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Effectiveness of health family strategy in the unified health system in São Paulo


Health policies does not always produce desirable changes in or meet the expectations and needs of the population. In a context of significant social inequalities and lack of public resources for financing the health sector, evaluation is essential to establish the responsiveness of policies, programs and services to the health needs of the population. Considering the investment made for expansion and consolidation of the Health Family Strategy, it is essential to make surveys to assess in what extent this strategy is associated with changes in population health. The development of a research on the effectiveness of the Family Health Strategy in the state of São Paulo is also important because, despite efforts to expand the strategy and the considerable increase in its population coverage in the State, the two models of care (family health and ‘traditional’) are operating in several municipalities. An evaluation of this kind can guide the managers about the effectiveness of such models and show ways to improve Primary Health Care. This project aims to assess the effectiveness of the Family Health Strategy on health indicators of different lines of care in the State of São Paulo and as specific objectives: to characterize the evolution of the coverage of the ESF in the municipalities of São Paulo state, characterizing the development of health indicators from different lines of care in the municipalities of São Paulo State; build theoretical models of networks of determining factors (social and political sectors) of the health situation; evaluating the effect of socioeconomic and demographic variables, and characteristics of the municipal health systems on health indicators of different lines of care. The epidemiology is the conceptual basis of the study, for its use in evaluation of policies and health programs. The rationale of the epidemiological study will be expressed by means of theoretical models, which seek to articulate the dimensions that have potential impact on public health. We propose an ecological and longitudinal study. Time series with annual data for the 645 municipalities will be obtained (dependent variable, independent variable principal and co-variables), from secondary data from various databases and information systems of the SUS. The outcomes consist of 12 indicators, grouped by rows of care: Women's Health, Child Health, Adult Health, Oral Health and Mental Health. The independent variable is the coverage of the PSF in each municipality and the co-variables are classified into three dimensions: the demographic, socioeconomic and organization of the health system. The influence of local coverage of ESF on the various outcomes I health indicators will be analyzed by multiple linear regression analysis for panel of data. (AU)

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