[Labor regularization of health workers paid with funds from the Mexican System for Social Protection in Health]. / Regularización laboral de trabajadores de la salud pagados con recursos del Seguro Popular en México.

OBJECTIVE: The process of regularization of workers paid by the Social Protection Health System of Mexico is described and analyzed. MATERIALS AND METHODS: Primary and secondary data collected by the external evaluation of the Mexican System for Social Protection in Health in 2009 were used. RESULTS: The regularization clearly improved the labor conditions of workers contracted by the system but a broader systemic implication of regularization does not seem to be necessarily positive. CONCLUSION: It is important to consider the need to guarantee that this type of changes in the contractual conditions of workers benefit all actors, particularly the insured population.

[Comment to DPR 177/011]. / Commento al DPR 177/2011.

The subject of this study is the analysis of DPR 177/2011 regarding occupational safety in confined environments suspected of pollution The study wishes to represent a platform for the knowledge of the relevant principles and issues that are the functional basis for occupational health professionals, to offer a scheme in which it is possible to implement local actions of occupational prevention in the confined spaces and to help Italian intervention plans Italian within the European area, such, e.g., the present "Healthy workplaces campaign working together for risk prevention" promoted by the European Agency for Safety and Health at Work. The interiorization of this behavioural scheme is needed for professionals and authorities in the occupational safety systems, both public and private, who have the institutional duty to obtain trheir effectiveness. To observe the safety system in the specific matter of confined spaces, their essential elements were considered. These elements were identified both in the DPR 177/2011 and in other pertinent documents. This study doesn't pretend to identify all relevant documents, but wishes to underline the open structure of the system for acquiring non strictly juridical documents, such as ICOH guidelines and International code of ethics for occupational health professionals and pertinent authorities. A specific matter of the study is the different role of rules and ethical principles in verifying the adequacy of the safety system. The role of guidelines and ethic principles in the internal evaluation of legal value was examined for their relevance in order to decide on adequacy of the employer's management in safety matter adequacy which can by evaluated looking at his effective knowledge of spaces and good selection of managers and professionals. Furthermore, the study establishes how central--in reaching the safety--is the method based on effectiveness in managing the prevention in occupational health. The managerial method, not based on formal interpretation but on the effective situation of the spaces and of the human resources, is a critical element in safety systems and represents an acceptable scheme for the conduct of the subjects in charge for the production cycle. They are those who effectively decide on the site, except for some situations, as it is for example the prevision of managerial liability for activity in outsourcing. It has been stressed in this study the dynamicity of safety system in confined spaces which can be derived by the employer's duty of vigilance for interference risks between his activity and the activity of other enterprises operating in outsourcing. This duty it is permanent in every space and moment of production cycle. This context of functional responsibility, and liability when it exists, based on reality as well as on the knowledge of the spaces and human resources, shows the central function of qualified MD and his functionality in both aspects. In the first, he is able to understand various risks existing for health. In the second, for the many strict contacts with workers, he can participate in developing their information and formation, which have educational importance for the safety system of the occupational health. To conclude about the occupational safety system, this study stresses that the activity of qualified MD is not a simple surveillance carried out by medical examinations as a routine, but it is a strategic issue for the realization of organizational wellness at work, which is functional to respect both the human rights and an efficient production cycle.

Rethinking care through social reproduction: articulating circuits of migration.

Care has come to dominate much feminist research on globalized migrations and the transfer of labor from the South to the North, while the older concept of reproduction had been pushed into the background but is now becoming the subject of debates on the commodification of care in the household and changes in welfare state policies. This article argues that we could achieve a better understanding of the different modalities and trajectories of care in the reproduction of individuals, families, and communities, both of migrant and nonmigrant populations by articulating the diverse circuits of migration, in particular that of labor and the family. In doing this, I go back to the earlier North American writing on racialized minorities and migrants and stratified social reproduction. I also explore insights from current Asian studies of gendered circuits of migration connecting labor and marriage migrations as well as the notion of global householding that highlights the gender politics of social reproduction operating within and beyond households in institutional and welfare architectures. In contrast to Asia, there has relatively been little exploration in European studies of the articulation of labor and family migrations through the lens of social reproduction. However, connecting the different types of migration enables us to achieve a more complex understanding of care trajectories and their contribution to social reproduction.

Occupational health and safety of merchant seafarers from Kiribati and Tuvalu.

Intensifying international competition in the shipping industry in response to global pressures makes seafarers' jobs increasingly difficult. Challenging conditions in ship employment are problematic, particularly in a development context where home communities' dependence on seafarers' income is high and social protection is low. Qualitative fieldwork revealed that seafarers from Kiribati and Tuvalu endure exceptionally lengthy work periods at sea to remain competitive. Absence from home while working in constrained and mobile spaces with multinational crews, frequent security controls and speedy turnarounds impacting on sleep deprivation and decreased shore time have implications for physical and emotional health and can become safety matters. Hence, there is a growing need to address mechanisms to protect seafarers from the physical and emotional effects of global demands in the shipping industry.

Análise do ciclo de política do Programa Mais Médicos no Brasil: cooperação Cuba Brasil e seus efeitos para o trabalho médico / More Doctors Program Policy cycle analysis Brazil-Cuba cooperation and the possible effects on medical workforce management in primary care

A formação e o provimento de profissionais de saúde são parte das estratégias que vêm sendo utilizadas pelos países para aumentar a capacidade de resposta dos seus sistemas de saúde e, assim, melhorar a qualidade de vida das suas populações. Recentemente, o governo brasileiro criou uma lei, instituindo um programa para melhorar a capacidade de resposta para escassez de médicos em áreas remotas, intitulado Programa Mais Médicos. Uma das ações polêmicas desse programa foi a importação de médicos cubanos, através de uma cooperação Cuba-Brasil, mediada pela Organização Pan-americana de Saúde (OPAS). Trata-se de uma iniciativa de grande vulto que envolveu, de 2011 a 2015, um total de 18 mil e 24 mil médicos novos no SUS. Nesse sentido, ganha relevância a análise do Programa Mais Médicos como política recém-implantada em contexto brasileiro, que constitui o objeto deste projeto de pesquisa. Este estudo de caso focaliza o provimento, fundamentalmente na cooperação Cuba-Brasil. Para analisar o programa, adota-se a abordagem do Ciclo de Políticas (Howlett e Ramesh, 2003) que organiza o estudo da política em cinco fases: (a) preparação da agenda, (b) formulação da política, (c) tomada de decisão, (d) implementação e (e) avaliação, adaptado pela análise de contexto de Bowe & Ball, 1992 que defende a análise de políticas a partir do seu campo de prática. Entrevistas com atores chaves, análise documental e estudo de caso foram desenvolvidos. Para o estudo de caso, focalizamos o PMM no Estado do Ceará e visitamos duas cidades no interior do Brasil neste mesmo estado. Os cenários de implementação do programa, as unidades com médicos cubanos e os espaços de supervisão foram os objetos de observação de campo da investigadora. O objetivo do estudo foi analisar os macro e micro efeitos da Cooperação Cuba- Brasil no trabalho médico brasileiro em APS, investigar seu potencial de inovação para o trabalho médico nas Américas e acompanhar todo o ciclo da política em questão, desde a sua entrada na agenda governamental até os mecanismos de avaliação, incluindo a identificação de desdobramentos para as políticas locais dos casos estudados. Ademais, construir novos saberes no campo da análise de políticas, inovações e provimento de profissionais de saúde no mundo. Na dimensão macropolítica, as entrevistas mostram a prática e a educação médica voltada para a atenção especializada, orientada pelo mercado, com um uso exagerado de tecnologias de alta densidade, comparados aos médicos cubanos. Os médicos cubanos trazem uma nova perspectiva para os profissionais de saúde na forma de construir vínculos com os usuários e na maneira de lidar com a pobreza e a iniquidade. Na dimensão micropolítica, ambos, brasileiros e cubanos, se beneficiam de estratégias de educação permanente, supervisão em loco, cursos EAD, rodas de conversa para discussão de problemas, grupos de troca de experiência e compartilhamento de estratégias no planejamento local. Um dos principais problemas apontados no programa é que a estratégia de provisão é temporária, não está bem afinada com a corporação médica brasileira e as supervisões não são bem organizadas pelas Universidades. Demonstra também a fragilidade na articulação entre gestão local e nacional na organização do processo

The education and provision of health professionals are the main strategies to increase capacity and respond to health systems needs among countries worldwide. Recently, the Brazilian government passed a law to create a national program, called the More Doctors Program, to improve the capacity to respond to the demand for doctors in underserved areas. The law was designed with three main axes: provision, education and infrastructure. The first, provision, would increase the provision of medical doctors through monetary and non-monetary incentives to attract national and foreign doctors to work in remote areas. The education axis was related to opening new Courses and Institutions to graduate new doctors in remote areas. The third axis was to improve primary care facilities. However, the most controversial aspect of this Program was the partnership between Cuba and Brazil, through an international cooperation mediated by the Pan-American Health Organization. It involved 18,240 new primary care physicians. Focusing on provision, mainly in the Brazil-Cuba international cooperation, a qualitative study was designed and conducted, analyzing the More Doctors policy cycle, using Howlet & Ramesh, 2003 as well as Ball, 1992 as a reference. This study examined the five stages of the policy cycle: agenda preparation, policy formulation, decision making, implementation and evaluation and context analysis and evaluation on the Ball cycle. Ball argues that policy has to be analyzed in the field. Interviews with stakeholders, document analysis and case studies were developed. As part of the case study, there were visits to three cities in the interior of Brazil; the researchers observed the locally managed education and program. The objective of the study was to investigate the macro and micro effects of Brazilian and Cuban physicians work processes in the Brazilian primary care units served by the program, as well as analyzing the policy as an innovation in health workforce management in the Americas and exploring the whole policy cycle and the implications for medical workforce management in Brazil. On the macro level, the interviews show that in Brazil medical education and practice are market oriented and focused on specialized care, with an overuse of high-technology resources, compared to Cuban doctors. All the Cuban physicians in Brazil were educated as General Practitioners. In addition, there could be an influence of the Cuban socialist model. The Cuban doctors bring a new perspective to Brazilian health professionals on how to build linkages with the users and how to deal with poverty and inequity. On the micro level, both groups benefited from ongoing learning strategies, supervisions in locus, distance learning courses, round tables on the main health problems, group practice sharing, and the interchange on health local planning. The main problems involve the temporary nature of the provision strategy, which is not well resolved with the Brazilian medical corporations and professional bodies. Furthermore, the supervisions are not always well organized by the Universities. The study also shows the fragilities of federative integration regarding policy implementation and management

Regularización laboral de trabajadores de la salud pagados con recursos del Seguro Popular en México / Labor regularization of health workers paid with funds from the Mexican System for Social Protection in Health

OBJETIVO: Describir y analizar el proceso de regularización del personal de salud pagado por el Sistema de Protección Social en Salud de México. MATERIAL Y MÉTODOS: Se utilizan datos primarios y secundarios provenientes de la evaluación del Sistema de Protección Social en Salud en 2009. RESULTADOS: La regularización mejora las condiciones laborales de los trabajadores pero sus implicaciones para el conjunto del sistema no son necesariamente positivas. CONCLUSIONES: Se requiere considerar la necesidad de que este tipo de inversiones beneficien a todos los actores interesados, principalmente la población asegurada por el sistema.

OBJECTIVE: The process of regularization of workers paid by the Social Protection Health System of Mexico is described and analyzed. MATERIALS AND METHODS: Primary and secondary data collected by the external evaluation of the Mexican System for Social Protection in Health in 2009 were used. RESULTS: The regularization clearly improved the labor conditions of workers contracted by the system but a broader systemic implication of regularization does not seem to be necessarily positive. CONCLUSION: It is important to consider the need to guarantee that this type of changes in the contractual conditions of workers benefit all actors, particularly the insured population.

Trends in approaches to night and shiftwork and new international standards.

While relatively few countries have changed their working time legislation in recent years, new working time patterns show some changes in approaches to night and shiftwork. Prominent trends include (i) the spread of irregular hours of work to different sectors, including services, often as a result of decoupling business hours from individual working hours; (ii) greater flexibility, often in return for shorter hours, in covering operating hours by different individuals; (iii) the appearance of complex combinations of different categories of working time arrangements, such as a combination of full-time semi-continuous shifts and part-time weekend shifts; and (iv) the adoption of a complex process for changes in schemes, incorporating group study and joint planning. Importantly, these trends reflect fundamental changes in the concept of night work (and that of nightworkers). The issues related to these recent trends were apparent in the two-year debate that led to new international labour standards, the Night Work Convention (No. 171) and Recommendation (No. 178), 1990, both of which apply to both sexes and to nearly all occupations. Also adopted was the Protocol of 1990 to the Night Work (Women) Convention (No. 89) of 1948, under which national laws or regulations may now permit night work of women in industry under strictly defined conditions. The new Convention and Recommendation define 'nightworker' to include workers performing a substantial amount of night work. They prescribe a variety of actions to improve the quality of working life of such workers, including measures related to working hours, rest periods, safety and health, transfer to day work, maternity protection, social services, and consultations. Strategies should be adopted that take into account the local situation, that are participatory, and that take due account of the diverse aspects of working life associated with the new concept of night work.

[Waiting for the EuGH verdict to be put into practice or "Introduction of the four-day week on full pay"]. / Warten auf die Umsetzung des EuGH-Urteils oder "Einführung der Viertagewoche bei vollem Lohnausgleich"

The submitted model of working time transposes and interprets german industrial law. The result of this interpretation is a high level of acceptance of the employees, a fast education that is high qualified with costs that are still affordable. The advantage of this model compared with the shift-model that runs after the EuGH-decision is obvious if you look at the reality of our health care system. This is why it is important to have an efficient interpretation of the existing law. Of course it will be a necessity also in the future to create new models of working time and to adapt these models in a way that it fits into the structure of a hospital. It would be the wrong way to force a juridical and political decision, how it was done by the german government that gave a deadline to put the EuGH decision into operation, without the possibility of an interpretation that fulfils the demand of the hospital.

Reformas al decreto 1441 del Congreso de la República, Código de Trabajo: decreto No. 007-2017 / Reforms to Decree 1441 of the Congress of the Republic, Labor Code: Decree No. 007-2017

Actualización del Código de trabajo -Decreto No. 1441- Reforma los artículos: 61 literal f); el 269; el 271; adiciona el 271 bis; reforma el 272; el 281; modifica la literal e) y adiciona la literal h) al artículo 292; reforma el artículo 415; crea el artículo 417 y el artículo 418. Contiene 13 Artículos.

A justiça do trabalho e o discurso normativo: a violação das garantias trabalhistas no Programa Mais Médicos para o Brasil (LEI 12.871/2013)

O Programa Mais Médicos para o Brasil (Lei 12.871/2013) foi implementado com o intuito de fortalecer o atendimento médico nas áreas do país onde a população é de baixa renda e não tem o direito à saúde garantido de forma plena. Assim, o poder público ofereceu bolsas acadêmicas aos médicos que se interessassem, com o intuito de atraí-los para suprir essa carência, porém com o pretexto de estar oferecendo curso de especialização aos profissionais.Portanto, o governo federal utilizou-se desse subterfúgio, não reconhecendo a evidente relação de trabalho instaurada entre poder público e médicos participantes. Isso pois, resta óbvio que os empregados do Programa preenchem todos os requisitos para a caracterização da relação de trabalho e, portanto, merecem ver garantidos seus direitos sociais trabalhistas previstos na Constituição. Assim, o objetivo do presente trabalho é demonstrar que tais pressupostos foram cumpridos e portanto, é competência da Justiça do Trabalho fazer valer tais direitos inerentes à qualquer relação laboral. Dessa forma, constatado que a Justiça Laboral é competente para processar e julgar qualquer relação de trabalho, em sentido amplo, devido ao fato da Emenda Constitucional n. 45 de 2004 ter ampliado sua competência, resta claro que sua jurisdição alcança os profissionais do Programa Mais Médicos. Portanto, uma vez caracterizada a relação de trabalho estabelecida entre a administração pública e os profissionais da Medicina e declarada a competência da Justiça Laborativa, cabe ao referido órgão exigir o cumprimento dos direitos sociais trabalhistas a eles devidos, visto que, a União, que deveria proteger os trabalhadores, nesse caso, não o fez.