A incorporação da saúde bucal no programa saúde da família do Rio Grande do Norte: investigando a possibilidade de conversão do modelo assistencial

The Health Family Program (HFP) was founded in the 1990s with the objective of changing the health care model through a restructuring of primary care. Oral health was officially incorporated into HFP mainly through the efforts of dental professionals, and was seen as a way to break from oral health care models based on curative, technical biological and inequity methods. Despite the fast expansion of HFP oral health teams, it is essential to ask if changes are really occurring in the oral health model of municipalities. Therefore, the purpose of this study is to evaluate the incorporation of oral health teams into the Health Family Program by analyzing the factors that may interfere positively or negatively in the implementation of this strategy and consequently in the process of changing oral health care models in the National Health System in the state of Rio Grande do Norte, Brazil. This evaluation involves three dimensions: access, work organization and strategies of planning. For this purpose,19 municipalities, geographically distributed according to Regional Public Health Units (RPHU), were randomly selected. The data collection instruments used were: structured interview of supervisors and dentists, structured observation, documental research and data from national health data banks. It was possible to identify critical points that may be impeding the implementation of oral health into HFP, such as, low incomes, no legal employment contract, difficulty in referring patients for high-complexity procedures, in developing intersectoral actions and program strategies such as epidemiologic diagnosis and evaluation of the new actions. The majority of municipalities showed little or no improvement in oral health care after incorporating the new model into HFP. All of them had failures in most of the aspects mentioned above. Furthermore, these municipalities are similar in other areas, such as low educational levels in children from 7 to 14 years of age, high child mortality rates and wide social inequalities. On the other hand, the five municipalities that had improved oral health, according to the categories analyzed, offered better living conditions to the population, with higher life expectancy, low infant mortality rates, per capita income among the highest in the state as well as high Human Development Index (HDI) means. Therefore, it is possible to conclude that public policies that include aspects beyond the health sector are decisive for a real change in health care models

Atuação profissional e vivência do cirurgião-dentista na estratégia do programa de saúde da família

The purpose of this research was to analyze the working profile of dentists from the Family Health Program (PSF Programa de Saúde da Família, Brasil) of some Municipal Districts of Rio Grande do Norte (Brazil) in order to understand the way they handle the experience acquired with the work developed in that Program. This discussion evolves a reflection about the perspectives of consolidation of the FHP as well as the possible advancements of the Brazilian Unified Health System (SUS - Sistema Único de Saúde). The target population was composed of dentists from the FHP of Rio Grande do Norte. Thus we performed twenty-one interviews orientated by a semi-structured guidebook with open questions and identification data. We opted for recording the speech of all the professionals in order to ensure the accuracy of the information gathered. The main results found were: predominance in the female gender; the majority of dentists has no post graduation courses; in those few cases of dentists with some post-graduation a lack of correlation with Public or Collective Health was observed; the dentists interviewed present a profile directed to clinical activities; the dentists used to develop basic restorative and periodontic treatment, simple surgeries and educative and preventive activities, even though the last two ones are carried out in an extremely traditional way (lectures and topical application of fluoride). In addition, as biggest difficulties to manage the work dentists pointed out the lack of permanent and consumer material, inadequate infrastructure, no transport to take them to distant places, no integration with the Health Family Team, technical difficulty such to perform educative and preventive activities as to provide adequate service to a repressed lawsuit. The results indicate the existence of a necessity to lead them to reflect and redirect their practices. In order to reach this aim it must be considered as initial measure the investment and encouragement toward to permanent education as well as a close follow-up and evaluation of the actions developed by them

Avaliação longitudinal do impacto da saúde bucal na estratégia saúde da família em Natal

As a result of the financial incentive provided by the GM / MS 1.444, since 2000, Brazil has experienced a substantial increase in the number of oral health services at the Family Health Strategy. There is, however, evidence that these teams have produced qualitatively different experiences which do not translate necessarily into improved quality of life and health. Thus, evaluative research of great importance. This study aims to assess the impact of the Family Health Strategy in oral health in a longitudinal perspective natalense the years 2006 and 2009. This is an intervention study whose design is a community trial in parallel, nearly randomized. The sample consisted of census tracts covered by oral health teams in the Family Health and the Traditional Model (Basic Health Units and non-FHS Program of Community Health Agents and areas not covered.) The sample was determined by drawing ten census tracts to form the experimental group and ten other sectors for the control group by pairing intentional based on socio-economic and geographic. To check the net effect of the intervention was performed multivariate analysis by Poisson regression. As a result of cross-sectional analysis of year 2009, it was found that the effects of the ESF in Natal were satisfactory only for the variables of injuries and for other purposes without and with negative impact on stock coverage reclaimers. However, the longitudinal analysis revealed that the ESB / ESF improved their performance in dealing with grievances, access and coverage of the type of actions and this fact is independent of age, sex and social and economic conditions. In other employees' words are related to the presence of the Family Health Strategy in the region. However it does not say that both models under study (the Family Health Strategy Model and Traditional) are different in terms of performance and it is pertinent to reflect on the need for further development of evaluation studies that use other approaches able to clarify the dynamics of the process whose results can come to the knowledge of the actors responsible for leading the ESF and encourage them to incorporate the assessment in their routine

Impacto do Programa de Saúde da Família sobre indicadores de saúde bucal na população de Natal -RN

The aim of this study was to assess the impact of the Family Health Program (FHP) on a number of oral health indicators in the population of Natal, Brazil. The study is characterized as a quasi-random community intervention trial. The intervention is represented by the implementation of an Oral Health Team (OHT) in the FHP prior to the study. A total of 15 sectors covered by the FHP with OHT were randomly drawn and paired with another 15 sectors, based on socioeconomic criteria, not covered by the teams. A few sectors were lost over the course of the study, resulting in a final number of 22 sectors, 11 covered and 11 not covered. We divided the non-covered areas into two conditions, one in which we considered areas that had some type of assistance program such as the Community Agents Program (CAP), FHP without OHT, BHU (Basic Health Unit) or no assistance, and the other, in which we considered areas that had only BHU or no assistance. Community Health Agents (CHAs) and Dental Office Assistants (DOAs) applied a questionnaire-interview to the most qualified individual of the household and the data obtained per household were transformed into the individual data of 7186 persons. The results show no statistical difference between the oral health outcomes analyzed in the areas covered by OHT in the FHP and in non-covered areas that have some type of assistance program, with a number of indicators showing better conditions in the non-covered areas. When we considered the association between covered and non-covered areas under the second condition, we found a statistical difference in the coverage indicators. Better conditions were found in covered areas for indicators such as I have not been to the dentist in the last year with p < 0.001 and OR of 1.64 and I had no access to dental care with p < 0.001 and OR of 2.22. However, the results show no impact of FHP with OHT on preventive action indicators under both non-covered conditions. This can be clearly seen when we analyze the toothache variable, which showed no significant difference between covered and non-covered areas. This variable is one of the most sensitive when assessing oral health programs, with p of 0.430 under condition 1 and p of 0.038 under condition 2, with CI = 0.70-0.90. In the analysis of health indicators in children where the proportion of deaths in children under age 1, the rate of hospitalization for ARI (Acute Respiratory Infections) in those under age 5 and the proportion of individuals born underweight were considered, a better condition was found in all the outcomes for areas with FHP. Therefore, we can conclude that oral health in the FHP has little effect on oral health indicators, even though the strategy improves the general health conditions of the population, as, for example child health

Avaliação da estratégia saúde da família na capital potiguar

This research aimed to evaluate the Family Health Strategy (FHS) in Natal, Rio Grande do Norte, through its managers, professionals and users, having as its support the Theory of Belief and the Cognitive-Behavioral Theory. This is a multimethod research and is divided into three sub-studies. In the first study, nine managers answered to a semi-structured interview, to verify the knowledge and beliefs on SUS; the quantitative data were analyzed with descriptive statistics with the aid of SPSS software and the qualitative data were submitted to lexical analysis with support of ALCESTE software. In the second study, we have a descriptive correlational research in which the antecedent variables are related to working conditions in the family health units (FHUs) and to the professionals‟ profile; the corresponding variables refer to the evaluations of the FHS; a stratified probabilistic sample with 475 professionals, who answered to two scales, both consisting of three factors: Physical infrastructure, Material resources, and Treatment effectiveness, and data were analyzed using descriptive, bivariate and multivariate statistics, with the aid of SPSS. The third study is a descriptive correlational research in which the antecedent variables refer to the treatment in the FHUs and to the users‟ profile, and the corresponding variables refer to the evaluations of the FHS, with a stratified non-probabilistic sample with 390 users, who contributed to the construction of a new scale with a factor, effectiveness in treatment, analyzed through descriptive, bivariate and multivariate statistics, with the aid of SPSS. The results showed problems which start from management, under the shape of admission due to political indication and lack of knowledge on SUS and the FHS; they pass through the low tenure of professionals and insufficient professional; and they end up spreading all over the analyzed items: infrastructure of FHUs, material resources, professionals‟ training, accessibility and referral system. One concludes that, despite following an ideal model, the FHS is in need of changes with regard to the barriers to its operational reality

Saúde mental na estratégia saúde da família: notas cartográficas sobre processos de trabalho em saúde

This study aims to map the working process in the health area starting from the meeting between the family and health teams and mental trouble carriers./MTC. The area of research was the Family Health Unit of Ozeas Sampaio, which is located in the county of Teresina-PI. As regard to the methodology procedure, we used a semi-structured interview timetable, aimed to detail the care practices, admittance and diagnostics that those teams realize with their users. Three teams of eleven workers each were interviewed. There was a doctor, a nurse and two health community agents in each team. The other tools we used were a camp logbook, in which we wrote down some informal dialogs, daily observations and feelings of the unit, and also the accompaniment of the staffs in house calls as well as the weekly meetings in the unit. Those meetings allowed us the construction of two analytic axes: 1) description of the establishment (Family Health Unit) of the organization, (municipal foundation of health and the service network), and the institutions and practice of health. 2) Analysis of the meetings between the worker and the user of Mental Trouble Carriers. In the first axis, we verified the repetition of the working logic focused on jobs in the hospital with the maintenance of the hierarchical relations between worker and the work processes which dissociate management and watchfulness in health care. We identified the lack of physical structure, the lack of self-confidence of the worker in the attention of the mental health care. At the second axis, we assess that the meetings, at the Family Health Unit (FHU) or at the dwelling of the users cause nuisance, discomfort and anxiety to the workers because they deal with issues that go beyond what is named as being the health order such as life stories, family conflicts, unemployment, hunger, sexual and psychological violence. As a matter of fact, they involve difficulties for having new relationships, reception and responsibility for this request

A psicologia e o programa de saúde da família :novas possibilidades, velhos dogmas?

The model of attention to health has been suffering alterations due to the difficulty faced to put into practice its universal, democratic and institutional layout. Since the movement of Sanitary Reform, which focused in the demands of a new health context and the process of work in the area of health, one seeks uninterruptedly, to find a way which leads to the execution of the principles of SUS. Despite having tried, the model of Sanitary Vigilance centered within the work of a multi-professional team has shown fragmentation and little adequacy to the necessity of health in the population. Whilst inserting himself in the field of health, the psychology professional has taken with him his clinic way of attending to individuals being one more in the team to act in a de-contextualised and little critical way. In virtue of this framework, the Ministry of Health invests in the Family Health Program as a new guide in the health system, restructuring the basic attention at a new logic of action. In this way, the municipality of Natal-RN implants, in the year 2002, the PSF in the Northern Sanitary District, a context in which professional teams are created where there is not an inclusion of a psychologist. Consequently, this professional is excluded of his work space in the previous Basic Unities of Health. This piece of work constitutes in the investigation of the implementation and instrumentalization of the Northern Sanitary District PSF of Natal-RN, having as its objective to analyze the implications of this execution for the structuring of the health network services and more specifically the alterations that this implementation could be making to the practice of the Psychology Professionals, emphasizing its advances, obstacles and limitations. To make this work feasible it was necessary to search for data and information from the implementation and execution of the PSF in the DSN, carrying interviews from a semi-structured guide, with 21 institutional actors (members of the team, coordinators and directors of the unities and psychologists)

O fazer do psicólogo no núcleo de apoio à saúde da família

The Brazilian Ministry of Health regulated in 2008 the Family Health Support Nucleus (FHSN) as a device for support and complementarity to the Family Health Strategy. The FHSN, through the matrix support, potentiates the Family Health teams on dealing with a great variety of demands and activities that are under their responsibilities. It is structured in teams of professionals from various health specialties, among which is the mental health. In preliminary studies we noticed that the psychologists have been the main representatives of mental health professionals at the FHSN from Rio Grande do Norte (RN-Brazil). On this scenario, this study intends to problematize the professional practice of the psychologists who work at the FHSN teams in RN, regarding how their work is done, discussing it under the perspective of collective health and the directions for the basic health care on Brazilian s health system. Still as a goal, in more specific ways: identify the forms of professional insertion of the psychologists in this field; characterize the work done by the psychologist at the FHSN (developed activities); and produce an analysis of the characteristics and limits of those actions, from theoretical and methodological references based on Marxian ontology. Were performed semistructured interviews with psychologists working in the oldest FHSN teams form RN. We conducted the analysis of the material following the blocks of information: determinants of the psychologist entry at the services, training for current practice; operation of FHSN; activities performed by FHSN team and the psychologist; joint actions; and limits of psychology practice in the FHSN. An important result, we observed the little articulation of practicing between the psychology and other professionals and teams, further indicating the prevalence of the traditional medical model (individual and outpatient) as guidance of their performance instead of the matrix logic that is the foundation of the proposed action for the FHSN. We also emphasize the potential of psychologists actions at the FHSN on contributing to the achievement of comprehensive care

Práticas educativas e integralidade na saúde da família: um estudo etnográfico

Primary Health Care, especially in the family health strategy, it is expected that the joint assistance and actions of health promotion. The Ministry of health (BRAZIL, 2007) defines health education as an eyeshadow strategy of prevention and health promotion, based on reflective practices, which allow the user to their condition of historical, social and political subject, under the vision of an expanded clinic on the part of health professionals. In this sense, there are guidelines for it professionals to develop educational activities and that they can interfere in the health/disease process of the population, with a view to the development of autonomy of the subject. This research had as objective to understand in the light of the integrality of the care, as is the production of health education practices, within the framework of the family health strategy from ethnographic study in a family health unit (USF). The location of the research was the unit of USF Felipe Camarão II in West Health District, in the city of Natal, RN, Brazil, selected from preliminary mapping of educational practices deployed in units of health of the family of this municipality, based on criteria such as time-to-deployment of USF and sustainability of existing actions. Immersion in the field consisted of participant observation with journaling, held during the period of August 2012 to January 2013, in which she accompanied team work processes in clinical-welfare actions on the USF, in households and in educational activities of group character. The results presented in ethnographic description were analyzed based on the axes proposed by Ayres (2009) for identification of integrality in health practices:the axis of the needs; the axis of the purposes; the joint axis; and the axis of the interactionsThe evidence described from observation point the presence of each axle up health education practices developed by the teams, even incipient form, namely: articulation and appreciation of knowledge and practices of popular culture with local initiatives (Pastoril do Peixe Boi Encantado, Auto de Natal e Grupo Terapia e Arte); Clinical integration with health promotion actions and coordination of multidisciplinary knowledge, with professional-user link (course for pregnant women). However, a few challenges were identified to be faced in order to move forward in these practices in integral care: the need to break with the fragmentation of actions; strengthening teamwork; need for greater sustainability policy of collective actions; intersectoral work aimed at a better role of the State in the face of the health-disease process, adding to the action of individuals.The analysis produced from observation of the processes experienced indicates the need for a better recognition of local managers that actions similar to those that occur in the USF Felipe Camarão II enable advances in completeness as allows inclusion of actors involved in the processes of health work, and stimulate participation and shared responsibility in the fight for health-disease situations

Avaliação das ações do Núcleo de Apoio à Saúde da Família (NASF) em Macaíba/RN

This research evaluated the contribution of the Support Center for Family Health (SCFH) in relation to its effect on the Family Health Units through perception of the Family Health Strategy (FHS) and SCFH professionals, in addition to the satisfaction of users in relation to that role. Data were collected in the public health services of the city of Macaíba-RN in 2012, through semi-structured questionnaire and non participant systematic observation and it counted as investigated subjects 272 individuals (60 FHS professionals, 12 SCFH professionals and 200 users representatives of 20 units). For analysis of the responses of the opened questions was used categorization process and, in relation to the observational method, that was based on checking the space organization, the characteristics of the participating subjects and the specific set of activities performed by SCFH teams through an observation guide. The results point to a good acceptance of the SCFH teams role by most FHS professionals who reported active participation in the health units routine, its integration activities to the FHS teams with resolving based health promotion actions. Regarding the SCFH professionals, they also reported positive contribution by participating actively in the units routine with integrated activities to the ESF teams and developing resolute actions. For users, the SCFH brought assurance services with better access to specialized, resolving and welcoming care. Systematic observation ratified data obtained by questionnaire. It was perceived the need to implement actions related to man`s health, to invest in expanding the number of the SCFH teams, the greater supply of medications, improving the regulatory process and planning together as a key strategy to promote a more effective integration between teams SCFH / FHS

Análise de redes do cotidiano a partir do encontro entre usuários e profissionais da estratégia saúde da família

O presente estudo discute a formação de Redes Sociais no cotidiano da Estratégia Saúde da Família, a partir de aportes da teoria sociológica sobre redes, interações, dádiva e reconhecimento. O objetivo geral é analisar as redes sociais locais em saúde a partir da interação de usuários e profissionais da Estratégia Saúde da Família na Unidade de Saúde de Ligéia, em Natal, RN. Seus objetivos específicos são: Mapear as redes sociais locais em saúde existentes no território adscrito; Identificar os tipos de interações cotidianas entre os sujeitos; Compreender a percepção dos sujeitos sobre o processo de formação de redes sociais a partir das interações. Caracteriza-se enquanto pesquisa qualitativa exploratória cujos sujeitos foram profissionais e usuários vinculados à referida unidade de saúde. Para a coleta de dados foram utilizadas entrevistas individuais semiestruturadas e debates em grupos focais, estimulados pela Metodologia de Análise de Redes do Cotidiano (MARES), pertinente para abordar a complexidade das relações sociais e mapear os diferentes conteúdos expressos e as formas de mobilização coletiva. A análise dos dados foi realizada através da Técnica de Análise Temática de Conteúdo, proposta por Minayo. Os resultados foram interpretados à luz das Teorias da Dádiva (Mauss) e do Reconhecimento (Honneth). Os sujeitos visualizaram: Rede Virtual (28,20%); Rede de Atenção à Saúde (25,64%); Redes de Usuários (17,95%); Rede Pessoal (10,26%); Conselho Comunitário (10,26%); Escolas (7,69%). Os participantes não perceberam os arranjos familiares enquanto Redes Sociais. Os tipos de interações sociais identificadas foram: Confrontação/Negociação (41.02%); Harmônicas (25,70%); Correlativas (17,90%); Definidas pela Organização (15,38%). A formação de redes sociais ocorre a partir de interações cotidianas entre pessoas, pela articulação inseparável de conteúdos e formas, catalisadas pelo contexto, experiência e cognição, valorizando a liberdade, a expressividade e a diversidade dos parceiros de significação. Foram encontradas duas categorias, na percepção dos sujeitos, sobre a formação de redes sociais do cotidiano: Diálogo e Encontro. Validamos e recomendamos o uso da metodologia MARES: Na formação, para despertar uma visão mais tolerante e humana de si e do outro; Na avaliação qualitativa dos serviços, por facilitar a reflexão sobre a prática e (re)organização do processo de trabalho; Na comunidade, para estimular movimentos sociais existentes ou emergentes. A aposta no circuito da dádiva e do reconhecimento recíproco, durante o trânsito nas redes sociais em saúde, pode ser capaz de tecer uma práxis transformadora, pela busca e alcance de confiança, respeito e estima, nos espaços de encontro entre usuários e profissionais da Estratégia Saúde da Família

Limites e possibilidades da educação em saúde na estratégia de saúde da família de Pau dos Ferros/RN

A Estratégia Saúde da Família (ESF) apresenta-se como um espaço privilegiado para a efetivação de práticas de educação em saúde orientadas pelo diálogo entre o saber científico e o saber popular, uma vez que é nesse espaço de saúde que profissionais e indivíduos/família se interrelacionam, criam vínculos, dialogam e constroem soluções para o enfrentamento dos problemas de saúde da população. O objetivo geral deste estudo foi analisar os limites e as possibilidades de efetivação da educação em saúde voltada para a coletividade na ESF de Pau dos Ferros/RN. Nesse sentido, buscou-se conhecer as concepções de educação em saúde dos profissionais de nível universitário da ESF; observar onde as práticas de educação eram desenvolvidas; conhecer os conteúdos e metodologias utilizadas para a efetivação das práticas de educação em saúde e caracterizar os espaços onde tais práticas eram desenvolvidas. Trata-se de uma pesquisa qualitativa, de caráter descritivo-exploratório realizada junto a nove equipes localizadas na zona urbana do município. Foram investigados 28 profissionais que atuam nessas equipes, dentre os quais elencamos: quatro médicos, oito enfermeiros e dezesseis cirurgiões dentistas. Fez-se uso da entrevista semiestruturada e da observação baseada em princípios etnográficos. Os dados foram analisados com base na técnica de análise de conteúdo de Bardin. O estudo obedeceu aos aspectos éticos contidos na Resolução 196/96 que regulamenta as Pesquisas Envolvendo Seres Humanos. Os resultados apontam que as concepções e práticas de educação em saúde dos profissionais da ESF são orientadas por uma educação bancária , pautadas pela transmissão e reprodução de conhecimentos. As temáticas são desenvolvidas de forma verticalizada, dissonantes da realidade de vida e saúde dos usuários. As práticas educativas são ofertadas majoritariamente por enfermeiros e estudantes de graduação em estágio na USF. Em sua maioria não são planejadas em equipe, e estão direcionadas à prevenção de doenças, distanciando-se da promoção da saúde. As principais dificuldades apontadas para a efetivação da educação em saúde dizem respeito à dificuldade de trabalhar em equipe, à falta de apoio da gestão, à estrutura física inadequada e a pouca adesão dos profissionais as práticas educativas. Portanto, a educação em saúde praticada na ESF não consegue instrumentalizar os sujeitos para que estes tenham autonomia e possam tornar-se sujeitos de suas vidas, de sua história. A prática educativa centrada na transmissão de conhecimentos ainda é uma realidade presente na ESF, constituindo-se em um desafio a ser superado

Superando a aridez do semi-árido: encontros entre saúde mental e saúde da família na formação de médicos no alto sertão paraibano

A atenção primária à saúde é um importante cenário para o cuidado em saúde mental por suas características e pelo trabalho no território contribuir para a superação do modelo manicomial de atenção. Esta pesquisa partiu do questionamento sobre como acontece a atenção em saúde mental na atenção básica nas unidades em que se desenvolve a Residência de Medicina de Família e Comunidade em um município do sertão paraibano. Objetivou investigar as demandas de saúde mental e práticas de cuidado no contexto de ESF e da RMFC do município de Cajazeiras a partir do discurso dos profissionais ali inseridos e discutir estratégias de qualificação do cuidado em saúde mental nessa realidade. Utilizou-se abordagem qualitativa em que foram realizados grupos focais envolvendo profissionais de duas equipes da ESF e uma equipe de NASF. Os dados produzidos nos grupos foram analisados a partir do referencial da análise do discurso de inspiração foucaultiana. Como resultados evidenciou-se que os profissionais percebem a demanda em saúde mental na atenção básica principalmente na forma de sofrimento psíquico inespecífico e transtornos mentais graves. A atenção a essas pessoas não consegue superar a medicalização que é identificada por esses profissionais. A prática asilar persiste como alternativa para os casos de transtornos mentais graves, sendo limitada a incorporação do paradigma da desinstitucionalização como referencial para a prática profissional. Além disso, a relação com a rede de saúde encontra vários limites destacando-se a dificuldade de produção de continuidade e integralidade do cuidado. A partir disto, analisa-se a formação médica e sua capacidade de garantir o cuidado integral na atenção às demandas de saúde mental. No campo da pesquisa, dois modelos de formação se encontram. Os residentes participantes ou graduaram-se em Cuba ou em escola médica brasileira orientada pelas Diretrizes Curriculares Nacionais. Percebe-se então que a graduação, ao incorporar questões relativas à integralidade do cuidado, não é suficiente para gerar bons profissionais para o SUS. Considera-se necessário somar às mudanças na graduação a perspectiva da Educação Permanente em Saúde no mundo do trabalho, o envolvimento dos profissionais com a transformação das práticas de atenção à saúde e a construção da perspectiva da integralidade e da atenção psicossocial por dentro da Residência de Medicina de Família e Comunidade como importantes estratégias para a formação de médicos generalistas aptos para a atenção às demandas de saúde mental

O programa de saúde da família e os princípios básicos do Sistema Único de Saúde na realidade de Santana do Matos RN

This work shows the professional staff of the Family Health Program (PSF) in Santana do Matos City perceive the Unified Health System (SUS). Their discourse and recognition of the advances of SUS, as well as their participation on the implementation of the system, are analyzed. The Brazilian Ministry of Health instituted it in 1994 in order to rebuild the health politics on a new basis, substituting the traditional model. The city-centered implementation of SUS was instituted on May 27, 1992 by the act nº 631/92 and today it experiences a Full Management of Basic Attention. In July 2001 the PSF program was started in the city with 5 teams: 2 in the urban zone and 3 in the rural one. The methodology was developed with the combination of qualitative and quantitative research with the employment of a questionnaire with both open and closed inquiries to 31 members of the program. The study appointed that, no matter how positive and enlarged be the staff s concept of health and SUS, they dont s have on understanding of the total chain of the system on its integrality, hierarchy and regionality what hinders the system performance close to the users. The PSF incorporates and reaffirms the basic principles of the SUS; however, on its everyday employment it has not yet abandoned totally the curative model, which is reinforced by the hospital-centered and physiscian-centerend culture

Do mundo como norma ao lugar como forma: o uso do território pela estratégia da saúde da família

This work aims to check whether there is a congruence between the purposes of regulations imposed by SIAB and the materiality constitution of places where your information is produced, since our hypothesis is that there is a mismatch between the rules and forms, which means, between reality as it is in places and how the territory is scrutinized by the Family Health Strategy (FHS) as for the performance of their teams as to the generation of their information. For this, the methodology used was the literature, documentary and empirical research, in special about territorialization of the Family Health strategy of Natal-RN. From the empirical mediation was possible to see the gap between full exploration and information produced by the ESF and the reality of the places. Thus, we highlight the importance of considering the conditioning of geographical forms as a guiding principle of the strategy for Family Health