PHC service resilience during COVID19 in Brazil’s Northeast

COVID19 affected health system, including its ability to care for other health issues. Health System Resilience is related to the ability of a health service to continue to offer ongoing care for health issues while under a stressor. Brazil has a public-funded unified health system with a Primary Health Care (PHC) organized by the Family Health Strategy (FHS), which comprise a family doctor, a nurse, a dentist, nurse auxiliaries and Community Health Agents (CHAs). The CHAs are individuals from the community trained to provide a range of services in the territories, including home visits, and act as liaisons between health units and communities-key informant on the reality faced in the public services during COVID19. Brazil's northeast region is one of the country's poorest regions, with poor social indicators, including low HDI and high illiteracy, utilization of Brazil's conditional cash transfer program and COVID19 mortality. This study evaluated aspects regarding the impact of COVID19 in PHC activities related to diabetes&hypertension, tuberculosis, leprae, pre-natal care, pap smear and oral health care in Brazil's northeast region public service. Questionnaires were applied to CHAs from 8 different cities - 4 capitals and 4 country-side municipalities. A total of 1935 CHAs were interviewed. The data show unequal COVID19 impact in PHC (different impact of COVID19 in the various municipalities and health care services). For 21.3% of CHW, the activities related to pre-natal care diminished during 2021 COVID19 pandemia, this percentage was 25.6%, 30.2%, 41.9%, 79.9% and 79.3% for tuberculosis, leprae, diabetes & hypertension, pap smear and oral health respectively in the PHC. The lack of a unified federal plan, due to a political misleading perspective may have negatively influenced the PHC. Understand how PHC was affected in different scenarios is important to strength the system in a more resilient manner, which is central in the event of other stressful events KEY MESSAGES: • There was an unequal impact of COVID19 on different PHC public services, which may be due to political tension and lack of federal guidance of the health system. • Understand how PHC was affected is important to reorganize the system in a more resilient manner, which is central in the event of another COVID19 wave or other stressful event.