Financiamento da Atenção Básica dos municípios da Bahia: análise das transferências federais de 2008 a 2017.

Abstract

By means of an exploratory descriptive time series approach, this study aims to analyze the transfer of resources from the federal government to the Primary Health Care (PHC) accounts of the municipalities of the state of Bahia. Specifically, it will characterize the fixed and variable components of the Basic Attention Floor (PAB), according to population size, during the period of implementation of the SUS financing blocks (2008 to 2017). The study used data available on the National Health Fund website, stratified into four groups of municipalities according to population size, based on the population of the 2010 Census. Absolute (n) and relative (%) frequencies of financial volume and per capita value were calculated, as well as a central tendency measure. For the purpose of comparing the financial data across the years of interest, monetary restatement for the last year of the study was carried out using the Broad Consumer Price Index (IPCA). The results revealed a 14.3% increase in federal funding for primary care, in real values, for municipalities in the state of Bahia, especially for small ones, which recorded a per capita variation in the PAB of R$ 124.32 inhab/year in 2008 to R$143.36 inhab/year in 2017. It is worth to mention that more than 60% of large municipalities received fixed PAB transfers per capita below the minimum values established by the legislation. It is also noteworthy that, for the fixed PAB of small municipalities, parliamentary amendments (temporary increases in the PAB) were found to be fundamental for the financing of primary care in Bahian municipalities between 2015 and 2017. The findings reinforced the significance of the variable PAB within municipal PHC accounts, especially for small and medium-sized municipalities. The predominant vertical ministerial programs within the variable PAB were the Family Health Program (PSF), the Community Health Agents (ACS) Programme, the National Program for Improving Access and Quality of Primary Care (PMAQ-AB), and the Family Health Support Units (NASF), across all the analyzed population groups. Thus, the research revealed an overall scenario of federal funding of primary care for the municipalities of Bahia with a relatively equitable perspective, given the distribution of federal resources according to population size. Further investigations are recommended to be carried out at the municipal level, as well as across the geographic regions of Brazil, to better understand the patterns of allocation of federal resources, as well as to identify whether the distribution of federal resources has contributed to the reduction of health inequalities across the Brazilian territory. Furthermore, given the change in policies related to the federal funding of primary health care, it is recommended that studies be carried out on the possible effects of the Previne Brazil Programme on the distribution of federal resources for this level of care in Brazil.