[Challenges in primary health care: the experience in Vila Mariana District, São Paulo, Brazil]. / Desafios da atenção básica em saúde: a experiência de Vila Mariana, São Paulo, Brasil.

This article presents the results of a case study aimed at identifying challenges for the delivery of primary health care in a health district in the city of São Paulo, Brazil, considering comprehensiveness as a central device for organizing work at this level of care. Five units in the district's primary care network were studied. We collected the data by observing work routines and flows, conducting interviews with managers and health professionals from different backgrounds, and through focus groups with family health teams. The analysis shows a mismatch between users' characteristics and their presumed needs and the heterogeneity of the health professionals' perceptions concerning their work. Lack of staff and time and difficulties with referrals were the main problems identified by interviewees.

Desafios da atenção básica em saúde: a experiência de Vila Mariana, São Paulo, Brasil / Challenges in primary health care: the experience in Vila Mariana District, São Paulo, Brazil

Este artigo apresenta resultados de estudo de caso visando identificar desafios na oferta de atenção básica à saúde em um distrito de saúde da cidade de São Paulo, Brasil, considerando integralidade como dispositivo organizador do trabalho neste nível de atenção. Foram estudadas as cinco unidades que compõem a rede de atenção básica à saúde no distrito considerado. Os dados foram coletados mediante observação dos fluxos e rotinas de atendimento, realização de entrevistas com gerentes e profissionais de diferentes formações e ainda realização de grupos focais com equipes de saúde da família. A análise mostra um descompasso entre as características da clientela e suas necessidades presumidas e as ofertas dos serviços, e heterogeneidade nas percepções dos profissionais sobre seu trabalho. Falta de profissionais, de tempo, e dificuldades para encaminhamentos foram os principais problemas apontados pelos entrevistados.

This article presents the results of a case study aimed at identifying challenges for the delivery of primary health care in a health district in the city of São Paulo, Brazil, considering comprehensiveness as a central device for organizing work at this level of care. Five units in the district's primary care network were studied. We collected the data by observing work routines and flows, conducting interviews with managers and health professionals from different backgrounds, and through focus groups with family health teams. The analysis shows a mismatch between users' characteristics and their presumed needs and the heterogeneity of the health professionals' perceptions concerning their work. Lack of staff and time and difficulties with referrals were the main problems identified by interviewees.