Maria Inês Carsalade Martins

Saúde da família: limites e possibilidades para uma abordagem integral de atenção primária à saúde no Brasil

The article analyzes the implementation of the Family Health Strategy (FH) and discusses its potential to guide the organization of the Unified Health System in Brazil, based on the integration of FH to the health care network and intersectorial action, crucial aspects of a comprehensive primary health care. Four case studies were carried out in cities with high FH coverage (Aracaju, Belo Horizonte, Florianopolis e Vitoria), using as sources: semi-structured interviews with managers and surveys with health care professionals and registered families. The integration analysis highlighted the position of FH Strategy in the health services network, the integration mechanisms and the availability of information for continuity of care. Intersectoriality was researched in relation to the fields of action, scope, sectors involved, presence of forums, and team initiatives. The results point to advances in the integration of FH to the health care network, strengthening basic services as services that are regularly sought and used as a preferential first contact services, although there are still problems in the access to specialized care. The intersectorial initiatives were broader when defined as integrated municipal government policy for the construction of interfaces and cooperation between the diverse sectors.

Desafios para gestão do trabalho a partir de experiências exitosas de expansão da Estratégia de Saúde da Família

This article discusses the management of the work in Family Health Strategy in four major urban centers. The research includes perspectives from different actors who compose and integrate the network of working relationships in Public Health System through questionnaires with employees of professional categories family health team and interviews with managers and representatives of professional bodies. It is a qualitative-quantitative evaluation study. The dimensions analysed were: insertion and remuneration policies, strategies and qualification of employees. The insertion and remuneration policy highlights the replacement of outsourced frames and hiring by public tender that allows links labor more stable. Other strategies are the establishment of allowance for expertise in areas of greater social vulnerability and the assimilation of specialists in Family and Community Medicine with other experts engaged in secondary services. The political will of municipal Manager to qualify the workforce of family health, maintaining the provision of adequate human resources needs of the health system is a fundamental factor for the consolidation of family health strategy in the face of the low degree of specialization of professionals to work in primary health care.

Productive restructuring and its impact on labor relations in the public health services in Brazil

The restructuring of productive systems and economic globalization are directly impacting the basic social rights of workers. In the semi-peripheral countries such as Brazil, where the wage-based society and the consolidation of social rights are not completely implemented, this process of change in the world of labor contributes to aggravate the inequality in the capital-labor relationship and hampers access to employment. By means of a critical review of the scientific literature regarding changes in the world of labor and its impact on the organization and production of health services in Brazil, this article pinpoints the weakness of regulation of the labor market in Brazil, especially in the health sector. It also stresses the need to increase the debate on new forms of institutionalization of the labor relationship in order to ensure equity in the workplace and protect the rights to work and in the workplace.

Reestruturação produtiva e seu impacto nas relações de trabalho nos serviços públicos de saúde no Brasil

A reestruturacao dos sistemas produtivos e a globalizacao economica vem interferindo diretamente sobre os direitos sociais basicos dos trabalhadores. Em paises semiperifericos como o Brasil, onde a sociedade salarial e a consolidacao dos direitos sociais nao se implantaram de fato, este processo de mudanca, nas formas e relacoes de trabalho, assume caracteristicas particulares, acentuando-se a desigualdade na relacao capital-trabalho e dificultando o acesso ao emprego. Atraves de uma revisao critica da producao cientifica sobre as mudancas no mundo do trabalho e seu impacto na organizacao e producao dos servicos de saude no Brasil este artigo procurou mostrar a fragilidade da regulacao do mercado de trabalho no Brasil, principalmente na area da saude. Aponta a necessidade de ampliar a reflexao sobre novas formas de institucionalizacao das relacoes de trabalho, no sentido de garantir a equidade e o direito ao e no trabalho.

Práticas assistenciais das Equipes de Saúde da Família em quatro grandes centros urbanos

This paper examines reports on how care is administered by Family Health Teams (FHT) doctors and nurses in four state capitals. It identifies issues relating to priority actions, routine activities and the association between the professional profile and how selected activities are performed, in an attempt to ascertain how far these approximate to the comprehensive approach to primary health care. The cross-section reflects results from data collected via self-applied questionnaires. Cross-analyses were made using the Pearson chi-square (÷2) test for categorical variables. A and B variables are, or are not, associated, at a 5% level of significance. The analyses point to a tendency to strike a balance in meeting programmed and spontaneous demand, corroborating the person-centered approach. Action to address chronic infectious disorders is not a priority for all FHTs, which impairs health surveillance actions and comprehensive care. Home visits are not yet a weekly activity for all personnel. Lack of involvement in community activities restricts care to conventional practices and undermines the logic of change of model. Contradictions identified between training and practice indicate a need to review policies for ongoing professional development.

A transição tecnológica na saúde: desafios para a gestão do trabalho

This article is part of an empirical study about changes in health work due to the introduction of new technologies. The study uses an interdisciplinary approach and the theoretical referential orienting the research has as bases the concepts of productive restructuring, competency and subjectivity. Focusing on the organization of the services and on the demands for further qualifications for secondary level workers, the research analyses the relation human being-work from the perspective of technological changes, work competences, autonomy, communication and language. The results indicate some trends in the health work process that point to the technologizing of care, to teamwork, and to the need for professional development and for a restructuring of the work in this area. Among the challenges that need to be faced, we emphasize the valorization of both work and worker, the incorporation of the concept of competency, the recognition of subjective relationships and the communication process.

Articulando ensino e pesquisa: construindo uma proposta de capacitação para docentes do ensino técnico

Based on the experience of a teacher training program entitled Program for Continuing Education of Polytechnic Faculty (PAETEC) developed by the Escola Politécnica de Saúde Joaquim Vemâncio (EPSJV/FIOCRUZ), this article is intended to contribute to the discussion of alternatives for continuing vocational teacher education programs. In the search for new on-the-job teacher training models fostering interaction between the educational process and research activity, the experience employs a strategy based on the construction of an integrated methodology allowing teachers to reflect on their own practices and turn them into the object of their research.

Precarious employment, precarious work, outsourcing, inequity, and risks from the workers’ health perspective: a dialogue with the authors

The articles by Carles Muntaner and Graça Druck focus the debate on the flexibilization of labor relations since the 1980s and its direct impact on workers’ health. As Muntaner emphasizes, the discussion on flexibility resumes the historical line of labor exploitation in capitalism, which has always been characterized by clear inequality in its different stages and contexts. The changes that occurred in the timeline of capitalism in the post-War period (1950 to 1970) expanded the public regulation of labor, conferring a leading role to public representative and regulatory institutions, thereby contributing to a decrease in the historical capital-labor asymmetry. In the 1970s, new forms of economic organization, combined with technological development and with a direct impact on the organization of production, gained space, resuming the process of flexibilization of labor from the perspective of inequity. The 1980s were marked by a decrease in the state’s participation in the regulatory process, changes in social protection policies, and flexibilization of existing rights. This new scenario reveals a change in the relationship between state and society, marked by a decrease in public regulation, with negative social consequences. However, the impact and consequences of these changes have differed according to each country’s greater or lesser public regulation and degree of institutionality of social policies and democratic mechanisms. As Muntaner highlights, “what is considered precarious in Norway may not be seen as precarious in Colombia”. In semi-peripheral countries like Brazil that have still not achieved a wage-earning society and consolidation of social rights in practice, this process of change in labor formats and relations takes on particular characteristics, accentuating the inequality in the capital-labor relationship and hindering access to (and quality of) employment 1. Maria Inês Carsalade Martins

Comentario sobre los artículos de Carles Muntaner y Graça Druck

The articles by Carles Muntaner and Graça Druck focus the debate on the flexibilization of labor relations since the 1980s and its direct impact on workers’ health. As Muntaner emphasizes, the discussion on flexibility resumes the historical line of labor exploitation in capitalism, which has always been characterized by clear inequality in its different stages and contexts. The changes that occurred in the timeline of capitalism in the post-War period (1950 to 1970) expanded the public regulation of labor, conferring a leading role to public representative and regulatory institutions, thereby contributing to a decrease in the historical capital-labor asymmetry. In the 1970s, new forms of economic organization, combined with technological development and with a direct impact on the organization of production, gained space, resuming the process of flexibilization of labor from the perspective of inequity. The 1980s were marked by a decrease in the state’s participation in the regulatory process, changes in social protection policies, and flexibilization of existing rights. This new scenario reveals a change in the relationship between state and society, marked by a decrease in public regulation, with negative social consequences. However, the impact and consequences of these changes have differed according to each country’s greater or lesser public regulation and degree of institutionality of social policies and democratic mechanisms. As Muntaner highlights, “what is considered precarious in Norway may not be seen as precarious in Colombia”. In semi-peripheral countries like Brazil that have still not achieved a wage-earning society and consolidation of social rights in practice, this process of change in labor formats and relations takes on particular characteristics, accentuating the inequality in the capital-labor relationship and hindering access to (and quality of) employment 1. Maria Inês Carsalade Martins

Comment on the papers by Carles Muntaner and Graça Druck

The articles by Carles Muntaner and Graça Druck focus the debate on the flexibilization of labor relations since the 1980s and its direct impact on workers’ health. As Muntaner emphasizes, the discussion on flexibility resumes the historical line of labor exploitation in capitalism, which has always been characterized by clear inequality in its different stages and contexts. The changes that occurred in the timeline of capitalism in the post-War period (1950 to 1970) expanded the public regulation of labor, conferring a leading role to public representative and regulatory institutions, thereby contributing to a decrease in the historical capital-labor asymmetry. In the 1970s, new forms of economic organization, combined with technological development and with a direct impact on the organization of production, gained space, resuming the process of flexibilization of labor from the perspective of inequity. The 1980s were marked by a decrease in the state’s participation in the regulatory process, changes in social protection policies, and flexibilization of existing rights. This new scenario reveals a change in the relationship between state and society, marked by a decrease in public regulation, with negative social consequences. However, the impact and consequences of these changes have differed according to each country’s greater or lesser public regulation and degree of institutionality of social policies and democratic mechanisms. As Muntaner highlights, “what is considered precarious in Norway may not be seen as precarious in Colombia”. In semi-peripheral countries like Brazil that have still not achieved a wage-earning society and consolidation of social rights in practice, this process of change in labor formats and relations takes on particular characteristics, accentuating the inequality in the capital-labor relationship and hindering access to (and quality of) employment 1. Maria Inês Carsalade Martins