Mudanças e perspectivas teóricas no âmbito da saúde pública: a Política Nacional de Atenção Básica

Abstract

There are several changes in the paradigms related to the health care model in force in Brazil today, as opposed to the assistance model used in the past. Shortly after World War II, both medicine and the hospital became more visible to society. As a result of this fact, a pattern of health care based on medical knowledge and on hospital and curative practices has been disseminated, to the detriment of preventive practices carried out by Primary Care. In Brazil, the use of the term Basic Attention refers to the Primary Health Care in its broadest and most complete sense, proposed by the Sanitary Movement and differentiating itself from the Primary Primary Care proposal. Aiming for a new model of health care, since its implementation, many were the advances observed in the Unified Health System. However, it was from 1991 with the creation of the Program of Community Health Agents and in 1994 of the Health Program of the Family that the Primary Care has greater visibility. In this perspective, in order to regulate these actions, the National Policy on Basic Attention appears in 2006, which received updates in 2011 and 2017. Immersed in this context, this study aimed to analyze the changes that have occurred in the National Primary Care Policy since its creation in 2006 until its last version in 2017. This is a bibliographic review of a descriptive nature, using documentary analysis. The selected documents that were part of the analysis of this study were: Administrative Rule No. 648 / GM of March 28, 2006, which approves the National Policy for Basic Attention, Administrative Rule No. 649 / GM of March 28, 2006, which defines values of funding for the year 2006, with a view to the structuring of Basic Health Units for the Family Health teams. There was also an analysis of Administrative Rule no. 650 / GM dated March 28, 2006, which defines fixed and variable Basic Care Floor financing amounts through the revision of guidelines and standards for the AB organization, for the Family Health Strategy and for the Community Health Agents Program; being further verified, Administrative Rule No. 822 / GM of April 17, 2006, which modifies the criteria for defining the modalities of the FHPs set forth in the PNAB. In this perspective, we analyzed Administrative Rule no. 2.488, dated October 21, 2011, which refers to the changes in the PNAB, establishing a revision of guidelines and standards for the organization of Primary Care, the Family Health Strategy and the Community Agents Program. It is necessary to investigate Administrative Rule No. 978, dated May 16, 2012, which defines variable PAB funding values for Family Health Teams, Oral Health Teams and Family Health Support Centers established by the Ministry of Health. politics. Lastly, there was a careful reflection with the decree 2436 of September 21, 2017, which establishes the revision of guidelines of the National Policy of Basic Attention. In order to carry out the analysis, a set of categories was constructed by means of a critical reading of the documents mentioned above. The changes that occurred in this policy at the national level were evidenced, which were subdivided into 3 chapters, which provide the future projections and the possible impacts of the modifications, which may lead to a reduction in the quality of the health care offered to the population, promoting important inflections about the creation of the possible setbacks with the creation and recognition of basic care teams with a decrease in professionals and work hours; professional categories of community health agents and those of endemics; in the course of the studies the changes that favor the structuring of the public health policy and those that tend to deconstruct the postulates conquered in consolidation of the basic attention are exposed.