Hospital humano: etnografia da humanização hospitalar na perspectiva de usuários

This ethnographic work studies the experiences of patients admitted in public (PUH) and private (PRH) hospitals in the Brazilian northeastern region. 28 adult patients of different clinics participated in the study. Data were analyzed by the patient path method, consisting in a combination of complemented and articulated techniques free observation, participating observation, ethnographic interview and patient testimonials collected prospectively during the patients admissions, from their arrival and until their discharge. The analysis was carried out according to the Thematic Categories Analysis Technique and the data were interpreted pursuant to medical anthropology, healthcare humanization and healthcare promotion theoretical references. The ethical principles of Resolution 196/96 were followed. The human hospital, as revealed by the patient, highlights the significance of subjectivity. 225 (54.7%) out of 411 mentioned concepts were collected in a public hospital (PUH) and 186 (45.3%) in a private institution (PRH). The results show that the patient at the PUH and PRH ethnoevaluates different aspects of the healthcare professionals´ human and technical competence, the hospital´s functioning structure, the access to and the ethics in the financial management, and develops overcoming strategies for his stay at the hospital. This ethnoevaluation is mediated by different factors, namely: social and economic status, personality, religiosity, ironic speech, somber diagnosis and satisfied needs, prior hospital experiences and the conditions under which the interview was carried out. A pedagogic proposal for the hospital humanization must include structural, managerial and organizational changes of the offered services and use active methodologies aimed to the political resolution of problematic situations at work and the inclusion of affective and subjective factors, and become as well a tool for the collective learning. This study shows the importance for the user´s ethnoevaluation to be incorporated into the hospital management and care as a guideline in the decision making and clinical action, thus promoting practices that shall lead to a decent and humanized care. The multidisciplinary nature of this study allowed a wide understanding of the user´s perspective as a socially critical ethnoevaluator

A gestão educacional das secretarias municipais de educação de municípios maranhenses a partir do plano de ações articuladas 2007-2011

The main purpose of this thesis was to analyze educational management of Municipal Departments of Education (SEMED’s) of cities in Maranhão inserted in the Plan of Articulated Actions (2007- 2011). We evidence the role of Union in that public policy. The leading argument is that Brazilian federal government is not demos constraining in relation to its national sub-governments, what makes the central government to enforce, primarily, educational politics like PAR. This kind of politics interferes in the educational management by national sub-governments, turning them into mere executors. By turning them into mere executors, PAR limits their autonomy and over imposes the results-based management as a parameter to improve the education quality. In order to develop the hypothesis, we adopted Political Science as theoretical basis, represented by Federalism Theory as pact which premise is the cooperative pattern of federalism as being the best form of government because it allows a joint decision-making process from the idea of no centralization of power. The methodology was historical materialism, which assumes the totality and contradiction as a form to understand the phenomenon that does not express in direct way its existence, but can be analyzed from such categories that made possible to interpret the reality. So, we used as tools the semistructured interview and documental analyses with triangulation of data. The empirical basis of the research is 04 (four) cities in Maranhão that obey the following criteria: 1. The municipality has to be assigned on the FNDE Resolution nº 29/2007; 2. To present the lowest educational management indexes from the diagnosis made in loco by PAR; 3. To present the lowest financial management indexes based on the diagnosis in loco by PAR. The results suggest that PAR does not effect a resultbased management which are proposed in its legal rules neither the SEMEDs can propose their conception of educational management. That situation creates a hybridism that sometimes turns to managerialism and performativity, sometimes to bureaucracy, sometimes to a total uncoordinated and unarticulated action. In relation to SEMEDs management, this thesis shows that these institutions have no own conception about educational management and end up acting in an uncoordinated and unarticulated way. The thesis concludes that PAR is an over imposition by federal government towards national sub-governments that conflicts with management patterns of those institutions that are used to a less managerial logic. This over imposition makes the Central government to be the center of Brazilian federalism, which is in reality an incomplete pact.