A nurse navigating a complex healthcare system.

Nursing the Gap: Addressing Challenges in Primary Health Care

Lena Voss in Health & Wellness November 2025 • 4 min read.

"Explore the critical role nurses play in achieving primary health care goals and the obstacles they face in education, practice, and training."

Primary health care is the bedrock of any robust healthcare system, aiming to provide accessible, community-based services that address the majority of a population’s health needs. The National Primary Health Care Policy sets ambitious goals to improve care quality and tackle inequalities, but faces significant hurdles. Nurses, central to this framework as members of family health teams and coordinators of community health agents, navigate a complex landscape of challenges.

These challenges span various domains, most notably education, practice, and ongoing training. Effectively addressing these areas is crucial for fully realizing the potential of primary health care and ensuring that nurses are well-equipped to meet the diverse needs of their communities. This analysis explores the multifaceted issues that impact nursing within primary health care, providing a comprehensive overview of the current situation.

Understanding these challenges is the first step toward developing targeted strategies for improvement. By examining the educational preparation of nurses, the realities of their daily practice, and the opportunities for continuous professional development, a path forward can be created to strengthen primary health care systems and empower nurses to excel in their vital roles.

The Triad of Challenges: Education, Practice, and Training

A nurse navigating a complex healthcare system.

The challenges confronting nurses in primary health care can be categorized into three main areas: undergraduate education, the realities of daily practice, and the necessity for continuous training. Each area presents unique obstacles that must be addressed to optimize the effectiveness of primary health care services.

Undergraduate education forms the foundation for a nurse’s career, yet significant gaps exist in preparing graduates for the demands of primary health care. A key issue is the expansion of graduate nursing programs, particularly within private institutions. While this expansion aims to meet the growing need for nursing professionals, concerns arise regarding the quality and consistency of education. The National Examination of Student Performance (ENADE) reveals that nursing students require broader skills to effectively support the principles and guidelines of the public health system (SUS).

Curricula often emphasize specializations over generalist knowledge, leading to a disconnect between teaching and service.
Inadequate preparation for primary health care, regardless of whether the institution is public or private, remains a persistent issue.
There are, some adaptations, such as rural strategies and inclusion in research groups and university extension activities.
There's an ongoing debate around the need to integrate community needs and public health policies into nursing education.

Beyond education, the daily practices of nurses in primary health care settings present a host of challenges. Nurses must navigate a complex bureaucratic structure, often facing obstacles related to budget constraints and conflicting management priorities. Despite their commitment to primary health care, nurses may find themselves struggling against a system that is not fully aligned with the principles of the Brazilian National Health System (SUS). The decentralization and equity goals of the SUS, while commendable, are often undermined by a fragmented and diverse scenario characterized by precarious public provisions and limited social control. This environment complicates the effort to establish a truly hegemonic primary health care system.

Moving Forward: A Call to Action

Addressing the challenges in primary health care requires a concerted effort from educators, policymakers, and healthcare professionals. By strengthening nursing education, improving working conditions, and prioritizing continuous professional development, the full potential of primary health care can be realized. The journey toward a more equitable and effective healthcare system may be long, but with dedication and strategic action, significant progress can be made in the years to come.

About this Article -

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Everything You Need To Know

What are the key educational challenges nurses face in preparing for primary health care roles, especially concerning the National Examination of Student Performance (ENADE)?

Nurses face hurdles in undergraduate education, particularly with the expansion of graduate nursing programs. The National Examination of Student Performance (ENADE) reveals students often lack the broad skills needed to support the public health system (SUS) principles. Curricula may prioritize specializations, causing a disconnect with real-world service needs. Adapting to community needs and integrating public health policies into education remains an ongoing debate, vital for improving primary health care outcomes.

What obstacles do nurses encounter in their daily practice within primary health care settings, particularly concerning the Brazilian National Health System (SUS)?

Daily practice challenges in primary health care settings include navigating bureaucratic structures, budget constraints, and conflicting management priorities. Nurses may struggle against a system not fully aligned with the principles of the Brazilian National Health System (SUS). Decentralization and equity goals of the SUS are often undermined by fragmented public provisions and limited social control, complicating the establishment of a hegemonic primary health care system.

What are the implications of not addressing the educational gaps identified in nursing programs, particularly concerning alignment with the public health system (SUS)?

Addressing educational gaps involves improving undergraduate curricula to emphasize generalist knowledge and public health principles, as highlighted by the National Examination of Student Performance (ENADE). It also requires balancing the expansion of graduate nursing programs with ensuring consistent education quality. Failing to address these gaps means nurses will continue to be ill-equipped to meet the demands of primary health care, hindering the goals of the public health system (SUS).

What is meant by 'the triad of challenges' in primary health care, and why is it important to address all three components simultaneously?

The triad of challenges refers to the interconnected issues in undergraduate education, the realities of daily practice, and the necessity for continuous training that nurses face in primary health care. Ignoring any one area undermines the effectiveness of interventions in the others. For instance, even well-trained nurses will struggle if their daily practices are hampered by bureaucratic obstacles or inadequate resources within the Brazilian National Health System (SUS).

What strategic actions are needed to overcome the challenges nurses face in primary health care, and what are the potential consequences of inaction regarding the National Primary Health Care Policy?

Strategies for improvement involve a concerted effort from educators, policymakers, and healthcare professionals. Strengthening nursing education, improving working conditions, and prioritizing continuous professional development are essential. This requires aligning nursing education with the principles of the public health system (SUS), addressing bureaucratic obstacles, and ensuring adequate resources. Neglecting these strategies will perpetuate inequalities and limit the potential of primary health care to meet community needs effectively. The National Primary Health Care Policy needs to be aligned across all areas.