Tatiana Wargas de Faria Baptista

O modelo assistencial em saúde mental no Brasil: a trajetória da construção política de 1990 a 2004

This article analyzes the underlying conditions in the development of Brazils national policy for mental health care from 1990 to 2004, with the aim of identifying the priorities in each historical stage of the policy, based on a review and analysis of rulings and other official documents issued by the Ministry of Health during this period. Four stages in the mental health care policy are discussed, the seminal period, latency, resumption, and expansion, seeking to identify the principal policy guidelines and their correlations with the overall context of the Unified National Health System (SUS). Finally, the article provides an overview of the mental health care model developed under this policy, comparing it to the Basaglian theoretical and ideological framework, the reference adopted by the Brazilian psychiatric reform movement, and suggesting elements for reflection on the work of the National Division of Mental Health.

Políticas de saúde no Brasil nos anos 2000: a agenda federal de prioridades

This article analyzes Brazilian national health priorities from 2003 to 2008 under the Lula Administration. The study included a literature review, document analysis, and interviews with Federal health administrators. Four priorities were identified on the national health agenda: the Family Health Program, Smiling Brazil, Mobile Emergency Services, and the Popular Pharmacy Program. The first is a policy with high institutional density launched by the previous Administration, constituting an example of path dependence. The other three are innovations in areas where there had been weaknesses in Federal government action. The four policy priorities are strategies focused on solving key problems in the Brazilian health system. However, they display important differences in their historical development, political and institutional base, inclusion on the Federal agenda, and implications for the principles of the Unified National Health System. Although incremental changes have been introduced, national health policy has been characterized predominantly by continuity.

Sistema de saúde universal e território: desafios de uma política regional para a Amazônia Legal

This article presents the results of a study on Federal health policy in the Brazilian Legal Amazon (BLA) from 2003 to 2005, aimed at backing the development of regional health policies. The region has peculiar dynamics, an extensive border area, and adverse social indicators. The methodology included documental and financial analysis, participatory observation, interviews with heads of various Federal Ministries and State and Municipal health secretaries from the BLA; characterization of geographic situations in the BLA; and field studies in 15 municipalities. Institutional consolidation of health policy proved to be low in the Amazon during the study period, due to structural, institutional, and political difficulties. The identification of six geographic situations was useful for systematizing land use differences with repercussions on health, and which should be considered when implementing public policies. There is a certain gap between Federal actions and territorial dynamics, expressed as a mismatch between the current policy and its recognition by local administrators. In addition to establishing a regional policy for the Amazon, there is an evident need for differentiated policies within the region.

Saúde e territorialização na perspectiva do desenvolvimento

The relationship between health and development is complex and lies in the field of political economy, given that it involves different social, political, and economic interests. In the Brazilian case, this association is particularly relevant in terms of the territorial dimension, in light of the central role of healthcare services in the organization of the urban network and the demarcation of territorial schedules and limits. In the theoretical-conceptual field, this study explores analytical areas that approach the relations between health and development, as well as between health and the territorial issue; and analyzes the history of the decentralization and regionalization policy in the Unified National Health System (SUS) and Federal investments that constitute the basis for its spatial evolution. Based on this conceptual review and empirical data, the study attempts to establish theoretical and political-institutional connections between health and development. The aim is thus to support the discussion on challenges facing a new role for health in the Brazilian development model, historically marked by economic and social inequalities with strong territorial overtones.

O planejamento nacional da política de saúde no Brasil: estratégias e instrumentos nos anos 2000

This paper discusses the national planning of health policy between 2003 and 2010, in the light of the development of state planning in Brazil and Lulas administration. Firstly an historical overview is presented of the key moments for national planning, regarding its effects on health care. The governmental context is then described with a review of the strategies and instruments in health planning over recent years. The methodology involved a bibliographic and documental review - including the Multi-year Plans, the National Health Plan, the Health Pact and the More Health program - considering their intention, contents and development processes. The results indicate that national health planning has been condensed in order to enable better direction of the policy. Two key moments in federal health planning were identified: between 2003 and 2006 a managerial and participative line was followed; between 2007 and 2010, the managerial line was kept allied to an effort to tie health policy to the development model. Despite the advances, health planning has displayed limitations, such as: restrictions in health financing, which has compromised the execution of the plans; failure to tackle structural problems in the health care system; and the fragile territorial organization.This paper discusses the national planning of health policy between 2003 and 2010, in the light of the development of state planning in Brazil and Lulas administration. Firstly an historical overview is presented of the key moments for national planning, regarding its effects on health care. The governmental context is then described with a review of the strategies and instruments in health planning over recent years. The methodology involved a bibliographic and documental review - including the Multi-year Plans, the National Health Plan, the Health Pact and the More Health program - considering their intention, contents and development processes. The results indicate that national health planning has been condensed in order to enable better direction of the policy. Two key moments in federal health planning were identified: between 2003 and 2006 a managerial and participative line was followed; between 2007 and 2010, the managerial line was kept allied to an effort to tie health policy to the development model. Despite the advances, health planning has displayed limitations, such as: restrictions in health financing, which has compromised the execution of the plans; failure to tackle structural problems in the health care system; and the fragile territorial organization.O artigo enfoca o planejamento nacional da politica de saude de 2003 a 2010, a luz da trajetoria do planejamento estatal no Brasil e do contexto do Governo Lula. Inicialmente, e tracado um historico dos momentos relevantes para o planejamento nacional, considerando suas interfaces com a saude. A seguir, situa-se o contexto governamental e discutem-se as estrategias e instrumentos de planejamento em saude recentes. A metodologia envolveu revisao bibliografica e analise de documentos - os planos plurianuais, o Plano Nacional de Saude, o Pacto pela Saude e o Mais Saude - considerando o seu proposito, conteudo e processo de elaboracao. Os resultados sugerem um adensamento do planejamento nacional em saude, visando dar direcionalidade a politica. Foram identificados dois momentos no planejamento federal em saude: entre 2003 e 2006, predominou uma orientacao participativa e gerencialista; entre 2007 e 2010, a orientacao gerencialista se manteve e houve um esforco de atrelar a politica de saude ao modelo de desenvolvimento. Apesar dos avancos, o planejamento em saude expressou limitacoes como a nao regulamentacao do financiamento setorial, que tem comprometido a execucao dos planos, o escasso enfrentamento de problemas estruturais do sistema de saude e a fragilidade da logica territorial.

Responsabilidade do Estado e direito à saúde no Brasil: um balanço da atuação dos Poderes

The 1988 Federal Constitution set forth a new political-institutional moment in Brazil reasserting the Democratic State and defining a broad social protection policy including health as a social citizenship right. Since its promulgation, a great number of laws, ministerial decrees and administrative actions have attempted to make feasible the political project outlined in the Constitution. On the other hand, in the same period, the number of legal orders regarding health related demands has increased. Such a movement has revealed inconsistencies and contradictions in the legal and normative scope of SUS (Unified Health System), as well as problems not calculated by health policies, questioning the Executive Branchs actions and creating a new demand for legislation. This article discusses the role of the State in health as of 1990, considering the action of the Branches. The perspectives on the right to health in the construction of a democratic State oriented to social wellbeing, facing the challenges related to coordination mechanisms and balance among Branches in the health issue, are discussed.

Análise das portarias ministeriais da saúde e reflexões sobre a condução nacional da política de saúde

Ministry of Health rulings and provisions are important policy regulation tools that aim to orient the enforcement of health-related laws passed by the Legislative Branch, under the terms of the 1988 Federal Constitution. Such provisions have played a major role in the health sector, due not only to the number of documents submitted since the late 1990s, but mainly because of this tools persuasive power in defining health sector policy. The current article aims to foster reflection on both national health policy management in Brazil and the main obstacles to the implementation of health reform operational aspects. The article classified and analyzed Ministry of Health rulings issued from 1990 to 2002. The study highlights the Ministrys centralizing approach and the use of financial and political persuasion tools that subject State and Municipal governments to the systems rules without creating a negotiated and sustained health policy that the countrys institutional realities ratify and support.

Os sentidos e disputas na construção da Política Nacional de Promoção da Saúde

Este estudo teve como objetivo analisar a definicao da Politica Nacional de Promocao da Saude de 2006 no Brasil, buscando explicitar os sentidos e disputas no processo de formulacao e suas implicacoes para o campo da saude. Para tanto, foram feitas revisao bibliografica, analise de documentos e entrevistas com participantes da rede de discussao sobre promocao da saude no Brasil. Partimos de uma visao de ciencia construcionista, compreendendo a politica como um processo dinâmico que se constitui a partir de diferentes fatores que influenciam as escolhas e posicionamentos dos atores e grupos. Identificamos no processo alguns tensionamentos que podem ser entendidos como dilemas que o debate da promocao suscita. Um primeiro dilema apresentou-se no debate propriamente dito em torno do modelo de promocao, que decorre da polarizacao historicamente construida entre a perspectiva regulatoria e a perspectiva emancipatoria. Um segundo dilema refere-se a apropriacao desta polarizacao se desdobrando na discussao entre o amplo e o restrito, onde as propostas voltadas para o coletivo sao tidas como comprometidas com um projeto emancipatorio e as propostas voltadas para o individual sao entendidas numa perspectiva de controle. O terceiro dilema se traduziu no emprego do conceito de empowermentsem uma discussao aprofundada de seus efeitos no processo de construcao desta politica em nosso âmbito.

Análise da produção bibliográfica sobre atenção primária à saúde no Brasil em quatro periódicos selecionados

O artigo analisa a producao bibliografica em atencao primaria no Brasil publicada em quatro revistas de grande circulacao no campo da Saude Coletiva - Cadernos de Saude Publica, Revista de Saude Publica, Ciencia e Saude Coletiva e Saude em Debate -, com o intuito de identificar os conceitos utilizados, as abordagens dos estudos e os principais temas associados a discussao da atencao primaria. A analise foi feita a partir da compreensao do contexto politico-institucional da saude, buscando correlacoes do momento da politica com a producao de conhecimento. A analise abrangeu a discussao realizada nesses periodicos de 1977 ate 2006. Verificou-se uma carencia de estudos de abordagem conceitual e uma abundância de estudos de caso sem a promocao do dialogo entre autores e instituicoes, fragilizando essa area como produtora de conhecimento. Com este estudo, pretendese contribuir para o aprofundamento do debate teorico sobre o modelo assistencial com foco na atencao primaria e identificar linhas de forca das propostas, contribuindo para a consolidacao do campo.

Índice de desenvolvimento da família: uma análise comparativa em 21 municípios do Estado do Rio de Janeiro, Brasil

This article presents an adaptation of the family development index, with a detailed description of the results of its application in 21 municipalities in the State of Rio de Janeiro, Brazil, in 2000. The research is part of the Baseline Study on the Project for Expansion and Consolidation of the Family Health Strategy and was proposed as an instrument for monitoring and analyzing the municipal reality in the context of a family-centered public policy. The results show a serious-to-severe situation for families in the State of Rio de Janeiro. The most critical dimensions relate to inequalities in results, availability of resources, and labor market access, in addition to a key aspect involving inequality of opportunities, namely access to knowledge. The most vulnerable groups consist of families headed by individuals over 65 years of age and families headed by women.