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

A casa própria: sonho ou realidade? : um olhar sobre os conjuntos habitacionais em Natal

This dissertation is about housing provision under a capitalist system. It aims at analyzing the economic relevance of the Brazilian housing policy, in particular, looking at the housing estates built in Natal city. It also draws on a data-base about living and housing conditions in Natal, produced in the wake of a more comprehensive research of the 50 largest housing estates in the city. Theoretically, the dissertation discusses: the symbolic dimension of housing; housing as a commodity; the alleged social and economic stability of homeownership; and the urban dynamic of housing estates. It also discusses the historic and conceptual references of the Brazilian housing policy and its consequences to Natal city. From the 1960s, polilcy under the BNH privileged the production of large housing estates. Although this was more closely related to economic rather than social objectives, this policy helped expand the urban limits. This was the case for Natal. At the end, this policy was not targeted towards the poorest in society but towards those low income house buyers who could afford to pay for the mortgages on offer

O corredor cultural: espaço de materialização da exclusão social em Mossoró-RN

In contemporary society, social exclusion is an actual and pertinent theme, because it presents itself as a challenge to management and planning of the public policies. In this perspective, the thesis entitled "The Cultural Corridor: space materialization of social exclusion in Mossoró-RN" is a moment of apprehension and analysis of the local reality from the urban policy implementation that emphasized an enterprising model, which has, as the concrete space to urban renovation manifestation, the cultural complex called cultural corridor. Because of the investigation and the directional hypothesis, it is possible to say that the urban development policy implemented in Mossoró, starting from the 1990 decade, based in the model of modernizing/enterprising management, has been causing an intensification of a society parcel exclusion from the city public space, since this public policy didn't prioritized job market increasing, as well as population incomes improving, poverty and social inequality reduction, at the same proportions it promoted geographic space reorganization with directional actions to build the "spectacle city"

Educação tecnológica e pré-sal: necessidades e urgências

The purpose of this dissertation is whether the demand for manpower trained in technical school for the sector of Oil and Gas (O&G) is in balance with the offer of that training in the Brazilian education system. The methodology used to obtain such information was based on School Census 2000 and 2008 where data were worked out in order to clarify the numbers of enrollments in secondary technical level demanded by the sector of O&G. The demand for manpower with that qualification as a data source was the 2010-2014 Business Plan Program for Mobilization of the National Oil and Natural Gas (PROMINP). This Program identified the future demand for manpower for the Sector of the O&G until 2014 where the occupational categories are mapped prerequisite training and experience. In order to better understand the object of this study was dome a review of the literature with regard to technical education in Brazil but also the importance of the education to economic growth and the peculiarities of the oil economy in different countries possessors of those mines, or that is, developed and underdeveloped countries. Analysis showed that enrollment in technical education in Brazil had a significant increase between the dates 2000 and 2008. It also don´t bring balance with the characteristic of the dynamics of the productive sectors of the economy mainly due to heating of the economy before the global growth especially in the Construction Industry as well as in the Oil and Natural Gas Engineering and a Naval account of the discovery of oil in the Pre-Salt. Another important aspect is that one of the major problems of qualification of manpower in Brazil is due to a bad quality of the student´s school and high school which makes difficult a good performance in office work and also this ability to learn new functions. The rapprochement between the supply of the education system and the demand for manpower with training mid-level technical support for the sector O&G showed that most technical courses demanded or had no enrollment in 2008, had few enrollment in 15 states with demand expect to occur and those enrollment were unevenly distributed among states. The analysis therefore signalize the needed of a public policy that enables the adequacy of the education system (Secondary Technical Education) to Sector of O&G in terms of enrollment and its distribution between the oil producing states and in relation to technical expertise offered

Educação tecnológica e pré-sal: necessidades e urgências

O objetivo desta dissertação de mestrado é verificar se a demanda de mão-de-obra com formação no ensino médio técnico para o setor de Petróleo e Gás (P&G) está em consonância com a oferta daquela formação no sistema educacional brasileiro. A metodologia aplicada para obter tal informação foi baseada no Censo Escolar 2000 e 2008, em que os dados foram trabalhados de maneira a explicitar o número de matrículas nos cursos de nível médio técnico, demandados pelo setor de P&G. A demanda de mão-de-obra com aquela qualificação teve como fonte de dados o Plano de Negócios 2010-2014 do Programa de Mobilização da Indústria Nacional de Petróleo e Gás Natural (PROMINP). Este Programa identificou a demanda futura de mão-de-obra para o setor de P&G até 2014, onde as categorias ocupacionais mapeadas possuem pré-requisitos de formação e experiência. Com o intuito de entender melhor o objeto deste estudo foi feita uma revisão de literatura no que diz respeito ao ensino técnico no Brasil, como também a importância da educação para o crescimento econômico e as peculiaridades da economia do petróleo nos diferentes países possuidores daquelas jazidas, ou seja, países subdesenvolvidos e desenvolvidos. As análises demonstraram que as matrículas no ensino técnico no Brasil apresentaram um significativo aumento entre as datas de 2000 a 2008. Traz também como característica a desarmonia com a dinâmica dos setores produtivos da economia, devido principalmente ao aquecimento da economia antes da crise mundial de 2008, e a retomada recente do crescimento notadamente no Setor de Construção Civil, bem como no setor de Petróleo e Gás Natural e Engenharia Naval por conta da descoberta de petróleo na camada Pré-sal. Outro aspecto relevante é que um dos grandes problemas da qualificação de mão-de-obra no Brasil se deve a má qualidade do ensino fundamental e médio, que dificulta para o futuro profissional um bom desempenho nas suas funções laborais e na capacidade de aprender novas funções. A aproximação entre a oferta no sistema educacional e a demanda de mão-de-obra com a formação de nível médio técnico para o setor de P&G, demonstraram que a maioria dos cursos técnicos demandados não apresentava matrículas em 2008, ou possuíam poucas matrículas nos 15 estados com demanda prevista, e aquelas matrículas estavam mal distribuídas entre os estados. A análise aponta para a necessidade de uma política pública que possibilite a adequação do sistema educacional (Ensino Médio Técnico) ao setor de P&G, tanto no que se refere ao número de matrículas e a sua distribuição entre os estados produtores de petróleo quanto no que se refere à especialidade técnica oferecida

Políticas públicas de atendimento à criança: desafio da ação articulada no Projeto Belém Criança (2001-2004)

Public politics of Service to the Child: The Challenge of the Action Articulated in the Project Belém Criança (2001-2004) if it constitutes in a study on the politics directed toward the children of 0 the 6 years. It has as objective to analyze the configuration of the politics of integral attention to the child, evidencing the form as the same ones they had been redimensioned by the neoliberal ideas and by the lines of direction of the international organisms. The work has like empiric reference the project Belém Criança, developed by county of Belém from a partnership with the Deep of United Nations for Infancy (UNICEF), in the period of 2001 and 2004. The project intends to develop an articulated action among the several county departments which offer assistance to the children looking for to rationalize the resources and to optimize the services. Amongst the methodological procedures that materialized the research distinguished: The bibliographical review and documental allowed to analyze the contextualization of the public politics and, between them, the social politics of attendance to the child; the historical revolution this attendance; the paper of the UNICEF how articulator of the politics in municipal scope; and the paper of county how executer these politics. Still it was utilized, the half-structuralized interview, Having like subjects: the representative of the UNICEF in Belém, the municipal co-managers and actors of community in which the project was implemented. The result of the analyzes review that, historically, the politics destined to the child they had been being dimensioned having like support the fight of social movements vindictive for publics politic which guarantee the fundamentals rights these citizen. Although legal dimension of current politics of attendance to the child, to assume a vision of completeness and the guarantee of the rights, it still has a great exaggeration between the speech and the practical one. Actually, the same one are elaborate inside the neoliberal optics, with ruled actions by the beginning in combat to the poverty, implanted with low costs and with practice which to lead to the excessive fragmentation, generating inadequate actions and punctual programs which don t guarantee the social quality of the attendance. This perspective was evidenced to the most of the actors which the Project Belém Criança don t constitute itself a real public politic toward the child of 0 the 6 years, although present innovating aspects, how the mobilization and participation. It was demonstrated yet, in the participant s depositions of the research, that the bureau had numberless of difficulty to develop the action preview in the project, it has seen the great complexity of articulation between the several organism responsible by politics of attendance

Educação ambiental: mediações sociais e políticas e a indolência do Poder Público à sua inclusão no ensino formal

As a result of the prediction of irreversible changes on necessary conditions to maintain life, including human, on the planet, environmental education got the spotlight in the political scenario, due to social pressure for the development of individual and collective values, knowledge, skills, attitudes and competences towards environmental preservation. In Brazil, only in 1999 the right for environmental education was officially granted to people, having the status of essential and permanent component in the country s education. Since then, it has been Government s duty, in each federal branch, to plan actions to make it happen, in an articulate way in all levels and modalities of the education process, both formally and informally. This work of research has environmental education in the school as subject matter, and aims on analyzing social and political mediations established between this National Environmental Education policy and the contexts associated to the legislative production process, the political nature of the conceptions about environmental education that underlie Law 9.795/99 (Brazil, 2009c) and also Rio Grande do Norte Government s actions and omissions related to the imperative nature of the insertion of environmental education in the schools ran by the state, during the ten years this law has been in force. The investigation of the subject matter was led by a social and historical understanding of the social and environmental phenomena, as well as of the education system as a whole, considering that only through a dialectical view we can see the real world, by destroying the pseudo-concreteness that surrounds the topic. While analyzing, we assumed that in face of the dominance of a social organization in which market regulations rule on environmental ones, by developing individual and collective critical conscience, environmental education can become a threat to dominant economical interests in exploiting natural resources. The results of this research suggest that as an educational practice to be developed in an integrated, continuous and permanent fashion in all levels and modalities of formal education, environmental education has not yet come to pass in the state of Rio Grande do Norte, due to the neglect and disrespect of the government when facing the need of promoting the necessary and legally appointed measures to make it present in the basic education provided by the state. The legislators silence when it comes to approving a regulation on environmental education essential to define policies, rules and criteria to teaching the subject in the state and the omission from the public administration regarding critical actions in order to integrate in public schools the activities related to the National Environmental Education Policy, represent a political decision for not doing anything, despite the legal demand for an active position. This neglecting attitude for the actualizing of strategically concrete actions, urgent and properly planned for the implementation of environmental education in schools in a multidisciplinary way, exposes the lack of interest the predominant classes have in such kind of education being made available, as it could be developed based on a critic political view, becoming a political and educational action against dominance. When analyzing the basic principles and fundamental goals in Law 9.795/99 (Brazil, 2009c) the development of a critic environmental education is really possible and concurs with the National Environmental Education Policy, reflecting the social and political mediations established between this public policy and the contexts associated to its legislative production process, which are responsible for approving a regulation which also represents the mind of the people about environmental protection above anything else

O desafio da parceria na implementação do PRONERA: o caso do projeto alfabetização cidadã no nordeste Paraense.

El desafío de la parcería en la implantación del PRONERA: el caso del Proyecto Alfabetización Ciudadana en Noreste de Pará se constituye en un estudio sobre las políticas públicas de educación del campo. El trabajo tiene como objeto de análisis la implantación del PRONERA, a partir del estudio de caso del Proyecto de Alfabetización Ciudadana en Noreste de Pará, con el objetivo de comprender como la parcería, principio operacional y metodológico propuesto por el PRONERA, se concretó en la implantación del Proyecto y cuales sus posibles implicaciones en las políticas públicas de educación del campo. Entre los procedimientos metodológicos, realizamos la investigación bibliográfica y documental que nos permitieron situar la educación del campo en términos históricos y políticos, sistematizar la constitución y la organización del PRONERA y reflexionar acerca de la parcería a partir de diferentes ópticas. Realizamos también la investigación de campo por medio de entrevistas semi-estructuradas, con el propósito de analizar la implantación del Proyecto da Alfabetización Ciudadana, a partir del dialogo con los actores sociales involucrados. Los resultados de las análisis indicaron que, históricamente, las políticas públicas de educación destinadas a las poblaciones de la zona rural fueron instituidas verticalmente, desvinculadas de la realidad del campo e incompatibles con las necesidades e intereses de los sujetos. Constatamos que, en período reciente, movimientos sociales del campo reivindican y proponen acciones que se establezcan como políticas públicas de educación del campo. Identificamos que el PRONERA resulta de ese movimiento y se presenta como anuncio de una política pública de educación del campo, teniendo como diferencial el hecho de ser un programa del gobierno federal idealizado fuera de la esfera gubernamental, construido por los movimientos sociales del campo y presentar, entre otras innovaciones, el modelo de parcería y la gestión compartida, participativa y democrática. En esta perspectiva, en este estudio de caso, se evidenció que la parcería, frente a los conflictos y las disputas entre sus miembros participantes, no es el problema de la implantación del PRONERA, sino su punto fuerte. De este modo, la parcería es uno de los elementos necesarios para la construcción de políticas públicas, en particular, de educación del campo, una vez que posibilita la interacción de instituciones públicas y movimientos sociales locales, atribuyendo legitimidad a la educación del campo. Al promover un proceso de aprendizaje democrático, la parcería se presenta como estrategia de democratización de la educación del campo.

A participação popular na elaboração de políticas públicas de desenvolvimento local: um estudo no Município de Serrinha/RN (1997-2004)

The question of participation has been debated in Brazil since the 1980 decade in search a better way to take care of poulation s demand. More specificaly after the democratic open (1985) begins to be thought ways to make population participates of decisions related to alocation of public resources. The characteristic of participates actualy doesn t exist, population to be carried through is, at top, consulted, and the fact population participates stays restrict to some technics interests at the projects, mainly of public politics of local development. Observe that this implementation happens through a process and that has its limits (pass) that could be surpassed through strategies made to that. This dissertation shows results of a research about participative practices in city of Serrinha between 1997 and 2004, showing through a study of the case of Serrinha what was the process used to carry through these pratices in a moment and local considered model of this application. The analyses were developed through a model of research elaborated by the author based on large literature respects the ideal process to implant a participative public politics. The present research had a qualitative boarding, being explorative and descritive nature. The researcher (author of this dissertation) carried through all the research phases, including the transcriptions of interviews that were recorded with a digital voice recorder. Before the analysis of these data was verified that despite the public manager (former-mayor) had had a real interest in implant a process of local development in city, he was not able to forsee the correct process to do it. Two high faults were made. The first was the intention to have as tool a development plan, what locked up to make this plan was the booster of supossed participative pratice and no the ideal model that would be a plan generate by popular initiative. The second one was absence of a critical education project for the population that should be the fisrt step to carry through a politc like that

O psiquiatra na atenção psicossocial: entre o luto e a liberdade

No Brasil, vemos surgir, a partir da década de setenta, diversas propostas inovadoras no campo da atenção à saúde mental. A partir de então, multiplicam-se no país ambulatórios de psicologia e psiquiatria, hospitais-dia, residências terapêuticas e diversos núcleos/centros de atenção psicossocial. Transformados em política pública, os centros de atenção psicossocial espalham-se pelo país, preconizando um atendimento ambulatorial, interdisciplinar e de orientação territorial. Geralmente formado sob os auspícios de um grande hospital, o psiquiatra que se propõe a trabalhar, a partir da ótica psicossocial, imerso em uma pequena cidade, vê-se exposto às diversas contradições e ilogicidades do discurso psiquiátrico clássico. Os variados saberes locais são uma ameaça ao saber psiquiátrico medicamente constituído. Respostas, antes fáceis no interior do hospital, têm variadas implicações no território e adquirem uma complexidade para a qual o psiquiatra não se encontra preparado. Assim, este trabalho tenta demonstrar a dissonância entre essas duas espécies de psiquiatria: a clássica (afinada com a biologia, com a normatividade e com a instituição) e a psicossocial (que se volta para respostas localmente construídas e que se afina com o homem, em uma dimensão muito além do seu corpo).

A mídia dos outros somos nós: a experiência audiovisual do Ponto de Cultura Cinema para Todos

This research aims to identify the process of appropriation of audio visual (in digital video) for collective symbolic production (participatory video practice that expresses popular culture) in a socio-cultural context where the minorities are. Therefore, we based this study on the students‟ experience of the film and video workshops held by Cinema para Todos (Culture Point Cine for All), in Natal, RN. Culture Point is the basis of the project Programa Nacional de Cultura, Educação e Cidadania Cultura Viva (National Program of Culture, Education and Citizenship - Living Culture) of the Brazilian Ministry of Culture. In 2010, the Cine for All developed three film and video workshops in the state of Rio Grande do Norte (Northeastern of Brazil), in the municipalities of Açu, Lajes and São Gonçalo do Amarante, within a public policy project of socio-cultural inclusion. These three workshops are the focus of this empirical investigation. To support the analysis of this research we consider that the spaces of workshops are sites of the social practices origin, assuming they show the development of the changes of actions that generate new practices. In this socio-cultural context the students as interlocutors process the communicative culture mediation, where come from the logics of action (using digital video) to become a mediatic practice (video auto ethnographic). With the overall goal set and the field of investigative action delimited we considered the methodology of case study suitable for the observation of the object, because it is a phenomenon of modernity, occurring in a context of real life and with little or no control over events. Participant observation and interviews was also applied to this case study. The analytical theoretical support comes from the notion of mediation by Jesús Martín-Barbero and the concept of habitus by Pierre Bourdieu. The research found that a new way of communicating has been developing by this social group, and this reflects the technological change experienced by them. The auto ethnographic videos, short movies, reveal an allegorical trial of the mainstream media, because while they use the mainstream format, they rework the aesthetic, but without revising the history, in fact they proposing to retell the history of themselves full of colorful details and with richness of their forgotten popular culture.

Efeitos da previdência rural na agricultura familiar da microrregião Serra de São Miguel - RN

The objective of the present work is to verify the effects of Rural Social welfare in the family agriculture of the microrregião Serra de São Miguel-RN. The study based on available bibliography on the theme, in secondary data and in a rising amostral accomplished in three municipal districts (Encanto, São Miguel and Riacho de Santana) of the microrregião. The universe of the study was the establishments of the family agriculture appeared in the Agricultural Census of 2006, in those municipal districts. The unit of considered analysis was the rural family, with the interviews being applied close to the farmers' families with and without retired rural. The sample was of 94 present families in the family establishments. The results demonstrate that the Rural Precaution reaches a significant covering degree in the rural area of the researched municipal districts, with an average of 1,57 beneficiaries for home in the families with retired. The data of the research attest that the family agriculture in the microrregião Serra de São Miguel-RN it has few favorable conditions for his/her development, once, besides the shortage of lands and of the climatic factor of the area, the returned public politics the family farmers' totality - like PRONAF and PAA -, it has been unable to give effective answers for the improvement of the life conditions in the rural way, have seen the minimum amount of families reached by those politics, be in function of the drawing or of the atmosphere where they are done. In this context, he/she stands out the importance of the Rural Precaution that, in function of the application of the constitutional devices that you/they guaranteed his/her universalization, it has been the only relevant public politics that, in fact, it has been reaching her/it all their beneficiary potentials. Given the general situation of the family agriculture of the microrregião and of the specific characteristics of the researched family establishments, the hypothesis was corroborated that the rural retirement doesn't contribute directly to the increase / making possible of the family agriculture. In spite of 57,4% of the families with retired have declared to use resources of the retirement in the costing of the rural activity carried out by the family, the annual medium value of the expense just located around 7,02% of the annual value of the retirements gained by the families in the year of 2010. Data the low levels in that the social reproduction of the great majority of the family establishments of the microrregião, the maintenance of the families is operated represents the main destiny of the resources precautions. It was also confirmed the hypothesis that the Rural Precaution constitutes the main monetary contribution of the families with retired. For more than 93% of the families with retired, the retirements doing 50% or more of the total of the family monetary income, and in the composition of the rural income of the families with retired and pensioners, the originating from income the rural retirements are equal to 65,24% of the total of the annual income obtained by the families. It is ended, because, that the rural precaution, given to the adversities for the development of the family agriculture, of the operational inefficacy of the public politics and of the few opportunities of generation of existent income in the local savings, it is the main responsible for the reduction of the poverty and, consequently, for the improvements of the conditions of life of the families of and with seniors in the rural way of the microrregião Serra de São Miguel-RN

A relação juventude-trabalho no projovem integrado do município de Natal/RN

The National Program for Youth Inclusion (ProJovem) has been created in 2005 in order to break the reproductive cycle of social inequality, through the improvement of the basic education and the professional qualification. Therefore, our objective is to discuss how the categories youth-work are inserted and implemented on ProJovem Integrado , which could be translated as Integrated , in Natal/RN. In 2008, ProJovem is has started to be executed based in four modalities: (1) Teenagers Socio-Educational Service, (2) Urban, (3) Worker and (4) Countryside Land Knowledge, aiming to serve a population from 15 to 29 years old who were seldom helped by specifics policies so far. In order to implement this research, three semi-structured interviews have been made, as well as observations at the program units and analysis of the official documents. In Natal, the operating modalities are: ProJovem Urban, which three units, divided in two districts of the city; the ProJovem Teenagers , which has ten units on Natal s four administrative regions; and ProJovem Worker , which were still structuring its courses until the beginning of the data collection. The data has been qualitatively analyzed through the Marxian Theory, tied to the Constant Comparative Method. The referred approach, based on the Grounded Theory, enables the understanding of the phenomenon s meanings through the perspective of the participants. The neighborhoods in which ProJovem s units are inserted has been characterized as well the Program s target. The results have been presented in three blocks: a) the modality s structure, which includes the implementation, functioning and operationalization of the activities; b) management of the modality s management, concerned to the main difficulties, expectations and functions; and c) the relation youth-work at the modalities. About the objectives and qualification and insertion goals, there is incongruence at the offer of occupational arches. We have observed that offered occupations are historically subservient and precarious. Hence they do not promote significant changes on the students career paths by usually inserting them into informal jobs or underemployments. Besides that, the professional qualification is very incipient. For that reason, it does not go with the necessary requirements to enable the youngster to enter the work world. It is considered that other researches are necessary to for better understanding of the remaining aspects of the relation youth-work

O dispositivo alta nos Centros de Atenção Psicossocial/CAPS : loucura, vida cotidiana e organização social

The present paper proposes an analysis about the Brazilian Psychiatric Reform as a public policy and deriving from a research developed with the workers of a Psychosocial Attention Centre III (CAPS III) and the managers of the Psychosocial Attention Web (REAP) in Aracaju. This analysis is developed as an investigation of the discharge at those services, understood not as a procedure, but as a dispositive from which different elements can be articulated: users, knowledge, technical procedures, police measures, juridical decisions, laws, services edifying. This, form the background of the articulation between mental alienation and the subject of right alienation, in the ways through which this articulation develops to the relations between madness,citizenship, internment and substitutive practices. Our investigation about the discharge as a dispositive was built with some narrative constructions, as a discourse analysis inspired by Michel Foucault s method, from the perspective of some of the main dispositive operators: workers and managers. The main aspect observed were: the articulations built by the discharge as a dispositive based on two discursive grate, the Reform as a new treatment substituting internship, and the Reform as juridical insertion and users rights practice; the exercise of these discursive grades based on the workers and managers perspective; the transference of limitations and contradictions of these grades to the competence of the dispositive operators, emerged in an outstanding way, as sometimes those operators are liable for the emergent limitations and difficulties, and some other times they are restrained by their institutional role, which is to maintain the domination relations articulated by the dispositive; finally, some aspects extracted which the dispositive operators - when they were expected to act in a way to maintain certain power relations - were capable to resist, managing other power relations from the dispositive, that we call, as Agamben, dispositive profanity

Práticas institucionais/discursivas acerca dos cuidados com os bebês prematuros e/ou de baixo peso: o programa canguru

The Kangaroo Program was implemented in Brazil in 2000 through the Unified Health System (Sistema Único de Saúde SUS) sustained with a humanized rethoric of health care assistance. This program adopts the skin-to-skin contact contributing to the mother-infant bond, breastfeeding and promoting security in mother s care. The users of SUS are encouraged to live in the maternity ward to follow the baby health improvement. However, it was verified in previous observations that mothers participation in the Kangaroo Program has been done through an imposed practice. Therefore, this study intended to understand the texts that permeate the kangaroo practice. This research was developed through two studies: 1) an historic exploration of motherhood concept and an analysis of how the motherhood is presented in the official document that orients the program; 2) an analysis of institutional dynamic of Kangaroo Program, emphasizing the study about the health workers everyday practice, the mothers view about their life in the maternity wards, and the attendance practice. It is highlighted that the relation between this two studies allowed the comprehension abouthow the official discourses can influence the health workers behaviors and how their viewpoint and position can shape the everyday work in a public health program. This research, supported by Institutional Ethnography, considers that people s practices and experiences are socially organized and shaped by broad social forces. The discourse method was used in the documental analysis and in the analysis of qualitative data from empiric research. The research showed that the kangaroo program has been an excellent way to save resources and to improve some baby s biologic and psychological aspects. However, this program has failed to consider the social, economic and cultural complexity of mothers and the structural limitation of the health care system. The official document uses the economic and medical approach, following the hegemonic biomedical model and the life style of the people that don t use the public health system. Consequently, the program has not been successful because it is planned without people participation. On the other hand, it was verified that although some professionals are committed with their work, the mainly does not consider mothers participation as an active process, using the institutional power as a social control to keep mothers uninformed about the possibility to leave the maternity wards. As a result, the research also showed that mothers perceive the program as mandatory and not as option that can improve pleasure moments. It is, therefore, necessary to consider the complex social determinants of health that can increase mothers participation in the Kangaroo Program. Bringing these issues into debate can be a reflective exercise on citizenship and governance, allowing spaces for the improvement of public health programs