Analysis of the implementation of nutritional care in the context of Primary Health Care.

OBJECTIVE

To evaluate the implementation of nutritional care within the Primary Health Care (PHC) system in Brazilian municipalities and to identify the association between the degree of implementation and aspects of the sociodemographic and political-organizational context.

METHODS

This is an evaluative study with a quantitative approach that examined the responsibility of municipal managers in ensuring conditions and implementing interventions, based on the analysis of 17 indicators grouped into the dimensions of management and care. The municipalities were classified according to the degree of implementation of nutritional care in PHC by assessing the observed score relative to the maximum score, using the criteria "incipient," "intermediate," and "advanced." The influence of the context on the degree of implementation was analyzed, with the independent variables grouped into two blocks, using multivariate logistic regression.

RESULTS

A total of 4,064 Brazilian municipalities were evaluated, with an advanced level of implementation observed in 11.6% (n = 471). Management aspects received lower scores compared to care aspects. The contextual factors associated with a higher level of implementation of nutritional care were municipalities with a population of fewer than 25,000 inhabitants, located in the Southern Region, better social indicators, a lower proportion of children under five years of age, 100% coverage by the Family Health Strategy, and support from a dietitian in PHC.

CONCLUSION

The implementation of nutritional care in Brazilian PHC was considered in its early stages during the period under investigation. Despite significant advances in food and nutrition surveillance, nutritional care exhibited major weaknesses in the management and coordination of care. We reiterate the need for continuous processes to evaluate and monitor interventions in Primary Health Care, improve the quality of care, and integrate nutritional care into the care model.