Abstract
This paper discusses meanings produced by Community Healthcare Agents (ACSs) on whether or not they feel that ACSs in Brazil's Family Health Strategy are receiving the recognition they deserve, considering their work with social networks. Discussion groups with 28 agents of six Health Units were held, sound-recorded and transcribed. Qualitative analysis of the material enables us to identify, in the discursive practices of ACSs, a tension on whether proper value is attributed to their work, or not. There was attribution of value when they talk of their activity in close proximity with the community, and their potential for construction of human connections; but there was non-attribution of value when they talk of the system's macro-structural aspects, such as low salaries, and low recognition of their function, in comparison to higher-level professionals. We conclude that the view of their work - still involving fragmented work processes, and expectation by the population that they will be able to provide immediate solutions to demands - might be preventing them from taking on board a more wide-ranging concept of primary healthcare, as a structuring and communication agent of the Healthcare Network, and as an organizing agent of Brazil's Unified Health System.
Highlights
Brazil’s Family Health Strategy (Estratégia Saúde da Família, or ESF) has stood out among the elements of the country’s Unified Health System (Sistema Único de Saúde, or SUS), and is considered an important element in the process of transformation of the healthcare model, which was previously – traditionally – marked by biomedical references[1,2]
The Family Health Strategy shares a wide conception of primary care, including Primary Healthcare as a strategy of organization of the healthcare system, within Healthcare Networks[3,4]
As Mendes[4] sums it up, in this point of view, three functions articulated by primary healthcare stand out: the solution-providing function of attending 90% of the most common health problems, not necessarily the simplest; the coordinating function of ordering the flows and counter-flows of people, products and information through the Healthcare Network; and the function of assuming or allocating responsibility for the health of the user population which is restricted, in the Healthcare Network, to the teams of the Family Health Strategy
Summary
Brazil’s Family Health Strategy (Estratégia Saúde da Família, or ESF) has stood out among the elements of the country’s Unified Health System (Sistema Único de Saúde, or SUS), and is considered an important element in the process of transformation of the healthcare model, which was previously – traditionally – marked by biomedical references[1,2]. Accompanying an international movement of increased attribution of value to Primary Healthcare[2], this strategy seeks to plan actions guided by the needs of the communities served. In the ESF provision of care is territorialized, and provided by multi-professional teams responsible for the planning of actions in accordance with the local needs of a community[2]. In this strategy, the figure of the Community Healthcare Agent (ACS) is distinguished by the fact that s/he lives in her area of activity, and has knowledge of the territory, and its peculiarities and needs[5,6]. His/her involvement from within the territory enables identification with the community and construction of a relationship of proximity with it, often characterized by a propensity to solidarity, mutual help and community leadership
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