Almeida Erika Rodrigues de, Medina Maria Guadalupe
Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil.
Cad Saude Publica. 2021 Oct 8;37(10):e00310820. doi: 10.1590/0102-311X00310820. eCollection 2021.
The article reports on the sociogenesis of the Family Health Support Center (NASF) in Brazil, based on document analysis and 16 in-depth interviews with key informants. Based on triangulation of data and sources and with Pierre Bourdieu as the theoretical reference, a sociohistorical analysis was performed to build a timeline of events related to the formulation of the NASF, including conflicts, interests, alliances, and agreements to allow the proposal's implementation. Four moments were identified in the history of the NASF: from 2000 to 2002, the first discussion for building a proposal to expand the family healthcare (PHC) teams; from 2003 to 2005, drafting a proposal to expand the core team, with the design centered on curative and individual interventions (NAISF); from 2005 to 2006, the repeal of the Brazilian Ministry of Health ruling that established the first proposal, revealing a "vacuum" in the debate on the expansion of PHC teams; and from 2007 to 2008, when the NASF was created with the central purpose of inter-consultation support activities with the family health teams. The genesis of the NASF resulted from a favorable situation in Brazil's political and institutional context, featuring important linkage with members of the government administration and pressure on the Ministry of Health from professional societies and municipal health administrators. The two proposals (NAISF and NASF) were designed differently, although both aimed to expand the scope of practices and case-resolution capacity in PHC. The analysis of the policy's genesis allowed understanding possible repercussions on the policymaking process in ambiguities that are still present in NASF practices.
本文基于文献分析以及对关键信息提供者的16次深度访谈，报道了巴西家庭健康支持中心（NASF）的社会成因。基于数据和来源的三角互证，并以皮埃尔·布迪厄为理论参考，进行了社会历史分析，以构建与NASF制定相关的事件时间表，包括冲突、利益、联盟和协议，从而使该提议得以实施。在NASF的历史中确定了四个阶段：2000年至2002年，首次讨论关于扩大家庭医疗保健（PHC）团队的提议；2003年至2005年，起草扩大核心团队的提议，设计围绕治疗性和个体干预（NAISF）；2005年至2006年，巴西卫生部废除了确立首个提议的裁决，这揭示了在关于扩大PHC团队的辩论中的“空白”；以及2007年至2008年，NASF成立，其核心目的是为家庭健康团队的相互咨询支持活动提供支持。NASF的产生源于巴西政治和制度背景下的有利形势，其特点是与政府行政部门成员有重要联系，以及专业协会和市卫生管理人员对卫生部施加的压力。尽管两项提议（NAISF和NASF）的目标都是扩大初级卫生保健的实践范围和病例解决能力，但设计有所不同。对该政策成因的分析有助于理解NASF实践中仍然存在的模糊性对决策过程可能产生的影响。
