Apontamentos sobre os desafios (ainda) atuais da atenção básica à saúde

Abstract

In recent decades, Brazil has witnessed a proposal to create an extensive basic health care network as the main portal of entry to a universal public health system. Based on the recognition of consistent strides in that direction, the article addresses four issues on some important challenges for the consolidation of the basic health care proposal: (1) the use of the term "basic health care" as opposed to the usual, hegemonic concept of "primary health care"; (2) the disconnect or mismatch between the policy's wording and its real-life implementation, underscoring the need for a review of the Brazilian National Basic Health Care Policy (PNAB), which centralizes and standardizes rules and routines for the entire country while overlooking Brazil's continental dimensions, heterogeneity, and wide local diversity; (3) the isolation of basic health care and its peripheral position in the health system, pointing to the need for more complex arrangements in the coordination of care, not left merely under the organization and responsibility of basic health care; and (4) the lack of health policymakers, administrators, and professionals who are prepared and aligned with a project aimed at transforming the country's prevailing health care model.

Care handover to chronic conditions to regionalized planning

“…One of the paths found by the municipal managers was to qualify case management although this option is far from the recommendation because the information is not shared among the care levels and the municipalities of the same Health Region, as specified in Decree 7.508 (2) . Consequently, users with chronic diseases have difficulty accessing the health care they need (7)(8)(9) .…”

“…The political conjuncture of fiscal austerity (3) imposes additional difficulties on the municipalities, considering that chronic conditions require extended health care and a change in the care model (8,17) . However, in the present study, the municipalities have limited resources offered by the State to meet the demands of chronically ill patients.…”

“…The challenge in collective health care is transitioning care in a scenario that does not adapt to assist chronically ill users and has a limited capacity to promote health and prevent diseases due to factors such as the unstable establishment of public policies (1,(3)(4)(5)8) .…”

“…When this link is not achieved, the planning of health services and communication between the services are weakened. Moreover, the absence of this link prevents the transition of care from occurring, which affects those who need this strategy to access quality health care actions (8) .…”

Nasf: fragmentação ou integração do trabalho em saúde na APS?

“…As recentes publicações sobre a PNAB evidenciam retrocessos no âmbito da APS, tais como: relativização da cobertura universal, não obrigatoriedade dos ACS na composição das equipes, fragmentação do processo de trabalho, com a possibilidade de contratação de médicos com uma menor carga horária, e possibilidade de padrões distintos de atenção básica. Tais mudanças estão em estreita relação com o projeto neoliberal privatista em curso no País, o qual impacta diretamente no trabalho das equipes da APS, colocando em questão direitos, continuidade do cuidado e a qualidade dos serviços prestados à população 43,44 .…”