Nem sempre sim, nem sempre não: os encontros trabalhadores e usuários em uma unidade básica de saúde

• Ano de defesa: 2015
• Autor(a) principal: Melo, Sonia Maria de [UNIFESP]
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: atenção básica em saúde; acesso aos serviço de saúde; demandas em saúde; necessidades de saúde; rede básica de saúde
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=2893522; http://repositorio.unifesp.br/handle/11600/48168

Introduction - The network of basic public healthcare services, has been considered the main entry to the SUS (Unified Health System) and the coordinator of care to be provided in the healthcare net, as recommended by the national healthcare policy. Therefore, studies are necessary to better characterize if and how the net of basic health units guarantee access of users to primary healthcare and subsequently to other levels of the health system. Methodology - Experiencing daily life at a basic health unit was the driving force for the construction of this ethnographic study, aimed at better understanding how users access a ?traditional? basic health unit. In order to do that the study used as data analyzers the demands that users bring to the unit, from the privileged observation point the worker / user encounter (intercessor space). To characterize the demands, 109 scenes were used, recorded by the researcher during the 12 months during which she remained in the aforementioned basic unit, in which users explicitly stated their demands. Results - The outcomes of these encounters between workers and users were organized into 2 categories: demand met ( when the user received exactly what he requested or alternative offers were made by workers to somehow meet the demands) and demand unmet (when the user leaves the unit with his demands unmet and no alternative offers were made). Areas of juxtaposition between the two previous categories were also considered: namely situations involving multiple demands and/or complex demands which are either incompletely or unsatisfactorily met.The study showed how, in various situations, ?pressure? exerted by users is essential to have the demand met, even when the resources are apparently unavailable at the unit. The main causes of demands not being met were: 1. The availability of services, in particular medical appointments, is always below demand; 2 The lack of qualified customer service staff and the limited autonomy of the reception personnel.; 3. The rigidity of territorial distribution rule; 4. The confrontational attitude of users when they refuse the offer that is made,particularly when this does not coincide with their demand; 5. The existence of a program rationale that hinders access of patients who do not fit the priorities set by the system; 6. The existence of rules for referral of patients to specialists and provision of drugs and supplies; 7. The lack of some supplies. Discussion. Analysis of outcomes has allowed us to identify both the difficulties in the daily life of health teams, and the arrangements and strategies used by workers in order to meet the demands presented by users. Thus, not always yes, not always no expresses the multiplicity of responses that can arise from the worker / user encounter, an open-ended game despite happening in a field marked by many rules and restrictions. The fact of the unit studied is of the " traditional " type , (and in particular) the fact that it does not have a hosting service, community health agents, or adequate availability of medical appointments in accordance with parameters adopted by the Ministry of Health itself, all had a strong influence on the results . Conclusions . Although several authors emphasize the power within the worker-user encounter - an intercessor space - one has to consider that it is intercepted by and made up of multiple logics that ultimately define how the employee may or may not meet the demands presented by users, including: the still hegemonic biomedical model that presides over work processes and shapes users? demands; technical or vocational training of workers; Management processes that interfere and try to shape, somehow , these spaces ; and of course the concrete work conditions, namely the worker's limits to face the demand. The main contribution of this study is to focus on the daily life of the unit studied, its limits and powers and perhaps make us think about the elements of .the policy from its formulation to its implementation, when the user meets the worker who then embodies the long years it took to build a basic healthcare policy , which is defined as universal , resolute and easily accessible to users..