Health promotion and intersectoriality at school: the monumental ambition of the School Health Program

‘PSE: 15 YEARS PROMOTING HEALTH AT SCHOOL’ is the result of the intersectoriality between health and education in the long commitment of those sectors in the implementation of the School Health Program (PSE) in Brazil. It is an initiative of the Department of Health Promotion of the Secretariat of Primary Health Care of the Ministry of Health (DEPROS/SAPS/MS), and supported by the United Nations Educational, Scientific, and Cultural Organization (UNESCO). Its proposal is to disseminate knowledge on the implementation, intersectoral management, and actions of the PSE in health promotion, prevention of diseases and injuries, as well as health care for students in the public Basic Education network.

This special issue is part of a series of activities by the MS and the Ministry of Education to commemorate the 15th anniversary of the PSE, one of the largest intersectoral programs in Primary Health Care (PHC) and Brazilian Basic Education, based on the National Policy of Primary Care (PNAB), the National Health Promotion Policy (PNPS), and the National Curricular Common Base (BNCC)¹.

Since the publication of Presidential Decree No. 6,286, of December 5, 2007², the trajectory of the PSE has been marked by a progressive implementation in Brazilian municipalities, pulverizing the articulation between those sectors in the national territory and a condescending implementation with the institutional and technical-conceptual contexts of intersectoral praxis, both in the daily routine of the health and education teams and in the management of the program in the respective federated entities³, ⁴.

Intersectoral actions have been used as strategies in the Unified Health System (SUS) to overcome the fragmentation generated by the administrative and disciplinary sectorization of social policies, a condition that provides an effective and comprehensive approach to social problems, supported by a systemic and interdependent thinking of the health issues.

The idea of social network finds in the relations of the sectors the understanding of the complexity of the system, both in the personal and organizational fields, by establishing cooperation agreements. This integration of services within the scope of the PSE makes it possible to promote health and prevent diseases and injuries in the school environment, as well as to incorporate health into the school curriculum through the BNCC by integrating knowledge and experiences, thus promoting and aiming at the cross-sectoriality of the program¹,⁴,⁵.

It is worth noting that intersectoriality is one of the guidelines and pillars of the PSE, and the discussion and recognition of such concept in the program are often mentioned in its regulations and implementation support materials¹,².

Despite that, its appropriation and applicability in the work process is a challenge for managers and health and education professionals, and the theoretical-practical distance is sometimes pointed out as a multifactorial problem capable of favoring the reproduction of sectorial and hierarchical practices, which limits the rupture of the hygienist and biomedical models in favor of the health promotion model at school prioritized by the PSE⁴, ⁶.

Such a scenario encourages the PSE to measure and improve the quality of intersectoral action, or to face the absence of it, in addition to evaluating and monitoring the mechanisms for implementing health promotion strategies at school, in order to insert some elements, such as: the organization of spaces of governance capable of inducing bureaucratic changes; sharing human, financial or administrative resources to address social and health inequalities and inequities; joint planning that considers school development and the reality of the territories; a plan to include the school community in the identification of needs with effective student participation; networking and ongoing and permanent training to adopt biopsychosocial strategies to promote healthy habits in the school environment; and the permanent monitoring and evaluation of actions with a view to sustainability⁷,⁸.

It is noteworthy that those elements are present, to a greater or lesser extent, in the implementation of the PSE, such as the historical constitution of the Intersectoral Work Groups (GTI), of the continuous orientation of shared, coordinated, and planned management of actions and resources, and of the monitoring and evaluation of practices¹. As the program spread and gained space in the PHC and Basic Education agenda, managers and health and education professionals noticed an implementation variable³, whose barriers and facilitators once again take up the challenge of intersectoriality for the effectiveness of actions⁹.

In 2021, the PSE, in partnership with the National Council for Scientific and Technological Development (CNPq), launched a Call for a project to evaluate the effectiveness of intersectoral management and actions of the program¹⁰, under development by the Oswaldo Cruz Foundation – Brasília, conceived as an opportunity to evaluate, at the federal level, the management and actions of the PSE, and to identify successful experiences of intersectoral praxis, being an evaluative research of magnitude not carried out so far and with the potential to determine the results of the implementation of the program in Brazil, in order to respond to administrative and academic concerns, since there is a lack of robust studies and validated instruments to determine the effectiveness of health promotion at school¹¹.

Despite the challenge of intersectoral action in the logic and operationalization of the PSE, it is considered that there is no stagnation of its implementation, as there is collective recognition of its importance for the development of Brazilian students. In the perception of managers, professionals and students, the PSE is relevant, but there is undoubtedly a path to be followed to break up fragmented practices and the incorporation of health promotion, which is gradually pointed out as a promising strategy in educational practices¹², ¹³, ¹⁴.

In that regard, DEPROS/SAPS/MS and the Ministry of Education, in partnership with the UNESCO, have invested in the publication of thematic notebooks and guides to orient health and education professionals in carrying out the thematic actions of the PSE¹⁵. In addition, through the Support Program for Institutional Development of the Unified Health System (PROADI-SUS), methodologies for health education have been developed in the PSE network, with materials for Elementary, Middle, High school, and Youth and Adult Education (EJA).

The instrumentalization and training of health and education professionals, in line with the BNCC, are being validated in 18 territories over the triennium 2021-2023, so that the federal management of the PSE has been encouraging the implementation of this policy on several fronts, supporting its role in inducing a paradigm shift.

Undoubtedly, the SUS is a project that is improved daily through the dedication of countless health professionals, managers, researchers, and other community representatives, and the BNCC, a social construct to pave the way for Brazilian Basic Education. The PSE, in turn, is also a 15-year project of constant transformation, matured by the gradual implementation and the lessons learned since its implementation, worthy of a complex work due to the audacious desire to make the intersectoriality in the context of two substantial social policies.

In celebration of the 15th anniversary of the PSE, DEPROS/SAPS/MS, with the support/ partnership of the UNESCO and the Brazilian Center for Health Studies (CEBES), chose to celebrate a feast of scientific knowledge of innovations in the field of intersectoriality between health and education through the publication of this special issue of the journal ‘Saúde em Debate’. For this special publication, 68 manuscripts were submitted and, after an extensive and dedicated editorial process, 18 unpublished articles were selected, comprising field research and literature reviews on the implementation, management, and thematic actions developed within the scope of the PSE.

We hope that this special issue ‘PSE: 15 years promoting health at school’ will provide relevant reflections and debates on PSE in Brazil throughout this young journey of 15 years of existence.

Enjoy your reading!

Referências

• ¹
  Brasil. Ministério da Saúde. Caderno do gestor do PSE. Brasília, DF: Ministério da Saúde; 2022.
• ²
  Brasil. Decreto nº 6.286, de 5 de dezembro de 2007. Institui o Programa Saúde na Escola - PSE, e dá outras providências. Diário Oficial da União. 5 Dez 2007.
• ³
  Wachs LS, Facchini LA, Thumé E, et al. Avaliação da implementação do Programa Saúde na Escola do Programa de Melhoria do Acesso e da Qualidade da Atenção Básica: 2012, 2014 e 2018. Cad. Saúde Pública. 2022 [acesso em 2022 out 17]; 38(6):1-14. Disponível em: https://www.scie-lo.br/j/csp/a/3dcVzH7x3cj6dhBvNMt85PJ/ abstract/?lang=pt
  » https://www.scie-lo.br/j/csp/a/3dcVzH7x3cj6dhBvNMt85PJ/ abstract/?lang=pt
• ⁴
  Silva CS. Saúde na escola: intersetorialidade e promoção da saúde. Rio de Janeiro: Fiocruz; 2019.
• ⁵
  Junqueira LAP. Intersetorialidade, transetorialidade e redes sociais na saúde. Rev. Adm. Pública. 2000 [acesso em 2022 out 18]; 34(6):35-45. Disponível em:https://bibliotecadigital.fgv.br/ojs/index.php/rap/ article/view/6346
  » https://bibliotecadigital.fgv.br/ojs/index.php/rap/ article/view/6346
• ⁶
  Sousa MC, Esperidião MA, Medina MG. A interse-torialidade no Programa Saúde na Escola: avaliação do processo político-gerencial e das práticas de trabalho. Ciênc. Saúde Colet. 2017 [acesso em 2022 out 19]; 22(6):1781-1790. Disponível em: https://www. scielo.br/j/csc/a/nGRj8mdvvwZHvy6G76MrjfJ/ abstract/?lang=pt
  » https://www. scielo.br/j/csc/a/nGRj8mdvvwZHvy6G76MrjfJ/ abstract/?lang=pt
• ⁷
  Silva JL, Domene FM, Shine L, et al. Quadros de referência (frameworks) sobre colaboração intersetorial em promoção da saúde. Brasília, DF: Fiocruz; 2022. Disponível em: https://docs.bvsalud.org/bi-blioref/2022/09/1392102/37_rr_depros_interseto-rialidade_estruturas.pdf
  » https://docs.bvsalud.org/bi-blioref/2022/09/1392102/37_rr_depros_interseto-rialidade_estruturas.pdf
• ⁸
  Prado NMBL, Aquino R, Hartz ZMA, et al. Revisitando definições e naturezas da intersetorialidade: um ensaio teórico. Ciênc. Saúde Colet. 2022 [acesso em 2022 out 20]; 27(2):593-602. Disponível em: https://www.scielo.br/j/csc/a/BcgPsrHzCP7SnTgqxc-TBSWw/
  » https://www.scielo.br/j/csc/a/BcgPsrHzCP7SnTgqxc-TBSWw/
• ⁹
  Melo RC. Barreiras e facilitadores na implementação de ações de promoção da saúde em municípios brasileiros. Brasília, DF: Fiocruz; São Paulo: Instituto de Saúde; 2021. [acesso em 2022 out 20]. Disponível em: https://docs.bvsalud.org/biblio-ref/2022/03/1361700/26_rr_depros_promocao_mu-nicipios_final.pdf
  » https://docs.bvsalud.org/biblio-ref/2022/03/1361700/26_rr_depros_promocao_mu-nicipios_final.pdf
• ¹⁰
  Brasil. Ministério da Ciência, Tecnologia e Inovações. Chamada CNPq/DEPROS/SAPS/MS Nº 20/2021 -Avaliação nacional da efetividade da gestão interse-torial e das ações do Programa Saúde na Escola. 2022. [acesso em 2022 out 20]. Disponível em: http://me-moria2.cnpq.br/web/guest/chamadas-publicas?p_p_id=resultadosportlet_WAR_resultadoscnpqportlet_ INSTANCE_0ZaM&filtro=resultados&detalha=cha madaDivulgada&idDivulgacao=10442
  » http://me-moria2.cnpq.br/web/guest/chamadas-publicas?p_p_id=resultadosportlet_WAR_resultadoscnpqportlet_ INSTANCE_0ZaM&filtro=resultados&detalha=cha madaDivulgada&idDivulgacao=10442
• ¹¹
  Lopes IE, Nogueira JAD, Rocha DG. Eixos de ação do Programa Saúde na Escola e Promoção da Saúde: revisão integrativa. Saúde debate. 2018 [acesso em 2022 out 20]; 42(118):773-789. Disponível em: https:// www.scielo.br/j/sdeb/a/SNsdFnbvBdfdhn76GQYG-DtM/abstract/?lang=pt
  » https:// www.scielo.br/j/sdeb/a/SNsdFnbvBdfdhn76GQYG-DtM/abstract/?lang=pt
• ¹²
  Schneider SA, Magalhães CR, Almeida AN. Percepções de educadores e profissionais de saúde sobre interdisciplinaridade no contexto do Programa Saúde na Escola. Interface (Botucatu). 2022 [acesso em 2022 out 20]; 26:1-17. Disponível em: https://www.scielo.br/j/icse/a/dr4YJSfvkxCthHWzNfNgGDL/?format=pdf⟨=pt
  » https://www.scielo.br/j/icse/a/dr4YJSfvkxCthHWzNfNgGDL/?format=pdf⟨=pt
• ¹³
  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 2022 out 20]; 34(5):1-15. Disponível em: https://www.scielo.br/j/csp/a/d9GHPC4rRF9WJKQxyqm-bZCG/abstract/?lang=pt
  » https://www.scielo.br/j/csp/a/d9GHPC4rRF9WJKQxyqm-bZCG/abstract/?lang=pt
• ¹⁴
  Oliveira FPSL, Vargas AMD, Hartz H, 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 2022 out 20]; 23(9):2891-2898. Disponível em: https://www.scielo.br/j/csc/a/BDk6KBvzRGsrR89t9YJfB7m/?lang=pt
  » https://www.scielo.br/j/csc/a/BDk6KBvzRGsrR89t9YJfB7m/?lang=pt
• ¹⁵
  Brasil. Ministério da Saúde. Caderno temático do Programa Saúde na Escola: promoção da atividade física. Brasília, DF: MS; 2022. [acesso em 2022 out 20]. Disponível em: http:// bvsms.saude.gov.br/bvs/publica-coes/caderno_tematico_pse_atividade_fisica.pdf
  » http:// bvsms.saude.gov.br/bvs/publica-coes/caderno_tematico_pse_atividade_fisica.pdf

Publication Dates

• Publication in this collection
  10 Feb 2023
• Date of issue
  Nov 2022