Abstract
During the period of 1990-2000, Rio de Janeiro was characterized by a limited supply of public and universal primary care services. In 2008, family health team coverage corresponded to 3.5% of the population, the lowest among capital cities. At the end of 2013, coverage reached more than 40% of Rio residents with teams comprised of doctors, nurses, practical nurses, community health agents, and health surveillance agents, in addition to oral health teams. This article describes and analyzes the main components of the Reform in Primary Health Care (RCAPS) implemented since 2009, focusing on three lines of action: administrative reform, organizational model, and model of care. A new organizational chart of the Municipal Health Secretary and a legal framework for a new results-based model were created. As for the model of care, the standardization of procedures and health activities for all units and the monthly assessment of clinical indicators of results of implanted electronic medical records were created. Experience has shown the feasibility of RCAPS, pointing to new challenges that will allow consolidation of the expansion of access, training of human resources, health communication, and a shift to a managerial results-driven model.
Primary health care; Health assessment; Administrative reform
Source: Developed by the authors, based on the existing official structure of the Municipal Secretary of Health of Rio de Janeiro, July 2008 and January 2009.Legend: SUB-G = Undersecretary of Management; SUBVISA = Undersecretary of Health Surveillance and Inspection and Control of Zoonoses; SUBDC – Undersecretary of Civil Defense; SUBHUE – Undersecretary of Hospital, Urgent, and Emergency Care; SUBPAV = Undersecretary of Health Promotion, Surveillance, and Primary Care.
* Projection via the Strategic Planning of City Hall.Source: DAB/SAS/Ministry of Health4 and IBGE, resident-population estimated by year.Note: December was considered the reference month to represent population coverage (%) for each year.
