Trabalho em equipe na atenção primária à saúde: Fundamentos histórico-políticos

O livro tenta compreender, por meio de uma abordagem histórica e política, as contradições e os dilemas que enfrentam os trabalhadores da área de saúde pública. Eles se formam geralmente em meio a modelos biomédicos e individualistas, mas nesse segmento da medicina predomina um candente discurso em defesa do trabalho em equipe e multidisciplinar. Conforme diz o autor, mesmo esse discurso está impregnado de abordagens com viés simplesmente organizativo ou tecnicista. Além disso, confunde o processo de trabalho médico com o processo de trabalho em saúde. Em tal contexto, saem do foco as necessidades sociais em saúde da população e dos próprios trabalhadores e, ainda, a necessidade de se criar espaços coletivos, onde as práticas das equipes possam ser compartilhadas, debatidas e transformadas. O pesquisador discorre também sobre algumas políticas de saúde no Brasil ao longo da história, enfatizando especialmente o período pós-regime militar (1964-1985), em que os movimentos sociais, em particular o da Reforma Sanitária Brasileira, tiveram papel central nas mudanças empreendidas na área. Ele cita, por exemplo, a implantação do Sistema Único de Saúde (SUS) e a Estratégia de Saúde da Família, modelo adotado posteriormente e hoje priorizado nas políticas

Adesão de idosos a programa de atividade física em unidade de atenção primária à saúde

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Políticas públicas municipais de saúde: fortalecendo a democracia em pequenos municípios brasileiros

This article presents the endeavors of health municipal teams in building services that meet citizens’ demands, in a small municipality from a less developed area of the state of São Paulo. Beyond health services practice characterization and organization, our study assesses the challenges and advances in the implementation of public, health policies in Brazil. In this way it is possible to perceive how the family health strategy needs to overcome impasses in the service work processes, as well as more dynamic local and regional relations to provide comprehensive care to citizens. Health care exemplifies how, in democracy building, municipal action is indispensable to strengthen the effectiveness of public actions.

De direito social a dispositivo de saúde: o trabalho na legislação de saúde vigente

Starting from the theoretical contributions of Michel Foucault and from a critical appraisal of the Declaration of Universal Human Rights and the 1988 Brazilian Constitution, this article maps the constitution of labor as a dimension that goes from social right to health device. In our analysis we find that labor as a social right and health device has a subjective protagonism and has social and economic aspects contemplated by documents. However in defining and orienting ways of being of individuals that work delivered speeches that fall in and control, hindering the openness of workers for movements of creation expansion of life and work in its positivity of experimentations. We conclude that is not enough to recognize labor as a social right, indicate its role as a health strategy or direct political efforts without problematizing not “what kind of work” can be supportive in a more creative construction of its own work and health.

Parâmetros assistenciais em saúde bucal: comparação entre duas programações do atendimento clínico no serviço público

Objective: To compare two forms of scheduling clinical dental care for the oral health teams (OHT) included in the strategy of family health, regarding productive aspects of assistance. Methods: Two OHT worked concurrently, using two methods of clinical care: the parameter recommended by the Ministry of Health Ordinance No. 1101, 2002, which establishes 03 dental visits per hour (c/h) per team, and a Testing model, with 02 c/h, being each method applied for a period of 615 hours. The quantitative data was collected in OHTs’ daily production spreadsheets, covering the following items: the number of dental visits (initial, for maintenance and for emergency procedures), procedures performed, consumption of material and sterilization cycles. Data was compared and statistically analyzed through the BioStat 5.0 by applying the paired t-test (p <0.05). Results: Under the Ministerial method and the Testing model, were performed, respectively, 288 and 365 first dental visits, 921 and 686 return dental visits, 167 and 172 emergency dental attendances, with 469 and 110 fouls, 212 and 327 treatments were finished and 2501 and 3046 dental procedures were realized. Among eleven analyzed consumables, five were consumed in smaller quantities in the Testing model: gloves (9%), anesthesia (38%), anesthetic needle (34%), suture material (24%) and aspirators (11%), while the six remaining items presented similar consumption rates between the two models. Conclusions: The testing model revealed to be more productive and economical.

O cuidado em saúde mental infantil na perspectiva de profissionais, familiares e crianças

Introdução: A preocupação e a incorporação da problemática da saúde mental infantil nas políticas públicas de saúde são recentes, assim como o desenvolvimento de ações voltadas a esse cuidado. Preconiza-se que essa atenção se proceda a partir de uma rede composta por serviços atuando de modo articulado a outros setores. Objetivo: Analisar os processos e as condições de produção de cuidados em saúde mental de criança na perspectiva do modo psicossocial na Rede de Atenção Psicossocial. Método: Pesquisa qualitativa, com referencial teórico-metodológico oriundo da Análise Institucional, desenvolvida por meio de Observação Participante em (1) espaços de articulação entre serviços de saúde, (2) Unidade Básica de Saúde e (3) Centro de Atenção Psicossocial Infantojuvenil (CAPSi) no município de Mauá, São Paulo. A Observação Participante permitiu reconhecer os procedimentos de cuidados no cotidiano dos serviços. Para aprofundamento da investigação, foram realizados Grupos Focais com profissionais da Estratégia de Saúde da Família e do CAPSi, com familiares de crianças que frequentam o CAPSi e com crianças usuárias do serviço. Os dados foram analisados e interpretados a partir de conceitos advindos da psicanálise winnicottiana, do modo de atenção psicossocial e da análise institucional. Resultados e Discussão: O interesse, o investimento político e o direcionamento das ações e da organização dos serviços, coerentes com a lógica de atenção psicossocial, têm propiciado um terreno fértil para a construção de práticas transformadoras de cuidado em saúde mental. A incorporação desse cuidado na Atenção Básica, ainda que apresente desafios e tensões entre o modelo instituído (departamentalizado em especialidades) e instituinte (saúde mental integrante da saúde geral), levou a mudanças nas ações e concepções dos profissionais. Contudo, o desenvolvimento de ações intersetoriais e a construção de uma rede ampliada de atenção têm sido limitados pela escassez de serviços e profissionais da rede e por diferentes concepções que atravessam o campo. Os participantes da pesquisa expressam visão conflitante em relação à concepção acerca de problemas de saúde mental e das expectativas quanto ao cuidado, sendo observada forte presença de uma cultura psiquiátrica, que se acentua nas falas dos familiares e na articulação com outros serviços, e uma inclinação a favor da atenção psicossocial, mais presente nas expressões dos profissionais. Nos serviços de saúde, há movimentos instituintes que enfatizam a integralidade da atenção, a interdisciplinaridade do cuidado, a multideterminação do processo saúde-doença, alinhados ao modo de atenção psicossocial. O acolhimento, o vínculo, a escuta e a confiança, importantes elementos do cuidado estão presente nas ações dos serviços. As intervenções terapêuticas têm sido desenvolvidas a partir da singularidade dos casos por meio de Projetos Terapêuticos Individuais, embora sejam consideradas aquém das necessidades das crianças, limitações advindas da escassez de profissionais e serviços da rede. Considerações Finais: Embora os serviços de saúde atuem na direção do cuidado alicerçado no modo psicossocial, eles têm atuado de forma pouco articulada com outros setores. A hegemonia da cultura psiquiátrica é um desafio a ser enfrentado. São urgentes ações que possam promover mudanças nessa cultura predominante e no imaginário social no que toca aos problemas de saúde mental e aceitação das diferenças.

A organização do trabalho para o desenvolvimento de recursos imateriais em equipes de saúde da família: um estudo de caso no município de Caraguatatuba.

Em organizações que operam segundo a lógica de serviço há uma mudança estratégica, com o deslocamento da produção de um produto para um valor. Seguindo esta dinâmica, surgiram na Saúde Pública propostas de modelos de atenção alternativos ao hegemônico, centrado em procedimentos e equipamentos. O presente estudo analisou o modelo da Estratégia de Saúde da Família, cuja proposta centra-se nas necessidades do usuário e no vínculo usuário-equipe multiprofissional, tendo como objetivo investigar como a organização e as condições do trabalho influenciam na utilização de recursos imateriais pelas equipes. Consistiu em um estudo de caso realizado junto a oito equipes de saúde da família do município de Caraguatatuba/SP. A metodologia compreendeu observação direta e realização de grupos focais com os profissionais das equipes. A análise abrangeu a categorização dos temas mais relevantes, em especial aqueles que se relacionavam ao uso e desenvolvimento dos recursos imateriais. Os resultados indicaram que, embora os profissionais valorizassem os aspectos relacionais, o processo de trabalho das equipes encontrava-se centrado na produção de procedimentos e informações quantitativos dos atendimentos, não incorporadas às práticas do cuidado. Os recursos imateriais, bem como seus resultados, não encontravam uma forma sistematizada de avaliação. E, dessa forma, enfrentavam desafios para serem apropriados e desenvolvidos como conhecimento pela organização.

Percepção dos usuários sobre o programa de saúde da família : um contributo para a reflexão

A Estratégia Saúde da Família apresenta-se como uma possibilidade de reestruturação da atenção primária, a partir de um conjunto de ações conjugadas em sintonia com os princípios de intersetorialidade, descentralização, equidade, coresponsabilidade e priorização de grupos populacionais com maior risco de adoecerem ou morrerem. Assim, este estudo objetivou caracterizar a percepção dos usuários da Unidade Básica de Saúde da Família (UBSF) sobre o Programa Saúde da Família (PSF). Trata-se de um estudo qualitativo desenvolvido na USF Barra de Sirinhaém, do Estado de Pernanbuco. Para tanto, contou-se com a participação de 54 usuárias do sexo feminino. Estas responderam a um formulário sócio-demográfico e um roteiro de entrevista semi-diretiva. Os discursos foram submetidos a análise de conteúdo à luz da literatura pertinente. Os principais resultados mostraram que a percepção das usuárias acerca do Programa de Saúde Familiar é de que este ainda funciona com abordagem curativa, mas que possuem maior acessibilidade e construíram um vínculo mais efetivo com os profissionais de saúde. Diante do exposto infere-se que a estratégia de saúde da família ainda não se concretiza pela dificuldade das pessoas entenderem a filosofia do programa, ainda polarizarem uma visão hospitalocêntrica da saúde e revelaram um certo alheamento da compreensão do significado do PSF. Palavras-chave: Estratégia Saúde da Família; Percepção; Assistência à Saúde.

História oral de vida de pessoas com úlcera venosa nos serviços de atenção primária à saúde

The Chronic Venous insufficiency is characterized as a set of physical changes including how most serious complication of venous ulcers, characterized by irregular and progressive loss of continuity of the skin. The occurrence of venous ulcers in people with chronic venous insufficiency generates dependence on them with health services, with long-term treatments that cause limitations and high-impact changes, affecting their quality of life, affecting the physical, psychological, social, cultural and spiritual as an important public health problem. This study aimed to describe the experience of having a venous ulcer, in the scenario of primary health care services to Health, which includes Primary Care Units and Family Health Strategy in the city of Natal / RN, based on the life histories of users. This is a qualitative study, exploratory and descriptive, with the Oral History of Life as a methodological framework. From the ponto zero was the recruitment of participants who formed the network, totaling six employees, of both sexes and aged between 57 and 79 years. After approval by the Research Ethics Committee - UFRN under the Protocol 653 788/2014 and CAAE 30408014.0.0000.5537 was held data collection, between the months of July and August, through interviews, using identification and characterization of the instrument employees and open questions. Interviews were recorded, transcribed, transcriadas and returned to employees for a conference. The narratives were subjected to Content thematic analysis technique, according to Bardin, allowing the construction of three themes that encompass categories, namely: Axis I - Perspectives on the changes: the impact wound in social relations (changes with ulcer venous, venous ulcer and social and family relationships); Axis II - Brands in body and soul: the story of being hurt (conceptions of the body injured; therapeutic itinerary in primary care services); and Axis III - Reconstruction of being hurt: coping mechanisms (redefinition of the wounded body, resilience to chronic wound). The impact of having a chronic venous ulcer generates impact of physical, psychological and social order. As aspects related to changes after the appearance of venous ulcers, survey participants reported the presence of pain, physical limitations, psychological distress, social and emotional isolation, incapacity, aesthetic discomfort and dependency on health services; the family was the aspect thatshowed no significant change after the occurrence of wound for most participants, an ally in the therapeutic process as a support network. The redefinition of the body and the wound are the main coping mechanism of chronic condition. The services in the Primary Care Network play a fundamental role in the rehabilitation of patients with venous ulcers, although there are difficulties in accessing appropriate treatment and need for expanded services, with permanent professional training of health teams and providing the resources managers to strengthen the comprehensive care of people with venous ulcers in Health Primary Care.

A terapia comunitária e a vivência de estudantes de medicina: uma estratégia de ensino aprendizagem do cuidado humanizado na ESF?

Before the scenario full of criticism about a medical model that gives privilege to the diseases and not to the diseased, there are many arguments that defend the need of redeem the humanized relationship between doctor and patient. It became indispensable to mold during the medical graduation a professional capable of perform a special care, less instrumental and more humanized; however, even though the advances of the pedagogical program of the medical graduation, we still face numerous challenges in the process of molding. This study has as general goal to understand if the students medicine experience with the Integrative Community Therapy (TCI) at the Primary Attention – APS/Family Healthy Strategy-ESF, presents potential to configure itself while strategy of teaching-learning to the integral and humanized care. It was held a qualitative research with the students of the medical graduation from the tenth to the twelfth semester that had experience with the TCI, as part of the Boarding of Family and Community Medicine – MFC. We used interviews with script and we resorted to analyze the narratives to Gadamerian Hermeneutics. It was possible to find that before join the boarding of MFC, the students were unaware the TCI and their preconceptions lined up with depreciated character. The experience with the TCI enabled the reframing of the prejudices and the build of new concepts. Internship in ESF and participate of TCI revealed potential to learning of the humanized care by the practical exercise with experiences that privilege the built of ties; the autonomy of the patient; the fulfillment of the longitudinality at the care of the patient; the acknowledgment of the power of resilience of the patients, at the strength of the collective, at the pain sharing, at the strength of a good communication, at the gains of qualified listening exercise. The absence of models of what to do was replaced by experiences of pains and joys at the learning of becoming a doctor. The pains spoke of the structural difficulties (inputs), at the get along with the socials vulnerabilities of the users and the difficult of perform a good communication with the patients. The joys were experienced at the finding of the humanized care exercise. Questions as structural difficulties, low number of people with TCI degree, a shortly experience of with TCI, show up as limitations to its utilization as pedagogical tool. In turn, the reflective potential is capable of cause resignifications about the know-how before the pain of the other being very much present at the narratives, signaling the potential of the learning of TCI. Therefore, this study advocate that the participation of the students at the TCI, beyond the power of offering the students a teaching-learning strategy to the humanized care, represents the possibility of enlarge the horizons of those future doctors at a glance much more conscious of the difficulties and potential of a professional at the ESF, contributing to the graduation of more sensitized professionals and prepared to perform an integral and humanized approach of the person and his/her community, contributing to an APS/ESF more resolute and rewarding to everyone.

Processo de construção do conhecimento a partir do diálogo ensino-serviço na ótica dos profissionais de saúde

INTRODUCTION: In Brazil, the health training policies have been going through deep changes, which are the fruits of the sanitary reform and of the breakage with the biomedical model, still hegemonic. Nevertheless, the paradigm of comprehensiveness is being introduced in health and, in order to consolidate this concept, the training has been gaining new methodological approaches. One can mention the teaching-service interaction (education-health system/citizenship health), whose proposal enables the expansion of the perception of the health-disease process, as well as the warranty of compromises of training in relation to SUS. OBJECTIVE: Understand, from health professionals, the relevance of teaching-service-community interaction, vocational training of students of the Faculty of Health Sciences / UFRN. METHODOLOGICAL PROCEDURES: This study is grounded on qualitative approach. The technique used to obtain research data was the focus group. Two focus groups (FG) were accomplished in two family basic health units of the municipality of Santa Cruz – RN, where there is participation of professionals of the Family Health Strategy. The discussions were performed from a previously elaborated script. The analysis of results was held from the categorical thematic content technique. RESULTS: The study had the participation of 18 health professionals, and 13 (72%) were females. For these professionals, the teaching-service interaction enables the student to understand the model of comprehensive health care, since the contact with the community enhances its perception about the health-disease process, but also enables recognizing the importance of teamwork to comprehensive health care. FINAL CONSIDERATIONS: The results highlight the importance of a policy of reorientation within the context of training so that students have an early contact with the service and therefore develop technical skills within the context in which they are inserted.

As ações em saúde mental nos Núcleos de Apoio à Saúde da Família - NASF

The National Police for Basic Care (PNAB), regulated by ordinance nº2488 from October 2011, restates the Family Health Strategy (ESF) as a priority to the expansion, consolidation and qualification of basic attention to health matters in Brazil. In order to bring it about, city counsellors along with other federal entities ought to ordinate their work process deepening principals, directions and fundaments of Basic Care (AB). Besides ESF, the new PNAB expatiates on the Family Health Support Centres (NASF), reaffirming their role on broadening the scope of basic care actions and their improvements, ratifying their ability to share knowledge and support Basic Care professionals. All this considered, the purpose of this work is to investigate how NASF is currently structured in João Pessoa and what has been achieved by it on what concerns to mental health. Its main objectives are to analyse the practices of mental health professionals that are part of NASF teams and if they differ from what has been developed by the other members of the teams; to discuss the articulation of NASF in managing mental health measures on what concerns to internal organisatio n and to the city health network; to identify strategies used to organise such measures on mental health in Basic Care. To reach such goals, individual interviews have taken place two city health managers and four of NASF professionals that participated on the Mental Health Office as representatives of their sanitary districts. Also a focal group formed by various supporters of NASF was created, contemplating the diversity of professional categories involved with the teams and sanitary districts. It was possible to identify in NASF, in João Pessoa, an organisation based by the matrix support in which both management and basic care demands reflect a series of actions developed alongside with ESF. Amongst such actions, matrixing, home visits and the Singular Therapeutic Project (PTS) stand out. These activities have been discussed on the focal group and integrate the daily work of all NASF supporters despite their professional categories. NASF presents itself as a powerful strategy to SUS proper qualification and support to strengthen Basic Care and broaden family health teams‟actions.

Construção e validação do instrumento de investigação do conhecimento de gestantes sobre sua saúde bucal e a do seu bebê: perspectiva do cuidado em saúde

INTRODUCTION: Humanized and quality prenatal and post-partum care is critical to maternal and newborn health, as well as oral health care. Currently, the National Oral Health Policy is aiming at expanding dental care for pregnant women. Thus, the promotion of oral health and attention to prenatal care policies should be integrated; however, there is still limited participation of pregnant women. Thus, it is necessary to verify the knowledge of pregnant women related to oral health, seeking to estimate the quality of dental care provided during prenatal care, being essential for the Family Health strategy to organize personnel, plan costs and to ensure the quality standard of care. OBJECTIVE: To develop and validate a research instrument on the knowledge of pregnant women about their oral health and of their baby. METHOD: This is a construction and validation study with 93 pregnant women in Family Health Units and specialized private clinics in Obstetrics, in the city of Natal / RN. It was authorized by the Onofre Lopes University Hospital Ethics Committee of the Universidade Federal do Rio Grande do Norte (UFRN) under the registration number 421.163/13. The construction of the instrument followed steps so that it was valid, reliable and sensitive: creation and reduction of the items (drafting of the instrument), content validity and testing of the instrument, and hypotheses validation. Once constructed, the instrument was evaluated by experts who suggested modifications. There was consultation with the target population about the new version of the created instrument, which had the instrument validation verified by internal consistency through intra and inter-calibration and test-retest. Next, the hypotheses were validated. A database was built in the Statistical Package for Social Sciences (SPSS), version 22.0. After creating the hypotheses, an association was found for validating the criteria between each of the specific issues for each established criteria, considering a 5% significance level. Data analysis was carried out by describing the absolute and relative frequencies of the variables pertaining to issues relating to their pregnancy knowledge about their oral health and their baby. The Kappa coefficient was used for the calibration process (Inter and Intra-examiner calibration) and Cronbach's alpha coefficient was used to analyze instrument reproducibility (test-retest). In addition, the chi-square test was used to cross the dependent variable with the (dichotomized) independent variables. RESULTS: The intra and inter agreement analysis presented a Kappa coefficient between 0.400 and 1.000. Internal consistency through the analysis showed that 90% of the instrument's questions showed great reliability in the answers (Cronbach α ˃ 0.7). In the investigation of the relationship between the dependent variable (knowledge about oral health) and the independent variables (trimester of pregnancy, education, income and multiparous), it was found that none of these independent variables were significantly associated. All hypotheses had their Ho confirmed. CONCLUSION: The constructed instrument was validated, considering that it showed to be sensitive with good reliability and good accuracy, and therefore can be used to assess pregnant women’s knowledge about their oral health and the oral health of their baby.

Construção e validação do instrumento de investigação do conhecimento de gestantes sobre sua saúde bucal e a do seu bebê: perspectiva do cuidado em saúde

INTRODUCTION: Humanized and quality prenatal and post-partum care is critical to maternal and newborn health, as well as oral health care. Currently, the National Oral Health Policy is aiming at expanding dental care for pregnant women. Thus, the promotion of oral health and attention to prenatal care policies should be integrated; however, there is still limited participation of pregnant women. Thus, it is necessary to verify the knowledge of pregnant women related to oral health, seeking to estimate the quality of dental care provided during prenatal care, being essential for the Family Health strategy to organize personnel, plan costs and to ensure the quality standard of care. OBJECTIVE: To develop and validate a research instrument on the knowledge of pregnant women about their oral health and of their baby. METHOD: This is a construction and validation study with 93 pregnant women in Family Health Units and specialized private clinics in Obstetrics, in the city of Natal / RN. It was authorized by the Onofre Lopes University Hospital Ethics Committee of the Universidade Federal do Rio Grande do Norte (UFRN) under the registration number 421.163/13. The construction of the instrument followed steps so that it was valid, reliable and sensitive: creation and reduction of the items (drafting of the instrument), content validity and testing of the instrument, and hypotheses validation. Once constructed, the instrument was evaluated by experts who suggested modifications. There was consultation with the target population about the new version of the created instrument, which had the instrument validation verified by internal consistency through intra and inter-calibration and test-retest. Next, the hypotheses were validated. A database was built in the Statistical Package for Social Sciences (SPSS), version 22.0. After creating the hypotheses, an association was found for validating the criteria between each of the specific issues for each established criteria, considering a 5% significance level. Data analysis was carried out by describing the absolute and relative frequencies of the variables pertaining to issues relating to their pregnancy knowledge about their oral health and their baby. The Kappa coefficient was used for the calibration process (Inter and Intra-examiner calibration) and Cronbach's alpha coefficient was used to analyze instrument reproducibility (test-retest). In addition, the chi-square test was used to cross the dependent variable with the (dichotomized) independent variables. RESULTS: The intra and inter agreement analysis presented a Kappa coefficient between 0.400 and 1.000. Internal consistency through the analysis showed that 90% of the instrument's questions showed great reliability in the answers (Cronbach α ˃ 0.7). In the investigation of the relationship between the dependent variable (knowledge about oral health) and the independent variables (trimester of pregnancy, education, income and multiparous), it was found that none of these independent variables were significantly associated. All hypotheses had their Ho confirmed. CONCLUSION: The constructed instrument was validated, considering that it showed to be sensitive with good reliability and good accuracy, and therefore can be used to assess pregnant women’s knowledge about their oral health and the oral health of their baby.

O PROCESSO DE TERRITORIALIZAÇÃO DA RESIDÊNCIA MULTIPROFISSIONAL EM SAÚDE DA FAMÍLIA/COMUNIDADE, FORTALEZA, CEARÁ, BRASIL

O presente artigo apresenta o processo de organização e gerenciamento dos serviços de saúde da Atenção Básica no Programa Saúde da Família que tem a territorialização como um dos pressupostos, o qual vem sendo implementado pela Secretaria Municipal de Saúde. Assim, objetivamos analisar as práticas de territorialização da Residência Multiprofissional em Saúde da Família/Comunidade (RMSFC), Fortaleza, Ceará. A RMSFC é uma modalidade de pós-graduação lato sensu caracterizada pela formação em serviço. Optou-se pela realização de estudo interpretativo de sistematização de experiência, partindo, do entendimento das questões locais para as gerais. Os levantamentos realizados revelaram que as 12 equipes multiprofissionais seguiram os seguintes passos: Visitas institucionais, Reconhecimento da área de abrangência dos Centros de Saúde da Família, elaboração e execução de duas oficinas de territorialização. Nas oficinas foram levantadas potencialidades, fragilidades e desafios de cada território e a partir dessas informações foram organizados os dados e executados o planejamento coletivo das ações de saúde. Cada equipe utilizou metodologias diferenciadas buscando adequar-se as necessidades locais e com isso, desenvolver ações mais efetivas de atenção à saúde a partir do conhecimento aprofundado da realidade. A partir dessas vivências percebemos que o processo de territorialização não acaba nas oficinas, mas se inicia nelas.