REFORMA NEOLIBERAL EN LA ATENCIÓN PRIMARIA DE SALUD BRASILEÑA: UN ANÁLISIS CRÍTICO DEL DESMANTELAMIENTO DEL NASF Y LA PRECARIEDAD DE LOS EQUIPOS EMULTI

Resumen

This study critically analyzes the impacts of the transition from Family Health Support Centers (NASF) to multidisciplinary teams (eMulti) in Brazilian Primary Health Care (PHC), with an emphasis on the psychosocial dimensions of care, matrix support, and working conditions. Adopting a mixed-methodological approach, we conducted a documentary analysis (53 regulatory instruments and government reports), an integrative literature review (127 publications indexed between 2008 and 2024), and secondary data analysis from the DATASUS and CNES systems. The results reveal a scenario of progressive disorganization: a 38.7% reduction in federal funds allocated to eMulti, an increase in professional turnover to 58.3% (compared to 12.1% in the NASF model), and a 73.2% decline in the frequency of matrix support meetings. At the same time, there was a 133% increase in psychotropic prescriptions and a weakening of the Psychosocial Care Network (RAPS) in 68% of the municipalities analyzed. The conclusion is that this transition represents a paradigmatic reorientation in PHC, aligned with neoliberal principles, characterized by: (1) precarious employment relationships; (2) medicalization of mental suffering; and (3) erosion of the principles of expanded clinical practice. The findings highlight the urgent need for public policies that restore interprofessionality as a structuring axis, guarantee permanent funding, and strengthen territorialized care practices.

DOI: https://doi.org/10.56238/sevened2025.029-015