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Cuidados de saúde primários em Portugal
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RESUMO - A evolução dos cuidados de saúde primários em Portugal
nos últimos trinta anos conheceu várias fases. A partir de
1971 foram criados os primeiros centros de saúde — os
centros de saúde de primeira geração, associados ao que
então se entendia por saúde pública —, incluindo actividades
como a vacinação, vigilância de saúde da mulher, da
grávida e da criança, saúde escolar e ambiental, entre
outras. Em 1983 os primeiros centros de saúde foram integrados
com os numerosos postos dos ex-Serviços Médico-
-Sociais («caixas»). Este processo de fusão conduziu a uma
maior racionalidade formal, mas não resultou numa
melhoria naquilo que eram as principais virtudes dos componentes
integrados — acessibilidade a consultas e a visitas
domiciliárias, por um lado, e, por outro, a programação de
actividades com objectivos de saúde. Em 1999 foi
publicada a legislação sobre os «centros de saúde de terceira
geração». Esta aparece na sequência de experiências
sobre o terreno — «projectos Alfa» e outras iniciativas
semelhantes, baseados numa filosofia de «prática de
grupo» — e do início de um regime remuneratório experimental
para a clínica geral. As unidades operativas dos
novos centros de saúde pressupõem um processo de
mudança organizacional que não pode ser implementada
pela via normativa clássica tipo top down. Embora necessite
de um enquadramento «de cima», a sua realização dependerá
essencialmente da capacidade de despoletar uma
dinâmica de mudança em cada centro de saúde e de proporcionar
acompanhamento e apoio técnico a esses processos
de mudança locais.
ABSTRACT - Over the last 30 years primary health care in Portugal has gone through different stages of development. Since 1971 the first Portuguese health centers were progressively established throughout the country. These first generation health centers performed mainly what was then known as «public health activities» — these included imunisations, MCH, school health, sanitary inspections among others. During the early 80’s these health centers were integrated with the medical clinics of the social insurance system. These 2nd generation health centers became the basis of the Portuguese primary health care system. However the normative nature of this integration resulted in the fact that the main assets of its original components — access to medical care and community health practices — were not fully protected and further developed by the new arrangements. As a consequence various field experiences in «group practice» and community based health initiatives, as well as the adoption of a new experimental scheme for remunerating general practice, stimulated recently the emergence of new organisational model for the Portuguese health centers. Previous experience has shown that these 3rd generation health centers — placing strong emphasis both in group practice and community work — cannot be developed through the classical «top down» normative approach. They will require support for a local health center for their development process.
ABSTRACT - Over the last 30 years primary health care in Portugal has gone through different stages of development. Since 1971 the first Portuguese health centers were progressively established throughout the country. These first generation health centers performed mainly what was then known as «public health activities» — these included imunisations, MCH, school health, sanitary inspections among others. During the early 80’s these health centers were integrated with the medical clinics of the social insurance system. These 2nd generation health centers became the basis of the Portuguese primary health care system. However the normative nature of this integration resulted in the fact that the main assets of its original components — access to medical care and community health practices — were not fully protected and further developed by the new arrangements. As a consequence various field experiences in «group practice» and community based health initiatives, as well as the adoption of a new experimental scheme for remunerating general practice, stimulated recently the emergence of new organisational model for the Portuguese health centers. Previous experience has shown that these 3rd generation health centers — placing strong emphasis both in group practice and community work — cannot be developed through the classical «top down» normative approach. They will require support for a local health center for their development process.
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Citação
Branco, António Gomes; Ramos, Vítor - Cuidados de saúde primários em Portugal = Primary health care in Portugal. Revista Portuguesa de Saúde Pública. ISSN 0870-9025. Volume temático, Nº 2 (2001), p. 5-12
Editora
Universidade Nova de Lisboa, Escola Nacional de Saúde Pública