Coverage Extension or Reorganization of Primary Health Care? The Implementation of the Family Health Program in the City of Manaus, State of Amazonas

Este trabalho analisa sete anos de implanta????o do Programa de Sa??de da Fam??lia (PSF) de Manaus, procurando identificar mudan??as no sistema municipal de sa??de a ele relacionadas e capazes de contribuir para a redu????o de desigualdades em sa??de. Contextualiza a g??nese do PSF no munic??pio, suas caracter??sticas, contradi????es e limita????es, investigando se o programa construiu apenas uma trajet??ria de extens??o de cobertura ou contribuiu efetivamente para a reorganiza????o do modelo de aten????o b??sica ?? sa??de. As categorias de an??lise priorizaram princ??pios espec??ficos de gest??o do PSF: car??ter substitutivo, integra????o com institui????es e organiza????es sociais, territorializa????o, planejamento situacional com base na fam??lia e na comunidade, participa????o popular e controle social. A metodologia utilizada foi quali-quantitativa, compreendendo a an??lise dos dados de duas pesquisas avaliativas da implementa????o do PSF no munic??pio, realizadas em 2001 e em 2006. Os resultados mostram que, em Manaus, o PSF se constitui em uma estrat??gia de extens??o de cobertura, com parcial superposi????o ?? estrutura assistencial de aten????o b??sica (AB) preexistente e paralelismo de a????es. Dadas as condi????es de sua implanta????o, conclui-se que o PSF se expressa como um programa isolado dentro do sistema municipal de sa??de, com potencialidade para se converter em estrat??gia reestruturadora da AB em Manaus. A conflu??ncia com a implanta????o dos Distritos Sanit??rios poder?? contribuir para um caminho de reorienta????o do modelo assistencial que garanta aten????o integral e concretize o direito ?? sa??de.This paper analyzes seven years of implementation of Programa Sa??de da Fam??lia (PSF - Family Health Program) in the city of Manaus, state of Amazonas, aiming at identifying its influence on changes in the municipal health care system that are capable of contributing to the reduction in health care inequalities. It contextualizes the genesis of the PSF in the municipality, its characteristics, contradictions and limitations, thus investigating whether the program has built only a coverage extension history or whether it has effectively contributed to the reorganization of the primary health care model. The analysis categories prioritized specific management principles of the PSF: substitutive nature, integration with institutions and social organizations, territorialization, situational planning based on the family and community, popular participation and social control. The methodology was qualitative-quantitative, including the analysis of data from two studies evaluating the implementation of the PSF in the municipality, carried out in 2001 and 2006. The results show that, in Manaus, the PSF is a coverage extension strategy, with partial superposition on the preexisting primary medical care structure and parallelism of actions. Given the conditions of its implementation we conclude that the PSF expresses itself as an isolated program within the municipal health care system, with the potentiality to become a restructuring strategy of primary health care in Manaus. The confluence with the implementation of the Sanitary Districts may be able to contribute to redirect the medical attention model, thus assuring integral care and concretizing the right to health