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Primary Health Care (PHC) intends to rearrange services to make it more effective. Nevertheless, effectiveness in PHC is quite a challenge. This study reviews several articles regarding the effectiveness improvements in PHC between 2010 and 2020. Ninety out of 8,369 articles found in PubMed and the Virtual Health Library databases search were selected for thematic analysis using the Atlas.ti® 9.0 software. There were four categories identified: strategies for monitoring and evaluating health services, organizational arrangements, models and technologies applied to PHC. Studies concerning the sensitive conditions indicators were predominant. Institutional assessment programs, PHC as a structuring policy, appropriate workforce, measures to increase access and digital technologies showed positive effects. However, payment for performance is still controversial. The expressive number of Brazilian publications reveals the broad diffusion of PHC in the country and the concern on its performance. These findings reassure well-known aspects, but it also points to the need for a logical model to better define what is intended as effectiveness within primary health care as well as clarify the polysemy that surrounds the concept. We also suggest substituting the term "resolvability", commonly used in Brazil, for "effectiveness".

This study compares the challenges for work in emergency services of publicuniversity hospitals in Algeria, Brazil and France. The description and analysis are organized in three topics: context and trajectory of the health systems; hospitals and emergency services; and the challenges that are faced. The research carried out interviews, surveys, observation and "groupes de rencontre du travail" / GRT. The data analysis was done using participatory appraisal techniques associated to triangulation of sources and data. The main challenges found were: workforce deficit; lack of hospitals beds in inpatient units; deficit of infrastructure and materials; excess of "chronophagic activities"; generational transition; and violence by patients and families.Despite their particularities, the countries coincide regarding the challenges. Measures to rationalize and restrain spending have a greater impact on Algeria and Brazil due to the low level of public funding, but they also occur in France. The hospital management cannot be dissociated from healthcare system planningconsidering the increasing pressures of the demographic and epidemiological transition. In medium term, measures that may mitigate "chronophagic activities", materials deficit and the violence should be considered to improve work in emergencies.

Comparison can be an important resource for identifying trends or interventions that improve the quality of health services. Although Portugal and Spain have accumulated important knowledge in primary health care-PHC driven national systems, the Ibero-American countries have not been object of comparative studies. This paper presents an assessment using an analytical dashboard created by the Ibero-American Observatory on Policies and Health Systems. It discusses aspects that have stood out in monitoring the service systems of Argentina, Brazil, Colombia, Spain, Paraguay, Peru, and Portugal throughout the 21st century's first decade. Forty-five indicators and time series showing the highest completeness degree divided into social determinants, conditions and performance were analyzed. Three trends are common to almost all countries: overweight increase, negative trade balance for pharmaceutical products, and an increase in health system expenditure. This convergence trend reveals the need for changes in the way of regulating, organizing and delivering health services with public policies and practices that guarantee comprehensive care, including health promotion actions enabling systems sustainability.

This paper describes and analyzes the legal and normative framework guiding the use of mobile units in Portugal, United States and Brazil, which seek to improve access and continuity of care for people in homelessness. We used a comparative analysis through literature and documentary review relating three categories: context (demographic, socio-economic and epidemiological), services system (access, coverage, organization, management and financing) and, specifically, mobile units (design, care and financing model). The analysis was based on the theory of convergence/divergence between health systems from the perspective of equity in health. Improving access, addressing psychoactive substances abuse, outreach and multidisciplinary work proved to be common to all three countries, with the potential to reduce inequities. Relationships with primary healthcare, use of vehicles and the type of financing are considered differently in the three countries, influencing the greater or lesser extent of equity in the analyzed proposals.

This article describes the contributions of Chilean physician San Martín Ferrari (1915-200), arguing that they constitute important cornerstones in collective health in Brazil, Latin America, and the Iberian Peninsula. His work is reviewed, establishing a dialog with the current theoretical research in this field and the context of contemporary health systems. Two main aspects are emphasized: the innovation of San Martín in insisting on the importance of analyses that incorporate the relationship between environment and health; and his role in the creation of the Chilean and the Spanish National Health Services. Although they arose in distinct moments and had different trajectories, these systems constitute examples for the creation of universal public health systems, such as the Brazilian health reform and the ongoing challenge to improve the Unified Health System. The analysis of his work and biography contribute elements for the comparative study of these reforms, as well as an eco-systemic approach to health.

The paper discusses the issue of waiting times based on a study of Spain's National Health System (Sistema Nacional de Salud, SNS), focusing on the national context, management issues and local practices. Observation visits and interviews with health personnel and managers conducted in the metropolitan areas of the Autonomous Communities of Madrid, Andalusia, Catalonia and Basque Country were complemented by secondary data and a review of the literature. There is unanimity as to the positive results of the SNS, but cutting waiting times seems to be one key aspect requiring improvement. Two directions were identified for complementary measures: guaranteed maximum waiting times in the macro-social sphere associated with local measures to increase service integration and primary care resolution rates. The peculiarities of the Spanish decentralisation process and the existence of economic, political and health profession corporate interests were mentioned as factors hampering waiting list regulation, transparency and management. A comprehensive approach to this issue shows the need to shift discussion from waiting list monitoring and/or expanded supply to guaranteed timely access. That is the quality differential that primary care-oriented systems must bring to public health systems.

This study analyzes the health-disease-care experience reported by users of the Brazilian supplementary system in cardiovascular, oncological, mental health and obstetric care in Florianópolis, capital of the state of Santa Catarina. It discusses the selection of indicators in these areas such as myocardial infarction, breast cancer, alcoholism and childbirth besides exploring socio-anthropological contributions to the management field. The results show a search for solutions in three interconnected sub-sectors of the system - the professional sector, the popular sector and the folk sector, the two latter being of greatest importance in mental and oncological care. Combined use of public and private services appears in cardiovascular and oncological field. Seeking to overcome the gaps with respect to access and integrality by using their own choices with respect to accessibility and comprehensiveness of care by using paths or strategies the users establish a variety of arrangements in their everyday life. The socio-anthropological approach is therefore useful for deepening the understanding of the meaning of public and private in health systems as well as of the care models undertaken by the patients.

This paper focuses on the experience with Primary Health Care as a strategy for reorganizing the health care model, based on reforms in this direction and their implementation in the Brazilian case. The article identifies a shift in the discourse concerning health sector reforms, with a return to emphasis on primary care and integration of services. The Brazilian context demands reflection on the possibilities for synergy between this strategy and other social policies and the factors needed to ensure adequate performance. Evaluation research has suggested that primary care activities are slightly superior as compared to traditional health care units, despite persistent difficulties in access, physical infrastructure, team formation, management, and organization of the network. These difficulties correlate with a low level of public financing, persistent segmentation of the system, and weak integration of primary care services with other levels of care. From the technical perspective, a reasonable target is to guarantee the strategy's continuity with the necessary adjustments, conditioned by the dynamics of the health care technical models involved in the dispute.

As a policy guideline, ideal, or objective, comprehensiveness is a relevant attribute in the evaluation of quality of care and health systems. The article discusses the meaning of the concept of comprehensiveness in practice in some health services and systems, analyzing various methodologies to implement the concept. In Brazil, what prevails is an expanded perception emphasizing the complete, continuous, and coordinated nature of health care and management. The article highlights the importance of combining the evaluation of comprehensiveness with measures of access, suggesting the selection of indicators pertaining to agreements on goals for local health systems and their monitoring. This initiative could enhance the validity of existing evaluation instruments, from a communications perspective.

This article describes and evaluates the Jury Trial technique, an innovative educational instrument used in a pilot workshop on Social Control and Gender by health council members in Greater Metropolitan Florian polis, Santa Catarina, Brazil. The reliability and validity were studied based on the participants' opinions, complemented by qualitative observation of the work. There was consensus in acceptance of the technique based on "acquisition of knowledge" and the fact that it was participatory, democratic, and dynamic. The positive evaluation agrees with a previous study that interviewed municipal health secretaries, with a smaller preference of formal cognitive activities that were also part of the workshop. The article concludes by emphasizing the importance of this innovative technique in training programs, since it is accepted by different target publics, allows for designing the program contents, and is useful in relation to new and controversial issues since it favors practical and reflexive experiences.

This article discusses the evaluation of primary health care policies based on a case study of the Family Health Program in Florianópolis, Santa Catarina, Brazil. The results are presented in two stages. First, the Program is placed in the context of the Municipality's policies, identifying perceptions of the Program at the administrative level. Second, the author studied the Program's practices based on a sample of five family health care teams using an evaluative framework including variables on accessibility and comprehensiveness. The Program began relatively late in the State capital, but developed a unique model. There is a greater supply of services available to the population not covered by private health plans, although there is a major diversity of practices. The degree of implementation is moderately adequate: the care provided is more comprehensive, but there are problems with access (in the ratio between staff and number of families covered). It is suggested that such proposals for reorienting health care models tend towards rationalization, political legitimization, or democratization of services. The accessibility policy can set the predominant direction.

This paper analyzes recent changes in the Canadian health system through a case study of Quebec. As the last Province to adopt federal principles of universal coverage, comprehensiveness, and public management, its reform, conducted in 1971, met these objectives by means of key innovations. In the 1980s and early 90s, a process of health services evaluation in this Province and in Canada as a whole launched a period of extensive changes. The relevant measures are described herein: decentralization and regional management, "clinical shift", selective reduction in the supply of services, and new mechanisms for resource allocation and social control. There is a tendency towards an environment of public competition, but the approach that was adopted for regulation does not correspond to the main models from central countries. Within a scenario of budget constraints, technocratically-defined measures allowed for the settlement of benefits, preserving the system's main guidelines. This evidence is one of the main contributions of comparative analysis to health system reform in peripheral countries. The study identifies the relationships between these measures and a worldwide trend towards cost control and macroeconomic adjustment policies, discussing the relevant implications for health services.

This paper presents different models that describe health determinants, services, and systems. It highlights the important model developed by Contandriopoulos, proposing a separation between the health status and health care circuits. The article is intended as a contribution to the field of comparative analysis with a new theoretical, methodological, and evaluative approach. Problems were identified in the development of a new model. Decentralization and access are introduced as categories, suggesting that they may take part in such new model.

This study describes the 'Law Court' technique as applied to City Health Departments in the State of Santa Catarina, in dealing with the issue of obligations on the part of public officials. The project was the first part of a training course for public administrators held in 1997. The article presents the technique's components and results. Some 98% of the 156 participants had a positive opinion of the training course, considering it dynamic/participatory (31%), educational/stimulating reflection (27%), and realistic (24%). The technique fostered the discussion of the main subjects pertaining to the country's Unified Health System (SUS). Although all five juries acquitted the defendants, the issue of ethics was reported by 58% of the participants as the main prerequisite for a public administrator.

This article discusses about a recent procedure in health care studies, the comparison as a methodology of analysis. The different analytical currents refer to a particular method of understanding health-disease process. They are: functionalism, the historical-materialism and the new currents. Their phylosophical and sociological basis, concepts, analysis instruments and purposes are showed here by a review of the principal works from representative authors as Navarro, Terris, Roemer, Fry, Illich, Capra and others. The paper suggests that comparative analysis can take two directions: the first is a operational approach for analysing the concrete situations of health's service organization, the second, a more conceptual one, aimed at identifying critical questions and international tendencies in health's systems. The recent discussion search for the overcoming of these dichotomies toward the progress of the production of knowledge and its effects in health's services organization.