Súde como direito: o acesso da população em situação de rua ao Sistema Único de Saúde

Abstract

In Brazil, health was instituted as a right in the 1980s. During the same period, the homeless people were organized to ensure their citizenship. Access to the Unified Health System is a prerequisite for the dignity of this group, which, due to social vulnerability, is exposed to factors that interfere with health and require technical, managerial and intersectoral policy responses. The objective of this research was to understand the access to the Unified Health System in the perception of the homeless adults in the city of Juiz de Fora, Minas Gerais. We chose a qualitative methodological approach, with an exploratory descriptive study. The techniques used were the semi-structured individual interviews and the observation followed by recording in the field diary. Twenty homeless people participated in the research. The information was analyzed in the light of Dialectic Hermeneutics. The interviews were transcribed and the information was organized and classified, finding cores of meaning that made it possible to form the following categories of analysis: "motives that lead homeless people and their strategies for survival or change of life," "The experience on the street and its interference in health", "the access of the homeless people to health services: reception and difficulties faced" and "the right to health: the voice of the homeless population". About the reasons that led people to the street situation, it was identified the rupture or fragility of family ties and the harmful use of alcohol and other drugs. The reported main strategy for street survival was informal work. Regarding the aspects of living on the streets that interfere with health, there were difficulties to meet basic needs, such as food, access to bathrooms and personal hygiene; difficulties related to weather change; discrimination and prejudice; harmful use of alcohol and / or other drugs; vulnerability to physical and sexual violence, vulnerability from informal work; and the difficulty to have a place to stay during the day. Access to health services occurs more frequently in urgent and emergency situations. Thus, the most accessed services are those that receive this type of demand. In contrast, Basic Attention is underutilized, being offered two weekly vacancies to the population studied in a Basic Health Unit of the municipality. The access takes place through the mediation of the social protection network or the Street Clinic. There are difficulties in accessing health services: the need to present documents; proof of residence; treatment that disregards the socioeconomic and cultural conditions of the individual; and prejudice. Many participants in the research showed that they know their rights, but they found barriers to exercise it, such as prejudice, lack of information and difficulty accessing various services, including health services. The research evidenced the need for capacitation of health professionals, as well as the need to expand the Primary Care services and the Street Clinic team.