Analysis of Primary Health Care indicators and expenditures after changes in Federal Co-financing in the municipalities of Pernambuco, Brazil.

The Previne Brasil program and the new 2024 methodology altered the federal co-financing of Primary Health Care (PHC) in Brazil. This study aimed to analyze the temporal trend of performance indicators and the number of registrations in PHC services and to compare the cost of PHC expenses from federal resources, after the co-financing changes, in the municipalities of Pernambuco. This is an ecological study with temporal trend analysis using Joinpoint regression, from 2018 to 2024. In this study, Pernambuco was used as an illustrative case to discuss the application of payment for performance (P4P) in universal systems. A growing trend was observed in registrations and performance indicators. A punctual reduction in federal funding was identified in 2021. After the discontinuation of Previne, the Union's participation in the financing of PHC was greater. However, the challenge of overcoming evaluation models restricted to the process dimension persists, making it imperative to recover Donabedian's triad and the essential attributes of primary health care to guarantee quality of the Unified Health System.