Mediation for intersectoral health promotion: the design Settling Health SESC

Abstract

Esta disserta????o tem como tema os fatores envolvidos na sustentabilidade das iniciativas de promo????o da sa??de, mais especialmente a consolida????o de alian??as na perspectiva da a????o intersetorial para a cria????o de ambientes saud??veis. O estudo aborda o ide??rio te??rico-??tico pol??tico da promo????o da sa??de, buscando evidenciar os deslocamentos conceituais que caracterizam a ruptura paradigm??tica trazida por esse movimento, com destaque para aconcep????o ampliada de sa??de que incorpora a tem??tica dos determinantes sociais, atualizando a discuss??o sobre a intersetorialidade na consolida????o do compromisso com a equidade e ajusti??a social. Discutem-se as controv??rsias e as implica????es pol??tico-ideol??gicas expressas na pluralidade de olhares sobre tal estrat??gia, evidenciando-se as distin????es e aproxima????es conceituais entre a promo????o da sa??de, a preven????o e a educa????o em sa??de. Adotou-se como estrat??gia a pesquisa qualitativa com abordagem metodol??gica do tipo estudo de caso, de car??ter descritivo e interpretativo. A constru????o da base emp??rica foi desenvolvida em um Departamento Regional do SESC com experi??ncia bem sucedida do projeto Transando Sa??de, tendo como foco de an??lise as estrat??gias de media????o e articula????o intersetorial implementadas nesse contexto. O projeto em quest??o ?? de iniciativa da Atividade Educa????o em Sa??de e se volta para a preven????o de doen??as sexualmente transmiss??veis e Aids, atuando nos cen??rios da escola e do local de trabalho mediante o estabelecimento de alian??as intersetoriais e o uso da metodologia de educa????o entre pares. Na investiga????o realizada fez se um recorte quanto ?? unidade de an??lise, optando-se por este ??ltimo cen??rio. Utilizou-se a t??cnica de triangula????o na coleta de dados, mediante pesquisa documental, observa????o direta e entrevistas semi-estruturadas. A an??lise dos dados, feita segundo a perspectiva hermen??utica-dial??tica, problematiza os elementos implicados na ordena????o da rede intersetorial, discutindo as concep????es e valores que orientam as pr??ticas e os fatores favor??veis e restritivos ao estabelecimento das alian??as intersetoriais com vistas ?? sustentabilidade das iniciativas de promo????o da sa??de. Desse modo, s??o apontados aspectos que podem informar as iniciativas em outros marcos institucionais, com destaque para a import??ncia do nexo conectivo responsabilidade/ ??tica/ compromisso na consolida????o da rede de alian??as; a perspectiva relacional e comunicativa dos fluxos de poder na rede; a import??ncia da institui????o de espa??os de forma????o continuada com co-engendramento de sujeitos e mundo do trabalho; e a capacidade dos atores para dialogar e negociar, ampliando os consensos intersubjetivos que geram co-responsabilidades nos processos de gest??o e cuidado. Confirma-se a hip??tese formulada sobre o potencial do SESC na media????o intersetorial, que se materializa pela cria????o de condi????es pr??ticas e simb??licas para a conforma????o de novas identidades por entre as entidades da rede, as quais v??o gradativamente se tornando mais vinculadas, no ensaio de estrat??gias que incorporam a perspectiva pol??tica, ??tica e cultural mais ampla da promo????o da sa??de.This dissertation has as its theme those factors involved in the sustainability of health promotion initiatives, most especially in the alliances consolidation in the perspective of intersector action for the creation of healthy environments. The study addresses the theoreticalethic- political ideation, seeking to focus on those conceptual displacements that characterize the paradigmatic rupture translated by this movement, outlining the extended health conception which embeds the social determinants thematic, updating the discussion over inter-sectors in the commitment consolidation with equity and social justice. It discusses controversies and political-ideological implications expressed in the plurality of views over such strategy, focusing on distinctions and conceptual approaches among health promotion, prevention and health education. The qualitative research was adopted as a strategy, with typical descriptive and interpretative case study methodological approach. The empirical basis was developed in one of the SESC regional departments, with well succeeded experience of the ???Transando sa??de project??? (???Dealing with Health Project???), and its analysis focus is on strategies of inter-sector mediation and articulation, in this context. The project in question is of initiative of the Health Education Activity and is turned to the prevention of sexually transmitted diseases and Aids, with actions in the school and local work settings through the establishing of inter-sector alliances and the use of peer education methodology. In the performed investigation, it was made a cut in the analysis unit, opting for this latter setting. The triangulation technique was used in the data collection through documental research, direct observation and semi- structured interviews. The data analysis was made according to the hermeneutical-dialectic perspective, and it addresses the implied elements in the ordering of the inter-sector network, discussing on the conceptions and values that guide the practices and factors which are favorable and restricted to the establishing of inter-sector alliances in view of the health promotion initiatives. Thus, it points out those aspects that may inform the initiatives in other institutional hallmarks, outlining the importance of the nexus connective responsibility / ethics / commitment in the consolidation of alliances network; the relational and communicative perspective of power fluxes in the network; the importance of fostering the continued education with co-engendering of subjects and the work world; and the actors capability to dialogue and negotiate, extending the inter-subjective consensus that generate co-responsibilities in the management and care processes. The formulated hypothesis on the potential of SESC is confirmed on the inter-sector mediation which is then materialized by the creation of practical and symbolic conditions for the conformation of new identities among network entities, which will gradually become more related, in the assay of strategies that embed the most broadened political, ethical and cultural perspective of health promotion