Atenção primária à saúde e atenção básica à saúde : os discursos ideo-políticos do Ministério da Saúde

• Autor(a) principal: Melo, Rutinéia Jacob de
• Data de Publicação: 2009
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Repositório Institucional da Universidade Federal do Espírito Santo (riUfes)
• Texto Completo: http://repositorio.ufes.br/handle/10/6512
• topic: Primary Health Care; Basic Health Care; Family Health Strategy; health politic; World Bank; Ministry of Health; Atenção Primária à Saúde; Atenção Básica à Saúde; Estratégia da Saúde da Família; política de saúde; Banco Mundial; Ministério da Saúde; Serviço Social; Cuidados primários de saúde; Família - Saúde e higiene.; Brasil. Ministério da Saúde; 32

The aim of this work is to analyze the ideological and political format of the Ministry of Health (MS) discourse about Primary Health Care (APS) and Basic Health Care (AB), with a view to unveiling the context in which such discourse emerges. The analysis focuses on the following questions: why is it that the MS assumes that AB is synonymous with APS, which rationales underlies this assumption and what were the implications of this point of view for the adoption of the Family Health Strategy (ESF), during the 1993-2007 period. Following the analysis, a documental research was carried out. Reference for this analysis was the wider context of the Brasilian health policies. Within such context an attempt has been made to grasp the concrete meaning of APS, considering their insertion in the Unified Health System (SUS), as well as their abstract dimension, in terms of the ideological definition perceived in the documents produced by the World Health Organization (OMS), Panamerican Health Organization (OPAS) and by the MS. The data have revealed that what is prevalent in Brazil is a reductionist interpretation of APS, focused on a basic basket of services recommended by the World Bank (BM) to the peripherical countries; APS can be looked at from multiple viewpoints and lends itself to different interpretations, all of them intersected by political, ideological and theoretical issues as well as by different sanitary practices. Yet that discourse does not cover the whole scope of practices derived from the guidelines proposed in the Alma-Ata Declaration. It further points out that discourse is emphatically states the principles upheld by SUS, including the concept of an all-inclusive APS, it prioritizes a marketing perspective of health. Besides demonstrating that the discussion is restricted to the AB scope, held to be synonymous with APS, with the purpose of hiding its reductionist nature. As the political and economic aspects of the question are not considered, is left out of the discussion, thus denying the responsibilities inherent to the State and therefore reducing its social role. There is evidence that the health services are fragmentary and that the implementation of EFS is affected by problems such as the underfunding of the health sector together with the precarious conditions of the work relationships. It also hides rationales such as shared social responsibility for the services rendered and for the administration of the public sector, in the interest of cost reduction, while it overemphasizes the family and the ACS work and the election of basic services as an absolute priority. The MS seems to adopt the assumption that a new terminology will automatically change practices, with no consideration for structural aspects such as low quality services, social inequality and unfair income distribution, factors which, together, make for the permanence of all the iniquities inflicted on the population. As no effort is made to face the more general economic and social determinations of the health-disease possesses, the problems detected require actions not only within the health care system itself. Summing up, in spite of the positive discourse of MS and the innovations proposed, no significant changes have been noticed to emerge in the health system, which has in fact remained medic-centered model.