PNS 2019: Frequent users of SUS see quality of its Primary Health Care Services mostly positive

October 21, 2020 10h00 AM | Last Updated: October 22, 2020 01h37 PM

In 2019, for the first time, the National Survey of Health (PNS) collected information on Primary Health Care (PHC). It was also the first time an official statistical agency made use of the Primary Care Assessment Tool, which is recommended by international cooperation bodies and allows user to grade, by means of questionnaire answers, the services provided to them.

The first results of Module H of PNS-2019 encompassed a group of questions from the Primary Care Assessment Tool (PCATool Brazil), an internationally adopted instrument issued in Brazil by means of the Ministry of Health, showing that frequent users of SUS provided mostly positive evaluations of primary healthcare quality in our country.

In 2019, 17.3 million (10.7%) persons aged 18 and over sought Primary Health Care (PHC) in the six-month period preceding the survey. A total 69.9% were women; 53.8% had no employment and 64.7% had per capita household income below one minimum wage.

Considering the Overall PHC Score, which ranges between 0 and 10, the final score was 5.9, that is, below the index that indicates excellence in health care (6.6). That means the score of Brazil was slightly lower than the minimum level to guarantee high-quality healthcare services, according to the methodology of this instrument. For example, persons referring to heart diseases graded services 6.4; to diabetes, 6.3; to high blood pressure, 6.2; to depression, 6.1; being all grades higher than in cases not identified with such morbidities. Persons visited by community health care agents or endemic combat agents also graded them higher.

Data also shows that he elderly, who are mostly affected by morbidities and are most frequent users of health care services, graded services higher (6,1), in comparison with grades from adults aged 18 to 39 (5.6) aged 40 to 59 years of age (5.9). Men (5.9) and women (5.8) graded those services similarly, as well as white residents (5.9) and black/brown ones (5.9).

In 2019, approximately 25.9% of the country’s population aged 18 and over (or 41.2 million persons) were obese: 29.5% of the female and 21.8% of the male population. About 60.3% of the population in this age group (96 million persons) were overweight. The proportion among women (62.6%) surpassed that among men (57.5%).

A total 19.4% of the teenagers aged 15 to 17 were overweight, being 22.9% of female and 16% of male ones. Obesity affected 6.7%: 8.0% off emale teenagers and 5.4 % of male ones.

Between 2003 and 2019, results of two IBGE surveys (POF and PNS) showed the proportion of obesity in the population aged 20 and over in the country went from 12.2% to 26.8%. In this period, prevalence of female obesity increased from 14.5% to 30.2% and remained above male obesity, which changed from 9.6% to 22.8%.

The proportion of overweight persons in the population aged 20 and over increased from 43.3% to 61.7%, in the same 17 years.

These data are part of the second volume of the National Survey of Health (PNS) 2019, which is conducted in partnership with the Ministry of Health, presenting data on malnutrition, overweight and obesity in the population 15 aged 15 and over, besides information about Primary Health Care and visits paid by health care agents.

Primary Health Care has a national score of 5.9

n 2019, for the first time, the National Survey of Health (PNS) collected information about Primary Health Care (PHC). The questionnaire was administered to residents aged 18 years of age and over who had been seen by the same physician at least twice in Basic Health Care Units (UBS) or Family Health Care Units (USF).

The questionnaire is an adapted and reduced version of the “Primary Care Assessment Tool – adult version”. Brazil was the first country where an official statistical agency used this internationally valid instrument. The analysis of this questionnaire will allow international comparisons and the development of a basis for the evaluation of SUS and of primary care policies in the country.

In 2019, 17.3 million persons aged 18 and over (or 10.7% of that population) sought Primary Health Care services, in the six months preceding the survey, in an appointment that was not the first one with the same physician. The answers to questionnaires received grades that were used to the overall PHC score, which ranges between 0 and 10. According to international patterns, a score equals to or above 6.6 indicates excellent quality in primary health care. The Overall PHC score for Brazil was 5.9.

Persons aged 18 and over who used some type of Primary Health Care service, in the six months prior to the date of the interview, and Overall Score of Primary Health Care – 2019

Characteristics Persons aged 18 and over who used some type of Primary Health Care service and Overall Score of Primary Health Care (0 to 10)
Total (1 000) Distribution (%) Overall Scorel
Total    17 261 100.0      5.9
Sex    
   Men 5 204          30.1             5.9
Women 12 057              69.9       5.8
Age groups   
    18 to 39 5 627           32.6         5.6
40 to 59 6 177        35.8           5.9
60 and over 5 457      31.6    6.1
Color or race  
   White 6 555      38.0          5.9
Black or brown 10 514         60.9           5.9
Marital status      
   With a spouse or partner 11 222            65.0             5.9
Without a spouse or partner 6 039         35.0             5.9
Source: IBGE, Diretoria de Pesquisas, Coordenação de Trabalho e Rendimento, Pesquisa Nacional de Saúde 2019.

Some of the investigated characteristics were sex, age groups, color or race and marital status of users of those services. Among persons aged 18 and over who used primary Health Care Services in the six months prior to the survey, 69.9% were women; 60.9% were black or brown; 65.0% were had spouses or partners and 35.8% were between 40 and 59 years of age.

Men graded PHC 5.9 and women, 5.8. Among youngsters (aged 18 to 39 years of age) the score was 5.6 and, among the elderly (60 years of age and over), 6.1. Unemployed persons graded PHC 5.9 and employed ones, 5.8.

64.7% of the PHC users have per capita income below one minimum wage

In the country, 53.8% of the PHC users had no employment (job) 64.7% had per capita household earning below one minimum wage. Income of the other 32.3% ranged between 1 to 3 minimum wages.

As for ranges of per capita household income, the overall score was not linear: both the poorest and the richest had the same perception regarding the service rendered, classifying its attributes with a similar overall score: 5.8.

Approximately 94.4% of the users had no health insurance plan. Their grades for PHC attributes was 5.9.

76.5% of the PHC users had a register in Family health care units

Among housing units with residents aged 18 years of age and over seen at least twice for PHC, 76.5% had a register in a family health care unit. On the average, 73.0% of the housing units registered had at least one visit from an endemic combat agent.

Residents of housing units registered in the health care unit graded PHC 6.0, and residents not registered, 5.5. Among those who had been visited at least once by a Community health care agent, the score was 6.1, and for those who were never visited by any of those professionals, the score was 5.7. Residents who had been visited at least once by endemic combat agents graded PHC higher (6.0) than those who were never visited (5.6).

Half of PHC users rank their own health as good or very good

Among persons aged 18 and over who received some PHC service in the six months prior to the date of the survey, in Brazil, 50.1% ranked their health conditions as “good or very good”. The remainder ranked their health parameters as “regular, bad or very bad”. These persons tended to score the service provided by the health care unit slightly higher.

Six out of every ten adults are overweight
PNS estimated that 60.3% of the adult population were overweight, which means a total 96 million persons. That proportion was higher among women (62.6%) than among men (57.5%).

Prevalence of overweight increases with the age and surpasses 50% in the age group of 25 to 39. For that age bracket, the proportion of overweight is slightly higher among men (58.3%) than women (57.0%). However, in the other wage groups, overweight percentages were highest among women.

Three out of every ten adult women are obese

Obesity, characterized by BMI equals to or above 30 kg/m², was observed among 21.8% of men and 29.5% of women aged 18 and over.

It follows the same age pattern of overweight and it is highest among women, reaching 38.0% of the women aged 40 to 59 years of age, against 30.0% of men in the same age group.

One out of five teenagers aged 15 to 17 is overweight

PNS collected anthropometric measurements of weight and height of residents aged 15 and over,  randomly selected from a subsample of housing units in the survey. In order to keep comparability with PNS 2013, whose sample included residents aged 18 and over, data were divided into two age groups, teenagers 15 to 17 and adults aged 18 and over.

Prevalence of overweight among teenagers aged 15 to 17 was 19.4% (1.8 million persons), being highest for female teens (22.9%) in comparison with male ones (16.0%). The obesity indicator was 6.7%, with about 8.0% for females and 5.4% for male ones.

Prevalence of weight deficit, overweight, obesity and total estimated figures for the population aged 18 and over, by sex, by age groups - Brazil –  2019
Age groups Prevalence of weight deficit, overweight, obesity and total estimated figures, in the population aged 18 and over (%)
Total Sex
Men Women
Prevalence  Absolute  Prevalence  Absolute  Prevalence  Absoluto 
% (1 000 persons) % (1 000 persons) % (1 000 pessoas)
Weight deficit
Total 1.6 2 215 1.7 1 104 1.5 1 112
18 to 24  - - - - - -
25 to 39  1.9  876 2.4  541 1.4  335
40 to 59  0.8  441 0.9  230 0.7  212
60 and over 2.6  898 2.2  333 2.9  565
Overweight
            Total 60.3 95 901 57.5 42 899 62.6 53 002
18 to 4  33.7 7 434 25.7 2 850 41.7 4 585
25 to 39 57.6 26 817 58.3 13 087 57.0 13 730
40 to 59  70.3 39 497 67.1 17 533 73.1 21 964
60 and over 64.4 22 153 63.3 9 429 65.3 12 724
Obesity
            Total 25.9 41 230 21.8 16 252 29.5 24 978
18 to 24 10.7 2 366 7.9  876 13.5 1 490
25 to 39 23.7 11 038 19.3 4 333 27.9 6 705
40 to 59 34.4 19 305 30.2 7 889 38.0 11 415
60 and over 24.8 8 521 21.2 3 153 27.5 5 368
Source: IBGE, Diretoria de Pesquisas, Coordenação de Trabalho e Rendimento, Pesquisa Nacional de Saúde 2019.      (1)  Due to sample characteristics precisios was not as expected.

Proportion of weight deficit in the population is 1.6%, below the malnutrition threshold

For the World Health Organization, only weight deficit prevalences equals to or above 5% indicate the adult population is exposed to malnutrition. Prevalence of weight deficit in adults aged 18 and over was 1.6%, (1.7% for men and 1.5% for women), and stayed significantly below the expected threshold, for thin individuals. 

In almost all the age groups, prevalence of weight deficit is usually higher. The exception is the elederly  (60 years of age and over): in this group, female prevalence  (2.9%) is sligtly higher than male (2.2%).

In 17 years, proportion of obese Brazilians more than doubled 

Evolution of the anthropometric profile of the Brazilian population aged 20 and over can be monitored by means of overweight and obesity prevalence estimates, of POF (editions of 2002-2003 and 2008-2009) and PNS (editions of 2013 and 2019).

Between POF 2002-2003 and PNS 2019, the proportion of obese persons in the population aged 20 and over went from 12.2% to 26.8%. Prevalence figures of men and women grew at similar rates, but female obesity (from 14.5% to 30.2%) remained at a higher level than male obesity (from 9.6% to 22.8%).

In the same 17-year period, the proportion of overweight persons in the population aged 20 and over was less than half (43.3%) in 2003 and went to a percentage that was close to two thirds (61.7%) in 2019.

In 2003, prevalence of female overweight (43.2%) was slightly lower than male (43.3%), but positions were reversed in 2013 and remained so in 2019, when female prevalence reached 63.3% and male, 60.0%. Prevalence evolution is shown in the graph below.