Visita domiciliar: espaço privilegiado para diálogo e produção de saberes / Home visit: special opportunity for dialogue and experience

O presente artigo tem por objetivo abordar a visita domiciliar no contexto do Programa Saúde da Família (PSF) como espaço privilegiado para diálogo e produção de saberes à luz do pensamento de Boaventura Sousa Santos e de Edgar Morin. Os dados que apóiam esta constatação foram alcançados por uma pesquisa descritiva realizada no período entre 2001 e 2003 para avaliar a experiência de implantação do PSF em seis municípios do Estado do Rio de Janeiro, da qual participaram 78 médicos e 131 enfermeiros. Diante dos resultados alcançados sobre a abrangência da visita domiciliar na agenda dos profissionais e usuários do PSF é possível concluir que o caráter estratégico da mesma contribui para consolidar o Sistema Único de Saúde e superar desigualdades sociais. Também, a visita domiciliar incorporada à práxis profissional demonstra que o Pólo de Capacitação em Saúde da Família do Rio de Janeiro alcançou seu propósito na preparação de pessoal para atuar em equipes de saúde da família.

Health workforce issues and the Global Fund to fight AIDS; Tuberculosis and Malaria: an analytical review

Recent studies have shown evidence of a direct and positive causal link between the number of health workers and health outcomes. Several studies have identified an adequate health workforce as one of the key ingredients to achieving improved health outcomes. Global health initiatives are faced with human resources issues as a major; system-wide constraint. This article explores how the Global Fund addresses the challenges of a health workforce bottleneck to the successful implementation of priority disease programmes. Possibilities for investment in human resources in the Global Fund's policy documents and guidelines are reviewed. This is followed by an in-depth study of 35 Global Fund proposals from five African countries: Ethiopia; Ghana; Kenya; Malawi and Tanzania. The discussion presents specific human resources interventions that can be found in proposals. Finally; the comments on human resources interventions in the Global Fund's Technical Review Panel and the budget allocation for human resources for health were examined. Policy documents and guidelines of the Global Fund foster taking account of human resources constraints in recipient countries and interventions to address them. However; the review of actual proposals clearly shows that countries do not often take advantage of their opportunities and focus mainly on short-term; in-service training in their human resources components. The comments of the Technical Review Panel on proposed health system-strengthening interventions reveal a struggle between the Global Fund's goal to fight the three targeted diseases; on the one hand; and the need to strengthen health systems as a prerequisite for success; on the other. In realizing the opportunities the Global Fund provides for human resources interventions; countries should go beyond short-term objectives and link their activities to a long-term development of their human resources for health