Models of primary health care in large cities in the State of S?o Paulo: effectiveness, efficaciousness, sustainability and governableness

摘要

> face="Verdana, Arial, Helvetica, sans-serif" size="2"> Through an extensive analysis of secondary data and interviews (structured questionnaires) with the main actors in the municipal health system, the article identifies models of primary health care and degrees of effectiveness, efficaciousness, sustainability and governableness of the municipal health and primary health care systems of cities in the state of São Paulo with more than 100 thousand inhabitants. The article also presents and discusses the main external and internal (by sector) obstacles faced when structuring Primary Health Care in these municipalities. The external obstacles are mostly due to the urbanization profile and to old and new social problems expressed in situations of extreme inter and intramunicipal inequality, knowing that facing these obstacles depends on many intersectoral public policies, especially in the social and work fields. Meanwhile, the internal or sectoral obstacles are due to the way the health services and technologies are distributed and to the standard of organization of these services. The solution depends on specific health policies especially oriented towards problems in metropolitan regions and towards an increased effectiveness and sustainability of the municipal primary health care systems.