Dificuldades de organização das ações de saúde bucal na atenção básica em uma microrregião de saúde: a percepção de gestores e cirurgiões dentistas

Abstract

Introduction. Launched in 2004, the National Policy of Oral Health (NPOH), Smiling Brazil, enabled the possibility of changing the way of organizing the oral health care in the Public Health System (SUS). The impact in the oral health indicators has been showing improvements. However, the change in the working process and the reorientation of the care model has yet not become effective. In the health micro-region of Ituiutaba (MG), with nine townships, the organization of the oral health services in the Basic Care has been characterized by a recent implementation in the strategy of Family Health, yet, still not showing official records on the ways of managing the care model, the planning, the organization of the work process and the population participation. Objectives. This study aimed at evaluating the perception of managers and dental surgeons about the main difficulties in organizing the actions to oral health in the basic care, in the micro-region of Ituiutaba (MG), according to the conjectures of the National Oral Health Policy and raising issues inherent to the work process, integrality, management, health planning and population participation. Methods. This is a case study, of qualitative nature which was performed through interviews with ten managers and a focal group with nine dental surgeons of SUS in the micro-region. The content analysis aimed at correlating the management of the care model, the work process, the planning and social control with the policies principles of promoting health, basic care and oral health, in light of the care integrality principle. It was performed as proposed by Bardin (2009). Results and discussion. There is little understanding over the care model proposed by SUS, which leads to a predominantly curative praxis, without adopting planning, in an isolated work, which is fragmented and repetitive, performed by unmotivated professionals and with a fragile presence of the management of the townships and of the Regional Health Management (GRS). The management happens through centralized actions, adopting programs and projects proposed by the Health Ministry, disregarding the local regional peculiarities, without sharing the decisions taken. The Oral Health Teams (ESB) do not use the planning to organize their actions and this happens, countless times, due to the lack of role playing of their members, or due to the omission of Municipal Health Departments (SMS).. There is no institutional support to the organization of the work process. Thus, the organization of the access, of the promotional actions and of preventing clinical nature are at the mercy of previous knowledge, of the implication and action of the dental surgeon, facing difficulties in planning, implementing and evaluating actions which are not developed in the dental office scope. This situation discourages the professionals and helps maintain the care model of biomedical science and curative making. The constitutional principle of the social control in SUS practically does not exist and it is still one of the biggest challenges faced in the Micro-region.