Fifteen years of the Primary Health Care Reform (RCAPS) in Rio de Janeiro, Brazil

Pinto, Luiz Felipe; Caldas, Ana Luiza Ferreira Rodrigues

doi:10.1590/1413-81232025307.04112025

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THEMATIC ARTICLE • Ciênc. saúde coletiva 30 (07) • July 2025 • https://doi.org/10.1590/1413-81232025307.04112025EN linkcopy

Fifteen years of the Primary Health Care Reform (RCAPS) in Rio de Janeiro, Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Rio de Janeiro has become a paradigm for Brazilian Primary Health Care (PHC). How did the city, which until 2008 was the capital city of the country with the lowest coverage of complete Family Health Strategy (FHS) teams, with 3.5% of its population, manage to give access to more than 70% of cariocas (residents of the city of Rio de Janeiro) by 2024? The present study analyzes the main axes and results of the Primary Health Care Reform (Reforma dos Cuidados em Atenção Primária à Saúde - RCAPS) over a 15-year period, inspired by PHC in Lisbon, Portugal. Limits, challenges, and advances are discussed. Our study highlights changes in the organizational chart, the management model, health care by results, and the strengthening of PHC as a network organizer and care coordinator. The feasibility of RCAPS for a large city is demonstrated, with the following limitations: (i) the need to reorganize continuing education processes, (ii) improved communication with the SUS user population, and (iii) insufficient tripartite funding, especially from the state government. Digital Health as an axis for improving communication, expanding access, and greater resolutiveness is today consolidated as management’s greatest challenge.

Key words:
Primary Health Care; Health evaluation; Primary care attributes; Rio de Janeiro

2009: Axis 0 Organizational and Administrative Change	Examples and Actions
PHC in the “Driver’s Seat”²¹	Inspiration from European experiences of PHC, particularly in the United Kingdom and Portugal, to develop RCAPS guidelines.
Participatory definition of the Network, construction of Integrated Health Care Territories	Working meetings for the construction of Integrated Health Care Territories, starting with PA 5.3 and 3.2.
Basis of administrative reform and contracting	Change in the administrative organogram of the Municipal Health Department, Decree-Law on Social Health Organizations, Management Contracts.
2010: Axis I Expansion of Access	Examples and Actions
Leadership and management autonomy	Selection of leaders for local management of PHC, with the implementation of classes in the Specialization Course in Public Health.
Improved accessibility	Opening and implementation of 17 new units in the new Family Clinics model.
Management of Information and Communication Technologies (ICTs) in Health	Implementation of electronic health records in the first PHC units.
Assessment and surveillance	Greater frequency in updating Health Information Systems; began issuing the first management reports of electronic health records.
2011: Axis II Clinical Governance and Knowledge Management	Examples and Actions
Clinical management	Creation of clinical protocols based on evidence and in accordance with the reality of SUS in Rio de Janeiro; computerization of the list of municipal medicines (Remume).
Knowledge management and professional qualification	Implementation of the Residency Program in Family and Community Medicine, the Professional Master’s Degree in Primary Health Care, the Specialization Course in Public Health, Proformar-Rio, the Technical Course for Community Health Agents, the Pharmaceutical Care Workshops in PHC and consolidation of the OTICS-Rio Station Network.
Innovation and simplification in the provision of care	Standardization of health procedures and actions for all units: PHC service portfolio.
2012: Axis III Sustainability and Development	Examples and Actions
Service accreditation	Certificate of Recognition for Quality Care (CRCQ).
Financial viability of PHC	Monthly cost estimate for each Family Health team.
Estimated monthly cost of each Family Health team. Communication with citizens and professionals.	SUBPAV portal (internet) and “Where to be treated?” tool (which links each person’s address to a reference PHC unit), later updated annually by the OTICS-Rio Network.
2013: Axis IV Care Coordination and Accountability	Examples and Actions
Care Coordination	Family doctors, technical managers of each unit, are responsible for regulating outpatient procedures and exams.
People-to people connections, organization of user lists	Workshops with Community Health Agents and Family Health teams, publication of Statistics and Maps Notebooks (Cemaps-RJ) with maps of teams and micro-areas.
Accountability and transparency in results	Accountability Seminars prepared and presented by each health unit.
2014: Axis V Timely Response and All For SUS	Examples and Actions
Individual responsibilities and deliverables	Job description of each FHS team member.
Timely response	Study of waiting times for outpatient procedures and exams in Sisreg, SIA-SUS integration, SCNES, and scale of vacancies offered in Sisreg. Integration with hospital and ambulance regulation.
Service-research interaction	“PCATool” evaluation survey with users selected in independent and comparable statistical samples by the City’s Planning Department.
2015: Axis VI Driving Efficiently	Examples and Actions
Transparency and Financial Discipline	Budget meetings with each unit.
Network of relationships between patients and communities	Expansion of the number of vacancies available at Sisreg through the (re)contracting of providers.
Network formation and care lines	Hospital information management panel and waiting time management.
2016: Axis VII Consolidation of the Reform and Pride in “Being SUS”	Examples and Actions
Consolidation of the values of RCAPS	Residents of Rio de Janeiro have the highest life expectancy in the country! Reduction in hospital beds due to improved resolution of PHC teams. Significant reduction in inequalities between social indicators.
Proud to be SUS	“I am SUS Pride, and I am committed to making SUS better!”
2017-2019: Axis VIII Reorganization of Primary Care Services	Examples and Actions
Study for resource optimization	Preparation of the “PHC Services Reorganization Plan”.
Reduction of FHS teams	Extinction of 183 FHS teams with a brutal reduction in access to PHC services.
2020: Axis IX COVID-19 Pandemic - Part 1	Examples and Actions
Riocentro Field Hospital	Opening of the Field Hospital to treat COVID-19 (even though the city of Rio de Janeiro had 2,200 beds deactivated at the time due to a lack of professionals in existing units in the municipal and federal networks).
Ceasing of the role of PHC during the pandemic	Implementation of the “PHC Services Reorganization Plan”, which in some regions of the city had its inequity exacerbated by the reduction in FHS teams.
2021: Axis X Pandemic - Part 2: PHC Protagonism in the Fight Against COVID-19	Examples and Actions
Investment in its own network - Ronaldo Gazolla Municipal Hospital in Acari	The Ronaldo Gazolla Municipal Hospital became the main reference for COVID-19, expanding the unit’s capacity to 420 beds, 280 of which were ICU beds.
Largest vaccination campaign in the city’s history	Application of around 13 million doses of the COVID-19 vaccine in the city of Rio de Janeiro, which corresponded to 82% of the population of Rio de Janeiro vaccinated with two doses or a single dose at the time.
Facing the public health emergency	Implementation of the Emergency Operations Center (EOC COVID-19 Rio), which fostered integration between technical areas, innovation in epidemiological analyses, institutional partnerships, and transparency in adopted measures. Formation of the first class of Episus Fundamental Rio in field epidemiology training at the basic level.
Vaccine, testing, and access	Opening of 17 COVID-19 Care and Testing Centers throughout the city, which was recognized and served cariocas from all social classes.
2022: Axis XI Recovery of the Healthcare Network as a Priority	Examples and Actions
Return of PHC teams	Return of more than 140 FHS teams in all PHC units, with the replacement of 6 CHAs per team. Expansion of the Street Clinic and Prison Primary Care teams to 100% coverage.
Budget rebalancing	Improvements in the infrastructure of health units with a balance between investment in partnerships and budget availability.
Super Carioca Health Center	Creation of the public health complex comprising the following units: Centro Carioca do Olho, Centro Carioca de Diagnóstico e Tratamento por Imagem, and Centro Carioca de Especialidades. The complex is modern, efficient and accessible, and aims to offer more services, speeding up care for the population of the city of Rio de Janeiro.
Center for Epidemiological Intelligence (CEI)	The CEI is characterized by epidemiology, integration, innovation, technology, and transparency. It was created as a strategy to work with health data and transform it into information for society and the entire network.
2023: Axis XII We can Live Longer, Better, and Happier	Examples and Actions
Happiness matters	Ensuring that all service points in the network have connectivity and a system. Launching of the online vaccination booklet and offering at least 10% of consultations remotely.
Digital Health and Debureaucratization	“MinhaSaúde.Rio” delivers all test results, prescriptions, and renewals, in addition to allowing 24-hour access to pre-medical consultations by telephone.
Strengthening knowledge centers	Expansion of the OTICS-Rio Network to the Souza Aguiar Hospital, planning to carry out the PHC user evaluation survey, PCATool “Rio 2024” (10 years after the first).
Restore the public-private relationship	Public-private partnerships (PPP) for hospital hotel services, with the purchase of services and procedures in public units.
2024: Axis XIII Public Health in Rio de Janeiro	Examples and Actions
Reestablishing bonds	Integration of specialists with each specialty center making its own regulation.
New forms of costing and payment	Units that train their own human resources, with the support of qualifications through the OTICS-Rio Network, and management of the acquisition and incorporation of specialized inputs.
2025: Eixo XIV Strengthening the SUS Network in Rio de Janeiro	Examples and Actions
Ampliação do acesso	Expansion of 700 beds in the two municipalized federal hospitals - Andaraí and Cardoso Fontes - with plan to create two more Super Health Centers to reduce waiting times, along with the expansion of the functionalities of “MinhaSaúde.Rio”.

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[TFN2n] Source: Based on Soranz et al.⁴, updated for the period of 2015 to 2025.