Regionalização Da Saúde: (in)visibilidade E (i)materialidade Da Universalidade E Integralidade Em Saúde No Trânsito De Institucionalidades

Regionalization is a strategy of organization and integration of services in national health systems, in a path to be followed toward comprehensiveness and universal access. However, its principles are still invisible in Brazilian society, and the forms of management in health regions are questioned, as well as its actual effects on the construction of health as a right. This article is dedicated to such questioning and falls as a production aiming to denature processes and enable the emergence of events put into invisibility because of the “discursive formations” of health regionalization. This study comprises the regionalization process of Ceará’s health system since the 1990s. This is a qualitative study that examines the reports of 23 state managers of health, as well as the documentary narratives related to this issue. This study aims to build “bundles of relations”, articulating the subjects and institutions in the production of “knowledge-power and truth-power”, according to Foucault’s reference, and in dialogue with public health authors. The regionalization of Ceará points to a reform of the health sector, delegating the management and provision of services to the Social Organization and to the consortium, on procedural and productive contracting, strengthening the “entrepreneurship” of health and thus affecting the production of comprehensiveness and universality. We conclude that the Unified Health System's constitutional stratum is undergoing a breaking process, forging another “regime of comprehensiveness and universality”, that can be observed in the fact that the Unified Health System is between institutionalities, and in the change from the right to health care to customer right in a reductionist shift. © 2016, UNIV SAOPAULO. All rights reserved.25490291

Interfederal Health Networks: A Challenge To Sus In Its Twentieth Year [redes Interfederativas De Saúde: Um Desafio Para O Sus Nos Seus Vinte Anos]

The present paper deals with the construction of health interfederal networks, composed by each federate organization that together will manage nationwide the Unified Health System in a shared and coordinated way. It also ranks the necessary conceptual elements to the network construction and adequate operation like local management boards, interfederal board of trustees and administrative organizational contracts.16316711680Arendt, H., (1983) A Condição Humana, , Rio de Janeiro: Forense UniversitáriaCastells, M., (2007) Sociedade Em Rede, , 10 a ed. São Paulo: Paz e TerraFleury, S., El desafio de la gestión de las redes de políticas (2002) Revista Instituiciones Y Desarrollo, 17. , http://www.ebape.fgv.br/academico/asp/dsp_professor.asp?cd_pro=36, [acessado 2008 mar 1 o], Disponível emMorais, S.A., (1987) Novo Dicionário Da Língua Portuguesa, , São Paulo: Horizonte Confidência, v. ICapra, F., (2006) A Teia da Vida, , São Paulo: CultrixBraga, E.C., Critérios de suficiência para análise de redes assistenciais [minuta] (2006) Exposição De Motivos, 26. , http://www4.ensp.fiocruz.br/informe/anexos/ANS_CP26_motivos.pdf, Consulta Pública, Rio de Janeiro: Agência Nacional de Saúde Suplementar2006, [acessado 2011 fev 21]: [cerca de 4 p.]. Disponível emSilva, J.A., (2007) Curso de Direito Constitucional Positivo, , São Paulo: MalheirosJusten, F.M., (2005) Parecer Sobre Minuta De Anteprojeto De Lei Da Política Nacional De Saneamento Básico, , http://www.planalto.gov.br, Disponível emMedauar, O., (2003) O Direito Administrativo Em Evolução, , 2 a ed. São Paulo: RTLópez-Valcárcel, B.G., Políticas contractuales en atención especializada (2006) Sistemas Y Servicios Sanitarios, , Repullo JR, Iñesta A, organizadores, Madri: Diaz de Santo

Relação médico-paciente: entre o desejável e o possível na atenção primária à saúde Doctor-patient relationship: between desire and possibility in primary health care

A relação médico-paciente no contexto da atenção primária é um desafio para a implementação de práticas humanizadas em saúde, considerando sua relevância e a emergência da problemática da humanização como necessidade social. Para que se possa avançar nesse campo, faz-se necessário rever o que se tem produzido sobre o assunto, mapeando os limites e avanços dessa relação. Este estudo busca compreender o encontro no âmbito da atenção primária à saúde, pensando a relação médico-paciente em termos hermenêuticos, a partir da construção de novos horizontes normativos no plano dos valores morais e éticos, com vistas à humanização da saúde. O estudo foi realizado no período de 2008-2009 em duas unidades de Saúde da Família do Município de Fortaleza, Ceará. Utilizaram-se técnicas de entrevista aprofundada e observação participante, totalizando 11 encontros com médicos e 37 com pacientes, além da gravação de 53 consultas. Os dados foram organizados e analisados no software Qualitative Solutions Research Nvivo (QSR). Pacientes e médicos ponderaram sobre três aspectos principais que influenciam a interação clínica na Estratégia Saúde da Família: as características pessoais do médico, o agir profissional e os problemas na organização dos serviços. Entre os resultados, apareceram três perfis do encontro médico-paciente: o encontro centrado no paciente, o encontro sem entendimento e o realizado a curto prazo. O estabelecimento de um vínculo requer apoio intensivo às mudanças na organização dos serviços, com ênfase numa formação profissional que valorize a cultura, o protagonismo e a reflexão filosófica da convivência humana, visando à qualificação da atenção primária.<br>The doctor-patient relationship in the context of primary health care challenges the implementation of humanized health practices, considering their relevance and the emergence of humanization as a social need. In order to advance in this field, it is necessary to review what has been produced on this issue, mapping the boundaries and advances of this relationship. This study seeks to understand this relationship as part of primary health care practices, thinking the doctor-patient relationship in hermeneutic terms, from the construction of new horizons in terms of normative ethical and moral values in order to obtain a more humanized health. The study was conducted from 2008-2009 in two family health units in the city of Fortaleza, state of Ceará. Techniques of in-depth interview and participant observation were applied, totaling 11 interviews with doctors and 37 with patients, in addition to the recording of 53 consultancies. Data were organized and analyzed using the software NVivo Qualitative Solutions Research (QSR). Patients and doctors reflected about three main aspects that influence the clinical interaction in the Family Health Strategy, which are: personal characteristics of the physician, professional acting and problems in the services organization. Among the results, three profiles of the physician-patient encounter emerge: the patient-centered encounter, the consultations "without understanding" and the short-term encounter. Establishing a relationship requires intensive support to change services organization, emphasizing training that values culture, leadership and philosophical reflection of human society, aiming at the qualification of primary care