Implementation of the National Policy for Comprehensive Attention to Men’s Health: challenges experienced by nurses

Descriptive, qualitative study, carried out with nurses working in Primary Health Care in a city in the state of Bahia, Brazil. Individual interviews were carried out and then analyzed using the Discourse of the Collective Subject, in the light of the guidelines of the National Policy for Comprehensive Attention to Men’s Health.

Results

A total of 40 nurses participated. The challenges for the implementation of the policy are related to the inoperability of government actions, weaknesses in municipal management, underfunding and discontinuity of actions.

Conclusion

Nurses face complex macro-management challenges in the implementation of the National Policy for Comprehensive Attention to Men’s Health in Primary Health Care.

Nursing; Men’s Health; Health Policy; Primary Health Care; Health Care (Public Health

Authorship

Anderson Reis de Sousa

Universidade Federal da Bahia, Escola de Enfermagem, Programa de Pós-Graduação em Enfermagem, Salvador, BA, Brazil.Universidade Federal da Bahia, Escola de Enfermagem, Programa de Pós-Graduação em Enfermagem, Salvador, BA, Brazil.BrazilBrazilUniversidade Federal da Bahia, Escola de Enfermagem, Programa de Pós-Graduação em Enfermagem, Salvador, BA, Brazil.

http://orcid.org/0000-0001-8534-1960

Josias Alves de Oliveira

http://orcid.org/0000-0002-5100-5536

Marcio Soares de Almeida

http://orcid.org/0000-0002-9912-1640

Álvaro Pereira

http://orcid.org/0000-0003-1899-7374

Éric Santos Almeida

Faculdade Pitágoras de Eunápolis, Eunápolis, BA, Brazil.Faculdade Pitágoras de Eunápolis, Eunápolis, BA, Brazil.BrazilBrazilFaculdade Pitágoras de Eunápolis, Eunápolis, BA, Brazil.

http://orcid.org/0000-0001-9043-5988

Oscar Javier Vergara Escobar

Fundación Universitaria Juan N Corpas, Bogotá, Colombia.Fundación Universitaria Juan N Corpas, Bogotá, Colombia.ColombiaColombiaFundación Universitaria Juan N Corpas, Bogotá, Colombia.

http://orcid.org/0000-0003-3158-9017

Corresponding author: Anderson Reis de Sousa Rua Basílio da Gama, 241, Canela CEP 40110-040 - Salvador, BA, Brazil son.reis@hotmail.com

SCIMAGO INSTITUTIONS RANKINGS

Faculdade Pitágoras de Eunápolis, Eunápolis, BA, Brazil.Faculdade Pitágoras de Eunápolis, Eunápolis, BA, Brazil.BrazilBrazilFaculdade Pitágoras de Eunápolis, Eunápolis, BA, Brazil.

Fundación Universitaria Juan N Corpas, Bogotá, Colombia.Fundación Universitaria Juan N Corpas, Bogotá, Colombia.ColombiaColombiaFundación Universitaria Juan N Corpas, Bogotá, Colombia.

Tables

Tables (4)

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Chart 1
Discourse of the Collective Subject of nurses working in Family Health Strategy on the ineffectiveness of governmental actions, Bahia, Brazil, 2020.

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Chart 2
Discourse of the Collective Subject of nurses working in Family Health Strategy on the weaknesses in municipal management, Bahia, Brazil, 2020.

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Chart 3
Discourse of the Collective Subject of nurses working in Family Health Strategy on the underfunding for the implementation of PNAISH, Bahia, Brazil, 2020.

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Chart 4
Discourse of the Collective Subject of nurses working in Family Health Strategy on the discontinuity of actions for the implementation of PNAISH, Bahia, Brazil, 2020.

Chart 1 Discourse of the Collective Subject of nurses working in Family Health Strategy on the ineffectiveness of governmental actions, Bahia, Brazil, 2020.

Key expressions: [...] Access of men... strategy to attract patients... there is no manual... [...]	Men’s health policy is positive because it seeks to address the problems that specifically affect the male population, as a proposal for health promotion and disease prevention. However, its strategies need to be improved in order to facilitate the access of men to the services offered in health center, but this has still not happened. There is no incentive from the government for health professionals to develop strategies for attracting men, nor an instrument for the development of consultations and specific promotion actions for the male audience. There is an absence of Ministry of Health manuals that provide specific guidelines, and the dissemination of the policy is still weak or almost nonexistent. There is a lack of commitment of the federal government to prioritize and strengthen the presence of men in the services before they become ill (DCS, nurses who work on the FHS).
Central ideas: [...] strengthening actions... dissemination is very weak... something that guides us [...].
Anchorage: [...] the federal government also needs to be committed [...].

Source: Research data.

Chart 2 Discourse of the Collective Subject of nurses working in Family Health Strategy on the weaknesses in municipal management, Bahia, Brazil, 2020.

Key expressions: [...] they only order.... implement... request [...].	I work directly in care at the health center, I know the needs of the population and the demands of the area, but the managers who are at the top, whether municipal, such as the health secretary, or coordinators, only send the assignments to be fulfilled, implemented and then charge us, but do not ensure that the actions take effect. They do not provide the necessary support to be successful in the actions, nor do they follow up on how they can be implemented. In addition, they are not concerned with working together with the health team to promote this policy and observe the needs of men up close, which could improve access and assistance. I do not have an adequate structure to develop the policy actions, such as educational actions, locomotion, with the provision of transportation for the team to go to the coverage area in the community, so I have to use my own vehicle, and expose myself to dangers, due to the risk areas in my territory (DCS, nurses who work in FHS).
Central ideas: [...] assignments to be fulfilled... do not ensure that they are carried out... do not provide the necessary support [...].
Anchorage: [...] I don’t have an adequate structure to develop the policy’s actions [...].

Source: Research data.

Chart 3 Discourse of the Collective Subject of nurses working in Family Health Strategy on the underfunding for the implementation of PNAISH, Bahia, Brazil, 2020.

Key expressions: [...] financial resources... transportation... investment... campaigns [...].	The government needs to invest financial resources to attract men to the health center. It is the manager’s responsibility to demand these resources, because, as a nurse, it is not my competence. There is a lack of resources to carry out health education actions and disseminate services and health campaigns on social networks and radio programs. Without these benefits, the development of constant actions on health care awareness becomes difficult (DCS, nurses who work on FHS).
Central ideas: [...] lack of resources [...].
Anchorage: [...] as a nurse, it is not my competence... without these benefits in this center [...].

Source: Research data.

Chart 4 Discourse of the Collective Subject of nurses working in Family Health Strategy on the discontinuity of actions for the implementation of PNAISH, Bahia, Brazil, 2020.

Key expressions: [...] negative... no priority is given [...].	Health policies are implemented, but depending on the target audience, the government does not give them the same priority, which becomes negative, as actions lose continuity and are forgotten. This is a reality that I observe for PNAISH. The actions must not only be implemented, but government officials and managers must press for the policy to be continued. They must actually participate and follow up, provide the necessary support, because if this does not happen, how will the policy work? Only in the Blue November campaign that the government provides everything, such as exams, screening, places for medical appointments, referral to specialized centers and adequate support to the demands, but on other days men need to schedule, wait for medical regulation to make a referral in case there is a bigger problem like the identification of a cancer and it all takes a long time. Actions need to happen all year round, not just in a month (DCS, nurses who work on FHS).
Central ideas: [...] in blue November, the government provides everything [...]. [...] actions need to happen all year round [...].
Anchorage: [...] losing continuity... being forgotten [...].

Source: Research data.

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Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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Implementation of the National Policy for Comprehensive Attention to Men’s Health: challenges experienced by nurses

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[1] Corresponding author: Anderson Reis de Sousa Rua Basílio da Gama, 241, Canela CEP 40110-040 - Salvador, BA, Brazil son.reis@hotmail.com