Universidade Federal da Bahia
Instituto de Saúde Coletiva
Programa de Pós-Graduação em Saúde Coletiva
PRIMARY HEALTHCARE
EVALUATION
Rosana Aquino
Salvador, Bahia
Julho de 2011
Memórias da Saúde da Família no Brasil
PHC evaluation, ISC-UFBA
PHC evaluation, ISC-UFBA
Observational studies
Ecological design
 Household surveys
 Case studies

Randomized community trial
Ecological design
ecological and longitudinal approach in which
we used a panel data - observations on multiple
entities (e.g., individuals, cities, counties), for
which each entity is observed at 2 or more
points in time.
 In our study, the municipality (county) was the
unit of analysis, and time-series data were
assembled from several databases.

Infant mortality and childhood mortality
Primary Health Care-sensitive Conditions
PHC and conditional cash transfer
Surveillance and health system organization
Surveys

a evaluative cross-sectional study in one sanitary
district in the city of Salvador, Brazil

cross-sectional study in some municipalities - the
physical environment, material resources, and
staff
Accessibility, service organization and
social participation
Conselhos Municipais de Saúde
5
4
3
2
Conselhos Locais de Saúde
1
0
12
1996
1997
1998
1999
2000
2001
2002
2003
2004
10
Grupo com PSF
Grupo de comparação
8
6
4
2
Fonte: LOPES, SM. A influência da implantação do
PSF na criação de Conselhos Locais de Saúde nos
municípios da Bahia, 2007.
0
19 9 6
19 9 7
19 9 8
19 9 9
G rup o c o m P S F
2000
2001
G rup o d e c o mp a ra ção
2002
2003
2004
Case studies

Mix approach - qualitative and
quantitative study;

Deeply observation of an object
(primary health care) and its
interactions with the its context
Evaluation of the implementation of primary care in two
municipalities of the state of Bahia
Po pulação -alvo
Equilíbrio nas relaçõ es de po der
Repartição das respo nsabilidades
Espaço s co mpartilhado s de decisão
Discussão de caso s e atividades
100
80
60
Cadastramento das famílias
M apeamento
Ló gica do mapeamento
40
A nálise da situação de saúde
20
1
100
Circulação da info rmação
20
Ló gica da análise
da situação de
19
saúde 80
0
2
3
18
Enfo
que po r pro blemas60
P articipação po pular no PP LS
4
40
Princípio de respo nsabilidade
17 que de risco
Enfo
5
20
Co mpreende co ntexto co munitário
Abo rdagem individual/co letiva
16
0
Co mpreede co ntexto familiar
P arcerias co m instituiçõ es
Co nhece po pulação e territó rio
15
7
Município A
Município B
Fonte: Medina MG e Hartz ZMA, The role of the Family Health
Program in the organization of primary care in municipal health
systems. Cad. Saúde Pública, 2009.2009.
14
8
13
9
12
10
11
Randomized community trial
RCT – 10 municipalities – 5 with
intervention and 5 controls;
 Municipalities of State of Bahia –
according select criteria (size of
population, coverage of PSF and PSE,
NASF and public high school in urban
area).

Prose Promovendo Saúde na Escola
Ensaio comunitário para avaliação de uma intervenção
de promoção de hábitos saudáveis de alimentação e
atividade física
Assumptions
Intervention interacts with implemented
public policies versus pilot project;
 Relationship between research and
management;
 Relevance of social and cultural context;
 Intervention is not isolated of its context development of articulated intervention
improvement public policies.

Limitations
1. Ecological design - we cannot be
certain that it was FHP users who
experienced improved health
conditions;
2. Source of the data - national health
information systems (coverage,
availability and quality of data).
Challenges
1. Independent variable
o define a consistent and verifiable measure
of primary health care;
2. Dependent variable
o mortality;
o list of primary health care–sensitive
conditions
o partnership with other stakeholders
o indirect measure of the effectiveness of PHC
3. Covariates
o availability – interpolation/extrapolation;
o covariate cutoff value.
4. Counterfactual
All photos used in this presentation were taken from the book:
Memories of Health Family in Brazil
Photography: Radilson Carlos Gomes
Rosana Aquino
[email protected]