O SISREG na atenção primária de Saúde: um estudo sobre a reorganização da porta de entrada do SUS no Município do Rio de Janeiro

Abstract

This dissertation approaches the SISREG as the gateway of the SUS in the city of Rio de Janeiro, aiming to analyze its operationalization by Primary Health Care (PHC), in the period from 2012 to 2018. It consists of a qualitative, exploratory and descriptive study, based on the critical-dialectical method and used: secondary data of free and unrestricted access -that served for the characterization of SISREG; search on electronic sites; data collection in public documents digitized on the website of the Municipal Health Department, in order to identify the operationalization of regulation via SISREG, in the municipality of Rio de Janeiro and systematized observations in the daily practice as a social worker of a health unit of the municipality. In 2012, the municipality reorganized and created conditions for PHC to assume the attribution of being responsible for the entrance door of workers/users in the Health System through an online Job Regulation System. The results were grouped into two subperiods - 2012- 2017 - years that mark the decentralization process in the operationalization of the system and - 2017-2018 - which indicates the beginning of a reorganization of the SISREG centralized at the central level of the city hall and that goes back to autonomy and the reduction of responsibilities to PHC units as of 2012. In the subperiod - 2012-2017 - the: the process of decentralization of responsibility from regulation to PHC; The SISREG as the main tool of outpatient care regulation in the municipality; the expansion of PHC in the municipality through the privatization route, which was not accompanied by the expansion of the health care network (RAS), at secondary and tertiary levels, in order to increase the access of more citizens to health services in a way that fully paid-up; the decentralization of the regulation of specialized procedures for PHC, by assigning the regulatory function to the doctors responsible for the municipality's technical guardians; the development of protocols on SISREG; the concern with the training of professionals; respect for protocols and professional regulation. In contrast to the sub-period - 2017-2018 -, the SISREG was marked by the reorganization of the system, via dismantling of what had been implemented; difficulties in accessing public data; by the creation of the Transparency Portal, which has not been effective in practice; by clientelist regulation, marked by scandals related to the use of SISREG; the withdrawal of autonomy from PHC and the centralization of the process under the responsibility of regulatory physicians; by the excess of rules and protocols that hinder access to the system and facilitate the dismantling of PHC based on the reformulation of the 2017 PNAB; negligence/omission in relation to the training of health professionals; by tripling the number of people waiting in the virtual queue. Thus, access to The RAS by SISREG in Rio de Janeiro is marked by adversities and impasses, being in disagreement with the principles of the SUS, a reality that can be highlighted by the long virtual queues of the SISREG in the period studied.