Análise do sistema de referência e contra-referência nos níveis de complexidade de atenção a saúde no município de Juiz de Fora: o desafio de integrar os serviços

Abstract

The aim of this study was to analyze the access in health through the reference and against-reference system in the city of Juiz de Fora, considering the dimensions: availability, acceptability, accessibility, functional adequacy, based on the perspective of the process of consolidation of the integrality principle in care of three levels of attention to health. At first, a brief retrospective of the Politics of Health in Brazil is presented, taking as starting point the decade of 1970. Afterwards, the concepts that supported the study were discussed, having as central pivot the integrality and the contextualization of the reference and against-reference. For the development of this study, the qualitative methodology was picked up, using as a technique to be used to the health professionals the half-structuralized interview, and the narrative, technique to be applied to the users that makes it possible the recapitulation of the experience through the combination of the verbal sequence of sentences with the sequence of events that in fact had occurred. Not only health professionals (social doctors, assistants, nurses) took part in this research but, mainly, the users of these health services. The convergences allowed to glimpse that despite the system of reference and against-reference in the city of Juiz de Fora presents structural problems as precarious organization, concealing difficulties of integration among the attention levels, there are real possibilities of improvement, that will be dealth with in this study.