A política pública do controle e do cuidado: há efetividade na implementação da estratégia de saúde da família em Santa Maria/RS

Abstract

This research is about the implementation of public health policies, with a specific look at the National Basic Care Policy (NBCP), starting with the research problem "How can implementation actions affect the effectiveness of the Family Health Strategy in the municipality of Santa Maria/RS?". Based on this questioning, this work aims to analyze the factors that affect the effectiveness in the implementation of the Family Health Strategy (FHS) in Santa Maria/RS. The FHS is the main service of NBCP and includes a reorientation in the work model, seeking prevention and health promotion, increasing care towards the individual, and also the family and community, being also considered managerial to the other levels of health care. The choice for this municipality occurred due to some specifications found in the implementation of the FHS, which began in 2004, when the municipality joined Proesf (Expansion and consolidation of FHS Project) and in 2015 there were only 16 teams of FHS implemented, representing a coverage of 22.94% of the municipal territory. In addition, the process of implementing the FHS in this municipality went through periods of discontinuity and rupture according to the policy proposal. The design of this research, of mixed approach, predominantly qualitative, with an analytical inductive logic base method, starts from the theoretical recognition of the object, based on the concepts of public policies, implementation and effectiveness. It builds a historical-political clipping of public health policies in Brazil, starting from the Brazilian Sanitary Reform, up to the NBCP and in the empirical field analyzes the process of implementing the FHS in Santa Maria, through analysis of documents produced over the 13 years of this service. Semi-structured interviews were performed with health counselors and Community Health Agents (CHA), in addition to direct observation in the FHS teams implemented do far. The results point at many weaknesses along the implementation, regarding the planning of the territorialisation of the FHS teams, the compliance with work guidelines established in the public policy, the practices of professionals in the community, and the institutional support for professionals to carry out their activities. Nevertheless it is also possible to perceive specific changes in the communities assisted by the policy, in what refers to a change of habits of the users concerning the health care. The research made possible to perceive the "State in action" (SOUZA, 2006) in the work practices of the CHA that implement the FHS, and the existence of a service that exercises the coming and going of health care in the social context in which it is inserted.