Avaliação responsiva e construtivista do programa núcleo de apoio à saúde da família – NASF quanto ao princípio da integralidade

Abstract

In the context of Primary Health Care (PHC), the proposed core activities of Core Support Family Health (CSFH) aims at increasing and upgrading of health actions together with the teams of the Family Health Strategy (FHS), contributing compliance with the principle of completeness. However, its major challenge is to change an organizational culture in the Unified Health System (UHS), focusing on the achievement of individual procedure and meeting numerical productivity goals, a situation that is desirable, but that does not happen so spontaneous and / or natural. Thus, monitoring and evaluation of the program are important tools for improvement, aiming to develop actions that are effective against the population's needs. It is in this context that justifies the proposed work, in which we call for a constructive and responsive evaluation process, with the objective of evaluating the performance of the CSFH program on the principle of comprehensive PHC. It is an evaluative study with a qualitative approach, based on the Fourth Generation Evaluation proposed by Guba and Lincoln in 1989. As a backdrop to this study, we have the city of Sobral (CE). As subjects, we had 27 participants representing different interest groups, subjects who somehow had become involved with the proposed role of the CSFH program: Managers, professionals CSFH members of the team, representares the FHS, and user representatives assisted by program. To collect data we use the methodology of the Hermeneutic-Dialectic Circle, through semi-structured interview. For data analysis, we use the Content Analysis according to Minayo. The survey was conducted in accordance with Resolution No. 466/2012, with approval by the Ethics and Research Committee to paragraph 842 476. Claims, Concerns and Issues (CCI) that emerged from the speeches of the representatives of different interest groups, have resulted in 11 thematic categories, in response to the specific objectives of this evaluation. As the design of completeness, the subjects showed two main views, the individual completeness to, including individuals in their biopsychosocial context and completeness as UHS principle, claiming the attention of guarantee to all individual needs. Also claimed the possible contributions of the program on the principle of completeness, referring to the expansion of human resources in PHC, support for FHS teams through interdisciplinary support tools such as the matrix support, and the program's potential for the articulation of Health Care Networks (HCN). However, they showed concerns with the performance in practice, when it was possible to identify the restrictive aspects of the program's activities, especially the fragility of the link with the FHS and with the territory and lack of competence on the part of professionals to work in the APS and CSFH. Reflecting on the restrictive aspects of the program's operation, the issues that arose showed the expected expansion of the FHS with the possibility of inclusion of CSFH professionals in the FHS team. We believe therefore, that the evaluation process of CSFH program developed here, contributed to a reflective building on the work of the same, allowing different interest groups, an evaluative approach to training features, providing them the opportunity to build and rebuild their conceptions and practices involved with the proposal of CSFH.