Trilhas da articulação das vigilâncias com a atenção básica no município de São Bernardo do Campo: análise da experiência do Núcleo em Vigilância em Saúde-NEVS
Data
2022-03-30
Autores
Paniagua, Fabiana Aparecida Toneto [UNIFESP]
Orientadores
Capozzolo, Angela Aparecida [UNIFESP]
Tipo
Dissertação de mestrado profissional
Título da Revista
ISSN da Revista
Título de Volume
Resumo
No Sistema Único de Saúde (SUS) a integração entre as vigilâncias sanitária, epidemiológica,
saúde do trabalhador, meio ambiente e controle de zoonoses, e destas com a atenção básica tem
sido um grande desafio, demandando a invenção de novos arranjos organizativos de trabalho e de
gestão. A mobilização de gestores e trabalhadores das vigilâncias institucionalizadas de um
município de grande porte da região metropolitana de São Paulo, concebeu e gerou o “Núcleo em
Vigilância em Saúde-NEVS” a ser implantado em unidades básicas de saúde. A figura de um
articulador em vigilância em saúde, diversos arranjos de articulação e de educação permanente
foram apostas importantes nesse processo. O presente estudo tem como objetivo geral analisar
essa experiência de articulação das áreas de vigilâncias e da Atenção Básica na perspectiva da
integralidade do cuidado. E, como objetivos específicos: descrever o processo de construção e
implantação do NEVS; identificar arranjos e estratégias de articulação entre as vigilâncias e
destas com os serviços de Atenção Básica; identificar tensões, fragilidades e potencialidades do
NEVS. Trata-se de uma pesquisa qualitativa-interferência, que considera a implicação da
pesquisadora e que o ato de pesquisar já produz mudanças no processo que se pretende estudar.
Diferentes instrumentos na produção de dados foram utilizados, envolvendo trabalhadores e
gestores das vigilâncias e da atenção básica do município: entrevistas semiestruturadas e rodas de
conversas, consulta de documentos, registros de atas de reuniões e diário da pesquisadora. As
análises indicaram potencialidades do Núcleo em Vigilância em Saúde em articular as áreas das
vigilâncias (epidemiológica, controle de zoonoses, sanitária, saúde do trabalhador e ambiental) e
estas com a Atenção Básica (UBSs). O trabalho com as informações epidemiológicas e a
educação em saúde nos territórios contribuíram para fortalecer essas articulações O articulador
em vigilância em saúde confirma-se como elo central do NEVS, capaz de produzir interferências
nos processos de trabalho de ambas as áreas, ampliar as reflexões e ações envolvendo as equipes
das UBS e das vigilâncias. A investigação indicou a importância do articulador estar localmente
inserido e imerso no cotidiano da unidade básica de saúde, para contribuir na transformação das
práticas em saúde, envolvendo o ethos vigilância em saúde, com estratégias de apoio das áreas
especializadas das vigilâncias. O deslocamento dos profissionais das áreas das vigilâncias para
dentro da UBS produziu fortalecimento ao processo e abertura de novos olhares e possibilidades
na integração, para ambas as equipes. Constata-se que ocorrem dificuldades no entendimento
inicial das equipes da atenção básica sobre o papel do articulador na UBS e que são necessárias
estratégias singulares para construir aproximações com as equipes dos serviços, apoiar e executar
as ações de vigilância em conjunto com os profissionais da UBS. Também ocorrem dificuldades
no reconhecimento do articulador pelas equipes das vigilâncias. Diversas estratégias de apoio
para ampliar a circulação das informações e as articulações foram importantes para dar
sustentação ao processo. A formação em serviço com o compartilhamento de saberes entre a
atenção básica e vigilância em saúde pode ser uma força potente de qualificação e gestão do
cuidado na perspectiva da integralidade, considerando os cenários territoriais e epidemiológicos e
as distintas características populacionais, geográficas e sociais envolvidas. Na contramão de um
forte contexto assistencial e de desmonte do SUS, produzir novos movimentos fortalecendo a
prevenção, promoção, proteção e vigilância em saúde, foi e é possível, com suas tensões e
disputas, com a união de trabalhadores e gestores municipais, na busca de uma saúde pública de
qualidade, na perspectiva da integralidade do cuidado.
In the Brazilian National Health System the integration between sanitary, epidemiological, worker's health, environment surveillances and zoonosis control center, and these ones with primary care, has been a great challenge, demanding the creation of new organizational arrangements for work and management. The mobilization of managers and workers of institutionalized surveillance in a large city in the metropolitan region of São Paulo, conceived and generated the “Nucleus in Health Surveillance-NIHS” to be implemented in basic health units. The figure of an articulator in health surveillance, various arrangements of articulation and permanent education were important bets in this process. The present study has the general objective of analyzing this experience of articulating the areas of surveillance and Primary Care from the perspective of comprehensive care. And it has specific objectives: to describe the process of construction and implementation of NIHS; to identify arrangements and articulation strategies between surveillance and between these ones and the Primary Care services; to identify tensions, weaknesses and potential of NIHS. It is a qualitative-interference research, which considers the researcher's involvement and that the act of researching already produces changes in the process that is intended to be studied. Different instruments were used in the production of data, involving workers and managers of surveillance and primary care in the municipality: semi-structured interviews and conversation circles, consultation of documents, records of minutes of meetings and the researcher's diary. The analyses indicated the potential of the Nucleus in Health Surveillance in articulating the areas of surveillance (epidemiological, zoonosis control center, sanitary, occupational and environmental health) and these with Primary Care. The work with epidemiological information and health education in the territories contributed to strengthening these articulations. The articulator in health surveillance confirms itself as a central link of NIHS, capable of producing interferences in the work processes of both areas, expanding reflections and actions involving BHU and surveillance teams. The investigation indicated the importance of the articulator being locally inserted and immersed in the daily life of the basic health unit, to contribute to the transformation of health practices, involving the ethos of health surveillance, with strategies to support the specialized areas of surveillance. The displacement of professionals from the surveillance areas to the BHUs strengthened the process and opened new perspectives and possibilities in integration, for both teams. It is verified that there are difficulties in the initial understanding of primary care teams about the role of the articulator in the BHU and that unique strategies are needed to build approximations with the teams of the services, support and execute the surveillance actions together with the professionals of the BHU. There are also difficulties in recognizing the articulator by the surveillance teams. Several support strategies to expand the circulation of information and articulations were important to support the process. In-work training with the sharing of knowledge between primary care and health surveillance can be a powerful force for qualification and care management from the perspective of comprehensiveness, considering the territorial and epidemiological scenarios and the different populational, geographical and social characteristics involved. In the opposite direction of a strong context of assistance and Brazilian National Health System failure, it was and is possible to produce new movements in order to strengthen prevention, promotion, protection and health surveillance, despite tensions and disputes, with the union of workers and municipal managers, in the search for quality public health, from the perspective of the comprehensive care.
In the Brazilian National Health System the integration between sanitary, epidemiological, worker's health, environment surveillances and zoonosis control center, and these ones with primary care, has been a great challenge, demanding the creation of new organizational arrangements for work and management. The mobilization of managers and workers of institutionalized surveillance in a large city in the metropolitan region of São Paulo, conceived and generated the “Nucleus in Health Surveillance-NIHS” to be implemented in basic health units. The figure of an articulator in health surveillance, various arrangements of articulation and permanent education were important bets in this process. The present study has the general objective of analyzing this experience of articulating the areas of surveillance and Primary Care from the perspective of comprehensive care. And it has specific objectives: to describe the process of construction and implementation of NIHS; to identify arrangements and articulation strategies between surveillance and between these ones and the Primary Care services; to identify tensions, weaknesses and potential of NIHS. It is a qualitative-interference research, which considers the researcher's involvement and that the act of researching already produces changes in the process that is intended to be studied. Different instruments were used in the production of data, involving workers and managers of surveillance and primary care in the municipality: semi-structured interviews and conversation circles, consultation of documents, records of minutes of meetings and the researcher's diary. The analyses indicated the potential of the Nucleus in Health Surveillance in articulating the areas of surveillance (epidemiological, zoonosis control center, sanitary, occupational and environmental health) and these with Primary Care. The work with epidemiological information and health education in the territories contributed to strengthening these articulations. The articulator in health surveillance confirms itself as a central link of NIHS, capable of producing interferences in the work processes of both areas, expanding reflections and actions involving BHU and surveillance teams. The investigation indicated the importance of the articulator being locally inserted and immersed in the daily life of the basic health unit, to contribute to the transformation of health practices, involving the ethos of health surveillance, with strategies to support the specialized areas of surveillance. The displacement of professionals from the surveillance areas to the BHUs strengthened the process and opened new perspectives and possibilities in integration, for both teams. It is verified that there are difficulties in the initial understanding of primary care teams about the role of the articulator in the BHU and that unique strategies are needed to build approximations with the teams of the services, support and execute the surveillance actions together with the professionals of the BHU. There are also difficulties in recognizing the articulator by the surveillance teams. Several support strategies to expand the circulation of information and articulations were important to support the process. In-work training with the sharing of knowledge between primary care and health surveillance can be a powerful force for qualification and care management from the perspective of comprehensiveness, considering the territorial and epidemiological scenarios and the different populational, geographical and social characteristics involved. In the opposite direction of a strong context of assistance and Brazilian National Health System failure, it was and is possible to produce new movements in order to strengthen prevention, promotion, protection and health surveillance, despite tensions and disputes, with the union of workers and municipal managers, in the search for quality public health, from the perspective of the comprehensive care.
Descrição
Citação
PANIAGUA, Fabiana Aparecida Toneto. Trilhas da articulação das vigilâncias com a atenção básica no município de São Bernardo do Campo: análise da experiência do Núcleo em Vigilância em Saúde-NEVS. 2022. 126 f. Dissertação (Mestrado em Ensino em Ciências da Saúde) - Instituto de Saúde e Sociedade, Universidade Federal de São Paulo, Santos, 2022.