School Health Program: challenges and possibilities for health promotion from the perspective of healthy eating

DallaCosta, Marcia; Rodrigues, Rosa Maria; Schütz, Gabriel; Conterno, Solange

doi:10.1590/0103-11042022E318I

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REVIEW • Saúde debate 46 (spe3) • Nov 2022 • https://doi.org/10.1590/0103-11042022E318I copy

School Health Program: challenges and possibilities for health promotion from the perspective of healthy eating

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ABSTRACT

The School Health Program (PSE) elects health promotion as a guideline for developing health actions at school. The aim is to identify and analyze the program’s strengths, opportunities, weaknesses, and threats to implement health-promoting actions that promote healthy eating habits. This review, of qualitative approach, comprises 29 articles of evaluation of the program published between 2015 and 2021. By the SWOT matrix, the analysis grouped the results into Strengths, Opportunities, Weaknesses, and Threats. Among the strengths, the proximity of the health and education sectors and the integration between the school, health unit, and family stood out; as opportunities, the possibility of intersectoral planning for health promotion was observed. The weaknesses refer to the intersectoral disarticulation, the lack of training, and the predominance of biomedical actions. The threats found demonstrate the centralization of power in health and the schoolchildren’s approach to the health service without a broader understanding of health promotion, providing opportunities for medicalization. It is concluded that it is possible to develop intersectoral educational actions to promote healthy eating in basic services involving schoolchildren and their families. This practice should be prioritized in public agendas in order to enable its daily practice in services.

KEYWORDS
School health promotion; Health promotion; Intersectoral collaboration; Food and nutritional health promotion

Referencias	Objective, study site and methodological approach	main features of interest
Carvalho KN, Zanin l, Flório FM, 2020¹⁸18 Carvalho KN, Zanin L, Flório FM. Percepção de escolares e enfermeiros quanto às práticas educativas do programa saúde na escola. Rev Bras Med Fam Comunidade. 2020 [acesso em 2021 dez 1]; 15(42):2325. Disponível em: https://rbmfc.org.br/rbmfc/article/view/2325. https://rbmfc.org.br/rbmfc/article/view/... .	Identify the nurses’ difficulties in the actions developed in the PSE and evaluate the students’ perception of the program. Paranaiba, Piauí. Qualiquantitative.	Nurses highlight that the excess of attributions in the UBS; the lack of involvement of schools; the lack of articulation between the Health and Education Departments; the lack of engagement of other professionals in the activities developed constitutes limitations to the success of the PSE.
Suassuna AP, et al., 2020¹⁹19 Suassuna AP, Oliveira SF, Diniz Papa T, et al. Percepções de alunos da rede pública de ensino de Natal/ RN sobre educação em saúde na escola. Rev Ciênc Plural. 2020 [acesso em 2021 dez 3]; 6(2):66-71. Disponível em: https://periodicos.ufrn.br/rcp/article/view/19841/12844. https://periodicos.ufrn.br/rcp/article/v... .	To identify the health education activities carried out in high schools in the city of Natal in the state of RN, as well as to verify the expectations of students regarding the role of health professionals and government officials. Quantitative	The action of the PSE in the public network of Natal-RN is flawed; health education in schools is incipient, especially actions aimed at health promotion; students do not recognize PSE actions in their respective schools.
Brambilla DK, Kleba ME, Magro MLP, 2020²⁰20 Brambilla DK, Kleba ME, Magro MLP. Cartografia da implantação e execução do Programa Saúde na Escola (PSE): implicações para o processo de desmedicalização. Educ Revista. 2020 [acesso em 2021 dez 1]; 36:1-14. Disponível em: https://www.scielo.br/j/edur/a/CGCSFCswjgpYXCV7FYswhDf/?format=pdf. https://www.scielo.br/j/edur/a/CGCSFCswj... .	To present a cartography of the implementation and execution of the School Health Program and its effects on the demedicalization process in a small municipality in southern Brazil. Qualitative.	The PSE, through intersectoral articulation (Education, Health and Social Assistance), carried out actions aimed at comprehensive health care that generated demedicalization. However, they consider that the simple approximation between the health and education sectors, which does not involve reflected practices and the co-responsibility of different professionals, can strengthen the medicalization of health, by expanding students’ access to health professionals.
Rodrigues RM, et al., 2020²¹21 Rodrigues RM, Silva GF, Conterno SFR, et al. Implantação dos componentes I, II e III do Programa Saúde na Escola. J Manag Prim Health Care. 2020 [acesso em 2020 ago 10]; 12:1-18. Disponível em: https://www.jmphc.com.br/jmphc/article/view/976. https://www.jmphc.com.br/jmphc/article/v... .	Identify how the actions of components I, II and III of the School Health Program are being developed. West of PR. Documentary.	Component I actions were expressively agreed, highlighting assistance actions. In component II, actions to promote food security and healthy eating were agreed. Component III activities were the least agreed upon and carried out, especially in smaller municipalities. The implementation of the PSE requires institutional organization for the development of the foreseen components.
Mello MAFC, et al., 2019²²22 Mello MAFC, Rodrigues RM, Conterno SFR, et al. Avaliações de Saúde de Escolares no Programa Saúde na Escola. Rev Interdisciplinar Estudos Saúde UNIARP. 2019 [acesso em 2020 set 12]; 2(18):261-277. Disponível em: https://periodicos.uniarp.edu.br/index.php/ries/article/view/1546/1083. https://periodicos.uniarp.edu.br/index.p... .	Identify the health actions carried out by the PSE and describe the problems identified. West of PR. Quantitative	Need to invest in the training of professionals, given that the data available for systematization and analysis suggest discrepancies in the methods for data collection, disqualifying actions and compromising the quality of analysis, weakening the proposition of policies and actions to face the identified conditions. The expansion of PSE is suggested.
Medeiros ER, et al., 2019²³23 Medeiros ER, Feijão AR, Pinto ESG, et al. Professional qualification in the School Health Program from the perspective of Complexity Theory. Escola Anna Nery. 2019 [acesso em 2021 dez 3]; 23(3):e20190035. Disponível em: https://www.scielo.br/j/ean/a/Wf89KbbB3PY5m7YfFNQqJpv/?format=pdf⟨=pt. https://www.scielo.br/j/ean/a/Wf89KbbB3P... .	Reflect on the process of training professionals in the School Health Program through the Complexity Theory. Qualitative.	Need to integrate health and education professionals in training, which require complex processes, however, interdisciplinarity and intersectionality can provide solutions to the complex needs of the educational context, by sharing knowledge among professionals.
Oliveira FPSL, et al., 2018²⁴24 Oliveira FPSL, Vargas AMD, Hartz Z, et al. Percepção de escolares do ensino fundamental sobre o Programa Saúde na Escola: um estudo de caso em Belo Horizonte, Brasil. Ciênc. Saúde Colet. 2018 [acesso em 2021 dez 3]; 23(9):2891-2898. Disponível em: https://www.scielo.br/j/csc/a/BDk6KBvzRGsrR89t9YJfB7m/?format=pdf⟨=pt. https://www.scielo.br/j/csc/a/BDk6KBvzRG... .	To investigate the perception that Brazilian schoolchildren have in relation to the activities developed by the School Health Program. Belo Horizonte, MG. Qualitative.	Students report activities related to health care and difficult access, however, health promotion and disease prevention activities were not mentioned. They recognize the actions as a benefit, for which they show their gratitude, without the necessary protagonism to produce their own health.
Vieira LS, Belisário SA, 2018²⁵25 Vieira LS, Belisario SA. Intersetorialidade na promoção da saúde escolar: um estudo do Programa Saúde na Escola. Saúde debate. 2018 [acesso em 2020 ago 13]; 42(4):120-133. Disponível em: https://www.scielo.br/pdf/sdeb/v42nspe4/0103-1104-sdeb-42-spe04-0120.pdf. https://www.scielo.br/pdf/sdeb/v42nspe4/... .	To analyze the School Health Program in the health district of one of the Brazilian capitals from the perspective of intersectionality in school health promotion actions. Qualitative.	The integration between health and education takes place with punctual and fragmented actions, but little by little articulated proposals that are committed to intersectionality and health promotion emerge, with the need for monitoring and evaluation of the program in the context of health promotion.
Moraes AC, et al., 2018²⁶26 Moraes AC, Reis ACE, Rodrigues RM, et al. Programa Saúde na Escola em instituições de educação básica estaduais e municipais. Mundo saúde. 2018 [acesso em 2020 set 15]; 42(3):782-806. Disponível em: https://revistamundodasaude.emnuvens.com.br/mundodasaude/article/view/120/97. https://revistamundodasaude.emnuvens.com... .	To compare the implementation of the Saúde na Escola Program in municipal and state elementary schools in five municipalities in the state of Paraná, Brazil. Qualitative.	In municipal schools, actions direct nutritional habits for a healthy life, improving the quality of life of students and their families. Intersectoriality was a contributing factor in caring for students’ demands and health promotion activities. This issue is not addressed in state schools, with distance and lack of understanding between the health and education sectors, harming the quality of the actions carried out. Both allege lack of teacher training.
Corrêa HW, Toassi RFC, Firmino LB, 2018²⁷27 Corrêa HW, Toassi RFC, Firmino LB. Programa Saúde na Escola: potencialidades e desafios na construção de redes de cuidado. Saúde em Redes. 2018 [acesso em 2019 nov 22]; 4(3):37-47. Disponível em: https://www.researchgate.net/publication/333950911_Programa_Saude_na_Escola_potencialidades_e_desafios_na_construcao_de_redes_de_cuidado. https://www.researchgate.net/publication... .	Understand, from a phenomenological perspective, the meaning of the actions of the School Health Program for Primary Health Care teams. Porto Alegre, RS. Qualitative.	The coordinators recognize the potential of the work on prevention and health promotion carried out by the PSE, with a challenge for working in networks, due to the great demand generated by the program. The school does not feel included in the actions, with distance from the families and little resolution of the clinical demands of the students.
Baggio MA, et al., 2018²⁸28 Baggio MA, Berres R, Gregolin BPS, et al. Introduction of the School Health Program in the city of Cascavel, Paraná State: report of nurses. Rev Bras Enferm. 2018 [acesso em 2020 set 20]; 71(supl4):1540-1547. Disponível em: https://www.scielo.br/pdf/reben/v71s4/0034-7167-reben-71-s4-1540.pdf. https://www.scielo.br/pdf/reben/v71s4/00... .	To understand the implementation of the School Health Program in the city of Cascavel, Paraná, based on the nurses’ report. Qualitative.	The program presents weaknesses in the training of professionals, in the structure of schools, human and material resources, and incipient intersectoral interaction. The PSE actions are based on health assessments of students.
Chiari APG, et al., 2018²⁹29 Chiari APG, Ferreira RC, Akerman M, et al. Rede intersetorial do Programa Saúde na Escola: sujeitos, percepções e práticas. Cad. Saúde Pública. 2018 [acesso em 2020 ago 15]; 34(5):e00104217. Disponível em: https://www.scielo.br/j/csp/a/d9GHPC4rRF9WJKQxyqmbZCG/?format=pdf⟨=pt. https://www.scielo.br/j/csp/a/d9GHPC4rRF... .	Evaluate the implementation and execution of the PSE in the Municipality of Belo Horizonte, Minas Gerais, the mechanisms that favor intersectoral action and the managers’ perception of intersectionality. Qualiquantitative.	Difficulty in building intersectoral work in the fields of management and development of PSE actions. Little sharing of responsibilities between sectors, little scope in the development of health promotion and its determinants. Centrality of power in the higher levels of management, needing to give priority to training and continuing education processes that include the current discussion on intersectionality, with the participation of students and the community to ensure the sustainability of actions.
Medeiros ER, et al., 2018³⁰30 Medeiros ER, Pinto ESG, Paiva ACS, et al. Facilidades e dificuldades na implantação do Programa Saúde na Escola em um município do nordeste do Brasil. Rev Cuid. 2018 [acesso em 2020 jul 10]; 9(2): 2127-2134. Disponível em: http://www.scielo.org.co/pdf/cuid/v9n2/2346-3414-cuid-9-2-2127.pdf. http://www.scielo.org.co/pdf/cuid/v9n2/2... .	To identify the facilities and difficulties in the implementation of the PSE in a municipality in the northeast of Brazil. Natal, RN. Quantitative	The most frequent facilities were intersectoral articulation (38.1%) and professional satisfaction (24.8%) in carrying out PSE activities. The difficulties were: scarcity of material and financial resources (50.5%), lack of intersectoral articulation (26.7%) and excess of activities in the work process (17.1%).
Sousa MC, Esperidião MA, Medina MG, 2017³¹31 Sousa MC, Esperidião MA, Medina MG. A intersetorialidade no Programa Saúde na Escola: avaliação do processo político-gerencial e das práticas de trabalho. Ciênc. Saúde Colet. 2017 [acesso em 2020 maio 22]; 22(6):1781-1790. Disponível em: https://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232017002601781&lng=pt&tlng=pt. https://www.scielo.br/scielo.php?script=... .	To analyze the intersectoral action developed between the health and education sectors in the process of implementing the Health at School Program in a municipality in the metropolitan region of Northeast Brazil. Qualitative.	In the implementation of the Program, health leadership was noted, with education playing a peripheral role. The activities have a biomedical approach, carried out through lectures. However, the program strengthened the relationship between the two sectors, but the intersectoral articulation in the political-management process and in practices showed weaknesses and limitations.
Brasil EGM, et al., 2017³²32 Brasil EGM, Silva RM, Silva MRF, et al. Promoção da saúde de adolescentes e Programa Saúde na Escola: complexidade na articulação saúde e educação. Rev esc enferm. 2017 [acesso em 2020 nov 13]; 51:1-9. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0080-62342017000100454&lng=pt&nrm=iso. http://www.scielo.br/scielo.php?script=s... .	To analyze the context of health promotion with adolescents in the health and education interface, focusing on PSE actions. Fortaleza, CE. Qualitative.	The organization of spontaneous demand causes disharmony in scheduled appointments and health actions at school. The professionals’ lack of knowledge about the PSE and the lack of planning of actions confirm the disarticulation of the education and health sectors, although they signal possibilities of this intersectoral practice.
Fontenele RM, et al., 2017³³33 Fontenele RM, Sousa AI, Rasche AS, et al. Construção e validação participativa do modelológico do Programa Saúde na Escola. Saúde debate. 2017 [acesso em 2021 dez 3]; 41(esp):167-179. Disponível em: https://www.scielo.br/j/sdeb/a/LkbZdCSgP5FTjcHFq3jRBSh/?format=pdf⟨=pt. https://www.scielo.br/j/sdeb/a/LkbZdCSgP... .	Build and validate the logical model of the School Health Program. Rio de Janeiro - RJ. Qualitative.	Intersectionality presents itself as a challenge to be overcome by the program, having as strategies and recommendations: local meetings, with periodicity, in their respective areas, and a unique information system for the program, which allows its use in a timely manner by the departments involved.
Barbieri AF, Noma AK, 2017³⁴34 Barbieri AF, Noma AK. A função social do Programa Saúde na Escola: formação para a nova sociabilidade do capital? Perspectiva. 2017 [acesso em 2021 dez 1]; 35(1):161-187. Disponível em: https://periodicos.ufsc.br/index.php/perspectiva/article/view/2175-795X.2017v35n1p161/pdf. https://periodicos.ufsc.br/index.php/per... .	To analyze the social function of the PSE based on a bibliographic and documentary study, based on the historical materialist method. Documentary research.	The PSE, as an educational assistance program, plays a mitigating role in the face of social manifestations, conservative, integrates neoliberal policies, however, it does not disqualify it as important initiatives in the scope of the democratic struggle for rights.
Farias ICV, et al. 2016³⁵35 Farias ICV, Sá RMPF, Figueiredo N, et al. Análise da Intersetorialidade no Programa Saúde na Escola. Rev bras educ med. 2016 [acesso em 2021 dez 3]; 40(2):261-267. Disponível em: https://doi.org/10.1590/1981-52712015v40n2e02642014. https://doi.org/10.1590/1981-52712015v40... .	To know and analyze the process of intersectionality in the PSE in a municipality in the metropolitan region of Pernambuco. Olinda, PE. Qualitative.	The operation of an intersectoral policy in an environment with actors that have previously assembled sectoral agendas and with no space for their execution, makes it difficult to reconcile the institutional times of the sectors, preventing the sustainability of actions. There is a shortage of training and continuing education, in addition to the lack of protocols that guide the development of intersectoral actions. However, the PSE allowed health professionals to perceive their social role as educators and enabled adolescents to have greater contact with the health team.
Machado WD, et al. 2016³⁶36 Machado WD, Oliveira KMCP, Cunha CG, et al. Programa Saúde na Escola: um olhar sobre a avaliação dos componentes. Sanare. 2016 [acesso em 2020 maio 20]; 15(1):62-68. Disponível em: https://sanare.emnuvens.com.br/sanare/article/view/929. https://sanare.emnuvens.com.br/sanare/ar... .	To evaluate the actions developed by the Family Health Strategy teams and their impact on improving the quality of life of adolescents in Sobral. Sobral, CE. quantiqualitative.	In the evaluation of the components, the study identified relevant values of component I, regarding the presence of students with health alterations. Component II, on the other hand, presented satisfactory numbers in health promotion and disease prevention actions, which proved the reach of these actions developed by the municipal teams with the adolescent public. The PSE is little recognized among educators.
Soares CJ, et al. 2016³⁷37 Soares CJ, Santos PHS, Nery AA, et al. Percepção de enfermeiras da estratégia de saúde da família sobre o programa saúde na escola. Rev enferm UFPE. 2016 [acesso em 2021 set 10]; 10(12):4487-4493. Disponível em: https://periodicos.ufpe.br/revistas/revistaenfermagem/article/viewFile/11514/13397. https://periodicos.ufpe.br/revistas/revi... .	To understand the perception of nurses from the Family Health Strategy on the PSE. Jequié, BA. Qualitative.	The PSE is understood as an intersectoral policy focused on the health of children in the public school system, showing the limited knowledge of professionals about the program. The work overload in the ESF, the problems related to municipal management and the lack of partnership with the parents, are presented as weaknesses. However, they recognize their capacity for integrality in health.
Tusset D, et al. 2015³⁸38 Tusset D, Nogueira JAD, Rocha DG, et al. Análise das competências em promoção da saúde a partir do marco legal e dos discursos dos profissionais que implementam o Programa Saúde na Escola no Distrito Federal. Tempus, actas de saúde colet. 2015 [acesso em 2021 nov 3]; 9(1):189-204. Disponível em: https://www.tempusactas.unb.br/index.php/tempus/article/view/1701. https://www.tempusactas.unb.br/index.php... .	To assess the presence of the Domains of Core Competencies in Health Promotion in the discourses on the practices carried out by actors who implement the PSE as well as in the regulations that guide this program in the Federal District (DF). Qualitative.	Limitations were identified to develop practices in a broader perspective of health promotion, with the need to broaden the understanding of these domains and the theme, with specific training for managers and health and education workers, with educational methodologies of a participatory and multidisciplinary character, through continuing education.
Carvalho FFB, 2015³⁹39 Carvalho FFB. A saúde vai à escola: a promoção da saúde em práticas pedagógicas. Physis: Rev Saúde Coletiva. 2015 [acesso em 2021 dez 1]; 25(4):1207-1227. Disponível em: https://www.scielo.br/j/physis/a/TTdz6ZMxbV7ft8L9KyxkPyr/?format=pdf⟨=pt. https://www.scielo.br/j/physis/a/TTdz6ZM... .	To analyze the entrance of health in the school space through PSE actions, classify them as pedagogical practices and, from there, verify if they align with the perspective of health promotion. Duque de Caxias and Nova Iguaçu, RJ. Qualitative.	In the municipalities, the school community does not participate in the planning of actions, and the participation of FHS professionals took place through feedback of information from the actions carried out. Intersectionality was characterized with social assistance, sport and leisure, among others. Health actions in schools change school dynamics and health professionals may not be prepared to interact with students outside of health services. The PSE supports critical reflection on administrative limitations in the execution and effectiveness of intersectoral policies.
Köptcke LS, Caixeta IA, Rocha FG, 2015⁴⁰40 Köptcke LS, Caixeta IA, Rochao FG. O olhar de cada um: elementos sobre a construção cotidiana do Programa Saúde na Escola no DF. Tempus Actas de Saúde Colet. 2015 [acesso em 2021 dez 3]; 9(3):213-232. Disponível em https://doi.org/10.18569/tempus.v9i3.1798. https://doi.org/10.18569/tempus.v9i3.179... .	Understand the intersectoral relationships from the perception of managers and professionals in the health and education sectors, in the implementation of the PSE, in two regions of the DF: Gama and Candangolândia. Qualitative.	The program enhances intersectoral articulation, presents communication challenges and in the distribution of power between sectors in all spheres. Intersectoral Working Groups are important in supporting intersectoral work. It was noticed that the PSE is not a priority for health and education, with a disconnection between formal adherence and activities carried out.
Magalhães R, 2015⁴¹41 Magalhães R. Constrangimentos e oportunidades para a implementação de iniciativas intersetoriais de promoção da saúde: um estudo de caso. Cad. Saúde Pública. 2015 [acesso em 2021 dez 3]; 31(7):1427-1436. Disponível em: https://www.scielosp.org/article/ssm/content/raw/?resource_ssm_path=/media/assets/csp/v31n7/0102-311X-csp-31-7-1427.pdf. https://www.scielosp.org/article/ssm/con... .	Understand the implementation of intersectoral actions foreseen in the Bolsa Família, Family Health and School Health programs, in Manguinhos, north area of the city of Rio de Janeiro, Brazil. Qualitative.	Importance of the PSE for the transformation of the organizational culture of the State. Managers and professionals at the ‘front’ recognize the importance of intra and intersectionality, pointing to the need to create an exclusive sector for the development of the Program’s actions and consider internal articulation positive, when it occurs. Despite intersectionality and territorialization being dimensions valued in the normative plan of the program, isolated, overlapping and discontinuous actions were frequent.
Souza NP, et al., 2015⁴²42 Souza NP, Lira PIC, Andrade LASS, et al. O Programa Saúde na Escola e as Ações de Alimentação e Nutrição: Uma Análise Exploratória. Rev APS. 2015 [acesso em 2020 out 22]; 18(3):360-367. Disponível em: https://periodicos.ufjf.br/index.php/aps/article/view/15555/8161. https://periodicos.ufjf.br/index.php/aps... .	Check the development of activities to promote adequate and healthy food in the school environment, from the perspective of the PSE. Pernambuco. Qualitative.	Nutrition education such as the PSE is little recognized. The professional related to excessive attributions, precarious working conditions [physical, material and human resources] and lack of planning and execution of PSE actions. The program is strategic in health promotion and prevention, it needs continuous actions, reinforced by the importance of the nutritionist in primary care for actions to promote healthy eating.
Tavares Leite C, et al. 2015⁴³43 Tavares Leite C, Machado MFAS, Vieira RP, et al. Programa de Saúde na Escola: percepções dos professores. Invest educ enferm. 2015 [acesso em 2020 nov 13]; 33(2):280-287. Disponível em: http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0120-53072015000200010&lng=en&nrm=iso. http://www.scielo.org.co/scielo.php?scri... .	Understand the perception that teachers have of a school health program and its relationship with health education actions developed at school. Barbalha, CE. Qualitative.	Teachers perceived the PSE as assistentialist, without integration between teachers and health professionals, for which adolescents show no interest. The educational actions in the school were perceived as clinical evaluations that were not integrated with the actions already developed in the school.
Cavalcanti PB, Lucena CMF, Lucena PLC, 2015⁴⁴44 Cavalcanti PB, Lucena CMF, Lucena PLC. Programa Saúde na Escola: interpelações sobre ações de educação e saúde no Brasil. Textos Contextos. 2015 [acesso em 2020 ago 15]; 14(2):387-402. Disponível em: https://revistaseletronicas.pucrs.br/ojs/index.php/fass/article/view/21728. https://revistaseletronicas.pucrs.br/ojs... .	Identify the inconsistencies of the PSE from its conception of health promotion, having as a counterpoint the understanding of the WHO on the subject. Documentary research.	Health promotion actions are curative and of assistance nature, being confused with prevention. However, health promotion does not seem to be adopted as the core of the PSE. There is a predominance of the conservative concept, which focuses on behavioral change without taking into account social determinants.
Machado MFAS, et al. 2915⁴⁵45 Machado MFAS, Gubert FA, Meyer APGFV, et al. The health school programme: a health promotion strategy in primary care in Brazil. J Hum Growth Dev. 2015 [acesso em 2020 nov 13]; 25(3):307-312. Disponível em: http://pepsic.bvsalud.org/pdf/rbcdh/v25n3/pt_09.pdf. http://pepsic.bvsalud.org/pdf/rbcdh/v25n... .	Identify and describe the actions developed by the Family Health Teams in the PSE, participants of the National Program for Improving Access and Quality of Primary Care. Quantitative	The training of professionals to work with education and health needs to be strengthened. The PSE has mobilized relevant actions, even if this has not happened homogeneously in all Brazilian regions.
Silva ARS, et al. 2015⁴⁶46 Silva ARS, Monteiro EMLM, Lima LS, et al. Políticas públicas na promoção à saúde do adolescente escolar: concepção de gestores. Enf Global. 2015 [acesso em 2021 dez 4]; 14(1):250-285. Disponível em: https://revistas.um.es/eglobal/article/view/eglobal.14.1.196021. https://revistas.um.es/eglobal/article/v... .	To know the public policies that promote adolescent health at school proposed and developed under the responsibility of education and health managers in the city of Recife, PE. Qualitative.	The PSE promotes comprehensive health care and enables reflection on administrative limitations for intersectoral practices. Professional training for the care of adolescents, and the practice of intersectoriality in the daily life of professionals in the health care network of the municipality, are necessary, however, responsibility for actions should not be centered on workers.

SWOT evaluation matrix applied to PSE		Internal elements
SWOT evaluation matrix applied to PSE		Strengths	Weakness
External elements	Opportunities	When the strengths of the program meet positive conjunctures of achievement, they express the potential at stake.	Positive conjunctures of achievement can reveal still weak points of the program, which can be read as a Challenge to overcome
	Threats	Adverse situations can compromise the performance, including the strengths of the program, constituting alerts to be considered	When adverse circumstances meet with program weaknesses, they express the conditioning and restrictions on the ability to respond.

Strengths

Weaknesses

Internal Facts to the PSE

1. Strengthens the relationship between health and education, among other sectors involved, for intersectionality and comprehensive care;

2. Health and education professionals recognize the potential for health promotion, including actions that promote healthy eating;

3. Integration between health, school and family;

4. Students recognize the importance of health at school;

5. Expansion of contact between health professionals and schoolchildren for a better perception of health problems.

1. Intersectoral disarticulation between the areas of health and education (secretaries, professionals);

2. Incompatibility of health and education agendas;

3. Lack of professional training for those involved in the ‘Program’, for health promotion in the PSE;

4. Health actions are assistance, curative/biomedical model, isolated, overlapping and discontinuous;

5. Lack of involvement of schools and educators;

6. Health professionals recognize the great demand for work generated by the PSE;

7. Lack of structure, human and material resources;

8. Centrality of power in the health sector;

9. Lack of knowledge and appreciation of the program by students;

10. Lack of family involvement;

11. School Health Program is not a priority of the areas;

12. Health Promotion is not at the core of the program and professionals do not have a proper understanding of the concept;

13. Poor monitoring, evaluation and information system.

Oportunities

Threats

External Facts to the PSE

1. Institutional strategic planning for intersectionality;

2. Development of intersectoral protocols;

3. Inclusion of health promotion actions in the public agenda;

4. Sharing of knowledge, experiences and actions between health, education and family;

5. Working in networks, in a dialogic way;

6. Proximity of services to students;

7. Potential intersectoral articulation.

1. Centralization of power in the health area;

2. Schoolchildren’s access to health services without a proper understanding of health promotion can reinforce the medicalization of health;

3. Deficient intersectionality and integrality of care reinforces the biomedical model;

4. Creation of an exclusive sector to develop PSE actions, due to problems in spontaneous demand;

5. Students seek health care and clinical actions to the detriment of health-promoting actions;

6. Students recognize health actions at school as a benefit and not as a right.

Centro Brasileiro de Estudos de Saúde Av. Brasil, 4036, sala 802, 21040-361 Rio de Janeiro - RJ Brasil, Tel. 55 21-3882-9140, Fax.55 21-2260-3782 - Rio de Janeiro - RJ - Brazil
E-mail: revista@saudeemdebate.org.br

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