Multi-centre study in primary health care: Health care models, health system integration and intersectoral relations in urban contexts in Argentina, Brazil, Paraguay and Uruguay

The multicentric research conducted in Argentina, Brazil, Paraguay and Uruguay aim to identify limits on, and opportunities for, reorienting PHC as a strategy for achieving integrated, universal health systems, in view of the degree of health system segmentation and the fragmentation in health care provision. To overcome difficulties posed by the segmentation of health systems and fragmentation of healthcare is a challenge to improve equity in health.
The study analyzes PHC policies in each country and draw comparisons among them, examining PHC in five dimensions: 1)stewardship capability; 2)PHC financing; 3)provision, human resources and comprehensiveness; 4)integration and continuity of care; 5)intersectoral partnership and relationships between PHC and social/political stakeholders.
Qualitative and quantitative techniques were used (key-informant interviews, focal groups and questionnaires), indicators were defined and data collection tools built, ensuring comparability criteria among countries. The results were analysed with a strategy of methodological triangulation in order to characterize system segmentation and health care fragmentation, and its consequences for PHC.
The study contribute to analytical inputs to discuss the tensions among different Primary Health Care (PHC) approaches being applied in Latin American countries. These models, in the studied countries, range from selective PHC, which threatens social cohesion by not guaranteeing access and quality at all levels of care, to comprehensive PHC, where continuity in health care is assured and health determinants are addressed.
The developed methodological tools for the multicentric study to allow comparisons, respecting countries’ particularities could contribute to others research on PHC policies.  
The study is financed by the IDRC and framed by the Network for Health System and Service Research in the Southern Cone of Latin America.