Os Núcleos Ampliados de Saúde da Família e Atenção Básica (NASF-AB) e os impactos das mudanças na Política Nacional de Atenção Básica (PNAB): um estudo em uma região do interior do estado de São Paulo

Abstract

The Family Health Support Centers (NASF) emerged in 2008 with the aim of supporting the Family Health Strategies (ESF) teams and expanding the scope of Primary Care (PC) actions. In 2017, with the publication of a new National Primary Care Policy (PNAB), other forms of PC organization were recognized; there was a change in the NASF nomenclature, which is now called the Expanded Family Health and Primary Care Center (NASF-AB); among other changes. PC's funding also changed in 2019, with the implementation of the Previne Brasil Program, which ended up withdrawing funding from the NASF-AB. Given these current PC policies and considering the importance of maintaining the NASF-AB teams in the articulation of health care networks and in supporting comprehensive care in PC, the general objective of this research was to study the work of the NASF-AB in the region of DRS 3 – Araraquara, seeking to identify if there are, and what are, the repercussions of the changes implemented by the PNAB in recent years. This research was a qualitative and exploratory study. In the first stage of the research, an online questionnaire was sent to health managers in the municipalities of DRS 3 – Araraquara, with the objective of mapping the NASF-AB teams in the region, as well as their current work processes. In the second stage, focus groups were held with NASF-AB workers and professionals who were part of teams that were deactivated. In the first stage, the 24 municipalities answered the questionnaire, where it can be seen that 14 municipalities have NASF-AB teams, most of which have been operating for between 5 and 10 years. Individual consultations are the work processes most carried out by these teams and matrix support meetings are the least mentioned by managers, where most also did not identify the impact of the PNAB on their NASF-AB teams. In the second stage, it can be identified that, during the implementation of most of the NASF-AB teams, the needs of the territory, where they would work, were not considered and that the professionals were relocated from other points of the network. Like the managers, the workers did not identify the impacts of the PNAB on their work, but they pointed out numerous perceptions about Previne Brasil, such as difficulty in purchasing materials, expanding teams and even worsening the relationship with PC teams. In addition, they perceived the COVID-19 pandemic as an aggravating factor to the existing difficulties at work, which currently takes place in a disjointed way with the AB teams, with great difficulty in resuming collective activities. The support of the municipal management in implementing the NASF-AB was little recognized by the workers. It is concluded that there are countless challenges for the work of the NASF-AB to occur from the perspective of comprehensiveness; that Previne Brasil was a policy that discouraged matrix support in the territories and that research is needed to investigate the work of the NASF-AB in the “new” primary care teams, as well as studies that discuss new work arrangements where the NASF-AB is actually inserted in the AB.