Innovate by returning to premises: the case of Sobral – 03/15/2024 – Public Health

“We want to take care of the patient before they become hypertensive or diabetic.” This phrase, said by a community health agent from the Family Health Center (CSF) Alto do Cristo in Sobral, Ceará, sums up well the challenge of universalizing or universal health systems, such as the SUS, since its conception: need to promote the efficiency of health spending and humanize care. In the Global South, the discussion about spending efficiency necessarily involves investing in Primary Health Care (PHC) in its promotion and prevention actions. These actions lead to a reduction in the burden of comorbidities, chronic conditions and neoplasms by transforming risk factors – smoking, physical inactivity, family history, among others – into protective factors, such as healthy eating and physical exercise. Even more important than ensuring the efficiency of public spending is always reiterating the humanist argument of the Declaration of Alma-Ata (1978), which asserts the role of governments in guaranteeing a healthy, dignified and fulfilling life for their population.

In the Brazilian context, we are facing a difficult situation for promotion and prevention within PHC. We simultaneously have an increase in the prevalence of chronic conditions, such as hypertension and diabetes, due to the progressive aging of the population, and the growth of risk factors and inadvisable habits. As an example, data from the Vigitel survey points to a 65% increase in the population reporting a diagnosis of diabetes between 2006 and 2021. This combination of factors means that PHC has gradually lost its promotion and prevention character, dedicating itself a lot more to the monitoring and care of chronic conditions than to the risk factors that lead to their development.

InovAPS: screening, management and prevention of chronic diseases

Through the InovAPS project, the Institute of Health Policy Studies and the City of Sobral seek to innovate by returning to the premises of what PHC should be. Recognizing the importance of caring for users with chronic illnesses, the initiative aims to inspire health professionals to devote broader attention to risk factors and behaviors in the population of Sobral. The pilot initiated at CSF Alto do Cristo stands out for the implementation of interdisciplinary interventions conducted by the professionals who make up the team, based on screening, management and prevention actions for comprehensive care.

The core of the project is the development of light technologies (protocols, campaigns, educational actions) by the professionals themselves, with the support of IEPS, since primary care territories are alive and there is not just one way to track, manage and prevent risk factors. At the same time, the logic of co-creating, testing and documenting results-oriented solutions is common to all healthcare units, which has provided impressive results at CSF Alto do Cristo.

In the six months prior to the implementation of InovAPS in the CSF, only 17 individual consultations for risk factors were recorded. In the first month of the project (in August 2023), 307 consultations related to these factors were recorded, providing more access and a broader view of the territory’s population. These results demonstrate that work oriented towards clear and feasible goals, with technical support for adequate recording in electronic medical records, can be replicated and expanded to different territories of Brazilian primary care. In January 2024, workshops were held with another 4 CSFs in Sobral to expand the project, with the goal of universalizing the work process proposed by InovAPS in the coming years.

Finally, the words of Regilânia Parente, manager of CSF Alto do Cristo, echo the community health agent’s phrase about caring before illness: “These actions are carried out to promote reflection in professionals and users and thus guide them to the development of their autonomy. We work together, involving professionals, managers and users in health educational practices, so that we can provide the implementation and construction of preventive health actions aimed at improving the quality of life of our population”.

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Beatriz Almeida is a public policy assistant at IEPS; Caio Rabelo is an IEPS project consultant; Jéssica Remédios is a public policy analyst at IEPS; Danielli Mendes de Sousa is general manager of Primary Care in Sobral; Larisse Araújo de Sousa is coordinator of Primary Care in Sobral; Letícia Reichel dos Santos is Sobral’s Secretary of Health; and Regilânia Parente is manager of CSF Alto do Cristo, in Sobral.

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