Resumo:
Since 2004, the Family Health Strategy (FHS) has been implemented in the city of
Salvador with the expectation of a new dynamic in the organization of health services system
based on principles of accessibility, and completeness longitudinality the care provided by
staff Health. However, despite being one of the pioneer cities in the implementation of health
reform in Brazil to join the Decentralized System and Unified Health System (SUDS) in
1987, incorporating as a strategy for organizing services for implementation of health districts
(DS) has great internal inequalities organize the system of health services, as studies indicate
that the weaknesses of the local health system, particularly with regard to the principle of
comprehensiveness. Thus, the study aimed to describe why the organization of health services
in the city of Salvador ESF is far from the principle of comprehensiveness. The field survey
was heard subjects involved in the management of health services in the city. For data
collection, we used semi-structured interviews, content analysis allowed the categorization of
all the units of meaning. The results showed that, in the municipal context, the construction
processes of the NHS and its policies are marked by discontinuity, rights and wrongs in
relation to their guidelines. Noteworthy is the great heterogeneity of political and
administrative elements which constitute the correlation of forces around the organization of
basic health services in the ESF, polarizes in components such as: priority management
strategy around the discontinuity political-administrative and spraying of the strategy in the
municipality. Added to this the existence of a network of health services disjointed and poorly
distributed, weaknesses in the culture of planning as a guiding tool in the organization of
basic health services and failing links and working conditions, which reflect the quality
interrupts services rendered to population. It is concluded that the organization of health
services in the city of Salvador involves contradictory and conflicting elements in all spheres
of political and administrative dimension. This situation creates discontinuities,
fragmentations that much explain why the distance from the organization of the principle of
comprehensive services. Existing structures and mechanisms used by the municipal
administration has not contributed to effect the integral attention. The organization of health
services in primary care, in particular the ESF, remains distant image-goal of a health system
that incorporates the principle of comprehensiveness as one of its structural axes, pointed out
that this dimension, but it is a of the great challenges of the SUS.
