Modelo para avaliação de desempenho do sistema de saúde municipal com foco nas ações da saúde materno-infantil da atenção básica por meio de indicadores sociais

O presente trabalho aborda o desempenho dos sistemas municipais de saúde, tendo como foco a saúde materno-infantil. Com o objetivo de apontar as possíveis fragilidades dos sistemas de saúde, especificamente daqueles em que a Atenção Primária (AP) é a principal ou exclusiva estratégia de atuação da gestão municipal, foi criado um modelo teórico de avaliação dos indicadores de saúde, denominado de ADS. Aplicado às cidades com população entre 14 mil e 35 mil habitantes, onde o sistema de saúde se baseia exclusivamente na política de AP, esse modelo foi construído por meio da técnica de consenso, com a formação de um grupo de 12 especialistas na área de saúde coletiva para definição e validação de critérios para análise dos sistemas. Testado na cidade de Iati, localizada no Agreste Meridional e distante 282 quilômetros da capital pernambucana, o ADS apontou fatores ambientais e socioeconômicos abaixo da média, além de vulnerabilidades da assistência materno-infantil que influenciam negativamente a situação de saúde do município. A avaliação verificou ainda desempenho insatisfatório no que diz respeito ao acompanhamento das crianças e gestantes por meio de consultas médicas (efetividade); assistência à criança (continuidade); cobertura de consultas em crianças e imunização de gestantes (acesso aos serviços da Atenção Primária); produtividade das ações realizadas pelos profissionais de saúde (eficiência) e capacidade de investigação dos óbitos infantis, qualidade dos registros e controle da sífilis em gestantes (vigilância à saúde). Também foi observada baixa alocação de investimentos em saúde em combinação com a carência de recursos humanos e materiais para prestar os serviços. Ao final da pesquisa, foi possível constatar a viabilidade de aplicação do modelo para planejamento das auditorias, avaliando o desempenho dos indicadores de saúde no âmbito municipal.

Povoações, freguesias e vilas na Paraíba Colonial: Pombal e Sousa, 1697-1800

The towns presently named Pombal and Sousa, located in the hinterland of the State of Paraíba, Brazil, still keep vestiges of the colonization process they went through along the 18th and 19th centuries, when they both emerged as settlement nuclei in the extreme West of the then captaincy of Paraíba and attained the status of freguesia and vila in a later period. This research aims to comprehend the process of urban formation and development of the colonial urban nuclei of Pombal and Sousa as they became povoados (hamlets), freguesias (parishes) and vilas (small urban communities with a local government), according to territorial expansion policies implemented by the Portuguese government from 1697 to 1800. The choice of the two urban settlements for this survey lies in the fact that they were part of the great conquest and colonization program undertaken by the Portuguese Crown. Another aspect that was considered was the fact that those towns are the oldest urban nuclei of Paraíba s hinterland. They came into being as early as in the times of the colony, thus producing a favorable environment to the study of the changes that occurred in the captaincy s hinterland scenery resulting from the process of formation and development of the colonial urban space. Three fundamental categories of analysis were defined since they have a direct bearing upon the urban configuration of the two colonization nuclei: povoado, freguesia and vila. The three of them are related to civil and ecclesiastic jurisdictions. Field, documentation and bibliography surveys were undertaken in order to develop the study. They allowed for the finding of vestiges of the old, colonial urban structures and for the development of theoretical analysis based on present-day studies of issues relating to the colonial urban history. The study purposes were, therefore, to try to understand how the old urban nuclei of Pombal and Sousa fit in the territorial expansion policies undertaken by the Portuguese government; to relate the process of urban formation and development of such nuclei with the categories of analysis povoação-freguesia-vila by discussing the relations and influences they exert over one another and their territory, as well as to unveil, as much as possible, the configuration the urban spaces that were shaped along the 18th century

Uma cidade em transformação: a influência da atividade do crediário nas mudanças da paisagem urbana de Tenente Ananias-RN

Studies on the urban landscape and on the changes of the urban space are relevant, since they reveal the economic dynamics and the way of life in the cities. Research on small towns, in particular, can display particular aspects and by so doing broaden the comprehension of this theme. The purpose of this research is to analyze the changes in the urban landscape and in the way of life of the inhabitants of the town of Tenente Ananias-RN that have been taking place since the 1990s up to the present (2013) and which result mainly from the commercial activity of crediário. The study is, therefore, a reflection on the impact of crediário economy on the urban landscape and on the way of life of a small town located in the hinterland of the State of Rio Grande do Norte. For this reason, it was necessary to study the landscape and the way of life found in Tenente Ananias in two moments: a) before the rise of the crediário, a period of time ranging from the town‟s initial emergence until the beginning of the 1990s; b) during the progress of crediário activity, from the beginning of the 1990s, when it starts, up to the present (2013). For this research, primary data (interviews, local survey visits) and secondary data (books, articles, reports, census data) were used. As a result of this study, it was possible to conclude that crediário plays a fundamental role for the explanation of the changes taking place in Tenente Ananias-RN, especially in the urban landscape and in the way of life of people. We have attempted, through this research, to contribute to the studies of a historical, social and economic process related to the urban landscape and space of a small town in the State of Rio Grande do Norte

Estudo comparativo da variação temporal da comunidade fitoplanctônica do açude Cruzeta inserido no bioma caatinga, Rio Grande do Norte

The Cruzeta impoundment, situated in the city of Cruzeta, hinterland of the state of the Rio Grande do Norte state has significant importance to the municipality as it represents the only source of supplying water to the region. It was hypothesized that the regional consequence of the global warming and the warming of surface water could substantially contribute the significant growth of the aquatic macrophytes in the years 2008-2009. The growth of these vegetation believed to be improved the degree of water transparency and as a consequence of the improved growth of phytoplankton species and chlorophyll biomass. At the same time the aquatic macrophyte could interact and compete potentially for the dissolved inorganic nutrients resources and the phytoplankton community. This study presents a comparison of years 2004-2005 when it did not have the expressive presence of the aquatic macrophyte community or restricted to the littoral region. In contrast, the years 2008-2009 showed a significant growth of the aquatic macrophyte in the Cruzeta/RN impoundments. The present study is an attempt to elucidate the significant presence of the aquatic macrophyte, Eichhornia crassipes, Ceratophyllum submersum, Nymphea sp and Pistia sp, and its interference on the ecology of phytoplankton. The samplings had been carried out from September of 2008 to April of 2009 and consistently between 10:00 h and 12:00 h with the aid of Van Dorn bottle and the plankton net of mesh size 20 Qm. The collections were made in three depths ie., surface, mid-column and bottom. The Physical-Chemical parameters such as pH, temperature, electrical conductivity and dissolved oxygen had been analyzed in situ. The samples for analysis of nutrients and chlorophyll were kept under refrigeration for posterior analysis in the laboratory. Phytoplankton samples were preserved in Lugol-iodine and kept for sedimentation for quali-quantitative analysis of phytoplankton. Enumeration of cells, colonies and filaments was done with the aid of Sedgwick-Rafter counting chamber and expressed as numbers/ml. Chlorophyll a was analyzed as a functional component of phytoplankton biomass and extracted with cold 90% acetone. The results indicate that the chlorophyll concentration varied between 5,65-8,08 Qg.L-1 for the dry period and 5,09-6,23 Qg.L-1 for the rainy period and showed considerable reduction when compared to the values to the 2004-2005 study period. The temperature was always presented higher in relation to the 2004-2005 study. Phytoplankton species showed a relative abundance of the Cyanophyceae for both the period of dry and rainy. The predominance species are filamentous Leptolymbya geophila Borzi (Planctolyngbya sp), Anabaena plankctônica Brunnthaler, Oscillatória limosa Ag. and Cylindrospermopsis raciborskii (Wolosz). The concentration of the nutrients such as nitrate and orto-phosfato had always presented higher values during the rainy period and the ammoniacal nitrogen retained moderate values in the dry period and a slight increase in rainy season. The main conclusions are the reduction of the concentration of chlorophyll, diversity of phytoplankton, and the increase in temperature and transparency of the water during the period of the study

Relação entre ambiente familiar e capacidade funcional de idosos residentes no município de Jequié-BA

(Objective) Assess the functional capacity and determine the difference between the means of functional capacity (basic and instrumental activities of daily living) and the age groups of elderly residents in an outlying area in the hinterland of Bahia/Northeast of Brazil. (Methods) Analytical study with cross-sectional design and a sample of 150 elderly individuals enrolled in four Health Units in the municipality of Jequié, Bahia, Brazil. The instrument consisted of sociodemographic and health data, the Barthel Index and the Lawton scale. (Results) In all, 78.00% of the elderly were classified as dependent in the basic activities and 65.33% in the instrumental activities of daily living. Using the Kruskal- Wallis test, we found a statistically significant difference between the means of instrumental activities and the age groups (p= 0.011). (Conclusion) An elevated number of elderly were classified as dependent in terms of functional capacity and increased age is related to greater impairment in the execution of instrumental activities of daily living

Afinal, quantos éramos? Um estudo da mortalidade pretérita na freguesia da gloriosa Sant Anna

Search mortality in the glorious St. Anna Parish, hinterland of Rio Grande do Norte in the time frame 1788-1838 is the main objective of this research. Questions that the research aims to answer are: how many were after? Data parish deaths allow us to study mortality in Town? To conduct the research, first appealed to the population maps of the years 1777, 1810, 1811, 1824, 1844, 1853; censuses of 1872 and 1890. As well, the first two books of burials / deaths of the Parish, the first dating from 1788 to 1811 and the second from 1812 to 1838 and a book of baptism 1803-1806. Among the findings it was realized that, for now, the question of knowing, "After all, how many were?" Still cannot be answered, because during the analysis we noticed a high rate of underreporting, demonstrated through a study of the first infant mortality, in which the records we have was very high, which goes against the pre-transitional period, but with the exercise of inverse projection found the opposite, a population that would have a life expectancy higher. Demonstrating the problem of underreporting. Infant deaths occur mainly with the male children in the first months of the year due to infectious causes, and in the early days and weeks, we raised a hypothesis is that these deaths have as a backdrop the poor condition of the mother leading to poor training child, thus leading to his early death

Avaliação do desenvolvimento sustentável na bacia hidrográfica do Rio Seridó em face das políticas públicas e da gestão dos recursos hídricos

The reality of water resources management in semiarid regions, such as the Seridó region, has been shaped by a complex chain involving social-cultural, political, economic and environmental aspects, covering different spheres of activity - from local to federal. Because water is a scarce element, the most rational way pointed out by our recent history has been to move towards an increasing emphasis on the need for a truly rational, integrated, sustainable and participatory water resources management, supported by legislation and by a network of institutions that could materialize it. In this sense, despite all the advances in the formulation of public policies in water resources, which ones have indeed lead to significant changes that have occurred or are underway in semiarid regions such as Seridó? What factors may be preventing the realization of the desires rationality embedded in the framers of water policies intents? How to properly manage water resources if the current actors who promote their management and the political, human, cultural and institutional processes that intervene in this management, show strong traces of unsustainability? The research methodology adopted in this paper led to a breakdown of the traditional approach to water resource management, to integrate it into other areas of knowledge, especially to political science and public administration, catalyzed by the concept of "sustainable development". From a broad, interdisciplinary literature review, an exhaustive characterization of the river basin Seridó, a set of interviews with key people in the public administration acting in the region, a series of diagnoses and a set of propositions were made in order to correct the direction of current public policies for the region. From the point of view of public policies, it is in the deployment phase, not in its formulation, which lies a major problem of the lack of significant progress in water management. The lack of coordination between government programs are well characterized, as well as the lack of efficiency and effectiveness of their actions. The causes of this secular model are also discussed, including political factors and social relations of production, which led to a stalemate difficult, but of possible solution. It can be perceived there is a scenario of progressive deterioration of natural resources of the fragile ecosystem and a network of environmental and social consequences difficult to reverse, the result of a persistent and inertial sociopolitical culture, whose main factors reinforce itself. The work leads towards a characterization of the water resources management also from the perspective of environmental, institutional, political and human sustainability , the latter being identified, particularly as investment in the development of people as autonomous beings - not based in ideological directives of any kind - in the emancipation of the traditional figure of the poor man of the hinterland" to the "catalyst for change" responsible for their own decisions or omissions, based upon an education for free-thinking that brings each one as co-responsible epicenter of (self-) sustainable changes in their midst

Um olhar sobre as veredas rosianas.

The present work objective to study the configurations that the hinterland it acquires in the workmanship Great hinterland: trails, of Guimarães Rosa demonstrating as this author humanize this element, conferring to it characters universal mystics and through investigations, uncertainties, the auto-corrections of Riobaldo that become hinterland a metaphor of the human interior. Three are the chapters, that they will guide this work: the chapter 1 presents as element key for characterization of the epic one in Great hinterland: trails, the mining hinterland replete of trails, palco of exuberant vegetation, huge and multidimensional scene, where it has an entrecruzamento of fiction and reality. It retakes quarrel of critics as Manuel Cavalcanti Proença, Roberto Schwarz, on the existing epic character in the Great hinterland: trails, constructed from deriving myths of the universal culture, that they had been become popular. The brave and gracious knight, that it has its representabilidade in the popular culture. Thus the medieval hero, the knight represented for the Riobaldo personage, it is cognominado by Proença as Don Riobaldo of the Urucuia, knight of the general fields. O chapter 2 is a study on the popular culture in Rosa and Cascudo. Cascudo the example of Rosa also is exímio studious of the brazilian life, the regionalization and the popular manifestations proceeding from other cultures. O chapter 3 it has as focus of analysis two mitopoéticas personages: Diadorim e Luzia-Homem, which in the cited narratives they generally they assume functions generally atribute the men. Since children, if they dresses male. Valley to point out that Diadorim is not characterized as man, since in Great hinterland:trails if trajaq always as gunman. Luzia, when complete 18 anos pass if to dress as woman, but the stigma of male and female, inherited of the time where it coexisted the father folloies it for all the life. They suffer pain to have been born to fight and to não conhecer to love. They die you deliver the God. This study detects exactly that Diadorim and Luzia-Homem, are personages associates the myths of the universal culture and popular (sphinx, Jellyfish, Venus, Mother d water), that they possess similarities n the archetypes, that transit between the sexos masculine and feminine, without any sexual connotation, possesss it proper code of honr, of this not abdicating ahead of the death. Parallel, in this chapter two cascudianas workmanships willbe studies, that contemplate thematic of the dressed woman of man and being the woman without disguice: the enchantment tale Maria Gomes and romance Flower of tragics romances. The first one will be revisited in order to present subject in Great hinterland:trails through the Diadorim personage. As it will discourse on cases of brave women, cited for Cascudo, immortalized for the tradition, who had made history, that already is not disfarçam of men to carry through acts of bravery and honor.

DINÂMICAS MERCANTIS COLONIAIS : Capitania do Rio Grande do Norte (1760-1821)

The size and dynamics of the market producer, consumer and exporter of the Captaincy of Rio Grande do Norte, in the period between 1760 and 1821 is the primary goal of this dissertation. In order to establish relations between the founding of new towns built from 1750 and its incorporation into the water supply and domestic market, showing more specifically the colonial economic relations established between the coast and the hinterland of the Province. Based on references by authors such as Edward Shils and Immanuel Wallerstein have investigated topics such as formation of colonial space, deployment-action of colonial institutions regarding business practices, and the dynamic market of the Province of Rio Grande do Norte.

O reino encantado do sertão: uma crítica da produção e do fechamento da representação do sertão no romance de Ariano Suassuna

Based on the relation history, literature and space, this work examines the production and the closing of the representation of the hinterland in the Romance d A Pedra do Reino of the paraiban writer Ariano Suassuna. Inspired by method proposed by deconstructionist by Jacques Derrida, our reflection decomposes the writing scene of Suassuna by means of it s tracks to interpret the operation of the representation of the space-hinterland for the speech of the writer. Being thus, we present the elements chosen for Suassuna to weave an identification it s with this space-hinterland, taking a priori as a sentimental place and of familiar origin . The construction of this relation of belonging in great is measured grounded for a familiar memory entangled in the context politician who culminated in the Revolution of 1930 and that he resulted for the writer in the death of father. Suassuna launches a look on the identity and the Brazilian culture that guided in the tradition concept it searchs to deny the gift grounding its speech in the return to the past, a past order . Specifically in it s romance we notice to exist the fusing of these tracks in the production of a representation of the hinterland that it intends to close a concept of this space and its culture. Soon, the idea of kingdom sends to the space of the enchantments manufactured in infancy and retaken by the intellectual radical who in the anxiety of honor the father figure, does not save efforts in constructing a space representation that, over all, either faithful the representation that it searchs to trace of proper itself. Under one it marks of universality , the hinterland-kingdom of Suassuna if discloses eurocentric in the measure where it perpetuates discurse the filiation of the European cultural traditions.

Ser(Tão) Seridó em suas cartografias espaciais

The aim of this work is to analyze the spatial frames of reference of the Seridó a region Iocated in the hinterlands of Rio Grande do Norte state from the following texts: Homens de Outrora (1941), by Manuel Dantas; Seridó (1954), by José Augusto Bezerra de Medeiros; Velhos Costumes do Meu Sertão (1965), by Juvenal Lamartine de Faria; and Sertões do Seridó (1980), by Oswaldo Lamartine de Faria. The historiographical discourse will be investigated as to representations of space and the frames of reference that demarcate it. We highlight the space of 1 as delimited by the subjectivity and significances expressed by each author, considering closely the relation between author, writing and body, either in historiography or in the subjects that give shape to the Seridó region in their writings. The Seridó is particularly framed in the relevant historiography as the hinterland (sertão) space, where the drought is a representation referred to recurrently, and as a space of fight , in which man and nature would be in constant struggle, challenging each other. Spatial frames of reference are then situated between the 1 and notions of hinterland and fight with nature

Ocidentalização, territórios e populações indígenas no sertão da Capitania do Rio Grande

The objective of this work is to understand some of the modifications caused for the phenomenon of the westernization in the hinterland of the Capitania do Rio Grande e in the life of the indians populations that inhabited there during the Colonial Period. We break of the quarrel of Serge Gruzinski concerning the westernization, understood while immersed phenomenon in the context of the expansion of the commercial capitalism and that, for the imposition of the culture occidental person to the alteridades of the New World, emprende the conquest of its territories, bodies and souls. The space clipping has covered the hinterland of the Capitania do Rio Grande, specifically the colonial territory of the Freguesia da Gloriosa Senhora Santa Ana do Seridó. The chosen chronological limit for the research corresponds to the Colonial Period and part of the Imperial one. However, the emphasis falls again on the period that it initiates in 1670, year of the oldest concession of would sesmaria known until the moment in the hinterland of the Rio Grande, extending itself until the decade of 1840. Sources of written by hand nature, cartographic printed and compose the used document roll: official correspondence and legislation, petitions of would sesmaria, inventories post-mortem, justifications of debt, registers of parish, maps, action civil court jurisdiction, notes of notary's office, land landmarks. We take the method, analyzed for Carlo Ginzburg, to cross these sources between itself and to detect its implied particularitities and ideas in the space between lineses, but, attributing it status to they of a colonial speech, fruit of the bureaucracy of where it was originated and of the social place of who produced it. We look for to demonstrate, throughout the work, that the phenomenon of the westernization desestruturou the aboriginal societies and its habitat, constructing, over its rubbles, a colonial territory that found in the cartography of the Freguesia de Santa Ana an efficient instrument of control of the space and the population. On the other hand, if the imposition of the culture occidental person exterminou great part of the native population that inhabited the hinterland of the Rio Grande, the remainders of these indians and the mestizos of descending them had survived in diverse ways in the freguesia: in the condition of captives of war or in regimen of servile work, as living or assistants in the farms, populations and village; rambling without route in the fields and the population spots; as mediating agents between the world occidental person and the native, exerting military or civil positions and still appealing to Justice in search of its rights of inheritance. Experiences of slavery, servitude, errância and mediation, but, also of resistance, adaptation, mestization in the Freguesia de Santa Ana

Dinâmica da paisagem na Microbacia do Riacho Cajazeiras no semiárido potiguar

The semi-arid Northeast region are coming through changes since its formation causing changes in the landscape and increased degradation. The economic dynamics which was established at the Potiguar semiarid had for a long time settled in livestock, subsistence agriculture and cotton, however, these economies decline from the year 1970. Thus, the Potiguar spaces are undergoing by a process of space reordering marked by the growth of agricultural activities and the process of urbanization. In the Potiguar western region these changes weaken significantly transform the landscape. In these areas, the process of urbanization and agricultural activities have caused changes in the hinterland landscape changing the natural dynamics of the caatinga biome that has been subject to negative interference with the indiscriminate removal of vegetation. In this case, the specific study area of the watershed of Cajazeiras Creek located in the cities of Pau dos Ferros, Água Nova, Encanto and Rafael Fernandes, changes in the landscape has led to degradation and environmental fragility. From this perspective, the research objective is to assess the dynamics of the landscape of the watershed of Cajazeiras Creek, semiarid region of the state of Rio Grande do Norte, identifying the degrading factors, the most degraded areas and/or susceptible to degradation and environmental fragility. The research investigated the phenomena of light geosystems theory that emphasizes the integration of elements in shaping the landscape. During this reporting period, it was carried out exploratory and bibliographical research, and geoprocessing techniques to assess the social and environmental conditions of the researched area and its environmental fragility. To do so, first, it was made an multitemporal analisis on the basis of the years 1984, 1996 and 2009 demonstrating that the dynamics of use and land cover in the watershed of Cajazeiras Creek showed a significant change in the landscape, especially in the caatinga vegetation. This has been recovering in various areas of the watershed, especially in its upper course in the mountains of Bom Sera, in Encanto city. The analysis showed the need to develop policies and programs for the maintenance, restoration and preservation of the caatinga vegetation of the river network and of water bodies. In addition, it was identified the most degraded areas of the watershed, environmental fragility and potential emerging that take into account the landscape components such as climate, topography, geology, pedology, geomorphology and the use and occupation of the soil in an integrated manner. The results show that the landscape of the watershed has medium and high environmental fragility throughout its area, especially on the banks of the river network provided by the use and occupation of the soil in an inadequate way with the environmental conditions of the watershed

Experiências de inverno no seridó potiguar

The knowledge known as "winter experiences" has been developed for centuries among country people in the Brazilian Northeast hinterlands. It consists in the systematic observation of the nature to forecast and protect people against the effects of droughts. This knowledge is transmitted orally through generations. These experiences are guided by the observation of the behavior of fauna, flora, stars, the weather in the holy days and other very specific aspects of the lives of country people. Almost all country people living in the rural area know at least one experience, but the Prophets of Rain are known as the communicators of winter prophecies formulated from the observation of the experiences. The country person is identified as a Prophet of Rain because of his close relationship with nature and his ability to forecast. No matter if the prophecies are always right, he possesses a vital social role, as his practices contribute to prevent, ease and encourage other people. The main aim of this work is to analyze the role of the winter experiences for the country people in the Seridó Potiguar. In this sense, we sought to understand to what extent this knowledge still orients the productive practices of farmers living in this region and identify which factors instigate the observation of winter experiences nowadays. 241 questionnaires were applied to farmers in the rural cities of Acari, Caicó, Parelhas and Lagoa Nova and interviews were conducted with 15 Prophets in the Seridó. The methodological framework of this work is the analysis of content proposed by Bardin (2010). In this study area, the experiences exert influence and relevance to the country people in the Seridó, because they consider them as a way to ease their anguishes face the possible drought in the region. The major role of the Prophet is to feed the hope of country people for better days, rather than contribute for the organization of the productive activities. Among the interviewed people, the forecast from the observation of winter experiences have greater credibility than the meteorological and disseminated by media. The Prophets of Rain base their prophecies on the set of natural elements present in the environment. Many factors stimulate the winter experiences by the Prophets nowadays, as cultural transmission, age, relationship with nature, level of education, faith, among others, but specially the productive activities (agriculture and cattle raising) and the droughts. The winter means abundance and happiness in this region and the experience is one of the ways that people find to minimize the anxiety and, according to their possibilities, to prepare for a year of droughts or for winter

Concepções dos agentes comunitários de saúde sobre suas práticas assistenciais

O presente estudo objetivou identificar as representações elaboradas por agentes comunitários de saúde (ACS) acerca de suas práticas assistenciais. Utilizamos a metodologia qualitativa de pesquisa, adotando, como instrumento de coleta de dados, a entrevista semiestruturada e, para a interpretação dos dados, recorremos à Análise Temática. Foram ouvidos 12 ACS das Equipes do Programa de Agentes Comunitários de Saúde (PACS) de um município do interior paulista. O material obtido permitiu verificar como temas: o vínculo como instrumento de trabalho e a prática pautada na promoção da saúde e na prevenção das doenças. Os relatos demonstram a importância do vínculo na prática diária, enfatizam os princípios humanitários que embasam as ações de solidariedade, destacam o sentimento de gratificação quando o trabalho executado é reconhecido pelas famílias e revelam que os sujeitos ouvidos têm dificuldades para discernir o alcance de seus limites. Embora estes profissionais apresentem um bom suporte técnico para o cumprimento de suas ações, também demonstram carência na instrumentalização para o exercício profissional. Concluímos que as diretrizes e normas estabelecidas para o PACS funcionam como norteadoras do processo de assistência, mas ainda não respondem a questões mais subjetivas encontradas na assistência ao indivíduo-famíliacomunidade. Além disso, os ACS parecem estar vulneráveis às flutuações de gestão dos municípios, estados e Governo Federal, apresentam inconsistência na ideologia do desempenho do próprio papel e não conseguem inverter o modelo assistencial pautado na doença e na intervenção médica individual.