Corrêa Daniel Seabra Resende Castro, Moura Alexandra Gouveia de Oliveira Miranda, Quito Marcus Vinícius, Souza Heloiza Machado de, Versiani Luciana Martins, Leuzzi Sérgio, Gottems Leila Bernarda Donato, Macinko James
Secretaria de Estado de Saúde do Distrito Federal. STN, Asa Norte. 70086-900 Brasília DF Brasil.
Escola Superior de Ciências da Saúde. Brasília DF Brasil.
Cien Saude Colet. 2019 Jun 27;24(6):2031-2041. doi: 10.1590/1413-81232018246.08802019.
The Unified Health System has undergone constant evolution and expansion since the publication of Brazil's 1988 Federal Constitution. The Federal District has provided contributions to the field of Primary Health Care Policy, especially between 2016 and 2018, by defining the Family Health Strategy as the definitive way of organizing Primary Health Care (PHC) services and by establishing a set of actions aimed at conversion of existing PHC services to this model. This article describes and analyzes the key processes of this change. The method used was analysis of ordinances, resolutions, reports and other documents, as well as assessment of data from official databases. We emphasize the development of a normative structure that includes the teams' implementation, the professionals' work processes, changes in medical specialties and reorganization of the health professionals who already worked in PHC. with an effect of increasing the population's Family Health Strategy coverage (in a population of approximately 3 million inhabitants) from 28% to 69% during a two-year period, the experience demonstrates the feasibility of incremental changes in health policies such as defining priorities, better management of the workforce, training and decentralized planning to increase access to health services.
自1988年巴西联邦宪法颁布以来，统一卫生系统经历了持续的发展和扩张。联邦区为初级卫生保健政策领域做出了贡献，特别是在2016年至2018年期间，将家庭健康战略定义为组织初级卫生保健（PHC）服务的最终方式，并制定了一系列旨在将现有初级卫生保健服务转变为该模式的行动。本文描述并分析了这一变革的关键过程。所采用的方法是对法令、决议、报告和其他文件进行分析，以及对官方数据库中的数据进行评估。我们强调了一个规范结构的发展，其中包括团队的实施、专业人员的工作流程、医学专业的变化以及对已在初级卫生保健领域工作的卫生专业人员的重组。在两年时间里，该经验使家庭健康战略在大约300万居民中的覆盖范围从28%提高到了69%，证明了诸如确定优先事项、更好地管理劳动力、培训和分散规划等卫生政策渐进式变革的可行性，以增加获得卫生服务的机会。
