Célia Regina Rodrigues Gil

Atenção primária, atenção básica e saúde da família: sinergias e singularidades do contexto brasileiro

This article analyzes the concepts of primary health care, basic health care, and family health care as used in official documents by the Brazilian Ministry of Health, final reports of the National Conferences on Health and Human Resources, the Basic Operational Ruling on Human Resources, and texts accessed on-line by BIREME. The data analysis, through double-entry matrices, showed a lack of these references in Brazilian health policy formulation and implementation. Basic Operational Ruling 96 (NOB/96) plays a distinct role in this regard; the national conference reports show an important gap in this debate, and most of the published articles present the concepts of primary care and basic care with the meaning of health unit or local service. Articles on the Family Health Program refer to it more as a program than a strategy, and the articles analyzing such concepts show the influence of rationalities underlying the different strategies for organization of health services in the Brazilian scenario, namely Health Surveillance and Programmatic Actions in Health and in Defense of Life.

Interação ensino, serviços e comunidade: desafios e perspectivas de uma experiência de ensino-aprendizagem na atenção básica

Teaching, Care and Community Interaction Practical Activities are curricular modules of the medical course of the State University of Londrina aimed at early introduction of students to the Family Health Program in order to give them the opportunity to understand the determinants of the health-disease process, the importance of health promotion and preventive actions and of the local health services. The activities are developed in the first four years of the medical course in modules of about 140 hours, with sequential contents structured in concept maps ranging from knowledge about the covered neighborhood to medical activities making part of primary care. The most evident results include diversification of the teaching-learning scenario, early contact of the students with the primary care system and development of skills involving the doctor-patient relationship and patient-centered care. Among the challenges is the need to make the work in the local health services more attractive to students, teachers and local health teams.

The implementation of undergraduate courses in public health: the viewpoint of the coordinators

Undergraduate courses in Public Health are now a reality in Brazil. The main goal of this article is to present the viewpoints of the coordinators of these courses on the process of their creation and implementation, emphasizing their contextual and procedural elements. Ten actors working in eight different institutions were interviewed and the interviews were submitted to content analysis as proposed by Bardin. The results showed that the creation of such courses resulted from a long process of discussion on the field of Public Health, and was hastened by some important decisions in Brazilian education, including the Program to Support Restructuring and Expansion Plans of Federal Universities. The testimonies of the coordinators enabled the researchers to understand the context prior to the proposal and the way it was developed by each university, making it possible to establish not only the aspects common to each institution, but also their specificities. Currently, these courses have the purpose of training professionals focused on the different areas of health services, especially those related to the Unified Health System (SUS), representing an irreversible advance in the field of Public Health.

Estudantes de graduação em saúde coletiva: perfil sociodemográfico e motivações

Os Cursos de Graduacao em Saude Coletiva (CGSC) consistem em uma nova modalidade formativa no campo da Saude Coletiva que visa formar profissionais focados nas principais necessidades em saude da populacao brasileira e no Sistema Unico de Saude. Assim, torna-se relevante tracar o perfil sociodemografico de seus alunos e conhecer seus interesses quanto a formacao e atuacao profissional. Com esses objetivos, em 2010, adotando uma abordagem quantitativa ao tema, realizamos um inquerito, atraves da aplicacao de um questionario semiestruturado aos alunos dos CGSC de universidades federais dos estados do Acre, Bahia, Minas Gerais, Mato Grosso, Parana, Rio de Janeiro e Rio Grande do Norte. Entre os 304 respondentes, encontramos uma populacao majoritariamente feminina, com 26 anos de idade, composta por individuos solteiros que moram com os pais, cursaram principalmente o ensino publico, pertencem a familias com baixa renda e escolaridade, aprovam o estudo noturno, trabalham e contribuem com a renda familiar, desejam trabalhar no setor publico, preferencialmente em capitais e identificam no CGSC uma oportunidade para trabalhar na area da saude. Esse perfil aponta para desafios e avancos presentes na formacao pretendida, reforcando a necessidade de monitoramento do processo de implementacao dos CGSC.

Força de trabalho e gestão do trabalho em saúde: revelações da Avaliação Externa do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica no Paraná

Trata-se de estudo sobre a composicao e gestao da forca de trabalho na Atencao Basica no Parana. Os dados foram coletados do Censo de Atencao Basica e da Avaliacao Externa do Programa Nacional de Melhoria do Acesso e da Qualidade da Atencao Basica, realizados entre julho e setembro de 2012. Destaca-se, no censo, a predominância (59,9%) de trabalhadores, cuja exigencia de formacao e o ensino fundamental ou medio. Entre os profissionais de nivel superior que participaram da avaliacao externa, 76% atuam ha cinco anos ou menos; 82,7% ingressaram por concurso publico; e quase nula a participacao/utilizacao de mecanismos de ensino/atualizacao a distância, evidenciando a necessidade de acoes voltadas ao fortalecimento de politicas de gestao do trabalho e da educacao em saude no estado.

Implantação do curso de graduação em saúde coletiva: a visão dos coordenadores

Os Cursos de Graduacao em Saude Coletiva sao hoje uma realidade. O objetivo deste artigo e apresentar a visao dos coordenadores desses cursos sobre o processo de criacao e de implementacao dos mesmos, com destaque para seus elementos contextuais e processuais. Foram entrevistados dez atores integrantes de oito instituicoes de ensino superior, e estas entrevistas foram submetidas a analise de conteudo proposta por Bardin. Os resultados demonstraram que a criacao dos cursos advem de longo processo de discussao no campo da Saude Coletiva e foi impulsionada por alguns marcos na educacao brasileira, entre eles o Programa de Apoio a Planos de Reestruturacao e Expansao das Universidades Federais. Os depoimentos dos coordenadores permitiram resgatar os antecedentes da proposta e seu percurso nas diferentes instituicoes de ensino, alem de estabelecer os pontos comuns e os especificos de cada processo. Atualmente, esses cursos, implantados e em andamento, se propoem a formar profissionais voltados para os diferentes niveis do sistema de saude, em especial para aqueles integrantes do Sistema Unico de Saude, constituindo-se como um processo irreversivel no campo da Saude Coletiva.

Expansão e diversificação da força de trabalho de nível superior nas Unidades Básicas de Saúde no Brasil, 2008 - 2013

This article aims to identify the university level workforce enrolled in the Primary Health Care Units (UBS) between 2008 and 2013, to contribute to the debate on the primary health care workforce planning. It is a descriptive and retrospective study of quantitative approach. Although physicians, nurses and dentists comprise the traditionally hegemonic university level workforce in UBS, there was observed an increasing participation of other professional categories, which may be due to the implementation of health supporting teams throughout the Country.

Necessidade e dinâmica da força de trabalho na Atenção Básica de Saúde no Brasil

Primary care and the healthcare workforce can be considered the greatest challenges of SUS (Sistema Único de Saúde), principally in recent decades. This article aims to describe the growth and regional distribution of the professions requiring higher education registered in the primary healthcare units. This descriptive study with a quantitative approach is concerned with the 14 accredited professions in the five major regions of Brazil from 2008 to 2013. The data was collected from the national database of the Ministry of Health. Among the professional categories with the greatest rates of national growth are physical education teachers, nutritionists, occupational therapists, physiotherapists, and pharmacists. In the North region of Brazil, physiotherapy, social work, and speech therapy stand out as having the greatest growth rates; in the Northeast, physical education, physiotherapy, and occupational therapy; and in the Center-West, nutrition and physiotherapy; in the Southeast, nutrition and pharmacology; and physical education showed prominent growth in the South. The major losses occurred in the professions of biologist and veterinary doctors in all regions. In general, the professional categories that comprise the Family Health Support Nuclei, NASF, demonstrate greater growth rates than nurses and doctors.