Sentidos e significados atribuídos pelos coordenadores da atenção básica à dinâmica organizativa do acesso ao pré-natal de alto risco

Abstract

The 1988 Federal Constitution established health as a right of all citizens and a duty of the State, instituting the Unified Health System (SUS) based on the principle of universal access. However, the existence of inequalities, influenced by socioeconomic, geographic, and cultural factors, hinders access to essential health services. Primary Health Care (PHC) plays a fundamental role in ensuring access; however, in certain situations, it is not sufficient to promote comprehensive care. In the context of High-Risk Prenatal Care (HRPC), challenges such as the lack of well-defined care pathways, unequal distribution of resources, inadequate infrastructure, and difficulties in regulation affect the effectiveness of care provided to pregnant women. Despite advances in the Maternal and Child Health Care Network (HCN), barriers to specialized care remain, particularly at the secondary and tertiary levels of care. This study aimed to: analyze the different dimensions of access to High-Risk Prenatal Care from the perspective of Primary Health Care coordinators; identify elements that facilitate or hinder access to High-Risk Prenatal Care within the context of the Health Care Network; understand how communication processes, regulation, and the organization of care pathways influence access to High-Risk Prenatal Care; and develop an analytical flowchart of the Maternal and Child Health Care Network in the Central-Northern region of Bahia. This is a descriptive and exploratory study with a qualitative approach, conducted in municipalities of the CentralNorthern region of Bahia, involving 10 Primary Health Care coordinators. Data were produced through semi-structured interviews and analyzed in light of Thematic Content Analysis as proposed by Minayo. The findings reveal that access to HRPC occurs in an unequal and fragmented manner, marked by weaknesses in the definition of care pathways, limitations in regulation, and failures in communication among health services. It was observed that, in the face of these gaps, coordinators resort to informal strategies to enable care delivery, revealing limitations in the organization and integration of the Health Care Network. Nevertheless, specific initiatives were identified, indicating potential strengths in the organization of care. As a result of this study, an analytical flowchart of access to HRPC was developed as a technical product. This flowchart represents the care trajectories of pregnant women within the network, highlighting the main access points, referral pathways, and critical bottlenecks identified from the perspective of Primary Health Care coordinators. It is concluded that, although normative advances have been achieved, challenges persist in the operationalization of the network. Strengthening management, regulation, and coordination among services is necessary to ensure access to and comprehensiveness of care for high-risk pregnant women.