Inequalities in the work process of Brazilian primary health care teams: a rural-urban analysis based on PMAQ-AB data = Desigualdades en el proceso de trabajo de los equipos de Atención Primaria de Salud en Brasil: un análisis rural-urbano basado en el PMAQ-AB

Resumen

Objective: To evaluate the work process of Primary Health Care teams in Brazil, based on the rural/urban typology defined by the Brazilian Institute of Geography and Statistics. Method: This is a cross-sectional evaluative study with a quantitative and analytical approach, based on secondary data from the third cycle of the National Program for Improving Access and Quality of Primary Care (PMAQ-AB), conducted between 2017 and 2018. A total of 37,350 Primary Health Care (PHC) teams (96.1% of those approved for participation) were analyzed. The study focused on two analytical axes: (1) territorialization and (2) team planning. Data were processed using Multiple Correspondence Analysis (MCA), which enabled the identification of patterns in the organization of work processes based on municipal typology. Results: The study revealed important disparities across municipal strata. Adjacent rural municipalities had the lowest percentage of teams with uncovered populations (21.0%), while urban and remote intermediate municipalities showed the highest rates (42.0% and 43.6%, respectively). Regarding planning, 15.1% of teams reported not conducting planning activities, with the lowest proportions found in remote municipalities. The MCA perceptual maps identified three main clusters,showing the concentration of positive organizational attributes in intermediate adjacent municipalities and weaker work processes in remote areas. Conclusion: The organization of PHC teams' work processes varies significantly according to the rural/urban classification of municipalities. These findings reinforce the need for territorialized policies and differentiated support strategies to strengthen PHC performance in diverse Brazilian contexts.