A prática no Núcleo de Apoio à Saúde da Família (NASF): apoio matricial como inovação tecnológica em saúde
Gozzi, Alana de Paiva Nogueira Fornereto
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In order to improve and broaden the care practices applied by Primary Health Care teams, the GM Ordinance n. 154 was issued in January 24th, 2008, creating Family Health Support Centers (NASF, in Portuguese) in some cities. Since this is an innovative resource to be implemented in this level of health care, building knowledge about the adoption of matrix support as a working strategy to be performed by different professionals related to health care is in accordance with the National Policy of Science, Technology and Innovation in Health, developed within the Sistema Único de Saúde, which indicates the need of research in the areas of health promotion and diffusion of knowledge to health care teams. The main goals of the present study were to investigate the practices of matrix support in NASF teams and verify the configuration of matrix support as technological innovation in health. The specific goals are: to analyse managers’ conceptions about matrix support, analyse NASF team practices regarding matrix support, identify educational and health care strategies used to develop matrix support in health care, contribute to the process of implementation of NASFs in a region of São Paulo state, and identify challenges and predicaments in the processes of matrix support development. The adopted methodology for this investigation was an interventional one, using a qualitative approach in the light of theoretical and methodological assumptions of Institutional Analysis. The procedures concerning this investigation involve: A) Preliminary research along with the DRSIII-Araraquara/SP and public information systems in order to map the services; B) Approximation and observation of intervention areas and conduction of an overall survey of needs through the application of a questionnaire to the representatives of NASF coordination in each municipality as well as filling a field journal; C) Development and implementation of a collaborative action plan involving all actors (intervention team); and D) Application of a questionnaire to the NASF workers in order to include information in the group data collection. Data analysis was performed by triangulation of methods, using ALCESTE 4.5 software to carry out categorical thematic analysis of interviews with representatives of NASF coordination and in Phase2, based on the principals of Institutional Analysis of Professional Practices. The results and analysis target three main aspects involving matrix support as technological innovation: A) necessary flexibility in order to operationalise matrix support, considering the health needs of the location, dynamics of actions and the proposed measures for such work methodology; B) centrality of the work on people’s and collectives’ health needs, discussion of cases and elaboration of the Singular Therapeutic Project; and C) modification of the ambulatory care and of the specialties that supervise interprofessional work. This investigation enabled the better understanding of the role performed by NASF professionals both in their teams and in combined action with Primary Health Care teams belonging to Basic Health Units or Family Health Strategy. Following the process of implementation of NASFs in the region, it was possible to discuss the professional practices and issues faced by the involved actors. The investigation is in alignment with the theoretical perspective of Institutional Analysis and the field of Science, Technology and Society as it brings specific knowledge about the production of knowledge in health and its impact in health and life conditions of Brazilian population. This intervention process brought about positive effects and important constructions to the target area and group. The Permanent Education process that professionals went through raised important questions about the need for improvement of the specialised ambulatory care and of a restricted clinic practice regarding the NASF and its Primary Health Care professionals.