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Objectives To assess home care programs implemented in three cities and to identify components indicating the integration of these programs into the reform of health care. Methods An exploratory descriptive study with a qualitative approach was carried out in the cities of Marília and Santos, state of São Paulo, and Londrina, state of Paraná, Brazil. Empirical data was obtained from interviews with five nurses and one social worker who worked in home care services, and through analysis of reports on these programs. The data was analyzed using the discourse analysis technique. Results The findings show the importance of home care services as a strategy for dehospitalization and humanization of care. Components were identified showing that home care focused on building up a health care model based on light technology, and multiprofessional and intersectorial work. It was found that, despite advances in the implementation of home care services, there are obstacles for an effective health care model change, such as ineffective referral and counter-referral mechanisms and complex relationship of health care providers with service users, their families and caregivers. Conclusions Care provided by home care programs is a strategy to decentralized care based on hospitals and to build up a new approach focused on health promotion and prevention, reducing risks and humanizing care. Strategies must be drawn up to allow its implementation in the public health network.
Objectives To assess home care programs implemented in three cities and to identify components indicating the integration of these programs into the reform of health care. Methods An exploratory descriptive study with a qualitative approach was carried out in the cities of Marília and Santos, state of São Paulo, and Londrina, state of Paraná, Brazil. Empirical data was obtained from interviews with five nurses and one social worker who worked in home care services, and through analysis of reports on these programs. The data was analyzed using the discourse analysis technique. Results The findings show the importance of home care services as a strategy for dehospitalization and humanization of care. Components were identified showing that home care focused on building up a health care model based on light technology, and multiprofessional and intersectorial work. It was found that, despite advances in the implementation of home care services, there are obstacles for an effective health care model change, such as ineffective referral and counter-referral mechanisms and complex relationship of health care providers with service users, their families and caregivers. Conclusions Care provided by home care programs is a strategy to decentralized care based on hospitals and to build up a new approach focused on health promotion and prevention, reducing risks and humanizing care. Strategies must be drawn up to allow its implementation in the public health network.
A democracia deve promover a satisfação de interesses diversos (o bem comum), o que é imprescindível à construção dos consensos, quando possível, entre os distintos atores. A partir de meados da década de 1970, o Brasil passa por importantes transformações político-democráticas, configurando-se em anos de mudanças nos paradigmas da saúde. Com a Constituição de 1988 e a criação do Sistema Único de Saúde (SUS), os gestores, trabalhadores e usuários do sistema se deparam com uma nova forma de pensar, estruturar, desenvolver e produzir serviços e assistência em saúde - modelo de produção social em saúde. Entretanto, para promover o desenvolvimento da real ruptura com o modelo sanitário anterior - flexneriano -, as relações trabalhistas devem superar a precarização do trabalho por meio de medidas como investimentos consistentes nas áreas da gestão de recursos humanos, com a criação de meios de discussão para uma gestão democrática. O presente artigo tem como proposta repensar as relações entre a democracia e a saúde, a partir da análise reflexiva das práticas de gestão do trabalho no Programa de Saúde da Família (PSF), no contexto das reformas políticas. Entende-se que a efetiva consolidação do PSF como reorganizador da Atenção Básica, possibilitará configurar novos arranjos institucionais, capazes de repercutir na cultura sociopolítica do País, e contribuirá para a construção de políticas mais eficazes, justas e solidárias propostas pelo SUS.
This literature review focused on the work process in health care, particularly issues linked to the Family Health Program. Since 1994, the Program has rapidly expanded health coverage for the Brazilian population, and as a result the Program's work force has also increased. The Program thus requires attention, allocation of responsibilities, and contributions of various types by stakeholders and institutions. The work occurs in the services sector, within a neoliberal scenario. Work in health care shares some characteristics with other occupations in the services sector, such as bureaucratization, the influence of capitalist division of labor, and difficulties in teamwork, in addition to little regard for the subjectivity of health system clients and workers. The study particularly focuses on work conditions of family health teams in Brazil, including strategies for revitalizing health care work and coping with alienating conditions in the work process. Finally, the study reiterates the dialectic condition of the work process in health care under the Family Health Program, with its possibilities for success, conceived and functioning in the midst of contradictions and difficulties.
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