Primary Health Care (PHC) has its own challenges. Routine consultations and exams, as well as the follow-up of chronic patients (such as those with heart disease and diabetes) requires the public system, in particular, to overcome some challenges in order not to overload the system. The “OECD Study of Primary Health Care in Brazil“, prepared in 2021 by the Organization for Economic Cooperation and Development (OECD), makes a detailed diagnosis of this problem and outlines guidelines for improving the public health care system for the Brazilian population. The goal is to identify the scope for Brazil to build a more solid PHC system while strengthening existing policies and practices to improve access and quality of care.

According to the publication, the introduction of the Unified Health System (SUS) in 1990 was a great achievement for Brazil, increasing access to services and reducing health inequalities. Through SUS, the Brazilian population has been able to benefit from free access to preventive primary care services provided by multidisciplinary teams of the Family Health Strategy (ESF), which have also contributed to changing a historically hospital-centered care system. Without a doubt, the Family Health Strategy expansion  has brought measurable improvements in terms of child mortality rates, among other positive impacts. For example, Family Health Strategy is associated with a 45% reduction in hospitalization rates per 10,000 population from 2001 to 2016, mainly for conditions sensitive to Primary Care, such as asthma, gastroenteritis, cardiovascular and cerebrovascular diseases. Brazil also prioritizes spending on PHC: in 2019 about 16% of financial resources were allocated to this segment, which is a similar level to other OECD countries.

Despite this progress, points out the OECD study, the main indicators suggest that PHC in Brazil is not working efficiently. The country still faces the challenges of striking inequalities in access and quality of PHC, with severe workforce tightness. The growing burden of chronic non-communicable diseases, coupled with the expanding exposure to risk factors and the rapid aging of the population, will exacerbate the challenges that exist in this context.

In Brazil, some types of cancer, hypertension, and diabetes have screening and prevention strategies. However, there is more to be done to improve the depth and comprehensiveness of these strategies. The study points out that improved data systems and health literacy are complementary measures that should not be underestimated to encourage greater cancer prevention and screening. As for hypertension and diabetes screening, Brazil must further develop therapeutic itineraries, with a person-centered perspective, integrating all health professionals in different sectors.

There are also obvious deficiencies in access to high-quality PHC. Only 65% of the population is served by Family Health Strategy teams, and many patients ignore primary health care, seeking direct care in hospital outpatient specialties. There are still challenges to the digitalization of PHC, even though Brazil has made great strides toward digital transformation. In 2019, about 78% of PHC units had electronic patient record (PEP) systems. However, progress toward the effective use of digital PHC is still not ideal, with significant inequalities in the use of digital tool technologies among health workers and citizens.

The OECD study brings public policy recommendations to improve PHC in Brazil. With regard to the general improvement of the provision quality the following points were indicated:

• Strengthen the data filtering system, with systematic patients’ registration in the Family Health Strategy’s, which guides patients to specialized care as needed through the referral system.
• Encourage a greater coverage of PHC, ensuring that all municipalities are able to perform health care actions and services.
• Develop educational programs in disease prevention and early diagnosis.
• Collect a richer set of quality indicators across a wider range of preventive and chronic condition management activities (such as alcohol consumption, obesity, cancer screening, and mental health), including PHC experiences, and implement public reporting systems to allow patients to monitor the performance of each ESF.
• Build accreditation systems around care standards for all ESF in order to assess their performance, identify areas that may require improvement, and provide support for such improvements.
• Expand health care networks to prioritize integrated care for patients with multiple needs.