The narrow entrance door of Brazil's national health system (SUS): an evaluation of accessibility in the family health strategy

This study has the purpose of analyzing users' perception of the accessibility to Estratégia Saúde da Família (ESF - Family Health Strategy) in its geographical, organizational, socio-cultural and economic dimensions. Process evaluation with qualitative approach through open interview, direct observation and documental analysis was performed in the city of Recife, northeastern Brazil. The main problems were: the deficient referral and counter-referral system; delayed return of laboratory test results; excessive number of families per team; difficulties in scheduling medical consultations; expenditures on medicines. Facilities were observed in the professional-user relationship, as well as in the geographical proximity of the health unit. ESF proved to be a narrow entrance door to Sistema Único de Saúde (SUS - Brazil's National Health System). Therefore, it deserves to be evaluated with a more critical look that takes into account, as a starting point, the needs of individuals who request its actions, as well as the reasoning which guides the actions of the subjects involved in care.