Brazilian National Primary Care Policy (2006-2026): Induction layers and a future agenda

Abstract

This qualitative study analyzes the trajectory of Brazil’s National Primary Care Policy (PNAB) from 2006 to 2026 by linking normative revisions, policy-induction instruments, political-fiscal conditions, and public health emergencies. Federal acts and institutional documents were examined through documentary analysis, complemented by narrative synthesis. ‘Induction layers’ were defined as incremental sets of regulatory, financial, organizational, informational, and relational instruments that operationalize Primary Health Care (PHC). Documents were classified into ten dimensions: care organization; professional practice; care modalities; oral health; equity; workforce provision and training; infrastructure and digital transformation; co-financing; management and governance; relationships, participation, and co-responsibility; and emergency response. Findings indicate that the PNAB remains a core norm, accompanied by institutional layering and conversion. The 2017 revision increased organizational flexibility amid fiscal constraint, while later instruments intensified induction through financing, information, and equity. The future agenda depends on coherence among equitable financing, workforce stability, regional coordination, digital transformation, continuous care, social participation, and protection of PHC attributes.