O trabalho do NASF na Paraíba: potencialidades e fragilidades da atuação profissional na perspectiva da política nacional de atenção básica à saúde

Abstract

Family Health Support Center (Núcleo de Apoio à Saúde da Família, NASF) was created in 2008 and it aims to expand the scope of actions developed in Family Health Strategy. This research aims to evaluate the knowledge that underlies NASF professionals’ performance in Paraíba (Brazil) and its practical use. An exploratory, descriptive and inferential research was developed using quantitative and qualitative approaches. Professionals working in NASF of 10 municipalities in Paraíba. All NASF professionals, research participants, answered a questionnaire that investigated sociodemographic data and these professionals’ knowledge regarding the National Policy of Basic Attention and the Basic Attention Notebook n. 39. In a second moment, some professionals still participated in an interview, guided by a semistructured script, in which it was investigated how the work takes place in NASF. For this stage, at least one NASF professional from each municipality participated, chosen by willingness to participate. Responses saturation criterion was used to define professionals’ final quantitative. Quantitative data were analyzed by descriptive analysis and, later, by Item Response Theory. In this turn, qualitative data were analyzed through Content Analysis, using ALCESTE software for data processing. The research respected ethical precepts, as indicated in CNS Resolution 466/12 (CNS: Conselho Nacional de Saúde, or National Health Concil). A total of 288 professionals answered the questionnaire; 33 professionals participated in the interviews. It was verified that NASF work knowledge comes from guiding documents, such as the National Basic Attention Policy (Política Nacional de Atenção Básica, PNAB) and the Basic Attention Report (Caderno de Atenção Básica, CAB) nº 39, as well as specialization courses, search by the professional him/herself and courses. It was not possible to identify in professionals’ speech actions of permanent education in health. NASF work corresponds preferably to individual curative activities, and, to a lesser extent, to matricity actions and collective activities. When presented to a problem situation, activities potentially developed by professionals correspond to dispensing and medication orientation, group activities and, to a lesser extent, intersectoral actions, use of the Singular Therapeutic Project (Projeto Terapêutico Singular, PTS) and interprofessional actions. There are weaknesses in the NASF work appointed by professionals who correspond to weaknesses in services management (inadequate physical space, low salaries, lack of transportation for the displacement of NASF team by the territory of its responsibility). In addition to such obstacles, the high demand and the overload of tasks, as well as workers’ inherent weaknesses, lack of dialogue in Health Care Network (Rede de Atenção à Saúde, RAS) and the non-use of NASF work tools were pointed out as fragilities. As potentialities, the use of PTS, interprofessional work, the link between EqSF (Equipe Saúde da Família, or Family Health Team) and users, increased health promotion activities, resulting in greater resolution of the cases followed had been pointed out. Thus, it is observed that there are limitations on NASF work assumptions, which is embodied in professional practice, while activities developed reproduce, for the most part, curative actions. However, there is a process of change under way, identified through collective actions such as health education and operative groups, matricidal actions, use of PTS, intersectoral and interprofessional actions. It should be noted that changes do not occur automatically, but they are procedural. In this context, it is observed that there is a search for this change, which can come to fulfill all NASF assumptions in the long run.