Made available in DSpace on 2014-12-17T14:27:20Z (GMT). No. of bitstreams: 1 FranciscoLS_DISSERT.pdf: 3460309 bytes, checksum: ba98a4a94dfa1c12a0926835de3bd2a4 (MD5) Previous issue date: 2012-04-16 / The 1988 Federal Constitution of Brazil by presenting the catalog of fundamental rights and guarantees (Title II) provides expressly that such rights reach the social, economic and cultural rights (art. 6 of CF/88) as a means not only to ratify the civil and political rights, but also to make them effective and practical in the life of the Brazilian people, particularly in the prediction of immediate application of those rights and guarantees. In this sense, health goes through condition of universal right and duty of the State, which should be guaranteed by social and economic policies aimed at reducing the risk of disease and other hazards, in addition to ensuring universal and equal access to actions and services for its promotion, protection and recovery (Article 196 by CF/88). Achieving the purposes aimed by the constituent to the area of health is the great challenge that requires the Health System and its managers. To this end, several policies have been structured in an attempt to establish actions and services for the promotion, protection and rehabilitation of diseases and disorders to health. In the mid-90s, in order to meet the guidelines and principles established by the SUS, it was established the Pol?tica Nacional de Aten??o Oncol?gica PNAO, in an attempt to sketch out a public policy that sought to achieve maximum efficiency and to be able to give answers integral to effective care for patients with cancer, with emphasis on prevention, early detection, diagnosis, treatment, rehabilitation and palliative care. However, many lawsuits have been proposed with applications for anticancer drugs. These actions have become very complex, both in the procedural aspects and in all material ones, especially due to the highcost drugs more requested these demands, as well as need to be buoyed by the scientific evidence of these drugs in relation to proposed treatments. The jurisprudence in this area, although the orientations as outlined by the Parliament of Supreme Court is still in the process of construction, this study is thus placed in the perspective of contributing to the effective and efficient adjudication in these actions, with focus on achieving the fundamental social rights. Given this scenario and using research explanatory literature and documents were examined 108 lawsuits pending in the Federal Court in Rio Grande do Norte, trying to identify the organs of the Judiciary behave in the face of lawsuits that seeking oncology drugs (or antineoplastic), seeking to reconcile the principles and constitutional laws and infra constitutional involving the theme in an attempt to contribute to a rationalization of this judicial practice. Finally, considering the Rational Use of health demands and the idea of belonging to the Brazilian people SUS, it is concluded that the judicial power requires ballast parameters of their decisions on evidence-based medicine, aligning these decisions housing constitutional principles that the right to health and the scientific conclusions of efficacy, effectiveness and efficiency in oncology drugs, when compared to the treatments offered by SUS / A Constitui??o Federal brasileira de 1988 ao apresentar o cat?logo dos direitos e garantias fundamentais (T?tulo II), traz, expressamente, que tais direitos alcan?am os direitos sociais, econ?micos e culturais (art. 6? da CF/88), como forma n?o s? de ratificar os direitos civis e pol?ticos, mas, tamb?m, de faz?-los efetivos e concretos na vida do povo brasileiro, especialmente diante da previs?o de aplica??o imediata dos referidos direitos e garantias. Nesse sentir, a sa?de passa ? condi??o de direito de todos e dever do Estado, o qual dever? ser garantido mediante pol?ticas sociais e econ?micas que visem ? redu??o do risco de doen?a e de outros agravos, al?m de garantir acesso universal e igualit?rio ?s a??es e servi?os para sua promo??o, prote??o e recupera??o (art. 196 da CF/88). Alcan?ar os fins almejados pelo constituinte para a ?rea da sa?de ? o grande desafio que se imp?e ao Sistema ?nico de Sa?de e aos seus gestores. Para tanto, diversas pol?ticas p?blicas t?m sido estruturadas na tentativa de estabelecer a??es e servi?os para a promo??o, prote??o e recupera??o de doen?as e agravos de sa?de. Em meados da d?cada de 90, e procurando atender as diretrizes e princ?pios estabelecidos pelo SUS, foi institu?da a Pol?tica Nacional de Aten??o Oncol?gica PNAO, na tentativa de esbo?ar uma pol?tica p?blica que buscasse atingir o m?ximo de efici?ncia e que fosse capaz de dar respostas efetivas ao integral atendimento aos pacientes com c?ncer, com ?nfase na preven??o, detec??o precoce, diagn?stico, tratamento, reabilita??o e cuidados paliativos. No entanto, muitas a??es judiciais t?m sido propostas com pedidos de medicamentos antineopl?sicos. Essas a??es v?m cercadas de muita complexidade, tanto nos aspectos processuais quanto nos aspectos materiais, especialmente em raz?o dos altos custos dos f?rmacos mais solicitados nessas demandas, bem como pela necessidade de serem balizadas as evid?ncias cient?ficas desses medicamentos em rela??o aos tratamentos propostos. A jurisprud?ncia nessa ?rea, apesar dos contornos j? delineados pelo Plen?rio do Supremo Tribunal Federal, ainda est? em pleno processo de constru??o, raz?o pela qual o presente estudo se coloca na perspectiva de contribuir para a efetiva, eficaz e eficiente presta??o jurisdicional nessas a??es, com foco na concretiza??o dos direitos fundamentais sociais. Diante desse cen?rio e utilizando-se da pesquisa explicativa, bibliogr?fica e documental, foram analisadas 108 a??es judiciais em tr?mite perante a Justi?a Federal, Se??o Judici?ria do Estado do Rio Grande do Norte, buscando identificar como os ?rg?os do Poder Judici?rio se portam diante das a??es judiciais que pleiteiam medicamentos oncol?gicos (ou antineopl?sicos), procurando compatibilizar os princ?pios e normas constitucionais e infraconstitucionais que envolvem a tem?tica, na tentativa de contribuir para uma racionaliza??o dessa pr?tica judici?ria. Ao final, considerando o Uso Racional de Medicamentos e a ideia de pertencimento do SUS ao povo brasileiro, conclui-se que, nas demandas de sa?de, o Judici?rio p?trio necessita lastrear suas decis?es em par?metros de medicina baseada em evid?ncias, compatibilizando nessas decis?es os princ?pios constitucionais que albergam o direito ? sa?de e as conclus?es cient?ficas de efic?cia, efetividade e efici?ncia dos medicamentos oncol?gicos, quando em compara??o aos tratamentos oferecidos pelo SUS

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2017-03-14T20:41:15Z No. of bitstreams: 1 AnnaCarolinaVidalMatos_DISSERT.pdf: 2351324 bytes, checksum: b015b6d254a35a6308eeae0d4b84e8ff (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2017-03-15T18:56:19Z (GMT) No. of bitstreams: 1 AnnaCarolinaVidalMatos_DISSERT.pdf: 2351324 bytes, checksum: b015b6d254a35a6308eeae0d4b84e8ff (MD5) / Made available in DSpace on 2017-03-15T18:56:20Z (GMT). No. of bitstreams: 1 AnnaCarolinaVidalMatos_DISSERT.pdf: 2351324 bytes, checksum: b015b6d254a35a6308eeae0d4b84e8ff (MD5) Previous issue date: 2016-07-12 / A presente pesquisa tomou como refer?ncia a popula??o em situa??o de rua como uma manifesta??o da quest?o social, o que implica um fen?meno gerado a partir de condi??es hist?ricas, com a media??o de aspectos sociais, econ?micos e pol?ticos. Em consequ?ncia da organiza??o e das lutas do Movimento Nacional da Popula??o de Rua, atualmente, no Brasil, tal fen?meno ? abordado pelo Estado como uma quest?o transversal a v?rias ?reas da gest?o p?blica. Assim, em 2011, surge a Pol?tica Nacional Para a Popula??o em Situa??o de Rua, em que foram criados os Consult?rios na Rua (CnaR). Estes s?o equipamentos da aten??o b?sica voltados para a preven??o e promo??o de sa?de junto ? popula??o em situa??o de rua. Nessa dire??o, esta pesquisa visou a entender a atua??o dos profissionais dos CnaR no munic?pio do Natal/RN. O objetivo geral foi analisar a atua??o das equipes do CnaR frente ?s demandas e necessidades de sa?de da popula??o em situa??o de rua do munic?pio de Natal/RN. De forma mais espec?fica, pretendeu-se caracterizar as pr?ticas dos profissionais do CnaR; problematizar os limites e as potencialidades desse equipamento na sua rela??o com a rede de sa?de e com a intersetorialidade; e discutir como se d? o acesso ao cuidado integral ? sa?de da popula??o em situa??o de rua, por meio das pr?ticas do CnaR. Assim, foram feitas entrevistas semiestruturadas com os profissionais das equipes e, concomitantemente, observa??o participante e registros em di?rios de campo a partir do acompanhamento de uma das equipes. Em Natal/RN, existem tr?s equipes do CnaR, localizadas em duas regi?es da cidade, sendo elas compostas por 19 profissionais e um coordenador. Participaram das entrevistas 17 profissionais. Foi constatado que as demandas que chegam para as equipes s?o bastante diversificadas, mas ligadas ao perfil de desassist?ncia e nega??o de direitos caracter?stico dessa popula??o, o que exige uma educa??o cr?tica e permanente acerca do fen?meno, algo que foi visto como incipiente. Al?m disso, o trabalho dos profissionais se d? na dire??o das pr?ticas voltadas para a inser??o dos usu?rios na rede de sa?de, como o matriciamento, e no atendimento ?s demandas apresentadas no campo ? e essas ?ltimas acabam sendo priorizadas por seu volume. A dificuldade de articula??o com outros servi?os da rede emergiu como uma das mais marcantes da atua??o e, junto com o excesso de atividades, foi apresentada como limite para a efetiva inser??o dos usu?rios na rede. Constatou-se tamb?m que h? uma necessidade de estimular a articula??o com parceiros centrais como o NASF e o MNPR. Por fim, ? importante ressaltar que entender as pr?ticas dos CnaR permite ampliar o entendimento da constru??o das pol?ticas sociais para a popula??o em situa??o de rua, diminuir a invisibilidade e promover a constru??o de possibilidade de uma transforma??o na realidade desse p?blico. / This research took people under street condition as a manifestation of the Social Issue, implying a phenomenon generated from historical conditions, with the mediation of social, economic and political aspects. As a result of the organization and the struggles of the National Movement of People Under Street Condition, currently in Brazil this phenomenon is addressed by the State as a transversal issue for various areas of public administration. Thus, in 2011, arises the National Policy to the Population under Street Condition, from which the Street Clinics were created (CnaR). These are equipments of Primary Care focused on prevention and health promotion among the people under street condition. In this sense, this research aimed to understand the work of CnaR professionals in the city of Natal/RN. The general objective was to analyze the practices of CnaR teams toward the demands and health needs of the people under street condition of Natal/RN. More specifically, it sought to characterize the practices of CNAR professionals; problematize the limits and potential of this equipment in their relationship with the health network and the intersectorality and; discuss how the access to full health care of the population people under street condition takes place through CnaR practices. Aiming these objectives, semi-structured interviews were conducted with professional teams and, concomitantly, participant observation and records in field diaries from the observations of one of the teams. There are three teams CnaR in Natal/RN, located in two areas of the city, composed of 19 professionals and a coordinator. Seventeen professionals participated in the interviews. It was found that the demands that come to the teams are quite diverse, but related to lack of assistance profile and denial of rights that characterizes this population, which requires a critical and permanent education about the phenomenon, which was seen as incipient. Moreover, the work of professionals takes place in the direction of practices aiming the integration of users in the health system, such as matrx support, and facing immediate demands in the field, and the latter end up being prioritized because its volume. Integration with other network services has emerged as one of the most outstanding difficulties for the practices and, along with excess of activity, was presented as limitation for the effective integration of users in the network. It was also found that there is a need to encourage cooperation with main partners as NASF and MNPR. Finally, it is important to highlight that the understanding of the practices of CnaR allows greater understanding of the construction of social policies for the people under street condition, reduces the invisibility and promote the construction of the possibility of a change in the reality of this public.