Planejamento em saúde no Brasil: convergências e divergências entre instâncias de gestão

Trata-se de uma investigação que busca revelar convergências e divergências no processo de planificação da Política Pública de Saúde, com foco primordial na participação dos organismos de representação social na consolidação do Sistema Único (SUS), destacando a Conferência Nacional de Saúde CNS, instância que deve ter participação obrigatória na formulação de recomendações para essa política estatal. Considera que a planificação reúne elementos de concepção jurídica, técnica e política para a elaboração dos documentos intitulados Planos Nacionais de Saúde PNS. A partir de pesquisa qualitativa de base documental e argumentação com apoio de Cartografia Simbólica, põe em exame o processo de elaboração e o teor presente nos relatórios da 12ª (2003), 13ª (2007) e 14ª CNS (2011), alinhando seus eixos, diretrizes e prioridades nos correspondentes PNS nos quadriênios 2004-2007, 2008-2011 e 2012-2015. A escolha desses instrumentos, na temporalidade sugerida, tem por esteio o período em que a implantação do sistema de Planejamento do SUS PlanejaSUS, orienta normativa e tecnicamente a elaboração do PNS, tendo como uma de suas referências o que foi emanado das conferências. Propõe-se verificar as tensões existentes entre momentos distintos da definição das prioridades elencadas nas políticas públicas de saúde à luz das contribuições teóricas sobre a concepção do Estado, numa visão contemporânea associada à sua dinâmica de atuação vinculada ao modo de produção e acumulação capitalista; sobre a metodologia do Planejamento Estratégico com base na participação de atores diversos; e ainda, na análise sobre a expressão desse participacionismo na ótica dos processos democráticos representativos no SUS. Na confecção dos mapas cartográficos foi proposta a correlação entre os conteúdos dos Relatórios das 12ª a 14ª conferências de saúde com o que está expresso nas prioridades constantes nos Planos Nacionais de Saúde (2004 a 2007, 2008 a 2011 e 2012 a 2015), verificando-se aproximações e distanciamentos existentes entre o que expressa a sociedade e a política governamental. Conclui-se que, do exame crítico entre as diretrizes e prioridades contidas no acervo documental existente e sua metodologia de construção, com fundamento na argumentação do aporte teórico trabalhado, são verificadas tensões e harmonizações que revelam pontos convergentes e dissonantes das pactuações e consensos entre os atores sociais representantes dos segmentos, no qual critério da representatividade condiciona a defesa de opiniões, interesses e prioridades, de modo diverso para os que estão implicados nesse processo de planificação

Financiamento e gasto público em saúde: o caso do Rio Grande do Norte

Conselho Nacional de Desenvolvimento Científico e Tecnológico

Zoneamento geoambiental como subsídio ao planejamento territorial municipal: estudo de caso para Currais Novos/RN

This paper presents the master plan and geoenvironmental zoning natures as instruments of environmental planning and management. The discussion of territory environmental planning is guided by two directions: at first the environmental elements involved in planning and the another is the implementation of these instruments at the municipal territory. To analyze the planning directed of the municipal territory we consider the fragments of its, represented by country and urban. The master plan inside of the Estatuto da Cidade (City Statute) and the geoenvironmental zoning are directed to territorial environmental planning. Regarding of the master plan the first challenge has been the spacial area that the plan can cover. It is necessary to prepare master plans that could include all the territory. The environmental zoning are directed for the territory totality.In this sense, the geoenvironmental zoning of the Currais Novos was done in the totality of the municipal territory and guided by the environmental physics variables. The geoenvironmental zoning sets in a planning and ordering of the territory instrument based in the landscape analysis. Therefore grounded in the Geosystems‟s Theory this work has like a main objective to propose a geoenvironmental zoning for the Currais Novos Municipality in RN. So, was used an analysis technique suggested for Bardin (2010) and the Currais Novos‟s physical environment characterization through of the fieldwork and cartographic data vectorization, beyond the image‟s treatment SRTM. The geoenvironmental systems definitions were based in the suggestion of Cestaro, et al. (2007) support in Bertrand (1968). For both were identified five geoenvironmental systems: Borborema Plateau, Residual plateau, Chapada da Serra de Santana, semiarid river valley and lagoon valley and eleven geoenvironmental subsystems: Borborema Plateau Western Slope, Isolated Massif of the Borborema Plateau, Residual Crest, Residual Massif, Erosional Scarp of the Chapada, flat top plateau, fluvial plains, temporary river of the semiarid and ornamental water or sluice

Construção e evidências de validação de instrumentos de pesquisa para avaliação da assistência nos centros de atenção psicossocial

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES

Plano setorial: a construção de estratégias para implementação do plano diretor de Natal

The Sectoral Plan was inserted as an urban instrument in Master Plan of Natal (LC82/07), since then it has been deepened. It is guided to the equitable distribution of the benefits of urbanization, aimed the efetivation of the Right to the City and the Environmental function of property in the context of urban planning. Thereby, the Sectoral Plan was inserted into the perspective of promoting a favorable field for applying articulated of instruments defined in the Master Plan, and them with urban interventions, through the deepening of macrozoning - coming out of dimension of the city and going to a small fraction of the urban by reducing scaling - facilitating democratic management in accordance with the City Statute. However, the absence of regulation and the conceptual and operational fragility of the instrument, approached it of other existent experiences and instruments, limiting its application and evaluation. Considering the innovative nature of the instrument and the intense social participation, we inquire about conceptual and operational elements which could give greater effectiveness to Sector Plan in construction? Guided by that question, this dissertation aim to understand the nature and operational procedures of Sectoral Plan, seeking to do indications about the conceptual and operational aspects of implementing a Sector Plan. The neighborhood of Ponta Negra was selected as empirical universe because it was the first sector defined in the Master Plan. This research adopts reference authors who´s make reflection and insights about the matrix of Urban Reform, whose principles constitute the basis of the trajectory of revision of urban planning in Brazil since the 1980s, highlighting Raquel Rolnik, Nelson Saule Júnior and Orlando Alves dos Santos Júnior. For the local monitoring, we use the authors Alexsandro Ferreira Cardoso Silva, Rosa Maria Pinheiro Oliveira e Marise Costa da Souza Duarte, in order to understand the growth dynamics of Natal, lawfully and urbanistically

Metodologia de utilização de dados de sensoriamento remoto em zonas costeiras sob influência da indústria petrolífera

Oil spills in marine environments represent immediate environmental impacts of large magnitude. For that reason the Environmental Sensitivity to Oil Maps constitute a major instrument for planning actions of containment and cleanup. For both the Environmental Sensitivity Maps always need to be updated, to have an appropriate scale and to represent accurately the coastal areas. In this context, this thesis presents a methodology for collecting and processing remote sensing data for the purpose of updating the territorial basis of thematic maps of Environmental Sensitivity to Oil. To ensure greater applicability of the methodology, sensors with complementary characteristics, which provide their data at a low financial cost, were selected and tested. To test the methodology, an area located on the northern coast of the Northeast of Brazil was chosen. The results showed that the products of ASTER data and image hybrid sensor PALSAR + CCD and HRC + CCD, have a great potential to be used as a source of cartographic information on projects that seek to update the Environmental Sensitivity Maps of Oil

Fatores determinantes da decisão sobre a prática da cesariana em Natal-RN

O objetivo deste estudo é analisar os fatores que contribuíram para as diferentes decisões para o parto cesáreo e a ligadura de trompas entre as mulheres de 18 a 45 anos de idade no Município de Natal, no Nordeste do Brasil, no ano de 2000. Tratou-se de um estudo longitudinal, originado da base de dados de um Estudo Multicêntrico, envolvendo outras localidades do Brasil, composta de mulheres em idade fértil que procuraram o serviço público ou privado. Foram realizadas três entrevistas: no início da gestação, no mês anterior à data provável do parto e até um mês após o parto, perfazendo um total de 433 entrevistas, sendo finalizada com uma amostra de 269 mulheres. O estudo satisfez a um critério de elegibilidade, abrangendo uma amostra das mulheres de 18 a 40 anos de idade, que residiam em Natal e que estavam grávidas no máximo, na 22a semana de gestação, e procuraram o serviço público ou privado para a realização do pré-natal. Não entraram no estudo, aquelas mulheres que faziam um acompanhamento em ambulatórios especiais (hipertensão ou diabetes gestacional, HIV/AIDS). A análise consistiu, primeiramente, num estudo descritivo, seguido de uma discussão sobre a trajetória do desejo à realização do parto e testou-se a significância estatística dos partos com variáveis socioeconômicas. Sequencialmente adotou-se uma análise bivariada centrada nos testes de associação, onde foi considerada a variável tipo de parto como sendo a variável resposta e as demais variáveis, relacionadas à condição sóciodemográfica e a saúde reprodutiva da mulher, como sendo as variáveis de risco ou independentes. Para o cálculo da razão de chance (OR), foi utilizado o modelo de regressão logística múltipla. Das 269 mulheres entrevistadas, 56,0% foram submetidas ao parto normal. Este tipo de parto foi desejado independente da categoria, por 71% das entrevistadas. Os resultados mostraram como fatores determinantes para cesárea, o serviço ser privado (OR = 5,6), a mulher ter idade acima de 20 anos (OR=2,87), ser primípara (OR=4,56) e a realização de ligadura de trompas (OR=12,94). Independente da parturição, 84% das mulheres do serviço público foram submetidas a um parto normal, enquanto que, 74% das primíparas do serviço privado, fizeram uma cesárea. Os resultados sinalizam um distanciamento efetivo entre o desejo por um tipo de parto e a sua realização, quando os fatores considerados, não foram somente técnicos, podendo, também, refletir a falta de prática do parto normal, pelo obstetra e a necessidade de uma maior consciência ética nos procedimentos obstétricos, de modo a favorecer uma maior abertura na participação da gestante na escolha pelo tipo de parto

Plano setorial: a construção de estratégias para implementação do plano diretor de Natal

The Sectoral Plan was inserted as an urban instrument in Master Plan of Natal (LC82/07), since then it has been deepened. It is guided to the equitable distribution of the benefits of urbanization, aimed the efetivation of the Right to the City and the Environmental function of property in the context of urban planning. Thereby, the Sectoral Plan was inserted into the perspective of promoting a favorable field for applying articulated of instruments defined in the Master Plan, and them with urban interventions, through the deepening of macrozoning - coming out of dimension of the city and going to a small fraction of the urban by reducing scaling - facilitating democratic management in accordance with the City Statute. However, the absence of regulation and the conceptual and operational fragility of the instrument, approached it of other existent experiences and instruments, limiting its application and evaluation. Considering the innovative nature of the instrument and the intense social participation, we inquire about conceptual and operational elements which could give greater effectiveness to Sector Plan in construction? Guided by that question, this dissertation aim to understand the nature and operational procedures of Sectoral Plan, seeking to do indications about the conceptual and operational aspects of implementing a Sector Plan. The neighborhood of Ponta Negra was selected as empirical universe because it was the first sector defined in the Master Plan. This research adopts reference authors who´s make reflection and insights about the matrix of Urban Reform, whose principles constitute the basis of the trajectory of revision of urban planning in Brazil since the 1980s, highlighting Raquel Rolnik, Nelson Saule Júnior and Orlando Alves dos Santos Júnior. For the local monitoring, we use the authors Alexsandro Ferreira Cardoso Silva, Rosa Maria Pinheiro Oliveira e Marise Costa da Souza Duarte, in order to understand the growth dynamics of Natal, lawfully and urbanistically

Metodologia de utilização de dados de sensoriamento remoto em zonas costeiras sob influência da indústria petrolífera

Oil spills in marine environments represent immediate environmental impacts of large magnitude. For that reason the Environmental Sensitivity to Oil Maps constitute a major instrument for planning actions of containment and cleanup. For both the Environmental Sensitivity Maps always need to be updated, to have an appropriate scale and to represent accurately the coastal areas. In this context, this thesis presents a methodology for collecting and processing remote sensing data for the purpose of updating the territorial basis of thematic maps of Environmental Sensitivity to Oil. To ensure greater applicability of the methodology, sensors with complementary characteristics, which provide their data at a low financial cost, were selected and tested. To test the methodology, an area located on the northern coast of the Northeast of Brazil was chosen. The results showed that the products of ASTER data and image hybrid sensor PALSAR + CCD and HRC + CCD, have a great potential to be used as a source of cartographic information on projects that seek to update the Environmental Sensitivity Maps of Oil

Produção pesqueira artesanal: diagnóstico ergonômico e bases para um planejamento nutricional situado e a promoção da saúde dos jangadeiros

The traditional fishing with rafts is characterized by unpredictability, high stakes and inadequate work conditions. The extensive working hours, physical wear, inadequate nutrition, unsanitary conditions, lack of salvage equipment and instruments suitable working, added by the presence of changes in the nutritional status of fisherman, that contribute to the picture of insecurity in high seas, injuries and health. This study aimed to analyze the activity of the fisherman s from Ponta Negra, Natal / RN, and check the conditions of supply of these fishermen and their implications on health and development of their work. To this finality, was used a methodology based on the ergonomic work analysis employing techniques such as observational and interactional conversational action, listening to the answers, observation protocols, photographic and video records. The script conversational dynamic action was developed from literature searches about the artisanal fisheries, culture and food habits of this population, and analyzes the overall situation of focus and two reference situations. To collect data on the usual diet of fisherman as well as quantitative and qualitative analysis that was used for data analysis and 24h recall the Food Frequency Questionnaire (FFQ). The impact of this power to the health of fisherman was evaluated performing a nutritional assessment. The results revealed that the fishermen carry out their activities with poor working conditions, health and nutrition. Feeding practices of these fishermen undertake development work, making it even more stressful, as well contributing to the emergence of Chronic Noncommunicable Diseases. The management of the activity, as well as the current structure of the vessel, also contributes to the adoption of inappropriate feeding practices during the shipment of catch. The results of this indicate the need for adequate interventions in order to assist in recovery and / or maintenance of health of fisherman minimizing reflections of nutritional disorders for the development activity by improving the quality of life in this population

Meio ambiente e planejamento: a relação cidade-natureza nos Planos Urbanísticos da cidade de Natal no século XX

This research studies the relation between city and nature in the urbanity s plans from Natal RN, Brazil, during the 20th century. Investigates and analyses the main documents that bring environmental s ideas inside from the urbanity s plans of Natal; gives the historical and economical situation from the city in each period studied; features the urbanity s plans, using categories of analyses to comprehension of this instruments. Try to contribute in the bigger process of historical rescue of Natal, and stimulates new studies. It was used documental s research, and bibliographic material. It was identified four (04) kinds of plans: the ones that focus in health and aesthetic (1901, 1929, 1935) technology and science (1968), zoning and control (1974, 1984) and environment. The hints founded shows that environmental ideas were put inside of the plans by government demands, especially in 1994 s plan, almost always without popular contribution and without this population get understands its meanings and implications

O direito coletivo prestacional à saúde e o poder judiciário: a concretização do art. 196 da Constituição de 1988 pela via jurisdicional

During the ninth century, owing to the process of industrialization, new social conflicts were showed, forcing the Government not to remain inert. The necessity of answer to these new demands requires from the State some actions that assure the new economic, cultural and social rights, able to exceed the formal equality, according to the principles of redistributive equality and well-being. Among the social rights, the right to health is showed up, which is placed at the Universal Declaration of Human Rights and the International Treaty for the Economic, Social and Cultural Rights, as a necessary term to promote the dignity and the free development of the human personality. Under the Constitutional Law, it is clear that the implementation of the right to health, placed at the 6th article of the Brazilian Constitution, demands a government activity, which usually requires a provision of material goods, depending on budgetary resources. The Legislative and Executive Branches have a very important role in compliance with the constitutional regulations about the satisfactory offer of health care services, besides the correct use of the resources at this area. The adoption of public policies is the way of Government action to the planning and realization of this right. Though, some public policies are usually made apart from the social compromises, to the detriment of the basic social rights. The government has a discretionary competence to manage the health services. That is the reason it is necessary the control of the political choices, through the popular control, the extrajudicial control by the Account Courts, or the judicial review. Owed to the constitutionalization of social rights, the constitutional justice has a very relevant role, concerning to the constitutional jurisdiction, in a way the Judiciary Branch assume your position as a player that transforms the society. On the control of the public health policies, there is a cast of official instruments, judicial or not, to the guarantee of the collective right to the public health services, and to allow the citizens to reach the real implementation of the right to health

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

A educação em saúde pública na práqtica cotidiana: atuação dos cirurgiões-dentistas do PSF de Natal-RN

Considering education a support to health promotion, care integration and citizenship formation,the purpose of this research was to analyze the perception of the oral surgeons from the Family Health Program of Natal-RN over education in health as well as their performance as educators based on their activities on the program. A qualitative study was accomplished by a semi-structured interview and a Free Association of Words Test with 80 oral surgeons from the Family Health Program of Natal-RN. The instruments were analyzed through the meaning analysis and the Central Nucleus of Vergès Theory. The results showed a lack of planning in health actions so there is no standardization on the educative practices done by the oral surgeons which mostly are focused on scholars. There was an agreement among the group according to the oral surgeons´ perception about education in health that education is related to its function of recall prevention ideas to the population. Most part of the context units analyzed by the professionals´ speech show the knowledge of education in health as an inadequate behavior change instrument of the individuals. An interesting point was a quotation cited by some professionals that included actual themes such as citizenship, motivation and life quality, put inside the speech of education in health. To the oral surgeons the biggest difficulties on the development of the educative actions are due to the lack of incentive by the Municipal Health Bureau and to the detachment and lack of valorization of the themes by the population. The oral surgeons consider themselves co-responsible for the formation of a population which is able to request its health. They also mention the knowledge about the need of the community participation on the planning of the Family Health Program actions. Finally, it is notable the need for more encouragement so the oral surgeons can be more capable and have more interest in applying education in health on the perspective of a new model in health, because once capable and stimulated they can awake the population to education importance as a great transformation instrument for people searching for a fair, equalitarian and citizeness society

Unidades geoambientais e áreas de preservação permanente como instrumentos de auxílio para o planejamento ambiental - o caso da via costeira de Natal-RN

Brazilian law provides a series of rules and policies which regulate space use and occupancy as well as guide environmental planning. Among those are the Permanent Preservation Areas (PPAs) which purpose is to ensure the preservation of elements that are essential to maintain the environmental function and landscape. Another important instrument identifier of spaces are geoenvironmental units, which are synthesis elements grouping areas of similar characteristics and can be used for the analysis of risk, fragility and potential use of spaces. The geoenvironmental units are defined by more complex processes (information integration), focusing not only on individual elements, but being determined from a systemic analysis. Is It possible to identify and delineate APPs from the identification and determination of geoenvironmental units? The aim of this study was to evaluate the potential of geoenvironmental units in the process of identification and delineation of APPs a see how much of the study area, the area by the Coast line in Natal/RN, is still good for occupation. It was used the physiognomic method, in which the limits of the units are plotted on a synthetic document (aerial photographs), valuing aspects of relief in a range of detail by the analysis of systemic categories (element, structure, function and interaction), observed. The methodology used allowed the identification and delineation of eleven geoenvironmental units and, from these, it was possible to identify and delineate four out of the five PPAs occurring in the study area. Only a small space of 1.2 ha of the study area is not considered APP by law. Thus, the occupation of the unoccupied area by the Coast line is not feasible from a legal standpoint. The geoenvironmental units as well as the identified and delineated APPs in the area by the Coast line are spaces which preservation is guaranteed by law in various scopes and are necessary to maintain the environmental functions of the area. The planning for the use and occupation of the area should involve the recovery of degraded areas and the creation of elements that make possible the use as well as attract the community, as provided in the initial planning, by ensuring the public utility and social interest in the Project.