PRIMARY HEALTH CARE, INDICATORS AND PATERNALISTIC PRACTICES: TENSIONS BETWEEN NATIONAL POLICIES AND TERRITORY

Abstract

Primary Health Care (PHC) occupies a central position within the Brazilian Unified Health System (Sistema Único de Saúde – SUS) and is internationally recognized for its capacity to promote equity, care coordination, and service effectiveness. However, the consolidation of PHC occurs in a context marked by tensions between the normative principles that guide public health policies—particularly those related to autonomy, social participation, and humanization of care—and the managerial mechanisms that structure its evaluation and financing. This article aims to conduct a literature review with a critical analysis of the contradictions and challenges associated with the use of ministerial indicators and targets in PHC, the importance of local epidemiological surveys, and the emergence of paternalistic practices in care delivery. This is a theoretical-conceptual essay grounded in a qualitative, exploratory, and interpretative approach, developed through a narrative and critical review of national and international literature, as well as normative documents issued by the Brazilian Ministry of Health. The findings indicate that, although indicators are essential tools for monitoring, resource allocation, and policy evaluation, their isolated and decontextualized use tends to oversimplify the complexity of care, potentially inducing practices primarily oriented toward the achievement of targets. Such a logic may undermine user autonomy and foster paternalistic approaches, which are misaligned with the principles of the National Primary Health Care Policy and the National Humanization Policy. Additionally, the limited implementation and systematic use of local epidemiological surveys restrict the understanding of territorial realities and compromise the development of more contextualized care practices. The study concludes that strengthening situational epidemiology and reframing the use of indicators are key strategies to enhance the quality of PHC, promote user autonomy, and align care practices with the ethical and political principles of the SUS.