Escutas onde a vida acontece: pistas para qualificar o cuidado de pessoas com deficiência cadastradas em uma Unidade de Saúde da Família em Salvador-BA

Abstract

Introduction: Access to health services for people with disabilities (PwD), especially at the Primary Health Care (PHC) level, is still permeated by multiple barriers that compromise the right to comprehensive care. Despite advances such as the National Policy for Comprehensive Health Care for People with Disabilities (PNAISPD), challenges persist related to the invisibility of PwD in service planning and delivery. Furthermore, scientific literature on the topic remains limited, especially in regions such as the Brazilian Northeast, where there is a high population concentration of PwD. Listening to these individuals is strategic for strengthening PHC as a space for welcoming, participation, and expanded care. Objective: To understand the perceptions of people with disabilities about health care in the PHC context, based on the experiences of users of a Family Health Unit (FHU) located in Salvador, Bahia. Method: This qualitative, exploratory study was part of a larger study on PwD care in PHC. Interviews with users, field diaries, and participant observation were used as data collection techniques. Thematic analysis was used to identify meanings in the narratives, focusing on access, connections, and social participation, giving rise to two analytical categories: (1) disability, access, and barriers; and (2) expanded health needs. The research was approved by the Ethics Committee and included 45 participants with different types of disabilities. Results: The results reveal important elements that permeate the care experience: the naturalization of home confinement, the limited repertoire of leisure activities, and the limited institutional and subjective recognition of disability, whether by individuals or professionals. These aspects indicate the existence of architectural, behavioral, and communicational barriers that restrict access to rights and compromise the comprehensiveness of care. The connection with Community Health Agents (CHAs) was identified as a key factor in access to care, directly influencing users' perceptions of the service. Conclusion: The study reveals that care for people with disabilities in PHC requires more than the physical presence of services—it requires sensitive actions, effective communication, and recognition of the individual's uniqueness. Strategies such as community-based rehabilitation, territorial appreciation, and the promotion of equity must be strengthened. The results point to the need for staff training, expanded accessibility in its multiple dimensions (architectural, communicational, and attitudinal), and the effective inclusion of the broader health dimension—such as leisure and participation—in the daily care process. By valuing the experiences of people with disabilities, this study contributes to strengthening PHC as a space for citizenship, belonging, and health production.