Dimensão técnico-pedagógica na atuação dos núcleos de apoio a saúde da família: estudo de casos múltiplos

Abstract

From 2008, the Ministry of Health established the Family Health Support Center, as a support device for the Family Health Strategy, and, consequently, for improving the quality of Primary Care. NASF's work process is guided by the clinical-care and technical-pedagogical dimensions. Regarding the technical-pedagogical dimension, it acts as an educational support with and for teams and users through actions involving collectives. We analyzed the performance of Family Health Support Centers from the perspective of the technical-pedagogical dimension, from the contextual levels defined by Hinds, Chaves and Cypress (1992). This is a multiple case study research. It had as cases three municipalities belonging to health macroregion of Sobral-CE, Brazil. The three municipalities identified were Crateús, Sobral and Tianguá, the three largest headquarters of health regions. The study was conducted between 2016 and 2017. Documentary data (activity planning reports, photographic records, spreadsheets and fact sheets from e-SUS), direct observation of NASF's work process, were used as information sources. structured script, and focus groups with Family Health team and NASF team, totaling six groups. The analysis was guided by the framework of the Contextual Analysis Technique of Hinds, Chaves and Cypress (1992), in which to understand the phenomenon it is necessary to grasp the contextual levels that are defined in four distinct interactive layers: the immediate context, the specific context, the general context and the metacontext. The study was conducted in accordance with National Health Council Resolution 466/2012, and was submitted for ethical consideration obtaining favorable opinion No. 1,633,555 / 2016.Concerning the municipalities, these are presented with implemented and acting NASF, guided by the guidelines that lead to its operation. The contextual layers identified were: NASF visibility as pedagogical support to the Family Health team (immediate context); Territory: challenges and potentialities for the operationalization of the NASF work process (specific context); NASF collaborative work process (general context); and Paradigmatic disruptions in health towards comprehensive care (metacontext). In the immediate context of understanding the phenomenon of the pedagogical support of NASF's work process with Family Health teams, it is expressed how and when this support happens. This is done in the diary of NASF professionals, in activities such as home visits, health education actions and case discussion. However, there are difficulties, such as the lack of knowledge of how this support is provided by eSF, which still sees as a help tool to relieve care clinical care. In the second layer of context, NASF's working territory is diversified, with health units and the community as dialogical spaces to exercise their support. There are weaknesses in this layer that make it difficult for NASF professionals to access, in Crateús specifically, there was a gap between NASF and eSF because they inhabit different spaces, which makes it difficult to exchange and dialogue between them, and thus not sharing actions with the NASF. eSF, strengthening invisibility aspects of support. In the general context there were difficulties in the integration between the teams, a reflection of the previous contexts, caused either by the physical distance, but also by the lack of knowledge of the other's field of knowledge. The last layer of context, the metacontext, presents the paradigmatic disruptions that occurred in health with changes in the epidemiological context of health and disease conditions that guided the reformulation of health care models towards comprehensive care. Analyze and understand the contexts in which the phenomenon of the pedagogical support of NASF's work process with the FHT becomes a significant aspect for the transformation and implementation of the advances achieved by health policies in ensuring the integrality of health care. This study hopes to contribute to this transformation.