[Challenges in primary health care: the experience in Vila Mariana District, São Paulo, Brazil]

This article presents the results of a case study aimed at identifying challenges for the delivery of primary health care in a health district in the city of São Paulo, Brazil, considering comprehensiveness as a central device for organizing work at this level of care. Five units in the district's primary care network were studied. We collected the data by observing work routines and flows, conducting interviews with managers and health professionals from different backgrounds, and through focus groups with family health teams. The analysis shows a mismatch between users' characteristics and their presumed needs and the heterogeneity of the health professionals' perceptions concerning their work. Lack of staff and time and difficulties with referrals were the main problems identified by interviewees.