Background Brazil is the most populous country with a public, universal and free health care system. The National Program for Access and Quality Improvement in Primary Care (PMAQ) was created to improve the quality of primary health care (PHC). Objective To evaluated whether progress generally has been made within Brazil’s PHC since PMAQ implementation, and if changes occurred uniformly in the country, while also identifying municipal characteristics that may have influenced the improvement. Methods This is an observational study using data from PMAQ external evaluation (2012 and 2014), a 1200-item survey used to evaluate Brazilian PHC quality. After confirming the groupings of items using factor analysis, we created 23 composed indexes (CIs) related to infrastructure and work process. Results On average, the large majority of CIs showed improvements between 2012 and 2014. Region and city size moderated changes in the PHC indices differently. Overall, there were better improvements in infrastructure in the Northeast compared with other country regions, and in smaller cities (10 000–20 000 people). Infrastructure indices appear to have improved equitably across the country. Work process improvements varied with city size and region. Conclusion Despite similar support of PMAQ across the country, improvements are not predictable nor homogeneous. Non-uniform improvements were seen in Brazil’s PHC. Though we do not directly evaluate the effectiveness of the PMAQ (financial reward) method, these initial findings suggest that it is a potentially useful tool to improve health systems, but additional support may be needed in regions that lag behind in quality improvements.

O estudo objetiva apresentar a Pesquisa Participativa de Base Comunitária (PPBC) como metodologia utilizada em estudo de participação com adolescentes. A metodologia adotada aborda questões relacionadas ao estudo e a intervenção em determinado grupo de pessoas, a comunidade a ser estudada, que nesse estudo são os adolescentes. Para tanto, alguns princípios devem ser seguidos para que as vantagens do método sejam evidentes. A pesquisa, nesse estudo relatada, enfatizou a temática participação na promoção da saúde do adolescente em uma perspectiva mais abrangente, sendo desenvolvida com um grupo de adolescentes que vivenciaram momentos educativos/participativos, baseados nos princípios da PPBC. A pesquisa abrangeu seis encontros, cada um foi planejado juntamente com os adolescentes. A avaliação do processo realizou-se mediante a observação e percepções colhidas através de registros escritos e verbais, além das manifestações não verbais. Destacaram-se como pontos positivos na implementação da metodologia a consecução de autonomia e vínculo entre a comunidade estudada e a científica (adolescentes e pesquisadores), e o aprendizado de temas realizados a promoção da saúde do público adolescente. Evidenciou-se que esse tipo de metodologia adequou-se ao estudo com adolescentes, tendo em vista que os passos foram seguidos para o alcance do objeto do estudo.

The aim of this study was to understand how the attendance of family planning to the adolescent happens on the point of view of nurses who work in the Family Healthcare Units (FHU) of the Regional Executive Secretariat VI in Fortaleza-CE. It is a descriptive study carried out with eight nurses of the FHU in March and April 2009. Semi-structured interviews were carried out and the data were organized through the discourse of the Collective Subject technique and analyzed with literary review. The results evidenced that the attendance to the adolescent occurs in these units, but not in a specific way. It is characterized by limited accessibility to contraceptive methods and fragility in the organization of the service, too much delay in client service besides lack of time or space to accomplish group activities. DESCRIPTORS: Family Planning; Adolescents; Community Health Nursing.

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