Structural typology of Brazilian primary healthcare units: the 5 Rs

The structural typology of Brazil's 38,812 primary healthcare units (UBS) was elaborated on the basis of the results from a survey in cycle 1 of the National Program for Improvement in Access and Quality of Primary Care. Type of team, range of professionals, shifts open to the public, available services, and installations and inputs were the sub-dimensions used. For each sub-dimension, a reference standard was defined and a standardized score was calculated, with 1 as the best. The final score was calculated by factor analysis. The final mean score of Brazilian UBS was 0.732. The sub-dimension with the worst score was "installations and inputs" and the best was "shifts open to the public". The primary healthcare units were classified according to their final score in five groups, from best to worst: A, B, C, D, and E. Only 4.8% of the Brazilian UBS attained the maximum score. The typology showed specific characteristics and a regional distribution pattern: units D and/or E accounted for nearly one-third of the units in the North, and two-thirds of units A were situated in the South and Southeast of Brazil. Based on the typology, primary healthcare units were classified according to their infrastructure conditions and possible strategies for intervention, as follows: failed, rudimentary, limited, fair, and reference (benchmark). The lack of equipment and inputs in all the units except for type A limits their scope of action and case-resolution capacity, thus restricting their ability to respond to health problems. The typology presented here can be a useful tool for temporal and spatial monitoring of the quality of infrastructure in UBS in Brazil.