This article proposes an analysis of the fiscal austerity measures of the Brazilian government and its unfolding in the public health system. It has examined the post-impeachment period of the president of Brazil and the changes of the social policies conduct in opposition to the principle of equity and universality in health with impacts on Brazilian sovereignty. It was a scientific essay on the perspective of the Unified Health System (SUS) and the policy development based on fiscal austerity that is taking place in the Brazilian political scenario, seeking to articulate a diagnosis of the impact of these actions on the structure of the country and the health rights. In this way, we conclude that the SUS is in imminent danger and that austerity policies in Brazil have denied the social gains achieved from previous governments, contributing to the discussion on health systems in the context of the neoliberal economic pressure and its impacts on lifestyles and access to the health services of the Brazilian people.

Resumo A Política Nacional de Atenção Básica proporcionou uma mudança significativa no que se refere às ações da saúde no território ribeirinho, criando equipes e equipamentos de saúde. As equipes de Saúde Ribeirinha e Saúde Fluvial para as áreas da Amazônia Legal e Pantanal foram inovadoras na atenção integral das populações da floresta. Esse estudo tem como objetivo analisar a atenção primária em saúde no contexto rural e ribeirinha no território amazônico, a partir da produção de ações individuais e coletivas das equipes de saúde, bem como o seu desempenho por meio de serviços ofertados nos municípios. O estudo é transversal, com delineamento descritivo-analítico e abordagem quantitativa, analisando a cobertura das ações de atenção básica de equipes da estratégia saúde da família em áreas urbanas, rurais e ribeirinhas de oito municípios situados no estado do Amazonas. Os resultados mostraram que houve aumento da cobertura da atenção básica em quase todos os municípios analisados, indicando que modelos tecnoassistenciais como das equipes ribeirinhas e fluviais produziram a inclusão de uma população que está dispersa em longas áreas do território dos municípios. Uma política de saúde com equidade produz mudanças e transformações nos modos de vida e nas condições de saúde das populações amazônicas.

A Unidade Básica de Saúde Fluvial constitui um novo modelo concebido para viabilizar cuidados básicos em saúde, visando a cobertura universal para populações ribeirinhas da Amazônia e Pantanal. O estudo tem como objetivo descrever o processo de planejamento e execução das atividades dessa unidade de saúde flutuante e a gestão do cuidado diferenciada nesse novo modelo de atenção à saúde preconizada pela Política Nacional de Atenção Básica. Trata-se de um estudo exploratório-descritivo sobre o processo de gestão do cuidado por meio de uma abordagem cartográfica, com observação participante e entrevista em duas viagens ao município de Borba no Estado do Amazonas. Destaca-se a relevância da política que dialoga com as características do território, entendendo o rio como caminho que o serviço de saúde deve utilizar para promoção da equidade, em especial para população ribeirinha da Amazônia.

Background: Almost 200,000 deaths from COVID-19 were reported in Brazil in 2020. The case fatality rate of a new infectious disease can vary by different risk factors and over time. We analysed the trends and associated factors of COVID-19 case fatality rates in Brazilian public hospital admissions during the first wave of the pandemic. Methods: A retrospective cohort of all COVID-19-related admissions between epidemiological weeks 10–40 in the Brazilian Public Health System (SUS) was delimited from available reimbursement records. Smoothing time series and survival analyses were conducted to evaluate the trends of hospital case fatality rates (CFR) and the probability of death according to factors such as sex, age, ethnicity, comorbidities, length of stay and ICU use. Results: With 398,063 admissions and 86,452 (21.7%) deaths, the overall age-standardized hospital CFR trend decreased throughout the period, varying from 31.8% (95%CI: 31.2 to 32.5%) in week 10 to 18.2% (95%CI: 17.6 to 18.8%) in week 40. This decreasing trend was observed in all sex, age, ethnic groups, length of stay and ICU admissions. Consistently, later admission (from July to September) was an independent protective factor. Patients 80+ year old had a hazard ratio of 8.18 (95% CI: 7.51 to 8.91). Ethnicity, comorbidities, and ICU need were also associated with the death risk. Although also decreasing, the CFR was always around 40–50% in people who needed an ICU admission. Conclusions: The overall hospital CFR of COVID-19 has decreased in Brazilian public hospitals during the first wave of the pandemic in 2020. Nevertheless, during the entire period, the CFR was still very high, suggesting the need for improving COVID-19 hospital care in Brazil.

This study analyzes the number of medical appointments and referrals performed in primary health care in Brazil focusing on the Mais Médicos Program (More Doctors Program). It is a cross-sectional study on the work of physicians included, or not, to the Mais Médicos Program in 2014. Based on validation protocols, a unified database was created from two health information system databases - SIAB and ESUS. Absolute indicators were defined: the total of medical appointments per month; medical referrals and community health education activities. In addition, other indicators were considered, such as weekly rates and productivity of appointments, in line with the profile of Brazilian municipalities. The mean of all appointments was 285 per month corresponding to an average of 14.4 appointments/day. In the poorest municipalities, the figures for the Mais Médicos Program physicians were higher than national rates. The educational activities provided by primary care teams that included a Mais Médicos Program professional were higher in Brazilian capital cities. The Mais Médicos Program achieved one of its main goals, which was to increase health access for vulnerable populations and to contribute towards the consolidation of primary health care in Brazil.

Objective: To analyse the mortality trends in children under five years old in Brazil from 2017 to 2020 and the influence of COVID-19 in 2020. Methods: A retrospective study employing secondary data from the Brazilian Mortality Informa-tion System. Deaths according to cause were extracted and disaggregated into early, late, post-neonatal, and 1 to 4-year-old periods. Corrected mortality rates per 1,000 live births and relative risk ratio for the cause of death were calculated. Results: There were 34,070 deaths, being 417 (1.2%) from COVID-19 in 2020. COVID-19 mortality was 0.17 per 1000 live births, reaching 0.006 in the early neonatal period, 0.007 in the late neo-natal, 0.09 in the postneonatal, and 0.06 in 1 to 4-year-old. Mortality decreased mostly for some diseases that originated in the perinatal period, congenital anomalies, diseases of the respira-tory system and external causes, in this order. In 2020, the highest rate was in the early neonatal period, with a fall from 7.2 to 6.5, followed by the postneonatal (3.9 to 3.4) and late neonatal (2.3 to 2.1). Among children aged 1 to 4-year-old, external causes had the highest proportional rate, and diseases of the respiratory system showed the highest decline. Conclusion: The mortality rate declined from 2017 to 2020, and this variation was higher in the early neonatal period. The risk of death from COVID-19 was 14 times higher in the postneonatal period and 10 times higher in children aged 1 to 4 year-old compared to the early neonatal period. (R) 2022 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/ 4.0/).