Access to care in Primary Health Care in Brazil: situation, problems and coping strategies

Abstract

Universal health systems oriented by Primary Health Care (PHC) present better population outcomes. This  article addresses the situation of access to care in  Brazilian PHC. A non-systematic narrative review was  carried out, which included published studies and  empirical experiences in several services and  municipalities. Three thematic axes guide the present  study: (1) Current access situation in Brazilian PHC; (2)  Problems and challenges; and (3) Strategies for  expanding access in PHC. Research shows that access  to PHC increased with the expansion of the Family  Health Strategy (FHS), but still remain insufficient. The  main barriers to access include: undersizing and  underfunding of PHC, excessive patient-list linked to FHS teams, reduced number of specialist physicians,  difficulty in interiorizing/fixing FHS professionals, and  excessive municipal autonomy in the management  of PHC services. To improve and qualify the access in  PHC, it is necessary to increase federal investments,  expand FHS coverage, reduce patient-list linked to  FHS teams, increase medical training in family and  community medicine, optimize nursing clinics,  diversify communication media with users, and  enhance appointment flexibility. In conclusion, to  strengthen PHC it is strategical to stimulate access to  longitudinal care.