The contribution of Primary Health Care in the SUS network to face Covid-19

Giovanella, Ligia; Martufi, Valentina; Ruiz, Diana Carolina; Mendonça, Maria Helena Magalhães de; Bousquat, Aylene; Aquino, Rosana; Medina, Maria Guadalupe

doi:10.1590/0103-1104202113014

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ESSAY • Saúde debate 45 (130) • Jul-Sep 2021 • https://doi.org/10.1590/0103-1104202113014 copy

The contribution of Primary Health Care in the SUS network to face Covid-19

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

The focus on individual care for severe cases neglected the community-centered approach required to cope with the Covid-19 pandemic in the Unified Health System (SUS) in Brazil. This essay argues that the Family Health Strategy (ESF), by means of its multi-professional teams and community and territorial orientation, is able to successfully develop the community approach required to deal with the pandemic. Inspired by local and international experiences, this essay analyzes four dimensions regarding SUS’ Primary Health Care (PHC) work in the fighting against Covid-19: community-based health surveillance, individual care for confirmed and suspected cases of Covid-19, community mobilization to support vulnerable local groups, and continuity of APS care routine. Limitations are acknowledged due to recent changes in the National Policy of Primary Health Care impacting health surveillance care model. The conclusion if for the need to: strengthen the community attributes of APS and Family Health Support multi-professional teams; collaborate with community organizations in initiatives of solidarity and articulate in an intersectoral way; guarantee the ongoing promotion, prevention and care actions by creating new working processes for health surveillance, social and health support for vulnerable groups, and for the continuity of the routine care for those in need.

KEYWORDS
Primary Health Care; Health surveillance; Care continuity; Community participation

Fields of action	Actions required
Health surveillance on the territories	• Carry out primary and secondary prevention actions - Identification of cases and active search of contacts - Notification of cases according to updated definition - Support for home isolation of cases and their contacts - Daily distance monitoring of cases in home care - Support for surveillance in nursing homes and other long-term care facilities in its territory • Provide health information and education for the community and on essential services - Leverage existing collective communication resources in the community such as community radios, message groups, sound car etc. - Inform on epidemiological situation of the territory and protective measures, such as social distancing, use of masks, hands washing etc. • Test cases, their contacts and healthcare professionals
Individual care of confirmed and suspected cases of Covid-19	• Organize care flows - Separate care flows of respiratory symptoms and suspected cases from those of patients with other problems or needs - Reduce to a minimum the number of professionals who contact personally each suspected or respiratory symptomatic case - Adapt the infrastructure • Care for patients with mild conditions - Evaluation of history and clinic should be timely and fast - Classify severity according to clinical protocol - Make available the equipment to UBS, such as oximeter, infrared thermometer, oxygen - Caring as for most updated protocols and based on the best scientific knowledge - Telemonitoring by the team of cases and their contacts: daily contact is recommended, preferably each 12hours • Provide appropriate PPE for all professionals according to the activity performed and train on appropriate use • Ensure timely referral of those in need of care from other care levels - Ensure timely and specific transportation to Covid-19 - Provide clinical stabilization until transportation arrives reference service premises • Teleservice that makes phone contact available for users - Line of care begins by a specific telephone designated to the attention of respiratory symptomatic cases with communication to the case teams of the area for daily telephone monitoring - All teams and UBS need to be provided with telephones and internet access to ease a non-person-to-person care to users - PHC integration with the Covid Call Centers, as in Rio de Janeiro: 160, and with Municipal Centers, for the monitoring of suspected cases by PHC teams • Training of professionals on care
Support for vulnerable groups on the territory due to their health or social condition	• Articulate community initiatives and promote intersectoral action - Mobilize leaders and social organizations - Disseminate information and clarify doubts on prevention measures - Support the distribution of donated resources, hygiene kits, and food parcels etc. • Map users at higher risk for Covid-19 such as the elderly, chronic patients, people under extreme poverty or food insecurity - Strengthen prevention measures and ensure resources so to establish the conditions to stay at home - Trigger social support networks - Articulate with Cras professionals to include in social programs - Monitor problems of domestic violence Any team professional can take charge of those actions, including CHWs, oral health teams, Nasf professionals.
The carrying on of PHC care routine	• Carry on care routines - Prenatal care, attention to hypertensive and diabetic patients, vaccination etc. - Develop lists of chronic patients who need continuous care - Develop new forms of daily distance care: availability of internet access, individual What-App and for user groups, telephone, video teleconsultation, telemonitoring - CHW visits within a certain radius around the domicile for monitoring and information • Leave the door opened, but under restrictions • Ensure the carrying on of pharmaceutical attention - Organize the home distribution of medicines by the CHW - Develop forms of electronic prescriptions with digital certification
For an effective action, provide INTERNET FOR ALL: health professionals and population. The government should provide Wi-Fi services in each neighborhood and community, and articulate with telephone companies to broaden the internet of all citizens carrying a cell phone; at least articulate to provide broadened access also in minutes as through messages and internet, for all professionals, including all CHW.

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E-mail: revista@saudeemdebate.org.br

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