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Ligia Giovanella

Bio: Ligia Giovanella is an academic researcher from Oswaldo Cruz Foundation. The author has contributed to research in topics: Health care & Public health. The author has an hindex of 30, co-authored 138 publications receiving 3502 citations. Previous affiliations of Ligia Giovanella include Rio de Janeiro State University & Carlos III Health Institute.


Papers
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Journal ArticleDOI
TL;DR: The expansion of the SUS has allowed Brazil to rapidly address the changing health needs of the population, with dramatic upscaling of health service coverage in just three decades, but analysis of future scenarios suggests the urgent need to address lingering geographical inequalities, insufficient funding, and suboptimal private sector-public sector collaboration.

460 citations

Journal ArticleDOI
TL;DR: A trend toward incremental change in the primary care model in Brazil is confirmed, and the expansion of the FHP in large urban areas faces several obstacles to guaranteeing all individuals access to comprehensive care with adequate clinical and collective health services, including secondary and tertiary care.
Abstract: As part of the implementation of the country's Unified Health System (Sistema Unico de Saude), the Brazilian Government created, in the second half of the 1990s, the Family Health Program (FHP) (Programa de Saude da Familia), based on community-oriented, multidisciplinary care serving people organized into small groups. For this study, we evaluated the implementation of the FHP, based on three criteria: (1) the construction of the program as an entry point for most health needs and for access to specialized care, (2) the program's linkages with a comprehensive network of health services, and (3) the incorporation of new care practices into the health system. We found that the implementation of the FHP was far from uniform. In some municipalities the FHP is a focused program that runs in parallel with other primary care efforts. However, in other municipalities the FHP is viewed as a strategy aimed at changing the primary care model, and it partially or completely replaces preexisting primary care health units. Our research confirms a trend toward incremental change in the primary care model in Brazil. However, the expansion of the FHP in large urban areas faces several obstacles to guaranteeing all individuals access to comprehensive care with adequate clinical and collective health services, including secondary and tertiary care. The positive results that we found with some of the experiences with the FHP indicate that, in addition to increased federal financial incentives, the success of the FHP depends on creative local strategies to deal with Brazil's diversity.

286 citations

Journal ArticleDOI
TL;DR: The article analyzes the implementation of the Family Health Strategy in Brazil and discusses its potential to guide the organization of the Unified Health System in Brazil, based on the integration of FH to the health care network and intersectorial action, crucial aspects of a comprehensive primary health care.
Abstract: The article analyzes the implementation of the Family Health Strategy (FH) and discusses its potential to guide the organization of the Unified Health System in Brazil, based on the integration of FH to the health care network and intersectorial action, crucial aspects of a comprehensive primary health care. Four case studies were carried out in cities with high FH coverage (Aracaju, Belo Horizonte, Florianopolis e Vitoria), using as sources: semi-structured interviews with managers and surveys with health care professionals and registered families. The integration analysis highlighted the position of FH Strategy in the health services network, the integration mechanisms and the availability of information for continuity of care. Intersectoriality was researched in relation to the fields of action, scope, sectors involved, presence of forums, and team initiatives. The results point to advances in the integration of FH to the health care network, strengthening basic services as services that are regularly sought and used as a preferential first contact services, although there are still problems in the access to specialized care. The intersectorial initiatives were broader when defined as integrated municipal government policy for the construction of interfaces and cooperation between the diverse sectors.

234 citations

01 Jan 2010
TL;DR: In this paper, the authors analyzed the development of instruments for coordination between the family health strategy and other levels in the health system, with a focus on measures to promote coordination linked to the integration among levels of care.
Abstract: This article analyzes the development of instruments for coordination between the Family Health Strategy and other levels in the health system, with a focus on measures to promote coordination linked to the “integration among levels of care”. The results of case studies in four large cities indicate the presence of mechanism for integration among levels of care, suggesting concern with guaranteeing comprehensive care. The principal strategies identified here were: creation and strengthening of regulatory structures in the Municipal Health Secretariats and family health units with decentralization of roles to the local level, organization of flows, electronic patient charts, and expansion in the supply of specialized services at the municipal level. However, lack of integration among different providers, insufficient formal flows for hospital care, and absence of policies for medium complexity care were detected as barriers to the guarantee of comprehensive care, making the network’s integration incomplete.

146 citations

Journal ArticleDOI
TL;DR: In this article, an estudo do tipo ecologico de series temporais com dados secundarios referentes ao numero de equipes implantadas de saude da familia and as ICSAB no SUS de 2001 a 2016.
Abstract: Resumo Criado em 1994, o Programa Saude da Familia gradualmente tornou-se a principal estrategia para a mudanca do modelo assistencial e a ampliacao do acesso de primeiro contato aos servicos de saude no SUS. Pouco mais de dez anos depois foi enunciada como Estrategia de Saude da Familia (ESF) na Politica Nacional de Atencao Basica (PNAB), em 2006. Este artigo avaliou os efeitos da implementacao da ESF ao longo das duas ultimas decadas no Brasil, demonstrando o acesso proporcionado e a tendencia das internacoes por condicoes sensiveis a atencao basica (ICSAB). Trata-se de um estudo do tipo ecologico de series temporais com dados secundarios referentes ao numero de equipes implantadas de saude da familia e as ICSAB no SUS de 2001 a 2016. Os resultados evidenciam a reducao em 45% das taxas padronizadas de ICSAB por 10.000 hab, que passaram de 120 para 66 no periodo de 2001 a 2016. Apesar de nao ser possivel isolar os efeitos da atencao primaria, e bastante plausivel que o resultado da reducao das ICSAB esteja vinculada ao avanco da cobertura da ESF no Brasil, em especial na melhoria do acompanhamento das condicoes cronicas, no aprimoramento do diagnostico e na facilidade do acesso aos medicamentos.

143 citations


Cited by
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Journal ArticleDOI
TL;DR: If the Brazilian health system is to overcome the challenges with which it is presently faced, strengthened political support is needed so that financing can be restructured and the roles of both the public and private sector can be redefined.

1,689 citations

Journal ArticleDOI
TL;DR: In the introductory article to a six-part PLoS Medicine series on Migration & Health, series guest editors Cathy Zimmerman, Mazeda Hossain, and Ligia Kiss outline a migratory process framework that involves five phases: pre-departure, travel, destination, interception, and return.
Abstract: In the introductory article to a six-part PLoS Medicine series on Migration & Health, series guest editors Cathy Zimmerman, Mazeda Hossain, and Ligia Kiss outline a migratory process framework that involves five phases: pre-departure, travel, destination, interception, and return.

494 citations

Journal ArticleDOI
TL;DR: Important improvements in health status and life expectancy are reported, which can be ascribed largely to progress in social determinants of health and to implementation of a comprehensive national health system with strong social participation.

471 citations

Journal ArticleDOI
TL;DR: The expansion of the SUS has allowed Brazil to rapidly address the changing health needs of the population, with dramatic upscaling of health service coverage in just three decades, but analysis of future scenarios suggests the urgent need to address lingering geographical inequalities, insufficient funding, and suboptimal private sector-public sector collaboration.

460 citations