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Primary Healthcare

IBGE surveys how parents and responsible persons address child Primary Healthcare for the first time ever

Section: Social Statistics | Caio Belandi | Design: Jessica Cândido

December 21, 2022 10h00 AM | Last Updated: December 22, 2022 12h53 PM

  • Highlights

  • Of the 38 million children under 13 years in Brazil in 2022, 82.9% (31.5 million) were attended by any service of primary healthcare.
  • The general score of Child Primary Healthcare for Brazil was 5.7. Such assessment is below the minimum level of quality (6.6) for assessment of the degree of extension and development of the services of Primary Healthcare in SUS.
  • Among the FUs, the general score varied from 6.4 in Mato Grosso to 4.8 in Rondônia.
  • 47.6% of those responsible for the children attended attribute either 9 or 10 to the health service, in a scale between 0 and 10.
  • The major reasons for such assessments were the work of professionals to solve the problem (35.7%) and the way these professionals attended the children (32.4%).
Continuous PNAD investigated issues about Child Primary Healthcare for the first time ever - Picture: Vinhedo City Administration

In a partnership with the Ministry of Health, the IBGE carried out the module of the Continuous PNAD on Child Primary Healthcare in the second quarter of 2022 for the first time ever. The questionnaire was applied to those responsible for the health of children under 13 years of age who had at least one attendance in a Basic Health Unit (UBS) or Family Health Unit (USF), popularly called “health centers”, “family health units”, etc.

The survey unveiled that 87.1% of the children under 13 years of age had their fathers or mothers responsible for their health care. The responsible persons interviewed attributed a grade to the service, based on any attendance received in those units in the 12 months before the interview.

“The survey was carried out jointly with the Ministry of Health, using assessment tools of primary healthcare, considered the major gateway of the Unified Health System (SUS),” states Adriana Beringuy, the coordinator of Household Sample Surveys. In this first approach, persons who look for health services are registered and followed. In Brazil, Primary Healthcare is developed in every municipality.

The Primary Healthcare module of the Continuous PNAD is a version of the Primary Care Assessment Tool (PCATool), an international survey tool used by many countries and validated by the Brazilian Ministry of Health. In this module, some attributes of Primary Healthcare are assessed for patients under 13 years of age, with the assessment score varying from 0 to 10.

“This scale varies from 0 to 10 and a score equal to or over 6.6 points out that the services provided are guided to address with quality, according to the protocols of Primary Healthcare,” clarifies Beringuy. The Continuous PNAD used the “general score of PCATool” as an average of the other attributes.

The key attributes assessed by this module of the Continuous PNAD were: ease of access in the first contact; longitudinality, i.e., regularity of the health service over time and humanized relation between the health team and patients; coordination, i.e., continuity of care, recognizing problems that require constant follow up; and integrality, assisting the most common needs of the population, including family planning or contraceptive methods, nutritional supplementation, psychological or mental health counseling.  On the other hand, the derivative attributes assessed by the survey were: family counseling and community counseling.

In 2022, Brazil had 38 million children under 13 years of age in its population and 82.9% of these children (or 31.5 million) were attended by any service of primary healthcare in the reference period of the survey. Nearly 47.6% of those responsible for children attended attributed either a 9 or 10, in a scale where “0” would not recommend the services and “10” would surely recommend them.

33.0% of those responsible attributed either 7 or 8 to the services of Primary Healthcare

For 33% of those responsible persons, the grade attributed to health services received would be either 7 or 8, whereas 19.4% attributed from 0 to 6, considering them below the recommendation. Within this result, an indicator known as Net Promoter Score (NPS) was attributed. “The calculation of the indicator implies values between -100 and +100 and, the highest the result, the more positive is the assessment,” explains Beringuy.

The results pointed out that child caretakers who accessed SUS assessed it positively (+28), with similar regional indexes. Among the Federation Units, similar grades were attributed as well, two of them scoring below 20 (Amapá with 17 and Rio Grande do Norte with 13) and only one above 40 (Rio Grande do Sul with 41). In every geographic division, the indicator of satisfaction in the use of health services in the UBSs and USFs remained between 0 and 50, signaling a positive assessment and also a need for improvement.

The factors that the responsible persons took into account in their assessment were assessed. The major ones were the work of professionals (35.7%) and the way these professionals attend the children (32.4%). Together, the two factors added up to more than two thirds of the reasons mentioned. Another factor mentioned was attendance time, with 23.2%.

General score of child Primary Healthcare remained below the minimum level in every FU

PNAD also investigated the attendance received by 4.1 million children under 13 years who carried out at least two appointments with the same doctor in either a Basic Health Unit or a Family Health Unit.

In 2022, such score was 5.7. The South obtained the highest grade (6.0) and the North, the lowest one (5.4). Among the FUs, none of them hit the result considered the minimum level of quality (6.6), with Mato Grosso (6.4) getting closer and Amazonas (4.9) and Rondônia (4.8) with the lowest ones.

Most people looked for public attendance in basic health units

The survey also shows that nearly 75% of the children under 13 years in Brazil (28.4 million) appointed a medical consultation in the last 12 months before the interview date, a proportion that was lower in the North (66.6%) and in the Northeast (71.8%).

In Brazil, most people (46.1%) looked for attendance in either Basic Health Units or Family Health Units, an index that was higher in the North (58.1%) and in the Northeast (51.1%). On the other hand, 29.3% looked for private attendance (medical offices, clinics and hospitals), with significant regional differences in the North (20.2%) and in the Southeast (36.5%). Lastly, 20,3% went to emergency units in either public hospitals or those linked to the armed forces.

In the South, respiratory and throat problems lead reason for appointments

Among the reasons that took the children to the appointments, the major one was routine, like revision, check-up, monitoring of growth and development, which corresponded to 39.1%. They were followed by respiratory and throat problems, like influenza, sinusitis, asthma, bronchitis, etc., with 30.9%. With 30%, other reasons, like fever, diarrhea, vomit, accidents and fractures, among others.

In the North and Southeast regions, the search for routine appointments appears with an index above the national average, with 43% and 42.9%, respectively. The result in the South creates awareness as well, where respiratory problems were the major reason for appointments, with 38.9%. “The characteristic climate in the region, a colder one, can help to explain it. Children are more impacted by respiratory symptoms associated with lower temperatures in the Brazilian South Region,” states Beringuy.

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