| |
- Municipal claims
- Corporate pressures
- Successful municipal experiences |
Decree 1,065, July 4, 2005
Created the NAISF |
- Had the purpose of expanding the integrality and resoluteness of health care.
- Decree repealed two days after its publication.
- Comprised of four modalities of action: diet/nutrition and physical activity; physical activity; mental health; and rehabilitation. For each modality, a specific team arrangement, within the following professions: professions, nutritionist, professional of physical education, phonologist, and instructor of body practices.
- MH would finance municipalities with a population equal to or more than 40,000 inhabitants, except in the Legal Amazon region, equal to or more than 30,000 inhabitants. |
| Support guidelines - 2008 to 2011 |
Decree 154, January 24, 2008
Created the NASF |
- Created to expand the coverage, scope, and resoluteness of PHC through the actions of continued education and clinical care for specific cases.
- Works in collaboration with the health services network, reviewing the practice of referrals.
- NASF 1: 8 to 20 associated FHS teams or 5 to 20 (Municipalities with less than 100,00 inhabitants from the states in the North Region of the country); 5 professionals of non-coinciding occupations: acupuncturist, social worker, physical education professional, pharmacist, physical therapist, phonologist, gynecologist, homeopathic doctor, nutritionist, pediatrician, psychologist, psychiatrist, and occupational therapist.
- NASF 2: minimum of 3 associated FHS teams; a minimum of 3 professionals of non-coinciding occupations: social worker, physical education professional, pharmacist, physical therapist, phonologist, nutritionist, psychologist, and occupational therapist.
- Federal incentives for implementation and monthly financing.
- Workload of 40 hours for the professionals with some exceptions.
- Nine strategic areas of work: physical activity/body practice; integrative and complementary practices; rehabilitation; diet and nutrition; mental health, social service; child health; women’s health; pharmacist care. |
Basic Care Notebooks (BCN) 27
NASF’s guidelines |
- Instruction manual that defines the technological tools of work: matrix support, expanded clinical care, Singular Therapeutic Project and Health Project in the Territory.
- Emphasis on the technical-pedagogical dimension, with the care provided directly to the users “only in extremely necessary situations”. |
Decree 2,843, September 20, 2010
Created NASF 3 |
- Priority in the prevention of disease and promotion of health, the treatment and reduction of risks and damages caused by alcohol and drug abuse, especially crack.
- Municipalities with a population of less than 20,000 inhabitants.
- 4 to 7 associated FHS teams |
Decree 2,488, October 21, 2011
1streview of the National Primary Health Care Policy |
- Incorporates the NASF and the concept of matrix support in the PNAB text
Increase in the number of professionals to 19 categories with the inclusion of: geriatrician, internal doctor (medical clinic), occupational physician, veterinarian, professional with a degree in art and education (art educator).
- Expand the work to the following teams: Street Doctor’s Office, Riverside Family Health, and Fluvial Family Health.
- Manager begins to take part in the team together with the professionals that he/she prefers.
- Define the minimal workload for the teams: NASF 1 - minimum 200 hours; NASF 2 - minimum 120 hours.
- Reduce the number of associated teams: NASF 1 - 8 to 15 (Municipalities that have less than 100,000 inhabitants from the States of the Legal Amazon Region and the Pantanal Region of Mato Grosso do Sul - 5 to 9); NASF 2 - 3 to 7; Minimum workload of 80 hours for the teams.
- Repeals NASF 3, with the teams converted to NASF 2. |
| Universalization of NASF - 2012 to 2015 |
Decree 978, May 16, 2012
Review of the Variable PAB |
- 1/3 increase in the values of incentives for the NASF 2 teams, maintenance of the same values for the NASF 1. |
Decree 3,124, December 28, 2012
Redefines the association parameters of NASF 1 and 2 and creates NASF 3. |
- Recreates the NASF 3, without focusing on the questions of drug use or drug abuse; 1 or 2 associated teams; 80 minimum work hours for the teams;
- Reduces the number of associated teams: NASF 1 - 5 to 9; NASF 2 - 3 to 4. |
Decree 548, April 4, 2013
Defines the financing value of the variable PAB |
- 50% increase in the values for NASF 2, defines the incentive for NASF 3, and maintains the same values to be transferred to NASF 1. |
Decree 562, April 4, 2013
Defines the monthly value of the financial incentive from the 3rd cycle of PMAQ-AB |
- Allowed the inclusion of all of the PHC teams, including the NASF.
|
Basic Care Notebooks (BCN) 39
Volume 1: tools for management and daily routine
|
- Discusses the matrix support as of the structural elements that comprise the professionals’ agendas, reflecting on the necessary infrastructure and the conditions for these activities to occur.
- Advances in the discussion regarding the tension between individual care and matrix support and concerning the main crossings in the operationalization of the matrix support. |
| Expansion of support - 2016 to 2018 |
Decree 1,171, June 16, 2016
Accreditation of municipalities referent to the NASF/congenital zika syndrome
|
- Aims to instrumentalize the accredited municipalities to conduct early stimulation actions and provide psychosocial support to the families undergoing follow-up.
- At least one physical therapy professional in each team, as well as recommending the inclusion of an occupational therapist, a phonologist, or a psychologist.
- Emphasis on the clinical care dimension of the matrix support and on individual care, which “does not contradict the logic of the matrix support”.
- Publication of the instruction manual “Early stimulation in primary care: guide for the neuropsychomotor development approach through the PHC, FHS, and NASF, in the context of the congenital zika syndrome”. |
Decree 2,436, September 21, 2017
2nd review of the PNAB
|
- Changes the name to Expanded Family Health and Basic Health Center (NASF-AB).
- Removes the matrix support concept from the text, with the loss of the focus on the technical-pedagogical dimension. Despite the removal of the concept, it is still reaffirmed in 3 specific competencies:
a - co-management / collaborative planning with the follow-up teams;
b - expansion of the clinic and increase in the capacity of analysis and intervention;
c - discussion of the case, individual care, collaborative construction of therapeutic projects, permanent education, discussion of the work process. |
| The dismantling of NASF? - 2019 to 2021 |
Decree 2,979, November 12, 2019
Implemented the Previne Brasil Program - new financing model to cover PHC costs |
- Changes the way PHC is financed, which becomes a mixture of weighted capitation, incentive for strategic actions, and payments per performance.
- End of discretionary financing for the NASF.
- Repeals Section II of the Consolidation Decree in the 2/GM/MS, from September 28, 2017, which includes the decree for NASF parameterization. |
Decree 3.222, December 20, 2019
Treats the performance payment indicators in the scope of the Previne Brasil Program
|
- Establishes the financing of interdisciplinary actions within the scope of PHC, with the arrangement and formulation of teams according to the criteria defined by the manager. |
Technical Note 03/2020
NASF-AB and Previne Brasil Program
|
- Reaffirms the changes brought by the Previne Brasil Program, such as the termination of discretionary financing and the extinction of the parameters for the creation of NASF. |
| Decree 99, February 7, 2020 |
- Redefines the registration of the PHC teams in the SCNES.
- Creates a new code for the team, which includes the three typologies of NASF:
team72 - Expanded Family Health and Basic Health Center teams (NASF-AP teams). |
| Decree 37, Janurary 18, 2021 |
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Source: Authors, based on SCNES, accessed on January 20, 2022.