[The Articulator of Primary Health Care Program: an innovative proposal for qualification of Primary Health Care]

Primary health care organization in municipalities of São Paulo, Brazil: a model of care aligned with the Brazilian Unified National Health System's guidelines

This study analyzes the main organization patterns used by primary health care (PHC) services in municipal networks and evaluates them according to indicators of local management-administration interface. Evaluative research analyzed 461 municipalities in São Paulo, Brazil, that participated in the Primary Care Services Quality Assessment Survey (QualiAB) in 2017/2018, classified according to the organizational arrangements composition of 2,472 PHC services. Eight indicators of local management and administration were selected to evaluate the identified patterns. Results indicate two groups of municipalities: homogeneous, with services presenting the same arrangement (43.6%); and heterogeneous, with different arrangements (56.4%). These were subdivided into seven patterns that ranged from homogeneous-traditional, homogeneous-Family Health Strategy, homogeneous-mixed, and different combinations in the heterogeneous group. All indicators showed significant differences between groups (p < 0.001), especially the homogeneous-traditional group, which presented an organizational pattern far from the desired model of a comprehensive and problem-solving PHC. Those integrated with family health units (FHU) and basic health units with community health workers and/or family health teams (BHU/FHU) showed a pattern closer to a comprehensive model - with planning and evaluation actions committed to the local reality and qualification of care. Implementation of federal and state policies are essential for defining the PHC health care model adopted by municipalities.

PMAQ na visão de trabalhadores que participaram do programa em Região de Saúde do Paraná

RESUMO Pesquisa com abordagem qualitativa que objetivou analisar as mudanças nos processos de adesão, avaliação externa e organização do processo de trabalho de 21 equipes na 10a Região de Saúde do Paraná, as quais participaram dos dois primeiros ciclos do Programa de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ). Os resultados apontaram melhor organização e registro das informações; planejamento a partir da autoavaliação e a avaliação externa como estratégia de mobilização da gestão e das equipes. Todavia, é necessário maior envolvimento das equipes na contratualização e monitoramento dos indicadores do PMAQ, assim como melhor uso das ferramentas da autoavaliação no planejamento local.