Family Health Program - of the attendance to the care: evaluation of the implementation of the primary health care / Programa Saúde da Família - da assistência ao cuidado: avaliação da implementação da atenção primária à saúde




The Primary Health Care (APS) it corresponds to the essential cares to the health, it constitutes the first contact level with the national system of health and the first element of a continuous process of attention. In Brazil, the Family Health Program (PSF) it is the main implementation strategy and organization of APS. PSF incorporates the beginnings of the Single Health System (SUS) and lens to transform the traditional model Brazilian sanitarium - doctor, medicamentoso, curative and individual, that it has at the hospital the solution lócus for whole and any problem of health -, in a collective model of health, multiprofissional and transdisciplinar, centered in the family and in the community. Like this, this study had as objective evaluates the primary health care in the context of PSF of the municipal district of Cajuri, MG, starting from the daily practice of the actions and services of health offered. It is a descriptive cross-sectional study, with a combined qualitative-quantitative approach, done during the period of month november of 2008. They made part of the study the protagonists of the municipal system of local health: the municipal managers (n=2), the professionals of PSF (n=22) and the pregnant women registered in PSF (n=21). The used data collections instruments used were: 1) semi-structured interviews conducted at the interviewees home or workplace and 2) revision of the handbooks starting from a structured itinerary, built in agreement with the orientations proposed by the Technical Manual of Ministy of Health - Prenatal and Puerpério: qualified attention and humanized. The questionnaires were elaborated by the coordinating team of the research, with base in the theoretical presuppositions of Gérvas et al. (1987), Mendes (2002) and Starfield (2002). The interviews were recorded after consent of the informants and transcribed, respecting the spelling and syntax used by interviewees. The Triangulation of Methods was used as strategy of approach of the data; the quantitative data were analyzed using the software Microsoft Office Excel; the content analysis proposed by Bardin (1977) was used to analyze the qualitative data. Analyzing the social representations on SUS, it was found an inadequate apprehension level and knowledge of their beginnings and guidelines, more expressivamente in the group of the Community Agents of Health (ACS) and in the pregnant women s group. Most of the speeches characterized PSF as a strategy that has been pointing characteristics possibilitadoras of the inversion of the model assistencial, bringing many benefits for the health of the population, especially due to the facilitation of the access provided by the home visits and for the search it activates accomplished by the professionals. In spite of, they were noticed strong influences of the biomedical model, mainly in the community agents of health speeches (ACS), that, although they accomplished the education in health, most of the time she happened in an individualized way, centered in the reinforcement of the medical aid and in the prevention of specific risks. As for the characteristics of APS, it was observed a group of positive perceptions predominantly, demonstrating an advanced apprenticeship of development of PSF in Cajuri. The attention to the first contact, the longitudinality and the integrality was the dimensions that presented an advanced apprenticeship in the actions accomplished by PSF, expressed for the facilitation of the access, for the creation of the bond between the professionals of health and the population user, and for the high resolubilidade of PSF in relation to the problems of health of the population. However, in relation to the coordination of the attention, this was the characteristic that presented the smallest reach in the municipal district, due to the inefficiency of the reference system and against-reference. Like this, the challenge of the integration with the other levels of attention appears as one of the main impediments to the full xxi development of the dimensions of APS in Cajuri, still associated to the high rotation and the non execution of the work workload by the medical professionals, besides the political subjects related to the old fair "play clientelista". Equally, the absence of the professionals profile for the work in PSF, the inexistence of I link labor and the low wages were also told as impediments to the full development of the characteristics of APS. In relation to the care in health and work in team multiprofissional, the focus in the care was noticed in the professionals speeches, especially for the knowledge of the population and of his/her middle of life, as well as of the main factors of risks to the which the families of his area adscrita were exposed. This way, the results appear for an identification of the protagonists of SUS on PSF as a strategy of restructuring of APS in the municipal district. As alternatives to the necessary changes for the improvement of the dimensions of APS, stand out the need of investments in the professionals training and in the structuring of the other levels of attention to the health on the part of the government, seeking to guarantee the creation of a net of integrated attention and continuous. Finally, it is essential that there is larger valorization of the public service, through the establishment of formal bonds of work and of the offer of fairer and suitable wages with the responsibilities that the work demands. Finally, it is essential that there is larger valorization of the public service, through the establishment of formal bonds of work and of the offer of fairer and suitable wages with the responsibilities that the work demands.


family health program programa saúde da família primary health care sistema Único de saúde single health system atenção primária à saúde nutricao

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