Management and Financing Models of Primary Health Care in Municipalities of the State of São Paulo

• Grant number: 25/10228-6
• Support Opportunities: Regular Research Grants
• Start date: January 01, 2026
• End date: December 31, 2027
• Field of knowledge: Health Sciences - Collective Health - Public Health
• Principal Investigator: Nivaldo Carneiro Junior
• Grantee: Nivaldo Carneiro Junior
• Host Institution: Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP). São Paulo , SP, Brazil
• City of the host institution: São Paulo
• Associated researchers: Arnaldo Sala ; Carla Gianna Luppi ; Mariana Cabral Schveitzer

Abstract

Project addresses the issues raised in the study raised by the analysis of the results of the research Participation of social organizations in the management of primary health care in municipalities of the state of São Paulo (PPSUS/FAPESP 2019/03961-8), adding new analytical perspectives to the agenda of the National Primary Health Care Policy (PNAB) of the SUS. The objective is to analyze the modalities of direct government management and outsourced public administration in Primary Health Care (PHC) in municipalities of São Paulo, addressing the attribute of comprehensiveness and the costs of the Family Health Strategy (FHS) team. This is an observational, cross-sectional, descriptive, and analytical study, using both quantitative and qualitative methodological approaches. The investigation will take place from 2026 to 2027. The methodological procedures will be carried out according to the following stages: 1 Construction of a municipal information panel related to PHC, based on secondary data from official databases on PHC and FHS coverage, composition of PHC/FHS teams, employment links of PHC/FHS professionals, municipal population sizes, and public administration modalities in PHC/FHS. A cluster analysis will be conducted using the panel data to form homogeneous groups of municipalities. 2 Case study based on the selection of three municipalities per homogeneous group. These municipalities will serve as priority research sites, where document analysis will be conducted on local PHC policies and FHS team funding, with the aim of consolidating this dimension across the different public administration modalities. 3 Qualitative approach: Semi-structured and structured interviews with social actors involved in PHC management at the municipal level and in the work processes of Basic Health Units (BHU) - one BHU will be selected per case. The interview guides will include questions adapted from the Primary Care Assessment Tool (PCATool). It is estimated that a total of 80 participants will be interviewed across the selected municipalities, using a semi-structured script: PHC coordinator from state and non-state public administration; UBS manager; physician, nurse, and community health agent from the FHS/UBS; and a professional from the FHS/UBS matrix support team. Additionally, in the selected municipalities and UBSs, it's estimated that 180 adult users registered in the FHS/UBS will participate in structured interviews. The data collected will be processed using qualitative data analysis software (for semi-structured interviews) and quantitative software (for structured interviews). Expected outcomes include contributions to the development of evidence-informed policies related to the comprehensiveness attribute of PHC and the costs of FHS teams within the different types of public administration in PHC in São Paulo. The findings may support the redirection and enhancement of sectoral public policies that strengthen the consolidation of the SUS. (AU)