Marcelo Rasga Moreira

Conselhos Municipais de Saúde do Brasil: um debate sobre a democratização da política de saúde nos vinte anos do SUS

Over 17 years, Health Councils were created in the 5,564 Brazilian towns, recruiting about 72,000 councilors. Authors affirm that the institutionalization of the Council is important for the democratization of municipal health policy, as it increases the actors who are participating in its decision-making process. However, they state that this is not enough to make this process fully democratized. This setting is investigated through a new census research about the functioning of the Municipal Health Councils. To understand it, we use three analytical dimensions (autonomy, organization and access) made up of 18 variable. The analysis of results shows that the MHCs have problems with autonomy and organization and good performance in access. Distribution by population size reveals that the best results are in the MHCs of towns with more than 250,000 inhabitants, and the worst are those in towns with a population below 50,000. The problems identified are reactions to the institutionalization of the MHCs. These reactions come from governors who consider the attributes and the deliberative character of the MHCs to be threatening to their interests. They occur due to their low cost, as the rules of the decision-making process do not discourage them. Here, we seek to understand reactions and rules, presenting proposals for overcoming problems.

A equipe multiprofissional da 'Saúde da Família': uma reflexão sobre o papel do fisioterapeuta

Este artigo pretende contribuir para o debate instituido sobre a composicao das equipes de Saude da Familia. Deve ser apreendido como uma reflexao sobre a possibilidade de integracao do fisioterapeuta nas equipes, na intencao de mostrar os aspectos da profissao que a tornam capaz de potencializar a resolutividade da atencao basica. No estudo, foram analisados os documentos legais que aprovam as normas para habilitacao ao exercicio da profissao de fisioterapeuta. Nos anos setenta e oitenta, acompanhando a reforma sanitaria brasileira, tais documentos oficializaram o processo que levou a fisioterapia, profissao historicamente reconhecida pela atuacao clinica, a mudar seu objeto de trabalho, aproximando o fisioterapeuta de praticas preventivas e de promocao da saude, tipicas do primeiro nivel do cuidado. Concluiu-se que tal mudanca abriu importante espaco de integracao ainda pouco trabalhado e propoe-se seu aprofundamento, direcionando a reflexao para as formas de integracao e a necessidade que se impoe aos gestores de planejar suas acoes de forma articulada com a comunidade, a partir da analise da situacao de saude no nivel local, garantindo a intervencao sobre problemas e grupos populacionais prioritarios.

A concretização de políticas públicas em direção à prevenção da violência estrutural

O presente artigo tem como objetivo demonstrar que a implementacao de um processo continuo e bem estruturado de avaliacao das politicas publicas pode significar uma importante estrategia de prevencao e combate a violencia estrutural. Neste sentido, o texto busca englobar como aspectos relevantes: a) a discussao do carater ideologico da concepcao do senso comum sobre a violencia; b) a conceituacao da violencia estrutural, distinguindo-a de outras manifestacoes de violencia e situando-a na realidade brasileira; c) a definicao da abrangencia e do papel das politicas publicas, ressaltando as responsabilidades politicas e sociais do Estado em seus diferentes niveis administrativos; d) a comprovacao de que a ineficacia ou precariedade das politicas publicas repercute de forma negativa nas condicoes de vida dos cidadaos, principalmente nas dos mais pobres, demonstrando a existencia de uma articulacao direta entre a avaliacao de politicas publicas e a prevencao da violencia estrutural, favorecendo a defesa e a melhoria de sua qualidade de vida.

Access to treatment for those with alcohol, crack or other drug dependency problems - a case study in the municipality of Rio de Janeiro, Brazil

Changes in psychiatric policies has meant more emphasis on the protection of the individuals rights, tougher regulations and disincentives regarding involuntary patient admissions, and the creation of a community network to support individuals needing help. The differing socioeconomic status of those requiring treatment coupled with guidelines issued by the Health Ministry has meant that more support and care is now being directed towards individuals and families. The rise in public awareness of the problems in these areas has aided in the changes that have taken place. Due to a lack of community public services, this has led to the proliferation of different types of services all with differing standards of care and has fueled the public debate surrounding involuntary patient admissions. Our analysis in relation to treatment for those with alcohol, crack and other drugs problems in the municipality of Rio de Janeiro, states that there are gaps related to access for all-day public services and a lack of psychiatrists in multi-disciplinary teams. There are many new and untried serviced offered by the private sector, religious bodies and public shelters which have arisen in the wake of the rise in people that need help. We took note of the development and progress of these new projects as well as the policy recommendations from the Government.

Relações entre representação e participação no Conselho Municipal de Saúde do Rio de Janeiro: segmento dos usuários, 2013-2014

O artigo analisa a influencia da “Configuracao Representativa” do Conselho Municipal de Saude do Rio de Janeiro na atuacao dos conselheiros dos usuarios. A Configuracao Representativa e definida como a combinacao de dois eixos de regras institucionais: o Eixo 1 e composto por regras de elegibilidade e participacao e o Eixo 2, por regras de representacao. A discussao teorica centrou-se nas relacoes entre Representacao e Participacao no contexto democratico contemporâneo, enfatizando os Conselhos Municipais de Saude. O metodo do estudo articulou Observacao Participante, Entrevistas e Analise Documental. Os resultados indicam que os representantes dos conselhos distritais atuam pautados pelo mandato de seus representados, pois firmam vinculos estreitos com tais instituicoes. Ja os conselheiros das entidades municipais tendem a ter autonomia em sua representacao, com relacoes mais tenues com suas entidades. A postura mandato dos representantes distritais associou-se a uma participacao mais expressiva nas reunioes e maior vocalizacao dos interesses de seus representados.

Obstáculos políticos à regionalização do SUS: percepções dos secretários municipais de Saúde com assento nas Comissões Intergestores Bipartites

Resumo O artigo tem como objetivo identificar e analisar os obstaculos politicos a implementacao do Contrato Organizativo da Acao Publica (COAP) a partir das percepcoes dos secretarios municipais de saude das Comissoes Intergestores Bipartites (CIB). Para isso, foram entrevistados, de outubro de 2015 a agosto de 2016, 195 secretarios (92% do total). A partir da abordagem da ‘analise de politicas’, os principais obstaculos identificados foram, em sintese: um obstaculo tradicional (a falta de recursos), um que vem ganhando forca nos ultimos anos (a judicializacao da politica) e outro, talvez inedito: o sistema politico-partidario e o Poder Executivo Estadual sao os grandes ausentes nas coalizoes de apoio as politicas de regionalizacao do Sistema Unico de Saude (SUS). Conclui-se que tais obstaculos indicam um cenario extremamente negativo para a implementacao do COAP e de outras politicas que busquem a regionalizacao do SUS. Diante disto, cabe aos envolvidos refletir, negociar, construir consenso em torno da melhoria da saude da populacao e superar tais obstaculos caso, logicamente, desposem da concepcao dos autores de que a regionalizacao e fundamental para o SUS.

A saúde do adolescente privado de liberdade: um olhar sobre políticas, legislações, normatizações e seus efeitos na atuação institucional

O objetivo do artigo e subsidiar o debate sobre os efeitos que o conjunto de pecas juridico-administrativas e politico-legislativas tem na atuacao institucional e na praxis dos gestores e profissionais dos sistemas socioeducativo e de saude. Levantaram-se e analisaram-se as leis, portarias, resolucoes, normas, textos academicos e institucionais que embasam e constituem a politica de saude voltada aos adolescentes infratores no Brasil. Ha assimetria entre as legislacoes e normatizacoes e a realidade das unidades socioeducativas, o que torna urgente superar as barreiras de preconceito e estigmatizacao via investimento em recursos humanos e parcerias governamentais interinstitucionais.

O COAP e a Regionalização do SUS: os diversos padrões de implementação nos estados brasileiros

This paper analyzes the implementation process of the Public Action Organizational Contract (Coap) and its impacts on state agendas of SUS regionalization, comparing the different institutional reactions of the states to the strategy proposed by Decree 7.508/11. The comparison of developing dynamics of state agendas took as reference a normative baseline structured in eight strategic political-institutional moments in the implementation of the Coap in accordance with the logic defined in Decree 7.508/11. We collected data through a questionnaire containing 35 questions (1 open, 25 closed and 9 mixed) and extensive documentary research in 2013 and 2014 in all states, except for the Federal District. Results showed that state agendas were distributed around three differentiated developing patterns: six states maintained greater distance from the national agenda established by Decree 7.508/11, engaging in a very fragmented way; 12 states engaged in the Coap agenda, selectively focusing on specific moments or stages, strengthening the process they have been developing; and 10 states maintained greater performance regularity during the eight moments of the Coap implementation cycle.

Políticas de saúde e lacunas federativas no Brasil: uma análise da capacidade regional de provisão de serviços

This paper analyzes Brazilian health regions according to their service delivery capacity from the debate on the crisis of cooperative federalism in the SUS that resulted from decentralizing process established in the 1988 Constitution. Service delivery capacity tracer indicators were selected by regions and statistical analyses evidenced greater regional capacity in hospital care and large asymmetries with regard to the availability of physicians, high complexity equipment and private insurance coverage. In conclusion,we argue that further solutions are required to strengthen governmental capacity to reduce regional inequalities throughincreased central coordination.

Inovação em ouvidorias do SUS – reflexões e potencialidades

This article seeks to reflect on the potential of innovative practices in the design and work of the government bodies that comprise the National System of Offices of the Ombudsman of the Unified Health System. It is divided into two parts, seeking to answer the following question: How to think of and implement innovative practices - which include sustainability - when the people are voicing their urgent demands and these are being heard by the public authorities? These grievances are all the more urgent as they involve the area of Health and can they be promptly discussed, attended and resolved? In the first part, the article discusses the polysemic concept of innovation, focusing on its application in the three spheres of public administration, and highlights the importance of its close correlation with the different notions of information and knowledge in a society such as the one we live in. In the second, it develops a task-force of ideas for the office of the ombudsman and based on this, a draft operational concept of innovation in the role of the office of the ombudsman, considering the context of high speed change and transformations and the complexity inherent to contemporary life and the need for resource management and expertise development in information management.This article seeks to reflect on the potential of innovative practices in the design and work of the government bodies that comprise the National System of Offices of the Ombudsman of the Unified Health System. It is divided into two parts, seeking to answer the following question: How to think of and implement innovative practices – which include sustainability – when the people are voicing their urgent demands and these are being heard by the public authorities? These grievances are all the more urgent as they involve the area of Health and can they be promptly discussed, attended and resolved? In the first part, the article discusses the polysemic concept of innovation, focusing on its application in the three spheres of public administration, and highlights the importance of its close correlation with the different notions of information and knowledge in a society such as the one we live in. In the second, it develops a task-force of ideas for the office of the ombudsman and based on this, a draft operational concept of innovation in the role of the office of the ombudsman, considering the context of high speed change and transformations and the complexity inherent to contemporary life and the need for resource management and expertise development in information management.