Primary health care in São Paulo, Brazil: As perceived by users, doctors, nurses and managers

The PROESF research, funded by the Brazilian Ministry of Health, plotted the base line of Primary Health Care in the largest Brazilian city, São Paulo, with a population of over 10 million inhabitants. The aim of this study is to present the perception of health professionals, managers and the public regarding the Primary Health Care offered. To fulfill this objective the Primary Care Assessment Tool (PCAT) was used, duly adapted and validated for Brazil, to evaluate the aspects of Primary Health Care services.  The application of the PCAT enabled the assessment of the basic health care network provided in São Paulo from the point of view of health professionals, managers and users, based on the Basic Health Care aspects understood as intrinsic to the first level of the health care system. Managers, doctors and nurses were interviewed from the 384 health care units in the city, as were a sample of users, totaling 1022 professionals and 559 users. Scores were calculated for each aspect of Primary Health Care and the General Basic Care Index, ranging from 5 (best) to 0 (worst). For the managers, the aspects "way in" and "coordination" gained the highest scores, approaching 5. Meanwhile the aspects "access”, “family approach" and "community guidance" gained the lowest scores. The General Basic Care Index ascertained based on managers’ opinions was 3.60. The assessment of the doctors and nurses follows the same trend as that of the managers. The worst evaluation was made by the users, with an overall index of 3.34, with the worst aspects identified precisely as family approach and community guidance.