A política pública de saúde no Brasil: dilemas e desafios para a institucionalização do SUS

A presente dissertação procura analisar as condições de implantação do Sistema Único de Saúde, identificando dilemas e desafios para a institucionalização do SUS. O estudo apresenta uma síntese histórica da Política Pública de Saúde no Brasil, ressaltando as dicotomias entre as ações de natureza preventiva, patrocinadas ao longo do tempo pelo Ministério da Saúde, e as de natureza assistencial, afetas ao Ministério da Previdência Social. Nesta perspectiva, o resgate do processo de formulação e implementação das ações integradas e descentralizadas de saúde comparece como de fundamental importância para a consolidação dos pressupostos do SUS, baseados nas diretr;zes constitucionais de universalidade, integralidade, descentralização e participação da comunidade na gestão do Sistema. Os limites desta consolidação são medidos através da verificação das competências das diferentes esferas de governo; do exercício do controle social pela população; e, das possibilidades de financiamento do sistema.

Linguagens da cidadania: os brasileiros escrevem para a Constituinte de 1987/1988

Esta tese analisa uma amostra de cartas pessoais que integram o fundo documental Coleção Memória da Constituinte, depositado no Arquivo Histórico do Museu da República. Esse fundo reúne documentos produzidos no curso do processo político que resultou na promulgação da atual Constituição Federal brasileira. O Brasil vivenciava um momento de transição democrática, que tinha por objetivo pôr fim ao regime autoritário instalado no país a partir do golpe civil-militar de 1964. A reconstitucionalização colocava-se como a via democrática de luta contra o autoritarismo, recebendo forte e crescente apoio social e tornando-se inclusive um ponto-chave na articulação da eleição indireta de Tancredo Neves e José Sarney à Presidência e Vice-Presidência da República em 1985. Com a eleição e morte de Tancredo, Sarney assume a Presidência e propõe oficialmente a convocação de uma Assembleia Nacional Constituinte no país. Tem início um intenso debate na sociedade e negociações em torno do tipo de Constituinte que se desejava estabelecer, com destaque para a organização de um amplo e bem estruturado movimento social em prol da participação popular na Constituinte, então aclamada como uma condição para a construção de um Brasil verdadeiramente democrático. As cartas analisadas nesta tese inserem-se no quadro das iniciativas de participação na Constituinte empreendidas no país. Elas foram escritas por populares, em razão daquele momento de reconstitucionalização, e enviadas a autoridades do mundo da política. Registram reivindicações, pedidos, comentários, críticas, denúncias e sugestões da população para a futura Constituição. O objetivo da tese é, por um lado, mostrar que essas cartas são formas de participação política, singulares e especiais, que valorizam a dimensão democrática da política. Por outro, identificar os sentidos atribuídos nas cartas às noções de “direitos do cidadão” e “deveres dos representantes políticos”, naquele momento em que o país se colocava a tarefa de elaborar uma nova Constituição – a “Constituição Cidadã”.

Gestão pública e cultura cívica: a participação pública no desenho do sistema de águas na cidade de Niterói

Este artigo diz respeito à participação popular nos processos de planejamento e implementação de políticas de gestão do uso do solo urbano por uma instância do poder municipal no Brasil. O foco de reflexão do trabalho busca analisar o processo de participação popular previsto na constituição brasileira, no caso da gestão municipal, e sua efetivação concreta nos sistema de água e saneamento na região de Itaipu, no município de Niterói, RJ. A partir desta análise teórica e empírica, o trabalho se propõe a discutir de que forma o aparato institucional e a cultura cívica existentes podem ser facilitadores ou não à participação pública na gestão municipal.

A ouvidoria pública como instrumento de controle das ações da Secretaria de Saúde do Pará

The State and Public Administration have gone through several reforms in search of a quick operation and the provision of services with quality. With the democratization of the country and the issue of the Constitution in 1988, further reform of the State and Public Administration, joined the government agenda in 1995 and included among its objectives, the principles of participation and social control. In view of this, it raises the Public Ombudsman in order to be a channel for the participation of users in the management of public affairs, social control, transparency of administrative actions, improving the quality of service and meeting the needs of the community. The aim of this study is to assess whether the Ombudsman of the State Department of Public Health to contribute to the period 2006-2008, for the improvement of specialized consulting services. The research is characterized as descriptive, qualitative approach. The collection technique used was the interview, conducted with 37 service users and two servants of the Ombudsman. The analysis was developed based on the perception of users and servers in the opinion of the Ombudsman. The most relevant results of the research showed that 41% of users search the Ombudsman because they believed that solve the problem presented. However, even with this level of public acceptance, the Ombudsman reached average index of resolvability of 53% in the period. In his role has not developed mechanisms for quality control of services, which is mentioned by 67% of users. It turned out the same fact in relation to popular participation, which is confirmed by 84% of users. For 24% of users, the problems raised were resolved, and of these, 56% believe that the Ombudsman has contributed to the positive outcome. As a result of the search results, it appears that the Ombudsman's SESPA / PA, is not fulfilling its role to ensuring the democratization of articipation in management, social control and has limited contribution to solving the problems of users and to improve the quality of services

São públicas as contratações do estado brasileiro? - uma experiência de contratações públicas junto à comunidade Coqueiral em Aracaju/SE.

State intervention generally demands the purchase or rental of goods and services, and such acquisitions are subject to a number of indispensable legal frameworks. In the Brazilian State, Law 8.666 of 21 June 1993 and further norms regulate the necessity of a formal process, usually licitation. Given the importance of this subject to public and private spheres, one of the prerequisites of these formal contracting rules is the openness of public acts, and society s knowledge and accompaniment. The objective of this study is to investigate society s participation in public contracting, with the aim of debating theories surrounding the state/society relationship proposed by public political thought and authors in relation to legal aspects involving licitations. The principal question of this research is: despite the possibility of society s participation being predicted in the legal frameworks which orientate licitations, why is this social control not carried out? Why does it only occupy a secondary position to both individual and collective agents? In order to test some of this study s hypotheses, field research was carried out in the Coqueiral community in Aracaju, Sergipe, in relation to public acquisitions of goods and services during the period of May to September 2009. Research involved observation visits and guided interviews with the relevant community and public sector representatives. This project s hypotheses were confirmed, as this social control is not apparent, even in areas where popular participation is a strong component in asserting ones local rights, like in the Coqueiral community.

ACRE: uma experiência inovadora de Governança?

About two decades ago Brazil has been suffered some important political changes on its government and supporter systems. In these changes the Partido dos Trabalhadores (Workers support) has been researched significant results as much legislation as executive ways. These conquests propitiate a structure for it to get an alternative motion in order to manage public goods by petista government way. Trying to examinate this we can study the Partido dos Trabalhadores government experience in Acre (1999-2002) to know about why the PT government characteristics are different from the others. To do this we assumed to conjecture a popular participation with priorities inversion and ethics in public resources administration. These are the elements of PT government way. This way we started our work making an evaluation of its bibliography. Them we do a field inquiry to analyses documents of the government projects (budget rules law, papers, approved laws, IBGE, PNUD, TSE) and semi-structured interviews with some characters of recent political Acres life. The scheme and the analysis about these givens disclose that weren t confirmed our hypothesis in part, since PT remained old local politics habitus. In other side the executive administration on PT government has got to inflect the Governance . Further on an efficient management as World Bank dispossess but PT absolve many requests of progressive sectors as well it expanded the society participation to resolutions process. By a cabinets enlargement. So it rescues a total administrative course which is printed in the called petista government way. Personally we think so it means important advancements in this Acre government way

A construction como método concretizador de direitos fundamentais: aplicação na jurisdição constitucional brasileira

The way of organization of the constitutional jurisdiction implies the possibility to extend the democratization of the same one in function of the popular participation in the active legitimacy to constitutional process (procedimentalist model) e, at the same time, to assure technical viable decisions fast and to the complex problems of the constitucional law (substancialist model). The comparison with the constitutional jurisdiction of U.S.A. becomes interesting from the knowledge of the wide power to decide experience of Supreme the Court that for a methodology of construction of rights and not simply of interpretation of the Constitution, brought up to date and reconstructed throughout its historical evolution the direction of the norms of basic rights and the North American principles constitutional. Construction while constitutional hermeneutic method of substancialist matrix works with techniques as the measurement of principles, the protection of interests of minorities and the entailing of the basic rights with values politicians, what it can be brought to evidence of the Brazilian constitutional jurisdiction in order to improve the construction of basic rights that comes being carried through for the judicial ativism in control of the diffuse and abstract constitutionality. To define the limits of construction is to search, on the other hand, a dialogue with the procedimentalists thesis, aiming at the widening of the participation of the citizen in the construction of the basic rights for the constitutional process and to argue forms of the society to evaluate the pronounced decisions activist in the controls diffuse and abstract of constitutionality

O serviço público de fornecimento de água nas regiões metropolitanas: cooperação entre entes da federação e desenvolvimento

This work aims to study the material conflict of jurisdiction as to the ownership of public water supply, between the municipalities and the Member States, in metropolitan areas. One of the important points of analysis is the realization of the fundamental right of access to water, a right that is implicit in the Constitution of 1988, being prevented from having their achievement considering the lack of definition of the ownership of the service. Knowing discussed the essential public service, in all its stages, it will realize it is a complex activity that depends for its operation, joint activities of federal entities and the society. In its pursuit of development (understood as better conditions of life), that in view of the Federal Law nº 11.445 of 2007 is the universal access to service, require the adoption of popular participation and the positive benefits of the state, such as planning. Moreover, it will find cooperation between federal entities (after the study of Brazilian federalism) peaceful solution to the conflict through the adoption of joint management or shared, depending on the factual situation and legal

Democracia participativa e regulação econômica: uma questão de legitimidade

This work presents an analysis about the legitimation of independent regulatory commission`s rulemaking power by participation procedure. It is observed that political and administrative decentralization and fragmentation of State, with the purpose of approaching citizens and provide, more efficiently, the functions acquired by the passage of the Welfare State, leads to a deficit of legitimacy (democratic crisis), which is noticeable in the making of legal norms by directors of independent regulatory commission to regulate specific economic sector. However, we understand that this crisis stems from the observation of the contemporary world from dogmas and legal institutions of the eighteenth century, without their evolution and adaptation to the modern world. The legitimacy must be perceived as the justification of power, relation command /obedience, which, from the Modern State, has the democracy as standard. Therefore, just as the world has evolved and demanded political and administrative decentralization to accompany him, it is necessary to the development of the idea of representative democracy (formal legitimacy) to participatory democracy (legitimacy stuff). Legitimacy is not confused with the legality: as the legality is on observance to internal legal system, the "rules of play"; legitimacy, as inputs to be fed into this system, the selection of the different expectations in the environment. Nevertheless, the legitimacy will take place by legality, through introduction of rational and communicative procedures: procedures get fundamental importance because these will be the means to select the expectations to be introduced in the legal system in order to make decisions more fair, rational and qualified towards society. Thus, it is necessary to its opening to the environment for dialogue with the government. In this context, we try to make an analysis of constitutional norms based on systematic and teleological interpretation of these norms to build these arguments. According to the Constitution of 1988, participatory democracy is a result of the democratic principle (sole paragraph of art. 1 of the Constitution), and it is an expression of citizenship and political pluralism, both foundations of Republic (respectively Art. 1st, inc . V and II of the Constitution), as well as the national consciousness. From another point of view, that principle consists of an evolution in the management public affairs (principle of Republic). The right of interested participate in the rulemaking process derives both the principle of popular participation (part of the democratic principle) and the republican principle as the due process constitutional (art. 5, LIV and LV, CF/88) and the right to petition (Art . 5 °, inc. XXXIV, "a", CF/88), and it is the duty of the State not only be open to participation and encourage it. Ignoring stakeholder involvement in procedures and / or expressions compiled can be causes of invalidation of the rule of law produced by addiction of procedure, motive, motivation and/or because of the administrative act. Finally, we conclude that the involvement of stakeholders in the process of making rules within the independent regulatory commission is the legitimacy and the validity of rules; and that, despite of the expressions do not bind the decision making, they will enter the system as juridical fact, balancing the field of technical discretionary of agencies

Etnobiologia do boto cinza (Sotalia guianensis, van Bénéden, 1864) por comunidades pesqueiras do Rio Grande do Norte, Basil

Ethnobiology studies Local Ecological Knowledge (LEK) as well as the use and management of natural resources by local communities in order to understand how the environment is perceived, known and classified by human groups. In fishing communities, LEK adds empirical information about the biology of aquatic species and complements scientific findings, especially when it is difficult to obtain factual information during studies on cetaceans, whose behavior is essentially underwater. Cetaceans (whales and dolphins) are constantly threatened by human activities, especially by accidental capture of small coastal species, as in the case of the estuarine dolphin (Sotalia guianensis), object of this study. Ethnobiological researches in fishing communities are of great importance and can clarify aspects of the biology and conservation of this species. Although extensively studied throughout its distribution range, there are still gaps in the knowledge about S. guianensis. Therefore, fishers local ecological knowledge becomes an additional tool to get and confirm information about S. guianensis. This study evaluated the LEK of artisanal fishers who are daily exposed to local population of S. guianensis, through the use of semistructured interviews (N=116). The interviewed fishers were asked about the biology and popular classification of S. guianensis and about possible interactions between this dolphin and them. The studied communities were located in Tibau do Sul (n=39), Pipa (n=36) and Baía Formosa (n=41), all on the south coast of Rio Grande do Norte, Brazil. The study was based on the assumption that differences in fishers LEK among those communities would be caused by both the variety of fishing environments (lagoon/estuary and ocean) and the intensity of tourism activities. Fishers knowledge is expressive and differed among the studied communities depending on the topic investigated. Fishers correctly reported the habitat, distribution, seasonality and behavioral particularities of S. guianensis. Tourism mainly affected the naming of the species. The study results also suggest that marine fishers have greater knowledge about the species than the estuarine/lagoon ones. Local populations accumulate empirical knowledge according to their environment. Hence, it is important to take into account both empirical knowledge and popular participation in management systems, in order to maintain information sharing among communities

Análise de qualidade da atenção à criança na estratégia saúde da família: o óbito infantil evitável como referência

Alma-Ata declaration bring the Primary Attention to the Health (PAH) as first level of health attention for individuals, family and community, which considers infant group as priority. Several initiatives that gave bases to integral attention to the children health formalized in the principles of Unique Health System. Family Health Strategy (FHS) comes to strengthen this attention, instituting new ways of work organization and professional practices that gave impact in their quality indicators. One of them is children mortality, showing decline in their values. Though, studies indicates persistence of avoidable infant deaths. In Natal RN, this reality is also perceptible leading to inquietudes, mainly at the space of services production, it means, which motivated the accomplishment of the present study intending to analyse the way that the organizational and structural processes as long as the professional practices in FHS interfered in the quality of children s health attention who died by avoidable death in the year of 2007 in municipal district of Natal-RN. It treats, therefore, to an exploratory and descriptive survey of cases study type, thar had as primary sources the oficial documents of MH, the family prontuary, pregnant card, child card and testimony obt ined from instrument of research elaborated based in investigation form of infant death by MH, applied to 10 mothers of children who had avoidable death. In analysis it was appealed silmultaneous triangulation of methods and sources, allowing a bigger aproximation from obtained informations. To elucidate the cases, the aspects studied were analyzed to the light of explicative model of Social Determinants of Health. Among individual and family aspects were highlighted the related to age, schooling, family habits and customs and mother s economic condition, besides of pregnancy age, newborn weight and associated diseases, which don t differ from literature about the theme. Reffering to the factors organizational and structural processes and professionals practice, highlihgted, the treatment given by the professionals, the territorialization and adscription of areas, the difficulty of having access to the services or sleepers and the reference and counterreference. But also, the ausence or few greet, the lack of communication, few assiduity and ponctuality by professionals in service, among others. In a general way mothers considers the attendance received in the hospital good and very good , opnions that in the Basic Attention weren t so favorable, in spite of many of predictible actions in this level have been performed in the studied cases. It is observed, therefore, that the social determinants of health has a strong influence in ocurrence of infant deaths, what implicates in a large actuation by Infant Mortality Committee from municipal district. This way, it becomes fundamental the reflection and evaluation about the effectiveness and execution by the processes of vigilance to health in FHUs; the rethink about the social determinants of health in a wide and articulate way to the services quality, to permanent education, to management in service, to the given attention and to the way how it is installed the popular participation and social control. To the professionals it is presented the great challenge to review their daily practice, their values, behaviors and commitment, which ones must be guided by logical of sharing, work in team, humanescence and alterity, not only by the accomplishment of a professional duty

Trânsito de saberes e campo representacional na visão dos profissionais da saúde da família e do programa de educação pelo trabalho e para a saúde

The Family Health Strategy (ESF) is emerging as a possible restructuring of services and new practices of intervention in health care; it requires skilled professionals to work with that framework. Within this purpose, we established the Education Programme for Work and Health (PET-Saúde), in order to integrate teaching and service activities, focusing on primary care. On this basis, the aim of this work is to apprehend the social representation of nurse, doctor and dentist (Project PET-Natal Health RN preceptors) on the ESF, while practice field of them. It is a descriptive and exploratory study, with a qualitative approach, carried out in 07 Family Health Units (USF) included in the PET-Saúde Natal (RN). The population was composed of 35 professional components of the primary care team with bachelor's degree of the USF linked to this project. The sample was composed of 05 nurses, 05 physicians and 05 dentists, for a total of 15 subjects. Data were collected through three instruments: the drawing-themed story, a semi-structured individual interviews and field diary. The data relating to the identification of the subjects were entered and tabulated by the Microsoft Excel software 2007 version. The drawing analysis and interpretation is given by the significance attributed to the resource chart from title and keywords assigned by the subjects, considering the ESF as an inductive term. The stories and interviews were transcribed and typed and then subjected to read/listen the material and a lexical analysis through Alceste. After this process, the discursive material was analyzed and discussed by theoretical and methodological feature of the Social Representations theory. The majority of health professionals were female, aged between 46 and 52 years old, married, income less than six minimum wage, time since graduation ranged from 22 to 29 years and working time in the ESF range from 02 to 11 years. From the classification system ALCESTE were selected categories identified by: Category 1 - ESF: relations and territory; Category 2 - Training and bond profile; Category 3 - Working process in the ESF; Category 4 - Articulation between teaching and service; Category 5 - Health care and disease prevention. The representational field construction, while a process, followed the logic of structural cores in existing categories. In this sense, it is clear that the ESF is an environment rich in diversity, experience and relationships with potential such as the relationship "very subject-subject" and the link established between professional-community, but also has some weaknesses such as poor working conditions, lack of popular participation and management support, thus difficulties in the achievement of teamwork. Being essential to that end, the teaching-service aimed at the formation of a new health professional able to work in the ESF. In this research, the training of the representational field encountered a diversity of structural cores, or thoughts on training, about the ESF because of the greater emphasis on the here and now of the interaction between health professionals, the ESF, the community, PET Health-UFRN and students, emphasizing that such proposals are still considered as concepts in the context of recent health and that, therefore, are not fully realized in the social imaginary