Search

The study aimed to create a meta-evaluation model for Primary Health Care applied in the External Evaluation of Access and Quality Improvement Program and discuss lessons learned in the process. We conducted a qualitative study in Natal/RN (Brazil) between August 2018 and March 2020. Literature review included quality standards from the Joint Committee Standards for Education Evaluation for Public Health Programs: A Self-Study Guide and examination of Access and Quality Improvement Program Instructional Manual. Steps for developing the study were elaboration, agreement, validation, and consultation with stakeholders. Results showed changes in political context from favorable to restrictive; consistency with metaevaluative assumptions and qualitative research; agreement between meta-evaluators, managers, and evaluators of universities participating in the program; and validation by experts. Stakeholders indicated the following for meta-evaluation: development of manuals, permanent education, workshops, seminars, online forums, and creation of a meta-evaluation network. In conclusion, the model is coherent with meta-evaluation of External Evaluation of PMAQ-AB, useful, and applicable to other evaluative contexts of Primary Health Care, including post-COVID-19.

BACKGROUND The increased applicability of information technology for evaluating health policies, programs, and care requires advancements in understanding trends, influences, its use by evaluators, and the implications for quality standards of evaluation. OBJECTIVE This study aimed to assess the applicability of information technology in evaluation the Access and quality of primary health care in Brazil considering international quality standards. METHODS We conducted a qualitative case study during the External Evaluation of Brazil’s National Program for Improving Primary Care Access and Quality. Data collection consisted of interviews, focus groups, and document analysis. Seven technicians from the Ministry of Health and 47 researchers from various high education and research institutions across the country participated in the study. Data were categorized using the software Atlas.ti, according to the quality standards of the Joint Committee on Standards for Education Evaluation, followed by Bardin’s content analysis. RESULTS Results related to feasibility, thematic scope, field activity management, standardized data collection, data consistency, and transparency, demonstrate improvements and opportunities for advancements in evaluation mediated by the use of Information Technology, favoring the emergence of new practices and remodeling of existing ones, taking into account the multiple components required by the complex assessment of access and quality in primary health care. Difficulty in operating, inoperative system, and lack of investment in equipment and human resources are challenges to increase the effectiveness of information technology in evaluation. CONCLUSIONS The strategic and intelligent use of information technology offered evaluators a greater opportunity to stakeholder engagement, to insert different organizational, operational, and methodological components, capable of triggering influences and confluences, with connections in collaborative and synergistic networks to increase the quality and allow the development of a more consistent and efficient evaluation with greater possibility of incorporating the results into public health policies.

Background: Considering advancements in information technology for disseminating results of evaluations, it is essential to demonstrate the functionalities and performance of these practices in order to achieve the objectives established by the evaluation proponents. This study aimed to evaluate the use of information technology for disseminating results obtained from the Primary Health Care evaluation in Brazil. Methods: A qualitative single-case study was performed with triangulation of techniques and key informants. Analyses of public documents and field research were conducted. Convenience sample of 54 participants (seven from the Department of Primary Care/Ministry of Health and 47 from teaching and research institutions) was selected from the external evaluation team. Content analysis was performed, and the Atlas ti.8.4.24 software organized, managed, and categorized textual data. Codification was performed by peers (three researchers) while experts validated codes (two researchers). Right after, codes were extracted and categorized.Results: Dissemination of results is complex due to multiple components. Incorporation also favored advances in data observation and implementation of data openness, becoming available for professionals, policymakers, and universities. Challenges regarding delivery time of reports, access restriction, lack of interest, and digital skills influenced reaching expected goals of the proponent.Conclusion: Information technology for disseminating results of evaluations may improve performance of health teams and managers and redefine priorities of work processes to strengthen Primary Health Care. Emphasis in planning, technological infrastructure, digital inclusion, and policy decision making is recommended to disseminate data effectively to the population.

Introdução: O Programa Bolsa Família está inserido no contexto das estratégias políticas adotadas para reduzir as desigualdades sociais e de renda no Brasil. O setor saúde tem importante papel na melhoria da qualidade de vida das famílias beneficiadas pelo programa através do acompanhamento das condicionalidades de saúde. Objetivo: O presente artigo relata a experiência de uma prática na comunidade que teve como objetivo apresentar um instrumento de Autoavaliação para Melhoria do Acompanhamento das Condicionalidades do Programa Bolsa Família na Estratégia Saúde da Família. Metodologia: Foram utilizadas a análise documental e a aplicação de uma ferramenta de autoavaliação elaborada a partir do instrumento de Autoavaliação do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (AMAQ/AB). Os sujeitos foram os Agentes Comunitários de Saúde de uma Unidade da Estratégia de Saúde da Família do Município de Natal (RN). A construção dos dados ocorreram durante três momentos: sensibilização e apresentação dos relatórios consolidados do Programa Bolsa Família, leitura e aplicação do instrumento de autoavaliação e análise dos resultados. Resultados: Os achados foram consonantes com os relatórios consolidados do Sistema de Informação do Programa Bolsa Família. Apresentou um instrumento pertinente de autoavaliação com potencial de ampliação nas demais unidades de saúde para auxiliar a gestão local no monitoramento das condicionalidades da saúde. Conclusões: A vivência contribuiu para aumentar o conhecimento dos participantes para a reflexão sobre seus processos de trabalho e para o aprimoramento de habilidades e competências auto avaliativas. Apontou a necessidade de realização de estudos complementares de natureza qualitativa para aprofundamento dos aspectos abordados.Palavras-chave: Programas de Autoavaliação; Programa Bolsa Família; Estratégia Saúde da Família.

Brazil is the most populous country in the world with a public, universal, and entirely free health care system. The Brazilian Sistema Unico de Saude - SUS, created in 1988 with the principles of universality, equity and integrated care, provides primary, secondary and tertiary health care. In 2006, SUS established Estrategia Saude da Familia (Family Health Strategy-FHS) as the primary health care (PHC) strategy at the municipality level. This strategy provides a broad range of primary health care services delivered by a multidisciplinary team comprised of physician, nurse, dentist, nursing assistant, dental assistant, and community health workers. Each team is responsible for about 4,000 people. The Family Health Team (FHT) professionals are supposed to work under the aegis of primary health care principles; providing basic health care, promoting health activities and preventing diseases, as well as referring those in need to other levels of care. As of 2017, there are 41,000 FHTs, comprised of about 700,000 professionals, who care for 124 million people in the country, present in 95% of Brazil’s municipalities (63.7% of the population). Considering the need for institutionalization of evaluation processes of the FHS, as well as the need to establish quality standards in public health services in the PHC system, the National Program for Access and Quality Improvement in Primary Care (Programa Nacional de Melhoria do Acesso e da Qualidade da Atencao Basica - PMAQ) was implemented in 2011. We are presently on the 3rd cycle of this program, which includes a multicenter FHT external evaluation in 2017.This is an investigation, with application of a single national survey. The questionnaires were organized into 3 major modules: 1. infrastructure conditions; 2. teams work process/care organization; 3. users satisfaction and perception of services. The implementation of such research proccess is complex and needs a series of organization strategies. We will present the methodology, as well as describe the advantages, disdvantages and chalenges of such endevour from the perspective of Universidade Federal do Rio Grande do Norte (UFRN), one of the 7 institutions performing the study. A total of 3,856 teams were evaluated in 2017. For the fieldwork of Rio Grande do Norte-RN and Ceara-CE (two Brazilian states), 90 interviewers, 18 field supervisors and State coordenators were hired and trained. Tablets were used to conduct the research and the questionnaires were sent via wi-fi to a data center. A gerential computational system was developed in order to facilitate the follow up of such wide research. Several chalenges were faced during the implementaion of the reseach: logistical pactuations (setting the best routs and pactuating with municipalities the dates of the data collection), interviewers locomotion between municipalities (distances, geographical barriers, lack of official transport), change of interviewers during the field, financial and wi-fi limitations, among others. Nevertheless, the implementation of a such survey guarantees important information for FHT planning activities and public policy implementation and survailance. The understanding of those chanleges, as well as the advantages and disadvantages of this type of evaluation may help the organization of other similar researches.

Resumo Objetivou-se nesta pesquisa quantitativa descritiva analisar o apoio institucional nas equipes que aderiram ao Programa de Melhoria do Acesso e da Qualidade da Atenção Básica. A coleta de dados foi realizada no período de fevereiro a outubro de 2014, a partir do banco de dados da avaliação externa do programa. A amostra compreendeu 2.941 respondentes do módulo II e os 22 gestores que responderam ao módulo IV (on line). As variáveis foram analisadas por meio da estatística descritiva, com uso do software IBM SPSS e os resultados organizados e agrupados em três dimensões: características do apoio institucional; processo de trabalho do apoiador institucional e apoio da gestão na administração e planejamento dos processos de trabalho. Observou-se que o apoio é uma realidade na atenção básica, porém identificou-se, nas ações apoiadas, um traço normalizador e burocrático. O apoiador institucional foi avaliado positivamente, embora se encontre sobrecarregado pelo número excessivo de equipes sob sua responsabilidade, evidenciando-se a necessidade de um dimensionamento que leve em consideração o modo de operar a função apoio. Em virtude das características do instrumento de coleta, não foi possível identificar qual a concepção de apoio dos entrevistados, constituindo-se um limite do estudo. Abstract The purpose of this descriptive quantitative study was to analyze institutional support among the teams that joined the Program for the Improvement of Access to and Quality of Primary Care. Data were collected from February to October 2014 from the program’s external evaluation database. The sample comprised 2941 respondents from module II, and the 22 managers who replied to module IV (on line). The variables were analyzed through descriptive statistics, using the IBM SPSS software, and the results were organized and grouped into three dimensions: Characteristics of the institutional support; the work of the institutional supporter, and management support in work process management and planning. It was noted that there is support in basic care; however, a normalizing and bureaucratic trait was identified in the actions supported. The institutional supporter was evaluated positively, although being overwhelmed by the excessive number of teams under their responsibility, evidencing the need for sizing that takes into account the way the support function operates. Due to the collection instrument’s characteristics, it was not possible to identify the interviewees’ concept of support, this being a limitation of the study. Resumen El objetivo de esta investigación cuantitativa descriptiva fue analizar el apoyo institucional en los equipos adheridos al Programa de Mejora del Acceso y la Calidad de la Atención Básica. La recolección de datos se realizó en el período de febrero a octubre de 2014, a partir del banco de datos de evaluación externa del programa. La muestra comprendió a 2.941 participantes del módulo II y los 22 gestores que respondieron al módulo IV (on line). Se analizaron las variables mediante estadística descriptiva, con software IBM SPSS y los resultados se organizaron y agruparon según tres dimensiones: características del apoyo institucional; proceso de trabajo del apoyador institucional y apoyo de la gestión en la administración y planeamiento de los procesos de trabajo. Se observó que el apoyo es una realidad en la atención básica, no obstante, se identificó, en las acciones apoyadas, un rasgo normalizador y burocrático. El apoyador institucional fue evaluado positivamente, aunque se encuentre sobrecargado por el número excesivo de equipos bajo su responsabilidad, poniendo de manifiesto la necesidad de un dimensionamiento que tome en consideración el modo de operar de la función apoyo. En virtud de las características del instrumento de recolección, no fue posible identificar cuál es la concepción de apoyo de los entrevistados, constituyendo un límite del estudio.

Objetivou-se investigar os limites e as potencialidades das diretrizes gerais das gestões da Atenção Básica das capitais brasileiras para o apoio institucional. O estudo é descritivo, exploratório, qualitativo, realizado de fevereiro a outubro de 2014, a partir do módulo IV do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica. Incluíram-se 22 formulários de gestão de capitais brasileiras analisados com o software Atlas ti.7.1 e análise de conteúdo. Nas capitais brasileiras, as condições de gerir os processos para a institucionalização do apoio não é uma realidade predominante. Conclui-se que essas gestões precisam ser apoiadas na condução desses processos. This study aimed to investigate the limits and potential of the general guidelines of the managements of Primary Care of the Brazilian capitals for the institutional support. The study is exploratory, descriptive, qualitative, conducted from February to October 2014, from the Module IV of the National Program for Access and Quality Improvement in Primary Care. Were included 22 Brazilian capital management forms analyzed with the Atlas ti.7.1 software and content analysis. In the Brazilian capitals, the conditions to manage the processes for the institutionalization of support is not a mainstream reality. We conclude that these efforts need to be supported in conducting these processes.

Este artigo objetiva discutir avanços e desafios do trabalho em equipe multiprofissional na reabilitação infantil. A pesquisa desenvolveu-se num centro de referência estadual, em Natal, RN, Brasil, entre maio e julho de 2010. O método utilizado foi o estudo de caso, com entrevistas semiestruturadas, numa amostra qualitativa de 20 profissionais de saúde de nível superior. Contemplaram-se as categorias: concepção de trabalho em equipe; interação nesta e com família e escola; intercâmbio de conhecimentos e interdisciplinaridade; flexibilidade da divisão do trabalho; integralidade e qualidade da assistência; valorização do trabalho; limites profissionais; e relações interpessoais. Aplicou-se a análise de conteúdo. Os resultados mostraram busca da integralidade e objetivos comuns. Como desafios destacaram-se: falta de projetos assistenciais, protocolos e discussões; dificuldades de interação, integração e delimitação profissional; rigidez na divisão de trabalho. Conclui-se que o trabalho organiza-se numa dimensão instrumental voltada à integralidade e à resolutividade, mas sem integração e reconhecimento mútuo de atuação em equipe.This paper aims to discuss advances and challenges of multiprofessional teamwork in child rehabilitation. The study was conducted in a state reference center, in Natal, Brazil, between May and July 2010. This is a case study using semi-structured interviews with a qualitative sample of 20 upper level health professionals. Three categories were considered: conception of teamwork; interaction with the team, family and school; exchange of knowledge and interdisciplinarity; flexibility in division of work; integrality and quality care; work values; professional limits and interpersonal relationships. Content analysis was applied. In relation to advances, professionals underscore common objectives and the search for integrality. The following challenges were cited: lack of assistance programs, protocols and discussions; interaction, integration and professional delimitation difficulties; and strict division of work. Work is organized into an instrumental dimension directed towards integrality and resoluteness, but without interaction and mutual recognition of teamwork.

Os cuidados de saúde primários de Portugal estão em processo de reforma, sendo as Unidades de Saúde Familiar (USF) uma das principais marcas desse processo. Este estudo teve como objectivo avaliar o processo de implantação das USF a partir de 2006. Utilizou-se metodologia de análise de implantação na mesma área de atenção primária em saúde de um estudo anterior no Brasil. Na análise foram empregadas as dimensões do cuidado integral, da organização dos cuidados e político-institucional. Evidenciaram-se como avanços principais a acessibilidade, trabalho em equipe, qualidade (técnico-científica) dos cuidados, inovações nas práticas de gestão, na sustentabilidade (condições de trabalho) e infraestrutura. Principais desafios: integração com especialidades hospitalares, indefinições político-institucionais, sistemas informatizados, integração nos centros de saúde e organização do processo de trabalho. Estes dados poderão vir a informar os decisores de gestão sobre correções a efetuar no processo de reforma.Primary healthcare in Portugal is undergoing a major reform, of which family health units (FHU) are one of the more visible results. This study aimed to evaluate the FHU implementation process from 2006 onwards. Methods from a previous study of primary healthcare implementation in Brazil were used. Dimensions studied included comprehensiveness of care, organization of care, and the political-institutional perspective. The main improvements identified included better availability of care, team work, technical quality of care, innovative management practices, sustainability of the model, working conditions and infrastructure improvements. Main challenges remaining include integration with hospital care, political and institutional gray areas, need for better information systems, integration within health centers and workflow organization. These data may be useful for management decision-makers when making adjustments and corrections in the reform process.

Este trabalho, representa um estudo de caso qualitativo, cuja unidade de análise é a equipe de Saúde do Programa Saúde da Família do município de Natal (RN). Tem como objetivos analisar as concepções dos profissionais sobre a prática do trabalho em equipe e reconhecer nessas práticas elementos que contribuam para a efetiva mudança do modelo de saúde hegemônico. Partiu-se da definição e tipologia de equipe de saúde elaborada por Peduzzi (1998), como principal fundamentação teórica. O estudo foi realizado em seis unidades de saúde da família, nos distritos sanitários Norte e Oeste. Esses serviços foram selecionados de acordo com critérios preestabelecidos. Foi utilizada como método para coleta dos dados empíricos a entrevista semi-estruturada com as equipes de saúde da família. Para análise do material empírico, utilizou-se o discurso do sujeito coletivo proposto por Lefèvre e Lefèvre (2003). Os resultados apontam para um predomínio da equipe do tipo integração. O trabalho em equipe surge como elemento essencial para o desenvolvimento da Estratégia de Saúde da Família.This article presents a qualitative case study where the unit of analysis was the Family Health Program team of Natal city, Rio Grande do Norte State, Brazil. The objectives were to analyze the conceptualizations of the professionals regarding teamwork as well as to identify in these practices the elements that contribute to an effective change in the hegemonic health model. The study was based on the Peduzzi (1998) typology and definition of health team and was conducted in six family health units in the North and East health districts selected by a pre-established criteria. Data were collected using a semi-structured interview applied in family health teams, which were analyzed using the Collective Subject Discourse proposed by Lefèvre and Lefèvre (2003). The results indicate a predominance of an integrated team type, and also that teamwork is an essential element for the development of the Family Health Strategy.

This article is part of the evaluation study on the Project for Expansion and Consolidation of the Family Health Strategy, conducted by the Center for Public Health Research at the Federal University in Rio Grande do Norte, Brazil, from March to December 2005. The study presents an assessment of primary health care access and receptivity from the perspective of patients and health professionals, comparing traditional primary care units and family health units in three State capitals in Northeast Brazil. The methodology included focus groups with content analysis. The results identified increased access, but there is still a disproportion between potential supply, capacity to meet the demand, and difficulties with referral in both the family health units and traditional primary care units. As an operational technology, receptivity is still under construction in the family health units, with varying levels of adherence to both the concept and the strategies for reorganizing daily work practices. Meanwhile, receptivity is totally absent from the traditional primary care units. The study suggests that qualitative analyses be included in health assessment in order to better explain the subjective aspects of the various actors.

O trabalho em equipe, embora não seja uma exclusividade da Saúde da Família, representa um de seus principais pilares, ainda pouco discutido em pesquisas na saúde coletiva. A perspectiva da integralidade das ações favorece uma ação inter/transdisciplinar. Na construção do projeto de Saúde da Família, é necessário que o trabalho em equipe seja norteado por um projeto assistencial comum e que os agentes desenvolvam uma ação de interação entre si e com a comunidade. Para tanto, é imprescindível o desenvolvimento de uma prática comunicativa orientada para o entendimento mútuo. Esse artigo apresenta considerações preliminares sobre o trabalho em equipe na Estratégia de Saúde da Família sinalizando seus entraves e possibilidades na construção desse modelo assistencial.Teamwork is one of the main pillars of Family Health Care projects, although it is not a strategy exclusively applied to such programs. It is not frequently discussed in current collective health research studies, but the perspective resulting from the full range of its action favors interdisciplinary and transdisciplinary actions. Thus, when building a Family Health Project, teamwork should be guided by a common health care purpose and the players involved should develop an interaction movement within the team itself as well as in relation to the community. It is therefore critical to establish communication practices for mutual understanding. This paper presents some preliminary considerations on the teamwork strategy in Family Health Care actions, indicating barriers and potentials in the construction of this health care model.

Objective. To analyze the work of health care teams delivering primary care in Portugal. Methods. We performed an evaluative research project, with a qualitative case study design. Data were obtained through semi-structured interviews, direct observation, and analysis of documents. We interviewed managers, workers, and users in 11 family health units (USF) in Portugal, for a total of 71 participants. Content analysis was used to assess the interviews. Results. Teams included a physician, a nurse, and an administrative employee. Each team was in charge of 1 250 to 2 060 users. A striking characteristic of the Portuguese experience was the voluntary and autonomous setup of teams at the USF, based on personal affinity. The services provided at the USF included a basic “service package” as well as activities of surveillance, health promotion, disease prevention, care of acute disease, clinical follow-up of patients with chronic or multiple diseases, home care, and networking with other services (hospital care). Difficulties in providing home care were reported. Electronic systems were widely available. According to interviewees, the changes resulting from the implementation of USF included improved user access to services, higher quality of care, and goal-oriented teamwork,guided by an action plan. Conclusions. Even without a coordinating role in the health care network, the delivery of primary health care through teams was positively evaluated in Portugal as promoting increased access, continuity, and humanization of health services., Objetivo. Analisar o trabalho em equipe na atenção primária em saúde em Portugal. Métodos. Foi realizada uma pesquisa avaliativa de abordagem qualitativa, com desenho de estudo de caso. Os dados foram obtidos por entrevista semiestruturada, observação direta e análise documental. Foram entrevistados gestores, profissionais e usuários de 11 unidades de saúde familiar (USF) portuguesas, totalizando 71 participantes. Utilizou-se a técnica de análise de conteúdo na interpretação das entrevistas. Resultados. Cada equipe era constituída por médico, enfermeiro e funcionário administrativo, atendendo entre 1 250 e 2 060 usuários. Uma característica marcante da experiência portuguesa foi a formação das equipes nas USF de forma voluntária, por meio de afinidades pessoais, com autonomia de composição. Observou-se nessas USF o desenvolvimento de “carteira básica de serviços” juntamente com intervenções de vigilância, promoção da saúde e prevenção de doença, cuidados em situação de doença aguda, acompanhamento clínico de doença crônica e de patologia múltipla, cuidados domiciliares, interligação e colaboração em rede com outros serviços (cuidados hospitalares). Foram relatadas dificuldades no atendimento domiciliar. A informatização era ampla nas USF. De acordo com os entrevistados, as mudanças advindas da implementação das USF foram maior acessibilidade dos usuários aos serviços, maior qualidade do cuidado prestado e trabalho em equipe com objetivos e metas, além da existência de um plano de ação. Conclusões. Mesmo não tendo assumido um papel de coordenação da rede de cuidados, a atenção primária em saúde organizada a partir de equipes foi avaliada positivamente em Portugal, como promotora de maior acesso, continuidade e humanização dos serviços.

To analyze the work of health care teams delivering primary care in Portugal.We performed an evaluative research project, with a qualitative case study design. Data were obtained through semi-structured interviews, direct observation, and analysis of documents. We interviewed managers, workers, and users in 11 family health units (USF) in Portugal, for a total of 71 participants. Content analysis was used to assess the interviews.Teams included a physician, a nurse, and an administrative employee. Each team was in charge of 1 250 to 2 060 users. A striking characteristic of the Portuguese experience was the voluntary and autonomous setup of teams at the USF, based on personal affinity. The services provided at the USF included a basic "service package" as well as activities of surveillance, health promotion, disease prevention, care of acute disease, clinical follow-up of patients with chronic or multiple diseases, home care, and networking with other services (hospital care). Difficulties in providing home care were reported. Electronic systems were widely available. According to interviewees, the changes resulting from the implementation of USF included improved user access to services, higher quality of care, and goal-oriented teamwork, guided by an action plan.Even without a coordinating role in the health care network, the delivery of primary health care through teams was positively evaluated in Portugal as promoting increased access, continuity, and humanization of health services.

ACESSO via B-on: http://dx.doi.org/10.1590/S1413-81232011000600023, Primary healthcare in Portugal is undergoing a major reform, of which family health units (FHU) are one of the more visible results. This study aimed to evaluate the FHU implementation process from 2006 onwards. Methods from a previous study of primary healthcare implementation in Brazil were used. Dimensions studied included comprehensiveness of care, organization of care, and the political-institutional perspective. The main improvements identified included better availability of care, team work, technical quality of care, innovative management practices, sustainability of the model, working conditions and infrastructure improvements. Main challenges remaining include integration with hospital care, political and institutional gray areas, need for better information systems, integration within health centers and workflow organization. These data may be useful for management decision-makers when making adjustments and corrections in the reform process. Os cuidados de saúde primários de Portugal estão em processo de reforma, sendo as Unidades de Saúde Familiar (USF) uma das principais marcas desse processo. Este estudo teve como objectivo avaliar o processo de implantação das USF a partir de 2006. Utilizou-se metodologia de análise de implantação na mesma área de atenção primária em saúde de um estudo anterior no Brasil. Na análise foram empregadas as dimensões do cuidado integral, da organização dos cuidados e político-institucional. Evidenciaram-se como avanços principais a acessibilidade, trabalho em equipe, qualidade (técnico-científica) dos cuidados, inovações nas práticas de gestão, na sustentabilidade (condições de trabalho) e infraestrutura. Principais desafios: integração com especialidades hospitalares, indefinições político-institucionais, sistemas informatizados, integração nos centros de saúde e organização do processo de trabalho. Estes dados poderão vir a informar os decisores de gestão sobre correções a efetuar no processo de reforma.

Primary healthcare in Portugal is undergoing a major reform, of which family health units (FHU) are one of the more visible results. This study aimed to evaluate the FHU implementation process from 2006 onwards. Methods from a previous study of primary healthcare implementation in Brazil were used. Dimensions studied included comprehensiveness of care, organization of care, and the political-institutional perspective. The main improvements identified included better availability of care, team work, technical quality of care, innovative management practices, sustainability of the model, working conditions and infrastructure improvements. Main challenges remaining include integration with hospital care, political and institutional gray areas, need for better information systems, integration within health centers and workflow organization. These data may be useful for management decision-makers when making adjustments and corrections in the reform process.

Este trabalho, representa um estudo de caso qualitativo, cuja unidade de análise é a equipe de Saúde do Programa Saúde da Família do município de Natal (RN). Tem como objetivos analisar as concepções dos profissionais sobre a prática do trabalho em equipe e reconhecer nessas práticas elementos que contribuam para a efetiva mudança do modelo de saúde hegemônico. Partiu-se da definição e tipologia de equipe de saúde elaborada por Peduzzi (1998), como principal fundamentação teórica. O estudo foi realizado em seis unidades de saúde da família, nos distritos sanitários Norte e Oeste. Esses serviços foram selecionados de acordo com critérios preestabelecidos. Foi utilizada como método para coleta dos dados empíricos a entrevista semi-estruturada com as equipes de saúde da família. Para análise do material empírico, utilizou-se o discurso do sujeito coletivo proposto por Lefèvre e Lefèvre (2003). Os resultados apontam para um predomínio da equipe do tipo integração. O trabalho em equipe surge como elemento essencial para o desenvolvimento da Estratégia de Saúde da Família. This article presents a qualitative case study where the unit of analysis was the Family Health Program team of Natal city, Rio Grande do Norte State, Brazil. The objectives were to analyze the conceptualizations of the professionals regarding teamwork as well as to identify in these practices the elements that contribute to an effective change in the hegemonic health model. The study was based on the Peduzzi (1998) typology and definition of health team and was conducted in six family health units in the North and East health districts selected by a pre-established criteria. Data were collected using a semi-structured interview applied in family health teams, which were analyzed using the Collective Subject Discourse proposed by Lefèvre and Lefèvre (2003). The results indicate a predominance of an integrated team type, and also that teamwork is an essential element for the development of the Family Health Strategy.

Este artigo apresenta parte dos resultados referentes à pesquisa avaliativa Estudos de Linha de Base, desenvolvida em 21 municípios com mais de 100 mil habitantes em três estados do Nordeste do Brasil. O objetivo geral foi avaliar experiências de implementação do Programa Saúde da Família (PSF), com foco nas induções do PROESF. Foi realizada Análise de Implantação utilizando-se como método o estudo de caso. Na análise utilizaram-se as dimensões: político-institucional, organização da atenção e cuidado integral. Como avanços destacam-se: priorização do PSF em áreas de risco; aprendizado institucional, qualificação dos gestores e equipes; centrais de regulação, vínculo e percepção positiva sobre PSF. Em relação aos desafios observaram-se: fortalecimento da capacidade formuladora local, alocação dos recursos na Atenção Básica, desprecarização do trabalho, efetivação de rede de atenção, fortalecimento da participação social, qualificação do monitoramento e avaliação para tomada de decisão; acolhimento; filas para exames, consultas e internação; implementação do trabalho em equipe e atividades promocionais e intersetoriais. This article presents part of the results from the Baseline Studies, an evaluative research conducted in 21 municipalities with more than 100,000 inhabitants each, in three States of Northeast Brazil. The overall objective was to assess experiences in the implementation of the Family Health Program (FHP), with a focus on inductions in the PROESF. An implementation analysis was performed, using the case study method. The analysis focused on these dimensions: political-institutional, health organization, and comprehensive care. Outstanding advances included: prioritize the FHP in high-risk areas; institutional learning, with qualification of managers and teams; definition of institutional levels for regulating the FHP; and health team-user bonds and positive perceptions concerning the program. Challenges included: strengthening of local policy and decision-making capacity; allocation of primary care resources; greater employment security for human resources; effective implementation of the health care network; strengthening of social participation; upgrading of monitoring and evaluation for decision-making; receptivity; waiting lines for tests, appointments, and hospital admissions; implementation of teamwork; health promotion and inter-sector activities.

Teamwork is one of the main pillars of Family Health Care projects, although it is not a strategy exclusively applied to such programs. It is not frequently discussed in current collective health research studies, but the perspective resulting from the full range of its action favors interdisciplinary and transdisciplinary actions. Thus, when building a Family Health Project, teamwork should be guided by a common health care purpose and the players involved should develop an interaction movement within the team itself as well as in relation to the community. It is therefore critical to establish communication practices for mutual understanding. This paper presents some preliminary considerations on the teamwork strategy in Family Health Care actions, indicating barriers and potentials in the construction of this health care model.

O trabalho em equipe, embora não seja uma exclusividade da Saúde da Família, representa um de seus principais pilares, ainda pouco discutido em pesquisas na saúde coletiva. A perspectiva da integralidade das ações favorece uma ação inter/transdisciplinar. Na construção do projeto de Saúde da Família, é necessário que o trabalho em equipe seja norteado por um projeto assistencial comum e que os agentes desenvolvam uma ação de interação entre si e com a comunidade. Para tanto, é imprescindível o desenvolvimento de uma prática comunicativa orientada para o entendimento mútuo. Esse artigo apresenta considerações preliminares sobre o trabalho em equipe na Estratégia de Saúde da Família sinalizando seus entraves e possibilidades na construção desse modelo assistencial. Teamwork is one of the main pillars of Family Health Care projects, although it is not a strategy exclusively applied to such programs. It is not frequently discussed in current collective health research studies, but the perspective resulting from the full range of its action favors interdisciplinary and transdisciplinary actions. Thus, when building a Family Health Project, teamwork should be guided by a common health care purpose and the players involved should develop an interaction movement within the team itself as well as in relation to the community. It is therefore critical to establish communication practices for mutual understanding. This paper presents some preliminary considerations on the teamwork strategy in Family Health Care actions, indicating barriers and potentials in the construction of this health care model.

This article is part of the evaluation study on the Project for Expansion and Consolidation of the Family Health Strategy, conducted by the Center for Public Health Research at the Federal University in Rio Grande do Norte, Brazil, from March to December 2005. The study presents an assessment of primary health care access and receptivity from the perspective of patients and health professionals, comparing traditional primary care units and family health units in three State capitals in Northeast Brazil. The methodology included focus groups with content analysis. The results identified increased access, but there is still a disproportion between potential supply, capacity to meet the demand, and difficulties with referral in both the family health units and traditional primary care units. As an operational technology, receptivity is still under construction in the family health units, with varying levels of adherence to both the concept and the strategies for reorganizing daily work practices. Meanwhile, receptivity is totally absent from the traditional primary care units. The study suggests that qualitative analyses be included in health assessment in order to better explain the subjective aspects of the various actors.

This article presents part of the results from the Baseline Studies, an evaluative research conducted in 21 municipalities with more than 100,000 inhabitants each, in three States of Northeast Brazil. The overall objective was to assess experiences in the implementation of the Family Health Program (FHP), with a focus on inductions in the PROESF. An implementation analysis was performed, using the case study method. The analysis focused on these dimensions: political-institutional, health organization, and comprehensive care. Outstanding advances included: prioritize the FHP in high-risk areas; institutional learning, with qualification of managers and teams; definition of institutional levels for regulating the FHP; and health team-user bonds and positive perceptions concerning the program. Challenges included: strengthening of local policy and decision-making capacity; allocation of primary care resources; greater employment security for human resources; effective implementation of the health care network; strengthening of social participation; upgrading of monitoring and evaluation for decision-making; receptivity; waiting lines for tests, appointments, and hospital admissions; implementation of teamwork; health promotion and inter-sector activities.

This article presents a qualitative case study where the unit of analysis was the Family Health Program team of Natal city, Rio Grande do Norte State, Brazil. The objectives were to analyze the conceptualizations of the professionals regarding teamwork as well as to identify in these practices the elements that contribute to an effective change in the hegemonic health model. The study was based on the Peduzzi (1998) typology and definition of health team and was conducted in six family health units in the North and East health districts selected by a pre-established criteria. Data were collected using a semi-structured interview applied in family health teams, which were analyzed using the Collective Subject Discourse proposed by Lefèvre and Lefèvre (2003). The results indicate a predominance of an integrated team type, and also that teamwork is an essential element for the development of the Family Health Strategy.