O trabalho prescrito e real do agente comunitário de saúde na estratégia de saúde da família.

Abstract

with the creation of the Sole Health System (SUS), the health practices began to prioritize health promotion and disease prevention actions. In this context, the Community Health Agent (ACS) is an important player for the consolidation of such practices. The work of the ACS, since the implementation of SUS, has been marked by the expansion of theperformance spaces and knowledge. This paper was guided by Laws, Ordinances and Health Departments Manuals, being applied in the real context accordingly to the demands of the professional practices. Goal: to understand the ACS work within the Family Health Strategy (ESF) considering the real and prescribed dimensions. Methodology: this paper regards a case study of the qualitative approach, performed in the Primary Health Attention (APS), in the Belo Horizonte County. The study was conducted in three phases. In the first phase, the Document Research Phase, Legislative documents Laws, Ordinances and Decrees, the Community Agent Program (PACS) best practices and the ACS Work Manual developed by the Health Department were used. The document analysis enabled the understanding of the ACS prescribed work. In the second phase, semi-structured interviews with Nurses, Nursing Technicians and ESF Doctors were conducted. The analysis of the interviews enabled the understanding of the real ACS work under the ESF point of view. Twenty-seven professionals participated in this phase. The third phase, Focal Groups (GF), was conducted with ACSs currently working within ESF. Four GF were conducted, with the average of nineparticipants per group, totaling thirty-five participants in this phase. The interviews conducted with the ESF health team, as well as the GFs conducted with the ACSs, were recorded and transcribed in full for analysis and data interpretation. The Content Theme Analysis was usedwith the aid of the ATLAS ti. 7.0 Software in order to organize the data. All ethics aspects were fully respected, according to resolution 466/2012, under judgement no. 49765715.8.0000.5149. Results: it was possible to determine that the work prescribed to the ACS encompasses health promotion and disease prevention actions and its aggravations dispensed to a determined population segment. The work of the ACS is considered, by the ESF health team, as a primordial factor for the consolidation of ESF. The work performed by this agent is capable of modifying the work practices of the health team, distancing them tothe practices centered on the bio-medical model. The ACS lives a duality in the way-of-being within the ESF. In the way-to-be-cared-for, the ACS acts in the relationship subject-subject, which overcomes meanings and symbols in this agents life. In the way-to-be-cared-fordomination, the ACS acts in the subject-object relations, making objective and prescribedmatters govern the agent in the ESF. The lack of infrastructure, material resources and workforce hinder the work of the ACS. The production way, centered in a capitalist model, the insertion of new work technologies and the lack of preparation of these professionals regarding some activities are considered causes for experiences of anguish and moralsuffering in the work of the ACS in ESF. Final Considerations: the understanding of the dimensions of the prescribed and real work of the ACS enabled reflections regarding the way these professionals live their work, assigning values and meanings to their way of production.