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Atenção primária em saúde: um estudo multidimensional sobre os desafios e potencialidades na Região Metropolitana de São Paulo (SP, Brasil) Primary healthcare: a multidimensional study on challenges and potential in the São Paulo Metropolitan Region (SP, Brazil)Resumo Este artigo apresenta resultados de estudo de caso na Região Metropolitana de São Paulo (SP) desenvolvido no âmbito de estudo multicên-trico na Argentina, no Brasil, no Paraguai e no Uruguai. O objetivo é analisar a Atenção Primá-ria em Saúde (APS) como estratégia para alcançar sistemas integrais e universais. A abordagem metodológica se pautou em cinco dimensões de análi-se: condução política; financiamento; provisão; integralidade e intersetorialidade. As técnicas incluíram revisão bibliográfica, análise documental e entrevistas com informantes-chave: gestores, especialistas, usuários e profissionais. Os resultados foram organizados em função dos desafios e das possibilidades da APS como estruturante do sistema segundo as cinco dimensões. Das entrevistas emergiram: distintas interpretações do conceito e papel da APS e o consenso como porta de entrada do sistema; debilidades no financiamento; desafios na gestão do trabalho e a necessidade de novo desenho jurídico-institucional para a gestão regional. Como potencialidades: a extensão de cobertura/ universalidade, base da organização do sistema, na vinculação com o território e na compreensão das especificidades da população. Palavras-chave Atenção Primária em Saúde, SUS, Região metropolitanaAbstract This paper presents some results of a case study in the Metropolitan Region of São Paulo (SP, Brazil) as part of a multicentric study conducted in Argentina, Brazil, Paraguay and Uruguay. The aim is to evaluate Primary Health Care (PHC) as a strategy to achieve integrated and universal healthcare systems. The methodological approach was based on five analytical dimensions: stewardship capability; financing; provision; comprehensiveness and intersectoral approach. The techniques included literature review, document analysis and interviews with key informants: policy makers; managers, experts, users and professionals. The results were organized in response to the challenges and possibilities of PHC as a structural system according to the five dimensions. The following emerged from the interviews: different interpretations on the concept and role of PHC and a consensus as the gateway to the system; weaknesses in funding; challenges in health workforce administration and the need for new legal-institutional design for regional management. The potential aspects were: broader coverage/universality, PHC as the basis for the organization of the system; connection with the territory and understanding specific population needs.

This article evaluates government measures to reduce inequity in the health sector in Belo Horizonte from 1993 to 1997. Our hypothesis is that a municipal administration committed to equity can reduce disparities in health with the support of the Unified National Health System (SUS). The methodology used an urban quality of life index in Belo Horizonte to detect social inequalities in living conditions, as well as differences between the component indices in the infant mortality rate. Other municipal measures were assessed according to the investment resulting from the implementation of a participatory local budget and open planning process. The urban quality of life index appeared to be an appropriate measure for orienting municipal administration. The infant mortality rate proved to be a good indicator for measuring inequality in health. There was a reduction in IMR and mortality reducing gaps in the districts studied. We observed greater investment of physical and financial resources in the districts with the lowest urban quality of life index, and it can thus be stated that the municipal administration reduced the prevailing inequalities.

OBJECTIVE:To describe an index to identify inequities in living conditions and health and its relationship with health planning. METHODS:Variables and indicators that would reflect demographic, economic, environment and education processes as well as supply and production of health services were applied for nondimensional scaling and clustering of 5,507 Brazilian municipalities. Data sources were the 2000 Census and the Brazilian Ministry of Health information systems. Z-score test statistic and cluster analysis were performed allowing to defi ning 4 groups of municipalities by living conditions. RESULTS:There was seen a polarization between the group with the best living conditions and health (Group 1) and the group with the worst living conditions (Group 4). Group 1 consisted of municipalities with larger populations while Group 4 comprised mainly the smallest municipalities. As for Brazilian macroregions, municipalities in Group 1 are clustered in the south and southeast and those in Group 4 are in the Northeast. CONCLUSIONS:The living conditions and health index comprises reality dimensions such as housing, environment and health which allows to identifying the most vulnerable municipalities and can provide input for setting priorities, and developing criteria for more equitable fi nancing and resource allocation.