Family health strategy (ESF), Family Health Support Nuclei (NASF) & occupational therapy: questioning the interfaces

Abstract

The Family Healthcare Support Nuclei/NASF were created in 2008 by the Ministry of the Health to support the Family Healthcare Strategy Teams (EqSF) and today they are one of the main fields of work for occupational therapists. Different healthcare providers work at the NASFs, who are supposed to share the work with the EqSFs based on the strategy of interconnected basic (preventive care/public education), secondary (diagnosis/treatment) and tertiary (healing/rehabilitation) public healthcare services. The NASFs have been irregularly implemented, without adequate qualification processes, with a bad definition of roles and work processes sometimes conflicting with those of the EqSFs, without relying on consolidated experiences where to base their practices on. Some demands for rehabilitation cannot be met due to shortage of adequate services in the healthcare network. Starting from a bibliographical review mainly based on the Ministry of the Health’s documents, a previous work experience of one of the authors in NASF teams, and on preliminary results of a research on the theme, this article contextualizes the NASFs implementation and reflects upon the insertion and performance of occupational therapists in those teams. Inserting and defining the work processes of different healthcare providers, particularly those of occupational therapists, have been based on documents with generic guidelines that fail to specify, discriminate or support daily practices. The focus on actions targeted on interconnecting basic, secondary and tertiary public healthcare services disposed in those guidelines conflicts with the population’s demands for specific rehabilitation care, among others, which results in overloaded and unsupported professionals unable to meet such demands. Descriptors: Family healthcare support nuclei, basic healthcare services, work process in healthcare, occupational therapy.