Avaliação da implementação de ações em saúde sexual e reprodutiva desenvolvidas pela Estratégia Saúde da Família no município de Juiz de Fora - Minas Gerais

Abstract

The attention to Sexual and Reproductive Health (SRH) includes a set of services and actions aimed at promoting autonomy, safety and freedom in reproductive and sexual decisions. The implementation of this care in the context of the Brazilian Unified Health System occurs mainly in Primary Health Care. The objective of this evaluative research was to examine the degree of implementation of SRH actions in the Family Health Strategy (FHS) in the city of Juiz de Fora-MG, verify the compliance of attention to SRH in this municipal setting and identify limiting and facilitating contextual factors that influence its implementation. In this normative assessment, which had as focus the structure and process, we chose to use a quali-quantitative approach. A theoretical model of care for SRH in PHC was built based on government regulations, structured in two components, promotion of SRH and clinical care for SRH, with 62 and 47 parameters, respectively. For data collection, two self-administered questionnaires were used, with closed and open questions, aimed at managers and professionals working with SRH. Documents from de municipality were analyzed to complement the information about the context of the study. Twenty-four managers and 46 professionals, who work in 24 of the 43 health units that have FHS in the studied municipality, participated in the research. In EpiData, a simple descriptive statistical analysis was performed, and open responses were analyzed based on the categorical thematic content analysis. The results of the component Promoting SRH in relation to compliance point to a better performance of the structure compared to the process; on the other hand, the evaluation of the process performed better in the Clinical Care component. No health unit achieved adequate implementation, with 17 of them presenting implementation evaluated as partial and seven as incipient, corroborating the hypothesis that the implementation of SRH in the FHS is still a challenge. Descriptions of open answers were organized into four categories that expressed limitations related to structure and process. The municipality’s documents indicate initiatives to be implemented that have the potential to contribute to the attention to SRH in PHC. It is necessary to invest in training of professionals and in improvements related to the organization of the work process; determine referral and counter-referral flows to improve communication in the care network; establish partnerships with PHC managers and professionals to build protocols that dialogue with government recommendations on SRH and are consistent with the reality and needs of the population, with a view to assisting the professionals involved and enabling advances in the process of implementing this care in the studied municipal context.