Navegando por Palavras-chave "Health policy"

Agora exibindo 1 - 20 de 25
  • Imagem de Miniatura
    Item
    Acesso aberto (Open Access)
    O agir leigo e a produção de mapas de cuidado mistos público-privados
    (Abrasco, 2017) Meneses, Consuelo Sampaio [UNIFESP]; de Oliveira Cecilio, Luiz Carlos [UNIFESP]; Andreazza, Rosemarie [UNIFESP]; Carapinheiro, Graca; Garcia Andrade, Maria da Graca; Santiago, Silvia Maria; Araujo, Eliane Cardoso [UNIFESP]; Medeiros Souza, Ana Lucia [UNIFESP]; Reis, Denizi Oliveira [UNIFESP]; da Silva Pinto, Nicanor Rodrigues [UNIFESP]; Spedo, Sandra Maria [UNIFESP]
    This paper discusses part of the results obtained from a study carried out in two cities of the so-called ABCD Paulista Region in the period 2010-2012, in an attempt to spot the existence of non-state regulatory rationale towards access and consumption of health care services. The first stage includes interviews carried out with strategic stakeholders (managers and politicians) and key workers players. The second stage collected the stories of 18 very frequent users of health care services. This study revealed the leading role played by users to produce "health care maps", with emphasis on the frequent use of public and private resources in their itineraries, circumventing or merging with government regulation to obtain the care they need. The different formats of public-private mix transcend the still prevailing "official" concepts about the clear distinction between the two systems, which reveals the importance of this theme to public health management.
  • Imagem de Miniatura
    Item
    Acesso aberto (Open Access)
    Análise qualitativa e quantitativa da produção legislativa relacionada à saúde em tramitação no Congresso Nacional nos anos de 2007 e 2008
    (Universidade Federal de São Paulo (UNIFESP), 2011-02-22) Santos, Viviane Cristina dos [UNIFESP]; Ferraz, Marcos Bosi [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    This dissertation had the objective to describe and analyse qualitatively and quantitatively the legislative production which deals with health, at the National Congress, happening in 2007 and 2008. It was done a descriptive-exploratory study with transverse cut and quantitative and qualitative approach. The material of analysis from the study was constituted by 112 draft bills which were performed at Social Security and family (House of representatives) and 32 draft bills at the Social Subjects (Federal Senate), related to health, which were performed from January 2007 to December 2008. The research had two distinctive phases, at the first phase there was a quantitative research through stratification, classification and analysis of the draft bills. At the second phase there was a qualitative approach made through a questionnaire containing closed questions to a specific group of professionals who performed in the Health System and the objective was to analyse the relevance, viability, strategic balance and impact of the selected projects. At the end of the study, the following results were found; from the 144 possibilities, 57,6% of the draft bills selected were presented in 2007 and 42,4% in 2008. The Labour Party, PT, was the one which most presented draft bills (12,5%) followed by PMDB (11,1%) and PSDB (10,4%). Only 25,7% of the Members of the Congress who presented draft bills deal with Health Policy. After a year of gathering the material to analyse the study, was verified that the majority of the draft bills (93,7%) were still being done, 4,9% were filed and only 1,4% were transformed in juridical norm. Considering the aim of the draft bills related to health, more than a half (57,7%) of the draft bills are related to the SUS ( Public Health Care ) and only 4,2% are related to quotation (financing for health). Considering the result of the applied questionnaire, 78,1% from the questioned people were dissatisfied, very dissatisfied with the Legislative Power and 41,8% classified as bad, extremely bad; at the private Health System only 9,6% considered bad, extremely bad. In relation to the criteria of the draft bills, more than a half (51,5%) from the questioned people declared that they did not understand, in the draft bills, the way of making viable what was proposed, 40,6% answered that there is no relevance; 52,7% answered there is not strategic balance from the draft bills to the priorities and the health policies of the country and 52,5% answered that the refusal of the draft bills would not bring negative impacts or would be prejudicial to the Brazilian society. Through a public enquire, more than a half (54,4%) answered they would approve the draft bill they analysed; 30,1% would not approve and 10,1% did not answer. Through the data of this study we can perceive that the Legislative production, related to health, is low; the members of the congress with academic graduation in the health area has a low output (25% of the amount) and the draft bills which become juridical norm is minimal (only 1,4% of the amount). It is important to point out the high rate of insatisfaction with the Legislative Power, with the Health Public Brazilian System and the low quality of the legislative production at the National Congress.
  • Imagem de Miniatura
    Item
    Acesso aberto (Open Access)
    Atenção integral ao portador da síndrome do olho seco grave pelo SUS: um estudo exploratório
    (Universidade Federal de São Paulo (UNIFESP), 2017-05-09) Almeida, Cleivania Lima de [UNIFESP]; Lacaz, Francisco Antonio de Castro [UNIFESP]; Gomes, José Álvaro Pereira [UNIFESP]; http://lattes.cnpq.br/2506247984223015; http://lattes.cnpq.br/7579223130627761; Universidade Federal de São Paulo (UNIFESP)
    Objective: Describing the paths covered by the Dry Eye Syndrome patient in search of the integral attention of health care by the Unified Health System (SUS). The object of study was constructed from the contextualization of the disease in the world scenario, including in Brazil, the understanding of the disease as a public health problem, as well as from the point of view of systemic integrality, through public policies, and the integral attention of individual health care, including psychosocial aspects. Method: This is a research with a qualitative and exploratory approach that involved two stages: the theoretical-conceptual and the empirical. In the first one, papers which approach the theme of this study were used, including a bibliographical research corresponding to the period of 2011-2015. In the second stage, the tools used were the observance of focal groups and semi-structured interviews, and as support, the field diary. The focal groups, with the participation of users of the Outpatient Clinic of External Diseases and Cornea, with Dry Eye Syndrome, in order to know the paths covered in the search for integral care. The final sample for the analysis consisted of 14 participants. The semi-structured interviews with managers of the Department of Ophthalmology to know the dynamics of the functioning of the services, including psychosocial assistance, and the ophthalmologist, regarding the assistance to the bearer of Dry Eye Syndrome by the service studied. The field diary was the instrument used to register the recognition of the research scenario, as well as other events during the study, including during focus groups and semi-structured interviews. This study was carried out in a university service linked to the Department of Ophthalmology of a Medical School linked to a Federal University. Results: Regarding the empirical analysis, it can be affirmed that health care for patients with Dry Eye Syndrome falls short of the principle of integrality. In both management and care, the Unified Health System has gaps that affect the quality of life of people suffering from the disease. Considerations: Finally, this study proposes some actions aiming at making the SUS more accessible to the bearer of Dry Eye Syndrome, including suggesting the approach of the Department of Ophthalmology with the basic network, the integration between psychology / psychotherapy services, social care and clinical-surgical ophthalmology, and, in the service studied, the stimulus for the formation of a support group with patients with the disease in partnership with the Association of Carriers of Dry Eye, an entity considered as the spokesperson for those who suffer from this disease to the Brazilian population, through its actions.
  • Imagem de Miniatura
    Item
    Acesso aberto (Open Access)
    Avaliação do sistema de saúde: serviços de saúde mental integrados à rede pública de saúde no município de Cotia, São Paulo, Brasil
    (Universidade Federal de São Paulo, 2022-02-15) Caparroce, Daniela Cheli [UNIFESP]; Razzouk, Denise [UNIFESP]; http://lattes.cnpq.br/2570757108117687; http://lattes.cnpq.br/4104165877603167
    Introdução: A adoção por diversos países do modelo de saúde mental comunitário desafia a organização, financiamento e avaliação dos serviços de saúde mental, bem como sua integração ao sistema como um todo. No Brasil, embora o número de centros comunitários de saúde mental tenha aumentado nas últimas duas décadas, pouco se sabe sobre sua distribuição e organização desigual são influenciadas por fatores locais, como disponibilidade de mão de obra, diferenças entre áreas rurais e urbanas, e indicadores sociais e econômicos da população. A avaliação longitudinal dos serviços de saúde mental é crucial, em parte para apoiar gestores de saúde, mas principalmente para projetar políticas de saúde mental que permitam a alocação de recursos financeiros de forma mais eficaz e eficiente no sistema de saúde. Objetivo: Este estudo visa classificar e comparar a distribuição dos serviços e profissionais que compõem a RAPS nos distritos do município de Cotia, São Paulo, Brasil. Método: Trata-se de um estudo longitudinal, retrospectivo, referente ao período de janeiro a julho de 2018, em que foram consultados o Portal da Transparência da Secretaria de Saúde de Cotia para a obtenção de dados demográficos e disponibilidade dos serviços e profissionais nos distritos de saúde. Os serviços foram classificados usando a Descrição e Avaliação dos Serviços e Diretórios de Atendimento, Cuidados de longa duração (DESDE-LTC). Os custos dos atendimentos foram estimados pela abordagem topdown, sob a perspectiva do SUS. Resultados: Os resultados foram úteis para identificar potencialidades e falhas na distribuição dos serviços e profissionais de saúde mental, que podem ser norteadoras para melhorar práticas de gestão, além de ser uma abordagem para comparar as regiões e sistemas de saúde mental.
  • Imagem de Miniatura
    Item
    Acesso aberto (Open Access)
    O difícil acesso a serviços de média complexidade do SUS: o caso da cidade de São Paulo, Brasil
    (IMS-UERJ, 2010-01-01) Spedo, Sandra Maria [UNIFESP]; Pinto, Nicanor Rodrigues da Silva [UNIFESP]; Tanaka, Oswaldo Yoshimi; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)
    The population access to the secondary health care services is being pointed, by managers and researchers, as one of the challenges to the implementation of integrality in the Brazilian National Health System (SUS). This paper aims to evaluate the mechanisms used by SUS manager's, in the city of São Paulo, to guarantee medical assistance, from 2005 to 2008. The strategy of case study was chosen, using as data sources such as managers interviews, focus groups with SUS users, and participative observation. Thematic analysis was performed on health services organization, with theoretical references of the integrality concept. We tried to describe the path covered by the users to have access to the services, based on the view of users and managers. Secondary health care services were identified by managers as the neck of a bottle and one of the main obstacle to the SUS integrality. To overcome this situation, the municipal manager invested in the computerization of services, as an isolated step, and still, without considering user´s needs. However, this technological incorporation had low impact on the improvement of the population access to the secondary health care services, which was confirmed by user's source. It is argued that to face such complex problem it will be necessary to articulate actions, not only in health politics but also in health services organization and also in the (re)organization of the working process in any other level of the health system.
  • Imagem de Miniatura
    Item
    Acesso aberto (Open Access)
    Education of dietitian's in Brazil: Minimum clock hours of instruction for a bachelor's degree in nutrition
    (Pontifícia Universidade Católica de Campinas, 2013-10-01) Medeiros, Maria Angélica Tavares de [UNIFESP]; Amparo-Santos, Ligia; Domene, Semíramis Martins Álvares [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Federal da Bahia Escola de Nutrição Departamento de Ciências da Nutrição
    This essay aims to debate the minimum clock hours of instruction necessary for obtaining a bachelor's degree in nutrition considering the challenges to educate health professionals. Official documents on the minimum clock hours of instruction required by undergraduate nutrition programs were analyzed to investigate compliance with the curriculum guidelines for the area, the law that regulates the profession of dietitian, and the necessary education for the Sistema Único de Saúde (Unified Health Care System). Compared with other health programs, nutrition presented the smallest increase in the minimum clock hours of instruction required for the degree. The changes that occurred in the epidemiological, demographic, and nutritional profile of the population and scientific advances require specific nutrition actions. Since Sistema Único de Saúde focuses on comprehensiveness in the three levels of care, on humanization, and on health care, the theoretical and methodological concepts given in undergraduate programs need to be improved for the dietitians education to meet the Sistema Único de Saúde needs. Incorporation of the knowledge needed for working with food and nutritional phenomena, including its social and cultural dimensions, management of public policies, quantity cooking, and food and nutritional surveillance requires a higher minimum clock hours of instruction. In conclusion, dietitians need a minimum clock hours of instruction of 4,000 to acquire a proper education, integrate into the university life, and coordinate interdisciplinary experiences of the triad teaching/research/extension.
  • Imagem de Miniatura
    Item
    Acesso aberto (Open Access)
    O ensino na área da saúde envolve a interseção de duas grandes áreas de conhecimento - educação e saúde
    (Universidade Federal de São Paulo (UNIFESP), 2016-08-25) Bahia, Silvia Helena Arias [UNIFESP]; Batista, Sylvia Helena Souza da Silva [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Introduction: The teaching in health education area in undergraduate and graduate levels, involves the intersection between two major areas of knowledge, the education and the health, both are constituted in the networks of the social, culture, institutional, economic and political. From 2003, the training and the teaching in health took a prominent role in the context of education and health policies, in order to ensure qualified training to health professionals and contribute to a resolutely and better health care. In this sense, inducing initiatives were implemented, among which the Pro-Education in Health, which was established collaboratively in 2010 by the Ministry of Health (MOH), in partnership with the Ministry of Education (MEC) and CAPES. Objective: To understand the inducer potential of the Pro-Education in Health, from the in a perspective of a training policy in the stricto sensu level, and of development of research on teaching in health. Methods: The study used mixed methods through the integration of quantitative and qualitative, through the methodological integration model dialogical type, being built in view of the triangulation of data, carried out from 2011 to 2016. The production data understood documentary analysis of the 31 projects included in the Notice 24/2010 and semi-structured interviews with 17 project coordinators. The data analysis was undertaken from the content analysis, of the thematic type. Results: The analysis of projects identifies that within the areas of CAPES evaluation, the Health Sciences was the Great predominant area, highlighting the medical and nursing majors, among the areas of knowledge. It was observed that the subject area, "The training and development of teacher in health" was the most interest; and the lower demand were the "teaching management in health," and the "integration between health, education, science, and technology policies". The South and Southeast regions concentrated the largest number of projects, covering 32 institutions and 59 Graduate Programs. It was conducted subjective analysis of 395 titles of research developed. The recurring terms were training and evaluation, and of less quotation was management. The analysis of the documents and of the voices of interviewed made possible to characterize the potential of the Pro-Education in Health on three main themes: the training, the research and the policy. In the context of thematic, the training in the Pro-Health Education emerge two categories: responses to the demand for education and training paths. The second theme that emerges from the potential of the Pro-Education in Health is the research, identifying two categories: (1) interfaces between the lines of research focus area and the objects of study and (2) the challenges for recognition the scientific area. The third thematic relates to the policy: 19 higher education institutions participants of the Pro-Education in Health has established and / or developed partnership with programs and policies, among which stands out the adherence to the Education Programs at Work in Health (Pet- health) and Reorientation National Program for Professional Training in health (Pro-health). The Difficulties or critical problems identified in the development of the projects are directed to issues of institutional relations and resource management: Link of the Project to the Graduate Program, use of resources, operational support, program coordination and (lack of) knowledge of institutional peers. The strengths of the research focus are the perspective of the coordinators, financing, institutional partnerships and the formation of collaborative networks. With regard to partnerships with the service recorded the desire to strengthen relations, assuming that exist much to build, as also emphasized the importance of establishing research networks and the scope of the connections that they make possible. Conclusions: Pro-Education in Health strengthened the qualified training process and teaching in health research, in the hope that they may carry out changes in the academy and the health service daily. In this context, it is assumed that the Pro-Education in Health as an inducer policy by developing collaborative networks and the production of knowledge, but also confronted with the challenge to establish itself as an effective constituent of a public policy formation and health work.
  • Imagem de Miniatura
    Item
    Acesso aberto (Open Access)
    Health technology assessment in Brazil: what do healthcare system players think about it?
    (Associação Paulista de Medicina - APM, 2011-01-01) Ferraz, Marcos Bosi [UNIFESP]; Soárez, Patricia Coelho de; Zucchi, Paola [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)
    CONTEXT AND OBJECTIVES: The health technology assessment (HTA) process has been developed locally. The aim of this study was to describe, analyze and compare the opinions of participants in international health economics symposia about the HTA process used in Brazil. DESIGN AND SETTING: Observational cross-sectional study at the 2006 and 2008 International Health Economics Symposia, in São Paulo. METHODS: A structured questionnaire was applied. For the statistical analysis, the percentage distribution for each category was calculated, and variables were compared using tests for two-sample proportion hypotheses. RESULTS: Totals of 153 and 74 participants answered the 2006 and 2008 surveys, respectively. The response rate was better for the 2006 survey (67.1%) than for the 2008 survey (31.8%). Most interviewees were between the ages of 30 and 49 years and were managers in the healthcare system. Most of them considered that the current HTA process was incomplete and unable to meet the needs of the healthcare system. They mentioned the government, academia and experts as the three main groups of people who should be involved in the process, and selected efficiency/effectiveness, safety and disease relevance as the three main criteria to be considered in the HTA process. There is a trend towards developing decentralized regionalized HTA processes, with separate assessment and decision-making for the public and private systems. CONCLUSIONS: The HTA concept is well known. Healthcare system players feel that the process has methodological limitations. Additional surveys are needed to track the HTA process and its application in Brazil.
  • Imagem de Miniatura
    Item
    Acesso aberto (Open Access)
    Iniciativa Hospital Amigo da Criança: uma política de promoção, proteção e apoio ao aleitamento materno
    (Escola Paulista de Enfermagem, Universidade Federal de São Paulo (UNIFESP), 2012-01-01) Figueredo, Sonia Fontes; Mattar, Maria José Guardiã; Abrão, Ana Cristina Freitas de Vilhena [UNIFESP]; Hospital Maternidade Leonor Mendes de Barros; Hospital Maternidade Leonor Mendes de Barros Banco de Leite; Universidade Federal de São Paulo (UNIFESP)
    OBJECTIVE: To conduct a literature review about the ten steps of the Baby Friendly Hospital Initiative (BFHI). METHODS: We sought documents and scientific papers published in the databases of PubMED, Medline, SciELO and LILACS. RESULTS: We initially identified 110 references about the BFHI, between the years of 1979 to 2009. Approximately 21% were published in the 1990s and 79% between 2000 and 2009; 10.8% were published in books and official documents of the Ministry of Health, Pan American Health Organization and World Health Organization; and, 89.2% were in articles indexed in the consulted databases. Of these, 35 references were selected. The analyzed studies showed that changes in hospital practices according to the Ten Steps of BFHI increased the prevalence of breastfeeding. CONCLUSION: Through the studies analyzed, the BFHI showed effectiveness in increasing breastfeeding in many regions of the world, contributing to the reduction of infant morbidity and mortality.
  • Imagem de Miniatura
    Item
    Acesso aberto (Open Access)
    Is psychiatric reform a strategy for reducing the mental health budget? The case of Brazil
    (Associação Brasileira de Psiquiatria - ABP, 2007-03-01) Andreoli, Sergio Baxter [UNIFESP]; Almeida-Filho, Naomar; Martin, Denise [UNIFESP]; Mateus, Mário Dinis [UNIFESP]; Mari, Jair de Jesus [UNIFESP]; Universidade Católica de Santos; Universidade Federal de São Paulo (UNIFESP); Universidade Federal da Bahia Institute of Collective Health
    OBJECTIVE: To investigate trends in the provision of mental health services and financing in Brazil. METHOD: Data from DATASUS (the Brazilian Unified Health Computerized System) with free access in the web were collected regarding the number of beds, the development of new community centers, the number of mental health professionals, and costs involved from 1995 to 2005. RESULTS: In ten years, the number of psychiatric beds decreased 41% (5.4 to 3.2 per 10,000 inhabitants) while community services have increased nine-fold (0.004 to 0.037 per 10,000 inhabitants). Psychologists and social workers have accounted for three and two-fold, respectively, as much hirings as psychiatrists. Psychiatric admissions accounted for 95.5% of the budget in 1995 and 49% in 2005, and the expenses with community services and medication have increased 15% each. As a whole, the expenses in mental health decreased by 26.7% (2.66 to 1.95 US$ per capita). CONCLUSION: There has been a clear switch from hospital to community psychiatric care in Brazil, where the system can now provide a diversity of treatments and free access to psychotropics. However, the coverage of community services is precarious, and the reform was not accompanied by an increased public investment in mental health. The psychiatric reform is not a strategy for reducing costs; it necessarily implies increasing investments if countries decide to have a better care of those more disadvantaged.
  • Imagem de Miniatura
    Item
    Acesso aberto (Open Access)
    Levantamento das políticas e recursos em saúde mental no Brasil
    (Universidade Federal de São Paulo (UNIFESP), 2009-07-29) Mateus, Mário Dinis [UNIFESP]; Mari, Jair de Jesus [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Introduction: A health policy is not an independent technical process, but a compromised negotiation with the choice between conflicting positions that steam from historical, social and economical factors that need to be taken into account in an evaluation process. Objectives: The aim of this paper is to evaluate the mental health policy in use nowadays in Brazil, calling attention to its advantages and disadvantages and how efficient it is in relation to its aims. Methods: We have used the WHO-AIMS, an instrument developed by WHO to systematize the description of resources and processes involved in the health care system. The data sources were extracted from the following sources: governmental data sets, (DATASUS and CNES); interviews with the Mental Health Coordination, the Health Ministry; a questionnaire to qualified informants; in addition to a legislation review, governmental documentation and studies linked to the Brazilian mental health system and the reform of psychiatric attention that took place in the last decades. Results: The Brazilian mental health policy was successful in obtaining social and governmental support to make a reform in mental health care. The advent of the SUS (Unified Health System), which happened at the same time, was fundamental to generate principles and investments to the mental health policy. The system is based in the principle of community care, with action centralized in the Psychosocial Community Centers (CAPS). There was a significant reduction of psychiatric hospital beds, and many long-stay patients have had access to a therapeutic residence program as well as a monthly rehabilitation benefit. Both the integration in the basic attention actions and in the general hospital is too far from what is needed. There is a small number of professionals well trained for the new model and the ideal of multi-professional team that, even though it is less dependent on the psychiatrist figure (a long and expensive formation, almost inexistent away from the great urban centers), it also brings the risk of actions lacking specialized knowledge and low quality care. The information system, essential to guide action planning in mental health, still needs to be improved, for its lack of data in many areas that are strategic to the mental health policy. Conclusion: The data shows that the mental health system reform presented, in the last two decades, intense chances in the psychiatric care model, in financial resources destination, and in the legislative framework. The mental health system in Brazil is based on a hybrid policy that moves in constant tension between different conceptions of psychiatric care reform: the traditional communitarian psychiatry and the one strongly influenced by the Italian psychiatric reform, sometimes generating contradictions and lack of clarity in the mental health policy planning.
  • Imagem de Miniatura
    Item
    Acesso aberto (Open Access)
    Mental health and psychiatric care in Bolivia: what do we know?
    (Biomed Central Ltd, 2014-05-15) Jaen-Varas, Denisse [UNIFESP]; Ribeiro, Wagner Silva [UNIFESP]; Whitfield, Jessie; Mari, Jair de Jesus [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); St Louis Univ
    Background: Recently Bolivia has implemented a universal health system, but their mental health policy is still emerging.Objectives: To investigate the current state of the mental health care system in Bolivia and discuss challenges for structuring a coordinated network of services that can effectively meet the needs of the Bolivian population.Methods: This review was conducted by searching for scholarly articles through the databases Lilacs, Medline OPS, HISA and IBECS REPIDISCA via the search portal in the Virtual Health Library - NLM (www.bireme.br).Results: Bolivia has a National Mental Health Plan that is intended to guide mental health promotion, prevention, treatment and rehabilitation of mental illness, but the resources for this area of health are limited. There are 1.06 psychiatrists and 0.46 psychologists per 100, 000 inhabitants. Information on psychiatric morbidity in Bolivia and the impact of mental disorders on the global burden of disease is scarce. Admission statistics reported by psychiatric hospitals in the country show that the main cause of hospitalization is substance abuse (30%). Alcohol consumption is responsible for 90% of these admissions, in addition to being a major cause of deaths in traffic and one of the main risk factors for domestic violence. Almost one in two women in Bolivia (47%) experienced some form of violence from their partner in the last year. Nineteen percent of women living with a partner reported being physically abused, while 7% were sexually abused by their partners. Isolated studies report that suicide rates are disproportionately high in Bolivia.Conclusions: Although there is a shortage of epidemiological data in Bolivia, it is clear the impact of alcohol addiction in psychiatric admissions, domestic violence and traffic accidents. Violence against women and suicides are important issues to be tackled. Among the proposed strategies to afford human resources for mental health in Bolivia, task shifting, the delegation of tasks to non-specialists should be extensively adopted in the country to improve mental health care.
  • Imagem de Miniatura
    Item
    Acesso aberto (Open Access)
    Mental health research in Brazil: policies, infrastructure, financing and human resources
    (Faculdade de Saúde Pública da Universidade de São Paulo, 2006-02-01) Mari, Jair de Jesus [UNIFESP]; Bressan, Rodrigo Affonseca [UNIFESP]; Almeida-Filho, Naomar; Gerolin, Jerônimo [UNIFESP]; Sharan, Pratap; Saxena, Shekhar; Universidade Federal de São Paulo (UNIFESP); Universidade Federal da Bahia Instituto de Saúde Coletiva; World Health Organization Department of Mental Health and Substance Abuse
    The objective of this descriptive study was to map mental health research in Brazil, providing an overview of infrastructure, financing and policies mental health research. As part of the Atlas-Research Project, a WHO initiative to map mental health research in selected low and middle-income countries, this study was carried out between 1998 and 2002. Data collection strategies included evaluation of governmental documents and sites and questionnaires sent to key professionals for providing information about the Brazilian mental health research infrastructure. In the year 2002, the total budget for Health Research was US$101 million, of which US$3.4 million (3.4) was available for Mental Health Research. The main funding sources for mental health research were found to be the São Paulo State Funding Agency (Fapesp, 53.2%) and the Ministry of Education (CAPES, 30.2%). The rate of doctors is 1.7 per 1,000 inhabitants, and the rate of psychiatrists is 2.7 per 100,000 inhabitants estimated 2000 census. In 2002, there were 53 postgraduate courses directed to mental health training in Brazil (43 in psychology, six in psychiatry, three in psychobiology and one in psychiatric nursing), with 1,775 students being trained in Brazil and 67 overseas. There were nine programs including psychiatry, neuropsychiatry, psychobiology and mental health, seven of them implemented in Southern states. During the five-year period, 186 students got a doctoral degree (37 per year) and 637 articles were published in Institute for Scientic Information (ISI)-indexed journals. The investment channeled towards postgraduate and human resource education programs, by means of grants and other forms of research support, has secured the country a modest but continuous insertion in the international knowledge production in the mental health area.
  • Imagem de Miniatura
    Item
    Acesso aberto (Open Access)
    Ministers of Health: short-term tenure for long-term goals?
    (Associação Paulista de Medicina - APM, 2011-03-01) Ferraz, Marcos Bosi [UNIFESP]; Azevedo, Rafael Teixeira [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    CONTEXT AND OBJECTIVE: Healthcare investments should consider short and long-term demands. The objectives here were to compare the average tenures of ministers of health in Brazil and in another 22 countries and to evaluate the relationship between ministers' tenures and a number of indicators. DESIGN AND SETTING: Descriptive study conducted at Centro Paulista de Economia da Saúde (CPES). METHODS: Twenty-two countries with the highest Human Development Indices (HDIs) and Brazil were included. The number of ministers over the past 20 years was investigated through each country's Ministry of Health website. Pearson's correlation coefficient was used to compare the number of ministers in each country with that country's indicators. The Mann-Whitney test was used to compare ministers' tenures in Brazil and other countries. RESULTS: The mean tenure (standard deviation, SD) of Brazilian ministers of health was 15 (12) months, a period that is statistically significantly shorter than the mean tenure of 33 (18) months in the other 22 countries (P < 0.05). There was a moderate and statistically significant positive correlation between the number of ministers and mortality rates for several conditions. The number of ministers also presented moderate and statistically significant negative correlations with per capita total healthcare expenditure (r = -0.567) and with per capita government healthcare expenditure (r = -0.530). CONCLUSION: On average, ministers of health have extremely short tenures. There is an urgent need to think and plan healthcare systems from a long-term perspective.
  • Nenhuma Miniatura disponível
    Item
    Acesso aberto (Open Access)
    Os modelos em saúde mental de santos e São Paulo e a política nacional de saúde mental: a história desvelada
    (Universidade Federal de São Paulo (UNIFESP), 2014) Vieira, Marcia do Nascimento [UNIFESP]; Marcolan, Joao Fernando [UNIFESP]; http://lattes.cnpq.br/5449589014899461; Universidade Federal de São Paulo (UNIFESP)
    A Política Nacional de Saúde Mental tem história recente, e se mostrou possível após período de grande mobilização social durante a redemocratização do País, por meio de importantes movimentos sociais como a Reforma Sanitária e a Reforma Psiquiátrica. Experiências consideradas inovadoras em Saúde Mental ocorreram nos municípios de Santos e São Paulo entre as décadas de 1980-1990, e são apresentadas como referências na escolha do modelo CAPS (Centro de Atenção Psicossocial), serviço substitutivo ao hospital psiquiátrico e norteador desta política. Neste estudo analisamos a influência destas experiências na escolha do modelo CAPS, utilizando como Metodologia a História oral, por meio das narrativas de atores sociais (nossos colaboradores) que participaram de sua execução nos municípios mencionados, assim como de representantes do Ministério da Saúde que estavam à frente da Política Nacional de Saúde Mental dessa época. Concluímos que a influência do modelo santista foi predominante nos aspectos ideológicos em decorrência da maior penetração de seus representantes na esfera política e partidária (Partido dos Trabalhadores) no aparelho estatal. A experiência inovadora de Política de Saúde Mental construída na cidade de São Paulo foi excluída da história oficial, e o CAPS (Centro de Atenção Psicossocial) Itapeva, serviço estadual independente da rede de Saúde Mental municipal foi mantido como serviço inspirador para a escolha do CAPS atual. A Política Nacional de Saúde Mental vem tentando ao longo dos doze anos desta escolha implantar um modelo centrado em serviço especializado e pautado na sua execução no paradigma psiquiátrico, por não ter havido superação da lógica manicomial. Tal contexto demonstra distanciamento das proposições antimanicomiais originárias da Reforma psiquiátrica brasileira presentes nas primeiras Conferenciais Nacionais de Saúde Mental.
  • Imagem de Miniatura
    Item
    Acesso aberto (Open Access)
    Oral health care after the National Policy on Oral Health - Smiling Brazil: a case study
    (ABRASCO - Associação Brasileira de Saúde Coletiva, 2015-01-01) Aquilante, Aline Guerra; Aciole, Geovani Gurgel; Universidade Federal de São Paulo (UNIFESP)
    In 2004, the National Oral Health Policy (PNSB) - Smiling Brazil was launched. Its guidelines seek to qualify Primary Health Care, ensure comprehensive actions, work on the basis of health surveillance, plan actions in accordance with the epidemiology and information available on the territory, financing and scheduling the research agenda so that the work can be based on scientific evidence. The purpose of this case study was to investigate the perspectives of health care professionals and managers on oral health care after launching the PNSB. For the gathering of information, an oral interview was conducted with health care professionals and managers and direct observation of oral health services. The interpretation of meaning method was used for analysis of the interviews. Approximately 10 years after launching the PNSB, even though the care and the oral health actions have been amplified and qualified, the cities still find it difficult to implement their basic premises.
  • Imagem de Miniatura
    Item
    Acesso aberto (Open Access)
    Parteiras indígenas e os objetos do partejar : apropriação, usos, sentidos e significados
    (Universidade Federal de São Paulo (UNIFESP), 2017-11-17) Gusman, Christine Ranier [UNIFESP]; Villela, Wilza Vieira [UNIFESP]; Rodrigues, Douglas Antonio [UNIFESP]; http://lattes.cnpq.br/7808005294527243; http://lattes.cnpq.br/1311802831007681; http://lattes.cnpq.br/7658080225128628; Universidade Federal de São Paulo (UNIFESP)
    This thesis is the result of a study that sought to analyze the strategies of the Working with Traditional Midwives Program and its repercussions on a group of Krahô women. Midwife kit delivery is an icon of the program, a presumption that a new practice aligned with hegemonic knowledge will begin there after. Thus, the study sought to analyze how Krahô women view their participation in the program and take ownership of and resignify midwife kit objects in the home birth context. The thesis is structured in four papers, each representing different moments of the study. The first two occurred prior to fieldwork and result from issues raised during the development stage of the midwifery program and throughout the process of approval by ethics committees.The last two stem from fieldwork and were mainly supported by anthropology and the ethnographic method. The procedures for the ethical approval of the study were tortuous and overly bureaucratic. Experience has indicated that ethical or unethical stances can be experienced in the singular and subjective processes, regardless of what may be recorded in forms. Results point to a mismatch between the discourse and the practice of recognizing traditional knowledge and a clear ethnocentric bias of the program when offering tools outside the rationale of women care and assuming an impact on health indicators from the acquisition of hegemonic knowledge. The objects were appropriated and resignified in the daily life of villages, but they failed to find a clear place in the context of home birth. Symbolic violence traits emerged and the categorization of Krahô women as midwives brought impacts and losses in the social relationship of some women. We suggest reviving the intercultural realm in the formulation and implementation of public policies directed to this public as a profitable pathway, under penalty of engendering an alienated and alienating cycle, wasting resources and delaying important discussions such as the strengthening of the health care network around indigenous women.
  • Imagem de Miniatura
    Item
    Acesso aberto (Open Access)
    Percepções dos usuários de crack sobre suas relações familiares
    (Universidade Federal de São Paulo (UNIFESP), 2015-04-24) Barros, Naiara Alves de [UNIFESP]; Tucci, Adriana Marcassa [UNIFESP]; Silva, Eroy Aparecida da [UNIFESP]; http://lattes.cnpq.br/8738343026653952; http://lattes.cnpq.br/6278405456405903; Universidade Federal de São Paulo (UNIFESP)
    Drug use is a matter of public health, and the use of crack generates individual, family and social consequences, now getting worrying dimensions to the State and society in general. However, few national studies on family relationships of crack users although it is known that the family can be both a protective factor as a risk in relation to the abuse of alcohol or other drugs. This study aimed to understand the crack users perception of their family relationships. And the specific objectives were to understand the dynamics and family composition in childhood and adolescence of crack users, analyze drug use history, identify the access to health and social care services in the city of Santos / SP; and see how the public policies of health and social care are responding to the needs of crack users and their families. The method used was qualitative and the data were analyzed through content analysis. We interviewed 29 crack users of both sexes and aged eighteen years through semistructured interviews. The analysis categories were: family relationships and the fragility of bonds; crack and other drugs in the family context; family support network and access to health and social care services. Various problems faced by households related to drug use was reported, with the support of this was reported by users as an important form of motivation to control the use of this drug. The perception of crack users on its relations with the family of origin reveals the presence of several factors associated with increased vulnerability to drug use. The result of this study can help implement new forms of prevention and intervention with crack users, strengthening for public policies to take effect according to the issues presented by crack users and their families.
  • Imagem de Miniatura
    Item
    Acesso aberto (Open Access)
    A política nacional e a rede de cuidados à pessoa com deficiência no SUS: contextos de influência e de produção de textos
    (Universidade Federal de São Paulo, 2024-06-21) Kielmann, Samara [UNIFESP]; Reis, Ademar Arthur Chioro [UNIFESP]; Tofani, Luis; http://lattes.cnpq.br/3164317524680020; http://lattes.cnpq.br/9454572596499303; http://lattes.cnpq.br/8262399466196346
    Objetivo: Analisar os contextos de influência e de produção de texto da Política Nacional e da Rede de Cuidados às Pessoas com Deficiência no SUS. Método: A pesquisa tem caráter qualitativo. Foi desenvolvida por meio de revisão de literatura, análise de documentos e entrevistas com atores-chave que participaram da formulação da Política Nacional e da Rede de Cuidados à Pessoa com Deficiência (PCD). A análise teve como principal referência a Abordagem do Ciclo de Políticas desenvolvida por Ball e Bowe, uma abordagem crítica ao modelo estruturalista, flexível e não linear. Resultados e discussão: Os principais resultados apontam para uma Política Nacional de Saúde da Pessoa com Deficiência (PNSPCD) prescritiva e com pouca participação do movimento social em sua produção. Tem como influência o modelo biomédico da deficiência, a reabilitação como única forma de cuidado e evidencia as instituições filantrópicas enquanto principais responsáveis pela agenda e assistência às Pessoas com Deficiência. Já a Rede de Cuidados à Pessoa com Deficiência (RCPCD) apresenta maior influência do modelo social da deficiência e forte influência da Convenção Internacional dos Direitos da PCD, especialmente em relação ao conceito definidor de PCD. A rede de cuidados induz uma discussão mais ampla sobre cuidado e destaca a reabilitação enquanto parte de um processo maior e mais complexo que privilegia a participação do usuário no seu cuidado. Estabelece os Centros Especializados em Reabilitação (CER) como principal local de cuidado deste público, mas o coloca como matriciador da rede de atenção à saúde. Considerações finais: A abordagem do ciclo de políticas de Ball e Bowe contribui para a análise de políticas públicas de saúde na medida em que é um método de campo aberto e que provoca a reflexão sobre desconstrução de conceitos e certezas e induz engajamento crítico. A PNSPCD foi importante porque deu visibilidade ao tema à época de sua formulação. No entanto, possui muitas questões a serem superadas. A RCPCD se apresenta com a intencionalidade de ampliar acesso e fortalecer a integralidade do cuidado.
  • Imagem de Miniatura
    Item
    Acesso aberto (Open Access)
    Quantitative and qualitative analysis on the legislative production relating to healthcare in passage in the National Congress in the years 2007 and 2008
    (Associação Paulista de Medicina - APM, 2013-01-01) Santos, Viviane Cristina dos [UNIFESP]; Ferraz, Marcos Bosi [UNIFESP]; Universidade Federal de Minas Gerais Health Economics Research Group Center for Health Economics and Researcher; Universidade Federal de São Paulo (UNIFESP)
    CONTEXT AND OBJECTIVES:The Federal Constitution of 1988 allowed the National Congress to contribute towards formulation of new public policies. The objective of this study was to analyze the legislative production that dealt with health issues that was in passage in the National Congress between January 2007 and December 2008.DESIGN AND SETTING:Descriptive-exploratory cross-sectional study with quantitative and qualitative approaches, conducted in a federal university.METHODS:The analysis material for the study comprised 144 draft bills that were classified and subsequently randomly evaluated by 155 professionals working within the healthcare system.RESULTS:The analysis showed that the Workers' Party (PT) and Brazilian Democratic Movement Party (PMDB) were the parties that presented the largest proportions of the draft bills (12.5% and 11.1%); 25.4% of the draft bills were presented by congress members with academic qualifications within healthcare and only 1.4% of the draft bills became transformed into legal regulations. In questionnaire responses, 51.5% of the evaluators did not consider the draft bills to be viable, 40.6% did not consider them to be relevant and 52.5% said that if the draft bills were not approved it would not be harmful to Brazilian society.CONCLUSION:In analyzing the data from this study, it was noted that the legislative production relating to healthcare was low and the transformation rate from draft bill to legal regulation was negligible. The results from the evaluation showed that the quality of legislative production was impaired.