Community and Provider Perceptions of Brazil's O Programa de Saúde da Familia In Vespasiano, Minas Gerais, Brazil Pubblico

Abstract

Background: Under Brazil's universal public health care reform in the 1990s, the
Family Health Program (O Programa de Saúde da Família, or the PSF) was implemented
to reach populations with traditionally limited access to health care, using decentralized
primary care units and home visits from community health agents. The program
emphasizes prevention, health education and community participation.

Objective: The goal of this project is to identify and analyze patterns and differences
between the perceptions and satisfaction levels of community members and PSF
professionals and to identify ways in which the PSF can better serve communities.

Methods: We collected data from caretakers of children under five and PSF health
professionals through written surveys from June to August 2009 in Vespasiano, Minas
Gerais, Brazil. Caretakers were asked about their utilization and satisfaction with the
PSF's diarrhea services and with the PSF overall; professionals were asked about
diarrhea prevalence in the community, their job-related experiences and challenges, and
their evaluations of various aspects of the PSF.

Results: Caretakers had high satisfaction levels with the PSF's services for child
diarrhea and with their PSF experiences overall, but the PSF's diarrhea services were still
being underutilized. Although both populations had favorable perceptions on the various
aspects of the PSF, professionals generally had higher ratings than did caretakers.
Caretakers had more positive perceptions of home visits and health agents than with the
PSF units and unit staff.

Discussion: Although professionals had higher satisfaction levels with the PSF's
diarrhea services than caretakers, other aspects of the PSF had varied satisfaction levels
among caretakers and professionals. More comprehensive training for professionals,
improved scheduling processes for patients and increases in funding for human and
material resources at the PSF unit may increase satisfaction for both groups as well as
improve utilization levels and health outcomes in the Vespasiano community.

Table of Contents

REVIEW OF THE LITERATURE .................................................................................................. 10
The Brazilian Health System ......................................................................................................... 10
Indicators of User Satisfaction with Health Systems ............................................................. 13
Users' and providers' Perceptions of Brazil's Family Health Program ............................ 19
Successes of the Family Health Program ................................................................................... 21
AUTHOR'S CONTRIBUTIONS ..................................................................................................... 24
INTRODUCTION ................................................................................................................................. 25
METHODS .............................................................................................................................................. 28
Study Population ............................................................................................................................... 28
Caretakers ...................................................................................................................................... 28
Health Care Professionals ........................................................................................................ 29
Data Collection .................................................................................................................................. 29
Caretakers ...................................................................................................................................... 30
Health Care Professionals ........................................................................................................ 31
Data Analysis ..................................................................................................................................... 32
Caretakers ...................................................................................................................................... 32
Health Care Professionals ........................................................................................................ 33
RESULTS ................................................................................................................................................ 35
Population Characteristics .............................................................................................................. 35
Caretakers ...................................................................................................................................... 35
Health Care Professionals ........................................................................................................ 35
Perceptions and Experiences with PSF....................................................................................... 36
Caretakers ...................................................................................................................................... 36
Health Care Professionals ........................................................................................................ 37
Factors Contributing to PSF Professionals' Satisfaction ....................................................... 38
Professional and Community Differences ................................................................................. 39
Caretaker Perspectives..................................................................................................................... 40
PSF's Benefits ............................................................................................................................... 40
PSF's Problems ............................................................................................................................ 41
Recommendations for Improvement ....................................................................................... 42
DISCUSSION ......................................................................................................................................... 43

About this Master's Thesis

Rights statement

• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Parola chiave	PSF satisfaction SUS Brazil Family Health Program
Committee Chair / Thesis Advisor	Leon, Juan, Emory University
Partnering Agencies	Non-US governmental agency (e.g., Minister of Health in Haiti) University, college or educational institution (other than Emory)

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