CHILD HEALTH CARE IN BRAZIL: ASPECTS OF PROGRAM VULNERABILITY AND HUMAN RIGHTS

This study aimed to examine the epidemiological approach in Brazilian child health programs, towards the reflection on current guidelines from the perspective of program vulnerability and human rights. A descriptive study was carried out, based on the analysis of official documents elaborated by the Brazilian Ministry of Health. The expansion and reorganization of family health practices and integrated care for prevailing childhood diseases are aimed at promoting health and quality of life to children and families. Health professionals, imbued with observation and intervention, can be considered agents to respect, protect and implement human rights.


INTRODUCTION EPIDEMIOLOGICAL APPROACH IN PUBLIC POLICY GUIDELINES FOR CHILD HEALTH CARE IN BRAZIL
To examine the current public policy guidelines for child health care in Brazil, this study reviews some aspects and principles of the Brazilian health system, constructed over the past 25 years.
In the 1970's and 1980's, maternal-child health programs were characterized as vertical, because their goals and standards were decided on at the central level and by technical criteria, in line with the technocratic administration model adopted in Brazil at that time (7) .
In the 1980's, based on the analysis of the strategy, based on the principles of care universality, equity and integrality (9) . The FHP has revealed to be an appropriate field to implement the Integrated Management of Childhood Illness (IMCI) strategy. This strategy, adopted in Brazil in 1996, as proposed by the World Health Organization and the United Nation Children's Fund, aims to: reduce the mortality of children under 5 years old; reduce the incidence/ severity of infectious diseases, especially pneumonia, diarrhea, intestinal parasites, meningitis, tuberculosis, malaria, measles and nutritional disorders; ensure adequate health care quality for children under 5 years old, in health care services as well as at home and in the community; strengthen health promotion and preventive actions in childhood (10)(11) .
The epidemiological approach in this strategy is related to the country's child health profile, highlighting a proportion of deaths due to neonatal problems, which are considered difficult to intervene in, and, on the other hand, living with high morbidity rates due to the so-called underdevelopment diseases, such as pneumonia, diarrhea, malnutrition, and, especially in the North, malaria.

CHILD HEALTH PROGRAMS, PROGRAM VULNERABILITY AND HUMAN RIGHTS
Considering these child health programs, and focusing, specifically, on the current situation, this essay attempts to apprehend the aspects of program and social vulnerability, and to appoint human rights issues.
Vulnerability is a relatively recent notion and treated as a major contribution to the renovation of health practices in general, and health promotion and prevention in particular. It originates in Law, through Universal Human Rights, directed at groups or individuals who are weakened in terms of civil rights.
In the health area, it has been primarily studied in HIV/AIDS epidemic research, with discussions and answers to the need to advance beyond the approach of risk reduction strategies (14) .
In terms of program vulnerability, it should be highlighted that it is associated with the following  (15) .  transforming itself when needed (16) . The rationality of an intervention project should be expressed by clearly defined and objectively verifiable means and ends.
Hence, an evaluation protocol should be able to express and constantly give feedback to this rationality. Objectives, goals, strategies and some evaluation criteria like economic rationality, mainly efficacy in general, as well as other closed results were found when elaborating the programs evaluated in this study. However, the result assessment of program action was not feasible from the start, which made it impossible to give feedback to the program rationalities, offer better quality interventions and guaranteeing a solid evaluation process, that is, realistic, productive and operational (16) .
In terms of human rights, social rights are present in the political guidelines of child health care.
Social rights are fundamental civil rights, called positive or second-generation, and include the rights to education, work and health, presupposing concrete initiatives by the State to ensure them (17) .
In Brazil, the right to health gained strength in the last decades of the 20 th century. Initially, in the early 1960's, the 3 rd National Health Conference defined everybody's right to health, and the discussions proposed municipalization as a way to implement it (18) (18) .
Thus, child health programs are supported by policy guidelines that, to a certain extent, consider the right to health. Public health policies and programs can promote or violate human rights, posing difficult questions for researchers and health care professionals to reflect on (17) . In this sense, professional practice should be reconsidered, taking into consideration the importance of its transforming role, because it is expected that by transforming oneself and reality, after meeting people, health care spaces will be found. Nevertheless, countless difficulties remain in daily care, since many gaps persist and make it difficult to perform transformations, to execute a quality job, and to get to know and act on children's rights, specifically. It is in this context that the population learns how to use health services.