Política Nacional de Atenção Básica: para onde vamos?

Abstract

Resumo O artigo analisa políticas recentes no campo da Atenção Primária à Saúde (APS) e suas possíveis implicações para o modelo assistencial no Sistema Único de Saúde (SUS). Inicialmente resgatam-se algumas das concepções que influenciaram os modelos de atenção no sistema público brasileiro e argumenta-se que a Estratégia Saúde da Família (ESF) apresenta as bases para reorientação das práticas assistenciais na atenção básica coerentes com os princípios do SUS. A seguir, analisam-se elementos centrais de políticas federais recentes para a APS. Demonstra-se que as mudanças no modelo assistencial da APS com ameaças à multiprofissionalidade das equipes, prioridade ao pronto atendimento, centralidade no cuidado individual, enfraquecimento do enfoque territorial comunitário e cobertura por cadastramento, evidenciam redirecionamento da política de saúde, ferindo os princípios da universalidade, integralidade e equidade no SUS.

Atenção primária à saúde em tempos de COVID-19: o que fazer?

“…Despite this potential, the attempts since 2017 at dismantling the FHS, with the reduction in the number of community health workers, greater flexibility in health professionals' workweek, elimination of the priority for the fhs, extinction of the Family Health Support Centers in Basic Healthcare (NASF-AB), loss of professionals with the extinction of the More Doctors Program, disincentives to the territorial approach with the new model of financing basic care based on the number of enrolled users, and undermining the community focus, among others 12 , represent important constraints on adequate action by PHC in fighting the pandemic.…”

New Coronavirus: (Re)thinking the care process in Primary Health and Nursing

“…Considering the family health as the main strategy for PHC reorganization in Brazil, expressed in the National Policy of Primary Care (PNAB) of 2006, the practices of planning and implementing actions in the territories in health care stand out in the perspective of ensuring comprehensive care, access to the population and an understanding of the real needs of the territory. They are essential actions, as they contribute to the transformation of social determinants of health (4) .…”

“…In recent decades, neoliberal policies have intensified and dramatic changes for PHC, validated by the 2017 PNAB have been implemented (2,4) . Insufficient public budget in addition to the crisis set up by the new coronavirus, shows the weakness of PHC, which, due to its role as SUS ordering authority and resoluteness care processes in the territories, consequently affects the whole Health Care Network.…”

“…Also, the challenges imposed by the neoliberal policy are manifested in the priority given to meeting acute demands, instead of longitudinal care with a community and family approach. Specifically, for Nursing, overact care is aggravated by the precarious structural, material and dimensioning of professionals shorter than the ideal (4,7) . Thus, in a practical perspective, the fragile and critical situation that PHC is going through, especially due to neoliberalism, imposes a massive challenge for the effectiveness of the processes related to the continuity of care and resoluteness of the teams (2) and, today, to face the pandemic in community and family level.…”

“…Combining the history of serious disregard with the arrival of the pandemic in Brazil, there is an increase in the different obstacles faced by the FHS in providing care. However, because they establish fundamental attributes such as teamwork, interdisciplinarity, comprehensiveness, family and community guidance and cultural competence, it enables the daily remaking in health care and in the ways of creating and recreating ties with collectives, which allows the practical implementation of the care process in a particular way (4) .…”