The Family Health Strategy and Health Surveillance: is it possible to integrate?

Area of Science:

• Public Health
• Health Policy
• Epidemiology

Background:

• The integration of Health Surveillance (HS) and Primary Health Care (PHC) is a critical component of the Unified Health System (SUS) in Brazil.
• The Family Health Strategy (FHS) has been in place for 30 years, facing ongoing challenges in its articulation with HS, particularly in controlling endemic diseases like dengue.
• Recent years have seen a worsening of health indicators, with the COVID-19 pandemic exacerbating the incidence of arboviruses such as dengue.

Purpose of the Study:

• To analyze the integration between HS and PHC within the SUS, focusing on dengue control and the challenges encountered over three decades of the FHS.
• To identify convergences and divergences in guidelines for integrating health services and PHC.
• To map Brazilian experiences of collaboration between HS and PHC.

Main Methods:

• An exploratory-descriptive study employing a three-stage approach.
• Stage 1: Documentary review of SUS regulations to assess integration guidelines.
• Stage 2: Scoping review of Brazilian experiences in HS and PHC articulation.
• Stage 3: Secondary data analysis using dengue as a tracer condition, including data from the Arbovirus Monitoring Panel and the National Census of PHC units (2016-2022).

Main Results:

• Brazil experienced a deterioration in health indicators between 2016 and 2022, with increased dengue incidence, partly due to the COVID-19 pandemic.
• The study identified a need for intersectoral policies and coordinated actions between FHS and HS teams to improve public health outcomes.
• Persistent obstacles to integration include fragmented actions and resource scarcity, hindering effective disease control.

Conclusions:

• Successful integration of HS and PHC requires structural changes to bolster local governance and enhance social participation.
• Strengthening these integrated systems is essential for more effective responses to dengue and other health emergencies.
• Overcoming fragmentation and resource limitations are critical steps towards achieving better health surveillance and primary care synergy.