O NASF como apoio à efetivação da Estratégia de Saúde da Família: uma revisão sobre o tema nos seus quinze anos de existência

Abstract

The Unified Health System (SUS) is organized in a hierarchical and regionalized way, and has Primary Health Care (APS) as the coordinator of comprehensive care, over time, in a network and on a territorial basis. It must be responsible for resolving 80% of a population's health demands and as a population's first access to the health system, it must mediate the guarantee of this right. The Family Health Strategy (ESF) is the APS model currently promoted in Brazil. It operates with multidisciplinary teams in a specific territory, based on knowledge of local realities and populations. In order to enable the implementation of the ESF's mandate towards comprehensiveness, in 2008, the NASF teams were created, aiming to increase the resolution and scope of primary care actions. These are centers made up of multidisciplinary teams with specialists normally working at outpatient and hospital levels of care, which generally operate a fragmented biomedical model. It is precisely the specialists who must develop joint activities with the eESF, following a logic of support that transcends the fragmentation of the health system, and which aims to guarantee comprehensive care. This work, of specialties as enhancers of comprehensive care management, is still under construction, and its models are in dispute. The NASF strategy is just one of them. This study, carried out after 15 years of implementation, intends to carry out a bibliographical review understanding the importance of focusing on the academic production carried out as a way of understanding the paths to implementing a policy. From this survey, we intend to point out implementation difficulties regarding the procedural and structural conditions of its insertion, which is still incipient, as well as the progress made so far. A deeper understanding of these limits is fundamental in the attempt to overcome them, given that we understand that the ESF can only be implemented with the active presence of a multidisciplinary team that operates the political logic that the NASF proposes to support.