State and equity policies in health: participatory democracy?

Souto, Kátia Maria Barreto; Sena, Ana Gabriela Nascimento; Pereira, Vinicius Oliveira de Moura; Santos, Lia Maria dos

doi:10.1590/0103-11042016S05

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Essay • Saúde debate 40 (spe) • Dec 2016 • https://doi.org/10.1590/0103-11042016S05 copy

State and equity policies in health: participatory democracy?

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

State, equity policies and social participation: participatory management experience in the construction and implementation of public policies. Can health become a space for construction of citizenship that contributes to the reduction of social inequalities? Can the limits of the Brazilian state be prohibitive for the development of a participative management, in which social movements should be able to, in fact, speak about and participate without losing their autonomy? This essay brings elements to this reflection and cites possible advances in such issues, from the implementation of equity policies in health, pointing out, also, potentialities of articulation between the Unified Health System management spheres, as a space, also, of participatory management.

KEYWORDS:
State; Health; Equity; Public policies

	2012	2013	2014	2015
Health Technical Committees of the LGBT Population	GO, PE, PB, PR	MS, SP, RS	BA, RJ, PA	-
Health Technical Committees of the Black Population	AC, PB, RJ, RS	MG, DF	PE, RN	-
Health Technical Committees of the Population in Street Situation	-	Goiânia	GO, BA, Curitiba	PR
Health Technical Committees of the Populations of the Field, the Forest and the Waters	RJ (Working group)	-	RS	-
Expanded Committees for Equity Promotion Policies^ Expanded Equity Promotion Policies Committees are Committees that work with more than one of the following policies: National Policy for the Integral Health of the Black Population; National Policy for the Integral Health of the LGBT Population; National Policy for the Integral Health of the Populations of the Field, the Forest and the Waters; National Policy for the Population in Street Situation.	-	RN, PI, ES, MA, SE^* * The Expanded Committee of Sergipe includes Policies for the Promotion of Equity and Popular Education in Health.	MT	-

Objectives	Strategies/Actions	Advances
Recognition of institutional and social racism, broadly promoting the debate among managers, health professionals and society.	Launch of the Campaigns Racial Equality is for Real 2012, and the SUS without Racism - 2014 (posters, folders, tunnel in MH, social networks and media).	Inter-sectoral articulation, raising the visibility of the racism in institutions and in society, and adopting educational measures to combat racism in the SUS.
Recognition of racism as a social determinant of sickness and death of the black population and the need for training in the SUS.	Distance Learning Course about the Health of the Black Population (2014), through Provab (Program of Valorization of the Basic Attention Professional) in the Open University System of the SUS (UNA-SUS).	Training of managers and health professionals for better reception in the SUS network.
Qualification of care for people with sickle cell disease in the SUS.	Ordinance nº 1391, from august 16, 2005, which establishes in the SUS scope the guidelines for the National Policy for the Integral Attention to People with Sickle Cell Disease and other Hemoglobinopathies, and Ordinance nº 30, from june 30, 2015, which deals with the Incorporation of the Bone Marrow Transplantation for the treatment of the sickle cell disease.	Inclusion of the diagnosis of sickle cell disease in the Neonatal Screening Program (Guthrie's Test) in all the states and the examination of hemoglobin electrophoresis in primary care, in the Stork Network and in the donation of blood.
Production of knowledge and indicators about the health of the black population considering racism as a social determinant.	Launching of a research edit about the health of the black population in partnership with the National Council for Scientific and Technological Development (CNPq).	Inclusion in the research agenda of racism as a social determinant of sickness of the black population and its health specificities.

Objectives	Strategies/Actions	Advances
Visibility of the policy and implementation of the knowledge and practices of researchers, social leaders, managers/workers of the SUS.	Creation of the Observatory of the National Policy for the Integral Health of the Populations of the Field, the Forest and the Waters (Obteia), in partnership with the University of Brasilia.	Articulation of the SUS management and monitoring of actions and implementation strategies of the PNSIPCFA.
Recognition of social determinants, such as the ways of life and production of the field, forest and water, cause disease in the rural, forest and water populations.	Distance Learning Course about the National Policy for the Populations of the Field, Forest and Waters, by means of the Provab (Program of Valorization of the Professional of Primary Care) in the Open University System of the SUS (UNA-SUS).	Formation of managers and health professionals for better ability to identify signs and symptoms from recognizing how processes of production mode interfere in the health of the CFA populations (pesticides, venomous animals etc.)
Guarantee of access with quality and equity to the services and actions of health of the SUS for the field, forest and water populations.	Ordinance nº 1.591, of July 23, 2012. It establishes criteria for the qualification of Basic Fluvial Health Units (UBSF) for receiving the monthly cost incentive referred to in art. 4º of the Ordinance nº 2.490/GM/MS of october 21, 2011.	Enlargement of access to the SUS to riverine populations, extractivists, quilombolas, rural workers, dwellers etc.
	Ordinance nº 290, of February 02, 2013. It establishes the Construction Component of Basic Fluvial Health Units within the scope of the Requalification Program of Basic Health Units (UBS) to the states and municipalities of the Legal Amazon and the southern Pantanal of Mato Grosso.
	Ordinance nº 837, of May 09, 2014. It redefines the organizational arrangement of the Riverside Family Health Teams (ESFR) and Fluvial Family Health Teams (ESFF) of the Legal Amazon and the southern Pantanal of Mato Grosso.
	Ordinance nº 1.229, of June 06, 2014. It defines the values of the monthly costing financial incentive of the Riverside Family Health Teams (ESFR), the Fluvial Family Health Teams (ESFF) and the Basic Fluvial Health Units (UBSF).

Objectives	Strategies/Actions	Advances
Respect for gender identity in the SUS, using the social name.	Ordinance MS nº 1820/2009, which provides for the rights and duties of health users, among them the right to use the name.	Inclusion of the social name of transvestites and transsexuals in the Card of the Unified Health System (SUS Card) promoting access to the network with respect and without discrimination.
Visibility of homo/lesbo/transphobic violence recognizing that discrimination based on gender identity and sexual orientation produces violence and death, causing damages to the physical and mental health of the LGBT.	Change of the notification instrument to interpersonal and self-harm violence of the Notification of Injury Information System (Sinan) by the Department of Disease Surveillance and Non-Transmissible Diseases and Health Promotion/Health Surveillance Secretariat (SVS).	Enlargement of the notification object when incorporating homophobic/lesbo/transphobic motivations, as well as information about the gender identity and sexual orientation of the assisted person and the inclusion of a field for the social name of the victim of violence.
Enlargement of health care to transsexuals and transvestites in the SUS, considering actions of primary care to high complexity with respect and humanized reception.	Ordinance nº 457 of August 2008 and Ordinance nº 2.803 of November 19, 2013, that defines the Sex-assignment Process in the Unified Health System, establishing guidelines for assistance to the user with demand for the Sex-assignment Process, considering the integrality of the health care, with reception and care for transsexuals and transvestites in SUS.	Implantation and enlargement of referral services for transsexual and transvestite people in the SUS (outpatient services and referral hospital services in the states).
Recognition of discrimination and prejudice of sexual orientation and gender identity as a social determinant of illness and death of the LGBT population.	Distance Education Course (EaD) about the National Policy for the LGBT Integral Health for health professionals by means of the Program of Valorization of Primary Care Professionals (Provab) in the Open University System of the SUS (UNA-SUS).	Formation of managers and health professionals for better reception in the SUS network without prejudice and discrimination to the LGBT people.
Visibility of LGBT people in the SUS and in the society, with a view to recognizing the prejudices due to sexual orientation and gender identity, building respect and rights to an integral and humanized health with equity.	Campaigns like To Take Good Care of One's Health. It Does Good for Lesbian and Bisexual Women. It Does Good for Brazil (2015); To Take Good Care of Each One’s Health. It Does Good for Everyone. It Does Good for Brazil, for transsexuals and transvestites (January/2016); and for gay and bisexual men (April, 2016).	Awareness of society and health managers and professionals of the SUS for the best reception in the SUS network, without prejudice and without discrimination.

Objectives	Strategies/Actions	Advances
Expansion of primary care to attend the people in street situation.	Offices in the Street by means of specific teams for the PSS.	Humanized and qualified care in the SUS to the PSS, and articulation with other policies, in particular, social assistance.
Formation and capacitation of mental health services teams.	Workshops for SUS primary care teams and social assistance in the nine municipalities with the highest number of PSS.	Qualification of primary health care professionals to host with respect and without discrimination in the SUS.
Visibility of the people in the street situation, rescuing them as citizens of rights.	Social media campaigns, posters and booklet about the health of the PSS focus on professionals/health managers, and the population to host with respect and without discrimination the PSS.	Assistance with humanization in the SUS network, especially in the basic attention and visibility of the PSS with human respect in society.

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

Acompanhe os números deste periódico no seu leitor de RSS

[1] Conflict of interests: non-existent