Entre a hegemonia e a polissemia: a Política de Educação e Desenvolvimento para o SUS no contexto do Brasil contemporâneo

The proposal of the Unified Health System Policy (SUS) has been considered one of the most democratic public policies in Brazil. In spite of this, its implementation in a context of social inequalities has demanded significant efforts. From a socio-constructionist perspective on social psychology, the study focused on the National Policy for Permanent Education in Health for the Unified Health System (SUS), launched by the Brazilian government in 2004, as an additional effort to improve practices and accomplish the effective implementation of the principles and guidelines of the Policy. Considering the process of permanent interdependencies between these propositions and the socio-political and cultural context, the study aimed to identify the discursive constructions articulated in the National Policy for Permanent Education in Health for the Unified Health System (SUS) and how they fit into the existing power relations of ongoing Brazilian socio-political context. Subject positionings and action orientation offered to different social actors by these discursive constructions and the kind of practices allowed were also explored, as well as the implementation of the proposal in Rio Grande do Norte state and how this process was perceived by the people involved. The information produced by documental analyses, participant observation and interviews was analyzed as proposed by Institutional Ethnography. It evidenced the inter-relations between the practices of different social actors, the conditions available for those practices and the interests and power relations involved. Discontinuities on public policies in Brazil and the tendency to prioritize institutional and personal interests, in detriment of collective processes of social transformation, were some of obstacles highlighted by participants. The hegemony of the medical model and the individualistic and curative intervention practices that the model elicits were also emphasized as one of the drawbacks of the ongoing system. Facing these challenges, reflexivity and dialogism appear as strategies for a transformative action, making possible the denaturalization of ongoing practices, as well as the values and tenets supporting them

Os novos quixotes da psicologia e a prática social no âmbito do terceiro setor

A pesar del cuadro crítico de la pobreza y desigualdad social en que vivimos en el país, las perspectivas actuales apuntan para el fin del Estado Interventor y para la reducción del gasto público destinado a las políticas sociales. Con el enjugamiento del estado, el Tercer sector está encargado de pacificar la cuestión social, reduciéndola al ámbito del deber moral. Convocado al compromiso social, el psicólogo también empieza a trabajar en la frontera de la exclusión, sin cuestionar la finalidad y las implicaciones políticas del nuevo escenario. El objetivo de este trabajo es investigar la práctica social del psicólogo, en el ámbito del tercer sector , buscando el análisis que hace del nuevo campo de trabajo, así como las estrategias utilizadas en el enfrentamiento de la pobreza. Para la investigación, fueron realizadas 20 (veinte) encuestas semiestructuradas con psicólogos que actúan en instituciones del tercer sector . Las encuestas fueron analizadas cualitativamente, a la luz de la perspectiva gramsciana de sociedad civil y emancipación humana, bien como de los preceptos de la Psicología Comunitaria y Intervención Psicosocial. Utilizamos como base de análisis, todavía, el Método Comparativo Constante. Los resultados fueron agrupados en tres ejes: quien son los nuevos quijotes de la Psicología, las demandas del Tercer Sector y las estrategias utilizadas por el psicólogo en el Tercer Sector . La perspectiva defendida en este trabajo es la de que en el campo de las intervenciones sociales, y más acentuadamente en el Tercer Sector , los psicólogos serían nuevos quijotes , actuando con buena voluntad, con grandes sueños de transformación, pero realizando acciones que no parten de una lectura crítica y adecuada de la realidad, no percibiendo sus posibilidades reales y sus límites de actuación. Finalmente, defendemos que se debe buscar, con la inserción profesional; mejorar la calidad de vida y el bienestar, a través de una intervención proactiva, buscando el desarrollo, la organización y la emancipación de las personas, grupos y comunidades

O dispositivo alta nos Centros de Atenção Psicossocial/CAPS : loucura, vida cotidiana e organização social

The present paper proposes an analysis about the Brazilian Psychiatric Reform as a public policy and deriving from a research developed with the workers of a Psychosocial Attention Centre III (CAPS III) and the managers of the Psychosocial Attention Web (REAP) in Aracaju. This analysis is developed as an investigation of the discharge at those services, understood not as a procedure, but as a dispositive from which different elements can be articulated: users, knowledge, technical procedures, police measures, juridical decisions, laws, services edifying. This, form the background of the articulation between mental alienation and the subject of right alienation, in the ways through which this articulation develops to the relations between madness,citizenship, internment and substitutive practices. Our investigation about the discharge as a dispositive was built with some narrative constructions, as a discourse analysis inspired by Michel Foucault s method, from the perspective of some of the main dispositive operators: workers and managers. The main aspect observed were: the articulations built by the discharge as a dispositive based on two discursive grate, the Reform as a new treatment substituting internship, and the Reform as juridical insertion and users rights practice; the exercise of these discursive grades based on the workers and managers perspective; the transference of limitations and contradictions of these grades to the competence of the dispositive operators, emerged in an outstanding way, as sometimes those operators are liable for the emergent limitations and difficulties, and some other times they are restrained by their institutional role, which is to maintain the domination relations articulated by the dispositive; finally, some aspects extracted which the dispositive operators - when they were expected to act in a way to maintain certain power relations - were capable to resist, managing other power relations from the dispositive, that we call, as Agamben, dispositive profanity

Práticas institucionais/discursivas acerca dos cuidados com os bebês prematuros e/ou de baixo peso: o programa canguru

The Kangaroo Program was implemented in Brazil in 2000 through the Unified Health System (Sistema Único de Saúde SUS) sustained with a humanized rethoric of health care assistance. This program adopts the skin-to-skin contact contributing to the mother-infant bond, breastfeeding and promoting security in mother s care. The users of SUS are encouraged to live in the maternity ward to follow the baby health improvement. However, it was verified in previous observations that mothers participation in the Kangaroo Program has been done through an imposed practice. Therefore, this study intended to understand the texts that permeate the kangaroo practice. This research was developed through two studies: 1) an historic exploration of motherhood concept and an analysis of how the motherhood is presented in the official document that orients the program; 2) an analysis of institutional dynamic of Kangaroo Program, emphasizing the study about the health workers everyday practice, the mothers view about their life in the maternity wards, and the attendance practice. It is highlighted that the relation between this two studies allowed the comprehension abouthow the official discourses can influence the health workers behaviors and how their viewpoint and position can shape the everyday work in a public health program. This research, supported by Institutional Ethnography, considers that people s practices and experiences are socially organized and shaped by broad social forces. The discourse method was used in the documental analysis and in the analysis of qualitative data from empiric research. The research showed that the kangaroo program has been an excellent way to save resources and to improve some baby s biologic and psychological aspects. However, this program has failed to consider the social, economic and cultural complexity of mothers and the structural limitation of the health care system. The official document uses the economic and medical approach, following the hegemonic biomedical model and the life style of the people that don t use the public health system. Consequently, the program has not been successful because it is planned without people participation. On the other hand, it was verified that although some professionals are committed with their work, the mainly does not consider mothers participation as an active process, using the institutional power as a social control to keep mothers uninformed about the possibility to leave the maternity wards. As a result, the research also showed that mothers perceive the program as mandatory and not as option that can improve pleasure moments. It is, therefore, necessary to consider the complex social determinants of health that can increase mothers participation in the Kangaroo Program. Bringing these issues into debate can be a reflective exercise on citizenship and governance, allowing spaces for the improvement of public health programs

A humanização no parto e no nascimento: os saberes e as práticas no contexto de uma maternidade pública brasileira

The practice of medicine related to the gestational processes tend to be organized according to the context and the place of work, being thus dependent of the conditions both social and economical, and of the physical structure and the functionality of the services. The high mortality rate in this process has diminished, since 1986, the study made by the World Health Organization (WHO) as to the technical aspects and the social inequalities that influence this situation in different geographical contexts. This culminated recommendations that proposed the reorientation of the dynamical practice of medicine, with a focus on the safety of maternities. Brazil adopted, in the year 2000, the suggestions of the OMS, emphasizing the humanization as the main reason for these actions. However, this discussion tends to not consider the problems caused by the social inequalities and the epidemiological and social conditionings that define the actions of the Unified Health System (Sistema Único de Saúde SUS). In this area, this research seeks to analyze the practices, cares taken, and the universal symbol that promotes and rewards the assistance to the birth of children by the SUS. Besides the analysis of the public documents that deal with this subject, an ethnographic study was developed in a maternity in Natal/RN, considered a model of humanization after receiving the Galba de Araújo prize in 2002. In this stage, the methodological strategies were observed, and the focus of the individual interviews with workers and users of this service. In the analysis of the data, it became evident that the different professional workers and women who gave birth, tend to show concern of the standards the delimit production and reproduction of the practice of medicine, as they favor the absence of a critical posture of the actions destined to the population. Besides this, if became evident that the institutional difficulties associated to the economical, cultural, and political problems also difficult the involvement and the reflection of the workers in favor of assisting changes of the process. There is also a utilization of a perspective prescriptive of humanization in the everyday life of the social workers, without reflection of its meaning. Some workers present, in their statements, a preoccupation with the social and economical aspects that affect the practice of medicine, and with the limitations of the humanization discourse that disarticulates the necessities of those involved in the process of formation, and soon tend to return to the discussion of humanization while a kind practice characterized by the minimization of the interventionist actions. Now the users of the system show themselves before the dynamic of the services, submitting themselves to what is offered while assistance, without questioning and/or reflecting about their usual shortages. Therefore, to think of changes in the know and do of the practice of medicine destined to the birth of children implies reflection on the quotidian production of these practices and of the social contexts that influence the process of assistance in the practice of medicine. Herein it would be possible to predict the appropriation, by different workers concerning their exasperations and necessities, making them active in the pursuit of their rights as citizens

Ambiente institucional e desempenho diferenciado na agropecuária norte-rio-grandense: quais as relações?

This thesis aims to identify how civil servants perceive changes made inthe carrying out of their work after their taking part in the Course forTechnicians in Public Management of the Government of Rio Grande do NorteState. As for the methodological procedures, an exploratory-descriptivequantitative research has been carried out through structured questionnaires appliedto 118 civil servants from the first groups of the Course for Technicians, thusshowing a margin of error of 4.18% to 95% of confidence, according to theprocedures of finite sampling. The table processing and analysis rested uponthe Statistical Package for the Social Sciences SPSS and was carried outthrough univariate, bivariate and multivariate techniques with emphasis on thetechnique called Factor Analysis. It was possible to identify that the level ofsatisfaction of the students was high and there was a clear perception by themthat the course assisted to changes in their work. Through Factor Analysis itwas verified that the factors that may be related to changes in the work of thecivil servants are "Contribution to Society", "Efficiency andEfficacy in the Work Environment", "Applicability of Contents"and "Capacitating for Leadership". The conclusion of the studyindicates that the factors obtained are directly related to the basis of thenew public management by means of guidance toward efficiency and efficacy in aperspective of leadership, the contents of the course being thus made into newattitudes toward work which end up yielding better results for society

A CRONIFICAÇÃO NOS SERVIÇOS SUBSTITUTIVOS NA REDE DE SAÚDE MENTAL DE NATAL/RN

Brazilian Psychiatry Reform, through Psychosocial Care Strategy, has intended to build insane people care practices from community care services which contemplates the subjects complete lives. However, to change the traditional care ways demands the facing of a series of epistemological, political and cultural obstacles. One of the current challenges deals with patients aggravation processes, with management ways, with devices and with professionals, as well as with the assistance network. The purpose of this thesis was to investigate how these aggravation processes has been constituted in Natal mental healthcare network, understanding its effects in the work teams and patients. Theoretical and methodological perspective used was Institutional analysis was, subsidizing the usage of concept-tools as the implication analysis, selfmanagement and self-analysis, and restitution. The research was carried out at the Natal East Sanitary District Mental Healthcare Clinic, with the participation of technicians and patients. The research procedures were: literature and document research on the attendance and the analyzed theme; attendance registers analysis; participating observation of the institutional routine for three months and field log entries; talking groups, one with the team and one with the patients. Two main discussion points are shown: 1. The mental healthcare clinic organization logic and the intersector politics; 2. The work and management processes developed at the mental healthcare clinic. The analysis show diversity in the attended demands in the service, which has favored the patients aggravation, this device and the substitute network processes. The work processes are apart from the political sphere and from the managements processes. In this sense, we show the need to reevaluate the clinic device as well as the management models adopted in the Brazilian Psychiatry Reform context