Brazils family health strategy: factors associated with programme uptake and coverage expansion over 15 years (1998-2012)
Autor(a) principal: | |
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Data de Publicação: | 2018 |
Outros Autores: | , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UFMG |
Texto Completo: | http://hdl.handle.net/1843/55290 |
Resumo: | Universal Health Coverage (UHC) is one of the United Nations Sustainable Development Goals (SDGs). Achieving UHC will require strong health systems to promote and deliver equitable and integrated healthcare services through primary healthcare (PHC). In Brazil, the Family Health Strategy (FHS) delivers PHC through the public health system. Created in 1994, the FHS covered almost 123 million individuals (63% of the Brazilian population) by 2015. The FHS has been associated with many health mprovements, but gaps in coverage still remain. This article examines factors associated with the implementation and expansion of the FHS across 5419 Brazilian municipalities from 1998 to 2012. The proportion of the municipal population covered by the FHS over time was assessed using a longitudinal multilevel model for change that accounted for variables covering eight domains: economic development, healthcare supply, healthcare needs/access, availability of other sources of healthcare, political context, geographical isolation, regional characteristics and population size. Data were obtained from multiple publicly available sources. During the 15-year study period, national coverage of the FHS increased from 4.4% to 54%, with 58% of the municipalities having population coverage of 95% or more, and municipalities that had not adopted the programme decreased from 86.4% to 4.9%. The increase in FHS uptake and coverage was not homogenous across municipalities, and was positively associated with small population size, low population density, low coverage of private health insurance, low level of economic development, alignment of the political party of the Mayor and the state Governor, and availability of healthcare supply. Efforts to expand the FHS coverage will need to focus on increasing the availability of health personnel, devising financial incentives for municipalities to uptake/expand the FHS and devising new policies that encompass both private and public sectors. |
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2023-06-23T20:16:17Z2023-06-23T20:16:17Z201833336838010.1093/heapol/czx1891460-2237http://hdl.handle.net/1843/55290Universal Health Coverage (UHC) is one of the United Nations Sustainable Development Goals (SDGs). Achieving UHC will require strong health systems to promote and deliver equitable and integrated healthcare services through primary healthcare (PHC). In Brazil, the Family Health Strategy (FHS) delivers PHC through the public health system. Created in 1994, the FHS covered almost 123 million individuals (63% of the Brazilian population) by 2015. The FHS has been associated with many health mprovements, but gaps in coverage still remain. This article examines factors associated with the implementation and expansion of the FHS across 5419 Brazilian municipalities from 1998 to 2012. The proportion of the municipal population covered by the FHS over time was assessed using a longitudinal multilevel model for change that accounted for variables covering eight domains: economic development, healthcare supply, healthcare needs/access, availability of other sources of healthcare, political context, geographical isolation, regional characteristics and population size. Data were obtained from multiple publicly available sources. During the 15-year study period, national coverage of the FHS increased from 4.4% to 54%, with 58% of the municipalities having population coverage of 95% or more, and municipalities that had not adopted the programme decreased from 86.4% to 4.9%. The increase in FHS uptake and coverage was not homogenous across municipalities, and was positively associated with small population size, low population density, low coverage of private health insurance, low level of economic development, alignment of the political party of the Mayor and the state Governor, and availability of healthcare supply. Efforts to expand the FHS coverage will need to focus on increasing the availability of health personnel, devising financial incentives for municipalities to uptake/expand the FHS and devising new policies that encompass both private and public sectors.A Cobertura Universal de Saúde (CUS) é um dos Objetivos de Desenvolvimento Sustentável (ODS) das Nações Unidas. Alcançar a cobertura universal de saúde exigirá sistemas de saúde fortes para promover e fornecer serviços de saúde equitativos e integrados por meio da atenção primária à saúde (APS). No Brasil, a Estratégia Saúde da Família (ESF) oferece APS por meio do sistema público de saúde. Criada em 1994, a ESF cobria quase 123 milhões de indivíduos (63% da população brasileira) até 2015. A ESF tem sido associada a muitas melhorias na saúde, mas ainda existem lacunas na cobertura. Este artigo examina os fatores associados à implementação e expansão da ESF em 5.419 municípios brasileiros de 1998 a 2012. A proporção da população municipal coberta pela ESF ao longo do tempo foi avaliada por meio de um modelo multinível longitudinal para mudança que contabilizou variáveis que abrangem oito domínios : desenvolvimento económico, oferta de cuidados de saúde, necessidades/acesso aos cuidados de saúde, disponibilidade de outras fontes de cuidados de saúde, contexto político, isolamento geográfico, características regionais e tamanho da população. Os dados foram obtidos de várias fontes disponíveis publicamente. Nos 15 anos de estudo, a cobertura nacional da ESF aumentou de 4,4% para 54%, com 58% dos municípios com cobertura populacional de 95% ou mais, e os municípios que não adotaram o programa caíram de 86,4% para 4,9 %. O aumento da captação e cobertura da ESF não foi homogêneo entre os municípios e foi positivamente associado a pequeno tamanho populacional, baixa densidade populacional, baixa cobertura de plano de saúde privado, baixo nível de desenvolvimento econômico, alinhamento do partido político do prefeito e do governador do estado e disponibilidade de oferta de saúde . Os esforços para expandir a cobertura da ESF precisarão se concentrar no aumento da disponibilidade de pessoal de saúde, criando incentivos financeiros para os municípios adotarem/expandir a ESF e formulando novas políticas que englobem os setores público e privadoengUniversidade Federal de Minas GeraisUFMGBrasilFCE - DEPARTAMENTO DE CIÊNCIAS ECONÔMICASHealth Policy and PlanningCobertura universal de saúdeDesenvolvimento sustentávelAtenção primária à saúdeSaúde da famíliaPrimary healthcareUniversal health coverageFamily health strategyBrazilBrazils family health strategy: factors associated with programme uptake and coverage expansion over 15 years (1998-2012)Estratégia saúde da família no Brasil: fatores associados à adesão ao programa e expansão da cobertura ao longo de 15 anos (1998-2012)info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articlehttps://academic.oup.com/heapol/article/33/3/368/4810391Monica Viegas AndradeAugusto Quaresma CoelhoMauro Xavier NetoLucas Resende de CarvalhoRifat AtunMarcia C Castroinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UFMGinstname:Universidade Federal de Minas Gerais (UFMG)instacron:UFMGLICENSELicense.txtLicense.txttext/plain; charset=utf-82042https://repositorio.ufmg.br/bitstream/1843/55290/1/License.txtfa505098d172de0bc8864fc1287ffe22MD51ORIGINALBrazils Family Health Strategy.pdfBrazils Family Health Strategy.pdfapplication/pdf1141416https://repositorio.ufmg.br/bitstream/1843/55290/2/Brazils%20Family%20Health%20Strategy.pdf4f7287ea4fdcdfc37099841a3b6d14eaMD521843/552902023-06-23 17:42:00.431oai:repositorio.ufmg.br:1843/55290TElDRU7vv71BIERFIERJU1RSSUJVSe+/ve+/vU8gTu+/vU8tRVhDTFVTSVZBIERPIFJFUE9TSVTvv71SSU8gSU5TVElUVUNJT05BTCBEQSBVRk1HCiAKCkNvbSBhIGFwcmVzZW50Ye+/ve+/vW8gZGVzdGEgbGljZW7vv71hLCB2b2Pvv70gKG8gYXV0b3IgKGVzKSBvdSBvIHRpdHVsYXIgZG9zIGRpcmVpdG9zIGRlIGF1dG9yKSBjb25jZWRlIGFvIFJlcG9zaXTvv71yaW8gSW5zdGl0dWNpb25hbCBkYSBVRk1HIChSSS1VRk1HKSBvIGRpcmVpdG8gbu+/vW8gZXhjbHVzaXZvIGUgaXJyZXZvZ++/vXZlbCBkZSByZXByb2R1emlyIGUvb3UgZGlzdHJpYnVpciBhIHN1YSBwdWJsaWNh77+977+9byAoaW5jbHVpbmRvIG8gcmVzdW1vKSBwb3IgdG9kbyBvIG11bmRvIG5vIGZvcm1hdG8gaW1wcmVzc28gZSBlbGV0cu+/vW5pY28gZSBlbSBxdWFscXVlciBtZWlvLCBpbmNsdWluZG8gb3MgZm9ybWF0b3Mg77+9dWRpbyBvdSB277+9ZGVvLgoKVm9j77+9IGRlY2xhcmEgcXVlIGNvbmhlY2UgYSBwb2zvv710aWNhIGRlIGNvcHlyaWdodCBkYSBlZGl0b3JhIGRvIHNldSBkb2N1bWVudG8gZSBxdWUgY29uaGVjZSBlIGFjZWl0YSBhcyBEaXJldHJpemVzIGRvIFJJLVVGTUcuCgpWb2Pvv70gY29uY29yZGEgcXVlIG8gUmVwb3NpdO+/vXJpbyBJbnN0aXR1Y2lvbmFsIGRhIFVGTUcgcG9kZSwgc2VtIGFsdGVyYXIgbyBjb250Ze+/vWRvLCB0cmFuc3BvciBhIHN1YSBwdWJsaWNh77+977+9byBwYXJhIHF1YWxxdWVyIG1laW8gb3UgZm9ybWF0byBwYXJhIGZpbnMgZGUgcHJlc2VydmHvv73vv71vLgoKVm9j77+9IHRhbWLvv71tIGNvbmNvcmRhIHF1ZSBvIFJlcG9zaXTvv71yaW8gSW5zdGl0dWNpb25hbCBkYSBVRk1HIHBvZGUgbWFudGVyIG1haXMgZGUgdW1hIGPvv71waWEgZGUgc3VhIHB1YmxpY2Hvv73vv71vIHBhcmEgZmlucyBkZSBzZWd1cmFu77+9YSwgYmFjay11cCBlIHByZXNlcnZh77+977+9by4KClZvY++/vSBkZWNsYXJhIHF1ZSBhIHN1YSBwdWJsaWNh77+977+9byDvv70gb3JpZ2luYWwgZSBxdWUgdm9j77+9IHRlbSBvIHBvZGVyIGRlIGNvbmNlZGVyIG9zIGRpcmVpdG9zIGNvbnRpZG9zIG5lc3RhIGxpY2Vu77+9YS4gVm9j77+9IHRhbWLvv71tIGRlY2xhcmEgcXVlIG8gZGVw77+9c2l0byBkZSBzdWEgcHVibGljYe+/ve+/vW8gbu+/vW8sIHF1ZSBzZWphIGRlIHNldSBjb25oZWNpbWVudG8sIGluZnJpbmdlIGRpcmVpdG9zIGF1dG9yYWlzIGRlIG5pbmd177+9bS4KCkNhc28gYSBzdWEgcHVibGljYe+/ve+/vW8gY29udGVuaGEgbWF0ZXJpYWwgcXVlIHZvY++/vSBu77+9byBwb3NzdWkgYSB0aXR1bGFyaWRhZGUgZG9zIGRpcmVpdG9zIGF1dG9yYWlzLCB2b2Pvv70gZGVjbGFyYSBxdWUgb2J0ZXZlIGEgcGVybWlzc++/vW8gaXJyZXN0cml0YSBkbyBkZXRlbnRvciBkb3MgZGlyZWl0b3MgYXV0b3JhaXMgcGFyYSBjb25jZWRlciBhbyBSZXBvc2l077+9cmlvIEluc3RpdHVjaW9uYWwgZGEgVUZNRyBvcyBkaXJlaXRvcyBhcHJlc2VudGFkb3MgbmVzdGEgbGljZW7vv71hLCBlIHF1ZSBlc3NlIG1hdGVyaWFsIGRlIHByb3ByaWVkYWRlIGRlIHRlcmNlaXJvcyBlc3Tvv70gY2xhcmFtZW50ZSBpZGVudGlmaWNhZG8gZSByZWNvbmhlY2lkbyBubyB0ZXh0byBvdSBubyBjb250Ze+/vWRvIGRhIHB1YmxpY2Hvv73vv71vIG9yYSBkZXBvc2l0YWRhLgoKQ0FTTyBBIFBVQkxJQ0Hvv73vv71PIE9SQSBERVBPU0lUQURBIFRFTkhBIFNJRE8gUkVTVUxUQURPIERFIFVNIFBBVFJPQ++/vU5JTyBPVSBBUE9JTyBERSBVTUEgQUfvv71OQ0lBIERFIEZPTUVOVE8gT1UgT1VUUk8gT1JHQU5JU01PLCBWT0Pvv70gREVDTEFSQSBRVUUgUkVTUEVJVE9VIFRPRE9TIEUgUVVBSVNRVUVSIERJUkVJVE9TIERFIFJFVklT77+9TyBDT01PIFRBTULvv71NIEFTIERFTUFJUyBPQlJJR0Hvv73vv71FUyBFWElHSURBUyBQT1IgQ09OVFJBVE8gT1UgQUNPUkRPLgoKTyBSZXBvc2l077+9cmlvIEluc3RpdHVjaW9uYWwgZGEgVUZNRyBzZSBjb21wcm9tZXRlIGEgaWRlbnRpZmljYXIgY2xhcmFtZW50ZSBvIHNldSBub21lKHMpIG91IG8ocykgbm9tZXMocykgZG8ocykgZGV0ZW50b3IoZXMpIGRvcyBkaXJlaXRvcyBhdXRvcmFpcyBkYSBwdWJsaWNh77+977+9bywgZSBu77+9byBmYXLvv70gcXVhbHF1ZXIgYWx0ZXJh77+977+9bywgYWzvv71tIGRhcXVlbGFzIGNvbmNlZGlkYXMgcG9yIGVzdGEgbGljZW7vv71hLgo=Repositório de PublicaçõesPUBhttps://repositorio.ufmg.br/oaiopendoar:2023-06-23T20:42Repositório Institucional da UFMG - Universidade Federal de Minas Gerais (UFMG)false |
dc.title.pt_BR.fl_str_mv |
Brazils family health strategy: factors associated with programme uptake and coverage expansion over 15 years (1998-2012) |
dc.title.alternative.pt_BR.fl_str_mv |
Estratégia saúde da família no Brasil: fatores associados à adesão ao programa e expansão da cobertura ao longo de 15 anos (1998-2012) |
title |
Brazils family health strategy: factors associated with programme uptake and coverage expansion over 15 years (1998-2012) |
spellingShingle |
Brazils family health strategy: factors associated with programme uptake and coverage expansion over 15 years (1998-2012) Monica Viegas Andrade Primary healthcare Universal health coverage Family health strategy Brazil Cobertura universal de saúde Desenvolvimento sustentável Atenção primária à saúde Saúde da família |
title_short |
Brazils family health strategy: factors associated with programme uptake and coverage expansion over 15 years (1998-2012) |
title_full |
Brazils family health strategy: factors associated with programme uptake and coverage expansion over 15 years (1998-2012) |
title_fullStr |
Brazils family health strategy: factors associated with programme uptake and coverage expansion over 15 years (1998-2012) |
title_full_unstemmed |
Brazils family health strategy: factors associated with programme uptake and coverage expansion over 15 years (1998-2012) |
title_sort |
Brazils family health strategy: factors associated with programme uptake and coverage expansion over 15 years (1998-2012) |
author |
Monica Viegas Andrade |
author_facet |
Monica Viegas Andrade Augusto Quaresma Coelho Mauro Xavier Neto Lucas Resende de Carvalho Rifat Atun Marcia C Castro |
author_role |
author |
author2 |
Augusto Quaresma Coelho Mauro Xavier Neto Lucas Resende de Carvalho Rifat Atun Marcia C Castro |
author2_role |
author author author author author |
dc.contributor.author.fl_str_mv |
Monica Viegas Andrade Augusto Quaresma Coelho Mauro Xavier Neto Lucas Resende de Carvalho Rifat Atun Marcia C Castro |
dc.subject.por.fl_str_mv |
Primary healthcare Universal health coverage Family health strategy Brazil |
topic |
Primary healthcare Universal health coverage Family health strategy Brazil Cobertura universal de saúde Desenvolvimento sustentável Atenção primária à saúde Saúde da família |
dc.subject.other.pt_BR.fl_str_mv |
Cobertura universal de saúde Desenvolvimento sustentável Atenção primária à saúde Saúde da família |
description |
Universal Health Coverage (UHC) is one of the United Nations Sustainable Development Goals (SDGs). Achieving UHC will require strong health systems to promote and deliver equitable and integrated healthcare services through primary healthcare (PHC). In Brazil, the Family Health Strategy (FHS) delivers PHC through the public health system. Created in 1994, the FHS covered almost 123 million individuals (63% of the Brazilian population) by 2015. The FHS has been associated with many health mprovements, but gaps in coverage still remain. This article examines factors associated with the implementation and expansion of the FHS across 5419 Brazilian municipalities from 1998 to 2012. The proportion of the municipal population covered by the FHS over time was assessed using a longitudinal multilevel model for change that accounted for variables covering eight domains: economic development, healthcare supply, healthcare needs/access, availability of other sources of healthcare, political context, geographical isolation, regional characteristics and population size. Data were obtained from multiple publicly available sources. During the 15-year study period, national coverage of the FHS increased from 4.4% to 54%, with 58% of the municipalities having population coverage of 95% or more, and municipalities that had not adopted the programme decreased from 86.4% to 4.9%. The increase in FHS uptake and coverage was not homogenous across municipalities, and was positively associated with small population size, low population density, low coverage of private health insurance, low level of economic development, alignment of the political party of the Mayor and the state Governor, and availability of healthcare supply. Efforts to expand the FHS coverage will need to focus on increasing the availability of health personnel, devising financial incentives for municipalities to uptake/expand the FHS and devising new policies that encompass both private and public sectors. |
publishDate |
2018 |
dc.date.issued.fl_str_mv |
2018 |
dc.date.accessioned.fl_str_mv |
2023-06-23T20:16:17Z |
dc.date.available.fl_str_mv |
2023-06-23T20:16:17Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://hdl.handle.net/1843/55290 |
dc.identifier.doi.pt_BR.fl_str_mv |
10.1093/heapol/czx189 |
dc.identifier.issn.pt_BR.fl_str_mv |
1460-2237 |
identifier_str_mv |
10.1093/heapol/czx189 1460-2237 |
url |
http://hdl.handle.net/1843/55290 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.ispartof.none.fl_str_mv |
Health Policy and Planning |
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info:eu-repo/semantics/openAccess |
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openAccess |
dc.publisher.none.fl_str_mv |
Universidade Federal de Minas Gerais |
dc.publisher.initials.fl_str_mv |
UFMG |
dc.publisher.country.fl_str_mv |
Brasil |
dc.publisher.department.fl_str_mv |
FCE - DEPARTAMENTO DE CIÊNCIAS ECONÔMICAS |
publisher.none.fl_str_mv |
Universidade Federal de Minas Gerais |
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reponame:Repositório Institucional da UFMG instname:Universidade Federal de Minas Gerais (UFMG) instacron:UFMG |
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UFMG |
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