The health family program in Brazil: From the conquests to the challenges

This article presents the results of a research work which anlalyzes the implantation of the Family Health Program (PSF) in Brazil. The authors point to the issue of access to primary health care services within the fully publicly funded Unified National Health Service (SUS). PSF implantation started in 1994, as a strategic policy to reorganize the primary care in the municipal health systems. It involves the formation of multiprofessional teams including community health agents. This study was carried out in 12 municipalities that were pioneers in PSF implantation, and which are located in different geographical regions. We used the Collective Subject Discourse technique and our analysis is grounded in the Dialectic Hermeneutic Theory. We interviewed health service managers on the federal, state and municipal levels, as well as health professionals of the PSF teams and patients. Access remains seen from the perspective of disease. There are issues related to funding, care coverage, sustainability, continuous education of professionals, better definition on the role played by members of PSF teams, integration of PSF with other areas of the system (secondary and tertiary care). We conclude that PSF is still a strategy with potentiality to decrease health inequalities. It is necessary that health SUS managers and society realize that they can make of PSF that organizational base of primary health care, this would lead to the construction of a model of integral and family health care oriented by principles of solidarity, equality and social justice.