Estudo de análises temporais da implementação da Estratégia de Saúde da Família (ESF) sob o olhar da Política Nacional da Atenção Básica

Abstract

Introduction: After more than 30 years of the creation of the Unified Health System (SUS), there have been many changes in the health services provided to the population, especially within the scope of Primary Care (AB). In 1994, the Family Health Program (PSF) was created, changes in the form of health care were implemented, which allowed for the organization of primary care units (UBS) under the logic of the attributes of primary health care, with results of expansion of access to health by the population, especially in the North and Northeast regions. After 12 years, with the publication of the first National Primary Care Policy (PNAB 2006), the PSF became a priority strategy in the reorganization of AB in Brazil, changing its name to the Family Health Strategy (ESF). With the publication of other versions of the PNAB, in 2011 and 2017, changes were made to the ESF, in the work organization of the teams, in its composition and in the organizational structure of this level of care. Objective: The present study aimed to analyze the implementation process of the ESF, from the perspective of the three versions of the PNABs, seeking to highlight the impacts of the aforementioned policy through indicators of results of the implementation of the ESF in AB of the SUS. Methods: Descriptive study of a time series of selected indicators to assess the implementation of the ESF from the perspective of the PNABs of 2006, 2011 and 2017, based on the comparison of the performance of selected indicators for evaluation in a timeline between the years 2007 and 2020, using the Joinpoint trend analysis program. Main results: A downward trend in the number of CHAs was observed in the regions of the country, stability in the ascription in Brazil and in most regions were observed. The number of NASF-AB grew until the last PNAB, even with the number of eSB, which then stabilized. The number of DV showed growth throughout the time series, being higher in the initial years of the record, and with a downward trend at the end in some regions. Health education had an expressive growth in almost all regions of the country, and, after stabilizing the data, it stabilizes. The number of monitored pregnant women showed a downward trend in most regions. The hypertensive patients followed up remained stable.Final considerations: the last re-edition of the PNAB, in 2017, may have provided a disincentive to the continuity of the expansion of the Family Health Strategy (ESF) as a priority model of AB in Brazil, by allowing and financing new arrangements of teams in AB, suppressing the presence of the ACS and change the work organization of the existing AB teams. All these changes can lead to setbacks and losses within AB and ESF in Brazil.