Teorização dos fenômenos envolvidos na não estruturação dos serviços primários em saúde, considerando os atributos da Atenção Primária

Abstract

This study aimed to develop a theorization about the lack of organization and orientation of primary health services, considering the attributes of Primary Health Care (PHC) in the municipality of Juiz de Fora, Minas Gerais. PHC, the first level of care in the Unified Health System, is responsible for the system's entry point, addressing primary health needs and providing continuous care, as well as coordinating and integrating the broader health care network. Therefore, primary health services must be structured according to the following attributes: access to initial contact, longitudinality, comprehensiveness, coordination of care, family orientation, community orientation, and cultural competence. The study is qualitative and grounded in a theoretical framework based on the PHC attributes outlined in the Brazilian National Primary Care Policy. Methodologically, it is supported by grounded theory (GT). Eleven in-depth interviews were conducted with social actors involved in the provision of public health services in the municipality, including professionals working in primary health care units, residents affiliated with them, and managers. Through data analysis, a theoretical construct emerged, with the central category identified as follows: “The hegemony of specialized care and the legacy of the biomedical model as structuring elements in the orientation of health services.” This theorization enabled the identification of the roots of the phenomenon, revealing that, despite initiatives to strengthen PHC, the organization of services in the municipality remains heavily shaped by the biomedical model and historical legacies. These findings could inform strategies to strengthen primary healthcare services in the municipality and transform the care model. This study informed the development of a technical product, the objective of which is to strengthen the PHC by sharing scientific evidence and reflections on health policies considering the attributes of PHC through a series of episodes on the podcast platform titled "Podcast: Quem tem Boca vai ao SUS?" set in the context of the municipality of Juiz de Fora.