Organization of primary health care and surveillance in response to COVID-19 in municipalities in the Northeast of Brazil

Abstract

The aim of this study was to analyze the organization and development of primary health care and surveillance, including norma-tive frameworks and the implementation of local health actions. Qualitative descriptive multi-ple-case study involving three municipalities in the state of Bahia. We conducted 75 interviews and a document analysis. The results were cat-egorized into the following two dimensions: approach to the organization of the pandemic re-sponse; and development of care and surveillance actions at local level. Municipality 1 was found to have a well-defined concept of the integration of health and surveillance with a view to organizing team work processes. However, the municipality did not strengthen the technical capacity of health districts to support surveillance actions. In M2 and M3, delays in defining PHC as the entry point for the health system and the prioritization of a central telemonitoring service run by the municipal health surveillance department com-pounded the fragmentation of actions and meant that PHC services played only a limited role in the pandemic response. Clear policy and technical guidelines and adequate structural conditions are vital to ensure the effective reorganization of work processes and foster the development of per-manent arrangements that strengthen intersec-toral collaboration.