Humanização do atendimento à criança na atenção básica: visão dos profissionais

Objetivou-se compreender a humanização do atendimento à criança na Atenção Básica na visão dos profissionais. Estudo qualitativo, realizado em uma Unidade de Saúde da Família de Natal-RN, Brasil. Dezesseis profissionais responderam a um formulário contendo questões referentes ao atendimento à criança, à humanização e às práticas realizadas para humanizar o atendimento. Os dados foram categorizados por temas e analisados a partir dos princípios da Política Nacional de Humanização. Para os profissionais, humanizar o atendimento envolve acolher, escutar, aconselhar sobre o que está sendo realizado com a criança, valorizar a família, e tornar o sujeito ativo no atendimento, mesmo que de forma incipiente. A maioria dos profissionais descreveu atendimento que valorizava parte dos princípios da política de humanização, mesmo com dificuldades para implementá-los na rotina. Requer, portanto, estímulos e atualização dos profissionais para uma postura autocrítica sobre o atendimento

Cooperação e competição entre políticas no Brasil: os cursos da governabilidade no presidencialismo da catalização

Public policies have been studied in the various fields of humanities and social sciences, from different theoretical and technical aspects. However, there is still a lack of studies that incorporate the dimension that encompasses the political action and its interference in such actions, also recognizing the importance of the institutional setting of the Brazilian presidential model in implementing these policies. This fragmented and multiparty system has led to power heterogeneous sets of political parties. Thus, the ministerial offices, more than assisting the President´s government project, manage particularized agendas, which are party biased and have the influence of interest groups in hegemonic themes addressed by government agencies. When these agendas operate in sectoral and specialized policies, the friction level is apparently low. However, when this occurs in intersectoral actions, such as in regional development, there is evidence of strong signs of competition among government agencies, which in theory, should operate in an integrated manner. Although this is not a specific feature of Luiz Inacio Lula da Silva´s government- the period to be studied- there was similar behavior in Fernando Henrique Cardoso´s presidency, one realizes that the expansion of coalition on behalf of governance is increasingly interfering in the outcome of intersectoral public policies, due to these multiple arguments in action. In order to understand these processes, this study focused on the Sustainable and Integrated Development Programme for Differentiated Meso-Regions (PROMESO), part of the National Policy for Regional Development (NPRD). The program provides interface with various government agencies and their public policies in a clear intersectoral design. The research sought to identify and analyze the relationships between government agencies and their programs with interest groups, whether political parties or other segments of civil society, highlighting the logic of favoritism, which poses in second place the integration of actions in the intersectoral policies. Therefore, besides the theoretical debate that incorporates several categories of political science, public administration, public policy, geography and economics, the study focused on secondary sources, using different government agencies databases in order to raise information. It was observed that the interference of partisan politics has been disastrous for some public policies. Thus, the research confirms that cooperative character is fragile within government agencies, often limited to official documents, and that there is indeed, a striking feature of competition, especially when it comes to transversalized policies

Metodologias de serviços públicos de ater: estudo em instituições do Rio Grande do Norte

Due to the appreciation of family farming by the Brazilian Federal Government, the Technical Assistance and Rural Extension was induced to restructure and act in a more participative way, culminating in the National Policy of Technical Assistance and Rural Extension (PNATER), changing the profile of technology transfer and knowledge (diffusionism) for an action that uses participatory methodologies focused on exchange of knowledge between farmers and technicians. The process of discussion of the trends of ATER brought the New ATER , with the recognition of agroecology as the main guidance. This research aimed to analyze methods of public ATER developed by institutions of Rio Grande do Norte, under the guidance of New ATER. The research is qualitative. Secondary data were collected through documental research and literature. Primary data were collected through a set of interviews applied to representatives of public institutions ATER, namely EMATER-RN, Diaconia and AACC and representatives of organizations that receive public ATER. The research showed the difficulties of EMATER-RN in implementing of New ATER due to lack of infrastructure and low adherence of the new form of technical assistance and rural extension. It was shown also that the AACC and Diaconia act with ATER through projects with implementation deadlines set, often interrupting ATER while communities are still in need of assistance

Implementação da política de assistência social em Mossoró/RN : uma avaliação a partir dos centros de referência da assistência social

The current National Policy for Social Assistance (PNAS) is the instrument that regulates the organization and procedures of social-welfare actions. Developed and approved in 2004 since the Unified Social Assistance System (ITS) was crated in 2003, it reaffirms the democratic principles of the Social Assistance Organic Law (LOAS) focusing on the universalization of social rights and equality of rights when accessing the social-welfare system. In the SUAS point of view, the PNAS highlights the information, monitoring and evaluation fields for being the best way to assure the regulation, organization and control by the Federal Government paying attention to the principles of decentralization and participation. This political-institutional rearrangement occurs through the pact among all the three federal entities. The pact deals with the implementation of the task. It says that it has to be shared between the federal autonomous entities, established by dividing responsibilities. To the cities, considered as the smallest territorial unit of the federation and closer to the population, was given the primary responsibility, which is to feed and maintain the database of SUAS NETWORK and identify families living in situations of social vulnerability. In addition to these responsibilities, the cities that have full autonomy in the management of their actions, have the responsibility to organize the basic social protection and the special social protection, that using the Center of Social Assistance Reference (CRAS) and the Center of Specialized Social Assistance Reference (CREAS), are responsible for the provision of programs, projects and services that strengthen the family and community; that promote people who are able to enjoy the benefits of the Continuing benefit of Provisions (BPC) and transfer of incomes; that hold the infringed rights on its territory; that maximize the protective role of families and strengthen its users organization. In Mossoró/RN, city classified as autonomous in the social assistance management, has five units of CRAS that, for being public utilities, are considered the main units of basic social protection, since they are responsible for the connection between the other institutions that compose the network of local social protection. Also known as Family House, the CRAS, among other programs and services, offers the Integral Attention to Families Program (PAIF), Juvenile ProJovem Program, socio-educational coexistence services programs, as well as sending people to other public policies and social-welfare services network, provides information, among others. In this large field, social workers are highlighted as keys to implement the policy of social assistance within the city, followed by psychologists and educators. They should be effective public employees, as a solution to ensure that the provision of the services are to be continued, provided to the population living around the units. However, what we can find here is inattention to the standard rules of social assistance, which not only undermines the quality of programs and services, but also the consolidation of policy on welfare as public policy of social rights

"Antes que eu esqueça : trajetórias, laços e memórias produzidas por sujeitos da terceira idade na interação em territórios de sociabilidades

Currently the number of elderly in the world and Brazil is growing increasingly. However, old age is still presented as a complex issue that needs more depth. It is extremely important that society should create a discourse committed to reviewing negative stereotypes of old age as well as studies that allow the construction of new looks inclusive , as well as the creation of public policies that favor the elderly category, such as the National Policy and Elderly Statute established recently. The aim of this study is to analyze the spaces of sociability for the elderly Mossley and understand how the collective experiences in these environments influence the quality of life and influence in their depictions of the elderly subjects. To collect data observations were made, semi-structured interviews and wheels conversations with men and women aged 65 to 80 years old, retired, mostly widows, neighborhood residents Abolition in Mossley, participants (CCI) Coexistence Center Seniors Jose Sarney and (CRAS) Reference Center and Welfare. Thus, the spaces facing the elderly are presented as a good alternative for the rehabilitation, the fun and preserve their memories, while the agents posing as productive, active, and transformers of their reality

A política pública de segurança em Mossoró-RN: uma avaliação de processo da implantação da guarda civil (2009-2013)

The subject of public safety is part of the academic and popular discussions, due to several factors that act in society culminating in an increasing criminality. The importance of the evaluation of public policies in this context consists in a possible control tool, monitoring and necessary adjustments to the government to make the necessary changes. Given this reality, it is thought the research problem: how Mossoró (RN) city has implemented his public security policy? In general guideline of the research, we work with the following hypothesis: the own formulation of the National Policy of Public Safety there are elements that hinder the implementation of a public policy of municipal security in Mossoró. The objective of this research is to evaluate the existing security public policy in the city of Mossoró, by the elements that facilitate and/or hamper its implementation, through the actions of municipal government in the activities of the Mossoro Civil Guard (GCM). For this, a review of the implementation process was conducted, specifically its subprocesses of selection, training, and logistical or operational. Was used bibliographical research, documental primary and secondary, and field research, with conducting of interviews. It was found that with a staff of 197 guards, and with five years of creation, the actions developed by this institution refer to an early implementation of the municipal security policy. The guard has the basic pattern selection, part of function relocation and part of public tender. The formation occurs in an introductory way, however, not complete and specific, for the function performance. Its operability is limited by the number of existing effective and by the physical structure that has not matching the demand yet, which touches on the municipal budgetary reality of direct resource intended to safety. It was found the absence of a municipal plan of public security with principles, guidelines and goals that could direct the actions of the guard. It is concluded that despite of the implementation of the GCM Mossoró have not achieved, within the parameters of efficiency, efficacy and effectiveness have played their actions, projects and programs, it could trigger a process of opening for construction of a municipal security policy. As well as break with the paradigm of municipal actions just meant for surveillance of public property, interaction affirmative for the prevention of violence and crime

Desenvolvimento e assistência social : uma avaliação da efetividade da política de assistência social nos municípios de Assú e Mossoró (2004 -2008)

This thesis, whose title is DEVELOPMENT AND SOCIAL ASSISTANCE: AN EFFECTIVENESS EVALUATION IN SOCIAL ASSISTENCE POLICY IN THE CITIES OF ASSÚ AND MOSSORÓ/RN (2004/2008), has as main aim to evaluate effectiveness in Social Assistance Policy in the cities of Assu and Mossoró/RN, from 2004 to 2008, identifying its impacts and effects in life of its users. The methodological process for the research was composed by: a) Literature review on this theme, development of public policies; social public policies, public policy evaluation and Social Assistance Policy in Brazil; b) Documental research from Municipal Management of Social Development and Municipal Counsels of Social Assistance in the cities of Assu and Mossoró/RN about the object of this study and empirical field; c) Field Research constituted by the realization of Focal Groups with Social Assistance users and semistructured interviews with municipal managers from Assú and Mossoró. It was also taken into account participant observations in events and activities related to Social Assistance previously mentioned, considering field management and also the response to users demands. Articulating the themes of Development and Public Social Policy in Social Assistance was the theoretical purpose for this thesis. To achieve this purpose, it was performed two theoretical displacements related, at the same time, to the notion of development and to the concept of Social Assistance, which means to comprehend development as social change and improvement in users life quality, expressed in the expansion of their capacities and liberties (SEN, 1993, 2000), and the Social Assistance as an element for development. Such displacements provide a view of Public policy and Social Policies and evaluate National Policy of Social Assistance achieved in those cities. As product, this thesis presents a methodological purpose for effectiveness evaluation in Public Policy, taking into account expansion of capacities and liberties, concluding that Social Assistance Policy in Assú and Mossoró/RN, even in lesser extent had its impact and caused effective results in the life of their users and provided an expansion of their capacities and liberties, improving life quality and empowered agent condition for those subjects. The results show that this Policy has been proved to be effective, and consequently, it was considered, in this thesis, to be also an element and an allied for development

Política de assistência social no Brasil: uma análise a partir das tipologias de políticas públicas

The study of public policy typologies is still a knowledge field which lacks more embracing and applicable studies to different sectors. On that perspective, this work, Social Assistance Policy in Brazil: an analysis from the typologies on public policy, pursues to add the relevant literature to social assistance what focus on the public policy ratings. Moreover, it concerns about a study on the the national policy of social assistance implemented by the Brazilian government from the theoretical referrence of the public policy typologies. For that reason, the referential framework of the public policies as well as the analisys of its fundamentals/principles that are indispensable for achieving a bigger goal, that is to tipify the social assistance policy based on the different public policy typologies and characterize it through the main elements which are intrinsec to the social political and economic reality of Brazil. Thus, the issue suggested for the work is: what is the profile and the political trajectory of the social assistance implemented by the Brazilian Government? How it presents, above all, the features of a distributive, focused and lawful policy, the work has been done througho the following hypothesis: the social assistance policy in Brazil has been of universal, assistance, and focusing aspects. For each of those features granted to the social assistance policy, there is a gathering of changes according to the social, political and economic moment of the country and that stands out due to the different institutions within every cyclical period. The work showed that besides the social policy has gone through meaningful changes during the last decades, even though the adoption of the Organic Law of Social Assistance and its rules, some of the mentioned characteristics still remain, as long as the State s primacy goes on being the economic policies over the dubbed social policies. Notwithstanding, the social assistance will build up itself from the materialization of the growing of the social rights related to the State, but also assuming an important role on the amplified reproducing process regarding the capitalist social relations

O licenciamento ambiental como instrumento de um desenvolvimento verdadeiramente sustentável

Since the second half of the 20th century, mankind concerns about life quality and environment preservation began to grow. In Brazil, the edition of the Law nº 6.938/81, that instituted the National Policy of the Environment (Política Nacional do Meio Ambiente PNMA), contributing significantly to the singular treatment towards the environment by the Federal Constitution of 1988 (Constituição Federal de 1988), can be appointed as a landmark of this awareness. The Law nº 6.938/81, following the line observed on the legislation of some Brazilian States, predicted on its 9th article the instruments of PNMA, among which the environmental licensing can be highlighted. This instrument presents itself as indispensable to the construction, installation, extension and operation of enterprises and activities that utilize environmental resources, seen as effective and potentially polluter industries, or even to those that can cause environment degradation. On a parallel way and as a consequence of this awareness, the concept of development begins to acquire a new shape. The development of a country or a region begins to consider not only economical factors, but also environmental, political, cultural and social aspects. Ecodevelopment, or sustainable development, then, arises. In this way, through research on legislation and on theme related doctrine, this work has the intention of analyzing environmental licensing as a PNMA instrument responsible for uniting economical development and the right to an ecologically balanced environment, that is, by the consecution of a truly sustainable development

SINAES: as diferentes faces da avaliação na UFRN

This thesis entitled SINAES: the different faces of the evaluation at UFRN, aims to analyze the configuration that the national policy for assessment in higher education has taken on UFRN. We assume that in recent years there are an oscillation between the concepts of evaluation, according with the logic of public administration it has preferred an approach that presents itself as a promoter of quality, sometimes with regulatory aspects, sometimes with educational ones. The text discusses the use of the new assessment tools for higher education placing them under the new demands on state reform context in which this is to promote and measure quality based on the values of excellence and competitiveness. This movement arises from the redefinition of the role of the State that has been taking features of Evaluator State. From a historical review of government initiatives in the field of evaluation, we analyze the characteristics of assessment policies outlined over the past decades. We are based on the theoretical method that aims to examine the multiple determinants that shape a particular reality from the larger movement of totality. To identify, in this case, connections and ruptures that have emerged over the history of assessment policies aimed at higher education by checking their determinants in order to better explain the reality. To investigate the object of this study we used as instruments: the research literature and research documents, the semi-structured interviews and non-participant observation. The study revealed that there are different practices of evaluation and that before to establishment the SINAES program, the UFRN already had a culture of an institutional assessment, more participatory and democratic, opposing to the rigidity of the self-assessment in SINAES program that it was instituted by the Commission for assessment (CPA). We also noticed that the implementation of the SINAES at URFN has been performed very slowly and the breadth and complexity of the evaluation process has contributed to hinder its implementation in all dimensions provided by MEC. Although it was observed that in its operationalization the SINAES has assumed a more normative assessment and directed to establish rankings between courses and higher education schools than to establish a more qualitative assessment in this system. As regards the evaluation of the undergraduate course studied on this research and subjected to the three dimensions of evaluation proposed by SINAES (self-assessment, Evaluation of Courses and ENADE) it was not possible to verify an effective integration between the methods of assessing conducted. The results are considered separately, in only a partial view of the course evaluated the proposal what pits the SINAES as a system that involves the totality

Atenção à saúde da pessoa idosa na estratégia saúde da família no município de Santo Antônio/RN: um estudo de caso

According to demographic estimates, by the year 2025 Brazil will be the sixth country in the world in number of elderly. For this reason, it is a purpose of public policies to help people to reach that age being healthier. The current health care model of health surveillance through the Family Health Strategy (EFS, in portuguese) is configured as a gateway into the care of the elderly in the Unified Health System (SUS, in portuguese). It is also an area of development of practices to promote health, prevention and control of chronic nondegenerative diseases. The aim of this study was to analyze the health care of the elderly provided by ESF professionals for the achievement of a full care. The study is descriptive case study with a quantitative approach, performed in the city of Santo Antônio/RN. The population included all health professionals, who are FHS members of the city that agreed to participate of the survey, a total of 80 professionals. Data were collected using a structured questionnaire, having mostly closed questions and divided into two parts: one containing sociodemographic information of health professionals and vocational training and the other, the activities carried on by the professionals in senior care, being analyzed from a database tabulated in a spreadsheet and discussed according to the descriptive statistics in tables, graphs and charts using frequencies, medians and values of central tendency. It was verified a predominance of professionals who finished highschool, mostly female, aged from 30 to 34 years old, with training completed in the last 10 years, without being graduated in the field of geriatrics or gerontology and mostly without training in gerontology. Family members and caregivers were the components of the social support network most identified by the professionals (66.3%).The elderly access to the Family Health Basic Unit was considered by83.8% of professionals as the most important factor that interferes in the activities of health care of the elderly. Considering the inclusion of the family in care: 98.8% of professionals consider the family as one of the goals of care, but 82.5% assist the family to know their role and participate in the care of the elderly, emphasizing that no professional makes use of tools for evaluating the functionality of the family. Regarding the actions taken to assist the elderly, 91.25% have home visits program to the elderly, 88.75% use the host program; 77.5% know the habits of life, cultural, ethical and religious values of the elderly, their families and their community ;51.25% complement the activities through intersectoral actions, 50%participate in groups of living with the elderly; 33.75% keeps track and maintain updated the health information of the elderly; 11.25% of the professionals perform the Single Therapy Planning (PTS, in portuguese) and few implement the actions to promote health according to PTS; there is a deficit in the number of professional categories in the identification and monitoring of the frail older people in their households. It is concluded that the health care of the elderly developed by ESF professionals differs among the professional categories. It was identified weaknesses in the promotion of an active and healthy aging and also in the establishment of an integrated and full care of the elderly. It is recommended the adoption of permanent educational activities by the City Management, initially for ESF professionals in the the perspective of the guidelines of the National Policy of Health Care for the Elderly and later to the other professionals that are part of the health care network of the elderly, at all levels of care in the city for the development of strategies and practices that promote the improvement of the quality of healthcare for the elderly, expecting concrete and effective results in terms of promoting health within Brazilian reality

Gestão ambiental na educação: um estudo sobre fatores que afetam o comportamento ambiental de professores do ensino médio, na cidade de Floriano-PI

The present work sets out environmental issues in educational field. The aim of this research was to investigate the factors capable to influence the environmental behavior of the teachers in High school of the public school in Floriano, state of Piaui. For this, the methodology utilized an explanatory and descriptive search like a survey; questionnaires were applied with open and close questions establishing shifts that made up the following aspects; knowledge, behavior, responsibility, participation and trait of the teachers. The statistic techniques to analyze the data were descriptive analysis and analysis of multiple regression. The results reveal that teachers care about the real surrounding problems and believe that the school must develop ambient activities to stir the consciousness, it is important to the environmental improvement of the city. However, the results point out that are developed little activities related to theme concerned, besides the level of ambient consciousness given to the students are median. It was observed that teachers have little knowledge about theme like Agenda 21 and ISO14000. After identifying some factors of environmental knowledge, it was showed recommendations. The Agenda 21 recognizes in the educational field a mean of popular consciousness; the school should develop an education according to national policy of the environmental education

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

Ações educativas com portadores de diabetes Mellitus através da educação popular em saúde

Popular Health Education in its emancipatory dimension refers to individuals and groups to exchange knowledge and experiences, allowing them to associate health to the outcomes of their living conditions. Under this view, health workers and health users are subjects of the educative process. Thus, this study aims to identify the key clinical and socio sanitary attributes and promote educational activities with patients with Diabetes Mellitus (DM) in a Family Health Care Unit of the Western Sanitary District, in the city of Natal / RN. It is an action research which uses the references of the Theory of Liberating Education, which is based on a problem-solving pedagogy and that values dialogue in the process of understanding oneself and the world. Thirty-six diabetics, who are residents of the area covered by the health care unit, and thirty health workers participated in the survey. Each group had an average of twelve participants, and the meetings took place at the Unit´s hall, using conversation wheels, group dynamics, life narratives, experiences telling, movie exhibition and discussions, music, knowledge telling, desires, limitations, beliefs and values socially constructed. Data collection took place during the second half of two thousand and thirteen through Free Word Association Technique (FWAT), recordings of conversation wheels, participative observation, group dynamics, testimonies, questionnaires, life narratives and photographs. The empirical material was organized and subjected to three analyzes: thematic content (Bardin), textual statistics analysis by software IRAMUTEQ (Ratinaud), and photographic analysis (Edmund Feldman). The data analyses originated words, expressions, categories, themes and creative situations showing that popular health education is in process of construction, but still very incipient in primary care. The National Policy on Popular Health Education shows us the necessary ways for the transformation of health practices and the build of a more shared and solidary society. The meetings could be place to reverse that normative logic that has been happening over the years in primary care, but that by itself is not enough. It is possible to conclude that the use of active practices, increasing of listening and training on Popular Health Education will enable changes in the scenario where users and health workers deal with diabetes mellitus. Thus we see the popular health education is being timidly incorporated to the educational process of the subjects involved in this study, and far away from the principles of participation, organization of political work, increase opportunities for dialogue, respect, solidarity and tolerance among different actors involved in addressing the health problems that are fundamental to the improvement in building healthy practices of primary care

O financiamento da política de assistência social no contexto do SUAS: tendências e particularidades do município do Natal-RN

This dissertation analyzes the configuration of the financing of Social assistance in the municipality of Natal-RN in the context of their particular expressions of the problematizando municipal budget against neoliberal adjustment macroeconomic policy. The current trends of "disclaimer" and "desfinanciamento" of social protection by the State, in the context of contemporary capitalism, bring strong implications for Social Security, especially through the redirection of public resources to the international capital, which highlights the overlapping economic interests on social needs. Whereas the changes and innovations occurring in connection with the financing of Social assistance policy, the goal of this documentary research is to identify the characteristics and trends of funding this policy in Natal-RN, from the secondary data analysis from the City of Natal, the Ministry of Social development and hunger and Portal of transparency. In the light of the theoretical, research now presented, shows trends of investment in Social assistance in the municipality of Natal-RN, in the period 2005 to 2009, which are: the tiny role membership (08) Social assistance in the municipal budget; the dispersion and fragmentation of the resources of Social assistance in other organs and/or secretariats of municipal administration; the participation of just 47.5% in expenditure from own organ Manager; the low percentage of implementation of resources foreseen in the Annual Budget Laws; the low allocation of resources in Municipal Social Assistance Fund (FUMAS), which contradicts the national policy for Social Assistance-PNAS/2004; and the predominance of government transfers in the composition of the resources of Social assistance in the municipality. The results of this research suggest that the process of financing of Social assistance in Natal is distant from the principles and guidelines pointed by PNAS/2004. In addition to the effort to understand the complexity of the financing of Social assistance in Natal, this work seeks to contribute to a political analysis in the direction of strengthening social control and the struggle for the expansion of investment in social spending