Uma breve avaliação da Estratégia de Saúde da Família no Brasil: avanços, retrocessos e desafios na visão de uma equipe multiprofissional

Abstract

This study presents an evaluation of the Family Health Strategy (FHS) in Brazil, considering its historical development, advances, setbacks, weaknesses, and challenges from the perspective of a multidisciplinary team. The FHS constitutes an important strategy for reorganizing Primary Health Care and is grounded in the principles of the Brazilian Unified Health System (SUS), particularly universality, comprehensiveness, equity, territorialization, and social participation. The analysis shows that, since its implementation in the 1990s, the FHS has contributed to expanding access to health services, strengthening health promotion and disease prevention initiatives, bringing health teams closer to communities, and consolidating multidisciplinary work. The importance of community health workers in building relationships with families and understanding the needs of local territories is also highlighted. However, the policy presents weaknesses related to funding, infrastructure, professional turnover and staffing, inequalities among municipalities, and difficulties in coordinating the different levels of care. The changes introduced by the 2017 National Primary Health Care Policy also generated debate regarding greater flexibility in team composition and the possible weakening of the strategy’s community-based dimension. The evaluation demonstrates that FHS coverage should not be analyzed solely in quantitative terms; the quality of care, continuity of care, user satisfaction, and the capacity to reduce inequalities must also be considered. It is concluded that strengthening the FHS depends on adequate funding, appreciation and support of health workers, continuing education, social participation, and integration of the health care network, while preserving its territorial, community-based, preventive, comprehensive, and multidisciplinary dimensions.