Brazil's Family Health Strategy: factors associated with programme uptake and coverage expansion over 15 years (1998-2012)
Brazil's Family Health Strategy: factors associated with programme uptake and coverage expansion over 15 years (1998-2012)
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DOI：
10.1093/heapol/czx189
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发表时间：
2018-04-01
影响因子：
3.2
通讯作者：
Castro, Marcia C.
中科院分区：
文献类型：
--
作者：
Andrade, Monica Viegas;Coelho, Augusto Quaresma;Castro, Marcia C.
全民健康覆盖（UHC）是联合国可持续发展目标（SDG）之一。实现全民健康覆盖需要强大的卫生系统，通过初级卫生保健（PHC）促进和提供公平和综合的卫生保健服务。在巴西，家庭保健战略通过公共保健系统提供初级保健。FHS创建于1994年，到2015年覆盖了近1.23亿人（占巴西人口的63%）。FHS与许多健康改善有关，但覆盖范围仍然存在差距。本文研究了1998年至2012年巴西5419个城市实施和扩大FHS的相关因素。FHS覆盖的城市人口的比例随着时间的推移进行了评估，使用纵向多层次模型的变化，占变量涵盖八个领域：经济发展，医疗保健供应，医疗保健需求/访问，医疗保健的其他来源，政治背景，地理隔离，区域特征和人口规模的可用性。数据来自多个公开来源。在15年的研究期间，家庭保健服务的全国覆盖率从4.4%增加到54%，58%的城市的人口覆盖率达到95%或以上，未采用该方案的城市从86.4%下降到4.9%。FHS的吸收和覆盖范围的增加在各市之间并不均匀，与人口规模小、人口密度低、私人医疗保险覆盖率低、经济发展水平低、市长和州长的政党一致以及医疗保健供应的可用性呈正相关。扩大FHS覆盖面的努力需要侧重于增加卫生人员的可用性，为市政当局采用/扩大FHS制定财政激励措施，并制定包括私营和公共部门的新政策。
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 improvements, 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.