National primary health care policy in Brazil: An analysis of the review process (2015-2017)

Abstract

Objective. To describe and discuss events associated with the latest review of the national primary health care (PHC) policy in Brazil (Política Nacional de Atenção Básica, PNAB) so as to highlight narratives that may contribute to future analyses focusing on the formulation, implementation, and assessment of this policy. Method. Participant observation report of the PNAB review process, based on con-tent and document analyses. Results. The review process of PNAB, which took place between 2015 and 2017, was strongly marked by technical and political dispute between the Ministry of Health and authorities representing municipal and state health departments. The main changes introduced by the new version of PNAB are the financing of other PHC organizational models in addition to the Family Health Strategy; attribution of additional responsibilities to community health agents; introduction of a national set of core and extended PHC services and actions; and introduction of a manager role as part of PHC teams. Conclusions. Implementation of the revised PNAB, which was the result of inter-federation dispute, will depend on the convergence of interests in a PHC that is accessible and effective, strengthening the Unified Health System. This will substan-tially require societal engagement and leadership in the fight for the right to health in Brazil.