Navegando por Palavras-chave "políticas de saúde"
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- ItemAcesso aberto (Open Access)O discurso da institucionalização de práticas em saúde: uma reflexão à luz dos referenciais teóricos das ciências humanas(IMS-UERJ, 2008-09-01) Lins, Auristela Maciel; Cecilio, Luiz Carlos de Oliveira [UNIFESP]; Agência Nacional de Vigilância Sanitária; Universidade de Brasília; Universidade Federal de São Paulo (UNIFESP)This paper aims to promote reflections on the movement to institutionalize health practices evaluation: can it lead to the intended changes or may it reproduce old practices? To answer these questions, it was necessary to resort to the aid of Human Sciences mainly the authors who study social institutions. These authors based their theories on Positivistic sociology, on sociological phenomenology and on the precepts of the French institutionalism movement. Following their lines of thought, this paper is intended to further understand the concept of institution and institutionalization present in those social schools. Based on the theoretical framework which encourages this text, the authors suggest some special attention be placed on actions that support the movement for health evaluation institutionalization.
- ItemSomente MetadadadosJulgamentos de valor no processo de incorporação de tecnologias de saúde no Brasil(Universidade Federal de São Paulo (UNIFESP), 2014-11-26) Santoro Neto, Luiz [UNIFESP]; Ferraz, Marcos Bosi Ferraz [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Introduction: Treating the shortage of health resources ethically and rationally seems to be the best way to face the dilemmas related to health technology assessment. Many aspects influence this process, including ethical, economic and social issues, which should serve as a basis for setting priorities in health and for the development of decision analysis. Objectives: To evaluate the value judgment on critical decisions involving the allocation of resources and the use of technologies in the Brazilian Health System, through the vision of health professionals and managers, and, by this appraisal, estimating implications that have potential influence on the health policies in the country. Methods: Cross-sectional exploratory study applied online, through a decision-making questionnaire for incorporation of health technologies, endowed with four scenarios that simulate real situations of resource allocation in an environment of severe budget constraints, which was completely answered by 193 managers and professionals from various health sectors. The scenarios presented trade-offs such as patient age, disease prevalence, reduction/extinction of current health programs, creation of taxes, and choices between prevention and treatment. The variations found in the responses were measured by Chi-square test. Results: The survey had a response rate of 27.3%. Of these, almost half were medical doctors, 90% had at least one post-graduation, and there was an equal distribution between men and women, as well as among those working in the public and private system. There was a diverse sample of respondents with participation of all proposed segments. Of the four presented scenarios, Scenarios 1, 2 and 3 involved some form of incorporation. In Scenario 1, 78% of respondents opted for decisions that nothing, or very little, affected the budget. In Scenario 2, 68% of respondents also opted for decisions that nothing, or very little, affected the budget. In Scenario 3, we find the highest trend for the incorporation among the studied scenarios, with 58% of respondents choosing XI for one of the options that involved incorporation. In Scenario 4, when comparing the results between treatment and prevention programs, the latter was prioritized for resource allocation, with 65% of responses. Conclusion: This study suggests that Brazilian health professionals and managers are significantly influenced by economic and budgetary issues when deciding about the allocation of resources for health technologies assessment in the country. In search of a paradigm for decision-making, most professionals and managers generally prioritized to save resources, instead of incorporating the technologies. Among the segments, the pharmaceutical industry showed the greater tendency for technological incorporation. We hope that this and other studies are able to collaborate in the establishment and strengthening of health policies that ensure economic feasibility for an effective incorporation of progressive technologies, avoiding an undesirable technological gap, because of the severe budget constraint of Brazilian health.
- ItemSomente MetadadadosTrabalho do enfermeiro na atenção primária à saúde no Brasil: recortes históricos e desafios profissionais(Universidade Federal de São Paulo (UNIFESP), 2013-12-20) Ximenes Neto, Francisco Rosemiro Guimaraes [UNIFESP]; Cunha, Isabel Cristina Kowal Olm Cunha [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Nursing, since 1920, has been developing important role in the Brazilian Public Health, especially in Primary Health Care (PHC). As the Unified Health System (SUS) started in the 1980s, the country was undergoing an intense process of decentralization of policies, programs, projects, services and health actions, PHC was one of the priority attention. Thus, the Ministry of Health has institutionalized policies such as Community Agent Health Strategy in 1991, and the Family Health Strategy (FHS), created in 1994 with the designation of the Family Health Program (FHP), in which the nurse receives a new strategic role. The study aimed to analyze the process of nursing work in the PHC in light of the Brazilian Health Policies from SUS, based on a documented research, analytical and critical, with historical and interpretation recovery of information based on logic dialectic, developed during the period of April to November 2013, using five institutional documents of the Ministry of Health, in the light of the analysis of referential context of Souza (2001), which examines the events, scenarios, actors, force and structures relationships after being referred to the content analysis of Minayo (2008), which derived the following category of results: Conjunctures of the Nursing work in the FHS. Events and structures that showed potent symbolism for the work of nurses in PHC were: the creation of the PSF in 1994 as decentralization strategy of the Brazilian PHC; the strengthening of health decentralization, with the institutionalization of the Basic Health Tread funding via FHP, by Basic Operational Norm-SUS 01/1996, augmented with Operational Norm for Health Care-SUS 01/2001, which led to the consolidation and expansion of PHC and internalization of the labor market in Health and Nursing; improving indicators and the rapid growth in the number of PSF teams throughout the country, as institutionalization reason of it as policy, the FHS in 1997; the revitalization and strengthening of FHS with National Primary Care Policy. Scenarios where the health production development of nurses in the PHC occurring are: in the territory, in the community, at home and at Basic Health Unit, having focus on care of the family and individuals. Actors that influence the nursing work environment at PHC depend on the organization of the work process, whether individual (physicians, nursing assistants and CHA) or collective (multidisciplinary team, with minimal staff, Oral Health of CHA among others. The main actors/elements that mediate the forces in the field of practice with FHS nurses are community, the established local culture, local political power, the Municipal health Management, the pyramidal system model of health organization, health workers team, which exercises also strong social and technical work, among other. The working process of nurses in PHC is socially determined, influenced by instituted and instituting health policies and the territorialized political scene.