Abstract
OBJECTIVETo analyze humanization practices in primary health care in the Brazilian Unified Health System according to the principles of the National Humanization Policy.METHODSA systematic review of the literature was carried out, followed by a meta-synthesis, using the following databases: BDENF (nursing database), BDTD (Brazilian digital library of theses and dissertations), CINAHL (Cumulative Index to nursing and allied health literature), LILACS (Latin American and Caribbean health care sciences literature), MedLine (International health care sciences literature), PAHO (Pan-American Health Care Organization Library) and SciELO (Scientific Electronic Library Online). The following descriptors were used: Humanization; Humanizing Health Care; Reception: Humanized care: Humanization in health care; Bonding; Family Health Care Program; Primary Care; Public Health and Sistema Único de Saúde (the Brazilian public health care system). Research articles, case studies, reports of experiences, dissertations, theses and chapters of books written in Portuguese, English or Spanish, published between 2003 and 2011, were included in the analysis.RESULTSAmong the 4,127 publications found on the topic, 40 studies were evaluated and included in the analysis, producing three main categories: the first referring to the infrastructure and organization of the primary care service, made clear the dissatisfaction with the physical structure and equipment of the services and with the flow of attendance, which can facilitate or make difficult the access. The second, referring to the health work process, showed issues about the insufficient number of professionals, fragmentation of the work processes, the professional profile and responsibility. The third category, referring to the relational technologies, indicated the reception, bonding, listening, respect and dialog with the service users.CONCLUSIONSAlthough many practices were cited as humanizing they do not produce changes in the health services because of the lack of more profound analysis of the work processes and ongoing education in the health care services.
Highlights
The victories won by the Brazilian Unified Health System (SUS) challenge us to develop proposals for interventions that will encourage further improvement
The National Humanization Policy (NHP) is based on three structuring principles: transversality, indicating the expansion of communication between subjects and services, aimed at making changes in the areas of power, changes in the boundaries of knowledge and in labor relations; the inseparability of care and management, stating that there is an inseparable relationship between modes of care and ways to manage and own the work; and the affirmation that the roles and autonomy of subjects and collectives, understood as subjects in producing the services, for themselves and for the world, developing attitudes of co-responsibility in producing health care.a
In order for this to happen, various devices need to be used in producing health care, such as humanization working groups, an ombudsman, classification of the reception, among others.a Implementing these schemes calls for commitment on the part of all involved in the process of producing health
Summary
The victories won by the Brazilian Unified Health System (SUS) challenge us to develop proposals for interventions that will encourage further improvement. In this approach to constructing the SUS, the National Humanization of Hospital Care Program (PNHAH) was created in 2000. In 2003, the Brazilian Ministry of Health developed a proposal to expand humanization in the SUS beyond the confines of the hospital, establishing the National Humanization of Health Care and Health Care Management Policy, known as the National Humanization Policy (NHP) and/or HumanizaSUS.a. Faced with ethical, political, financial and organizational obstacles, it became necessary to discuss humanization, questioning the techno-care model and the quality of care.[15,32] the NHP aims to make itself effective in health care practices, together with SUS principles, forming a political commitment to bringing about effective transformations and creating new realities in health care.[5]. In order for this to happen, various devices need to be used in producing health care, such as humanization working groups, an ombudsman, classification of the reception, among others.a Implementing these schemes calls for commitment on the part of all involved in the process of producing health
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