Comprensión de la gestión de la política pública de protección integral de la infancia en Chile / Understanding the Children Integral Protection Public Policy Management in Chile / Compreensão da gestão da política pública de proteção integral da meninice no Chile

Resumen La desigualdad social afecta desfavorablemente el desarrollo infantil, por esto fue relevante comprender las experiencias vividas por los profesionales en la gestión de procesos del Sistema de Protección Integral de la Infancia en una comuna de la Región Metropolitana, Chile. Método: investigación descriptiva, cualitativa. Fueron entrevistados doce profesionales con cargos y funciones en un centro de salud familiar público. Se utilizó la entrevista en profundidad y para la interpretación de los datos el método fenomenológico desde la perspectiva de Schütz. Hallazgos: se develó el rol relevante que se atribuyeron en la implementación del sistema y resaltaron la complejidad y las dificultades en la gestión sistémica que requiere la política. Emergieron vivencias sobre la resistencia al cambio, la fragmentación de la gestión, la hegemonía del paradigma biomédico y la importancia de la participación ciudadana. La información reportada justifica el desarrollo de competencias para instalar una nueva gestión sanitaria sistémica en la red intersectorial del territorio local.

Abstract Social inequality adversely affects children development, which is the reason why it was relevant to understand the experiences of the process management professionals of the Children Integral Protection System in a commune of the Metropolitan Region in Chile. Method: qualitative descriptive research. We interviewed twelve professionals with certain position and functions in a public family health center. We used an in-depth interview, and, for data interpreting, we used the phenomenological method from Schütz's perspective. Findings: we uncovered the relevant role they attributed to themselves in the implementation of the system and they highlighted the complexity and difficulties in the systemic management required by the policy. Experiences related to resistance to change were brought up, and also related to management fragmentation, the hegemony of the biomedical paradigm, and the importance of citizen participation. The information reported justifies the development of competencies to set in pace a new systemic health management in the cross-sectional network of the local territory.

Resumo A desigualdade social afeta desfavoravelmente o desenvolvimento infantil, por isso é que foi relevante compreender as experiências vividas pelos profissionais na gestão de processos do Sistema de Proteção Integral da Meninice em uma comuna da Região Metropolitana do Chile. Método: pesquisa descritiva, qualitativa. Foram entrevistados doze profissionais com posições e funções em um centro de saúde familiar público. Entrevista em profundidade foi utilizada e para a interpretação dos dados o método fenomenológico desde a perspectiva de Schütz. Achados: o papel relevante que se atribuíram na implementação do sistema foi desvendado e ressaltaram-se a complexidade e dificuldades na gestão sistémica que a política requer. Emergiram vivências sobre resistência às mudanças, fragmentação da gestão, hegemonia do paradigma biomédico e a importância da participação cidadã. A informação relatada justifica o desenvolvimento de competências para instalar uma nova gestão sanitária sistémica na rede intersetorial do território local.

La gestión clínica de la política pública de protección social en la atención primaria de salud / Clinic management of public social protection policy in primary health care

OBJETIVO: Conocer la efectividad de la gestión clínica de los profesionales de atención primaria de salud en el ámbito del Sistema de Protección Integral de la Infancia «Chile Crece Contigo» y la Red Protege. MÉTODO: Estudio observacional, descriptivo, con información disponible desde fuentes secundarias del Sistema Chile Crece Contigo, realizado en la comuna de Pudahuel, Santiago de Chile. La población fue de 1.656 mujeres embarazadas adscritas el año 2009 al Sistema Chile Crece Contigo. La vulnerabilidad social se midió con la ficha de protección social. Se seleccionaron variables sociodemográficas y de prestaciones del Sistema Chile Crece Contigo. Se contó con una base de datos bruta y depurada. El procesamiento y análisis de los datos se realizó por medio del programa estadístico Statistical Package Social Sciences y Excel. Se calcularon estadísticos descriptivos de frecuencia, posición y dispersión. Se contó con la certificación del Comité de Ética Científico de la Facultad de Enfermería. RESULTADOS: Se observó un 91,4% de vulnerabilidad social detectada por tamizaje institucional (ficha de protección social). El riesgo psicosocial fue mayor en mujeres con vulnerabilidad social (42,0 vs.28,2%) reconociéndose como más frecuente el insuficiente apoyo familiar, los síntomas depresivos, violencia de género, abuso de sustancias y conflictos con la maternidad. En las prestaciones universales, específicas e integradas no se cumplió con el 100% del acceso a las mismas. CONCLUSIONES: La invisibilidad de la vulnerabilidad social y la baja efectividad de la transferencia de beneficios a mujeres/niños-as socialmente vulnerables merece el desarrollo de competencias de gestión clínica contextualizada e integrada en los profesionales de atención primaria de salud

OBJECTIVE: Knowing the effectiveness of clinical management of primary care health in the field of Integral Protection System for Children "Chile Crece Contigo" and "Red Protege". Method: Observational, descriptive, with information available from secondary sources of Chile Crece Contigo system in the district of Pudahuel, Santiago de Chile. The population was 1,656 pregnant women assigned to Chile Crece Contigo system in 2009. Social vulnerability was measured with the Social Protection Record. Sociodemographic and Chile Crece Contigo system performance variables were selected. It featured a raw and refined database. Processing and analysis of data was performed using the statistical program Statistical Package for Social Sciences and Excel. Descriptive statistics for frequency, position and dispersion were calculated. Certification of Scientific Ethics Committee of the School of Nursing was granted. RESULTS: A 91.4% of institutional social vulnerability detected by screening social protection record was observed. Psychosocial risk was higher in women with social vulnerability (42.0 vs.28.2%) more often recognized as inadequate family support, depressive symptoms, domestic violence, substance abuse and conflicts with motherhood. In the universal, specific and integrated performance it was not met with 100% access to benefits. CONCLUSIONS: The invisibility of the social vulnerability and low effectiveness of the transfer of benefits to socially vulnerable women/children deserves skills development of contextualized and integrated clinical management professionals in primary health care

[Clinic management of public social protection policy in primary health care]. / La gestión clínica de la política pública de protección social en la atención primaria de salud.

OBJECTIVE: Knowing the effectiveness of clinical management of primary care health in the field of Integral Protection System for Children "Chile Crece Contigo" and "Red Protege". METHOD: Observational, descriptive, with information available from secondary sources of Chile Crece Contigo system in the district of Pudahuel, Santiago de Chile. The population was 1,656 pregnant women assigned to Chile Crece Contigo system in 2009. Social vulnerability was measured with the Social Protection Record. Sociodemographic and Chile Crece Contigo system performance variables were selected. It featured a raw and refined database. Processing and analysis of data was performed using the statistical program Statistical Package for Social Sciences and Excel. Descriptive statistics for frequency, position and dispersion were calculated. Certification of Scientific Ethics Committee of the School of Nursing was granted. RESULTS: A 91.4% of institutional social vulnerability detected by screening social protection record was observed. Psychosocial risk was higher in women with social vulnerability (42.0 vs. 28.2%) more often recognized as inadequate family support, depressive symptoms, domestic violence, substance abuse and conflicts with motherhood. In the universal, specific and integrated performance it was not met with 100% access to benefits. CONCLUSIONS: The invisibility of the social vulnerability and low effectiveness of the transfer of benefits to socially vulnerable women/children deserves skills development of contextualized and integrated clinical management professionals in primary health care.