It was perceived that an imbalance exists between resource allocations for health care within the Ekurhuleni Health District (EHD). This study consequently used a retrospective, quantitative methodology to investigate health equity in the EHD and to collect information on clinic buildings, staffing and budget allocations. Although clinics were oversupplied in terms of the norms set by the National Department of Health, they were found not to be in keeping with population growth in the Ekurhuleni district. The study highlighted an inequitable spread of nursing staff, which would require that nursing personnel be re-deployed. The per capita spending in the different service delivery regions was also found to be inequitable. It was subsequently recommended that spending on clinics be revised (especially in the populous Southern SDR), that staff be reallocated and that budget allocations be reviewed to achieve equity in Ekurhuleni. / Health Studies / Thesis (M.A. (Public Health))

Thesis (MBA (Business Management))--Stellenbosch University, 2008. / ENGLISH ABSTRACT: The aim of this research report was to identify a set of strategic tools that can be transferred from the private health sector to the public health sector, to improve efficiency in the public health sector. To attain to this aim, this research report attempted to identify the selected best practices employed by successful private health providers, to determine the most effective modes to transfer these best practices, and to establish key success factors for the identified best practices. Interviews were conducted with opinion-leaders from the health industry in the Western Cape,and inputs gleaned from these individuals were useful in applying the strategic model to the public and private health sector in the Western Cape. Globally the public sector has already embarked on strategic management initiatives, through the implementation of the New Public Management-model. The introduction of NPM in a few selected countries aimed at achieving cost-efficiency, budget accountability and improved customer focus in service delivery. South Africa however still needs a unifying and all encompassing vision for public and development management to advance the ideals of Batho Pele. The use of evidence and the management of intellectual capital in the health care industry are recognised as important in decision-making. The health care trends of five selected countries (United Kingdom, United States of America, Greece, Canada, Slovakia) were researched , and demonstrated that countries face similar challenges (increasing resource demands, aging population, rapidly expanding technological possibilities, better-informed patients, rising expectations). It is recognised that business skills and knowledge, as well as investments in IT can be effective tools in moving an organisation from a reactive approach to a pro-active approach. Managers in the public sector need different competencies than managers in the private sector due to the differences between the two sectors, and thus there is a need to adapt management training. While there are examples of best practices in the South African government, there is still room for improvement. A stable political economy, political leadership, management skills of political office-bearers and the professionalism of civil servants will be decisive in this regard. The White Paper on the Transformation of the Public Service provides a framework for the development of strategies to promote continuous performance improvements in quantity, quality and equity of health service provision. The areas where improvements are necessary are customer and stakeholder satisfaction, processes, organisation results, leadership and people management. The comparison between the current strategic approach in the Western Cape and a model designed for the public sector revealed that some of the steps can be developed further, namely the assessment of the internal and external environments, the development of an effective implementation process, and the reassessment of the strategies and the strategic planning process. The comparison between the current strategic approach in the Western Cape and the global best practices framework established that there is not sufficient balance between the resource and position based views, the decision-making approach is "quite formal", implementation of strategy is not a carefully planned change management process, planning is regarded as the most important part of the strategic planning process, and evaluating strategy implementation involves more than mere financial measures. It was also established that the Western Cape Department of Health's strategic stance is offensive, that it can be regarded as a prospector, that managing multiple stakeholders is a challenge and that the competitive advantage of the department is its people. The industry analysis revealed that there is still a long way to go in terms of reliable information systems to support health services. The need for a strategic approach that can respond rapidly in a turbulent environment, and the re-look strategic processes to ensure delivery of quality health care through optimal use of resources were also established by the industry analysis. It was established that a gap exists in the public health sector in respect of the strategic planning processes, and that the private health sector portrays characteristics compatible with the global best practices framework. Modes for the successful transfer of best practices were explored, namely management consulting, commercialisation and management development. Two key success factors for the transfer of best practices were identified, namely the application of the Batho Pele principles, and the recruitment and retention of suitably qualified staff. From a global strategic management perspective, it was clear that there is a definite need for the public sector to change to private sector strategic approaches. A shift from a reactive to a pro-active approach is also advisable. The global trends in public health care demonstrate the importance of political leadership, competent management, business knowledge and skills, IT investment and the use of evidence in health. It is clear that the provision of public health care in South Africa faces similar challenges to those experienced by the five countries researched. The application of the global best practices framework confirmed that there are in fact best practices employed by the private sector that can be transferred to the public sector. Most of the best practices discussed in this research report are not employed in the public sector, or only on a limited scale. The use of these practices should be explored by the public sector. In order to equip managers in the public sector with the necessary strategic management tools, training and development opportunities must include modules on strategic management. / AFRIKAANSE OPSOMMING: Die doel van hierdie navorsingsverslag was om 'n stel strategiese benaderings te identifiseer wat van die privaat-gesondheidsektor na die openbare gesondheidsektor oorgedra kan word, om effektiwiteit in die publieke gesondheidsektor te verbeter. Ten einde hierdie doel te bereik, was daar gepoog om geselekteerde beste praktyke wat deur die privaat gesondheidsektor gebruik word te identifiseer, om te bepaal wat die mees effektiewe metodes sou wees om dit oor te dra, en om kritiese suksesfaktore vir die bepaalde beste praktyke te identifiseer. Onderhoude is gevoer met prominente leiers in die gesondheids-industrie in die Wes-Kaap, en hierdie insette was waardevol in die toepassing van die strategiese model op die publieke en privaat-gesondheidsektor in die Wes-Kaap. Op die internasionale front het die publieke sektor reeds strategiese bestuurs-inisiatiewe begin toepas, deur die implementering van die NPM-model. Die implementering van NPM in 'n paar geselekteerde lande was gemik op koste-effektiwiteit, begrotingsverantwoordbaarheid en verbeterde fokus op kliente in dienslewering. Suid Afrika het egter steeds die behoefte aan 'n oorkoepelende, verenigende visie vir publieke- en bestuursontwikkeling om uitvoering te gee aan die ideale van Batho Pele. Die gebruik van uitkomste en die bestuur van intellektuele kapitaal in die gesondheidsindustrie word erken as belangrik vir besluitneming. Die neigings in gesondheidsorg van vyf gekose lande (Verenigde Koninkryke, Verenigde State van Amerika, Griekeland, Kanada en Siovakye) toon dat die uitdagings vir gesondheid ooreenstem (verhoogde vraag na hulpbronne, verouderende bevolking, vinnige ontwikkeling van tegnologie, beter ingeligte pasiente, hoër verwagtinge). Dit word aanvaar dat besigheidsvaardighede en -kennis, sowel as beleggings in inligtingstegnologie effektief aangewend kan word om 'n organisasie van 'n reaktiewe tot 'n pro-aktiewe benadering te beweeg. Bestuurders in die publieke sektor benodig vaardighede wat verskil van bestuurders in die privaatsektor weens verskille tussen die twee sektore; daar is dus 'n behoefte om bestuursopleiding aan te pas. Daar is wel voorbeelde van beste praktyke in die Suid-Afrikaanse regering, maar daar is steeds ruimte vir verbetering. 'n Stabiele politieke ekonomie, politieke leierskap, bestuursvaardighede van politieke ampsdraers en die professionaliteit van staatsamptenare sal deurslaggewend wees in hierdie verband. Die Wit Skrif oor Transformasie van die Openbare Sektor verskaf 'n raamwerk vir die ontwikkeling van strategiee om voortgesette verbeteringe in hoeveelheid, kwaliteit, en gelykheid in die voorsiening van gesondheidsorg te bevorder. Areas vir verbetering sluit in kliente en belanghebbende tevredenheid, prosesse, organisatoriese uitslae, leierskap en bestuur van mense. Die vergelyking van die huidige strategiese benadering in die Wes-Kaap met 'n model wat ontwikkel is vir die publieke sektor toon dat sommige van die stappe verder ontwikkel kan word, naamlik die evaluering van die interne en eksterne omgewing, die ontwikkeling van effektiewe implementeringsprosesse, en die herevaluering van die strategiee en die strategiese beplanningsprooes. Die vergelyking van die huidige strategiese benadering in die Wes-Kaap met die globale beste praktyke raamwerk toon dat daar nie genoeg balans is tussen die posisie- en hulpbrongebaseerde stand nie, dat besluitneming "nogal formeel" is, dat implementering van strategie nie 'n sorgvuldig beplande veranderingsbestuursproses is nie, en dat evaluering van implementering meer behels as slegs finansiele maatstawwe. Dit het ook aan die lig gekom dat die Wes-Kaap departement van gesondheid 'n offensiewe stand het, dat dit as 'n prospektor beskou kan word, en dat die bestuur van veelvuldige belangehebbendes 'n uitdaging is. Die analise van die industrie het getoon dat daar nog baie gedoen kan word in terme van betroubare inligtingstelsels om gesondheidsdienste te ondersteun. Die behoefte aan 'n strategiese benadering om vinnig te reageer in 'n turbulente omgewing, en die her-evaluering van strategiese prosesse om die lewering van kwaliteit gesondheidsdienste deur die optimale gebruik van hulpbronne te verseker, is ook bevind in die analise. Daar is ook bevind dat daar 'n gaping in die publieke gesondheidsektor is wat die strategiese beplanningsproses betref, en dat die privaat-gesondheidsektor kenmerke openbaar wat verenigbaar is met die globale beste praktyke raamwerk. Metodes vir die suksesvolle oordrag van beste praktyke, naamlik bestuurskonsultasie, kommersialisasie en bestuursontwikkeling word beskryf. Twee sleutelsuksesfaktore vir die oordrag van beste praktyke, naamlik die toepassing van die Batho Pele beginsels, en die werwing en behoud van toepaslik gekwalifiseerde personeel is identifiseer. Uit 'n globale strategiese bestuursperspektief was dit duidelik dat daar definitief 'n behoefte is vir die publieke sektor om privaatsektor strategiese benaderings aan te neem. 'n Beweging van 'n reaktiewe tot 'n pro-aktiewe benadering is beslis aan te beveel. Die globale neigings in publieke gesondheidsorg demonstreer die belangrikheid van politieke leierskap, bevoegde bestuur, besigheidskennis en -vaardighede, beleggings in inligtingstegnologie en die gebruik van uitkoms-gebaseerde bewyse. Dit is duidelik dat die voorsiening van publieke gesondheidsorg in Suid-Afrika ooreenstemmende uitdagings het met die vyf lande wat ondersoek is. Die toepassing van die globale beste praktyke raamwerk het bevestig dat daar wel beste praktyke gebruik word deur die privaatsektor, wat oorgedra kan word na die publieke sektor. Meeste van die beste praktyke hier bespreek word nie deur die publieke sektor gebruik nie, of slegs op 'n beperkte basis. Die gebruik van hierdie praktyke moet ondersoek word deur die publieke sektor. Om bestuurders in die publieke sektor toe te rus met die nodige strategiese bestuursvaardighede, moet opleidings- en ontwikkelingsgeleenthede modules insluit oor strategiese bestuur.

<p>This study aimed to contribute to the current debate around equity in health care resource allocation by measuring the current allocation of resources, relative to need in the Northern Cape. It also discussed the level of inequities in health financing/expenditure and staffing at the primary health care level between different districts of the Northern Cape.</p>

The aim of this thesis was to conduct a situational assessment of human resources planning at one local health authority, in order to determine how decentralisation has impacted the effectiveness of human resources planning.

Compared to the general population, socially disadvantaged patients have higher rates of chronic illness and require more complex medical care. They also endorse higher levels of psychological distress and tend to engage in behavioral risk factors such as poor diet, physical inactivity, and smoking. These issues are particularly concerning given that this population tends to adhere less to medical recommendations, has limited access to health resources, and receives poorer treatment from providers. In an effort to address this disparity, The Affordable Care Act will expand health care access to an additional 23 million uninsured and 17 million underinsured Americans. However, simply expanding access to health care without examining and improving upon factors related to the physician-patient relationship would not fully address the health care needs of this population. This study sought to improve the quality of care received by socially disadvantaged patients by better understanding the role of race and gender on the physician-patient communication process and patient outcomes in a safety net primary care clinic. The study sample consisted of 330 low-income, uninsured/underinsured African American and White patients and 41 resident physicians. Overall, African American patients and their doctors and White doctors and their patients were viewed as engaging in the highest levels of communication. South Asian physicians, and male South Asian physicians in particular, had the lowest levels of communication and the patients of these providers experienced less improvement in their physical health. Patient education level influenced physicians’ perceptions of their patients to the extent that patients with higher educational levels were viewed as engaging in lower levels of communication. Last, indicators of a good physician-patient relationship were associated with higher levels of patient reported adherence. Practice implications and areas for future research are discussed.

Durante séculos as pessoas com transtornos mentais sofreram pela exclusão social e espacial. No Brasil, apenas a partir da Reforma Psiquiátrica se iniciaram propostas de inclusão social do doente mental, que passa a ser tratado em serviços substitutivos aos hospitais psiquiátricos. Hoje em dia, o principal equipamento com a missão de articular a atenção em saúde mental na comunidade é o Centro de Atenção Psicossocial CAPS. Com o recente aumento de numero de CAPS no território brasileiro, as práticas de inclusão social têm se desenvolvido e as pessoas com transtornos mentais têm enfrentado o desafio de buscar formas de interação na comunidade em que vivem. Este trabalho investiga os avanços na inclusão social do usuário atendido em CAPS. A finalidade deste estudo foi identificar ações que possibilitem a inclusão social do usuário e colaborar com diretrizes para as políticas públicas de saúde mental. Para atingir esta finalidade os objetivos específicos foram: analisar a concepção de inclusão social expressa na representação social dos usuários de CAPS e pessoas da rede social dos usuários, identificar o cotidiano e a rede social de suporte dos usuários e analisar as estratégias existentes nos CAPS que auxiliam na construção do cotidiano e da inclusão social do usuário. Como referencial teórico de suporte para o desenvolvimento da pesquisa, foi utilizada a teoria sobre cotidiano de Ágnes Heller, que considera que as transformações sociais muitas vezes começam no nível microscópico. Nesta investigação optou-se por utilizar como referência as seguintes categorias analíticas: exclusão/inclusão social, Reabilitação Psicossocial e Representações Sociais. O estudo foi realizado em um CAPS da cidade de São Paulo e os sujeitos desta investigação foram pessoas com transtorno psíquico, usuários do CAPS e pessoas de sua rede sua social. Para a coleta de dados foram realizadas entrevistas semiestruturadas, e para a apuração dos dados foi utilizada a análise do discurso. A partir desta análise foram identificadas as seguintes categorias empíricas: processo de exclusão/inclusão social, redes sociais e cuidado em saúde mental. Como resultados foram encontradas dificuldades no processo de inclusão social como: a existência de concepções alinhadas ao modelo manicomial, estigma e preconceito, desvantagens de recursos materiais, dificuldade em exercer a cidadania, isolamento social, pouco contato social fora do CAPS, poucas oportunidades no contexto e falta de uma rede de atenção à saúde e rede intersetorial articulada. Os avanços encontrados no processo de inclusão social foram: concepções sobre inclusão social de que todos devem estar integrados na comunidade, experienciais de participação em espaços da cidade, aumento da rede social do usuário, contato com pessoas fora do CAPS, inclusão em grupos religiosos, apoio de associações e ONGs e o CAPS enquanto espaço de acolhimento, inclusão, pertencimento e cuidado à saúde. Percebe-se que o CAPS tem favorecido a inclusão social dos usuários, criando acessos e opções, projetando um novo paradigma em saúde mental no Brasil. Porém, mais do que avanços nas práticas em saúde mental esta pesquisa encontra diversos desafios a serem solucionados. Estes desafios não são postos apenas para o CAPS, mas para a sociedade. / For centuries, people with mental health issues suffered social and spatial exclusion. In Brazil, it was only after the psychiatric reform that the proposal of inclusion of the mental patients started with treatment in public services that substituted psychiatric hospitals. Currently the main service with the purpose of articulating mental health attention in the community is the Psychosocial Care Center (CAPS). With the recent increase in the number of CAPS in the Brazilian territory, the practice of social inclusion has developed and people with mental health problems have faced the challenge of finding new ways to interact in the community they live in. This work investigates the advances of social inclusion of CAPS users. The purpose of this study was to indentify actions that allow for the social inclusion of users and to help the design of mental health public policies. To achieve this goal the specific object of the study was: to analyze the conception of social inclusion expressed in the social representation of CAPS users and people in their social networks, to identify the everyday life and their support social networks, and to analyze the strategies existent in CAPS that help building everyday life and the social inclusion of users. As support theoretical reference for the development of the research Agnes Heller´s everyday life theory, that considers that often social transformation starts at the microscopic level, was used. In this research the chosen analytic categories for reference are: social exclusion/inclusion, psychosocial rehabilitation and social representations. The research was conducted in a CAPS in São Paulo city and the subjects were people with mental health problems, CAPS users and their social networks. For data collection semi-structured interviews were conducted and subjected to discourse analysis. Based on this analysis the following empirical categories were identified: social exclusion/inclusion process, social network and mental health care. As results difficulties in the social inclusion process were revealed, such as: the existence of conceptions aligned with the asylum model, stigma and prejudice, lack of material resources, difficulties in the exercise of citizenship, social isolation, lack of social interaction outside CAPS, lack of opportunities in the milieu, lack of support in the health care network and in the articulated multi-sector network. The advances found in the process of social inclusion were: conceptions about social inclusion that everyone should be integrated in the community, experiences of participation in spaces in the city, increase of the social network of users, contact with people outside CAPS, inclusion in religious groups, support of NGOs and the CAPS as a space of welcoming, inclusion, belonging and health care. Thus, the CAPS have favored the social inclusion of users, crating access and options, projecting a new paradigm in mental health in Brazil. Nevertheless, even more than advances in the mental health practices the research finds several challenges to be solved. These challenges are not faced just by the CAPS but by the society.

Introdução: O Brasil vem passando por um processo de redirecionamento do modelo de atenção à saúde mental, que tinha o hospital psiquiátrico como principal equipamento assistencial, para um novo modelo pautado pela ampliação dos serviços comunitários, redução no número de leitos em hospitais especializados e na criação de enfermarias psiquiátricas de retaguarda em hospitais gerais. Este processo ganhou força no ano de 2001, quando foi promulgada a Lei Federal 10.216 que tornou a assistência à saúde mental no país parte de uma política nacional compatível com as premissas do Sistema Único de Saúde (SUS). Objetivo: Este trabalho analisa o perfil das internações psiquiátricas hospitalares na cidade de São Paulo no período de 2000 a 2010. Procura evidenciar se o processo de reestruturação da assistência psiquiátrica em nível hospitalar teve repercussão na utilização destes serviços e quais foram as mudanças decorrentes deste processo no âmbito municipal e intramunicipal. Métodos: Trata-se de um estudo exploratório de natureza quantitativa. Os dados desta pesquisa foram obtidos a partir do Sistema de Informações Hospitalares (SIH-SUS), e são referentes à Autorização para Internação Hospitalar (AIH). As informações sobre as internações foram organizadas em um banco de dados e processados através do programa SPSS. Foram selecionadas as informações relativas às internações de especialidade psiquiátrica e de pacientes cujo município de residência fosse São Paulo. A seguir foi realizado o georreferenciamento do CEP de residência do paciente. Resultados: Foram analisadas 153.208 internações psiquiátricas. Os resultados apontam que após uma redução inicial, seguiu-se um aumento no total de internações. Nesse processo houve a ampliação do percentual de internações realizadas em hospitais gerais e a diminuição do percentual de internações em hospitais especializados. Ressalta que houve uma queda no percentual de internações de longa duração e em hospitais situados em outros municípios do Estado. O georreferenciamento das internações mostra que a criação de leitos em enfermarias psiquiátricas de hospitais gerais ampliou o acesso a estes serviços para a população residente das subprefeituras com os indicadores socioeconômicos (IDH) mais baixos da cidade / Introduction Brazil has been undergoing a process of reorientation of the mental health care system, which had as its main care equipment the psychiatric hospital to a new model, based on the expansion of community services, the reduction of the number of beds in specialized hospitals and in creating psychiatric wards in general hospitals. This process gained momentum in 2001 when the federal law 10,216 was passed and made the mental health care in the country part of a national policy consistent with the assumptions of the Unified Health System (SUS). Objectives This paper analyzes the profile of psychiatric hospitalizations in the city of São Paulo in the period from 2000-2010. It seeks to bring evidence if the restructuring process had repercussions in the usage of hospital services and what were the changes in access to this equipments resulting from this process in an intramunicipal level. Methods This is an exploratory study of a quantitative nature. The data used was obtained from the Hospital Information System (SIH-SUS), and refers to the Authorization for Hospitalization (AIH). The data about the admissions were organized into a database and processed using SPSS. Only the cases relating to psychiatric specialty and patients whose municipality of residence was São Paulo were selected. Then GIS technology was applied to georeference the patients ZIP code of residence. Results Were analyzed 153,208 psychiatric admissions. The results show that after a reduction in the number of psychiatric hospitalizations between 2000 and 2002, an increase in the number of hospitalizations happened. In this process there was an expansion in the percentage of hospitalizations in general hospitals and a decline in the percentage of hospitalizations in specialized hospitals. Also stresses that there was a reduction in the percentage of long-term hospitalizations and in hospitals situated in other municipalities of the state. The georeferencing of admissions shows that the creation of beds in psychiatric wards of general hospitals expanded the 6access to these services for the residents of the boroughs with the lowest socioeconomic indicators (HDI) of the city

Este trabalho se propôs a analisar limites e possibilidades da participação social na saúde por espaços não institucionalizados, a partir de alguns dos limites decorrentes da institucionalidade posta e do conjunto de práticas sociais, técnicas e sistêmicas na saúde. A discussão enfoca a rádio comunitária como espaço de emergência de conflitos e questões que perpassam dada realidade e suas relações sociais, de forma a poder contribuir com a participação social na saúde. Nesse sentido, optou-se pela realização de um estudo de caso em Heliópolis, São Paulo, SP, por um olhar para o território na sua diversidade de espaços e vivências, e também para os conflitos que lhe são próprios e relacionados às relações sociais daquele espaço constitutivas. A partir das práticas significantes relacionadas à produção simbólica e material de Heliópolis, do entrejogo entre práticas sociais e trajetórias individuais, e entre aquelas e contexto global, foi possível uma formulação teórica em relação ao objetivo da pesquisa. A organização da população de Heliópolis se deu em resistência à dominação exercida por grupos político-econômicos e à repressão do Estado, pela construção de laços sociais de solidariedade em processos de subjetivação de indivíduos, que resultou na constituição de uma comissão de moradores. Com a transformação progressiva da relação do Estado com aquele corpo social, a comissão torna-se associação e deixa de fazer enfrentamento direto por manifestações e ocupações, passando a atuar na forma projeto financiável pelo Estado ou pela iniciativa privada. Hoje, parte das necessidades sociais, as financiáveis, é tomada pelo todo, e as determinações econômicas e sociais decorrentes da divisão de classes impedem que ganhe centralidade, nas ações sociais, a luta de classes. No entanto, a Rádio Comunitária possui historicidade e legitimidade distintas das dos projetos financiáveis, e disto decorrem distintas formas de ação social. O espaço é de lazer e trabalho, de produção e divulgação culturais, e também de constituição de sujeitos políticos, pois nele se dá a formação de uma cadeia coletiva de ações em resistência a determinações políticas, econômicas e sociais. Da especificidade da relação entre forma e conteúdo na produção e expressão culturais decorre a emergência diferenciada de necessidades sociais, de modo que a rádio possibilita a expressão, articulação e mobilização de sujeitos em ação política diferenciada daquela que ocorre em espaços institucionalizados. A atuação pela rádio comunitária também possibilita a construção histórica de necessidades sociais em sua relação com a saúde, e tem função organizativa de demandas que permitem guiar a satisfação dessas necessidades pela reivindicação frente ao poder público e ao sistema de saúde. Na atuação deste com a rádio, gera-se demandas a que existem respostas sistêmicas previamente definidas. No entanto, a rádio é espaço que auxilia na construção de processos instituintes, o que em Heliópolis se expressa pelo combate à política de privatização da saúde São Paulo e às Organizações Sociais (OS), além da articulação de sujeitos em ações como a organização da coleta de lixo / This study aimed to analyze the limits and possibilities of social participation in health by non-institutionalized spheres, from some of the limits imposed by the institutions and the set of social practices, techniques and systemic health. This discussion focuses on Community Radio as a sphere of emergency of conflicts and issues that permeate the reality and its social relations, in order to contribute to social participation in health. Accordingly, we chose to carry out a case study in Heliópolis, São Paulo, SP, by a view on the area in its diversity of spheres and experiences, and also on the conflicts which are related to the social relations of that sphere constitutive. From the signifying practices related to material and symbolic production of Heliopolis, by working between social practices and individual trajectories, and between those and the global context, it made possible a theoretical formulation for the purpose of research. The popular organization in Heliopolis was built in resistance to the political-economic domination and the one exercised by the State, constructed from social bonds of solidarity in processes of constitution of political subjects, which resulted in the formation of a residents committee. With the gradual transformation of the relationship between the State and that social body, the committee became an association, making no more direct engagement by occupations and demonstrations nowadays. It starts acting by projects fundable by the state or by private enterprise. Today part of the social needs, the fundable ones, are taken by all, and the economic and social determinations that are consequences of the classes division prevent to gain centrality in the social actions the class-conflict. The Community Radio, however, has legitimacy and historicity distinct from those of fundable projects, and from this results different forms of social action. The sphere is for work and leisure, for cultural production and dissemination and also for constitution of political subjects, because on it takes the formation of collective actions in resistance to political, economic and social determinations. From the specificity of the relationship between form and content on the cultural production and expression follows the differentiated emergence of social needs, so that the radio enables the expression, articulation and mobilization of subjects in different political actions from the one that occurs in institutionalized spheres. The action by a Community Radio also makes possible the historical building of social needs in their relationship to health. The Community Radio has an organizational function of the demands that allows subjects to conduct the satisfaction of social needs by claiming against the government and the health system. The System action in the radio is characterized by the generation of demands in which answers are previously defined by the System. However, a Community Radio is a sphere that assists the construction of instituting processes, which are in Heliópolis expressed by the struggle against privatization of health in São Paulo and the organized system, providing political articulation of subjects, such as the organization of garbage collect

O presente estudo tem como objetivo a análise das tecnologias presentes no trabalho da Equipe Itinerante da Rede de Saúde Mental do município de Viamão/RS. Para realizar o presente estudo foi utilizado o referencial teórico do processo de trabalho em saúde, articulado ao debate sobre o modo psicossocial. O estudo é de abordagem qualitativa, do tipo estudo de caso. A coleta de dados ocorreu nos meses de julho, agosto e setembro, através da observação participante, com anotações em diários de campo, análise documental e por meio de uma entrevista semiestruturada. Os participantes do estudo são três profissionais da Equipe Itinerante de Saúde Mental. Para realizar a análise dos dados foi utilizada a análise de conteúdo, modalidade temática. A análise evidenciou três categorias, a saber: Elementos constituintes do trabalho da equipe itinerante – seu objeto e tecnologias; Organização do trabalho da equipe itinerante; e, Potencialidades e desafios do trabalho da equipe itinerante para a rede de atenção psicossocial. Em relação à primeira categoria, os resultados apontaram para a clareza do objeto de trabalho, sendo este o usuário. O papel da equipe é relativizado como sendo de apoiador das equipes de referência, responsáveis pela inserção dos usuários nos serviços de saúde e pela aproximação e resposta ao judiciário em relação à judicialização da saúde. Em relação às tecnologias de trabalho, são usadas as reuniões de equipe, as visitas domiciliares e outras tecnologias, como as Guias de Encaminhamentos. Na segunda categoria foram identificadas ações de desburocratização das atividades da equipe itinerante, avanços em articulações e intervenções em conjunto com os serviços de referência - com maior abertura dos serviços de saúde mental à equipe itinerante -, e a necessidade de melhores diálogos com o setor judiciário para repensar prazos processuais e sanar dúvidas dos trabalhadores. Na terceira categoria, em relação às potencialidades, os participantes destacam a criação de uma equipe para atuar com o judiciário, a autonomia no processo de trabalho e abertura para trabalho em conjunto com a atenção básica e o CAPS AD. Já em relação aos desafios, são destacadas: a dificuldade de encontrar o usuário em sua casa, a mediação de conflitos familiares e as questões relacionadas ao tráfico, à violência e ao preconceito da sociedade com o usuário. Deste modo, acredito que o estudo possa contribuir no processo de reforma psiquiátrica ao propor novos modos de cuidado no território a partir da criação de equipes itinerantes. / The present study aims the analysis of the technologies present in the work of an Itinerant Team from the Mental Health Network in the city of Viamão-RS. In order to carry out the present study, a theoretical benchmark of the process in health work was used, linked to the debate on psychosocial level. It is a qualitative approach study, similar to a case study. The data was collected in the months of July, August and September, through the participating observation with note taking in field diaries and through semi structured interview. The study participants are three professionals from the Itinerant Team of mental health. To analyze the data we used the content analysis, thematic review. The analysis highlighted three categories, which are: Elements members of the itinerant working team - their purpose and technologies; Organization of the itinerant working team and potentials and challenges of the itinerant working team for the network of psychosocial attention. Concerning the first category, results pointed out for the clearness of the working object, that is, the user. The role of the team is seen as a supporting one for the reference teams, responsible for introducing the users in the health services and approximation and response to the judicial power concerning the judicialization of health. Concerning the working technologies, we used the team meetings, the visits and the new technologies as Referral Guidelines. In the second category, debureaucratization actions of the itinerant team activities were identified as well as advances in connections and interventions with the reference services – with bigger access of mental health services for the itinerant team – and the need of better dialogues with the judicial power to rethink procedural deadlines and solve doubts of the workers. In the third category, concerning the potentials: the participants highlight the creation of a team to work with the judicial power, the autonomy in the working process and the opening of joint work with the basic attention and the CAPS AD. The challenges are highlighted concerning the difficulty to find the user at home, the mediation of family conflicts and the issues involving traffic, violence and prejudice from the society against the user. Thus, I believe this study can contribute in the process of psychiatric reform when it proposes new ways to care for in the territory based on the creation of itinerant teams. / El presente estudio tiene como objetivo el análisis de las tecnologías presentes en el trabajo del Grupo Itinerante de la Red de Salud Mental del municipio de Viamão-RS. Para realizar tal estudio fue utilizado el referencial teórico del proceso de trabajo en salud, articulado al debate sobre el modo psicosocial. El estudio es de abordaje cualitativo, tipo estudio de caso. La recolección de los datos ocurrió en los meses de julio, agosto y septiembre, a través de la observación participante con apuntes en diarios de campo y por medio de una entrevista semiestructurada. Los participantes del estudio fueron los tres profesionales que componen el Grupo Itinerante de la Red de Salud Mental del municipio de Viamão-RS. Para realizar el análisis de los datos fue utilizado el análisis de contenido modalidad temática. El análisis evidenció tres categorías, a saber: Elementos constituyentes del trabajo del grupo itinerante – su objeto y tecnologías; organización del trabajo del grupo itinerante y Potencialidades y desafíos del trabajo del grupo itinerante para la red de atención psicosocial. Sobre la primera categoría, los resultados señalaron la claridad del objeto de trabajo, siendo éste, el usuario. El papel del grupo es relativizado como siendo de apoyador de los grupos de referencia, responsables por la inserción de los usuarios en los servicios de salud y por la aproximación y respuesta al judiciario en relación a la judicialización de la salud. En relación a las tecnologías de trabajo, son usadas las reuniones de grupo, las visitas domiciliares y otras tecnologías, como las Guías de Encaminamientos. En la segunda categoría fueron identificadas acciones de desburocratización de las actividades del grupo itinerante, avances en articulaciones e intervenciones en conjunto con los servicios de referencia – con mayor apertura de los servicios de salud mental al grupo itinerante -, y la necesidad de mejores diálogos con el sector judiciario para repensar plazos procesuales y sanar dudas de los trabajadores. En la tercera categoría, en relación a las potencialidades, los participantes señalan la creación de un grupo para actuar con el judiciario, la autonomía en el proceso de trabajo y apertura para trabajo en conjunto con la atención básica y CAPS AD. Ya cuanto a los desafíos, son señalados: la dificultad de encontrar el usuario en su casa, la mediación de conflictos familiares y las cuestiones relacionadas al tráfico, violencia y prejuicio de la sociedad con el usuario. De este modo, creo que este estudio pueda contribuir en el proceso de reforma psiquiátrica al proponer nuevos modos de cuidado en el territorio a partir de la creación de grupos itinerantes.

Introdução: O Brasil vem passando por um processo de redirecionamento do modelo de atenção à saúde mental, que tinha o hospital psiquiátrico como principal equipamento assistencial, para um novo modelo pautado pela ampliação dos serviços comunitários, redução no número de leitos em hospitais especializados e na criação de enfermarias psiquiátricas de retaguarda em hospitais gerais. Este processo ganhou força no ano de 2001, quando foi promulgada a Lei Federal 10.216 que tornou a assistência à saúde mental no país parte de uma política nacional compatível com as premissas do Sistema Único de Saúde (SUS). Objetivo: Este trabalho analisa o perfil das internações psiquiátricas hospitalares na cidade de São Paulo no período de 2000 a 2010. Procura evidenciar se o processo de reestruturação da assistência psiquiátrica em nível hospitalar teve repercussão na utilização destes serviços e quais foram as mudanças decorrentes deste processo no âmbito municipal e intramunicipal. Métodos: Trata-se de um estudo exploratório de natureza quantitativa. Os dados desta pesquisa foram obtidos a partir do Sistema de Informações Hospitalares (SIH-SUS), e são referentes à Autorização para Internação Hospitalar (AIH). As informações sobre as internações foram organizadas em um banco de dados e processados através do programa SPSS. Foram selecionadas as informações relativas às internações de especialidade psiquiátrica e de pacientes cujo município de residência fosse São Paulo. A seguir foi realizado o georreferenciamento do CEP de residência do paciente. Resultados: Foram analisadas 153.208 internações psiquiátricas. Os resultados apontam que após uma redução inicial, seguiu-se um aumento no total de internações. Nesse processo houve a ampliação do percentual de internações realizadas em hospitais gerais e a diminuição do percentual de internações em hospitais especializados. Ressalta que houve uma queda no percentual de internações de longa duração e em hospitais situados em outros municípios do Estado. O georreferenciamento das internações mostra que a criação de leitos em enfermarias psiquiátricas de hospitais gerais ampliou o acesso a estes serviços para a população residente das subprefeituras com os indicadores socioeconômicos (IDH) mais baixos da cidade / Introduction Brazil has been undergoing a process of reorientation of the mental health care system, which had as its main care equipment the psychiatric hospital to a new model, based on the expansion of community services, the reduction of the number of beds in specialized hospitals and in creating psychiatric wards in general hospitals. This process gained momentum in 2001 when the federal law 10,216 was passed and made the mental health care in the country part of a national policy consistent with the assumptions of the Unified Health System (SUS). Objectives This paper analyzes the profile of psychiatric hospitalizations in the city of São Paulo in the period from 2000-2010. It seeks to bring evidence if the restructuring process had repercussions in the usage of hospital services and what were the changes in access to this equipments resulting from this process in an intramunicipal level. Methods This is an exploratory study of a quantitative nature. The data used was obtained from the Hospital Information System (SIH-SUS), and refers to the Authorization for Hospitalization (AIH). The data about the admissions were organized into a database and processed using SPSS. Only the cases relating to psychiatric specialty and patients whose municipality of residence was São Paulo were selected. Then GIS technology was applied to georeference the patients ZIP code of residence. Results Were analyzed 153,208 psychiatric admissions. The results show that after a reduction in the number of psychiatric hospitalizations between 2000 and 2002, an increase in the number of hospitalizations happened. In this process there was an expansion in the percentage of hospitalizations in general hospitals and a decline in the percentage of hospitalizations in specialized hospitals. Also stresses that there was a reduction in the percentage of long-term hospitalizations and in hospitals situated in other municipalities of the state. The georeferencing of admissions shows that the creation of beds in psychiatric wards of general hospitals expanded the 6access to these services for the residents of the boroughs with the lowest socioeconomic indicators (HDI) of the city