title: [Strengthening primary health care: a strategy to maximize coordination of care].
abstract: OBJECTIVE
  To describe and analyze the actions developed in four large cities to strengthen the family health strategy (FHS) in Brazil.
  
  
  METHODS
  Case studies were carried out in Aracaju, Belo Horizonte, Florianópolis, and Vitória based on semi-structured interviews with health care managers. In addition, a cross-sectional study was conducted with questionnaires administered to a sample of FHS workers and services users.
  
  
  RESULTS
  Actions needed to strengthen primary health care services were identified in all four cities. These include increasing the number of services offered at the primary health care level, removing barriers to access, restructuring primary services as the entry point to the health care system, enhancing problem-solving capacity (diagnostic and therapeutic support and networking between health units to organize the work process, training, and supervision), as well as improving articulation between surveillance and care actions.
  
  
  CONCLUSIONS
  The cities studied have gained solid experience in the reorganization of the health care model based on a strengthening of health primary care and of the capacity to undertake the role of health care coordinator. However, to make the primary care level the customary entry point and first choice for users, additional actions are required to balance supplier-induced and consumer-driven demands. Consumer driven demand is the biggest challenge for the organization of teamwork processes. Support for and recognition of FHS as a basis for primary health care is still an issue. Initiatives to make FHS better known to the population, health care professionals at all levels, and civil society organizations are still needed.
authors: Centro de Ciências da Saúde, Universidade Federal do Recôncavo da Bahia, Santo Antônio de Jesus, BA, Brasil. patty@ensp.fiocruz.br
authors: Patty Fidelis
authors: PF
authors: de Almeida
authors: Márcia Cristina Rodrigues
authors: MC
authors: Fausto
authors: Lígia
authors: L
authors: Giovanella
mesh_terms: D001938:Brazil; D003256:Community Participation; D003258:Consumer Behavior; D003266:Continuity of Patient Care; D003430:Cross-Sectional Studies; D005192:Family Health; D006270:Health Facility Administrators; D006282:Health Personnel; D006297:Health Services Accessibility; D006801:Humans; D010346:Patient Care Management / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014504:Urban Health