Submitted by Natalie Mendes (nataliermendes@gmail.com) on 2015-07-25T15:33:44Z No. of bitstreams: 1 DISSERTA??O_FINAL_MARIANA.pdf: 1933246 bytes, checksum: cba7b57237fc6562b3b67a07e6bf6068 (MD5) / Made available in DSpace on 2015-07-25T15:33:44Z (GMT). No. of bitstreams: 1 DISSERTA??O_FINAL_MARIANA.pdf: 1933246 bytes, checksum: cba7b57237fc6562b3b67a07e6bf6068 (MD5) Previous issue date: 2014-03-14 / The access to health services in a global, equal and comprehensive way constitutes itself a civil right legally granted in the Brazilian Federal Constitution of 1988 which regulates and establishes the Unified Health System (SUS). However it is noticeable that the comprehensive access to health services has not been effectively put into practice, especially, in actions of medium and high complexity. Hence, this study aims to understand the organizational dynamic of the access of users of the Family Health Program (PSF) to the healthcare services of medium and high complexity of the SUS network and to analyze health practices performed by the primary care team, medium and high complexity for the feasibility of this access. We have analyzed the organizational dynamic of access to medium and high complexity healthcare services based on the guidelines of the dimensions of a political, technical and symbolical access analysis bounded by Giovanella and Fleury (1995) and supplemented with the theoretical model proposed by Assis et alii (2011). In the theoretical framework we discuss ways for the effectuation of the access to the healthcare services as a citizenship right as well as the organization of healthcare services in medium and high complexity under the focus of healthcare assistance models. This is a qualitative study, of critical and analytical approach in an approximate view of the dialectic method, which has as field of work the Family Health Units (USF), the Polyclinics and the Public Hospitals of Feira de Santana city in the State of Bahia. The participants of the study consisted of three groups: (1) healthcare professionals, (2) users and (3) managers/coordinators of healthcare services totaling 26 participants. We have used techniques such as data collection through semi-structured interviews, systematic observation and document analysis. The data analysis was an approximation of the hermeneutic-dialectic method. From the comparison of the studied data three categories rose up: (1) ORGANIZATIONAL DYNAMIC OF THE ACCESS OF THE USERS AND THE MATERIALITY OF ITS SENSES AND MEANINGS: the transversality of the political, technical and symbolical dimensions; (2) THE WORK PROCESS OF THE HEALTH PROFESSIONALS IN BASIC HEALTHCARE OF MEDIUM AND HIGH COMPLEXITY: an interweaving among healthcare; (3) THE ACCESS OF THE USERS TO THE SERVICES AND THE PRACTICES OF HEALTH OF MEDIUM AND HIGH COMPLEXITY: public/private relationship. The results make the senses/meanings of access to healthcare services that cross the political, technical and symbolical dimensions abundantly clear. The individual and collective practices, held by professionals working in primary care of medium and high complexity to promoting the access of the user to the SUS network, involve committed and welcoming actions by instituting bonds and enhancing the subjectivity of the users in some moments, and in other moments it involves a centered professional model geared towards the patients? concerns/conduct, medicalization and technicism co-existing dialectically an intertwining of lightweight, soft-hard and hard technologies in this process. Within the difficulties and limitations that the users have found to access healthcare services of medium and high complexity the demand was cited once these services are offered on a wider scale than its supply. We have come across several inputs used by users to access the health services of medium and high complexity. Furthermore the relationship between public and private is constitutive of the organization of this reality. The access of the user of the PSF to the practices of medium and high complexity still needs, for its embodiment, an all-embracing commitment of users, health professionals and health managers so as to operationalize it as a citizenship right. / O acesso aos servi?os de sa?de de forma universal, equ?nime e integral, se constitui em um direito de cidadania, garantido legalmente na Constitui??o Federal de 1988, a qual regulamenta e institui o Sistema ?nico de Sa?de (SUS). Contudo, percebemos que o acesso universal aos servi?os de sa?de n?o tem sido traduzido efetivamente na pr?tica, em especial nas a??es de m?dia e alta complexidade. Assim, este estudo teve como objetivos compreender a din?mica organizativa do acesso dos usu?rios do Programa Sa?de da Fam?lia (PSF) aos servi?os de sa?de de m?dia e alta complexidade da rede SUS e analisar as pr?ticas de sa?de realizadas pelos profissionais da aten??o b?sica, de m?dia e alta complexidade para a viabiliza??o deste acesso. Analisamos a din?mica organizativa do acesso aos servi?os de m?dia e alta complexidade, tendo como bases orientadoras as dimens?es de an?lise de acesso pol?tica, t?cnica e simb?lica, delimitadas por Giovanella e Fleury (1995) e complementadas com o modelo te?rico proposto por Assis e outros (2011). No referencial te?rico discutimos os caminhos para a efetiva??o do acesso aos servi?os de sa?de enquanto direito de cidadania, bem como a organiza??o dos servi?os de sa?de de m?dia e alta complexidade sob o enfoque dos modelos assistenciais em sa?de. Trata-se de um estudo qualitativo, de abordagem cr?tico-anal?tica, numa perspectiva aproximada do m?todo Dial?tico, tendo como cen?rio as Unidades de Sa?de da Fam?lia (USF), Policl?nicas e Hospitais p?blicos de Feira de Santana-BA. Os participantes do estudo foram constitu?dos de tr?s grupos: profissionais de sa?de (Grupo I), usu?rios (Grupo II) e gestores/ coordenadores dos servi?os de sa?de (Grupo III), totalizando 26 participantes. Utilizamos como t?cnicas de coleta de dados a entrevista semi-estruturada, a observa??o sistem?tica e a an?lise documental; a an?lise de dados foi uma aproxima??o do m?todo Hermen?utico-dial?tico. A partir do confronto dos dados emergiram tr?s categorias: 1) DIN?MICA ORGANIZATIVA DO ACESSO DOS USU?RIOS E A MATERIALIDADE DOS SENTIDOS E SIGNIFICADOS: a transversalidade das dimens?es pol?tica, t?cnica e simb?lica; 2) O PROCESSO DE TRABALHO DOS PROFISSIONAIS DE SA?DE NA ATEN??O B?SICA, DE M?DIA E ALTA COMPLEXIDADE: um entrela?amento entre as tecnologias de sa?de; 3) O ACESSO DOS USU?RIOS AOS SERVI?OS E ?S PR?TICAS DE SA?DE DE M?DIA E ALTA COMPLEXIDADE: rela??o p?blico x privado. Os resultados explicitam que os sentidos/ significados de acesso aos servi?os de sa?de transversalizam as dimens?es pol?tica, t?cnica e simb?lica. As pr?ticas individuais e coletivas realizadas pelos profissionais que atuam na aten??o b?sica, de m?dia e alta complexidade para a promo??o do acesso do usu?rio ? rede SUS envolvem a??es compromissadas, acolhedoras, com institui??o do v?nculo e a valoriza??o da subjetividade dos usu?rios em alguns momentos, e em outros passam pelo modelo profissional centrado, voltado para a queixa-conduta, medicaliza??o e tecnicismo, co-existindo dialeticamente um entrela?amento das tecnologias leve, leve-dura e dura nesse processo. Dentre as dificuldades e limites que os usu?rios t?m encontrado para acessar os servi?os de sa?de de m?dia e alta complexidade foi citada a demanda por esses servi?os ser maior que a sua oferta. Deparamo-nos com diversas portas de entradas utilizadas pelos usu?rios para acessar os servi?os de m?dia e alta complexidade. Al?m disso, a rela??o entre o p?blico e o privado ? constitutiva da organiza??o desta realidade. O acesso do usu?rio do PSF aos servi?os e ?s pr?ticas de m?dia e alta complexidade ainda necessita para a sua concretiza??o de um comprometimento dos usu?rios, profissionais e gestores da sa?de de modo a operacionaliz?-lo enquanto um direito de cidadania.