¿Es la atención primaria de salud integral parte de la respuesta a la pandemia de Covid-19 en Latinoamérica? / Is comprehensive primary health care part of the response to the COVID-19 pandemic in Latin America? / A atenção primária à saúde integral é parte da resposta à pandemia de Covid-19 na América Latina?

Resumen América Latina se ha convertido en uno de los epicentros de la pandemia de Covid-19, con una crisis sanitaria y humanitaria. El objetivo del artículo es analizar las medidas para enfrentar la pandemia en países de la Región y el rol de la Atención Primaria de Salud, discutiendo obstáculos y potencialidades. Son analizados los casos de Bolivia, Brasil, Chile, Colombia, Cuba, Uruguay y Venezuela. Los siete países adoptaran medidas de aislamiento social de diferentes alcances, con grados distintos de sostenibilidad. El énfasis de las respuestas estuvo más en la atención hospitalaria que en la vigilancia de la salud, identificación de casos y contactos y disposición de condiciones adecuadas para el confinamiento. En casi todos los países, se subestimó la capacidad de los servicios de atención primária en el territorio. No obstante, iniciativas de enfoque territorial y comunitario buscaron integrar la vigilancia de la salud con actividades de promoción, prevención y cuidado, aunque con alcance parcial. En este contexto la Atención Primaria Integral e integrada toma nuevo sentido y reclama desarrollos que contribuyan a recobrar el equilibrio entre sociedad y medio ambiente. Es necesario repensar los sistemas de salud y la importancia de la atención primaria de salud integrada e integral.

Abstract Latin America has become one of the epicenters of the COVID-19 pandemic, with a health and humanitarian crisis. The objective of the article is to analyze the strategies implemented by countries in the Region to face the pandemic and the role of Primary Health Care, considering obstacles and potential. The cases of Bolivia, Brazil, Chile, Colombia, Cuba, Uruguay and Venezuela were analyzed. The seven countries have adopted diverse social distancing strategies with varying degrees of sustainability. The responses emphasized hospital care more than surveillance, case identification, contact tracking, and enabling adequate conditions for isolation. In almost all cases studied, the capacity of primary care services in the territory was underestimated. Even so, primary care initiatives with a territorial and community focus sought to integrate health surveillance with promotion, prevention and care, despite partial implementation. In this context, comprehensive and integrated primary care takes on new meaning and requires new developments in order to contribute to the recovery of the balance between society and the environment. The pandemic showed the need to rethink health care systems and the importance of primary care for comprehensive and integrated health.

Resumo A América Latina tornou-se um dos epicentros da pandemia de Covid-19, com uma crise sanitária e humanitária. O objetivo do artigo é analisar as estratégias implementadas por países da Região para enfrentar a pandemia e o papel da Atenção Primária à Saúde, ponderando obstáculos e potencialidades. Foram analisados os casos de Bolívia, Brasil, Chile, Colômbia, Cuba, Uruguai e Venezuela. Os sete países adotaram estratégias de distanciamento social diversas com diferentes graus de sustentabilidade. As respostas enfatizaram mais a assistência hospitalar do que a vigilância, a identificação de casos, o rastreamento dos contatos e a viabilização de condições adequadas para isolamento. Em quase todos os casos estudados, foi subestimada a capacidade dos serviços de atenção primária no território. Ainda assim, iniciativas de atenção primária com enfoque territorial e comunitário buscaram integrar a vigilância à saúde com a promoção, prevenção e cuidado, apesar de implantação parcial. Nesse contexto, uma atenção primária integral e integrada adquire novo significado e requisita novos desenvolvimentos de forma a contribuir para a recuperação do equilíbrio entre a sociedade e o meio ambiente. A pandemia mostrou a necessidade de repensar os sistemas de atenção à saúde e a importância da atenção primária à saúde integral e integrada.

Mapping primary health care renewal in South America.

BACKGROUND: Primary health care (PHC) renewal processes are currently ongoing in South America (SA), but their characteristics have not been systematically described. OBJECTIVE: The study aimed to describe and contrast the PHC approaches being implemented in SA to provide knowledge of current conceptions, models and challenges. METHODS: This multiple case study used a qualitative approach with technical visits to health ministries in order to apply key-informant interviews of 129 PHC national policy makers and 53 local managers, as well as field observation of 57 selected PHC providers and document analysis, using a common matrix for data collection and analysis. PHC approaches were analysed by triangulating sources using the following categories: PHC philosophy and conception, service provision organization, intersectoral collaboration and social participation. RESULTS: Primary health care models were identified in association with existing health system types and the dynamics of PHC renewal in each country. A neo-selective model was found in three countries where coverage is segmented by private and public regimes; here, individual and collective care are separated. A comprehensive approach similar to the Alma-Ata model was found in seven countries where the public sector predominates and individual, family and community care are coordinated under the responsibility of the same health care team. CONCLUSIONS: The process of implementing a renewed PHC approach is affected by how health systems are funded and organized. Both models face many obstacles. In addition, care system organization, intersectoral coordination and social participation are weak in most of the countries.

Panorama de la Atención Primaria de Salud en Suramérica: concepciones, componentes y desafíos / Overview of Primary Health Care in South America: conceptions, components and challenges

El artículo presenta un panorama de la Atención Primaria de Salud en Suramérica a partir de mapeos realizados en los 12 países según una matriz analítica organizada en las dimensiones: conducción, financiamiento, características de la prestación y organización, coordinación de cuidados e integración a la red de servicios, fuerza de trabajo, participación social, acción intersectorial e interculturalidad. Se observa diversidad en la implementación y de abordajes de APS, condicionada por directrices políticas, modalidades de protección social y segmentación de los sistemas de salud. Se destacan iniciativas innovadoras de atención primaria integral y se identifican los principales desafíos.

The article presents an overview of Primary Health Care in South America. Developed from mappings in the 12 countries, it follows an analytical matrix organised into the following parameters: stewardship, funding, characteristics of provision and organisation, care coordination and integration with the service network, labour force, social participation, inter-sector collaboration and intercultural approaches. Diversity was observed in PHC implementation and approaches, which are conditioned by policy guidelines, social protection modalities and health system segmentation. Innovative initiatives in comprehensive PHC are highlighted and the main challenges are identified.