Influência das mudanças de governo nas políticas nacionais de Atenção Básica (PNAB) sobre os indicadores de saúde bucal: um estudo ecológico

Abstract

Introduction: The National Oral Health Policy (PNSB) was fundamental to expanding the provision of dental services in primary care, but it underwent changes with the different National Primary Care Policies (PNAB) implemented in the period from 2011 to 2023. Objective: To evaluate the influence of government changes in PNABs on oral health care in Primary Care Health Units in the city of Natal, Rio Grande do Norte and Northeast Region, from 2014 to 2023. Methodology: This is a longitudinal ecological study, with oral health data from Natal, Rio Grande do Norte, and the Northeast Region. Data collection was carried out through the Primary Care Information System (SIAB), where indicators of Oral Health Team Coverage, Access to Dental Care, and the Resolution Index were captured. The time series were examined through descriptive analyses and statistical tests, such as linear regression and Mann-Kendall, with a significance of 5% (p < 0.05). Results: An exponential increase in access and resolution was evidenced in 2015 for the NE (159% and 252%, respectively), RN (122%, 237%, respectively) and Natal (101.1% and 822%, respectively). Over the period, the coverage of oral health teams grew significantly only in the Northeast (3.9%). As for access and resolution, all three territories had significant drops (p<0.05), being more pronounced during the pandemic, but with a slight recovery in the years 2022 and 2023. Conclusion: Changes in the PNABs over time significantly impacted the analyzed indicators. While the 2011 PNAB promoted the expansion of ESB, the 2017 PNAB brought flexibilities that compromised coverage and resolution. On the other hand, the most recent versions, such as the 2023 PNAB, reinforce the importance of oral health in primary care (AB), but face challenges related to insufficient funding and unequal distribution of teams.