ANÁLISE DO TRABALHO DAS EQUIPES DE CONSULTÓRIO NA RUA DE MATO GROSSO DO SUL SOB A ÓTICA DA INTERSETORIALIDADE

Abstract

Due to the Covid-19 pandemic, social inequality in Brazil has been worsened, increasing the population living on the streets across all over the country. Consequently, the street clinic team that is able to provide comprehensive healthcare to this population which survives even though the extreme poverty and vulnerability becomes even more essential for ensuring their social rights. Historically, this population has endured numerous health inequities, viewed through the lens of social determinants of health, requiring the development of intersectoral actions to tackle the complexity of the health issues they face. So, studies focusing on this matter are necessary to inform public policies that safeguard the fundamental rights of the homeless people (HP). The objective of this research was to analyze the work of the street clinic teams (SCT) in Mato Grosso do Sul from the perspective of intersectoral collaboration. It was a qualitative, cross-sectional, descriptive, exploratory study conducted from October 2022 to August 2023 with the participation of 18 health workers from the 04 street clinic teams in the state, situated in the cities of Campo Grande, Corumbá, Ponta Porã, and Três Lagoas, as well as the management team of the State Health Secretariat. Data were collected through 03 focus groups and analyzed, post-transcription, based on the content analysis framework by Bardin (BARDIN, 2011), and the theoretical framework of intersectoriality by AKERMAN et al. (2014), defining intersectoral actions as actions undertaken for different sectors targeting the same audience facing health inequities. From the discourse analysis, four categories emerged: the work process of the street clinic teams; establishing bonds to facilitate access; stigma in daily practice; intersectoral collaboration in informality, and the competencies of each sphere. These categories highlighted that work is carried out considering the needs of this population despite challenges in organizing care due to chronic shortages of material and human resources. However, the strong bond between teams and the population is a significant strength of these teams. The stigma experienced by this population significantly impacts the work of the SCT along with other services that do not prioritize actions addressed to the HP. Non-institutionalized intersectoral actions dependent on workers interpersonal relationships result from the marginalization of policies related to vulnerable populations, poor partnerships, lack of organizational protocols, and service fragmentation. Moreover, weak management support, difficulties accessing basic hygiene and comfort services for HP, lack of service flows for migrants, and language barriers are also barriers compromising comprehensive care. Despite these obstacles, teams work to organize actions that can reduce these barriers. Therefore, this research demonstrated that despite the challenges faced by SCTs in executing their work from an intersectoral perspective, they agree that this approach can be effective in overcoming these difficulties, if it is provided by a well-organized and institutionalized actions to avoid dependence on professional work relationships. Additionally, based on the findings, recommendations were made for management and teams regarding actions to provide comprehensive care for the HP. These recommendations encompass creating experience seminars, team training, reinstating intersectoral groups, establishing boards among workers, expanding the scope of practice for teams, setting up planning, monitoring, and evaluation routines for team work, and including the team as part of an extracurricular internship program.

Descriptors: Family Health Strategy; Primary Health Care; Ill-Housed Persons; Health Equity, Unified Health System; Intersectoral Collaboration.