Ronice Franco de Sá

Planos locais de promoção da saúde: intersetorialidade(s) construída(s) no território

The article highlights the importance of considering the specificities of spaces/territories/ locations of individual and collective life in creating health promotion actions. It explores how this approach has conceptually consolidated respect for territoriality and territorial actions as a principle and an operational health promotion strategy. Based on the literature, the article also points to the need to envision the territory occupied as a locus to put intersetorialities into practice, giving a voice to people who live there, seek to and solve their complex problems, to existing and emerging social networks. It also presents a nationally and internationally validated strategy/method (Bamboo Method) for the development of local health promotion plans, which enables the prioritization of actions by listening to the people and to the managers.

A tool for exploring the dynamics of innovative interventions for public health: the critical event card.

ObjectivesPublic health interventions are increasingly represented as complex systems. Research tools for capturing the dynamic of interventions processes, however, are practically non-existent. This paper describes the development and proof of concept process of an analytical tool, the critical event card (CEC), which supports the representation and analysis of complex interventions’ evolution, based on critical events.MethodsDrawing on the actor-network theory (ANT), we developed and field-tested the tool using three innovative health interventions in northeastern Brazil. Interventions were aimed to promote health equity through intersectoral approaches; were engaged in participatory evaluation and linked to professional training programs. The CEC developing involve practitioners and researchers from projects. Proof of concept was based on document analysis, face-to-face interviews and focus groups.ResultsAnalytical categories from CEC allow identifying and describing critical events as milestones in the evolution of complex interventions. Categories are (1) event description; (2) actants (human and non-human) involved; (3) interactions between actants; (4) mediations performed; (5) actions performed; (6) inscriptions produced; and (7) consequences for interventions.ConclusionsThe CEC provides a tool to analyze and represent intersectoral internvetions’ complex and dynamic evolution.

La construction du réseau de villes en santé de Pernambouc au Brésil : un exemple de mise à l’échelle

L’intervention initiale cherchait à améliorer la qualité de vie de la population locale de cinq villes de l’État de Pernambouc. Le projet a réussi à obtenir des données probantes et à les utiliser comme source pour la formation et pour la réflexion sur la pratique dans les communautés participantes. De plus, grâce à la reconnaissance de partenaires externes, d’autres États du Brésil, du Japon et du Canada et grâce aussi à une stimulation venue de la part du gouvernement qui voulait obtenir ces données avant de s’engager dans la diffusion de l’expérience, un réseau comprenant maintenant 21 villes en santé a été créé.

Mapeando iniciativas territoriais saudáveis, suas características e evidências de efetividade

This paper is part of an excerpt from a study made in eight of the States of the Northeast of Brazil. Its purpose was to map initiatives taken by health organizations of cities, municipalities and communities; to become aware of their mechanisms of operation; and to acquire evidence of their effectiveness, and the characteristics of their key players. Information was collected by internet, telephone, and contact with government and non-government bodies of these Northeastern states. After this collection of data at distance, local visits were made to find out more about each initiative. During the visit a timeline of the activity was recorded, working with local participants. After recording of key information sources, semi-structured interviews were held, and documents analyzed. Under the name of ‘healthy municipality, city or community’, specific initiatives were highlighted in the State of Pernambuco, part of a network that has existed since 2006 and which has been maintained in spite of political and/or administrative changes at both local and State level. Key factors indicated for the effectiveness of the actions in the 23 municipalities were: support of the university; strong engagement of local leaderships; and participation of social movements.

Healthy Municipalities, Cities and Communities in Latin America: Strong Histories, Committed Futures

In this chapter we provide a brief overview of the historical context of democratization and urbanization in the 1980s that supported the growth of health promotion, community development and the Healthy Municipalities, Cities and Communities Movement throughout the Latin American Region. This region contains immense cultural, geographic, linguistic and political diversity. Within this diversity, dynamic and vibrant networks of healthy municipalities, cities and communities (HMC) have emerged. The chapter outlines the major milestones of HMC development over the last three-and-a-half decades and highlights case studies that showcase the range of initiatives, as well as their achievements and challenges. Over this period, many tools have been developed to support countries in their efforts; a sampling of these has been summarized with links to the tools themselves. The chapter concludes with a brief analysis and some reflections on future prospects for the HMC movement in Latin America.

Sustentabilidade de um programa de alimentação escolar bem-sucedido: estudo de caso no Nordeste do Brasil

The Brazilian School Food Program (PNAE) is intersectoral innature. It encourages social participation and local economies and is considered here as a health promotionpractice. In the Northeastern State of Pernambuco, the city of Tabira acquired international renownin 2012 for the management of its school food program (PAE). This study analyzed the positive and negative factors related to the sustainability of the innovations in Tabira to understand the processes related to the continuity of the innovative actions implemented. The research used a qualitative approach with a case study strategy. A focus group, semi-structured interviews with key actors and document analysis were performed. The data were processed using content analysis and the techniques of thematic analysis. Positive organizational and socio-political factors were: the program institutionalization, the efficient use of financial resources, municipalized management, high community participation and the use of local resources. Negative factors were: weak inter-sectoral coordination and training and poor professional qualification. The strong political engagement at the local level showed both positive and negative impacts on sustainability.The Brazilian School Food Program (PNAE) is intersectoral innature. It encourages social participation and local economies and is considered here as a health promotionpractice. In the Northeastern State of Pernambuco, the city of Tabira acquired international renownin 2012 for the management of its school food program (PAE). This study analyzed the positive and negative factors related to the sustainability of the innovations in Tabira to understand the processes related to the continuity of the innovative actions implemented. The research used a qualitative approach with a case study strategy. A focus group, semi-structured interviews with key actors and document analysis were performed. The data were processed using content analysis and the techniques of thematic analysis. Positive organizational and socio-political factors were: the program institutionalization, the efficient use of financial resources, municipalized management, high community participation and the use of local resources. Negative factors were: weak inter-sectoral coordination and training and poor professional qualification. The strong political engagement at the local level showed both positive and negative impacts on sustainability.

INTERPRETANDO AS RELAÇÕES DE PODER NO PÓS-AUDITORIA DO SUS À LUZ DOS CONCEITOS DA ANÁLISE ESTRATÉGIA DE CROZIER E FRIEDBERG

The purpose of this article is to present a study about games power structure involved in the post-audit process of the SUS and, for that, it was proposed to identify the unfolding of the healthcare audits performed by the Municipal Audit Component of the SUS of Recife, in 2015, the Hierarchical structure, behavioral regularities and the rationalities that govern the behaviors of the main actors involved, based on the concepts of strategic analysis by Crozier and Friedberg (1990). It was developed from the qualitative approach, using interviews, which were submitted to the Discourse Analysis technique. It can be identified that the execution of the audit recommendations is directly related to the areas of autonomy and uncertainty of the managers of the health units, and the audit is effective when the manager of the unit has freedom of action in the area where the recommendation was made.

Sairé Mais Saudável: política intersetorial como marco de mudança para equidade local

Public health studies see intersectoriality as a strategy to promote equity in addressing the social determinants of health. The municipality of Sairé, a member of the Healthy Pernambuco Municipalities Network (RPMS), stands out for its adoption of an intersectorial policy, named A Healthier Sairé. This present study examines how this policy has promoted local equity. It was a case study using a timeline to record critical events, analysis of documents, interviews and participant observation. Actor-Network Theory (ANT) was used as a theoretical reference, and showed how adoption of the municipal policy had been central in promoting local empowerment and equity. The results, based on the timeline, demonstrate that initially it was necessary to obtain a cognitive translation, conducted through the direct influence and responsibility of the RPMS, which facilitated a second, strategic translation, with the construction of a policy anchored on the municipal program - which is currently being translated logistically into concrete actions directed towards equity. Key factors in this process for promoting local equity were: the role of strategic leadership; the value given to training; and the retention and use of structures that had previously been built.Resumo Estudos na area da saude publica consideram a intersetorialidade uma estrategia de promocao de equidade no enfrentamento dos determinantes sociais da saude. O municipio de Saire, membro da Rede Pernambucana de Municipios Saudaveis (RPMS), se destaca pela adocao de uma politica intersetorial denominada Saire Mais Saudavel. Este estudo visou conhecer como essa politica impulsionou a equidade local. Foi realizado um estudo de caso que utilizou linha do tempo com registro de eventos criticos, analise documental, entrevistas e observacao participante. Como referencia teorica, utilizou-se a Teoria Ator -Rede, o que permitiu que fosse evidenciada a importância da adocao da politica municipal para o empoderamento e equidade local. Os resultados, alicercados na linha do tempo, demonstraram que foi necessario haver inicialmente uma traducao cognitiva, realizada mediante a influencia e a responsabilidade direta da RPMS, a qual facilitou uma segunda traducao, desta vez estrategica, com a construcao da politica ancorada no programa municipal e que agora esta sendo traduzida logisticamente em acoes concretas direcionadas a equidade. O papel de uma lideranca estrategica, valorizacao da formacao e do que ja estava construido foram categorias fundamentais nesse processo de mudanca local.

Autores-atores e processos organizacionais e relacionais na revisão da Política Nacional de Promoção da Saúde

This article offers an organizational and relational analysis of the review of the National Health Promotion Policy and aims to understand the role of the cluster that was formed to review this policy, the negotiations needed to achieve the product, the role and type of alliances that were formed, the strategies adopted and interests, and how they influenced results. To do so, a dialogue is created to discuss social capital, organizational and network approaches, and inter-institutional strategies that highlight coordination mechanisms, integration, zones of uncertainty and the type of centralization. Structural, cognitive and relational dimensions were analyzed in the particular historical context. This was a case study with sources of evidence collected in the review process and in the documents examined. The analysis was performed by building conceptual categories by author-actors presented in the process. It highlights the role of the relational dimension represented by strong ties built over time, and ideological identity, based on profession or origin, as factors that acted positively in overcoming conflicts.This article offers an organizational and relational analysis of the review of the National Health Promotion Policy and aims to understand the role of the cluster that was formed to review this policy, the negotiations needed to achieve the product, the role and type of alliances that were formed, the strategies adopted and interests, and how they influenced results. To do so, a dialogue is created to discuss social capital, organizational and network approaches, and inter-institutional strategies that highlight coordination mechanisms, integration, zones of uncertainty and the type of centralization. Structural, cognitive and relational dimensions were analyzed in the particular historical context. This was a case study with sources of evidence collected in the review process and in the documents examined. The analysis was performed by building conceptual categories by author-actors presented in the process. It highlights the role of the relational dimension represented by strong ties built over time, and ideological identity, based on profession or origin, as factors that acted positively in overcoming conflicts.

Violencia doméstica y el papel del dentista desde la perspectiva de salud pública: una revisión de literatura científica

This study systematically reviewed the systematic production about domestic violence, based on the professional practice of the dentist in a multidisciplinary and interdisciplinary context, from the perspective of public health. The goal was to verify how this issue has been addressed, identify which is the most explored focus, and point out possible gaps. The search was conducted in the Virtual Health Library (BVS Brazil), by selecting 40 articles: 37 on Lilacs, 2 in BBO and only 1 in SciELO, from 2000 to 2011. Of the total scientific production analyzed, 20% references have cited the dentist along the paper, among these 50% pointed for the practice of the dentist in a multidisciplinary and interdisciplinary context, from the perspective of public health. The health professional role in a multidisciplinary and interdisciplinary context, from the perspective of public health corresponded to 72.5% studies. In this way, the need for studies on the performance of professional dentist in interdisciplinary and multidisciplinary team is necessary before the Brazilian context, being an open and wide field to be explored, from the perspective of public health.