Perspectivas Atuais Do Sus E O Agir Tecnológico Do Trabalhador Como Um Ato ético-político

Palestra proferida no Auditório da Faculdade de Ciências Médicas em 13/11/2003 em comemoração ao XX Ciclo de Debates do Serviço Social do Hospital das Clínicas da UNICAMP.331-12Serviço Socia

Governing tensions in the health action as a permanent challenge of some managerial strategies

In the current essay, the author tries to synthesize what has livened him up lately in relation to his thinkings over the act of governing health organizations having several articles and books as a starting point, taking as a challenge the attempt of imprinting changes in the everyday life of the making of health attention models, in the core of the workers practices, even when a great concentration of power is not noticed as for transformation feasibility. Therefore there is a search to understand how and where power may be produced. How to explore terrains of potencies within the health field which are present in the tensional conformation of its action territory, using the managerial tools which are available in the area of science and government techniques - in health. Use managed care to developed analysis.O autor procura sintetizar, neste ensaio, o que tem animado, recentemente, suas reflexões sobre o ato de governar estabelecimentos de saúde, em vários artigos e livros, tomando como desafio a tentativa de imprimir mudanças no dia-a-dia do fabricar os modelos de atenção à saúde, no interior das práticas dos trabalhadores, mesmo não tendo grande concentração de poder para a transformação, procurando então compreender como e por onde produzir poderes. Como explorar terrenos de potências no campo da saúde que estão presentes na conformação tensional de seu território de ação, fazendo-se uso das distintas ferramentas gerenciais disponíveis no campo das ciências e técnicas de governo, na saúde. Utiliza a atenção gerenciada para desenvolver certas análises.30531

Mapas analíticos: una mirada sobre la organización y sus procesos de trabajo

The center of the discussion that this paper tries to face is the challenge of a method. An analytical look is searched for about the health organizations that have a mode of production depending on the "alive work in action", which in its own, provides a high complexity to the scene, since this alive work, while being operated in action in the work processes, contains a great power to form networks with a high capacity of subjectivity. We suggest the unions of workers build the cartography: a) the "maps of conflicts", b) the "maps of unusual acts", c) the "maps of useless acts", and from these maps, we may proceed with the discussion, analysis and self-analysis of the processes lived in the work situation. Through this experience, it was proved the efficiency of the "analytical maps" as cartographic tools. Applied to the work processes, we captured the continuous and non-continuous movements of the alive work in its dynamics, also revealing the affection and manifestations of desire in the production of the reality. These maps had the function of the "lens" of the cartographer to visualize the work process and the production of reality in its micropolicy.El centro de la discusión que este texto intenta enfrentar es el desafío de un método. Se busca una mirada analítica sobre las organizaciones de salud, que tienen un modo de producción dependiente del "trabajo vivo en acto"; lo que por sí solo aporta una alta complejidad a la escena, pues este trabajo vivo, al ser operado en acto en los procesos de trabajo, contiene una gran potencia instituyente para formar redes, con alta capacidad de subjetivación. Les proponemos a los colectivos de trabajadores la siguiente construcción cartográfica: a) los "mapas de conflictos", b) los "mapas de actos inusitados", c) los "mapas de actos inútiles"; y a partir de estos mapas se procede a la discusión, análisis y autoanálisis de los procesos vividos en situación de trabajo. A través de esta experiencia se comprobó la eficacia de los "mapas analíticos" como herramientas cartográficas. Aplicadas sobre los procesos de trabajo, captaron los movimientos continuos y discontinuos del trabajo vivo en su dinámica, revelando además los afectos y las manifestaciones deseantes en la producción de la realidad. Estos mapas cumplieron la función de las "lentes" del cartógrafo para visualizar el proceso de trabajo y la producción de la realidad en su micropolítica

El reconocimiento de la producción subjetiva del cuidado

This article assumes that there is a subjective production implicit in health care and suggests that qualitative investigation in health should also take into account studies on this dimension of reality. The subjective production of health care manifests itself on three levels: the first, the rizomatic networks which are formed and act in flows of intensities within health services and connect the workers in their working environment through lines of integral care; the second, the desire which is formed in primary, unconscious processes and operates as a productive energy to propel the processes that construct reality; and the third, the "live work in action" which serves as a platform upon which the networks of health care are produced. There is a combined and synergic movement among the three dimensions. This tells us that workers construct their work processes according to a unique way of understanding the world and taking part in it, putting a limit on the normative frameworks that attempt to structure the practice of care into rigid protocols. It is within the work of caring for health that these personal singularities manifest themselves and for this reason is a diverse, varied expression of manifold subjectivities in action.Este artículo parte del supuesto de que hay una producción subjetiva del cuidado en salud por lo cual sugiere que la investigación cualitativa en salud debe contemplar también estudios sobre esta dimensión de la realidad. La producción subjetiva del cuidado en salud se manifiesta en tres planos: el primero, las redes rizomáticas que se forman y actúan en flujos de intensidades al interior de los servicios de salud y conectan a los trabajadores en el ambiente del trabajo a través de líneas de cuidado integral; el segundo, el deseo que se forma en los procesos primarios, inconscientes, y opera como una energía de producción propulsora de los procesos de construcción de la realidad; y tercero, el "trabajo vivo en acto" que actúa como una plataforma sobre la cual se producen las redes del cuidado. Es un movimiento combinado y sinérgico entre las tres dimensiones. Esto nos revela que los trabajadores construyen su proceso de trabajo de acuerdo con un modo singular de significar el mundo e intervenir en él, poniendo un límite a las directrices normativas que intentan encuadrar las prácticas del cuidado en fórmulas rígidamente protocolares. El plano del trabajo y del cuidado en salud es el lugar de manifestación de las singularidades y por ello es diverso, múltiple, como expresión de las subjetividades en acción

Mapas analíticos: una mirada sobre la organización y sus procesos de trabajo

The center of the discussion that this paper tries to face is the challenge of a method. An analytical look is searched for about the health organizations that have a mode of production depending on the "alive work in action", which in its own, provides a high complexity to the scene, since this alive work, while being operated in action in the work processes, contains a great power to form networks with a high capacity of subjectivity. We suggest the unions of workers build the cartography: a) the "maps of conflicts", b) the "maps of unusual acts", c) the "maps of useless acts", and from these maps, we may proceed with the discussion, analysis and self-analysis of the processes lived in the work situation. Through this experience, it was proved the efficiency of the "analytical maps" as cartographic tools. Applied to the work processes, we captured the continuous and non-continuous movements of the alive work in its dynamics, also revealing the affection and manifestations of desire in the production of the reality. These maps had the function of the "lens" of the cartographer to visualize the work process and the production of reality in its micropolicy.El centro de la discusión que este texto intenta enfrentar es el desafío de un método. Se busca una mirada analítica sobre las organizaciones de salud, que tienen un modo de producción dependiente del "trabajo vivo en acto"; lo que por sí solo aporta una alta complejidad a la escena, pues este trabajo vivo, al ser operado en acto en los procesos de trabajo, contiene una gran potencia instituyente para formar redes, con alta capacidad de subjetivación. Les proponemos a los colectivos de trabajadores la siguiente construcción cartográfica: a) los "mapas de conflictos", b) los "mapas de actos inusitados", c) los "mapas de actos inútiles"; y a partir de estos mapas se procede a la discusión, análisis y autoanálisis de los procesos vividos en situación de trabajo. A través de esta experiencia se comprobó la eficacia de los "mapas analíticos" como herramientas cartográficas. Aplicadas sobre los procesos de trabajo, captaron los movimientos continuos y discontinuos del trabajo vivo en su dinámica, revelando además los afectos y las manifestaciones deseantes en la producción de la realidad. Estos mapas cumplieron la función de las "lentes" del cartógrafo para visualizar el proceso de trabajo y la producción de la realidad en su micropolítica

Social pediatrics and its reformist proposals

This article reflects on the constitution of Social Pediatrics in Brazil, viewing it as a movement for reform in children's health care involving teaching, services, and pediatric practice. The article includes a historical and bibliographical review of the Social Pediatrics' field and the provision of children's health care, analyzing its relations with movements for the reform of medical education and health care and its conceptual framework, including several authors' definitions and formulations on the theme.Realiza-se, neste artigo, uma reflexão sobre a constituição da pediatria social no Brasil, compreendendo-a como um movimento de formação de propostas de reformas da atenção à saúde da criança, que contempla uma tripla proposta reformista: do ensino, do serviço e da prática pediátricos. O trabalho inclui uma recuperação histórica e bibliográfica do campo da pediatria social que é relativo ao cuidado com a criança e a forma de prestá-lo, analisando-o através de suas relações com os movimentos mais gerais de reforma do ensino médico e da atenção à saúde. Tece, ainda, considerações sobre seu arcabouço conceitual, com base nas definições e formulações sobre o tema apontadas por alguns autores.97798

The clinical third edge : care production in Psychosocial Attention Centers.

Partindo de uma reflex?o a prop?sito do real papel desempenhado pelo trabalho cl?nico desenvolvido nos Centros de Aten??o Psicossocial (CAPS), servi?os substitutivos de aten??o aos casos graves de transtornos mentais, implantados a partir das modelagens assistenciais produzidas pela reforma psiqui?trica brasileira, no contexto hist?rico das sociedades de controle, os autores revisitam parte da produ??o te?rica sobre a cl?nica dos CAPS, reconhecem sua pluridimensionalidade e prop?em a ?terceira margem da cl?nica? como necess?ria nessa produ??o de cuidado.Arising from the reflection about the real papel of clinical work made in Psychosocial Attention Centers, substitutive services to serious mental disorders, created by assistencials models from the brazilian psychiatric reform, in control society historic context, the authors make a revision of teoric production about this clinical work, recognizing its pluridimension and proposing the ?clinical third edge? as necessary to that care prodution

Devenir cartógrafa

The subjective production of care constitutes an essential element of any health work process and it emerges as a common territory for everyone involved. During pregnancy, birth and in the postnatal period, care is produced daily by health professionals according to their singularity, and it enables them to open up territories of health practices. The article focuses on the reflections and discussions that emerge during a cartographic research, which took place in an Obstetric and Gynecologic Service of a regional hospital. We present a situated discussion of different dimensions of this cartographic research: entering into the context, the construction of the role of researcher, context rules and limits, the construction of intersectional spaces and the articulation between 'vibrant eye' and 'retina eye'. The production of care is seen as a territory of health practices in which micropolitical field seeks to reveal and create singularities to open fissures in the dominant subjectivity

Contribuciones metodológicas para estudiar la producción del cuidado en salud: aprendizajes a partir de una investigación sobre barreras y acceso en salud mental

This article presents methodological contributions and a conceptual innovation for thinking about the production of health care, stemming from a study on access and barriers in mental health carried out in the municipality of Campinas (São Paulo, Brazil). The study used a cartographic approach and, after an initial identification of the most complex cases (on the part of the teams of workers), adopted the users as guides to explore the different levels of production of their lives and to evaluate the possibility of forming a network of existential connections that produce life as a fundamental analyzer of access or barriers to care.Este artículo presenta algunas contribuciones metodológicas y una innovación conceptual para pensar la producción del cuidado en salud, a partir de una investigación sobre el acceso y las barreras en salud mental realizada en la municipalidad de Campinas (San Pablo, Brasil). La investigación utilizó el abordaje cartográfico y, a partir de una identificación inicial de los casos más complejos (por parte de los equipos de trabajadores), adoptó a los usuarios como guías para recorrer los diferentes planos de producción de sus vidas y evaluar la posibilidad de armar, o no, una red de conexiones existenciales productoras de vida como analizador fundamental del acceso o barrera al cuidado

Methodological contributions towards the study of health care production: lessons from a research study on barriers and access in mental health

This article presents methodological contributions and a conceptual innovation for thinking about the production of health care, stemming from a study on access and barriers in mental health carried out in the municipality of Campinas (Sao Paulo, Brazil). The study used a cartographic approach and, after an initial identification of the most complex cases (on the part of the teams of workers), adopted the users as guides to explore the different levels of production of their lives and to evaluate the possibility of forming a network of existential connections that produce life as a fundamental analyzer of access or barriers to care