization of a central telemonitoring service run by the municipal health surveillance department compounded the fragmentation of actions and meant that PHC services played only a limited role in the pandemic response. Clear policy and technical guidelines and adequate structural conditions are vital to ensure the effective reorganization of work processes and foster the development of permanent arrangements that strengthen intersectoral collaboration. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate the quality of information on gestational syphilis (GS) and congenital syphilis (CS) on the Sistema de Informação de Agravos de Notificação (SINAN-Syphilis Brazil - Notifiable Diseases Information System) by compiling and validating completeness indicators between 2007 and 2018. METHODS: Overall, care, and socioeconomic completeness scores were compiled based on selected variables, by using ad hoc weights assigned by experts. The completeness scores were analysed, considering the region and area of residence, the pregnant woman's race/colour, and the year of case notification. Pearson's correlation coefficients were used to validate the scores obtained by the weighted average method, compared with the values obtained by principal component analysis (PCA). RESULTS: Most selected variables presented a good or excellent degree of completeness for GS and CS, except for clinical classification, pregnant woman's level of education, partner's treatment, and child's race/colour, which were classified as poor or very poor. The overall (89.93% versus 89.69%) and socioeconomic (88.71% versus 88.24%) completeness scores for GS and CS, respectively, were classified as regular, whereas the care score (GS-90.88%, and CS-90.72%) was good, despite improvements over time. Differences in the overall, care and socioeconomic completeness scores according to region, area of residence, and ethnic-racial groups were reported for syphilis notifications. The completeness scores estimated by the weighted average method and PCA showed a strong linear correlation (> 0.90). CONCLUSION: The completeness of GS and CS notifications has been improving in recent years, highlighting the variables that form the care score, compared with the socioeconomic scores, despite differences between regions, area of residence, and ethnic-racial groups. The weighted average was a viable methodological alternative easily operationalised to estimate data completeness scores, allowing routine monitoring of the completeness of gestational and congenital syphilis records. DESCRIPTORS: Health Information Systems. Syphilis, Congenital. Data Accuracy. [ABSTRACT FROM AUTHOR]

Objectives. We evaluated the effects of the Family Health Program (FHP), a strategy for reorganization of primary health care at a nationwide level in Brazil, on infant mortality at a municipality level. Methods. We collected data on FHP coverage and infant mortality rates for 771 of 5561 Brazilian municipalities from 1996 to 2004. We performed a multivariable regression analysis for panel data with a negative binomial response by using fixed-effects models that controlled for demographic, social, and economic variables. Results. We observed a statistically significant negative association between FHP coverage and infant mortality rate. After we controlled for potential confounders, the reduction in the infant mortality rate was 13.0%, 16.0%, and 22.0%, respectively for the 3 levels of FHP coverage. The effect of the FHP was greater in municipalities with a higher infant mortality rate and lower human development index at the beginning of the study period. Conclusions. The FHP had an important effect on reducing the infant mortality rate in Brazilian municipalities from 1996 to 2004. The FHP may also contribute toward reducing health inequalities. doi: 10.2105/AJPH.2007.127480)

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Abstract Background Vital information, despite of being an important public health instrument for planning and evaluation, in most of the developing countries have still low quality and coverage. Brazil has recently implemented the Family Health Program (PSF), one of the largest comprehensive primary health care programs in the world, which demonstrated effectiveness on the reduction of infant mortality. In the present study we evaluate the impact of the PSF on mortality rates related to the quality of vital information: the under-five mortality rate due to ill-defined causes and unattended death. Methods Data on mortality rates and PSF coverage was obtained for the total 5,507 Brazilian municipalities from 2000 to 2006. A multivariate regression analysis of panel data was carried out with a negative binomial response by using fixed effects models that control for relevant covariates. Results A statistically significant negative association was observed between PSF coverage levels, classified in none (0%, the reference category), low ( Conclusions The PSF, a primary health care program developed mostly in rural and deprived areas, had an important role on reducing the unattended deaths and improving the quality of vital information in Brazil.

This paper is part of the PLOS Universal Health Coverage Collection. This is the summary of the Brazil country case study. The full paper is available as Supporting Information file [...]

Primary Health Care (PHC) is an area of study that has improved remarkably in the last decades. In Brazil, this academic production is highly expressed in the field of Collective Health. This paper aims to analyze the PHC production published in the first 25 years of the "Journal Ciência & Saúde Coletiva" (C&SC). A narrative review was carried out, with analysis of the themes, methods, scale of analysis, partnerships, and authorship. A total of 295 papers were published, which corresponds to 5.9% of the total publications. A growing trend in papers addressing PHC was observed. The studies were mostly empirical (78.6%), with a qualitative approach (58.0%) and were predominantly local or municipal. Studies on health professionals were more frequent. The three prevailing themes were the health care model, PHC performance or effectiveness, and the work process. The profile found dialogues with the rich and diverse experience of Brazilian PHC. However, the incorporation of broader analyses is still challenging. The published papers highlighted the debates and contributed to the reflection and dissemination of the experience of Brazilian PHC, which was and is central to the construction of the Brazilian Health System. [ABSTRACT FROM AUTHOR]

Copyright of Brazilian Journal of Kineanthropometry & Human Performance is the property of Brazilian Journal of Kineanthropometry & Human Performance and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Ciência & Saúde Coletiva is the property of Associacao Brasileira de Pos-Graduacao em Saude Coletiva and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Brazilian Journal of Kineanthropometry & Human Performance is the property of Brazilian Journal of Kineanthropometry & Human Performance and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: A usual source of care (USC) has been conceptualized as having a health provider or place available for patients to consult when sick or in need of medical care. Having a USC is a means to achieve longitudinality of care with Primary Health Care (PHC) providers. Brazil has made enormous progress in PHC and thus provides an important opportunity to investigate USC in a middle-income country context. Methods: This study uses data from a nationally representative household survey, the 2013 National Health Survey ( = 62,986), to describe the prevalence of having a USC in Brazil and to investigate to what extent the Family n Health Strategy (FHS) has contributed to USC prevalence. Analyses include descriptive, bivariate and multivariable Poisson regression. Results: Show very high rates of people reporting any type of USC (74.4 %) and more than one third reporting PHC as their USC. Household enrolment in the FHS was positively associated with having any USC (PR:1.09; 95 % CI: 1.07-1.12) and a stronger association with having PHC as the regular source of care (PR:1.63;95 % CI:1.54-1.73). FHS enrolment was negatively associated with reporting emergency/urgent care facilities as one's USC (PR: 0.67; 95 % CI: 0.59-0.76). The association between the more consolidated FHS with having a USC was strongest in the poorest regions of the country (North, Northeast and Central-West). Having PHC as one's USC showed a positive dose- response relationship with the FHS in all regions, especially in the Central-West. Conclusions: Our results have important implications for the health care model in Brazil and in other countries, especially those seeking to base their national health systems more strongly on primary health care. The study suggests expanding primary health care can increase the establishment of a USC which can help assure better monitoring of chronic conditions and attention to patient needs. [ABSTRACT FROM AUTHOR]

Copyright of Cadernos de Saude Publica is the property of Escola Nacional de Saude Publica Sergio Arouca and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Social determinants can affect the transmission of leprosy and its progression to disease. Not much is known about the effectiveness of welfare and primary health care policies on the reduction of leprosy occurrence. The aim of this study is to evaluate the impact of the Brazilian cash transfer (Bolsa Família Program-BFP) and primary health care (Family Health Program-FHP) programs on new case detection rate of leprosy. Methodology/Principal Findings: We conducted the study with a mixed ecological design, a combination of an ecological multiple-group and time-trend design in the period 2004–2011 with the Brazilian municipalities as unit of analysis. The main independent variables were the BFP and FHP coverage at the municipal level and the outcome was new case detection rate of leprosy. Leprosy new cases, BFP and FHP coverage, population and other relevant socio-demographic covariates were obtained from national databases. We used fixed-effects negative binomial models for panel data adjusted for relevant socio-demographic covariates. A total of 1,358 municipalities were included in the analysis. In the studied period, while the municipal coverage of BFP and FHP increased, the new case detection rate of leprosy decreased. Leprosy new case detection rate was significantly reduced in municipalities with consolidated BFP coverage (Risk Ratio 0.79; 95% CI = 0.74–0.83) and significantly increased in municipalities with FHP coverage in the medium (72–95%) (Risk Ratio 1.05; 95% CI = 1.02–1.09) and higher coverage tertiles (>95%) (Risk Ratio 1.12; 95% CI = 1.08–1.17). Conclusions: At the same time the Family Health Program had been effective in increasing the new case detection rate of leprosy in Brazil, the Bolsa Família Program was associated with a reduction of the new case detection rate of leprosy that we propose reflects a reduction in leprosy incidence. Author Summary: Leprosy is considered a poverty related disease. Not much is known about the effectiveness of welfare and primary health care policies on reduction of leprosy occurrence. We conducted a study to evaluate the impact of the Brazilian conditional cash transfer (Bolsa Família Program) and the Primary Health Care (Family Health Program) on the new case detection rate of leprosy in the period 2004–2011 in the Brazilian municipalities. All variables were obtained from national databases and a total of 1,358 municipalities were included in the analysis. The new case detection rate of leprosy was significantly reduced in municipalities with intermediate, high, and consolidated BFP coverage. There was a significant increase in new case detection rate of leprosy as Family Health Program coverage increased. We interpret this to mean that at the same time the primary health care had been effective increasing the new case detection rate of leprosy in Brazil, there is an impact of conditional cash transfer in the reduction of the new case detection rate of leprosy due to reduction in leprosy incidence. We expect that these results contribute with arguments to the discussion on the relationship between distributive social policies and health conditions of the population in developing countries worldwide. [ABSTRACT FROM AUTHOR]

Copyright of Brazilian Journal of Mother & Child Health (BJMCH) / Revista Brasileira de Saude Materno Infantil (RBSMI) is the property of Instituto de Medicina Integral and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Vital information, despite of being an important public health instrument for planning and evaluation, in most of the developing countries have still low quality and coverage. Brazil has recently implemented the Family Health Program (PSF), one of the largest comprehensive primary health care programs in the world, which demonstrated effectiveness on the reduction of infant mortality. In the present study we evaluate the impact of the PSF on mortality rates related to the quality of vital information: the under-five mortality rate due to ill-defined causes and unattended death.Methods: Data on mortality rates and PSF coverage was obtained for the total 5,507 Brazilian municipalities from 2000 to 2006. A multivariate regression analysis of panel data was carried out with a negative binomial response by using fixed effects models that control for relevant covariates.Results: A statistically significant negative association was observed between PSF coverage levels, classified in none (0%, the reference category), low (<30.0%), intermediate (>or= 30.0% and <70.0%) and high (>or= 70.0%), and all analysed mortalities rates, with a reduction of 17% (Rate Ratio [RR]: 0.83; 95% confidence interval [CI]: 0.79 - 0.88), 35% (RR: 0.65; 95% CI: 0.61-0.68) and 50% (RR: 0.50; 95% CI: 0.47-0.53) on under-five mortality due to ill-defined causes, respectively. In the mortality rate for unattended death the reduction was even greater, reaching 60% (RR: 0.40; 95% CI: 0.37-0.44) in the municipalities with the highest PSF coverage. The PSF effect on unattended deaths was slightly stronger in municipalities with a higher human development index.Conclusions: The PSF, a primary health care program developed mostly in rural and deprived areas, had an important role on reducing the unattended deaths and improving the quality of vital information in Brazil. [ABSTRACT FROM AUTHOR]

In 1994 Brazil launched what has since become the world's largest community-based primary health care program. Under the Family Health Program, teams consisting of at least one physician, one nurse, a medical assistant, and four to six trained community health agents deliver most of their services at community-based clinics. They also make regular home visits and conduct neighborhood health promotion activities. This study finds that during 1999-2007, hospitalizations in Brazil for ambulatory care-sensitive chronic diseases, including cardiovascular disease, stroke, and asthma, fell at a rate that was statistically significant and almost twice the rate of decline in hospitalizations for all other causes. In municipalities with high Family Health Program enrollment, chronic disease hospitalization rates were 13 percent lower than in municipalities with low enrollment, when other factors were held constant. These results suggest that the Family Health Program has improved health system performance in Brazil by reducing the number of potentially avoidable hospitalizations. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the quality of information on gestational syphilis (GS) and congenital syphilis (CS) on the Sistema de Informação de Agravos de Notificação (SINAN-Syphilis Brazil - Notifiable Diseases Information System) by compiling and validating completeness indicators between 2007 and 2018., Methods: Overall, care, and socioeconomic completeness scores were compiled based on selected variables, by using ad hoc weights assigned by experts. The completeness scores were analysed, considering the region and area of residence, the pregnant woman's race/colour, and the year of case notification. Pearson's correlation coefficients were used to validate the scores obtained by the weighted average method, compared with the values obtained by principal component analysis (PCA)., Results: Most selected variables presented a good or excellent degree of completeness for GS and CS, except for clinical classification, pregnant woman's level of education, partner's treatment, and child's race/colour, which were classified as poor or very poor. The overall (89.93% versus 89.69%) and socioeconomic (88.71% versus 88.24%) completeness scores for GS and CS, respectively, were classified as regular, whereas the care score (GS-90.88%, and CS-90.72%) was good, despite improvements over time. Differences in the overall, care and socioeconomic completeness scores according to region, area of residence, and ethnic-racial groups were reported for syphilis notifications. The completeness scores estimated by the weighted average method and PCA showed a strong linear correlation (> 0.90)., Conclusion: The completeness of GS and CS notifications has been improving in recent years, highlighting the variables that form the care score, compared with the socioeconomic scores, despite differences between regions, area of residence, and ethnic-racial groups. The weighted average was a viable methodological alternative easily operationalised to estimate data completeness scores, allowing routine monitoring of the completeness of gestational and congenital syphilis records.

The community health agents (CHAs) comprised the workforce at the forefront of health systems in the fight against COVID-19. The study identified the structural conditions for organizing and characterizing the work of CHAs in three municipalities of northeastern Brazil during the pandemic period. A qualitative study of multiple cases was carried out. Twenty-eight subjects were interviewed, including community agents and municipal managers. Data production assessed the interviews with document analysis. The operational categories that emerged from the data analysis were: structural conditions and characteristics of the activities. The results of this study disclosed the scarcity of the structural conditions in the health units, which during the pandemic made improvised adaptations of the internal spaces. As for the work characteristics, actions permeated by bureaucratic aspects of an administrative nature were evidenced in the health units, resulting in the elimination of their binding function of territorial articulation and community mobilization. Thus, changes in their work can be seen as signs of the fragility of the health system and, especially, of primary health care.

The aim of this study was to analyze the organization and development of primary health care and surveillance, including normative frameworks and the implementation of local health actions. Qualitative descriptive multiple-case study involving three municipalities in the state of Bahia. We conducted 75 interviews and a document analysis. The results were categorized into the following two dimensions: approach to the organization of the pandemic response; and development of care and surveillance actions at local level. Municipality 1 was found to have a well-defined concept of the integration of health and surveillance with a view to organizing team work processes. However, the municipality did not strengthen the technical capacity of health districts to support surveillance actions. In M2 and M3, delays in defining PHC as the entry point for the health system and the prioritization of a central telemonitoring service run by the municipal health surveillance department compounded the fragmentation of actions and meant that PHC services played only a limited role in the pandemic response. Clear policy and technical guidelines and adequate structural conditions are vital to ensure the effective reorganization of work processes and foster the development of permanent arrangements that strengthen intersectoral collaboration.

This paper describes the structure and results of Primary Health Care (PHC) in Brazil between 2008 and 2019. The medians of the following variables were calculated: PHC spending per inhabitant covered, PHC coverage, and rates of mortality and hospitalizations due to primary care sensitive conditions (PCSC), in 5,565 Brazilian municipalities stratified according to population size and quintile of the Brazilian Deprivation Index (IBP), and the median trend in the period was analyzed. There was a 12% increase in median PHC spending. PHC coverage expanded, with 3,168 municipalities presenting 100% coverage in 2019, compared to 2,632 in 2008. The median rates of PCSC mortality and hospitalizations increased 0.2% and decreased 44.9%, respectively. PHC spending was lower in municipalities with greater socioeconomic deprivation. The bigger the population and the better the socioeconomic conditions were in the municipalities, the lower the PHC coverage. The greater the socioeconomic deprivation was in the municipalities, the higher the median PCSC mortality rates. This study showed that the evolution of PHC was heterogeneous and is associated both with the population size and with the socioeconomic conditions of the municipalities.

Objective: To describe the completeness and characteristics of reported gestational syphilis and congenital syphilis cases in the state of Bahia, Brazil, between 2007 and 2017., Methods: This was an ecological study using data retrieved from the Notifiable Health Conditions Information System (SINAN). Incidence rates at the macro-regional and state levels and percentage completeness were calculated., Results: 15,050 gestational syphilis cases and 7,812 congenital syphilis cases were identified. The incidence rate varied from 1.3 to 15.1 cases in pregnant women/1,000 live births and from 0.5 to 6.7 cases in infants under 1 year old/1,000 live births. Completeness of 'clinical classification' of gestational syphilis varied from 58.2% to 67.2% in the periods studied., Conclusion: The study showed an increase in incidence rates, flaws in report form completion and the need to implement routine information quality evaluation.

Primary Health Care (PHC) is an area of study that has improved remarkably in the last decades. In Brazil, this academic production is highly expressed in the field of Collective Health. This paper aims to analyze the PHC production published in the first 25 years of the "Journal Ciência & Saúde Coletiva" (C&SC). A narrative review was carried out, with analysis of the themes, methods, scale of analysis, partnerships, and authorship. A total of 295 papers were published, which corresponds to 5.9% of the total publications. A growing trend in papers addressing PHC was observed. The studies were mostly empirical (78.6%), with a qualitative approach (58.0%) and were predominantly local or municipal. Studies on health professionals were more frequent. The three prevailing themes were the health care model, PHC performance or effectiveness, and the work process. The profile found dialogues with the rich and diverse experience of Brazilian PHC. However, the incorporation of broader analyses is still challenging. The published papers highlighted the debates and contributed to the reflection and dissemination of the experience of Brazilian PHC, which was and is central to the construction of the Brazilian Health System.

Objective: To evaluate the effect of the Family Health Strategy on infant mortality surveillance., Methods: An ecologic study was performed with a multiple group design, and the unit of analysis was municipalities in Bahia state (Northeastern Brazil) in 2008. The 3,947 deaths analyzed were obtained from the Mortality Information System, and the minimum acceptable level for death investigation was 25%. Logistic regression models were used for bivariate and multivariate analysis and adjusted for sociodemographic and service organization variables., Results: In 48.9% of the municipalities at least one infant death was investigated, and 35.5% of municipalities achieved the minimum target for investigation. In the bivariate model, the investigation of at least one infant death was statistically associated with more populous municipalities, higher Human Development Indices, existence of Investigation Committee and obstetric beds in the municipality; there were no associations with Family Health Strategy coverage and existence of a designated person in the municipality. In multivariate models, the investigation of at least one infant death was statistically associated with population size (OR = 4.02) and presence of obstetric beds (OR = 2.68). Achieving the minimum target was associated only with the existence of obstetric beds in the municipality (OR = 1.76)., Conclusions: The investigation rate for deaths of children less than one year of age was less than the level agreed upon in Bahia in 2008. There was no association between coverage of the Family Health Strategy and death investigations, which suggests that Infant Mortality Surveillance is at an incipient stage, especially in regards to decentralization to local primary care teams.

Objective: To evaluate the effects of the Family Health Program (FHP), a strategy for reorganization of primary health care in Brazil, on mortality of children younger than 5 years, particularly from diarrheal diseases and lower respiratory tract infections., Methods: Mortality rates and the extent of FHP coverage from 2000 to 2005 was evaluated from the 2601 (of 5507) Brazilian municipalities with an adequate quality of vital information. A multivariable regression analysis for panel data was conducted by using a negative binomial model with fixed effects, adjusted for relevant demographic and socioeconomic covariates., Results: A statistically significant negative association was observed between FHP coverage levels, classified as none (the reference category), low (<30%), intermediate (>or=30% and <70%), or high (>or=70%), and all analyzed mortality rates, with a reduction of 4% (95% confidence interval [CI]: 2%-6%), 9% (95% CI: 7%-12%), and 13% (95% CI: 10%-15%), respectively, on mortality rates or children younger than 5. The greatest effect was on postneonatal mortality. Reductions of 31% (95% CI: 20%-40%) and 19% (95% CI: 8%-28%) in mortality rates from diarrheal diseases and lower respiratory infections, respectively, were found in the group of municipalities with the highest FHP coverage., Conclusions: The FHP, one of the largest comprehensive primary health care programs in the world, was effective in reducing overall mortality of children younger than 5, and particularly deaths related to diarrheal diseases and lower respiratory tract infections.