Author / Partners:
PAHO/WHO and the ABRASCO Primary Care Network
Systematization and analysis of PMM studies and research
PPM scientific production
Bibliometric analysis; a systematic review study; content and relevance analysis.
Results / Conclusions:
The studies were predominantly on the supply of emergency care; most of them dealt with the quality and quantity of its coverage. Thirty-four opinion articles were published by public universities and the main authors were located in the Southeast region; 62% of the authors submitted arguments in favor of PMM and 35% of the articles were unfavorable; most of the 47 scientific articles analyzed were published in 2016, and the greater part were on Science and Collective Health, most of them in the Southeast region. Twenty-two articles were deemed of high and medium relevance. In 32 articles it was possible to identify the effects of PMM in the various areas, 29 of them were positive and 3 equally negative and positive. The supply and distribution of professionals was the most discussed issue and revealed an increase in the doctor-inhabitant ratio in previously unattended areas, a reduction in the number of municipalities with a scarcity of doctors, and a reduction in the lack of doctors in the Northern and Northeast regions. The analysis of the implementation showed a resistance by the institutions that represent the medical category and medical courses, Municipal Health Department Councils (COSEMS) support in the interrelation with municipalities, partisan political interests and conflicting ideologies, little support from the State Health Secretariat, a partial compliance with the municipal matching funds and vertical nature of the relationship Ministry of Health, states and municipalities; as well as Primary Health Care (PHC) structural and health care network problems that affected the actions of the teams with PMM professionals. The Program contributes to the structuring of PHC in smaller municipalities. Health care was made available to vulnerable populations by guaranteeing access; there was more population demand for health services, easier schedules for doctor appointments and more house calls; PMM effectiveness resulting in increased rates after the implementation of the Program in the Family Health Strategy (ESF), more PHC doctors, an increase in the assistance with medication expenses, the population’s participation in basic care services, an expansion of the basic care services and health care units, an increase in residential availability in NFC, and a reduction in hospitalizations due to PHC-sensitive issues; user satisfaction.
Recommendations / Lessons Learned:
Critical issues were revealed, such as the assignment of doctors to existing Federal Health teams, suggesting a complementary and substitution effect; additionally, the municipalities suffered from a continuous uncertain federal supply resulting from their dependency; there were persisting issues with an unequal distribution in the Northern and Northeastern regions and in smaller municipalities, as well as a low participation by the Basic Health Units under the previous infrastructure. There were some distortions regarding the municipalities involved and adhering municipalities and that did not comply with the criteria. The training of professionals and their performance in the Primary Health Care is a dimension that has not been a subject of much study. Preliminary results show that there is a trend toward the privatization of medical graduates along with a greater number of vacancies for graduates, as well as an increment in medical graduate residence programs away from the cities where they graduate.