Sueli Gandolfi Dallari

O direito à saúde

No fim do seculo XX a simples declaracao de direitos nao satisfaz ao povo. Busca-se delimita-los determinando seu conteudo, para se construirem estruturas que possam garantir o direito declarado. Nessa linha analisou-se a conceituacao de saude e de direito a saude para procurar na organizacao do Brasil, Estado federal e capitalista, meios para garantir o direito a saude. A municipalizacao das acoes de saude somada a necessidade de aprovacao legislativa do Plano de Saude e a organizacao judiciaria local foram considerados elementos importantes para a efetivacao do direito a saude.

The need for adequate ethical guidelines for qualitative health research

This paper discusses adequacy as to the application of Brazilian guidelines, Resolution 196/96(1) and complementaries to qualitative health researches, considering that these are based on non-positivistic paradigms. Frequently, decisions about the research are made together with the studied community. There is a concern with justice and social change. And, since subjectivity can be considered their privileged instrument, such researchers seek a balance between objectivity and subjectivity, discussing how to overcome the researchers view. We have studied the application and the concept of research found in international and in the Brazilian guidelines. We have noticed that they adopt a positivist conception of research, which establishes 1) the hypothesis test, 2) that all procedures are previously defined by the researcher; 3) neutrality of the researcher and of the knowledge produced. We will present some characteristics of qualitative research; the ethical implications in the way as qualitative research is conceived in non-positivist paradigms and a brief history of these guidelines. Our conclusion: it is inadequate to analyze qualitative researches using these documents, and we suggest the design of specific guidelines for them.

Tempo de mudanças: sobrevivência de um hospital público

The Brazilian health organizations have been forced to increase its efficiency and effectiveness. Changes in hospitals are observed in ways of financing and remuneration, due to the introduction of new regulation agents. The aim of this study was to know how this reforming environment, with budgetary restrictions and new game rules, was inductive of institutional adaptations in a public university hospital. A case study was carried out within the Hospital of Federal University of Minas Gerais (HC/UFMG) in order to analyze the behavior of selected production indicators for the period between 1994 and 2000. To understand how the workers and the management perceived the changes, partially structured interviews with the directive body as well as focal groups with the workers were conducted. Findings showed that in order to find a path for survival in an unstable and turbulent environment, the HC/UFMG implemented organizational strategies for adaptation, increased production and search for new supportive partners.

O princípio da precaução: dever do Estado ou protecionismo disfarçado?

The inclusion of public health as an agenda item within grass-roots movements, especially the anti-globalization movement, coincides with an impasse in continued liberalization of world trade, due to a lack of consensus between nations with regard to agricultural issues. The precautionary principle emerges within this complex equation as an obstacle to free trade, or as an attempt to mask the protectionist tendencies of developing nations.

Health advocacy in contemporary Brazil

The concept of health advocacy is presented by means of a description of its elements, practice and agents. The need to formulate this concept derives from one of the main functions of the university: the identification of social demands and the presentation of alternatives that aim at eliminating obstacles to their fulfillment. Social participation, as guaranteed by the 1988 Constitution, understood as an opportunity for the development of mechanisms for the construction of citizenship, especially as related to the conquist of the right to health, is emphasized.

Atendimento médico de urgência na grande São Paulo

Analisa-se a situacao do atendimento as emergencias medicas na Regiao Metropolitana de Sao Paulo, durante o ano de 1999, examinando toda a legislacao pertinente, descrevendo o processo de atendimento observado em um Plantao Controlador Regional (PCR) e verificando a adequacao dos procedimentos adotados as normas que regem o setor e ao efetivo atendimento da demanda. Foram analisados documentos, realizadas entrevistas e observacao do funcionamento do sistema, com um pesquisador no PCR, ao mesmo tempo em que outros acompanhavam os chefes dos plantoes nos tres hospitais gerais. Descreve-se a historia oral da criacao do sistema e a rotina dos servicos, onde se verificou que faltavam plantonistas no PCR; que os medicos responsaveis pelos plantoes da emergencia, nao obedeciam a mesma rotina de procedimentos; que muitas pessoas - inclusive os medicos plantonistas - nao sabiam o que e o PCR; que muitas vezes a falta de transporte impediu a transferencia; que os Servicos de Arquivo Medico e de Estatisticas dos hospitais pesquisados sao desatualizados; que faltam recursos materiais e humanos. Apesar de a amostra nao permitir generalizacoes, constatou-se que faltam leitos para UTI Neonatal; que os motivos mais frequentes para a solicitacao de recursos foram: falta de leito, falta ou quebra de equipamento e falta de profissional; que as solicitacoes tiveram, na quase totalidade dos casos, uma primeira resposta negativa, cujos motivos mais frequentes eram a falta de vaga, o equipamento nao estar disponivel e a indisponibilidade de transporte; que a maioria dos casos chegou ao PCR depois de ter procurado solucionar seu problema por conta propria, alegando a demora no encontro da solucao como justificativa para esse comportamento. Com base na normatizacao do sistema e na analise de experiencias internacionais, sao feitas sugestoes para a eficaz implementacao de um sistema metropolitano de atendimento a emergencia medica na Grande Sao Paulo.

O papel do município no desenvolvimento de políticas de saúde

A partir de uma analise das evidencias que constatam a predominância do interesse local pela saude nas diversas fases historicas de organizacao da vida social e, especialmente, da discussao sobre a eficacia dos direitos sociais declarados em algumas Constituicoes contemporâneas, procura-se definir a responsabilidade pela garantia do Direito a Saude. A possibilidade de responsabilizacao pela garantia dos direitos sociais decorre diretamente da definicao legal de tais direitos, exequivel na esfera local de governo. Examinando-se a estrutura constitucional brasileira para garantia da saude como direito de todos, conclui-se que a promocao dessa responsabilidade e facilitada pela enumeracao das competencias municipais em materia de saude que sao, pormenorizadamente, discutidas.Analysing the evidences for local concern with health in the various historical phases of the organization of social life, especially relating to the discussion of the efficacy of the social rights written into some contemporary constitutions, the attempt is made to define the responsibility for the guarantee of the right to health. The possibility of defining the responsability for the guarantee of social rights arises directly from the legal definition of such rights, practicable at the level of local government. Thus, after a thorough examination of the Brazilian constitutional organization in search of the guarantee of health for all, it is concluded that the promotion of the said responsibility is greatly favored, since Municipal competence regarding issues related to health are listed and discussed there in detail.Analysing the evidences for local concern with health in the various historical phases of the organization of social life, especially relating to the discussion of the efficacy of the social rights written into some contemporary constitutions, the attempt is made to define the responsibility for the guarantee of the right to health. The possibility of defining the responsibility for the guarantee of social rights arises directly from the legal definition of such rights, practicable at the level of local government. Thus, after a thorough examination of the Brazilian constitutional organization in search of the guarantee of health for all, it is concluded that the promotion of the said responsibility is greatly favored, since Municipal competence regarding issues related to health are listed and discussed there in detail.

Controle social no SUS: discurso, ação e reação

This article seeks to describe and analyze the dynamics of social participation, from the standpoint of the social representations of the City Health Councillors of Belo Horizonte on the significance of social control. A methodological approach was used, backed by qualitative research techniques: semi-structured interviews and participant observation. Three years after the survey, documentary research was conducted to check for signs of institutional reaction seeking to minimize or even to overcome the difficulties reported. It was ascertained that the City Health Council political institution activated several mechanisms to improve their techniques of action and organization and also the commitment of stakeholders to this forum.

Questões atuais sobre a vigilância sanitária das concentrações de flúor em alimentos

This study analyzed the position of the Federal (Brazil), State (São Paulo), and municipal (Bauru, São Paulo) governments, civil society representatives, the regulated sector, and research associations concerning issues with fluoride content in foods. Analysis of the interviews (N = 15) used a qualitative methodology (collective subject discourse theory). Various central ideas were identified, including the need for stronger health surveillance in monitoring and controlling fluoride levels, educational measures, and more research in the area. The study concludes that the health surveillance approach to fluoride levels in foods is necessary, but still incipient. There is a mismatch between research output and surveillance. Regulation alone does not suffice to solve all the issues. Health risk communication and health education measures need to be implemented. Issues with fluoride on food labels need further research for the intervention to be effective.

Public Health Advocacy on Behalf of Women in São Paulo: Learning to Participate in the Planning Process

In 1988, a new Constitution was adopted in Brazil in which guidelines for community participation in the development and implementation of the national health system were delineated. The health and welfare of women and children were given priority. Implementation of these guidelines presents a major challenge in a city such as São Paulo with a population of 15 million, of which an estimated 5.8 million are women of childbearing age. In order to determine the extent to which community organizations are actively participating in planning health services for women and children in São Paulo, a study was undertaken to examine the experience of community and professional organizations in public health advocacy. This paper describes a sample of these organizations, their constituents, membership, history, funding, advocacy objectives, and strategies used and results obtained. The information gathered indicates that the community organizations are involved in activities that include major efforts to improve access to health care by providing specialized courses in womens health, including the status of womens work, sexuality, discrimination, family planning, and the politics of health; publishing newsletters; producing radio programs; engaging in legal action; and using petitions, demonstrations, and public meetings to garner public support on specific issues.