Características del servicio social para profesionales médicos en los estados andinos / Characteristics of compulsory service programs for medical professionals in the Andean states

INTRODUCCIÓN: Se ha estudiado poco sobre el impacto de los programas de servicio social en salud en el desarrollo profesional de médicos de los Estados Andinos (Argentina, Bolivia, Chile, Colombia, Ecuador, Perú y Venezuela), programas cuya finalidad es incrementar los recursos humanos en salud en zonas rurales y remotas. OBJETIVO: Describir la normativa de los programas de servicio social para profesionales médicos de los Estados Andinos. MÉTODOS: Se realizó una revisión bibliográfica de documentos normativos concernientes al servicio social para profesionales médicos en sitios web de gobiernos de los Estados Andinos, con la finalidad de obtener información la condición de servicio, financiamiento del programa/remuneraciones y modos de adjudicación. Adicionalmente, se empleó el motor de búsqueda PubMed para complementar la información sobre servicios sociales obligatorios en estos países. RESULTADOS: El servicio social para profesionales médicos está establecido bajo un marco normativo en todos los Estados Andinos, a excepción de Argentina, donde no existe este programa. Los participantes perciben una remuneración, salvo en Bolivia, donde el servicio es realizado por estudiantes. Los sistemas de adjudicación para estos programas son heterogéneos, siendo que en algunos Estados Andinos existe asignación de plazas según criterios meritocráticos. La participación en programas sociales en salud condiciona el ejercicio profesional (Ecuador, Colombia y Venezuela) y el poder realizar una especialización (Chile y Perú). CONCLUSIONES: Se requiere estudiar del impacto de estos programas en el desarrollo profesional del participante, con el objetivo de implementar estrategias de mejora adecuadas a sus contextos particulares.

INTRODUCTION: There are few studies on the impact of social service programs on health in the professional development of doctors in the Andean States (Argentina, Bolivia, Chile, Colombia, Ecuador, Peru, and Venezuela). The purpose of these programs is to increase the availability of human resources in health in rural and remote areas. OBJECTIVE: To describe the regulations of social service programs for medical professionals in the Andean countries. METHODS: We carried out a bibliographic review of normative documents concerning the social service for medical professionals using websites of governments of the Andean States as data sources. We sought to obtain information regarding service conditions, funding of these programs­including remunerations, and means of program allocation. Additionally, we used PubMed/MEDLINE to find complementary information on mandatory social services in these countries. RESULTS: Social service for medical professionals is established under a regulatory framework in all the Andean countries, except for Argentina, where this program does not exist. Participants receive remuneration (except in Bolivia, where students perform the service). The allocation systems used for these programs are heterogeneous, and in some Andean countries, the allocation is merit-based. Participation in social programs influences later professional opportunities (Ecuador, Colombia, and Venezuela) and the ability to specialize (Chile and Peru). CONCLUSIONS: It is necessary to study the impact of these programs on the professional development of the participants to design and implement quality improvement strategies tailored to each context.

Regularización laboral de trabajadores de la salud pagados con recursos del Seguro Popular en México / Labor regularization of health workers paid with funds from the Mexican System for Social Protection in Health

OBJETIVO: Describir y analizar el proceso de regularización del personal de salud pagado por el Sistema de Protección Social en Salud de México. MATERIAL Y MÉTODOS: Se utilizan datos primarios y secundarios provenientes de la evaluación del Sistema de Protección Social en Salud en 2009. RESULTADOS: La regularización mejora las condiciones laborales de los trabajadores pero sus implicaciones para el conjunto del sistema no son necesariamente positivas. CONCLUSIONES: Se requiere considerar la necesidad de que este tipo de inversiones beneficien a todos los actores interesados, principalmente la población asegurada por el sistema.

OBJECTIVE: The process of regularization of workers paid by the Social Protection Health System of Mexico is described and analyzed. MATERIALS AND METHODS: Primary and secondary data collected by the external evaluation of the Mexican System for Social Protection in Health in 2009 were used. RESULTS: The regularization clearly improved the labor conditions of workers contracted by the system but a broader systemic implication of regularization does not seem to be necessarily positive. CONCLUSION: It is important to consider the need to guarantee that this type of changes in the contractual conditions of workers benefit all actors, particularly the insured population.

Neoliberalismo en salud: La tortura de trabajadoras y trabajadores del Instituto Materno Infantil de Bogotá / Neoliberalism in health: the torture of the health care workers of the Bogota s Instituto Materno Infantil (child and maternity hospital)

Objetivos Relacionar históricamente las transformaciones más significativas del Instituto Materno Infantil (IMI) en su proceso de crisis, cierre y liquidación con las experiencias de sus trabajadores/as. Encontrar elementos vivenciales y teóricos que interconecten el proceso de privatización de la salud con las experiencias de resistencia y dolor/sufrimiento de trabajadores/as. Métodos Etnografía inscrita en corrientes críticas y apoyada en trabajo de campo constante y colectivo, investigación histórica (fuentes primarias y secundarias) y entrevistas semiestructuradas con cinco mujeres que trabajaron por más de quince años en el IMI. Resultados Una línea del tiempo con cuatro periodos principales: Los años de gloria (hasta 1990), Llega el neoliberalismo (1990-2000), La crisis y las resistencias (2001-2005) y Liquidación (2006-). La narrativa de las mujeres entrevistadas devela múltiples agresiones que se intensificaron desde el 2006 generando dolor/ sufrimiento, relatos que ilustran violaciones a sus derechos humanos y laborales. Discusión Proponemos analizar las conexiones entre los diferentes tipos de violencia y el dolor/sufrimiento bajo la categoría tortura, entendida como acciones violentas que causan dolor físico-emocional, las cuales son ejecutadas por actores de poder sobre otros que desafían alterarlo. Enfatizamos en las burocracias, el confinamiento, los agentes torturadores y los resquebrajamientos a la unidad mente/cuerpo para argumentar que esta relación neoliberalismo y tortura pretende eliminar los últimos trabajadores/as de la salud del país con garantías laborales para avanzar en la acumulación de capital que genera la creciente sobreexplotación del trabajo y la mercantilización de la salud.

Objectives To link, from a historical point of view, the most significant transformations of the Instituto Materno Infantil (IMI) [the oldest child and maternity hospital of the country] during its process of crisis, closure and liquidation with the experiences of the hospital workers. To find experience-based and theoretical elements that can interconnect the process of health care privatization of the country with the workers' experiences of resistance and pain/suffering. Methods Critically-oriented ethnography based on continuous collective field work, historical research (primary and secondary sources) and semi-structured interviews with 5 women who worked at the IMI for more than 15 years.Results: A time line of 4 main periods: Los años de gloria [The golden years] (up to 1990); Llega el neoliberalismo [Neoliberalism arrives] (1990-2000); La crisis y las resistencias [Crisis and resistances] (2001-2005); and Liquidación [Liquidation (2006-20??)]. The narratives of the interviewed women unveil multiple aggressions that have intensified since 2006, have caused pain and suffering and are examples of violations of human and labour rights. Discussion We suggest to analyze the links between the different kinds of violence and pain and suffering as torture. This category is defined as the set of violent actions that cause physical and emotional pain, which are performed by actors in positions of power over other people who challenge that power and are part of modern States' ideological principles around a defined moral social order. For the IMI workers' case, the ideological principle that is being challenged is health care neoliberalism. From the analyses of bureaucracy, confinement, torturing agents, and the breaking-off of the body-mind unit we conclude that this relationship between neoliberalism and torture aims to eliminate the last health care workers of the country who had job stability and full-benefits through public labour contracts. Their elimination furthers the accumulation of capital generated by increasing over-exploitation of labour and commodification of health care.

O Pacto pela Saúde e a gestão da força de trabalho na Atenção Básica do SUS: um retrato da situação de alguns municípios no Estado de São Paulo / The Health Pact and workforce management within the Unified Health System's Primary Care: a portrait of the situation in some municipalities in São Paulo state, Brazil

Este artigo aborda o cumprimento, em oito municípios do Estado de São Paulo, dos compromissos concernentes à gestão do trabalho inscritos no Pacto de Gestão, assinado em 2006 por gestores dos três níveis do SUS. Entre os municípios estudados, três são polos de regiões metropolitanas; e cinco tinham, em 2008, população acima de 500 mil habitantes. Foram realizadas coletas de dados e análise documental, particularmente dos Planos de Carreira, Cargos e Salários (PCCS) de três municípios e entrevistas com gestores e representantes de trabalhadores e usuários nos Conselhos Municipais de Saúde. As categorias analisadas derivaram do Pacto de Gestão: democratização das relações de trabalho, direitos sociais e previdenciários, regime jurídico e vínculo, carreira, progressão funcional e educação permanente. Os resultados mostraram repercussão pouco relevante das decisões das mesas de negociação na política de gestão do trabalho; incorporação parcial das diretrizes do PCCS-SUS apenas em três municípios; política de formação de pessoal caracterizada por iniciativas pontuais dissociadas da progressão funcional. Foram também identificados: visão restrita dos conselheiros sobre sua participação na discussão do tema gestão do trabalho, expressa numa abordagem periférica pelos Conselhos Municipais de Saúde dos temas relativos à gestão da força de trabalho; deficiências na descentralização da gestão dos cargos no SUS municipal; tendência ao tratamento privado, pelos gestores, dos dados relativos ao quadro de pessoal. Embora seja incipiente a implementação dos compromissos formulados no Termo de Compromisso de Gestão, cabe destacar o ineditismo da inclusão no Pacto de Gestão das questões relativas à gestão do trabalho como uma política definida.

This paper discusses the implementation in eight municipalities in Sao Paulo state of the commitments concerning the management of work composing the Management Pact, signed in 2006 by the three levels of the Unified Health System (SUS). Among the municipalities studied, three are centers of metropolitan areas and five had in 2008 population over 500,000 inhabitants. Data were collected, particularly concerning the Career, Positions and Wages Plan (PCCS) and interviews were accomplished with managers and representatives of workers and users in Municipal Health Councils. The categories analyzed were derived from the Management Pact: democratization of labor relations, social rights and social security, juridical regime and working arrangements, career progression and permanent training. The results showed irrelevant repercussion of the collective-bargaining mechanisms' decisions on personnel policy; partial incorporation of the guidelines of PCCS-SUS in only three municipalities, staff training policy characterized by specific initiatives decoupled from career progression. It was also possible to identify a restricted view by the counselors interviewed about their participation in the work management discussion; Municipal Health Councils' peripheral approach of the issues related to the management of the workforce; deficiencies in the decentralization of management positions for municipal SUS; tendency for private treatment by managers of the data concerning staff. In spite of the incipient implementation of the commitments stated in the Management Pact, we highlight the innovative inclusion of the work management on the Public Health System managers' agenda as a definite policy.

Remuneraciones profesionales médicas / Medical remunerations

Desde que Aristóteles en su Ética a Nicomaco expresaba que "el fin que persigue el arte de la medicina es la salud" la profesión y la condigna remuneración de los médicos fueron consideradas en alta estima por parte de todos cuantos requerían de los servicios asistenciales médicos. Era sin lugar a dudas la del médico una de las profesiones más elogiosamente reconocidas y mejor remuneradas dentro de las variadas disciplinas humanas. En el presente trabajo se procura recrear la variable historia de las remuneraciones médicas y el particular destrato que ellas merecen en la actualidad en la República Argentina. Se hacen las consideraciones éticas, morales, laborales y legales sobre los conceptos remunerativos del médico y su discriminación cuando son considerados "honorarios" y cuando son considerados simplemente "salarios". Se concluye necesariamente que la histórica y merecida buena imagen del médico como agente de la salud se ha deteriorado y devaluado paulatinamente hasta llegar al presente en muchas comunidades a revestir el carácter de irrisoria, particularmente en lo atinente a su remuneración. Se toma en cuenta que en la actualidad la actividad médica depende no ya de sus pacientes asistidos, sino de terceros que ofician como pagadores de las prestaciones, preocupándose las más de las veces por el superávit económico que por el superávit de la salud. La labor médica se ha convertido en un mero objeto de intercambio y contienda económica, abandonando el espíritu de solidaridad individual y social de la atención para la salud. La medicina pasó a tomar parte integral de un "complejo comercial – industrial" para la salud y todo ello sin considerar la formación humana y profesional del médico, su permanente incentivo en estudiar y agregar conocimientos a su arte y sin verificarlo como una entidad esencial como soporte natural en la salud de la comunidad...

Since Aristoteles wrote in his "Etica a Nicomaco" was expressing that "the end that chases the art of the medicine is the health…", the profession and the deserved doctor’s remuneration were high esteem and consideration on the part for all those were needing of the welfare medical services. It was no doubt that the doctor, one of the professions more eulogistically recognized and best remunerated inside the varied human disciplines. In the present work one gets to recreate the changeable history of the medical remunerations and the individual mistreatment that they deserve at present in the Argentine Republic. There’re done the ethical, moral, labour and legal considerations on the remunerative of the doctor and his discrimination among when it’s considered to be "honorarium" and when are considered simply "wages". It concludes necessarily in that the historical and welldeserved good image of the doctor as a health’s agent, has deteriorated and gradually devaluated, up to managing to the present in many communities to re-dress the character of derisory, particularly in the relating thing to his remuneration. It born in mind that at present the medical activity depends not already on his assisted patients, but of third that officiate as payers presentations, worrying more of the times for the economic surplus that for the health’s surplus. The medical labor has turned into a mere exchange’s object and economic contest, leaving the spirit of individual and social solidarity for the health’s attention. The medicine passed to take integral report of a "commercial complex-industrially"for the health and all this without considering the doctor’s human and professional training, his art and withoutchecking it as an essential entity as natural support in the community’s health...

Análisis de la motivación del recurso humano. Comparación entre los Servicios de Cirugía del Hospital Dr. Calderón Guardia y Patología Forense del Organismo de Investigación Judicial / Analysis of the motivation of human resource. Comparison between the Surgical Services of Hospital Dr. Calderon Guardia and Forensic Pathology of Organismo de Investigacion Judicial

Se hace una revisión de las circunstancias que motivan al personal a realizar correctamente su trabajo, las cuales son diferentes para cada persona, y varían de acuerdo a las necesidades, valores sociales, y capacidades de cada individuo. El conocimiento básico de cada persona ayuda a las jefaturas a motivar a los empleados que tienen a su cargo. Se realiza una comparación del personal de los servicios de diferentes instituciones en la cual se analizan elementos satisfactorios e insatisfactorios del medio ambiente laboral

Guia dos direitos da mulher / Guide of the woman's rights

Talvez seja o mais importante trabalho publicado sobre a condiçäo feminina no Brasil. Detalha o que há de mais atual em relaçäo aos direitos da mulher nas áreas do direito constitucional, civil, penal, da saúde, da violência, da família etc. Livro de referência que consolida toda a legislaçäo relativa ao exercício da cidadania feminina

Atividades insalubres, perigosas e penosas: direitos, privilégios e incoerências / Insalubrious, dangerous and arduous activities: rights, privileged and incoherences

O reconhecimento e a legalização de atividades insalubres, perigosa e/ou penosas, constituiram, sem sombra de dúvida, um avanço social nas relações trabalhistas. Não obstante, no Brasil, o desejo de detalhar a regulamentação dessas atividades, acabou gerando privilégios e incoerências que este texto tenta analisar

Abstract - There is no doubt that labors relations experienced a social advance when certain activities received technical and legal recognition as hazardous to health. Nevertheless. inadequate detailing of the corresponding legislation led the brazilian context to an incoherent mixing of rights and privileges, here analyzed

Plano de benefícios da previdência social: lei, regulamento e legislaçäo complementar / Benefits plan of social security: law, regulation and complementary legislation

Legislaçäo da Previdência Social no Brasil. Contendo as alteraçöes havidas até agosto/92, as Leis números 8212 e 8213, de 24 de julho de 1991, e os respectivos regulamentos, conforme decretos números 611 e 612, de 21 de julho de 1992. Apresenta Indice Remissivo e Quadro Comparativo relacionando as alteraçöes havidas e a evoluçäo interpretativa das leis referidas e de suas modificaçöes posteriores