A Regulação na saúde e o fortalecimento do setor privado sob a orientação do Banco Mundial

Este trabalho faz uma análise de três modelos de regulação: a regulação no acesso aos serviços de saúde, que é realizado no âmbito do Sistema Único de Saúde; a regulação via agências reguladoras; e o caráter regulador que o Estado adquire ao repassar a execução dos serviços de saúde a entidades como as Organizações Sociais, as Organizações da Sociedade Civil de Interesse Público e às Fundações Estatais de Direito Privado. Estes três modelos são resultantes do denominado Estado Regulador Neoliberal, originado do modelo de acumulação capitalista financeirizado e difundido no campo social pelo Banco Mundial. O Estado Regulador Neoliberal foi adotado no Brasil, na década de 90, por meio da contrarreforma do Estado, que reorganizou as funções deste, tornando-o mais regulador do que interventor. No campo social, esse modelo de Estado foi estabelecido com a divisão e transferência da execução das políticas sociais para a sociedade e para o mercado, focalizando sua ação aos setores mais pobres. A política de saúde que, pela ação do movimento de reforma sanitária, se tornou direito social na Constituição Federal de 1988, vai ser atingida por uma contrarreforma desencadeada pelo Banco Mundial, que tratou de distorcer os princípios deste sistema, organizando-o, no sentido de ofertar serviços de saúde públicos somente aos grupos mais pobres, na tentativa de quebrar com a universalidade desta política. Esta situação gera um conflito de interesses de dois projetos distintos no campo da saúde no Brasil: um que defende a política de saúde pelo viés da reforma sanitária e outro que defende a saúde pela via do mercado. Os modelos de regulação aqui estudados são frutos destas contrarreformas e atuam sob a lógica do projeto de saúde voltado ao capital, portanto contrários a efetivação do SUS.

O impacto epidemiológico e social das ações do Programa de Saúde da Família - PSF, na saúde dos usuários em Feira de Santana - Bahia

Pós-graduação em Odontologia Preventiva e Social - FOA

Caminhos da política de saúde no Brasil: determinantes da “universalização excludente” em curso

O interesse deste estudo foi, de modo geral, poder identificar como o modelo privatista influenciou as ações da política pública de saúde no Brasil, como se deram os impactos da política macroeconômica neste sentido. Um dos pontos chave a ser verificado gira em torno da desigualdade de acesso da população ao serviço de saúde, com a não concretização da universalidade, gerando um processo denominado “universalização excludente”. Esse processo que consiste na migração de usuários do SUS para as operadoras de planos de saúde privados contribui para a mudança da racionalidade da saúde como direito para a racionalidade da eficiência, a racionalidade burguesa. Parte-se do referencial da Reforma Sanitária brasileira, como um marco da luta dos movimentos sociais pela democratização no país e como ponto inicial do reconhecimento da saúde enquanto direito de todos e dever do Estado, buscando fazer um resgate histórico deste movimento. Tem, ainda, como referência o pressuposto da minimização da atuação do Estado no trato às políticas sociais e a interferência direta de grandes organismos financeiros internacionais na condução do modo de fazer política de saúde, a exemplo do Banco Mundial. Esta consiste em uma pesquisa qualitativa, de cunho teórico, com o objetivo de proporcionar subsídios para a discussão do tema da política de saúde no Brasil, bem como promover e ampliar o debate teórico acerca da função que o Estado desempenha no modo de pensar e executar essa política.

A interdisciplinaridade na atenção psicossocial: um olhar fotográfico sobre a psiquiatria

Pós-graduação em Psicologia - FCLAS

Imigração e médicos italianos em São Paulo na primeira república

A imigração européia para a região sudeste do país, que foi responsável pela introdução da mão-de-obra assalariada, para atender às necessidades da cultura cafeeira, nas últimas décadas do século XIX e primeiras do século XX, tem sido suficientemente estudada pela historiografia da imigração. O que tem sido explorado em menor grau, é a inter-relação entre a imigração e a reforma sanitária que ocorreu no período. O estado de São Paulo, particularmente, foi palco de uma triste história de imigrantes italianos chegados e expostos à virulência das epidemias. Esse foi o ponto de partida para o início do movimento de reforma da saúde pública. Os fazendeiros consideravam a imigração uma necessidade vital para a economia cafeeira, havendo um consenso bastante forte entre as elites e o governo da necessidade de mostrar ao mundo que o Brasil estava disposto a combater sua má reputação em matéria de saúde pública. O pensamento reformista e a ação elegeramos imigrantes como principal alvo da política de saúde. Desta forma, o presente trabalho apresenta dados sobre essas ações e discute a maneira como os países estrangeiros – particularmente a Itália – enviaram ao Brasil agentes e inspetores, médicos, engenheiros e outros profissionais, no sentido de verificarem as reais condições de vida, de trabalho e de saúde de seus conterrâneos tanto nas áreas rurais como nas urbanas. Um dos fenômenos que resultaram dos esforços dos inspetores sanitários foi a consolidação de um mercado de trabalho para médicos italianos e a abertura de hospitais italianos em São Paulo e outras regiões do estado. O impacto da imigração e a consolidação da profissão médica, afetados pela vinda desses profissionais a São Paulo, são os focos principais deste trabalho.

Processo de construção do conhecimento a partir do diálogo ensino-serviço na ótica dos profissionais de saúde

INTRODUCTION: In Brazil, the health training policies have been going through deep changes, which are the fruits of the sanitary reform and of the breakage with the biomedical model, still hegemonic. Nevertheless, the paradigm of comprehensiveness is being introduced in health and, in order to consolidate this concept, the training has been gaining new methodological approaches. One can mention the teaching-service interaction (education-health system/citizenship health), whose proposal enables the expansion of the perception of the health-disease process, as well as the warranty of compromises of training in relation to SUS. OBJECTIVE: Understand, from health professionals, the relevance of teaching-service-community interaction, vocational training of students of the Faculty of Health Sciences / UFRN. METHODOLOGICAL PROCEDURES: This study is grounded on qualitative approach. The technique used to obtain research data was the focus group. Two focus groups (FG) were accomplished in two family basic health units of the municipality of Santa Cruz – RN, where there is participation of professionals of the Family Health Strategy. The discussions were performed from a previously elaborated script. The analysis of results was held from the categorical thematic content technique. RESULTS: The study had the participation of 18 health professionals, and 13 (72%) were females. For these professionals, the teaching-service interaction enables the student to understand the model of comprehensive health care, since the contact with the community enhances its perception about the health-disease process, but also enables recognizing the importance of teamwork to comprehensive health care. FINAL CONSIDERATIONS: The results highlight the importance of a policy of reorientation within the context of training so that students have an early contact with the service and therefore develop technical skills within the context in which they are inserted.

Os rumos do fundo público no capitalismo contemporâneo: uma análise sobre o financiamento da Política de saúde no estado do Rio Grande do Norte

This work analizes the financing of Health Policies on the state of Rio Grande Do Norte, starting at the presumption that SUS is “Bombarded” by fiscal ajustments, as a neoliberal strategy to face capital crises.The trafectory of the financing of SUS demands the comprehension of two principles which are, in essence, contradictory: the “principle of universatility”, which is caracterized by the uncompromising defence of the fundaments of the Sanitary Reform, and the “principle of containment of social costs”, articulating the macroeconomic policy that has being developed in Brazil since the 1990s and which substantiantes itself on the 2000s.This last defends the reduction of the social costs, the maintanance of primary surplus and the privatization of public social services. Considering these determinations, the objective of this research constitues in bringing a critical reflection sorrounding the financing of the Health Policies on the state of Rio Grande do Norte, on the period from 2004 to 2012.Starting from a bibliografic and documentary research, it sought out to analyze the budget planning forseen on the Budget Guideline Law (LDO) and on the Multiannual Plans (PPA), investigating the reports of the Court of Auditors of the State of RN and gathering information about expenses with health, available on the System of Information About Public Budgeting in Health (SIOPS).The Analises of the data obtained, in light of the theoretic referece chosen, reveals trends in the public budget setting for health on the State of Rio Grande do Norte, which are: a tiny share of investment expenditure on health, when compared to other expenses, the amount used in daily fees and advertising; the high expense in personnel expenses, especially for hiring medical cooperatives;the strong dependence of the state on revenue transferences from the Union; the aplication of resources in actions of other nature considered as health, in exemple of the expenditures undertaken by the budgeting unit Supplying Center S/A (CEASA) on the function of health and subfunction of prophylactic and therapeutic and on the Popular Pharmacy program. Since 2006, expenses refering to Regime Security Servers (RPPA) on the area of health also have being considered as public actions and services in health for constitutional limit ends, beyond the inconsistencies on the PPAs with the actions performed efectively.

Traps for the unwary : reform stories of private sector managers entering public service

The purpose of this research is to capture and interpret the stories of “outsider” managers who make the transition to the public sector. These experiences are considered in the context of efforts to shift public management culture in a direction consistent with meeting contemporary demands placed on public sector organisations. It is often noted that an important strategy for changing culture is the infusion of outsiders. Outsiders are thought to bring new perspectives that, through a dialectical process (Van de Ven 1995), create the potential for change. While there have been cross-sector comparisons (Broussine 1990; Silfvast 1994; Redman 1997), little attention has been given to the experience of those who make the transition in the context of efforts to reform public sector management culture. Not only is the infusion of private sector managers into the public sector a potential culture change strategy, it is also a personal experience for those who make the transition. Boundary crossing is typically an anxiety provoking experience (Van Maanen & Schein 1979) and the quality of this experience influences decisions to commit, engage, disengage or exit. The quality of the experience is likely to be affected by how the public organisation responds to people making this transition, that is, their investment in people processing (Saks 2007). The cost of recruitment and selection processes at middle and senior management levels warrants a greater research focus on this transition. In this paper we argue that the experiences of those who make the transition from private to public sectors has much to tell us about the traps that transition managers experience in making this change, the implications for injecting outsider managers as a strategy for achieving public management culture change, and how reform-oriented public organisations can manage the transitions of outsider managers into the public sector in order that best value might be achieved for both the individual and organisational change goals.

Commercialisation of regenerative human tissue : Regulation and reform in Australia and England, Wales and Northern Ireland

The commercialisation of therapeutic products containing regenerative human tissue is regulated by the common law, statute and ethical guidelines in Australia and England, Wales and Northern Ireland. This article examines the regulatory regimes in these jurisdictions and considers whether reform is required to both support scientific research and ensure conformity with modern social views on medical research and the use of human tissue. The authors consider the crucial role of informed consent in striking the balance between the interests of researchers and the interests of the public.

Assessment and curriculum reform in China : the college English test and tertiary English as a foreign language education.

Educational assessment was a worldwide commonplace practice in the last century. With the theoretical underpinnings of education shifting from behaviourism and social efficiency to constructivism and cognitive theories in the past two decades, the assessment theories and practices show a widespread changing movement. The emergent assessment paradigm, with a futurist perspective, indicates a deviation away from the prevailing large scale high-stakes standardised testing and an inclination towards classroom-based formative assessment. Innovations and reforms initiated in attempts to achieve better education outcomes for a sustainable future via more developed learning and assessment theories have included the 2007 College English Reform Program (CERP) in Chinese higher education context. This paper focuses on the College English Test (CET) - the national English as a Foreign Language (EFL) testing system for non-English majors at tertiary level in China. It seeks to explore the roles that the CET played in the past two College English curriculum reforms, and the new role that testing and assessment assumed in the newly launched reform. The paper holds that the CET was operationalised to uplift the standards. However, the extended use of this standardised testing system brings constraints as well as negative washback effects on the tertiary EFL education. Therefore in the newly launched reform -CERP, a new assessment model which combines summative and formative assessment approaches is proposed. The testing and assessment, assumed a new role - to engender desirable education outcomes. The question asked is: will the mixed approach to formative and summative assessment provide the intended cure to the agony that tertiary EFL education in China has long been suffering - spending much time, yet achieving little effects? The paper reports the progresses and challenges as informed by the available research literature, yet asserts a lot needs to be explored on the potential of the assessment mix in this examination tradition deep-rooted and examination-obsessed society.

Aligning school reform and teacher education reform in the middle years : an Australian case study

This paper discusses the development of a new Bachelor of Education (Middle Years of Schooling) at The University of Queensland, Australia. The middle years of schooling have increasingly been the focus of education reform initiatives in Australia, but this has not been accompanied by significant increases in the number of teacher education institutions offering specialised middle schooling-level teacher preparation programmes. Considering the rapidly changing social and economic context and the emergent state of middle schooling in Australia, the programme represented a conceptual and practical opportunity and challenge for The University of Queensland team. Working collaboratively, the team sought to design a teacher education preservice programme that was both responsive and generative: that is, responsive to local school contexts and to current education research and reform at national and international levels; and generative of cutting-edge theories and practices associated with middle schooling, teachers' work, and teacher education. This paper focuses on one component of the Middle Years of Schooling Teacher Education programme at The University of Queensland; namely, the practicum. We first present the underlying principles of the practicum programme and then examine "dilemmas" that emerged early in the practicum. These issues and tensions were associated with the ideals of "middle years" philosophy and the pragmatics of school reform associated with that approach. Within this context, we explore what it means to be both responsive and generative, and describe how we as teacher educators negotiated the extremes these terms implied.

High quality/high equity systems of education: Curriculum, teachers and reform in the search for equitable outcomes for all students

The issue of what an effective high quality / high equity education system might look like remains contested. Indeed there is more educational commentary on those systems that do not achieve this goal (see for example Luke & Woods, 2009 for a detailed review of the No Child Left Behind policy initiatives put forward in the United States under the Bush Administration) than there is detailed consideration of what such a system might enact and represent. A long held critique of socio cultural and critical perspectives in education has been their focus on deconstruction to the supposed detriment of reconstructive work. This critique is less warranted in recent times based on work in the field, especially the plethora of qualitative research focusing on case studies of ‘best practice’. However it certainly remains the case that there is more work to be done in investigating the characteristics of a socially just system. This issue of Point and Counterpoint aims to progress such a discussion. Several of the authors call for a reconfiguration of the use of large scale comparative assessment measures and all suggest new ways of thinking about quality and equity for school systems. Each of the papers tackles different aspects of the problematic of how to achieve high equity without compromising quality within a large education system. They each take a reconstructive focus, highlighting ways forward for education systems in Australia and beyond. While each paper investigates different aspects of the issue, the clearly stated objective of seeking to delineate and articulate characteristics of socially just education is consistent throughout the issue.

An evaluation framework for educational reform projects for teacher quality improvements in developing countries : a case study of Egyptian education reform

The role of the evaluation for Official Development Assistance (ODA) enterprises including educational development has become critical after increasing “aid fatigue” experienced by the international community in the 1990s. To date, however, monitoring and evaluating outcomes of the projects has been limited to the project life. Consequently these have been mainly through the international aid agencies. Furthermore, the monitoring and evaluation led by international aid agencies have paid little attention to aspects of the sustainability of technical cooperation in educational development. To sustain the impact of technical cooperation, the reinforcement of evaluation has drawn increasing attention in light of the emerging modalities in international development. Therefore this research was inspired to investigate alternative evaluation frameworks for an educational reform project for teacher quality improvement that may increase possibilities for long term sustainability. Importantly, the new modalities in international development and educational issues provide new options. In addition, the research reviewed theoretical and practical issues surrounding evaluation in general, and highlighted the evaluation of education reform projects. The research reported explored via case studies, the evaluation processes employed by the Egyptian education reform projects implemented by the Japan International Cooperation Agency (JICA) and the United Nations Children’s Fund (UNICEF). The case studies used three data sources (archival and relevant documents, a survey questionnaire and interviews) to illuminate the contextually-embedded evaluation processes. The research found that process evaluation is a potential alternative method since it is likely to be locally institutionalised, which may yield long-term sustainability of the projects.

Utmost good faith in insurance : reform overdue?

Considerable attention has been devoted to the duty or doctrine of utmost good faith in the academic literature and in the courts. This attention ranges from an analysis of the precise legal basis for the duty through a consideration of the continuing nature of that duty in the post-contract environment.It is quite clear that all contracts of insurance are subject to this duty of utmost good faith. What is less clear and certain are the incidents attendant upon such a duty and the scope of the obligations that such a duty imposes. This article examines the relative positions that have been reached in England and Australia and concludes with some recommendations for legislative reform to this area of the law.