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Guideline conceptual
The accumulation of the three technical and political levels of NHS management, the implementation of the Programme of Community Health Workers and the Family Health Strategy, essential elements for the reorientation of attention, has enabled the identification of a set of issues the conceptual and operational bases of what has been called "Primary Health Care" in Brazil, and its relations with other levels of the system. This discussion is based on the transverse axes of universality, comprehensiveness and equity, in a context of decentralization and social control of the management, care and organizational principles of the SUS, enshrined in constitutional law and infra.The expansion and qualification of primary care, organized by the Family Health Strategy, make up part of the overall policy priorities presented by the Ministry of Health and approved by the National Health This design overcomes the old proposition that is exclusively focused on the disease, developing by means of managerial practices and health, democratic and participatory, in the form of teamwork, targeted at populations delimited territories, for which they take responsibility.
The fundamental principles of primary health care in Brazil are: integrity, quality, equity, and social participation. Through periodic penalty payment of clientele, Family Health teams establishing a bond with the people, allowing the commitment and joint responsibility of these professionals with users and the community. Your challenge is to expand its boundaries of action aimed at greater solvability of attention, where the Family Health is understood as the main strategy to change this model, which should always include the entire context of the reorganization of the health system.
Management
The Department of Primary Care (DAB), structure linked to the Department of Health Care, the Ministry of Health, has the institutional mission to operationalize this policy within the federal management of SUS. The implementation of this policy is shared by states, Federal District and municipalities. When DAB fits also develop mechanisms for control and evaluation, provide technical cooperation to these management levels in the organization and implementation of the Family Health Strategy and actions of primary care as the Oral Health, Diabetes and Hypertension, Food and Nutrition , Management and Strategy Evaluation and Monitoring.
Family Health
The Family Health is understood as a strategy model reorientation, operationalized through the implementation of multidisciplinary teams in primary health care. These teams are responsible for the monitoring of a certain number of families, located in a geographical area. The teams with the actions of health promotion, prevention, recovery, rehabilitation of diseases and disorders more frequently, and in maintaining the health of this community. Responsibility for monitoring household places for family health teams need to push the boundaries classically defined for primary care in Brazil, especially in the context of the NHS.
The Family Health Strategy is a project facilitator SUS, conditioned by history and organization of the health system in Brazil. The rate of expansion of the Family Health proves the membership of state and municipal managers to its principles. Started in 1994, showed a significant growth in recent years. The consolidation of this strategy must, however, be supported by a process that allows the actual replacement of the basic traditional services at the municipal level and the ability to produce positive results in health indicators and quality of life of the population served.
Family Health as a structuring strategy of municipal health systems has provoked an important movement in order to reorder the model of care in the NHS. Search more rational utilization of other levels of care and has produced positive results in key indicators of the health of populations assisted the family health teams.
Health Teams
The work teams of the Family Health is the key element for the ongoing search for communication and exchange of experiences and knowledge among team members and those with popular knowledge Agent Community Health Teams are made at least by a family physician, a nurse, a nursing assistant and six community health agents. When expanded, it also has: a dentist, a dental assistant and dental hygienist.
Each team is responsible for monitoring up to 4000 inhabitants, being the recommended average 3000 inhabitants of a given area, and these are replaced co-responsibility in health care. The teams' work occurs mainly in primary health care, in homes and in community mobilization, characterized: as a gateway of a hierarchical system and regionalized health, to have a defined territory, a population defined under its responsibility, by intervening on the risk factors to which the community is exposed, for providing comprehensive care, permanent and quality; unfulfilled education activities and health promotion.
And yet: to establish bonds of commitment and co-responsibility with the population, for stimulating the organization of communities to exercise social control over the actions and health services, to use information systems for monitoring and decision making, for act in an intersectoral manner, through partnerships with different social and institutional, in order to intervene in situations that transcend the specificity of the health sector and have decisive effects on the living conditions and health of individuals, families and the community.
Community Health Workers
The Program Community Health Workers is now considered part of Family Health. In municipalities where there is only the PACS, this can be considered a transition program for Family Health. In PACS, the actions of community health workers are accompanied and guided by a nurse / supervisor packed in a basic health unit.
The community health workers can be found in two distinct situations in relation to the local health care system: a) linked to a basic health unit has not yet organized in the logic of Family Health, and b) connected to a base unit as Family Health member of the multidisciplinary team. Currently, they are working in the country 204 000 ACS, being present in both rural communities and urban neighborhoods in cities as highly urbanized and industrialized.
Professional Valuation
The Ministry of Health recognizes and appreciates the training of employees as a component to the process of qualification of the workforce in order to contribute significantly to the realization of national health policy. This training design seeks to characterize the need for increased schooling and profiles of professional performance to enable increased intellectual autonomy of workers, the field of technical and scientific knowledge, ability to manage time and work space, to exercise creativity, interact with service users, to be aware of the quality and ethical implications of their work.
Institutional Challenges
As institutional challenges to expand and qualify primary care in the Brazilian context stands out:
1 - expansion and structuring of a network of basic health units that allow the performance of the teams in the proposed family health;
2 - the ongoing review of the work processes of family health teams to strengthen the management structures in the cities and states;
3 - the development of integrated care protocols (promotion, prevention, recovery and rehabilitation) directed the most frequent problems of the health status of the population, indicating the continuity of care, under the logic of regionalization, flexible contexts on the basis of state and municipal and local;
4 - actions aimed at strengthening the management structures in the cities and states with a view to: programming basic care, supervision of staff, supervision of municipalities, regional supervision, use of information for decision making;
5 - Review of training processes. health education with emphasis on continuing education teams, coordinators and managers;
6 - establishing funding mechanisms that contribute to the reduction of regional inequalities and better proportionality between the three levels of care;
7 - the institutionalization process of tracking, monitoring and evaluation of primary health care;
8 - coordinated actions with educational institutions to promote changes in undergraduate and postgraduate health professionals in order to meet the challenges posed by the expansion and upgrading of primary procedures, including coordination with other levels of care.
Performance
- Model of Health Care in Brazil is an international reference.
- Family Health Strategy as drawn on the Brazilian case is highlighted and a model for other countries.
- Primary Health Care is the political agenda of public managers.
- The Family Health Strategy is consolidated in Brazilian municipalities.
- Academic studies in progress show that the Family Health in the period 1992-2002 shows encouraging indicators such as reducing child mortality.
- Survey conducted by the Ministry of Health, in partnership with the University of Sao Paulo and New York University, shows that every 10% increase in the coverage rate of infant mortality falls by 4.6%.
- Increased user satisfaction regarding the care received result of the changing practices of health teams.
Responsibilities of Managers in Primary Spheres
Federal
- Develop policy guidelines for national primary care;
- Co-financing the primary care system;
- Sort the formation of human resources;
- Propose mechanisms for programming, control, regulation and evaluation of primary health care;
- Keep the national databases.
State
- Monitor the implementation and execution of primary care activities in its territory;
- Regular inter-municipal relations;
- Coordinate the implementation of policies for training human resources in its territory;
- Co-financing of primary care activities;
- Assist in the implementation of strategies to assess attention basically in its territory.
Municipal
- Define and deploy the model of primary care in its territory;
- Contractually work in primary care;
- Maintain a network of basic health units in operation (administration and management);
- Co-financing of primary care activities;
- Food information systems;
- Evaluate the performance of primary care teams under his supervision.
Fonte: http://dab.saude.gov.br/atencaobasica.php
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