Sarah Escorel

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.

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.

Massa marginal na América Latina: mudanças na conceituação e enfrentamento da pobreza 40 anos após uma teoria

Approaches to, and expressions of, social issues as poverty involve discussing how social fractures connected with the process of capitalist restructuring are shaped and to be addressed in several dimensions (economic, political, cultural and social). This paper aims to review this debate 40 years after Jose Nuns marginality theory turned a fresh eye to Latin American poverty. It highlights singularities over that period in ways of looking at poverty as a social issue in Latin America and the approximation with French theorists of social exclusion. After the 1990s the debate is steered by the theoretical perspective of social exclusion, operationalised as a category capable of revealing the weakening and breakdown of social cohesion in terms of multiple levels and relational dimensions.

Reconhecer e superar os limites da participação institucionalizada

”. No entanto, desde entao nao foi possivel reproduzir suas principais caracteristicas: convergencia de propostas (em particular, com a retirada do setor privado e he-gemonia da esquerda nao radical ou reformista), a organizacao em torno de tres eixos estruturan-tes do direito, da organizacao e do financiamento da saude, numa conjuntura em que havia muitos estimulos para avancar no social, ou como se di -zia na ocasiao, pagar a divida social acumulada nos anos da ditadura civil-militar, produzindo um relatorio final lido e relido, citado e conheci-do, conciso e utilizado.O modelo de organizacao das conferencias apresenta “rachaduras” e as solucoes encon-tradas a cada nova realizacao revelaram-se ate o momento paliativas. Desse forum com mui-tas vozes e pouco dialogo resulta um relatorio de escassa serventia. Nao ha avaliacao do que foi deliberado em conferencias anteriores, nao sao discutidas prioridades nem as viabilidades tecnica, financeira e politica, nao ha analise da maneira como (nem quando) as resolucoes irao incidir nas condicoes de saude e de atencao a saude da populacao. A inclusao das multiplas proposicoes no relatorio final serve para legiti-mar demandas que depois precisam percorrer

Exclusão social fenômeno totalitário na democracia brasileira

O artigo distingue conceitualmente tres abordagens da tematica da democracia e o desenvolvimento de cada uma delas na sociedade brasileira: democracia como valor, como processo e como conteudo substantivo. Detendo-se nessa ultima abordagem, apresenta a categoria de exclusao social, construida e analisada por Hannah Arendt em Origens do totalitarismo, como elemento conceitual que permite refletir e compreender melhor a situacao de amplas parcelas da populacao brasileira. A analise permite identificar no Brasil a existencia de um processo com regras democraticas que convive com um conteudo substantivo totalitario, a exclusao social com violencia.