Análise da responsabilidade na assistência em saúde: percepção dos usuários e trabalhadores do centro de saúde cafezal.

Abstract

The involvement of the SUS user in the elaboration and implementation of public health policies is essential, so that we can reach the real needs of such public. For this, it is necessary to listen and understand people's perception of health, accountability and care. The purpose of this study was born out of a concern, which we find, in the routine of primary health care services in the Unified Health System (SUS), in Brazil: the low responsibility of users towards their own health. The objective of the study was to analyze the responsibility regarding health care, from the perspective of SUS users assigned to the coverage area of the Health Center Cafezal, in the city of Belo Horizonte - MG. A study with an exploratory qualitative approach was developed, whose data were obtained through observation and the realization of focus groups with users and workers of the Cafezal health center. Data analysis used the social theory of discourse, through the Critical Discourse Analysis (ADC) approach. The results point to a great challenge: to align the desire and participation of users, who, increasingly, feel supporting in the decision-making processes of public health policies, to an investment in education, for health and intersectoriality. The concept of health expressed by the participants refers not only to the absence of disease, but to the good coexistence between peers in the community, the freedom to come and go with their heads held high, and happiness, bringing health as the most precious asset of life. With this, the users' desire is fundamentally aimed at access to health care, mainly, to medical care, in a timely manner, at flexible times geared to their demand at the moment, being seen, by the majority, a care model that, compared to what is seen in emergency care units, in parallel to this, they bring the importance of qualified listening and welcoming, as well as activities that go beyond the service itself. Accountability for health was linked to the need to strictly follow the treatment prescribed by the doctor. Although most users consider themselves responsible for their health, it is identified that people are supporting the care process, with the doctor, the state and God as protagonists in such a relationship. There are several difficulties in achieving co-responsibility, such as: access to quality information and education; the need to invest in health promotion actions to the detriment of the “immediacy” brought in the reports of users and workers; as well as the guarantee of spaces of social control that actually provide users with the free expression of their wishes, safeguarding the power of equal decision, among the participants. There is also a criticism of the rules of operation of health units that, due to their physical and assistance limitations, block access to services, based only on the conditions of the team to provide care, without considering the particularities and needs of users. It is recommended to invest in health education with users, by strengthening spaces aimed at social control and health promotion, thus favoring a greater participation of people in the care processes.