O Acompanhamento Terapêutico (AT) é um dispositivo que tem caráter transetorial em seu fazer porque pode atravessar ou compor com os espaços interdisciplinares e intersetoriais, como o Centro de Atenção Psicossocial, uma infinidade de projetos construídos coletivamente para ampliar os sentidos da vida de um sujeito. A partir dessa premissa, esta pesquisa define como objeto de estudo o AT como dispositivo de intervenção na vida de uma usuária de um serviço público de saúde mental e as interferências operadas por este dispositivo na sua vida em relação com o corpo social. Trata-se de uma pesquisa qualitativa que utiliza o Estudo de Caso como procedimento metodológico para apreensão e compreensão dos dados empíricos. Para isso, o estudo se propõe a enfrentar as questões: o AT produz transformação real na vida dos sujeitos? Que tipo de transformações opera no interno do campo transferencial, no serviço e na rede de cuidados? Sustenta-se por si só ou depende da rede ampliada pelos serviços territoriais? A origem do AT se dá em instituições privadas e só timidamente é transposta para os serviços da rede pública de atenção à saúde. Essa transposição não se dá de forma instituída e sua oficialização como dispositivo em saúde mental sofre percalços, como constatado com o desaparecimento do termo acompanhamento terapêutico e do financiamento do procedimento na legislação vigente e que constava na Portaria SNAS n.° 189 de 19 de novembro de 1991. Essa anulação do AT das políticas públicas é defendida, nesta pesquisa, como uma contradição em relação às diretrizes do Sistema Único de Saúde (SUS) e da própria Reforma Psiquiátrica, que orientam ações territoriais, intersetoriais, articulação de rede de serviços e articulação de recursos do território para a atenção em saúde mental. O resultado é a inacessibilidade do dispositivo AT aos que dele se beneficiariam, como foi comprovado no caso em análise. O cenário do estudo destaca-se por acionar este dispositivo e construir em conjunto com as acompanhantes terapêuticas envolvidas uma trajetória de enriquecimento e acesso a novas territorialidades para a K. Entretanto, o estudo questiona porquê os trabalhadores dos serviços de saúde mental não assumem para si a função potencializadora do AT e sua conseqüente legitimação na esfera pública e coletiva, o palco de ações e conexões de redes, propiciadoras de produção de vida. Este estudo sustenta que o AT é, no campo da saúde mental, um dispositivo que vem se sofisticando no decorrer de seu processo histórico com o questionamento de sua função estritamente clínica e se propõe a enfrentar os desafios para a retomada do diálogo e conexão do seu fazer com as políticas públicas / Therapeutic Accompaniment (TA) is a device of a cross sector nature because it can interact with interdisciplinary and intersected areas, like the Social and Psychic Help Center (Centro de Atenção Psicossocial), \'crossing or being a component of an infinity of collectively built projects that can broaden the meaning of life of a subject. Starting from that premise, this research defines TA as the study object that acts as a device of intervention in the life of a woman who uses mental health public services and the interferences resulted from this device in her life related to her social interactions. It is a qualitative research that uses the Case Study as a methodological procedure for collection and comprehension of empirical data. Therefore, this study proposes to face the following questions: Does TA produces real changes in the lives of its subjects? What types of changes are produced in the internal transferential field, services offered and the care network? Is it self-sustainable or does it depend on an amplified network by territorial services? TA origins takes place in private institutions and only very timidly is used by public health services. The use in public services doesn\'t take place in an established form and its officialization in health care is not easy. It was found that the term therapeutic accompaniment and its financing procedures disappeared from the current legislation. It used to be part of the SNAS Bill number 189 of November 19th of 1991 (Portaria SNAS n°189 de 19 de novembro de 1991). This TA annulment of public policies is viewed on this research as not only a contradiction of the Brazilian Heath Care Program (Sistema Único de Saúde SUS) but also of the Psychiatric Reform, that suggests territorial actions, cross sectoring, articulation of networking services and articulation of territorial resources for mental health management. The result is the inaccessibility of the TA device to the ones that could benefit from it as it was proved on the case study analyzed. The study scenario differentiates itself because it triggers this device and builds, with the therapeutic companion, an enriching path and offers accessibility to new territories to the K. However, this paper questions why workers of public mental health system do not take the transforming responsibility of TA and its consequent legitimization in public and collective sphere, the stage of actions and connections of network, which are auspicious for a more broaden meaning of life. This paper sustains that TA is, in the field of public mental health, a device that is becoming more sophisticated through its historical process with the questioning of its strictly clinical mission and its willingness to face the challenges to restart dialogue and to establish a connection with public policies

As diretrizes do Sistema Ãnico de SaÃde apresentam o municÃpio como unidade administrativa bÃsica de sua operacionalizaÃÃo. A SecretÃria de SaÃde do MunicÃpio de Fortaleza vem, desde 1984, direcionando a organizaÃÃo dos seus serviÃos de saÃde em Distritos SanitÃrios na perspectiva do Sistema Ãnico de SaÃde. No perÃodo compreendido entre os anos de 1983 e 1994 ocorreram avanÃos na organizaÃÃo e municipalizaÃÃo dos serviÃos de saÃde desse municÃpio. A anÃlise da evoluÃÃo organizacional da Secretaria de SaÃde do MunicÃpio de Fortaleza, com Ãnfase nesse perÃodo, tem como base leis, decretos, planos de governo, relatÃrios de atividades e entrevistas com os SecretÃrios Municipais de SaÃde. A pesquisa està estruturada em trÃs capÃtulos: retrospectiva das polÃticas de saÃde no Brasil desde o inÃcio do sÃculo atà a atualidade para contextualizar a anÃlise; evoluÃÃo organizacional dessa Secretaria desde a sua criaÃÃo atà o ano de 1983 como referÃncia para o perÃodo em estudo; anÃlise da evoluÃÃo organizacional do perÃodo 1983/1994; e consideraÃÃes sobre os avanÃos organizacionais da InstituiÃÃo. / The guidelines and policies of the BASIC HEALTH SYSTEM in Brazil, introduces each county as na administrative UNIT, which also represents the basis for the implementation and operational functioning of the system itself. Since 1984, the Cityâs Health Department in Fortaleza, Brazil, has been directing the organization of all health services oftered according to the model of the BASIC HEALTH SYSTEM, and there fore administening the delivery of seervices on the basis of HEALTH DISTRICTS. In the period between the years of 1983 and 1984, significant advancements have occured, in the organization and process of local public health service delivery, adjusting to the model of BASIC HEALTH UNITS. The present paper, analyzes the organizational development of the local public Health Department, os the city of Fortaleza, focusing on the above mentioned period, and based upon laws, local government plans and policies, published annual health department activities reports, and interviews with local Secretary of Health officials. This research report is structured is there major chapters: 1) a retrospective survey on major public health policies and political plans, adopted in Brasil, since the beginning of this century, to set up the bacground for the present analysis 2) the organizational development, of the local Healt Department in Fortaleza, since its onset up to the year of 1983, as a reference to the period focused on this study 3) the analysis of the organizational development observed within the period from 1983 to 1994. Finally, some conclusive considerations are made, on the major organizational advancements in this public institution.

nÃo hà / As necessidades de saÃde da populaÃÃo nÃo sÃo atendidas de forma satisfatÃria, delineando desafios de diversas ordens Ãs prÃticas de saÃde. A superaÃÃo deste cenÃrio implica conhecer as necessidades dos grupos sociais e criar instrumentos e estratÃgias para atendÃ-las, o que requer esforÃos das ciÃncias e prÃticas em saÃde coletiva. Esta pesquisa analisa necessidades de saÃde em periferias urbanas de uma cidade mÃdia do Nordeste brasileiro. Ancorado no mÃtodo dialÃtico, as necessidades foram analisadas em sua articulaÃÃo com a totalidade, buscando a explicitaÃÃo das mediaÃÃes e contradiÃÃes envolvidas. Realizaram-se entrevistas semiestruturadas com moradores, observaÃÃes de campo, aplicaÃÃo de questionÃrio, alÃm de pesquisa documental. Evidenciaram-se cinco conjuntos de necessidades: necessidade de produtos e serviÃos biomÃdicos; necessidade de dinheiro para consumir produtos e serviÃos biomÃdicos; necessidade de alimentos saudÃveis; necessidade de hÃbitos saudÃveis; e necessidade de boas relaÃÃes interpessoais com os trabalhadores dos serviÃos de saÃde. Embora agrupadas, elas sÃo singulares aos modos de vida individuais e coletivos, tecidos numa trama que articula atores sociais, polÃticos, culturais, econÃmicos, cientÃficos e midiÃticos; e revelam contradiÃÃes em sua maioria desfavorÃveis à satisfaÃÃo das necessidades de saÃde e um processo de reproduÃÃo social fortemente direcionado para a acumulaÃÃo do capital. As necessidades de saÃde sÃo multidimensionais, assumem conteÃdos e formas diversificadas, conforme as especificidades de vida e saÃde dos sujeitos individuais e coletivos. Carecem, para sua apreensÃo, de mÃtodos inscritos em diferentes tradiÃÃes de pesquisa, sendo apenas parcialmente capturadas pelos indicadores epidemiolÃgicos tradicionalmente utilizados nos sistemas de saÃde. / The health needs of the population are not answered satisfactorily, outlining challenges of various orders to health practices. Overcoming this scenario implies knowing the needs of social groups and creating tools and strategies to meet them, which requires efforts of sciences and practices in public health.This research examines health needs in urban peripheries of a midsize city in Northeast Brazil. Anchored in the dialectical method, needs were analyzed in conjunction with their entirety, seeking clarification of mediations and contradictions involved.Semi-structured interviews were conducted with residents,besides field observations, questionnaires, as well as documentary research. They evidenced five sets of needs: need for biomedical products and services; need for money to consume biomedical products and services; need for healthy food; need for healthy habits; and need for good interpersonal relationships with employees of health services.Although grouped together, those needs are singular to the individual and collective lifestyles, woven into a web that articulates social, political, cultural, economic, scientific and media actors; and reveal contradictions that are mostly unfavorable to meet the health needs and a process of social reproduction that is strongly targeted to the accumulation of capital.Health needs are multidimensional,they assume diverse forms and contents, according to the specificities of life and health of individuals and groups. For their recognition, they require methodsenrolled in different research traditions, being only partially captured by the epidemiological indicators traditionally used in health systems.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-10-14T17:42:00Z No. of bitstreams: 1 lucianaalvesdominato.pdf: 266751 bytes, checksum: 77579ed12e08f1ddbdb337a6697d64cd (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-10-22T13:08:18Z (GMT) No. of bitstreams: 1 lucianaalvesdominato.pdf: 266751 bytes, checksum: 77579ed12e08f1ddbdb337a6697d64cd (MD5) / Made available in DSpace on 2016-10-22T13:08:18Z (GMT). No. of bitstreams: 1 lucianaalvesdominato.pdf: 266751 bytes, checksum: 77579ed12e08f1ddbdb337a6697d64cd (MD5) Previous issue date: 2008-09-30 / O presente estudo tem por escopo discutir o licenciamento compulsório de patentes dos anti-retrovirais como uma escolha do Estado para a implementação de determinada política pública na área da saúde. Para tanto, apresentamos a evolução histórica das políticas públicas de saúde no país, a forma de financiamento da saúde hoje e os critérios utilizados para a alocação de recursos na saúde. Posteriormente discutimos o papel dos atores sociais para a determinação da agenda, especificamente no campo da saúde e por fim, analisamos alguns aspectos do direito patentário e a possibilidade de utilização do licenciamento compulsório como um instrumento hábil para garantir o acesso universal à saúde, ponto em que ocorre um embate do Estado x Mercado. / This study aims to discuss the compulsory license for anti-retroviral drugs as a governmental choice for the implementation of certain public health policies. In order to accomplish such assignment, we present the historical evolution of public health policies in Brazil, the means of financial support concerning health policies today, and the criteria used for the allocation of financial resources in health policies. After, we discuss the role played by social actors in the determination of the health agenda, and, finally, we analyze some aspects of patent law in regards to the possibility of deploying compulsory license as an efficient instrument to ensure the universal access to health policies, which turns out to be a collision point between the government and the market.

A saúde do idoso sob a ótica da equipe do Programa de Saúde da Família é um estudo realizado nos quatro Núcleos de Saúde da Família, do Centro de Saúde Escola da Faculdade de Medicina e Escola de Enfermagem de Ribeirão Preto, da Universidade de São Paulo. Neste trabalho procuramos compreender como os trabalhadores das equipes de saúde estão percebendo a temática do idoso no Programa de Saúde da Família, as dificuldades enfrentadas, e quais os recursos utilizados para atender a essa população. Utilizamos como referencial teórico a Transição Demográfica e Epidemiológica, as diretrizes do Ministério da Saúde para o Programa de Saúde da Família e a Política Nacional do Idoso (PNI). Na construção deste trabalho contamos com a participação de 22 (vinte e dois) profissionais de saúde, dentre eles, médicos, enfermeiros, auxiliares de enfermagem e agentes comunitários de saúde. No percurso metodológico, utilizamos a entrevista semi-estruturada, sendo a ordenação dos dados realizada através do Discurso do Sujeito Coletivo a partir da identificação das Idéias Centrais e Expressões Chave presentes nos discursos individuais. Os resultados evidenciaram que nos núcleos com maior demanda de idosos é prioridade a sua assistência, as equipes buscam alternativas para melhor atender a essa população, ou seja, na formação de grupos, visitas domiciliárias ou em parcerias com outras instituições. Já os núcleos que possuem um número menor de idosos em suas áreas de abrangência, não têm o idoso como foco principal de sua atenção, pois há o predomínio da população adulto-jovem. Contudo, priorizam os idosos acamados e integram os demais nas atividades realizadas pelos núcleos. Percebemos que existe em todos os núcleos, independentemente do número de idosos presentes, uma sensibilização geral que expressa potencialidades no trabalho e na atenção à população idosa. / The elderly’s health under the view of the Family Health Program Team is a study that was conducted in the four Family Health Nuclei of the University Health Center of the University of São Paulo at Ribeirão Preto Faculty of Medicine and the University of São Paulo at Ribeirão Preto College of Nursing. In this study, an attempt was made at understanding how the workers on the health teams perceive the elderly-related topics in the Family Health Program, the difficulties faced and what resources they search for in order to assist this population. The Demographic and Epidemiological Transition, the Guidelines from the Health Ministry for the Family Health Program and the National Policies for the Elderly (PNI) were used as theoretical frameworks. Twenty-two (22) health professionals participated in this study among whom were physicians, nurses, nursing auxiliaries and community health agents. Data were collected by means of semi-structured interviews and organized through the Collective Subject’s Discourse based on the identification of the Main Ideas and Key Expressions present in individual discourses. The results showed that there was a care priority in the nuclei with a larger number of elderly participants, the teams searched for alternatives in order to better assist this population, that is, through the formation of groups, home visits or partnerships with other institutions. However, the nuclei with a smaller number of elderly participants in their coverage areas did not have the elderly person as their main focus of attention, since there was the predominance of a young adult population. Nevertheless, they prioritized the elderly who were in bed and integrated the others in all the activities carried out by the nucleus. It was noticed that there was a general sensitization in all the nuclei, regardless of the number of elderly people present, which demonstrates the potentialities in the work and care to individuals at this age range.

O estudo tem como objeto de investigação a implantação de uma política pública de enfrentamento do HIV/Aids no município de Marília. Para isso, descrevem-se as diretrizes político-institucionais do Programa de DST/Aids deste município, segundo seus gestores, no período de 1998 a 2008. Trata-se de uma pesquisa qualitativa que teve como sujeitos, Coordenadores de DST/Aids, que atuaram na Secretaria Municipal de Saúde de Marília, totalizando três pessoas. Foi realizada uma entrevista individual com questões abertas, gravada e transcrita. Os resultados foram descritos segundo as categorias de análise expressão e transformação do compromisso em ação pelo poder público e sustentabilidade da proposta, tendo como base conceitual a vulnerabilidade, na dimensão programática. Foi possível identificar os elementos que influenciaram a formulação e a implementação desta política pública, na identificação das subcategorias, relacionadas à expressão e transformação do compromisso: atores sociais, qualificação e implementação da política. Relacionadas à categoria sustentabilidade da proposta encontraram-se como subcategorias: financiamento e desafios à sustentabilidade. O estudo, ao descrever a trajetória do programa, identifica compromisso e ação da sociedade política no enfrentamento da epidemia. Nos mais de 25 anos de epidemia, tanto em âmbito nacional, estadual e municipal, os Programas de DST/Aids têm mostrado efetivamente a implementação do Sistema Único de Saúde (SUS), enfrentando desafios em diferentes frentes, na busca de garantia dos seus princípios. Dessa forma, os desafios da vulnerabilidade, na dimensão do programa de DST/Aids, estão conectados aos próprios desafios colocados ao SUS, que tratam de sua sustentabilidade, do acesso universal, do fortalecimento da gestão municipal, da integralidade do sistema, da equidade e aprimoramento do controle social / The study has as objective to research the establishment of a public policy of confronting the HIV/AIDS in the city of Marília. For that, it describes the political and institutional guidelines of the Program of STD/AIDS in this city, according to its managers in the period 1998 to 2008. This was a qualitative research that had as subject, Coordinators of STD/AIDS who worked in the Municipal Health Secretariat of Marília, totaling three people. We performed an individual interview with open questions, recorded and transcribed. The results were described by the categories of analysis: \"expression and transformation of commitment into action by public authorities\" and \"sustainability of the proposal, based on the vulnerability concept. It was possible to identify the factors that influenced the formulation and implementation of public policy in the identification of sub-categories related to the \"expression and transformation of commitment\": \"social actors\", \"qualification\" and \"implementation of the policy.\" Related to \"sustainability of the proposal\" is as subcategories: \"financing\" and \"challenges to sustainability.\" The study, by describing the trajectory of the program, identifies commitment and action of political society in combating the epidemic. In over 25 years of epidemic, both at the national, state and municipal levels, the Program of STD/AIDS have shown effective implementation of the Unified Health Care System (SUS), facing challenges on various fronts in the search for security of its principles. Thus, the challenges of vulnerability, in the STD/AIDS context, are connected to the very challenges placed before the Unified Health Care System (SUS) which deals with its sustainability, universal access, the strengthening of municipal management, the integrality of the system, equity and improvement of social control

Disparate healthcare experiences continue to pose a challenge; vulnerable populations such as low-income and racial and ethnic minorities may not be able to afford or utilize care when needed or receive quality care. The sources of disparities are complex and multi-factorial, which include health care system-level factors such as insurance and health care workforce. It is relatively less known to what extent these contribute to disparities related to a patient’s overall health care experience across three important domains – affordability, utilization and satisfaction with care. This dissertation has three objectives. First, to assess how insurance benefit design affects health care utilization among poorest adults. Second, examine the role of insurance in addressing racial and ethnic disparities in access to preventive care. Finally, examine the role of health care providers in differences related to satisfaction with care among low-income patients. To answer questions posed in this dissertation, two different types of datasets are used: a unique hospital administrative data from a coverage program for low-income adults and 2008-2014 Medical Expenditure Panel Survey (MEPS). To examine the role of insurance and health care providers in disparities related to different outcomes of patient experience, several models are estimated; including mixed effects linear probability and negative binomial regressions, decomposition and multivariate linear probability models. Several efforts are being made to address inequalities through coverage expansions, removal of financial barriers for preventive services and incentivizing health care providers to improve patient satisfaction. The findings suggest that differences in utilization and satisfaction with care continue to persist among low-income and racial and ethnic minorities. However, policy levers and system-level reforms including value-based insurance designs that may curb healthcare costs without shifting the cost burden to poorer adults, continued reforms to expand coverage and improve access to a usual of care, and policy interventions that extend beyond improving workforce diversity and enhance provider skills to elicit patient communication preferences may foster positive patient experiences and ameliorate existing disparities. Improving patient experiences of care will thus require policy efforts with a comprehensive multi-level strategy that targets broad sectors – including payers, health care providers and society at large.

Maternal mortality in Nigeria is one of the highest in the world. The rate is higher in the rural communities than in the urban. Given the complexity of causes of maternal mortality, it appears that the community is an important resource that is frequently overlooked. The contribution of which could be explored through collaboration with professional healthcare providers, to bring about reduction in maternal mortality. This study, proposed to empower members of the community to take action to prevent maternal mortality. Action research design was utilised, comprising cycles of fact-finding, planning/action, and evaluation with the aim of working towards a change in the status quo. In collaboration with the action research group, data were generated through 29 interviews, 8 focus group discussions and observation of 7 persons. Women of childbearing age were interviewed to gain understanding of their knowledge, attitude and practice towards maternal mortality. Focus group discussions were carried out with a cross section of the community. Observations were undertaken of skilled and traditional birth attendants (TBAs) in their places of practice. Altogether, there were 86 general participants and 12 action research group members in the study. Thematic data analysis and critical reflection were undertaken with emphasis on data which promote learning and change. The study revealed childbirth fallacies as evidenced in the causes of maternal deaths being attributed to superstitious beliefs. Other findings included religious beliefs/practices, birth practices, negative attitudes, lack of money, lack of transportation and health facilities issues as contributory factors. These findings were critically reflected upon by the action research group and actions based on the findings, aimed at empowering the people to take action to prevent maternal deaths were undertaken. The actions included community education, TBA training and development of a common forum between skilled birth attendants and TBAs. Participatory evaluation was undertaken from the perspectives of the participants to identify what made sense to them from the actions. Findings included some degree of empowerment and emancipation of the people evidenced in the acquisition of new knowledge which led to the repudiation of certain superstitious beliefs. Other findings include resumed utilisation of the service of skilled birth attendants at the local health facility by the women. The findings of this study have demonstrated implications for practice, policy and research to prevent maternal mortality in Bakassi LGA, Nigeria. Conclusion drawn is that, the community is an important resource which if mobilised through the process of action research, would be empowered to take action to prevent maternal mortality. The process will also foster the collaboration between skilled birth attendants and traditional birth attendants to improve maternal health care in the rural community.

O modo particular de apreensão do mundo e práticas diversificadas relativas a vários grupos sociais devem ser considerados no planejamento e na execução de programas ambientais e de saúde. O estudo de caso no município de São Sebastião busca a expressividade de questões ambientais na política pública de saúde. A formação de um quadro referencial a partir desta pesquisa focaliza o governo estadual na gestão 86-90, os municípios e a percepção que a população tem dos serviços de saúde. A percepção da população e gerentes do sistema de saúde, associada à observação participante e dados oficiais, foi analisada através de 819 questionários e 29 histórias de vida, em 2 regiões de saúde e 6 municípios. A população indígena aparece como alteridade. A percepção dos médicos no município de São Sebastião foi pesquisada com 19 questionários estruturados incluindo 55% dos profissionais. Os dados traçam o mapa do papel da cultura nas políticas públicas de saúde frente á crise mundial dos anos 90 e dos paradigmas da ciência. A ciência ambiental aparece com destaque nesta discussão e suas dúvidas epistemológicas têm afinidade com o cenário conceitual na epidemiologia. As questões da ética são centrais e este reflexo é locus privilegiado no diagnóstico de saúde de uma população. A pretensão da pesquisa é evidenciar a importância da interdisciplinaridade, da participação democrática nas decisões, da diversidade cultural e do saber. / The particular approach about the world and cultural practices must be considered in planning health programs. The case study in São Sebastião is about environmental issues in public health policies. The frame of reference from this research focuses on the state government in the management 86-90, municipalities and the perception that people have of health services. The perception of the people and managers of the public health system, associated with participant observation and official documents, was analyzed by 819 questionnaires and 29 life histories in 2 health regions and 6 municipalities. The indigenous people appear as otherness. The perception of doctors in São Sebastião was investigated with 19 structured questionnaires including 55% of professionals. The role of culture in public health policies will face the global crisis of the 90s and the paradigms of science. Environmental science features prominently in this discussion and epistemological questions have an affinity with the conceptual approach in epidemiology. The ethical issues are central and that reflection is a privileged locus for the diagnosis of population health. The aim is demonstrate the importance of democratic participation in decision making, interdisciplinary, knowledge and cultural diversity.

This study examines the 2019 ‘FEG’ through policy process and interest-based lenses, thus aiming to address the relationship between labour shortages and migration policy. Hence, the roles of political stakeholders and interest groups in the policy process are discerned.