População em situação de rua: abordagens interdisciplinares e perspectivas intersetoriais / Homeless population: interdisciplinary approaches and intersectoral perspectives

As abordagens interdisciplinares e perspectivas intersetoriais são uma grande contribuição para o enfrentamento político e sociopedagógico da presença cada vez maior da população em situação de rua. As respostas do chamado "poder público", além de insuficientes e inadequadas, são sempre de tutela e não facilitadoras e vivenciais da construção da autonomia. As chamadas "políticas públicas" são mantedoras da miséria, das desigualdades sociais. A população em situação de rua é condenada a viver os efeitos da política capitalista neoliberal, do descarte. A população em situação de rua é indesejável e sofre todas as consequências de ações violentas e higienistas travestidas de discursos pseudo-humanistas e com lógica do desprezo, preconceito e racismo estrutural. Que o presente, complexo e profundo trabalho ajude a aguçar um olhar crítico, histórico e de compromisso. Uma luta desigual, da qual, muitas vezes, sairemos derrotados. As derrotas e conflitos alimentaram nossa perseverança na luta contínua e permanente contra toda forma de opressão. Coniventes com a perversidade não seja nunca a nossa opção ou posição. Na academia, na convivência nas ruas, praças, vielas, quilombos e comunidades, unidos na uta pela liberdade a partir dos esquecidos e abandonados.

Programa Bolsa Família e o acompanhamento das condicionalidades na área de saúde / Family Allowance Program and the follow-up of the conditions related to the health field

Resumo: Este artigo consolida resultados de uma pesquisa realizada em dez municípios brasileiros, que buscou analisar a dinâmica de acompanhamento das condicionalidades de saúde do Programa Bolsa Família. A ideia central consistiu em abordar variáveis que poderiam afetar o desempenho municipal na gestão do programa, tais como: porte populacional e magnitude da população a ser coberta; estrutura e capacidade técnico-gerencial dos municípios; oferta e organização da Atenção Básica em Saúde e arranjos intersetoriais.

Abstract: This article consolidates results from a research carried out in ten Brazilian cities. The research analyzed the dynamic of the follow-up of the conditions related to the health field of the Family Allowance Program. The central idea was to approach the variables that could affect the City Hall performance in managing the program, such as: population size, magnitude of the population to be attended, the structure and both the technical and managing capacity of the each one of the City Halls analyzed, the offer and organization of the Primary Health Care and sector arrangements.

Serviço social na saúde coletiva: reflexões e práticas / Social work in public health: reflections and practices

A leitura deste livro é obrigatória para todos aqueles que buscam se aprimorar na arte de cuidar da promoção de saúde em seu conceito amplo de bem estar físico-psicossocial

Family health: limits and possibilities for an integral primary care approach to health care in Brazil.

The article analyzes the implementation of the Family Health Strategy (FH) and discusses its potential to guide the organization of the Unified Health System in Brazil, based on the integration of FH to the health care network and intersectorial action, crucial aspects of a comprehensive primary health care. Four case studies were carried out in cities with high FH coverage (Aracaju, Belo Horizonte, Florianópolis e Vitória), using as sources: semi-structured interviews with managers and surveys with health care professionals and registered families. The integration analysis highlighted the position of FH Strategy in the health services network, the integration mechanisms and the availability of information for continuity of care. Intersectoriality was researched in relation to the fields of action, scope, sectors involved, presence of forums, and team initiatives. The results point to advances in the integration of FH to the health care network, strengthening basic services as services that are regularly sought and used as a preferential first contact services, although there are still problems in the access to specialized care. The intersectorial initiatives were broader when defined as integrated municipal government policy for the construction of interfaces and cooperation between the diverse sectors.

Saúde da família: limites e possibilidades para uma abordagem integral de atenção primária à saúde no Brasil / Family health: limits and possibilities for an integral primary care approach to health care in Brazil

The article analyzes the implementation of the Family Health Strategy (FH) and discusses its potential to guide the organization of the Unified Health System in Brazil, based on the integration of FH to the health care network and intersectorial action, crucial aspects of a comprehensive primary health care. Four case studies were carried out in cities with high FH coverage (Aracaju, Belo Horizonte, Florianópolis e Vitória), using as sources: semistructured interviews with managers and surveys with health care professionals and registered families.The integration analysis highlighted the position of FH Strategy in the health services network, the integration mechanisms and the availability of information for continuity of care. Intersectoriality was researched in relation to the fields of action, scope,sectors involved, presence of forums, and team initiatives. The results point to advances in the integration of FH to the health care network, strengtheningbasic services as services that are regularly sought and used as a preferential first contact services, although there are still problems in the access to specialized care. The intersectorial initiatives were broader when defined as integrated municipal government policy for the construction of interfaces and cooperation between the diverse sectors.

O artigo analisa a implementação da Estratégia Saúde da Família (SF) e discute suas potencialidades em orientar a organização do SUS no Brasil, a partir da análise da integração da SF à redeassistencial e atuação intersetorial, aspectos cruciais de uma atenção primária abrangente. Foram realizadosquatro estudos de caso de municípios com elevada cobertura por SF (Aracaju, Belo Horizonte, Florianópolis e Vitória) tendo como fontes: entrevistas semi-estruturadas com gestores e inquéritoscom profissionais de saúde e de famílias cadastradas. A análise da integração destacou a posição da Estratégia SF na rede assistencial, os mecanismos de integração e a disponibilidade de informações para continuidade da atenção. A intersetorialidade foi pesquisada quanto aos campos de atuação, abrangência, setores envolvidos, presença de colegiados, e iniciativas das equipes. Os resultados apontam avanços na integração da SF à rede assistencial, propiciando o fortalecimento dos serviços básicos como serviços de procura regular e porta de entrada preferencial, todavia permanecem dificuldades de acesso à atenção especializada. As iniciativas intersetoriais foram mais abrangentes quando definidas como politica integrada do governo municipal para a construção de interfaces e cooperação entre os diversos setores.

Articulação intersetorial no âmbito do Programa Bolsa Família: a experiência do município do Rio de Janeiro / Articulation between the sectors in Programa Bolsa Família: the case of Rio de Janeiro, Brazil

Este artigo se propõe a examinar o processo de implantação do Programa Bolsa Família no âmbito municipal, enfocando o esforço de articulação intersetorial exigido no cumprimento das condicionalidades do programa. A análise toma por referência a experiência do município do Rio de Janeiro, a partir da perspectiva de gestores municipais. As informações foram obtidas através de um levantamento documental e de entrevistas realizadas durante o mês de junho de 2007 com gestores do programa. Destacaram se aspectos facilitadores e os limites de ordem político institucional à consecução das ações intersetoriais no processo de implantação do programa. (AU)

Desigualdades sociais, saúde e bem-estar: oportunidades e problemas no horizonte de políticas públicas transversais / Social inequalities, healthcare and well-being: opportunities and obstacles on the horizon of transversal public policies

O desenvolvimento de um modelo de justiça distributiva capaz de responder às novas exigências e demandas no campo da proteção social submete ao exame e à crítica o desenho e a implementação de políticas públicas. Reconstituir e analisar diferentes dinâmicas institucionais, contextos decisórios e o desempenho de programas sociais emergem como tarefas cruciais para a busca de alternativas capazes de fortalecer experiências de integração e emancipação. Neste artigo, a perspectiva é trazer à tona estas questões contribuindo para afirmação do compromisso em torno de ações públicas transversais e convergentes contra a pobreza, a exclusão e as iniqüidades em saúde.

The development of a distributive justice model that is responsive to new claims and demands in the social policy field requires in-depth examinations and critiques of the ways in which public policies are drawn up and implemented. Reconstituting and analyzing different institutional dynamics, decision contexts and program performances emerge as tasks that are crucial to the quest for alternatives ways of strengthening integration and empowerment experiences. The purpose of this article is to present these issues and help affirm commitments to transversal and convergent public actions combating poverty, social exclusion and unequal healthcare.

Do direito incondicional à condicionalidade do direito: as contrapartidas do Programa Bolsa Família / Unconditional to conditional rights: counterparts in Brazil´s Family Allowance Program

Este artigo analisa a concepção e desafios em torno da exigência de contrapartidas do Programa Bolsa Família (PBF). A obrigatoriedade de inserção de crianças e adolescentes na escola e de crianças, gestantes e nutrizes nos serviços de saúde é central no desenho do PBF e, à semelhança do que ocorre em outros países, tem sido alvo de intensa polêmica. Busca-se, assim, mapear a discussão teórica que embasa os argumentos favoráveis e contrários aos programas de transferência monetária condicionada, utilizando como estratégia metodológica a sistematização bibliográfica e estudo da legislação do PBF. A análise demonstra que, se de um lado, estão aqueles que rejeitam as contrapartidas sob alegação de que estas feririam o direito incondicional de cidadania, de outro, situam-se os que defendem as condicionalidades sob argumentos distintos. Aqui estão tanto concepções que entendem que é preciso dar algo em troca do recebimento do benefício quanto aquelas que vêem tais exigências como estratégia para favorecer o acesso aos serviços sociais e romper o ciclo da pobreza. Esta última visão está presente nos documentos oficiais do programa. Porém, na legislação complementar, a operacionalização das condicionalidades é definida de forma coercitiva, distanciando-se da concepção de inserção social.

This paper analyzes the concepts and challenges of the counterpart contributions demanded by Brazil's Family Allowance Program, which requires mandatory school attendance for children and adolescents, and healthcare for children, pregnant women and breast-feeding mothers. These issues are prompting much discussion in Brazil and elsewhere in the world. This study charts theoretical aspects that underpin arguments for and against conditional cash transfer programs, through a review and systematization of the literature and a study of the related legislation. This analysis demonstrates that the opponents of counterpart obligations claim they breach unconditional rights to citizenship. Some supporters of these conditional transfers believe that a return is required for these benefits, while others see such requirements as a strategy for ensuring easier access to social welfare services, thereby breaking away from the cycle of poverty. Although latter view is present in Brazil's original Family Allowance Program, the manner in which supplementary legislation defines the application of the conditions is coercive and remote from the concept of social insertion.

O Programa de Saúde da Família e a construção de um novo modelo para a atenção básica no Brasil / The Family Health Program and the construction of a new model for primary care in Brazil

As part of the implementation of the country's Unified Health System (Sistema Unico de Saúde), the Brazilian Government created, in the second half of the 1990s, the Family Health Program (FHP) (Programa de Saúde da Família), based on community-oriented, multidisciplinary care serving people organized into small groups. For this study, we evaluated the implementation of the FHP, based on three criteria: (1) the construction of the program as an entry point for most health needs and for access to specialized care, (2) the program's linkages with a comprehensive network of health services, and (3) the incorporation of new care practices into the health system. We found that the implementation of the FHP was far from uniform. In some municipalities the FHP is a focused program that runs in parallel with other primary care efforts. However, in other municipalities the FHP is viewed as a strategy aimed at changing the primary care model, and it partially or completely replaces preexisting primary care health units. Our research confirms a trend toward incremental change in the primary care model in Brazil. However, the expansion of the FHP in large urban areas faces several obstacles to guaranteeing all individuals access to comprehensive care with adequate clinical and collective health services, including secondary and tertiary care. The positive results that we found with some of the experiences with the FHP indicate that, in addition to increased federal financial incentives, the success of the FHP depends on creative local strategies to deal with Brazil's diversity.

O Programa de Saúde da Família e a construção de um novo modelo para a atenção básica no Brasil / The Family Health Program and the construction of a new model for primary care in Brazil

As part of the implementation of the country's Unified Health System (Sistema Unico de Saúde), the Brazilian Government created, in the second half of the 1990s, the Family Health Program (FHP) (Programa de Saúde da Família), based on community-oriented, multidisciplinary care serving people organized into small groups. For this study, we evaluated the implementation of the FHP, based on three criteria: (1) the construction of the program as an entry point for most health needs and for access to specialized care, (2) the program's linkages with a comprehensive network of health services, and (3) the incorporation of new care practices into the health system. We found that the implementation of the FHP was far from uniform. In some municipalities the FHP is a focused program that runs in parallel with other primary care efforts. However, in other municipalities the FHP is viewed as a strategy aimed at changing the primary care model, and it partially or completely replaces preexisting primary care health units. Our research confirms a trend toward incremental change in the primary care model in Brazil. However, the expansion of the FHP in large urban areas faces several obstacles to guaranteeing all individuals access to comprehensive care with adequate clinical and collective health services, including secondary and tertiary care. The positive results that we found with some of the experiences with the FHP indicate that, in addition to increased federal financial incentives, the success of the FHP depends on creative local strategies to deal with Brazil's diversity.(AU)

[Unconditional to conditional rights: counterparts in Brazil's Family Allowance Program]. / Do direito incondicional à condicionalidade do direito: as contrapartidas do Programa Bolsa Família.

This paper analyzes the concepts and challenges of the counterpart contributions demanded by Brazil's Family Allowance Program, which requires mandatory school attendance for children and adolescents, and healthcare for children, pregnant women and breast-feeding mothers. These issues are prompting much discussion in Brazil and elsewhere in the world. This study charts theoretical aspects that underpin arguments for and against conditional cash transfer programs, through a review and systematization of the literature and a study of the related legislation. This analysis demonstrates that the opponents of counterpart obligations claim they breach unconditional rights to citizenship. Some supporters of these conditional transfers believe that a return is required for these benefits, while others see such requirements as a strategy for ensuring easier access to social welfare services, thereby breaking away from the cycle of poverty. Although latter view is present in Brazil's original Family Allowance Program, the manner in which supplementary legislation defines the application of the conditions is coercive and remote from the concept of social insertion.

[Social inequalities, healthcare and well-being: opportunities and obstacles on the horizon of transversal public policies]. / Desigualdades sociais, saúde e bem-estar: oportunidades e problemas no horizonte de políticas públicas transversais.

The development of a distributive justice model that is responsive to new claims and demands in the social policy field requires in-depth examinations and critiques of the ways in which public policies are drawn up and implemented. Reconstituting and analyzing different institutional dynamics, decision contexts and program performances emerge as tasks that are crucial to the quest for alternatives ways of strengthening integration and empowerment experiences. The purpose of this article is to present these issues and help affirm commitments to transversal and convergent public actions combating poverty, social exclusion and unequal healthcare.

Local implementation of the Family Health Program in Brazil / A implementação do Programa Saúde da Família no cenário local

This article discusses the implementation of the Family Health Program in the municipalities of Camaragibe, Aracaju, São Gonçalo, and the Federal District of Brazil, aiming to identify possible interfaces between the program's shaping and different incentives structures, the local health system's case-resolving capacity, experiences with social participation, and accountability mechanisms. The article shows that aspects related to the constitution of local health systems in terms of the quantitative and qualitative supply of services, technical and management training within the Municipal Health Department, investment in other levels of care, and local political traditions are crucial variables for understanding the diversity of experiences in the implementation of the Family Health Program.

Este trabalho busca discutir a implementação do Programa Saúde da Família (PSF) nos municípios de Camaragibe, Aracaju, São Gonçalo e Distrito Federal, de forma a identificar as possíveis interfaces entre a conformação do programa e as diferentes estruturas de incentivo, resolubilidade do sistema local de saúde, experiências de participação social e mecanismos de accountability constituídos. O estudo demonstrou que aspectos relacionados à constituição do sistema local de saúde em termos da oferta quantitativa e qualitativa dos serviços, capacitação técnico-gerencial no âmbito das Secretarias Municipais de Saúde, investimento nos outros níveis de atenção e a tradição política local são variáveis cruciais para a compreensão da diversidade de experiências de implementação do PSF.

Local implementation of the Family Health Program in Brazil

This article discusses the implementation of the Family Health Program in the municipalities of Camaragibe, Aracaju, São Gonçalo, and the Federal District of Brazil, aiming to identify possible interfaces between the program's shaping and different incentives structures, the local health system's case-resolving capacity, experiences with social participation, and accountability mechanisms. The article shows that aspects related to the constitution of local health systems in terms of the quantitative and qualitative supply of services, technical and management training within the Municipal Health Department, investment in other levels of care, and local political traditions are crucial variables for understanding the diversity of experiences in the implementation of the Family Health Program.(AU)

Local implementation of the Family Health Program in Brazil.

This article discusses the implementation of the Family Health Program in the municipalities of Camaragibe, Aracaju, São Gonçalo, and the Federal District of Brazil, aiming to identify possible interfaces between the program's shaping and different incentives structures, the local health system's case-resolving capacity, experiences with social participation, and accountability mechanisms. The article shows that aspects related to the constitution of local health systems in terms of the quantitative and qualitative supply of services, technical and management training within the Municipal Health Department, investment in other levels of care, and local political traditions are crucial variables for understanding the diversity of experiences in the implementation of the Family Health Program.