[Paideia Education in primary care: an analysis of institutional democracy and power relations in health sector work practices]. / Formación Paideia en atención primaria: análisis de la democracia institucional y las relaciones de poder en las prácticas laborales en salud.

This article looks at two pedagogical initiatives based on "Paideia Education" in order to analyze their contributions to the production of democratic relations and the co-production of care in primary health care. The first of these initiatives was a seminar on matrix support (2015-2016) that trained 94 specialists, and the second was a seminar on family care (2018-2020) that trained 149 professionals. The 243 participating health professionals came from five different municipalities in Brazil. The results obtained through questionnaires and field diaries kept during the seminars indicate that "Paideia Education" has the ability to motivate professionals to incorporate notions such as the expanded clinic and matrix support into primary health care, and fosters the sharing of care and the co-construction of autonomy with users. However, authoritarian management practices are still frequently directed towards professionals, practiced among professionals themselves, and directed towards patients, and therefore it is necessary to invest in a greater democratization of services beyond training.

Este artículo parte de dos iniciativas pedagógicas de "formación Paideia" con el propósito de analizar sus contribuciones en la producción de relaciones democráticas y en la coproducción del cuidado en atención primaria de la salud. La primera iniciativa realizó una capacitación en apoyo matricial (2015-2016) que reunió a 94 especialistas y, la segunda, una capacitación en salud familiar (2018-2020), que reunió a 149 profesionales. Los 243 profesionales de la salud participantes provenían de cinco municipios brasileños. Los resultados obtenidos a través de cuestionarios y diarios de campo elaborados durante los cursos señalan que la formación Paideia motiva a los profesionales a incorporar una clínica ampliada y el apoyo matricial en atención primaria de la salud, y propicia compartir el cuidado y la co-construcción de la autonomía junto a los usuarios. Sin embargo, aún son frecuentes las prácticas autoritarias de la gestión hacia las y los profesionales, entre profesionales, y desde las y los profesionales hacia las personas usuarias, de modo que es necesario invertir, más allá de la formación, en una mayor democratización de los servicios.

Formación Paideia en atención primaria: análisis de la democracia institucional y las relaciones de poder en las prácticas laborales en salud / Paideia Education in primary care: an analysis of institutional democracy and power relations in health sector work practices

RESUMEN Este artículo parte de dos iniciativas pedagógicas de "formación Paideia" con el propósito de analizar sus contribuciones en la producción de relaciones democráticas y en la coproducción del cuidado en atención primaria de la salud. La primera iniciativa realizó una capacitación en apoyo matricial (2015-2016) que reunió a 94 especialistas y, la segunda, una capacitación en salud familiar (2018-2020), que reunió a 149 profesionales. Los 243 profesionales de la salud participantes provenían de cinco municipios brasileños. Los resultados obtenidos a través de cuestionarios y diarios de campo elaborados durante los cursos señalan que la formación Paideia motiva a los profesionales a incorporar una clínica ampliada y el apoyo matricial en atención primaria de la salud, y propicia compartir el cuidado y la co-construcción de la autonomía junto a los usuarios. Sin embargo, aún son frecuentes las prácticas autoritarias de la gestión hacia las y los profesionales, entre profesionales, y desde las y los profesionales hacia las personas usuarias, de modo que es necesario invertir, más allá de la formación, en una mayor democratización de los servicios.

ABSTRACT This article looks at two pedagogical initiatives based on "Paideia Education" in order to analyze their contributions to the production of democratic relations and the co-production of care in primary health care. The first of these initiatives was a seminar on matrix support (2015-2016) that trained 94 specialists, and the second was a seminar on family care (2018-2020) that trained 149 professionals. The 243 participating health professionals came from five different municipalities in Brazil. The results obtained through questionnaires and field diaries kept during the seminars indicate that "Paideia Education" has the ability to motivate professionals to incorporate notions such as the expanded clinic and matrix support into primary health care, and fosters the sharing of care and the co-construction of autonomy with users. However, authoritarian management practices are still frequently directed towards professionals, practiced among professionals themselves, and directed towards patients, and therefore it is necessary to invest in a greater democratization of services beyond training.

Analysis of the experience of Cuban physicians in a Brazilian metropolis in accordance with the Paideia Method. / Análise da experiência de médicos cubanos numa metrópole brasileira segundo o Método Paideia.

We had hoped that the Mais Médicos Program (More Doctors Program) would have generated several changes and reflections in each municipality in which it was deployed. In order to observe those changes, we sought to analyze the experience of Cuban physicians in the Mais Médicos program from an actor-centered perspective, based on the Paideia Method - an approach that seeks to enhance the ability of the subjects to analyze and intervene in their practice. We performed semi-structured interviews to analyze our research object that consisted in the experience of those actors included professionally in the Mais Médicos program in a metropolis with unique characteristics. In order to assess the interviews, we applied Content Analysis followed by Thematic Analysis. From the discourse of the actors, of which illustrative excerpts are transcribed in this article, we can affirm that the program's potential surpassed any initial barriers, presenting itself as fine-tuning instrument for replacing the biomedical model in line with the Paideia Method.

Alienação do trabalho médico: tensões sobre o modelo biomédico e o gerencialismo na atenção primária / Alienation of the medical work: tensions about the biomedical model and the managerialism in primary health care / Alienación del trabajo médico: tensiones sobre el modelo biomédico y el directivismo en la atención primaria

Resumo Com base na observação de que a perda de autonomia ante o mercado de capital e o gerencialismo contribuiu para o surgimento da alienação no trabalho médico no Sistema Único de Saúde, procuramos analisar como se dá esse fenômeno na atenção primária à saúde. Em 2015 e 2016, entrevistamos e observamos o trabalho de 15 médicos do município de Campinas (São Paulo), refletindo a respeito de autonomia profissional, clínica e gestão sobre o trabalho médico. A análise se deu por meio da construção de narrativas por núcleos temáticos, segundo referencial teórico marxista e os principais estudos acerca da profissão médica no Brasil. A partir de semelhanças nos discursos, forma de atuação e grau de alienação, dividimos os médicos em quatro modalidades: militante, sacerdote, missionário e tecnoburocrata. Concluímos que algumas dinâmicas aprofundam a alienação: o afastamento do planejamento; a fragmentação do cuidado; a predominância do modelo biomédico. Por sua vez, algumas características da atenção primária se relacionam a menor grau de alienação: a prática ampliada no território e menos focada em ações programáticas; a constituição em equipes; o diálogo e o compartilhamento de saberes; a maior participação dos usuários no próprio cuidado e no serviço de saúde.

Abstract Based on the observation that the loss of autonomy in the capital market and managerialism have contributed to the emergence of alienation in the medical work of the Brazilian Unified Health System, we tried to analyze how this phenomenon occurs in primary health care. In 2015 and 2016, we interviewed and observed the work of 15 physicians in the municipality of Campinas (in the state of São Paulo, Brazil), reflecting upon the professional and clinical autonomy, and the management of the medical work. The analysis was made by constructig narratives by groups of topics, following a Marxist theoretical framework and the main studies regarding the medical profession in Brazil. Taking the similarities in the discourses, ways of working and degree of alienation, we divided the physicians into four groups: activist, priest, missionary and technobureaucrat. We concluded that some dynamics intensify the alienation: the estrangement from planning; the fragmentation of care; and the prevalence of the biomedical model. In turn, some features of primary health care are related to a lower degree of alienation: the practice expanded on the territory and less focused on programmatical actions; the constitution on teams; the dialogue and the sharing of knowledge; a greater participation of the individuals in the care itself and in the health service.

Resumen Con base en la observación que la pérdida de autonomía ante el mercado de capital y el directivismo contribuyó para el surgimiento de la alienación en el trabajo médico en el Sistema Único de Salud Brasileño, buscamos analizar cómo se da este fenómeno en la atención primaria de la salud. En el 2015 y 2016, entrevistamos y observamos el trabajo de 15 médicos del municipio de Campinas (São Paulo), reflexionando al respecto de la autonomía profesional, clínica y la gestión sobre el trabajo médico. El análisis se realizó a través de la construcción de relatos por núcleos temáticos, con base en la referencia teórica marxista y los principales estudios acerca de la profesión médica en Brasil. A partir de semejanzas en los discursos, forma de trabajo y grado de alienación, dividimos a los médicos en cuatro modalidades: militante, sacerdote, misionario y tecnoburócrata. Concluimos que algunas dinámicas profundizan la alienación: el alejamiento de la planificación; la fragmentación del cuidado; el predominio del modelo biomédico. Por su parte, algunas características de la atención primaria se relacionan un menor grado de alienación: la práctica ampliada en el territorio y menos enfocada en acciones programáticas; la conformación de equipos; el diálogo y el intercambio de conocimientos; la mayor participación de los usuarios en el propio cuidado y en el servicio de salud.sigualdad.

Análise da experiência de médicos cubanos numa metrópole brasileira segundo o Método Paideia / Analysis of the experience of Cuban physicians in a Brazilian metropolis in accordance with the Paideia Method

Resumo Esperávamos que o Programa Mais Médicos (PMM) tivesse provocado mudanças e reflexões diversas em cada município onde foi inserido. A fim de observar tais mudanças, buscamos analisar a experiência dos médicos cubanos de trabalho no PMM numa perspectiva centrada em atores, orientados pelo Método Paideia – metodologia que busca aumentar a capacidade dos sujeitos de analisar e intervir sobre a práxis. Lançamos mão de entrevistas semiestruturadas para perscrutar nosso objeto de pesquisa, que se constitui na experiência desses atores sociais inseridos profissionalmente no PMM numa metrópole com características singulares. Trabalhamos o material empírico instruídos pela Análise de Conteúdo e procedemos a Análise Temática. A partir do discurso dos sujeitos podemos dizer que as potencialidades do programa ultrapassaram barreiras iniciais, apresentando-se como uma ferramenta de tensão para a superação do modelo biomédico, em consonância com o método Paideia.

Abstract We had hoped that the Mais Médicos Program (More Doctors Program) would have generated several changes and reflections in each municipality in which it was deployed. In order to observe those changes, we sought to analyze the experience of Cuban physicians in the Mais Médicos program from an actor-centered perspective, based on the Paideia Method – an approach that seeks to enhance the ability of the subjects to analyze and intervene in their practice. We performed semi-structured interviews to analyze our research object that consisted in the experience of those actors included professionally in the Mais Médicos program in a metropolis with unique characteristics. In order to assess the interviews, we applied Content Analysis followed by Thematic Analysis. From the discourse of the actors, of which illustrative excerpts are transcribed in this article, we can affirm that the program's potential surpassed any initial barriers, presenting itself as fine-tuning instrument for replacing the biomedical model in line with the Paideia Method.