Dimensões dos direitos fundamentais no Plano Nacional de Políticas para Mulheres / Dimensions of fundamental rights in the National Plan of Policies for Women

Objective: to analyze the proposals of actions of the three versions of the National Plan of Policies for Women (PNPM, in Portuguese) as contributions to the development of the human rights of women in Brazil, especially the right to health. Methodology: theoretical and documentary research on the historical advancement of women's rights as dimensions of rights, in aspects related to the attention of the State in public health promotion policies. The documentary revision was adopted as a technical procedure of indirect observation through official documents, using as sources of secondary data the texts of the three versions of the National Plan of Policies for Women, available in official sites of the Brazilian government. Results: PNPM brings the narrative of the search for innovations and advances in women's rights, but the proposed actions focus more on traditional practices for reproductive health. Conclusions: Despite some limitations, the strategies and actions of the plans can contribute to develop aspects of citizenship and rights that aim to increase social experience and equity, reduce vulnerabilities and improve the quality of life. (AU).

Objetivo: analisar os resultados da auditoria em saúde na área de órteses, próteses e materiais especiais (OPM) e cirurgias múltiplas e sequenciais (CMS), realizada pela Secretaria Estadual de Saúde do Rio Grande do Sul (SES/RS). Metodologia: estudo quantitativo descritivo, baseado em dados secundários da SES/RS, na área de OPM e CMS, referente ao período da prática de auditoria de pós-pagamento, de março de 2013 a janeiro de 2017, utilizando a abordagem estudo de caso. Resultados: foram analisadas 1.004 observações concluídas para o período; o número de processos administrativos com solicitação de devolução de recursos financeiros não teve uma tendência na série histórica analisada, resultado influenciado pela presença de processos administrativos não conclusos, em especial a partir de 2014, relativos à execução da auditoria ou até mesmo a judicialização do assunto pelas instituições auditadas. Quanto ao valor financeiro solicitado para devolução dos processos analisados, foi maior em 2014, decrescendo em 2015 e diminuiu consideravelmente nos anos 2016 e 2017. Considerando as 30 regiões de saúde do estado do Rio Grande do Sul, três instituições hospitalares tiveram destaque, a primeira com 43 processos administrativos com solicitação de devolução de recursos financeiros; a segunda com 30; e a terceira com 28. Conclusão: as ações em saúde, nessa área, podem ser qualificadas por meio de atenção especial para as regiões de saúde e instituições hospitalares que mais reincidem e tem grandes volumes financeiros glosados. (AU).

Objetivo: analizar las propuestas de acciones de las tres versiones del Plan Nacional de Políticas para las Mujeres (PNPM) como contribuciones al desarrollo de los derechos humanos de las mujeres en Brasil, especialmente el derecho a la salud. Metodología: investigación teórica y documental sobre el avance histórico de los derechos de las mujeres como dimensiones de los derechos, en aspectos relacionados con la atención del Estado en las políticas de promoción de la salud pública. La revisión documental se adoptó como un procedimiento técnico de observación indirecta a través de documentos oficiales, utilizando como fuentes de datos secundarios los textos de las tres versiones del Plan Nacional de Políticas para la Mujer, disponibles en los sitios oficiales del gobierno brasileño. Resultados: PNPM trae la descripción de la búsqueda de innovaciones y avances en los derechos de las mujeres, pero las acciones propuestas se centran más en las prácticas tradicionales de salud reproductiva. Conclusiones: A pesar de algunas limitaciones, las estrategias y acciones de los planes pueden contribuir a desarrollar aspectos de ciudadanía y derechos que tienen como objetivo aumentar la experiencia social y la equidad, reducir las vulnerabilidades y mejorar la calidad de vida. (AU).

Promoção da saúde e o desafio da intersetorialidade na Atenção Básica no Brasil / Health promotion and the challenge of intersectoriality in Primary Care in Brazil

Reflete sobre o desafio da intersetorialidade como uma estratégia de articulação transversal capaz de promover a saúde e fortalecer a Atenção Básica no Brasil. Compreendendo a promoção da saúde como um amplo processo reflexivo e crítico das intervenções em saúde tradicionalmente setorializadas, assistencialistas e pouco comprometidas com a natureza e diversidade dos contextos sociais e políticos locais, procura-se contribuir para a análise de práticas e iniciativas em curso e de processos de construção de novas agendas e estratégias no campo da Atenção Básica. (AU)

A promoção da saúde no ensino profissional: desafios na Saúde e a necessidade de alcançar outros setores / Health promotion in professional education: challenges in Health and the need to achieve in other sectors

Resumo O artigo discute a natureza dinâmica e complexa da promoção da saúde, o que requer formação profissional que facilite formular e colocar em prática seus princípios teóricos e metodológicos mediante contínua reflexão sobre as contradições dos contextos e a necessidade de enfrentamento dos desafios e expectativas das comunidades nos territórios. Considera também outro desafio que se coloca no trabalho em saúde, que é a mediação/ação intersetorial para implementação do seu conceito ampliado. Assim, demanda uma formação baseada em competências, o que significa um conjunto de atitudes e saberes para viabilizar a capacidade de agir em determinada situação. Apresenta duas experiências de ensino desenvolvidas no Brasil que tem contribuído na formação profissional em saúde, na perspectiva da promoção: a do Programa de Pós-graduação stricto sensu, em Promoção de Saúde da Universidade de Franca e a do Programa de Pós-graduação lato sensu da ENSP/Fiocruz. Em ambas, o uso de metodologias problematizadoras instrumentalizam a construção de capacidades, possibilitando que a teoria se aproxime da prática e proporcione uma formação crítica e reflexiva com rigor científico e relevância temática.

Abstract This article discusses the dynamic and complex nature of health promotion that requires training to facilitate, formulate, and put into practice its theoretical and methodological principles through continuous reflection on the contradictions of the contexts, and the need to face the challenges and expectations of communities in the region it serves. It also considers another challenge facing the health work, which is the mediation/intersectoral action for implementation of the expanded concept of health. Thus, a demand for competency based education, which means a set of attitudes and knowledge that enable the ability to act in a given situation. A discussion on two teaching experiences developed in Brazil that has contributed to the training of health from the perspective of health promotion: the Graduate Program in the strict sense, in Health Promotion at the University of Franca and the Graduate Program broad sense of the ENSP/Fiocruz will be discussed. In both cases, the use of problem-solving methodologies as a tool for capacity building, enabling theory to approach practice and provide critical and reflective training with scientific rigor and thematic relevance.

[Health practices in the reorientation of primary care in Rio de Janeiro State, Brazil, from the perspective of users and health professionals]. / Práticas em saúde no contexto de reorientação da atenção primária no Estado do Rio de Janeiro, Brasil, na visão das usuárias e dos profissionais de saúde.

This evaluative study focused on expansion of the Family Health Strategy in large cities in Rio de Janeiro State, Brazil. The study analyzed the functionality of health care modalities, performance, and supply of comprehensive care itself and its link to services at other levels. The thrust of the analysis was comprehensiveness of care in the daily routine of health services, with a focus on childbearing-age women, and with pregnancy as the tracer condition. The results emerged from an analysis of focus groups with health care users and health professionals, based on: characterization of key actors; their perceptions concerning health, healthcare model, and organization of primary care services and practices. The groups suggested that the actors perceive health as identified with social determinants. Access to services and actions was differentiated in the family health unit by enrollment of the clientele and active search, and the study showed the lack of a structured network. The study indicates that work processes contemplating the social determination of health and its intersectorality can lead to expanded access to comprehensive care for childbearing-age women.

Práticas em saúde no contexto de reorientação da atenção primária no Estado do Rio de Janeiro, Brasil, na visão das usuárias e dos profissionais de saúde / Health practices in the reorientation of primary care in Rio de Janeiro State, Brazil, from the perspective of users and health professionals

This evaluative study focused on expansion of the Family Health Strategy in large cities in Rio de Janeiro State, Brazil. The study analyzed the functionality of health care modalities, performance, and supply of comprehensive care itself and its link to services at other levels. The thrust of the analysis was comprehensiveness of care in the daily routine of health services, with a focus on childbearing-age women, and with pregnancy as the tracer condition. The results emerged from an analysis of focus groups with health care users and health professionals, based on: characterization of key actors; their perceptions concerning health, healthcare model, and organization of primary care services and practices. The groups suggested that the actors perceive health as identified with social determinants. Access to services and actions was differentiated in the family health unit by enrollment of the clientele and active search, and the study showed the lack of a structured network. The study indicates that work processes contemplating the social determination of health and its intersectorality can lead to expanded access to comprehensive care for childbearing-age women.

Estudo avaliativo sobre a expansão da Estratégia Saúde da Família em grandes centros urbanos no Estado do Rio de Janeiro, Brasil, analisando funcionamento das modalidades de atenção, desempenho e oferta de atenção integral em si e em sua articulação com serviços de outro nível. O eixo de análise foi a integralidade do cuidado no cotidiano dos serviços, com foco nas mulheres em idade reprodutiva, tendo a gestação como condição traçadora. Os resultados decorreram de análise permitida pela realização de grupos focais com usuárias e profissionais de saúde, tendo-se em conta: caracterização dos atores; suas percepções sobre saúde, modelo de atenção, forma de organização dos serviços e práticas da atenção primária à saúde. Esses grupos sugeriram que os atores envolvidos percebem a saúde identificada em seus determinantes sociais. O acesso ao serviço e às ações se diferenciou na unidade de saúde da família pela adscrição da clientela e busca ativa, observando-se inexistência de uma rede estruturada. O estudo indica que processos de trabalho que contemplem a determinação social da saúde e a intersetorialidade conduziriam à ampliação do acesso e do cuidado integral da saúde da mulher na fase reprodutiva.

Analyzing the outcomes of health promotion practices.

This article focuses on health promotion (HP) outcomes, illustrated through evaluation of case studies and identification of strategies which have contributed to their success and sustainability. Evaluation research and practice in three distinct sceneries are discussed: (i) institutional and governmental agencies; (ii) communities in the "Manguinhos Complex" and Nova Iguaqu Municipality, and (iii) building of potentially healthy municipality networks. The effectiveness of a social program in a health promotion perspective was based in the "School for Parents" program, undertaken by the First Court of Childhood and Youth of Rio de Janeiro, between 2001 and 2004. The analysis was grounded in the monitoring of 48 parents in charge of children under 18, who were victims of abuse, violence or negligence, and social exclusion, most of all. The study's objectives were: illustrating the evidence of effectiveness of health promotion, discussing the concept of HP effectiveness under macro unfavorable conditions, and identifying strategies that foster sustainability of results. Institutional resources included a multi-professional staff, multidisciplinary approaches, participatory workshops, family case management, partnership with public and private institutions, and volunteer and civil society sponsorship of the families. Evaluation was based on social impact indicators, and psychosocial and contextual determinants. Evaluation methods included program monitoring and quantitative-qualitative methods, through a longitudinal evaluation of 3 years, including one year post program. The evaluation showed highly favorable results concerning "family integration', "quality of family relations" and "human rights mobilization". Unsatisfactory results such as "lack of access to formal employment" are likely related to structural factors and the need for new public policies in areas such as education, professional training, housing, and access to formal employment. The training process of social actors in environmental management and housing, supported by the Public Health Technology Development Project of the Oswaldo Cruz Foundation, was employed as a tool of environmental education and healthy housing. The purpose of this study was to construct an integrated and participatory model of environment management. The methodology included training, research and evaluation of participants, from 21 to 50 years of age, who participated in building Thematic Learning Books and Community Guides about water quality monitoring. Participants'evaluations emphasized the training process, encouraging them to become multiplier agents of environmental education in their communities and to continue learning how to bring together sectors for problems solving. The Potentially Healthy Districts' Network (RMPS) aimed at increasing knowledge and building capacity to develop actions which originate from each of the local units, based on their characteristics and practices. Developed by the Preventive and Social Department of Campinas State University with PAHO/WHO and the Society Special Research Institute (IPES), RMPS's mission was to cooperate in the construction of healthy public policies in a participatory and articulated way through different municipal representatives. The network offered tools to municipal administrations to develop integrated projects that brought together government, managers, technicians, academy and organizations for the construction of public policies aimed at health promotion and quality of life. The methodology is based in the construction of knowledge and action networks by social actors, stimulating trans-sectorial and inter-district actions. The outcome evaluation is based on case studies, focus groups, oral stories, documents and image analyses.

Theory and practice in the context of health promotion program evaluation.

Evaluation of health promotion (HP) actions is a major challenge, generating inquiries and reflections that can contribute on the effectiveness of the actions themselves. With the aim on fostering exchange on monitoring and evaluation experiences related to the implementation of healthy settings, the 1 st Brazilian Seminar on Health Promotion Effectiveness was launched in 2005. The program included round table and workshops known as Working Groups (WG) in Brazil. The criteria used to constitute the workshops focused settings as spaces of circulation and living as an intrinsic connection to lifestyles and conditions, as well as to social and/or environmental risk factors associated with groups living in these settings day after day. Focusing on evaluation as an activity that generates knowledge, this article highlights and stimulates the discussion about some major issues arising from the theoretical-methodological approach and the discussions developed in the workshops. The debates carried out during the Seminar illustrated the different perceptions and views of the social players involved in implementation and evaluation of H P practices, disclosing a multiplicity of meanings. It became clear that procedures are needed to document a future maturation of concepts and methods, in combination with further in-depth theoretical discussion.

Analyzing the outcomes of health promotion practices

El artículo trata de los resultados de la promoción de la salud, ilustrándolo con la evaluación de casos prácticos y la identificación de las estrategias que han contribuido al éxito y a la sostenibilidad. Se aborda la evaluación tanto de la teoria como de la práctica en tres escenarios diferentes: (i) agencias institucionales y gubernamentales; (ii) comunidades del Complejo Manguinhos y del Municipio de Nova Iguaçu, y (iii) construcción de redes de municipios potencialmente saludables. La efectividad de un programa social desde la perspectiva de la promoción de la salud se basaba en el programa Escuelas para Padres, aprendido por el Primer Juzgado Especial para Niños y Jóvenes de Rio de Janeiro, entre 2001 y 2004. El análisis realizó en base al seguimiento de 48 padres que tenían a su cargo niños menores de 18 años, víctimas de abusos, violencia o negligencia, y casi todos ellos, tambén de exclusión social. Los objetivos del estudio eran: ilustrar con ejemplos la efectividad de la promoción de la salud, debatir el concepto de efectividad de la promoción de la salud en macrocondiciones desfavorables y definir estrategias que favorecerian la sostenibilidade de los resultados...(AU)

Theory and practice in the context of health promotion program evaluation

La evaluación de las acciones de promoción de la salud es un desafío de primer orden, que suscita interrogantes y reflexiones cuyo contenido puede contribuir a la efectividad de las propias acciones. Con el fin de promover el intercambio de experiencias de seguimiento y evaluación en relación con la implementación de entornos saludables, se organizó el Primer Seminario Brasileño sobre efectividad de la Promoción de la Salud em 2005. El programa incluía mesas redondas y talleres denominados grupos de trabajo en Brasil. Los criterios utilizados para organizar los talleres se concentraron en los entornos, entanto que espacios de tránsito y de vida intrinsicamente vinculados a los estilos y condiciones de vida, así como en los factores de riesgo sociales y medioambientales asociados a los grupos que viven en dichos entornos día tras dia. Este artículo trata sobre la evaluación en tanto que actividad que genera conocimientos, y subraya y estimula el debate en torno a algunas de las principales cuestiones que surgen del enfoque teórico-metodológico y de las discusiones que tuvieron lugar en los talleres. Todo lo que se habló en el transcurso del Seminario ilustró las diversas percepciones y puntos de vista de los actores sociales implicados en la aplicación y en la evaluación de las prácticas de la promoción de la salud, que desvelaron la multiplicidad de significados que encierran. Quedó claro que se precisan procedimientos para documentar la maduración de conceptos y métodos, sin olvidar la necesidad de profundizar en el debate teórico.(AU)