Background Two procedures stood out in the 2000s intended for changing the treatment model adopted in Brazil: The Country wide Policy on Principal Health Care, predicated on a grouped family members healthcare model, and the Country wide Policy on Wellness Promotion. was useful for evaluation of the full total outcomes. Results Varying degrees of healthcare activity were discovered, indicating that the managers have already been either incapable or lacked the dedication to execute the proposed activities. From a structural viewpoint, 87.5% from the teams were incomplete. Also of particular be aware was having less any doctors within the united groups, which, despite its harmful effect, HMN-214 was viewed with the interviewees as organic. Solid politics party influence within the specific area hindered relations between your team and the neighborhood population. Health education, especially through lectures was the main health promotion activity picked up in this study. No cross-sectorial or public participation actions were identified. Connections between the teams HMN-214 for sharing responsibilities were found to be very weak. Conclusion In addition to political factors, there are also structural limitations such as a lack of human resources that overburdens the teams daily activities. From this point of view, the political context and lack of professionals were restrictive factors for health promotion. Belford Roxo is not necessarily representative of other experiences in Brazil. However, problems such as patronage, political manipulation, poverty and incipient cross-sectorial actions are common to other Brazilian towns and cities. E2 In a study with Rabbit Polyclonal to EPHB1/2/3/4 similar objectives to this one, Beato (2011) showed how continued family health team stability over time helped improve the work process [24]. On the flip side to Beato study, the lack of doctors in the teams studied distorts the work of the family health strategy, as indicated by the following statement: E8 This account reports the physical absence of the doctor and the medical rationale that the policy on primary health care and health promotion intends to overcome; that of care based purely on curative activities. Geneua (2008) discussed medical practice in primary health care and pointed out how difficult doctors found it to take an active role in the educational activities [25]. This difficulty for doctors to commit to non-care and health promotion activities was confirmed by one interviewee. E1 In this context, Machado and Porto (2003) stated that the behavior of several actors reflects certain power structures and cultural practices that must be overcome in order to give way to other more effective ones. Even when there are resources available to facilitate the agents actions, the doctors fail to make use of such resources to change their practice and structure a form of care more in line with guidelines for health promotion and health care model change [26]. The population group allocated to each team varied from 400 to 1 1,500 families, and from 80 to 187 per ACS. It was found that 12.5% of the teams provided services to a larger population group than recommended. Bearing in mind the average family size in poor municipalities like Belford Roxo is 4.2 members, we could see that the majority of ACSs were working with less people than determined in the ministerial directive. However, ACSs represented the main human resources shortage in the region. This was a surprising discovery, as it had not been indicated in any nationwide studies. We found that this difference in relation to other scenarios in the country could be explained by the strong and long-standing connection between party politics and public health services in the area. No specific elements were expounded that confirmed this hypothesis; however, since the agents must live in the community, this impression remains strong. The political dispute over welfare in places like Belford Roxo is deeply rooted in the exchange of votes for personal interests. This issue has heavily interfered in the formation of trust relationships between the teams and the public. Some units belonged to local politicians and were leased to the municipal health secretariat, and rival groups attacked the unit where the health team was installed as a form of aggression against the owner, their political opponent. E8 Local party politics has also hindered the allocation of HMN-214 the family health services. Some teams did HMN-214 not cover people who lived on the same street, but covered other more distant neighborhoods. This was a result of the allocation not taking into consideration the needs of the local population and their proximity to the unit, damaging the work process of the.