Ordinance 154, January 24TH, 2008

It creates de Centers of Support to Family Health

The State Minister of Health, in the use of his powers, and

Considering the item II from Art. 198 of the Brazilian Federative Republic Constitution of 1988, which characterizes the integrality of health care as the guideline of the Universal Health Care (SUS);

Considering the sole paragraph from Art. 3rd of the Law 8080, 1990, which characterizes the health care actions designed to assure physical, psychological and social well-being for the individuals and the society;

Considering the basic principles and guidelines proposed by the Pact for Health, which is regulated by the Ordinance 399/GM, from February 22nd, 2006, which attends the Pact signed by the three republican powers in behalf of three dimensions: for life, for Universal Health Care and for Management;

Considering the Supportive and Cooperative Regionalization confirmed by the Pact for Health and what it presupposes: regionalization, cooperation, co-management, supportive funding, subsidiarity, social participation and control;

Considering the National Policy of Health Care defined by the Ordinance 648/GM, from march 28th, 2006, which regulates the development of the actions of Health Care at the Universal Health Care system;

Considering the strengthening of the Health Family strategy defined by Ordinance 648/GM, from march 28th, 2006, which advocates for the organization of health care based on the strategy of Health Family program;

Considering the National Policy of Health Promotion, regulated by the Ordinance 687/GM, from March 30th, 2006, which is about the development of health promoting actions in Brazil;

Considering the National Policy for the Integration of Disable People, in conformity with the Decree 3298, from December 20th, 1999, which regulates the development of disable people actions at the Universal Health Care system;

Considering the national guidelines for Psychological Health at the Universal Health Care system, based on the psychiatric reform Law 10.216, from April 6th, 2001;

Considering Ordinance 710/GM, July 10th, 1999, which approves the National Policy for Alimentation and Nutrition, and the Law 11.346, from September 15, 2006, which creates the Alimentation and Nutrition Security System;

Considering the National Policy of Children Health and the National Policy of Women Integral Health Care, in 2004, its principles and guidelines;

Considering the National Policy of Integrated and Complementary Practices – NPICP, from the Universal Health Care System, the Ordinance 971/GM, from May 3rd, 2006, which regulates the development of action defined as Traditional and Complementary/Alternative Medicine by OMS, the Homeopathy, Acupuncture, the Phytotherapy and Crenotherapy;

Considering the Ordinance 204/GM, from January 29TH, 2007,  which regulates the funding and transferring of federal funds for the actions and services of health by blocks of funds, with its due monitoring and control;

Considering the schedule for sending the databases information from the Clinical Information Systems, from the Decentralized Hospital Information, from the National Cadastre of Health Facilities, and from the Hospitalization Communications, established by the Ordinance 74/SAS/MS, from February 6th, 2007;

Considering the National Policy for Medicines, which aims at assuring the necessary security, effectiveness and quality of these products, the promotion of rational use and the population access to those medicines considered to be essential;

Considering that the National Policy of Pharmaceutical Care, established by the CNS Resolution 338, from May 6th, 2004, is part of the National Policy of Health, involving a collection of actions for the promotion, protection and recovery of health and assuring the basic principles of universality, integrality and equity  
 
Considering the Ordinance 399/GM, from February 22nd, 2006, which approves the Operational Guidelines for the Pact fro Health 2006, as well as the Ordinance 699/GM, March 30th, 2006, which regulates the Operational Guidelines of the Pact for Life and Management, decides:

Art 1st. To create the Centers of Family Health Support with the goal of enlarging the outreach and scope of Health Care actions, as well as its resolution, giving support the insertion of the strategy of Family Health in the services networks and the process of regionalization of the basic Health Care.  

Art. 2nd. To establish that the Centers of Family Health Support -CFHS, made of professionals from different specialization fields, work in partnership with professionals from the Family Health Teams - FHT, sharing the same health practices in the territories under the scope of FHT, working directly in the support of the teams and centers where the CFHS is subscribed.

§ 1st The CFHS are not the primary way of entrance in the Health Care system, and must work in an integrated fashion with the network of health services, from the needs identified in the joint work with the FHT.

§ 2nd. The responsibility shared by CFHS and FHT to the community foresees the revision of the practice of routing based on the processes of reference and contra-reference, expanding it for a process of longitudinal monitoring, whose responsibility is due to the team of basic Health Care/Family Health, working towards strengthening its attributes and the role of Health Care coordination at the Universal Health Care system.

Art. 3rd. To determine that the CFHS must be classifieds in two modalities, CFHS 1 and CFHS 2, prohibiting the implantation of the two modalities to the Municipalities and to the Federal District.      

§ 1st. The CFHS 1 will be composed by at least five professionals with a college degree, which must not be working in positions listed in the 2nd paragraph of this article.

§ 2nd. To the extent of federal funds transferring, the following occupations may compose the CFHS 1, based on the Brazilian Occupations Code – BOC: Acupuncturist Doctor; Social Assistant; Physical Education teacher; Pharmaceutical; Physiotherapist; Speech Pathologist; Gynecologist; Homeopath Doctor; Nutritionist; Pediatrician; Psychologist; Psychiatry; Occupational Therapist.

§ 3rd. The CFHS 2 will be composed by at least three professionals with a college degree, which must not be working in positions listed in the 4th paragraph of this article.

§ 4th. To the extent of federal funds transferring, the following occupations may compose the CFHS 1, based on the Brazilian Occupations Code – BOC: Social Assistant; Physical Education teacher; Pharmaceutical; Physiotherapist; Speech Pathologist; Nutritionist; Psychologist; Occupational Therapist.

Art 4th. To determine that the CFHS must function in the same work shift as the Health Family teams, and also that the health professionals considered for federal funding transfer must work at least 40 hours per week, observing the following:

I- for the medical doctors, when substituting a professional that works for 40 hours per week 2 other professionals can be registered if working at least 20 hours per week each one; and

II- for the other occupations, it is valid the definition of the caput of this article.

§ 1st. The composition of each one of the CFHS will be defined by the municipal managers, following the criteria of priorities identified from the local needs and the availability of professional in each one of the different occupations.

§ 2nd. Regarding the epidemiologic scope of psychological problems, it is recommended that each CFHS has at least one professional for mental health care.

§ 3rd. The CFHS professionals must be subscribed in a single health center, which should be preferably located within the territory of action of the FHT to which they are related.

§ 4th. The responsibility actions of all the professionals that compose the CFHS, to be developed along with the FHT, will be described in the Appendix I of this Ordinance.

Art. 5th. To define that each CFHS 1 must undertake its activities bound by at least to 8 FHT and at most to 20 FHT.

§ 1. Exceptionally in the Municipalities with less than 100,000 habitants in the North Region of Brazil, each CFHS 1 may undertake its activities bound by at least to 5 FHT and at to most 20 FHT.

§ 2nd.  The maximum number of CFHS 1 that the Municipalities and the Federal District can receive specific federal funds will be calculated by the formulae:

I- for Municipalities with less than 100,000 habitants of the North Region of Brazil = the number of the FHT from the Municipality/5;

II- for Municipalities with 100,000 or more habitants from the North Region of Brazil and for the rest of Municipalities from the other States = number of FHT of the Municipaly/8.

Art. 6th. To define that each CFHS 2 undertake its activities bound by at least 3 FHT.

§ 1st. The maximum number of CFHS 2 that the Municipalities and the Federal District can receive specific federal funds will be of one CFHS 2.

§ 2nd. Only the Municipalities that have population density below 10 habitants per square kilometers, according to the figures from the Foundation Brazilian Institute of Geography and Statistics –BIGS, from the year 2007, may implement CFHS 2.

Art. 7th. To define that it is the competence of the Municipal and Federal District Health Department :

I- to define each CFHS’ territory when the FHT to which the CFHS are related pertain to the same Municipality or Federal District.

II- to plan the action that will be undertaken by the CFHS, such as continuing education and treatment of specific cases;

III- to plan the CFHS action in accordance with the FHT, including reference and contra-reference forms, assuring the interface and leadership of FHT in the establishment of  longitudinal care of individuals, as well as their families.

IV- to select, hire and pay the professional for the CFHS, in accordance with the current legislation;

V- to keep updated records of the professionals, services and facilities under its management;

VI – to make available the adequate physical structure and guarantee the necessary resources for funding the development of the basic activities by the CFHS professionals;

VII- to make evaluations of each CFHS, encouraging and making professional trainings possible;

VIII- to assure that the CFHS professional comply with their work schedule;

IX- to establish strategies for developing partnerships with different social sectors and to involve the local community in health care of the population, in order to increase CFHS’ operation.  

Art. 8th. To define that it is the responsibility of the State and Federal District Health Department s:

I- To identify the needs and promote the connection between the Municipalities, encouraging, whenever necessary, the creation of inter-municipal consortiums for implanting CFHS 1 between the Municipalities that do not reach the populational requirements from ART 5th of this Ordinance;

II- to assessor, observe and monitor the development of the CFHS actions, according to the planning, assuring the interface and leadership of FHT in the establishment of longitudinal care of individuals, as well as their families;

III- to undertake evaluations and/or advisory to its performance;

IV- to monitor the organization of the practice and operation of the CFHS, according to the principles regulated in this Ordinance.

Art. 9th. To define that the process of accrediting, implantation and expansion of the CFHS:

I- the implantation/expansion must be linked to the Basic Health Care/Family Health within the formulae defined in article 5th of this Ordinance;

II- it must obey the operational settings regarding the accession and the flow of accrediting, implantation and expansion defined in Appendix II of this Ordinance, while it is also allowed to be used the charts of Appendix III of this Ordinance;

III- it must have approval from the Bipartite Inter-managers Commission from each state;

Art. 10th. To define the amount of transfer for the implantation of the CFHS, according to its category:

I – CFHS 1: the amount of R$ 20,000.00 in a single payment in the month following the SCNES competence, with the information of the initial accrediting of each CFHS 1, which will be transferred directly from the National Fund of Health to the Municipal Health Funds and to the Federal District Health Fund; and

II- CFHS 2: the amount of R$ 6,000.00 in a single amount in the month following the SCNES competence, with the information of the initial accrediting of each CFHS, which will be transferred directly from the National Fund of Health to the Municipal Health Funds.

Art. 11th. To define the value of the federal incentive to each CFHS, according to its category:

I- CFHS 1: the amount of R$ 20,000.00 every month, transferred directly from the National Fund of Health to the Municipal Health Funds and to the Federal District Health Fund; and

II- CFHS 2: the amount of R$ 6,000.00 every month, transferred directly from the National Fund of Health to the Municipal Health Funds.

§ 1st. The amount of financial incentives for each CFHS will be transferred every month, based on the number of CFHS accredited in the SCNES.

§ 2nd. The sending of the database from the SCNES by the Municipal and State Health Department s to the national repository must agree to the Ordinance 74/SAS/MS, from February 6th, 2007.

§ 3rd. The register of the procedures referring to the production of services made by the professionals accredited to the CFHS will be registered at SIA/SUS, but will not generate financial credits.

Art. 12th. To define that the budgetary resources mentioned by this Ordinance must take part of the fractional variable of the Basic Health Care Ground (variable BHCG) and compose the Basic Health Care Financial Block.

§ 1st. The requisites defined by the Ordinance 648/GM, from March 28th, 2006, apply to the flow and minimal requisites for keeping the transfer and solicitation of retroactive credit.

§ 2nd. The Ministry of Health will suspend the transfer of funds regarding the CHFS incentives to the Municipalities and/or the Federal District in those same situations fixed for Health Family and Mouth Health, according to what is established in Ordinance 648/GM, from March 28th, 2006, Chapter III, item 5, “on the suspension of PAB funds transfer”.

Art. 13th. To define that the budgetary resources mentioned by this Ordinance are on the Ministry of Health budget, encumbering the Work Program 10.301.1214.20AD – Variable of Basic Health Care Minimum – Health Family.

Art 14th. This Ordinance enter intro force on the date of its publication.

JOSE GOMES TEMPORÃO

APPENDIX I

The professionals that compose the CFHS are responsible for the actions undertaken along with the FHT:

To identify along with the FHT and the community, the activities, actions and practices to be adopted in each of the covered areas;

To identify the overriding public in each of the actions along with the FHT and the community
 
To be engaged in a planned and integrated way in the activities undertaken by the FHT, whenever those activities occur, and to attend and follow cases, according to previously established criteria.

To accommodate the users and humanize the health care;

To develop collectively and aiming to the inter-sectoriality actions that are integrated with other social policies such as education, sports, culture, employment, leisure, among others;

To promote an integrated management and users’ participation making decisions through participatory organization with Locals and/or Municipals council of health;

To develop communication strategies for dissemination of and awareness about activities from the CFHS through posters, newspapers, newsletters, banners, brochures and other medias;

To evaluate along with the FHT and the Health Council the development and implementation of actions and to evaluate the scope that these actions have with respect to the national health situation by using pre-established standard figures.

To produce and disseminate educational materials and information in the areas covered by CFHS; and

To create individual therapeutic projects by having periodical discussions that promote integrated health care actions between CFHS and FHT, producing multi-professional and transdisciplinary action, developing a responsible labor sharing.

Actions of Physical Activities / Body Practices – Actions that favor a better quality of life for the population, reducing the harm of non-transmissible diseases, the reduction of medicine consumption the formation of networks of social aid and that also facilitate the active participation of users in the development of different therapeutically projects.

The National Policy for Health Promotion – Ordinance 687/GM, from March 30th, 2006, understands that the Body Practices are individual and collective expressions of body movement from the knowledge and experience in games, dances, sports, martial arts and gymnastic. They are possible organizations, choices about the way of relationship to one’s body and the way one exercises, understood to be beneficial to individuals and the society’s health, including hiking and orientation for doing exercises, and also sportive, playful and therapeutic activities, such as: capoeira, dances, Tai Chi Chuan, Lien Chi, Lian Gong, Tuin-ná, Shantala, Do-in, shiatsu, Yoga and others.

With respect to the strategic status related to quality of life and the prevention from illnesses, the action of Physical Activities/Body Practices must aim to include the whole community, and not restricting it only to those more vulnerable and ill people.

Details of the actions:

- to develop physical activites and body practices with the community;

- to distribute information whose goal is the prevention, risk minimization and protection to the vulnerability, looking for producing the self-care behavior;

- to encourage the creation of social inclusion spaces, with actions that strengthen the feeling of social belonging to the communities, by having regular physical activities, sport, leisure and of body practices;

- proportionate Permanent   Education in Physical Activities/Body Practices, nutrition and health together with the FHT by co-participation, supervised joint activities, case discussions and other learning methodologies within a process of Permanent  Education;

- to create integrated actions with FHT about the conjunct of local priorities in health that include different sectors of public administration;

- to contribute for enlarging and valorizing the utilization of public spaces as a response for social inclusion and combating violence;

- to identify professionals and/or community members with potential for developing the work on body practices together with the FHT;

- to capacitate the professionals, including the communitary health agents, for acting as facilitators/monitors in developing Physical Activities/ Body practices;

- to supervise in a shared and participative way the activities developed by the FHT in the community;

- to promote actions linked to Physical Activities/ Body practices along with other public facilities present in the territory, such as schools, child care, etc.;

- to create partnerships with other sectors in the area, along with the FHT and the population, looking for the best use of public spaces and the enlargement of available areas for body practices;

- to promote events that stimulate actions that valorize Physical Activities/ Body practices and its importance to general population health;

  Actions of Integrative and Complementary Practices – Actions of Acupuncture and Homeopathy that aim to enhance the quality of life of individuals, enlarging the access to the health system, using different approaches, and making available other preventive and therapeutic options to SUS users;

Details of the actions:

- to develop individual and collective actions related to Integrative and Complementary Practices.

- to distribute information whose goal is the prevention, risk minimization and protection to the vulnerability, looking for producing the self-care behavior;

- to encourage the creation of social inclusion spaces, with actions that strengthen the feeling of social belonging to the communities, by having individual and collective actions referred to Integrative and Complementary Practices;

- proportionate Permanent   Education in Integrative and Complementary Practices, with the FHT by co-participation, supervised joint activities, case discussions and other learning methodologies within a process of Permanent Education;

- to create integrated actions with FHT about the conjunct of local priorities in health that include different sectors of public administration;

- to contribute for enlarging and valorizing the utilization of public spaces as a response for social inclusion and combating violence;

- to identify professionals and/or community members with potential for developing the work on Integrative and Complementary Practices together with the FHT;

- to capacitate the professionals, including the communitary health agents, for acting as facilitators/monitors in developing Integrative and Complementary Practices;

- to promote actions linked Integrative and Complementary Practices practices along with other public facilities present in the territory, such as schools, child care, etc.;

- to undertaker clinic activities according to its professional activities;
           
            Actions of Rehabilitation – actions that propitiate the number of disable and handicapped people, aiming for a better quality of life for the individuals, helping their social reintegration, combating the discrimination and enlarging the access to the health system;

The National Policy for the Integration of Disable People – decree 3298, from December 20th, 1999 – understands that “disability can be part or expression of a health condition, but do not necessarily indicate that the person is sick” (CIF, 2003).           

The process of rehabilitation, with the compromise of Social Inclusion, must happen closest as possible to the place where disable people live in order to make attendance easier, valorize the community knowledge and to get integrated to other facilities existing in the territory. Hence, it is crucial that the services of basic health care be strengthened for taking care of disable people and its team have the necessary knowledge for giving an effective and high-quality assistance, adequately sending the users for treatments at other levels of complexity when it turns necessary.         

Actions of rehabilitation must be multiprofessionaly and transdisciplinary, fomenting the development of shared responsibilities, in which by the constant relationship between different professionals, unique therapeutic project are organized, considering the person, his/her needs and the meaning of the disability in the social and family contexts. The results of the actions will be constantly evaluated for searching more adequate actions and to offer the best longitudinal health care for the users;

Detail of the actions:

- to make diagnostic with information about the health problems that require preventive actions of disabilities and necessities in terms of rehabilitation in the area to which each FHT is confined to;

- to develop actions that promote and protect the health together with the FHT, including physical and communicational aspects, such as knowledge and care of the body, body posture, auditory and vocal health, oral habits, breastfeeding, noise control, aiming at the self-care;

- to develop actions for helping the FHT work in respect to children’s development;

- to develop actions together with the FHT, aiming at monitoring children that present risk in development disturbs;

- to undertake preventive actions against disabilities in every phase of individuals’ life cycle;

- to receive the users that want  rehabilitation care, orienting, treatment, monitoring, according to the users’ needs and the structure of FHT;

- to develop actions of rehabilitation, priotizing collective treatments;

- to develop integrated actions with the social facilities, such as schools, pre-schools, among others;

- to make home visits in order to give orientation, provide adaptation and treatments;

- to capacitate, orientate and support to the ACS actions;

- to promote discussions and therapeutic conducts along with FHT;

- to develop projects and inter-sectorial actions for improving the social inclusion and quality of life of disable people;

- to orientate and inform disable people, care-takers and ACS about handling, positioning, daily activities, resources and technologies in order to allow each individual to develop their functional performance according to their specific characteristics;

- to develop Rehabilitation actions based on the community, which presuppose the valorization of the community’s potential, conceiving every people as agents in the process of rehabilitation and social inclusion;

- to welcome, support and orientate the families when dealing with the situations related to the disability of one of the family members, especially when giving diagnostics;

- to monitor the use of auxiliary equipments and routing when necessary;

- to undertake routing and monitoring of the indications and concessions of orthoses, prostheses and specific treatments made by other level of health care providers;

- undertake actions that enhance social, job and educational inclusion of the people of disabilities;

            Actions of Alimentation and Nutrition – Actions to promote healthy food habits in every phases of life cycle and answers to the main requests with respect to alimentary disturbs, nutritional problems and malnutrition, as well as with other therapeutic plans, especially non-transmissible diseases and grievance.

The promotion of healthy food habits is an important component for health promotion in every phase of the life cycle, encompassing the problems related to malnutrition, including those specific deficiencies, obesity and other nutritional disturbs and their relation to non-transmissible diseases and grievance.

Therefore, it is important to socialize the knowledge about food and alimentation process, as well as how to develop strategies to recover the alimentary habit and practices of eating regional food, which are related to consuming local foods under low costs and high nutritional value. The incorporation by actions of alimentation and nutrition at the Basic Health Care level will give answers to its main demands, enlarging the quality of therapeutic plans, especially on non-transmissible diseases and grievance, on child’s development, on pregnancy and breast-feeding periods.

The population diagnostic about the alimentary and nutritional situation, with the identification of geographical areas, social segments and population groups in greater risk of nutritional grievance, made possible by the system of alimentary and nutritional vigilance, it will give a rational base for making decisions for nutritional and healthy food habits actions that respect the ethnic, racial and cultural diversity within the population.

The Alimentation and Nutrition actions integrate the health sector’s compromise with respect to the components of the Nutritional and Alimentation Security System, created by Law 11.346, from September 15th, 2006, aiming at the human right to adequate alimentation.

Details of the actions:

- to know and encourage the production and the consumption of healthy food produced locally;

- to promote the connections of different sectors in order to make possible the cultivation of communitarian gardens and crops;
- to capacitate FHT and participate in the actions related to programs of control and prevention of nutritional disturbs, such as lack of micronutrients, overweight, obesity, chronic non-transmissible diseases and mal-nutrition; and

- to elaborate, along with the FHT, routines of nutritional care and treatment for diseases related to Alimentation an Nutrition, according with the protocols of basic health care, organizing a reference and counter-reference care;

Actions of Mental Health – Attention to the users and family members in situation of psychosocial risk or mental disease in order to make possible their access to health system and social reinsertion. The actions against subjective suffering associated to all and any disease and the subjective issues of inability of adhesion to preventive practice or to incorporation of healthy life habits, the actions of confronting grievance related to the abusive use of alcohol and drugs and the actions for reducing the damages from discrimination.

The mental health care must be made within a network of attention strategies – network of mental health care – which already includes the network of Basic Health Care/Family Health, the Center of Psychosocial Attention (CPA), the therapeutic residencies, clinics, the centers for livinghood, leisure clubs, among others. The CPA are strategic within the Policy for Mental Health for organizing this network, since services are also regionalized and are within the same area of the social space of the users that need them – and aim for recovering the potentialities of this communitarian resources, including them in mental health care. The CFHS must get integrated to this network, organizing its activities from the requests made at the FHT, contributing for making possible conditions for social reinsertion to users and for a better utilization of the potentialities of the communitarian resources in the search for better health practices, of promoting equity, integrality and the development of citizenship.

Details of the actions:

- to undertake the clinic activities according to their professional responsibility;

-to support the FHT in the approach and working process with respect to cases of severe and persisting mental problems, the use of abusive alcohol and other drugs, patients returning from psychiatric hospitalizations, patients treated by the CPA, suicide attempts, situations of family violence;

- to discuss with the FHT the identified cases that are in need of enlargement of clinic facilities;

- to create with the FHT strategies for approaching problems related to violence and abuse of alcohol, tobacco and other drugs, aiming at the reduction of the harms and to enhance the quality of the health care provided to the most vulnerable groups;

- to avoid the practices that lead individual and social situations that are common to daily life to psychiatric procedures and unnecessary medicines;

- to foster actions aiming at the propagation of health care not based on asylums, diminishing and the prejudice and segregation with respect to insanity;

- to develop actions of communitarian resources mobilization, looking for creating spaces of psychosocial rehabilitation in the communities, with workshops, highlighting the relevance of inter-sectorial actions, such as counsels, neighborhood associations, helping groups, etc.;

- to priotize the collective strategies, identifying the strategic groups in order for mental health care to be undertaken in the health centers of the community;

- to allow for an integration of agents working for reducing harms and the CFHS; and

- to enlarge the link with the families, making them partners in the treatment and aiming at creating supportive and integrative networks.
           
            Actions of Social Service – actions for promoting citizenship and the production of strategies that foster and strengthen networks of social support and greater integration among health services, its territory and other social facilities, contributing for the development of inter-sectorial actions for the effective realization of health care.

Considering the Brazilian context, its serious social inequalities and the great lack of information about rights, Social Service actions must be situated as a space for promoting citizenship and the production of strategies that foster and strengthen networks of social support, allowing for a greater integration between social services and other public facilities and the health services at their respective regions, contributing for the development of inter-sectorial actions that aim at the strengthening of citizenship.

Details of the actions:

- to coordinate works of social character related to the FHT;

- to encourage and to monitor the development of works with communitarian character along with the FHT;

- to discuss and to reflect permanently with the FHT the social reality and the ways of social organization in the territories, developing strategies of how to deal with the adversities and potentialities;

- to help families in an integral way, along with the FHT, stimulating reflection about the knowledge of these families, such as spaces for individual and group development, its dynamics and potential crisis;

- to identify the values and cultural norms of the families and communities along with the FHT within the territory, which can contribute for the development of illnesses.

- to discuss and make visits at homes with the FHT, developing techniques for qualifying health care;

- to allow for and share techniques that identify opportunities for income generation and sustainable development within the community, or strategies that allow for the full exercise of citizenship;

- to identify, organize and make available with the FHT a network for social protection;

- to support and to develop techniques of health education and mobilization;

- to develop with the FHT professionals strategies for identifying and approaching troubles related to violence and abuse of alcohol and other drugs;

- to encourage and monitor actions of Social Control with the FHT;

- to capacitate, to orientate and to organize, with the FHT, the services to the families under the ‘Bolsa Familia’ program and other federal and state programs for income distribution; and

- to identify the needs and to undertake actions of Oxigeniotherapy, capacitating the FHT in the treatment of this health care actions.

Actions of Child Health – Actions of attention to children, developed from the identified demands made by the team of Basic Healt Care / Family Health, whose complexity requires differential attention. Actions of inter-consultation developed along with generalist medical doctors and other components of the FHT, which are inserted in a process of permanent education. Actions of capacitating within a process of permanent education for the different professionals from the FHT and other procedures in areas that require a more specific knowledge and technology.

Details of the actions:

- to plan with the FHT actions of child health;

- to undertake clinic activities related to their professional responsibility;

- to support the FHT in the approach and process of working with cases of severe grievance and/or persistent in child’s health, as well as in specific situations, such as family violence;

- to discuss with the FHT the identified cases that need enlarging clinic installations for any specific issues;

- to create with the FHT strategies for approaching problems of greater vulnerability;

- to avoid the practices that lead individual and social situations that are common to daily life to procedures and unnecessary medicines;

- to develop actions that mobilize communitarian resources, aiming at developing spaces of healthy life in the community, such as communitarian workshops, highlighting the relevance of inter-sectorial actions, such as counsels, neighborhood associations, etc.;

-to priotize the collective strategies, identifying the strategic groups in order for child health care to be undertaken in the health centers and other spaces of the community;

- amplify the link with the family, making them partners in the treatment and aiming at creating supportive and integrative networks; and

- to make home visits with the FHT from the identified needs in the area, such as for example cases of patients that are unable to commute.

Actions of Woman’s Health – Actions developed with the generalists doctors and other components of the FHT that are inserted in a process of permanent education; Actions of capacitating in services within a process of permanent education for the different professionals from the FHT; actions of individual care to the women, developed from the necessities that were identified in the area and were referred by the Basic Health Care / Family Health; actions whose complexity of the case requires differential attention; differential actions, such as non-habitual high-risk pregnancy, where care is shared with the FHT; undertaken sections of colposcopy and biopsies, cirugies of high-frequency and additional procedures of the area that require a higher level of more specific knowledge or technology;

Detail of the actions:

- to undertake with the FHT the development of plans for actions of Women’s Health;

- to undertake the clinic activities according to their professional responsibility;

-to support the FHT in the approach and working process with respect to cases of severe grievance and persisting women health problems, as well as more specific situations as family violence;

- to discuss with the FHT the identified cases that are in need of enlargement of clinic facilities;

- to create with the FHT strategies for approaching problems related to greater vulnerability;

- to avoid the practices that lead individual and social situations that are common to daily life to procedures and unnecessary medicines;

- to develop actions that mobilize communitarian resources, aiming at developing spaces of healthy life in the community, such as communitarian workshops, highlighting the relevance of inter-sectorial actions, such as counsels, neighborhood associations, etc.;

-to priotize the collective strategies, identifying the strategic groups in order for women health care to be undertaken in the health centers and other spaces of the community;

- amplify the link with the family, making them partners in the treatment and aiming at creating supportive and integrative networks; and

- to make home visits with the FHT from the identified needs in the area, such as for example cases of patients that are unable to commute.

The Pharmaceutical Assistance at the CFHS aims to strengthen the insertion of the pharmaceutical activity and of the pharmaceutical professional in an integrated way with the Basic Health Care/ Family Health, working for guaranteeing the effective access and promoting the rational use of medicines, contributing for making the promoting actions more effective, prevention and recovery, as it is established by the guidelines of the Strategy of Family Health, by the National Policy of Medicines and by National Policy for Pharmaceutical Assistance.

Detail of the actions:

- to coordinate and execute activities of Pharmaceutical Assistance at the Basic Health Care / Family Health, assuring the integrality and the inter-sectoriality of the health actions;

- to promote access to the rational use of medicines to the population and the professionals of Basic Health Care / Family Health by having actions that discipline the prescription, the distribution and use of it;

- to assure an adequate distribution of the medicines and help to implement a Pharmaceutical Attention for Basic Helth Care / Family Health;

- to select, program and distribute medicines with attested product quality;

- to receive, storage and distribute the medicines adequately in the Basic Helth Care / Family Health;

- To provide the manager, the health professionals and the FHT with information related to morbimortality associated to medicines;

-To elaborate projects in the filed of Health Care/Pharmaceutical Assistance in conformity with municipal, state and national guidelines, and according to the epidemiologic profile of the area;

-To act directly with the users in specific cases, in conformity to the Basic Health Care /Family Health, aiming at a relational pharmacotherapy and for obtaining definite and measurable results that enhance the quality of life;

-To encourage, support, propose and guarantee the permanent education of professionals from Basic Health Care /Family Health involved in activities with Health Care/Pharmaceutical Assistance; and

-To train and capacitate human resources at Basic Health Care /Family Health for the fulfillment of activities related to Pharmaceutical Assistance.

Appendix II
Mechanisms for implementation of the CFHS

I. For implementing the CFHS, the Municipalities and the Federal District must elaborate an Implementation Project, disserting about:

- the zone of activity that is formed by continuous areas from the Basic Health Care /Family Health;

- the main activities to be developed;

- the professionals that will be hired/inserted;

- the method for hiring and the work schedule of the professionals;

- identification of the FHT related to the CFHS;

- plans or anticipation of the shared agenda between the different FHT and the CHFS teams, which must include individual and collective actions, assistance, pedagogical support both for the FHT as well as for the community, and also actions of home visits;

- The code of the CNES from the Health Unit in which the CFHS services will be subscribed, which must be within the related FHT zone;

- the format of integration in the health system, including flows and mechanisms of reference and counter-reference for additional services in the assistance network, foreseeing mechanisms for the return of the information and the coordination of the access by the FHT; and

- description of the necessary investments for making the Health Unit adequate for the good performance of the CFHS actions.

II. The proposal must be approved by the Municipal Health Counsel and be sent to the State Health Department or to the regional administrative office for analysis. The Federal District after the approval by the Health Counsel will have to send the proposal to the Health Ministry.

III. The State Health Department or the regional administrative office will have 30 days after the date of arrival of the project in the protocol for analyzing and sending it to the Bipartite Inter-managers Commission. After this period, the Municipality can send the solicitation of accrediting with the protocol number received from the State Health Department that proves the expiration of the deadline to the Health Ministry.

IV. After being approved, the Federal District and State Health Department will inform to the Health Ministry until the 15th day of every month the number of CFHS that can receive financial incentives from the variable PAB. 

V. The municipality will start to receive an incentive that corresponds to the team that were effectively implanted and were previously accredited by the State, after the professional have been accredited in the information national system defined for this purpose and feeding the data into the system that prove the start of the activities.