The work of permanent health education facilitators for the qualification of SUS health care in the region of Araraquara, São Paulo, Brazil

The Course for Permanent Health Education Facilitators (PHE) was created in 2005 by the Brazilian Health Ministry and by the National Public Health School (ESNP-FIOCRUZ) to capacitate students, teachers, users,  managers and workers of the service network of the Single Health System (SUS) regarding the work process and organization. It represents a strategy for the viability and expansion of the National PHE Policy. We analyzed the construction of PHE practices, advances and limitations in the daily routine of SUS health services in the region of Araraquara, SP, Brazil. This is a case study obeying ethical requirements, with data collected by means of 5 group meetings according to the theoretical framework of the operative group, with PHE facilitators trained in this course. The meetings were taped and transcribed. The PHE facilitators identified as advances, in addition to their own personal and professional growth, the introduction of team meetings regarding up-to-date information about relevant topics for health care, such as patient reception, urgency and emergency care, and mother-child follow-up. The PHE facilitators indicated limitations, such as low adhesion by managers and service heads regarding the democratization of decisions, and resistance by workers against the proposed changes. Another limitation refers to the facilitators' training, which did not enable them to deal with the anguish and conflicts typical of the implementation of changes, and the lack of tools to deal with group processes. We conclude that the work of EPS facilitators, as fundamental operators of PHE policy in Brazil, can qualify health care in the SUS. However, this requires a continuous PHE process of the facilitators themselves, establishming a monitoring and investment process as a policy on the political agenda of local health system and service managers.