Notes on persistent challenges for basic health care in Brazil

摘要

In recent decades, Brazil has witnessed a proposal to create an extensive basic health care network as the main portal of entry to a universal public health system. Based on the recognition of consistent strides in that direction, the article addresses four issues on some important challenges for the consolidation of the basic health care proposal: (1) the use of the term “basic health care” as opposed to the usual, hegemonic concept of “primary health care”; (2) the disconnect or mismatch between the policy’s wording and its real-life implementation, underscoring the need for a review of the Brazilian National Basic Health Care Policy (PNAB), which centralizes and standardizes rules and routines for the entire country while overlooking Brazil’s continental dimensions, heterogeneity, and wide local diversity; (3) the isolation of basic health care and its peripheral position in the health system, pointing to the need for more complex arrangements in the coordination of care, not left merely under the organization and responsibility of basic health care; and (4) the lack of health policymakers, administrators, and professionals who are prepared and aligned with a project aimed at transforming the country’s prevailing health care model.