A Política Nacional de Atenção Básica 2017: repercussões nas práticas de saúde de enfermeiros e agentes comunitários de saúde

Abstract

This thesis had as its object the repercussions on the health practices of Nurses and Community Health Agents in the city of Rio de Janeiro, state of Rio de Janeiro, based on the National Primary Care Policy (PNAB) implemented in 2017. Its general objective is to analyze the repercussions of the 2017 National Policy for Primary Care on the practices of nurses and community health agents in the municipality of Rio de Janeiro/RJ, considering the policies aimed at Primary Health Care and health management in the municipality. We defend the thesis that "The health practices of nurses and community health agents in Primary Health Care were mischaracterized by the 2017 National Primary Care Policy, interfering and deconstructing the profile of these professionals' competencies". This is an investigation with a mixed approach. To anchor this study, we chose the theoretical framework of historical and dialectical materialism. The study was carried out with nurses and community health agents from the Primary Care Units made up of Family Health teams from AP 3.1, Metropolitan Region I, city of Rio de Janeiro (RJ). Nurses and community health agents participated in the study. Data collection was carried out between the months of August 2020 and April 2021. Data were obtained through online forms and interviews via videoconference. For the treatment of quantitative data, the statistical package StatisticalPackage for the Social Science version 23 was used. Sociodemographic and professional data were analyzed and received statistical treatment through univariate analysis from descriptive statistics, with raw values and percentages. Data related to the repercussions of the 2017 PNAB in the practices of PC professionals were analyzed by checking the Mean, Median and Standard Deviation. The Kolmogorov-Smirnova and Shapiro-Wilk normality tests were applied to guide the choice of tests (parametric or non-parametric). Qualitative data were submitted in the light of thematic content analysis and three thematic categories emerged: 1- Structural and functional changes in Primary Health Care; 2- The implications of restructuring the work process, attributions and organization of the community health agent in Primary Health Care and 3- The PNAB 2017 and its repercussions for users and for the Family Health Strategy model. In identifying the changes that impacted their health practices, for the CHA, we observed the negative repercussion trends being the financing of other types of PHC team, the CHA as optional in these teams and the user's connection in other health units. With positive trends of repercussions in practices, we find the criterion of higher education training and preferably in the health area to managers of Basic Units, the change of nomenclature from NASF to NASF-AB and the offer of essential and expanded services. For nurses, we found the same results with trends of negative repercussions. In the evaluations of positive trends, the recognition of the manager figure and his criteria for occupying the position emerged. From this study, the thesis that the 2017 PNAB promoted important changes in the organization of services, in work processes, in the attributions of professionals was confirmed, with negative repercussions on the health practices of nurses and CHAs.