Access to and use of the services of the family health strategy from the perspective of managers, professionals and users/ Acesso e utilizacao dos servicos na Estrategia Saude da Familia na perspectiva dos gestores, profissionais e usuarios

Questionnaires adapted to the Brazilian reality (Primary Care Assessment Tool) to evaluate access to and use of services were distributed to 30 managers, 80 professionals and a random sample of 882 Family Health Strategy (FHS) users in Sao Luis in the state of Maranhao. The differences between the evaluations of managers, professionals and users were identified by the Kruskal-Wallis test and Dunn's post test. Users faced difficulties in access to and use of the services, which were also considered unsatisfactory by managers and professionals. Access was the dimension with the worst evaluation, and non-functioning of units after 6 p.m. and at weekends were the main difficulties. The evaluations of the managers and professionals were almost always divergent from those of the users, with the evaluation of the managers being more favorable. The fact that the service was free of charge, the use of preventive services and the FHS services before the specialized care were well evaluated. The operation of units should attend users' needs, especially that of the working population. Strengthening social participation in local management of the FHS may assist in identifying these needs, thereby reducing the divergent opinions of the players involved. Key words Family health program, Primary care, Health evaluation Utilizaram-se questionarios adaptados a realidade brasileira (PCATool) para avaliar acesso e utilizacao dos servicos, aplicados a 30 gestores, 80 profissionais e amostra aleatoria de 882 usuarios da Estrategia Saude da Familia (ESF) em Sao Luis. Diferencas entre as avaliacoes dos 3 tipos de entrevistados foram identificadas pelo teste de Kruskall-Wallis e pos-teste de Dunn. Usuarios tiveram dificuldades no acesso e na utilizacao dos servicos, tambem considerados insatisfatorios pelos gestores e profissionais. O acesso foi a dimensao pior avaliada e o nao funcionamento das unidades apos as 18 horas e finais de semana foram suas principais dificuldades. A avaliacao dos gestores e profissionais quase sempre divergiu com a dos usuarios, sendo a avaliacao dos gestores predominantemente mais favoravel. Gratuidade, utilizacao de servicos preventivos e da ESF antes das consultas especializadas foram bem avaliadas. O funcionamento das unidades precisa se adequar as necessidades dos usuarios, principalmente dos trabalhadores. Fortalecer a participacao social na gestao local da ESF pode ajudar a identificar essas necessidades, dirimindo divergencias entre os atores es