Avaliação da reorganização da Atenção Básica à Saúde no Brasil (2020-2023) durante a pandemia do Covid-19: análises críticas e propostas para o enfrentamento de futuros desafios sanitários

Abstract

The COVID-19 pandemic posed unprecedented challenges to the Brazilian healthcare system, with a particularly significant impact on Primary Healthcare (AB), which is responsible for a large portion of primary care provided to the population. The main objective of this study is to evaluate the reorganization of Primary Healthcare/Primary Health Care (APS) in Brazil in the context of the response to the COVID-19 pandemic, between 2020 and 2023, highlighting the repercussions and effects on the care provided to the population. The research adopts an evaluative approach, combining quantitative and qualitative methods through method triangulation, based on Implementation Analysis. This methodological design allowed for the examination of APS in multiple dimensions, covering both the structural changes implemented during the period and the perceptions and experiences of healthcare professionals and users of APS services. The analysis revealed a significant reorganization of APS services, with an emphasis on the implementation of technological innovations, such as telehealth, which enabled the continuity of remote care in a scenario of restricted mobility. It was also necessary to restructure care flows in primary healthcare units, adapting to the new health reality, and reorganize Family Health teams, which played a crucial role in ensuring access and continuity of care, despite the limitations imposed by the pandemic. The separation of care for patients with respiratory symptoms from other groups was an essential strategy in primary healthcare units to minimize the risk of contagion among users and healthcare professionals. However, the pandemic exposed deep structural inequalities within the Brazilian healthcare system, particularly in rural areas and regions with limited technological infrastructure and connectivity, where access to telehealth was extremely restricted or non-existent. The results indicate that, despite the increase in the number of Family Health teams, APS still faces critical challenges, such as fragmented care, work overload for healthcare professionals, and a lack of human, technological, and financial resources, especially in vulnerable areas. Regional disparities were accentuated by the pandemic, revealing fragilities in less developed areas, where access to basic healthcare services was already limited before the health crisis. The implementation of telehealth and other digital technologies proved to be an effective alternative to expand the reach of care. However, the lack of digital inclusion and insufficient technological training for professionals and users compromised the effectiveness of interventions, especially in the most vulnerable regions. The study concludes that a more robust and integrated planning is essential to ensure continuity and equity in access to healthcare services, even in crisis situations. It recommends the review and improvement of public health policies, guided by the principles of equity, accessibility, and service integration, to strengthen the central role of APS in the Brazilian Unified Health System (SUS) and ensure its responsiveness in future health emergencies. Moreover, the proper use of new information and communication technologies (ICTs) will be crucial to address the challenges posed by similar crises in the future.