The Family Health Strategy focused on access equity and targeted at the homeless population living in large urban centers

Abstract

This article reports the experience concerning the implementation of a health care program addressed to homeless people in the city of São Paulo, aiming at equity in the access to governmental health services. These individuals' difficulties in using the health services are due to their misconceptions about illness and care, health teams' and users' preconceptions, services' technical-administrative organization, and fragile intersector actions, among others. Additionally, this population is highly vulnerable to some health disorders, as shown by the high rates of alcoholism, tuberculosis and even pregnancy. Innovative actions as well as adequate health strategies addressing a real improvement in the access should be considered as essential. In this sense, the Family Health Strategy is a useful tool of the primary health care services. Since 2004, a Project named "A Gente na Rua", which resulted from a partnership between the Municipal Health Department of São Paulo and philanthropic institutions, has been implemented, with the action of community health agent teams. It is concluded that, in the city of São Paulo, the adoption of this health policy targeted at the homeless has promoted better access to primary health care services. Moreover, it has created a more focused approach to this population. Despite the success of this strategy, we should take into account that remaining challenges have to be tackled in future projects, such as the need of new strategies focusing on homeless people with mental disorders, as well as the guarantee of quality care characterized by comprehensiveness, longitudinality and coordination, among others.