Navegando por Palavras-chave "Health Policy"

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    Análise da atenção nutricional ao idoso na atenção primária à saúde
    (Universidade Federal de São Paulo, 2017-09-28) Melo, Carolina Lou de [UNIFESP]; Medeiros, Maria Angélica Tavares de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Nutritional Care (NC) to the elderly is an important element for comprehensive health care in Primary Health Care (PHC), for its potential to act on the morbidity and mortality profile of the elderly population and to promote healthy aging. The objective of this research was to characterize and to analyze NC for the elderly in the PHC in Santos-SP; to verify if NC is considered in health care planning and to identify if the strategies and instruments used at this level correspond to the specificities of the target public. This is a cross-sectional study, with a quantitative-qualitative approach, composed of two stages and originated from a PHC census research in Santos. For the first stage (characterization), the census data of the PHC services (n = 28) of the insular area of Santos, related to the NC for the elderly, were obtained from a structured interview with service managers. For the second (analysis), semi-structured interviews were conducted with nine health professionals, key informants of the subject matter. The selection of these was based on the criterion of saturation point. The data from step one were analyzed from frequentist statistics; those of stage two submitted to content analysis and the interpretations were based on the theoretical framework of comprehensive health care and socioanthropology of aging. The NC for the elderly, in PHC, was characterized as being fragmented and oriented under the biomedical care model. Aging was associated with the disease and the elderly was not recognized as an autonomous subject. Thus, the way the NC is organized is distant from the precepts of the comprehensive health care, weakening the role of PHC in the coordination of care.
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    Análise Das Ações De Educação Alimentar E Nutricional Em Municípios Do Brasil No Ano De 2010
    (Universidade Federal de São Paulo (UNIFESP), 2017-06-07) Ottoni, Isabela Cicaroni [UNIFESP]; Bandoni, Daniel Henrique [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    The Brazilian School Nutrition Program (PNAE) is considered one of the largest and most comprehensive school feeding programs in the world, with one of the guidelines being the inclusion of Food and Nutrition Education as a decisive component in promoting quality of life. However, there are few theoretical- methodological references that support these practices. Thus, the objective of this work was to analyze the implementation of Food and Nutrition Education actions in Brazilian municipalities. It was used the secondary data obtained from the School Feeding Efficient Manager Award database, formulated from the voluntary enrollment of 786 municipalities throughout Brazil in the year of 2010. The variables of the study were: the execution of Food and Nutrition Education actions, pedagogical gardens and culinary workshops execution, according to the great regions of Brazil, verifying if there was association of attendance to PNAE (number of students attended), financial resources and use of family agriculture in the execution of actions. Statistical analysis was performed using Pearson's Chi-square test and the Student's T-test for independent samples at a significance level of 5%. The qualitative analysis was done using the Content Analysis method. Among the enrollees (n = 786), 61.2% (n = 466) had EAN in their school curriculum, 44.8% (n = 348) of the municipalities use Family Agriculture food, 71.1% ( N = 322) carried out Pedagogical Gardens and 32% (n = 243) held Culinary Workshops. There was no statistical difference regarding the performance of Food and Nutrition Education according to the major regions. EAN actions are present in most municipalities enrolled in the award, but with a predominance of passive methods and punctual actions, as well as the appreciation of nutrition (nutrients and functions), to the detriment of food and local food culture. The implementation of active methodologies with an integral approach to food should be stimulated.
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    Análise do modelo de assistência em saúde mental na gestão Erundina - 1989-1992
    (Universidade Federal de São Paulo (UNIFESP), 2019-05-30) Migliari, Fabricia De Freitas Faria [UNIFESP]; Marcolan, Joao Fernando [UNIFESP]; http://lattes.cnpq.br/5449589014899461; http://lattes.cnpq.br/7588045554997309; Universidade Federal de São Paulo (UNIFESP)
    Brazilian Psychiatric Reform was characterized by mental health care services restructuration and working process with new ways of care, it occurred from a political process of social transformation based on great political and social mobilization during Brazilian re-democratization process in the Health Reform context. Innovative experiences in Brazil particularly involving the mental health care in São Paulo city which was highlighted due to the intense aim of social, political and technical movements and its innovative approach of service networks. This study aims to analyze the mental health care model implanted in the period between 1989-1992 in the São Paulo City, disclosed by its collaborators; the technical-welfare and theoretical-conceptual influences in the choice of the implemented Mental Health Care model; to verify the changes undertaken by this Mental Health Care model and to analyze the influence of this implanted model in the changing of the mental illness social paradigm through participants' perception. We used the oral history method to revisit past experiences from the managers’ narrative of the Mental Health Program of the São Paulo city. As a result, we introduce the social political engagement of health professionals in student movements and, later, in the social movements of Mental Health against the hospital-centered model. The São Paulo City model was built inside the Mental Health Nucleus of the Workers Party (PT), its creators were linked to the unions, popular movement and a political party, with influences on the Health Reform conceptual ground and from the epistemological data of the population. The network of Mental Health Care was established in a decentralized and hierarchical way, consisting of Basic Health Units (UBS), UNCOVITI, Day Hospital (HD), General Hospital (HG), Emergency Room (PS), Therapeutic Residential Service SRT) and Coexistence and Cooperative Center (CECCO). The Model had a great impact on the amount of implemented services, reduction of hospitals beds and the closing of psychiatric hospitals. The health care professionals’ training and qualification, developed by this management, was one of the factors responsible for the transformation of psychiatric care and for the breaking of the paradigm of madness in society. Despite all innovation of the São Paulo City model, its purposes were not considered by Health Mental Care National Policy. The incorporated and chosen model was in the CAPS (Center of Psychosocial Attention) type implement format, which maintained the excluding view of the person with mental disorder of health services in general and society. We conclude that the choice of the assistance model in Mental Health, both in São Paulo City and in Brazil, was caused through the political bias, in agreement with the directions of the political-ideological groups.
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    The challenge of decentralization of the Unified National Health System in large cities: the case of Sao Paulo, Brazil
    (Cadernos Saude Publica, 2009-08-01) Spedo, Sandra Maria [UNIFESP]; Tanaka, Oswaldo Yoshimi; Silva Pinto, Nicanor Rodrigues da; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)
    Decentralization of Brazil's Unified National Health System (SUS) still poses challenges in large cities. To characterize decentralization as an essentially political process, institutional policy variables, including local management capacity, are determinant for shaping decentralization in each context. Using the government triangle reference to evaluate management capacity, a case study was conducted with the objective of analyzing the system's decentralization in the city of Sao Paulo, Brazil's largest metropolis. An analysis of selected health system managers and administrative documents identified a trend towards focusing health management at the municipal level in 2005-2008, accompanied by dismantling of local/regional structures in the Municipal Health Secretariat, resulting in technical and policy depletion at these levels. Despite the limits of decentralization, the article emphasizes its power as an operational strategy to achieve the SUS' objectives. The article also stresses the need to resume the health decentralization process in the city of Sao Paulo, both moving towards local/regional levels and linked to the decentralization of municipal public management.
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    Concepções de práticas docentes de professores que vivenciaram a transição curricular no curso médico da Unimontes
    (Universidade Federal de São Paulo (UNIFESP), 2010) Souza, Anderson Gonçalves de [UNIFESP]; Sonzogno, Maria Cecília [UNIFESP]; http://lattes.cnpq.br/8179958381249653; http://lattes.cnpq.br/1293459110231326; Universidade Federal de São Paulo (UNIFESP)
    No ano de 2002, o Curso Médico da UNIMONTES passou por uma grande transformação com a mudança de currículo, abandonando uma metodologia tradicional de ensino e passando a utilizar uma metodologia ativa, baseada no ABP (Aprendizado Baseado em Problemas). É interessante ressaltar que muitos dos docentes do currículo tradicional, embora tivessem migrado para essa nova metodologia, davam a impressão de que continuavam a praticar o currículo tradicional dentro de uma metodologia ativa. A fim de estudar sobre semelhantes questões, foi realizada, neste trabalho, uma revisão dos documentos relativos a políticas públicas de educação que norteiam as tomadas de decisões sobre currículo, projetos pedagógicos (LDB, Diretrizes Curriculares para o Curso de Medicina, as Conferências Internacionais de Saúde), bem como o processo de ensino-aprendizagem, habilidades, competências e atitudes. Objetivou-se analisar a concepção de ensino-aprendizagem dos docentes do curso médico da UNIMONTES. Para tanto, desenvolveu-se uma pesquisa quantitativa e qualitativa, com predomínio do caráter qualitativo devido ao enfoque a questões sociais. Esta pesquisa foi realizada na UNIMONTES (Universidade Estadual de Montes Claros) e os sujeitos que a constituíram foram os professores, docentes do curso médico antes da mudança de currículo que ocorreu no ano de 2002, e que continuaram docentes de conteúdo específico no ABP. Além disso, foram aplicados questionários com questões objetivas, estruturadas para avaliar idade; formação didática e profissional; tempo de docência; capacitação para trabalhar com metodologias ativas e questões dissertivas nas quais os professores falavam sobre os documentos oficiais (LDB e Diretrizes Curriculares para o Curso de Medicina), as Conferências Internacionais, o processo de ensino-aprendizagem, as metodologias ativas e os currículos como meio de aprendizagem. Como resultados, notou-se a existência de uma população heterogênea com formação diversa, predominando o número de especialistas em relação ao número de mestres, destacando que a grande maioria participou de alguma formação para trabalhar com metodologia ativa. Porém, pouco se conhece sobre os Documentos Oficiais que regem a educação brasileira, bem como a importância das Conferências Internacionais para a Saúde. Existem concepções equivocadas sobre o processo de ensino-aprendizagem e existem diferenças na forma de trabalhar as habilidades, competências e atitudes. Entende-se que o ABP propicia maior oportunidade de aprendizagem, pois leva o estudante a ser mais crítico e a buscar ativamente o conhecimento. Nota-se que houve um progresso dentro da UNIMONTES com a adoção de metodologia ativa no curso médico; entretanto, há necessidade de maior capacitação docente, tanto por treinamentos internos com cursos de aperfeiçoamento para trabalhar com metodologias ativas quanto com a profissionalização dos docentes com titulações de mestres e doutores.
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    Conquistas e desafios no atendimento das mulheres que sofreram violência sexual
    (Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, 2007-02-01) Villela, Wilza Vieira [UNIFESP]; Lago, Tânia; Universidade Federal de São Paulo (UNIFESP); Santa Casa da Misericórdia de São Paulo Faculdade de Medicina
    This article analyzes treatment for female victims of sexual violence, with a focus on partnerships between government and the organized women's movement. The central references are the specific literature and testimony by key social actors who have participated in this process. The results show that despite the real and symbolic importance of care for rape victims, the government and the women's movement have not succeeded in guaranteeing the expansion of these services or adequately linking the discussion of sexual violence to women's right to abortion under any circumstances. It is thus necessary to step up the measures on this agenda.
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    Federalism and health policy: the intergovernmental committees in Brazil
    (Faculdade de Saúde Pública da Universidade de São Paulo, 2014-08-01) Machado, Cristiani Vieira; Lima, Luciana Dias de; Viana, Ana Luiza D'Ávila; Oliveira, Roberta Gondim de; Iozzi, Fabíola Lana; Albuquerque, Mariana Vercesi de; Scatena, João Henrique Gurtler; Mello, Guilherme Arantes [UNIFESP]; Pereira, Adelyne Maria Mendes; Coelho, Ana Paula Santana; Fundação Oswaldo Cruz Escola Nacional de Saúde Pública Sergio Arouca Departamento de Administração e Planejamento em Saúde; Universidade de São Paulo (USP); Fundação Oswaldo Cruz Escola Nacional de Saúde Pública Sergio Arouca Escola de Governo em Saúde; Universidade Federal do Mato Grosso Instituto de Saúde Coletiva Departamento de Saúde Coletiva; Universidade Federal de São Paulo (UNIFESP); Fundação Oswaldo Cruz Escola Politécnica de Saúde Joaquim Venâncio Laboratório de Educação Profissional em Gestão em Saúde; Universidade Federal do Espírito Santo Centro Universitário Norte do Espírito Santo Departamento de Ciências da Saúde
    OBJECTIVETo analyze the dynamics of operation of the Bipartite Committees in health care in the Brazilian states. METHODSThe research included visits to 24 states, direct observation, document analysis, and performance of semi-structured interviews with state and local leaders. The characterization of each committee was performed between 2007 and 2010, and four dimensions were considered: (i) level of institutionality, classified as advanced, intermediate, or incipient; (ii) agenda of intergovernmental negotiations, classified as diversified/restricted, adapted/not adapted to the reality of each state, and shared/unshared between the state and municipalities; (iii) political processes, considering the character and scope of intergovernmental relations; and (iv) capacity of operation, assessed as high, moderate, or low. RESULTSTen committees had advanced level of institutionality. The agenda of the negotiations was diversified in all states, and most of them were adapted to the state reality. However, one-third of the committees showed power inequalities between the government levels. Cooperative and interactive intergovernmental relations predominated in 54.0% of the states. The level of institutionality, scope of negotiations, and political processes influenced Bipartite Committees’ ability to formulate policies and coordinate health care at the federal level. Bipartite Committees with a high capacity of operation predominated in the South and Southeast regions, while those with a low capacity of operations predominated in the North and Northeast. CONCLUSIONSThe regional differences in operation among Bipartite Interagency Committees suggest the influence of historical-structural variables (socioeconomic development, geographic barriers, characteristics of the health care system) in their capacity of intergovernmental health care management. However, structural problems can be overcome in some states through institutional and political changes. The creation of federal investments, varied by regions and states, is critical in overcoming the structural inequalities that affect political institutions. The operation of Bipartite Committees is a step forward; however, strengthening their ability to coordinate health care is crucial in the regional organization of the health care system in the Brazilian states.
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    Health policy and management in the (re)construction of the Unified National Health System (SUS) in a large municipality: a case study of Sao Paulo, Brazil
    (Cadernos Saude Publica, 2009-04-01) Pinto, Nicanor Rodrigues da Silva [UNIFESP]; Tanaka, Oswaldo Yoshimi [UNIFESP]; Spedo, Sandra Maria [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    The (re) construction of the Unified National Health System (SUS) in the Municipality of Sao Paulo, Brazil, from 2001 to 2008 was analyzed by means of a case study, using different sources: documents, interviews with key informants, and participant observation. Health policy and health management were used as the analytical categories. The study selected and analyzed only the policies that were prioritized by the administration that took office in 2001 and that were maintained until 2008. The article discusses challenges for ( re) construction of the SUS in Sao Paulo, related to the political and institutional context and including the structural changes as implemented. Reorganization of the Municipal Health Secretariat in Sao Paulo enabled constituting and maintaining two municipal subsystems ( one hospital-based and the other outpatient). Negotiations between the Municipal, State, and Federal levels failed to make headway in order for the city of Sao Paulo to assume the de facto management of the entire health system, so that three public health subsystems coexisted ( two Municipal and one State). The Family Health Program was sustained politically, mainly because it was a Federal government priority and was not a trademark of the first Municipal administration.
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    Hospital Amigo da Criança: prevalência de aleitamento materno exclusivo aos seis meses e fatores intervenientes
    (Universidade de São Paulo, Escola de Enfermagem, 2013-12-01) Figueredo, Sonia Fontes; Mattar, Maria Jose Guardia; Abrão, Ana Cristina Freitas de Vilhena [UNIFESP]; Hospital Maternidade Leonor Mendes de Barros; Ministerio da Saude; Universidade Federal de São Paulo (UNIFESP)
    The objective of this research was to identify the pattern of exclusive breastfeeding (EBF) in the first 6 months of infants born in a Baby-Friendly Hospital and the factors that contribute to early weaning. This was a prospective cohort study with 261 mothers and children. The data were analyzed via the construction of a Kaplan-Meier survival curve, and the log-rank test was used for the univariate analysis. A multivariate analysis was performed using the Cox proportional-hazards regression model. During the 6 months, the percentage of mothers who practiced EBF for 30, 90, 120, 150 and 180 days was 75%, 52%, 33%, 19% and 5.7%, respectively. In the multivariate analysis, the variables that conferred a risk for early weaning were the hospital and the occurrence of a follow-up visit due to mammary complication, improper positioning and the association of both of these factors. The Baby-Friendly Hospital Initiative favored EBF.
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    (Im)possibilidades de implementar uma direção única no SUS em município de grande porte: o caso de São Paulo, Brasil
    (Faculdade de Saúde Pública, Universidade de São Paulo.Associação Paulista de Saúde Pública., 2010-09-01) Pinto, Nicanor Rodrigues da Silva [UNIFESP]; Spedo, Sandra Maria [UNIFESP]; Tanaka, Oswaldo Yoshimi; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)
    The construction of a unified health management is a challenge to the local Brazilian National Health System (SUS) management, especially in large cities. This article analyzed the implementation process of the SUS in the city of São Paulo. Its objective was to identify strategies to implement the unified health management, in the period from 2001 to 2008. The method used was a case study and data collection was based on management documents and interviews. The concept of health services integration was used as analytical category. Movements and strategies of the SUS institutional actors in the city of São Paulo were analyzed. Institutional improvements were observed, like the municipalization of the state healthcare centers and the qualification of São Paulo in the full management of the municipal health system. Despite this SUS management status and the political party identity that has been occurring between state and city governments since 2005, there were two separate public health subsystems with litle integration between them: the municipal one, which concentrated the primary healthcare services, and the state one, concentrating most of the secondary and tertiary health services. The management tools used, such as the regulation system, proved to be fragile to overcome the lack of integration between those health subsystems. As the implementation of a unified health management in SUS implies a (re)division of resources and power, rules and management tools are not enough to make it feasible. Implementing a negotiation process between the institutional and political actors involved in a common political project in health is a strategic challenge.
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    A Importância da capacitação de agentes comunitários de saúde (ACS) na detecção precoce de casos de demência e articulações em rede
    (Universidade Federal de São Paulo (UNIFESP), 2018-12-10) Barbosa, Mariana de Castro [UNIFESP]; Mattos, Emanuela Bezerra Torres [UNIFESP]; http://lattes.cnpq.br/3746624378040152; http://lattes.cnpq.br/1965337457374398; Universidade Federal de São Paulo (UNIFESP)
    O avanço das tecnologias e a possibilidade de novos recursos para a saúde tem como consequência o fato atualmente conhecido como envelhecimento populacional. A problemática passa a ser o controle e tratamentos para as doenças que acometem essa faixa etária e que tiveram incidência elevada nos últimos anos, por exemplo, as demências. A Organização Mundial de Saúde (OMS) chama atenção para a necessidade da detecção precoce na atenção primária de saúde e apresenta o Agente Comunitário de Saúde (ACS), como um potente intersector entre os idosos acometidos pela doença e a rede de atenção à saúde. Com isso, a pesquisa viu a necessidade de capacitação aos ACS, tendo como objetivo avaliar o impacto de uma educação permanente para esses profissionais. Metodologia Foi realizada uma Oficina de Capacitação aos ACS de uma Unidade Básica de Saúde (UBS) da cidade de Santos, após aprovação no Comitê de Ética e da Coordenadoria de Formação e Educação Continuada, tendo o objetivo de possibilitar à eles o conhecimento dos aspectos relacionados às Demências. Através da análise de respostas aos questionários e relatos dos participantes, foram comparados seus conhecimentos através de questionários aplicados Pré-Oficina e Pós-Oficina. A análise dos dados foi distribuída em 3 critérios: 1. O papel do Agente Comunitário de Saúde (ACS) na detecção precoce da demência; 2. A percepção dos ACS em relação à Demência e 3. Possibilidades de articulações do tema na Atenção Básica de Saúde. Resultados e Discussão Os ACS demonstraram preocupação e sentimentos de tristeza em relação às demências. A intervenção da oficina foi positiva para os profissionais que inicialmente diziam não conseguir identificar qualquer possibilidade de ação diante dessa demanda específica, ao final das oficinas metade dos participantes demonstraram uma melhor compreensão das características de uma síndrome demencial e das possibilidades de rastreio. O resultado da intervenção foi prejudicado devido a não presença em todos os encontros e, poderia ser potencializado com a realização fora do local de trabalho.Todos os participantes assentiram que a Atenção Básica deve ser responsável pela detecção precoce da doença. Considerações Finais A educação permanente de agentes comunitários de saúde é uma importante ferramenta para a efetividade do trabalho desses profissionais, possibilitando um olhar sensível aos quadros demenciais e a conscientização dos possíveis caminhos desses casos nos equipamentos de saúde
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    Interdisciplinaridade e as múltiplas dimensões do trabalho em saúde
    (Universidade Federal de São Paulo (UNIFESP), 2019-12-10) Pereira, Lucilene Alves [UNIFESP]; Mendes, Rosilda [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    This study aimed to develop a critical analysis on how interdisciplinarity has been understood and implemented by workers, based on the particularity of daily professional practices in health, and to promote the debate between the different positions on the theme. The production of data was carried out through the techniques of research, bibliography, documentary and integrative review of scientific articles in the health area, in journals indexed in the databases SCIELO, BVS, LILACS, PUBMED and theses and dissertations of the Library of Theses and Dissertations of CAPES, published in the period between January 2007 and December 2017. The literature search identified a lack of consensus on the concept of interdisciplinarity, as well as showed that the interdisciplinary perspective is guided by authors from different areas of knowledge. The analysis sought to identify whether the incorporation of terminology corresponds to coherent conceptions and practices in health care, as well as whether the interdisciplinarity present in professional discourses would be sufficient to ensure the performance of a collective and articulated work. The results were organized into three nuclei: interdisciplinarity in academic education; interdisciplinarity in professional performance; and the place of Social Service in interdisciplinarity. Among the findings it is noteworthy the finding that, although health work has as its guiding principle the comprehensive care and the National Curriculum Guidelines excel for an interdisciplinary education, it is still predominant among undergraduate courses, curricula based on disciplines, which reflects in disjointed and isolated practices. It was identified that discussion of interdisciplinarity in the scope of professional practice in health, despite being recurrent among professionals who integrate the different teams, is still restricted to the theoretical field. It is understood that there is a tendency to relate everything that is performed in group and collective way, with the interdisciplinary perspective. With regard to the Social Service, despite the reduced number of studies found, the discussions contributed to the development of critical-reflexive analyses about the reality where the practices materialize. The aspects observed throughout this study demonstrated that the place of Social Service in interdisciplinarity is to reflect on the theme within the capitalist society of production, as an element tensioned by the contradictions of the system, which outsources, flexibilizes and fragments the different work processes. Inserted in a historical movement of crisis of paradigms, interdisciplinarity as a strategy to cross the established barriers, has among its major challenges, that of taking as principles: the totality, the contradiction, the mediation, as well as the contradiction inherent to the capitalist mode of production. The implementation of interdisciplinary practices in line with the principle of integrality of health actions becomes increasingly necessary, both to maintain the dialogue between the different fields of knowledge and the strengthening of professional relationships, and to better respond to health needs. It is hoped that this study can contribute to the expansion, systematization and deepening of the theme, as well as provide elements to professionals for reflection and improvement of health practices.
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    Judicialização da saúde na voz do usuário: a procura do cuidado através da justiça
    (Universidade Federal de São Paulo (UNIFESP), 2019-02-05) Capiberibe, Cláudia Camargo [UNIFESP]; Rios, Ademar Arthur Chioro dos [UNIFESP]; http://lattes.cnpq.br/9454572596499303; http://lattes.cnpq.br/2555792761200636; Universidade Federal de São Paulo (UNIFESP)
    Introduction: In Brazil, health has been a constitutional right since 1988, but the lack of full service to the population by SUS [Sistema Única de Saúde – Brazil’s public healthcare system] or the private sector has led to the judicialization of health, a legal recourse that allows for the enforceability of rights when these are denied by the parties responsible, and which has transformed into an alternative means for accessing medicines, services and products not covered by the policies and protocols of SUS or on the lists of the ANS [Brazil’s National Health Agency]. It is a phenomenon that involves multiple parties, with distinct and often conflicting objectives and interests. Studies have shown that the judicialization of health is a legitimate form of pressuring the State, but one which has relevant secondary effects, such as significant impact on costs and increasing inequalities in access to and use of healthcare services. Its complexity and effects have been well studied, but the point of view of the user has been mostly ignored. Objective: To analyze the experiences of people who have sought redress in the courts to have access to services and to guarantee their health. Methodology: The investigation, based on a micropolitical approach, was conducted through qualitative research. Seven interviews were carried out with people who reside in Sao Paulo and have initiated court actions, selected at random from the search tool of the Sao Paulo Court of Justice and through indications from de first selected interviewed. Resorting to personal documents and using oral history techniques, the research seeks to identify the users' care maps, the obstacles they face, as well as the strategies and mechanisms used to attain their health objectives. Results and Discussion: The data from the research was organized along cutting-planes: the experience with the infirmity and the experience with the judicialization process. The first permitted the construction of care maps and the second allowed for the description and analysis of the trajectory relative to the legal requests. These experiences played out in different planes of visibility, with relevant meanings, made visible/utterable by repeated examination of the narratives. The users initiate actions in the Court against SUS and/or the private healthcare provider motivated fundamentally by their suffering and the desire to recover autonomy, reduce the financial impact of the infirmity and by the belief that therapies and innovative technologies not yet contemplated by the System might provide better quality of life. They see themselves as guaranteeing unseen and unconsidered health needs, exercising a kind of "social control" and demanding fair return for taxes paid. The Court becomes an important and decisive point on the care maps of these users and their families. Judicialization, however, ends up becoming yet another form of regulating access to use of the healthcare system and a form of privileged access to public funds, creating a “marketplace” for health services and products, a shortcut for technological incorporation and greater iniquity. To the users, however, the parties that act in this complex arena are not motivated by personal interests or economic gain. Instead, they are imagined to be links in the system willing to produce alternatives so that the care map may be complemented or improved, without any moral or ethical judgement, as well as providing an individualized solution. Conclusion: The empirical results of the research demonstrate that there is great diversity in the narrated experiences, which allowed for the identification of various facets to the judicialization of healthcare. The most common and relevant to the users who go through the experience is the desire to survive the infirmity, recover their health and improve their quality of life, whatever the cost and through whatever means at their disposal, including judicialization, and despite regulations or other rules of the system or societal interests, which appear to be insufficient to limit their actions.
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    Mulheres gestantes que vivem nas ruas: um olhar a partir do acesso (ou não) à política de saúde no município de Santos
    (Universidade Federal de São Paulo, 2020-10-22) Silva, Alessandra Gomes Conessa da [UNIFESP]; Bovolenta, Gisele Aparecida [UNIFESP]; http://lattes.cnpq.br/4488256741200083; http://lattes.cnpq.br/3874193977045056; Universidade Federal de São Paulo (UNIFESP)
    Esse Trabalho de Conclusão de Curso propõe analisar como a mulher gestante em situação de rua acessa (ou não) os serviços de saúde na região central de Santos. De acordo com Carneiro Junior et al. (1998), compreender a saúde das pessoas em situação de rua pressupõem um olhar diferenciado do processo saúde-doença já que elas vivem em condições de grande vulnerabilidade social e, portanto, sofrem influência do trabalho ou da falta dele, da violência urbana, da ausência ou fragilidade de vínculos familiares, da cultura, da renda e etc. o que impacta na promoção de seu bem estar e no acesso aos serviços. A análise bibliográfica, documental e legal apresenta-se como fonte de extrema importância para identificar o processo histórico de pobreza e suas consequências no mundo contemporâneo para a população em situação de rua, em específico no que tange a Política de Saúde. Dentro desse grupo heterogêneo, destacam-se as mulheres gestantes que estão imersas em dois tipos de violência: a do Estado, que contribuiu para a condição que se encontram e a de gênero, marcada pela desigualdade que a sociedade patriarcal e machista impõe a elas. A Política de Saúde no Brasil sofreu inúmeras mudanças no decorrer dos anos sendo o maior destaque a criação do SUS, a partir da Constituição Federal de 1988, e os ataques ocorridos com o avanço da política neoliberal que impactam diretamente na vida das mulheres em situação de rua. O Ministério da Saúde prevê em sua “Nota Técnica Conjunta 001 – SAS e SGEP” que o Estado cumpra com sua função de garantir acesso igualitário e universal à elas assim como as diretrizes do Sistema Único de Saúde, porém explicita que há dificuldades observadas para essa garantia o que contribui por justificar a importância dessa pesquisa.
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    Narrativas: utilização na pesquisa qualitativa em saúde
    (Faculdade de Saúde Pública da Universidade de São Paulo, 2008-12-01) Onocko Campos, Rosana Teresa; Furtado, Juarez Pereira [UNIFESP]; Universidade Estadual de Campinas (UNICAMP); Universidade Federal de São Paulo (UNIFESP)
    The present bibliographic review followed a path through several chains of thought concerned with studying narratives. Some classical studies on narrative structure with origins within literature, history, communications theory and psychoanalysis were analyzed with the aim of exploring whether their categories and concepts would be methodologically applicable to qualitative health-related research. In the conclusions, the potential for using narratives to study situations in which there is interest in mediations between experience and language, between structure and events, between subjects and collective groups or between memory and political action are highlighted. These are questions that traditionally are of interest within Brazilian public health with regard to the field of Policy, Planning and Management.
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    Política Nacional de Atenção Básica: o que pensam e como operam seus trabalhadores?
    (Universidade Federal de São Paulo (UNIFESP), 2019) Bizetto, Olívia Félix [UNIFESP]; Cecilio, Luiz Carlos de Oliveira [UNIFESP]; http://lattes.cnpq.br/0618708799649594; http://lattes.cnpq.br/4219325063484456; Universidade Federal de São Paulo (UNIFESP)
    Introduction: The Primary Health Care (ABS) was constituted in Brazil under influence of preventivist movement, in a scenario of tension between individual attention and collective practices. The official formulations sought to broaden this concept, especially in the last two decades. In this context, and the workers, what conceptions of ABS bring, and how it influences your practice? Objectives: To characterize what workers consider to be the role of ABS and to identify if, and in what way, such conceptions influence their work. Methodology: The empirical material of the research-matrix was used: Primary Health Care as a strategy for (re)configuration of National Health Policies: the perspective of its professionals and users, with ethnographic clipping, which sought to capture the daily life of seven basic health care units (UBS) in the São Paulo state capital and metropolitan region, in which the researchers stayed from 8 to 12 hours a week, for 10 to 12 months, between 2014 and 2015. In the field journals of the researchers, scenes containing the concepts and practices of the workers about the guiding question of this investigation were selected. Results and Discussion: The scenes were organized from similarities and/or contiguity, composing "visibility plans", which made visible /tellable aspects of the daily life of the UBSs. It was verified that there are multiple tensions that cross the practice of the professionals, with heterogeneous adherence to the norms of the official formulations for the ABS, in particular the Brazil’s National Primary Health Care Policy and the National Health Humanization Policy: there are important limits to the tools that workers have to address social issues; the qualified listening and the accomplishment of an extended clinic sometimes happens, in contraposition to protocolic and biological practices; the moral judgments and user blame interfere with the care provided; teamwork shows itself with its potentialities and also weaknesses; a preventivist discourse persists on the part of the professionals, who expresses themselves in their speech and attitudes, prioritizing prevention and promotion actions, in detriment mainly to the attention to spontaneous demand; the reception, proposed to increase the listening capacity and resolution of demands that arrive at the units, emerges as a highlighted point of tension and conflict in the teams, either because of the conception they bring about the role of ABS, or because they see limited offers demand that seems to have no end. Final Thoughts: The senses that workers give to whatever the ABS have a strong power to guide their practices, and strongly interfere with the way health care is provided. However, this composition contains other elements, which need to be considered in the discussion spaces of ABS guidelines and in the different processes of workers' training, in order to enhance their role of caring for people.
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    A política nacional de saúde integral da população negra numa unidade saúde da família: compartilhando saberes
    (Universidade Federal de São Paulo, 2018-12-11) Batista, Mateus do Amaral [UNIFESP]; Pezzato, Luciane Maria [UNIFESP]; http://lattes.cnpq.br/0088988136074066; http://lattes.cnpq.br/8005527716384718
    A Política Nacional de Saúde Integral da População Negra (PNSIPN) é um marco histórico para saúde, e será o guia principal desse estudo, pois seu maior objetivo é oferecer suporte para o SUS, a fim de garantir que suas diretrizes sejam de fato eficazes para as pessoas que por conta do racismo institucional são submetidas a exclusão de direitos e acessos a saúde. Esta pesquisa teve início com a Iniciação Científica cujo o objetivo foi identificar qual o conhecimento e percepções que os trabalhadores de uma Unidade de Saúde da Família do município de Santos-SP tinham sobre a PNSIPN. Dando continuidade à pesquisa neste Trabalho de Conclusão de Curso (TCC), nosso objetivo é propor ações de diálogos a fim de promover visibilidade da PNSIPN entre os/as usuários e trabalhadoras da mesma unidade saúde da família. Optamos por realizar um estudo qualitativo, de caráter participativo, exploratório e narrativo. O diário de campo foi nossa ferramenta para o registro das percepções do pesquisador em todo o trabalho de campo. As oficinas foram gravadas e transcritas, após anuência de todos os envolvidos. Pretende-se com este estudo uma maior aproximação das propostas desta política com trabalhadores e usuários deste serviço, possibilitando sua implementação
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    A regionalização intramunicipal do Sistema Único de Saúde (SUS): um estudo de caso do município de São Paulo-SP, Brasil
    (Faculdade de Saúde Pública, Universidade de São Paulo.Associação Paulista de Saúde Pública., 2010-09-01) Spedo, Sandra Maria [UNIFESP]; Pinto, Nicanor Rodrigues da Silva [UNIFESP]; Tanaka, Oswaldo Yoshimi; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)
    Regionalization has been pointed out as one of the most important challenges concerning the achievement of integrality and equity in the Brazilian National Health System (SUS). This study aims to evaluate the implementation process of a regional health project in the city of São Paulo. A case study was carried out in a selected region in the city based on the implementation assessment methodology. The data sources were management reports and interviews with key informants, and the period of analysis was 2005-2008. The thematic analysis showed that the regionalization project was not effectively implemented. The main factors involved in this failure were: a) the Municipal Health Department maintained a centralized decision-making process and a separate organizational framework for primary health care and for hospital care; b) specialized outpatient clinics and hospital facilities remained under the state level management and not under municipal responsibility; c) hospitals' strengthened institutional power generated resistance to integrate a comprehensive health system. The municipal decentralization process in the Brazilian National Health System (SUS) is still a challenge. It is important to identify new strategies to be able to improve the negotiation process among health managers, bringing together health organizations, in order to reach a cooperative and effective regionalization process within the National Health System in Brazil.