Balista Salma Regina Rodrigues, Santiago Sílvia Maria, Corrêa Filho Heleno Rodrigues
Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Rua Tessália Vieira de Camargo 126, Campinas, SP, Brazil.
Cad Saude Publica. 2011 Apr;27(4):759-68. doi: 10.1590/s0102-311x2011000400015.
This study evaluates the decentralization of workers' health surveillance to district teams in Campinas, São Paulo State, Brazil, from 1990 to 2006. The history and context of this process were retrieved from documents at the Municipal Health Department in order to establish evaluation criteria and define facilitating factors and obstacles in guideline implementation, as well as to measure the gap between guidelines and reality. The evaluation used qualitative techniques with stakeholders' focus groups. The results showed that decentralization was defined according to the prevailing political options and according to the principles of the Unified National Health System (SUS). Facilitating factors included the increase in technical capability and integration among the teams, and obstacles included excessively centralized planning with limited participation, insufficient resources, and lack of clarity between the services concerning roles and responsibilities. The discussion of these results with health system administrators, social actors, and participating health professionals has contributed to the analysis and organization of transformative measures in regional public practices in workers' health surveillance.
本研究评估了1990年至2006年期间巴西圣保罗州坎皮纳斯市将工人健康监测工作下放至地区团队的情况。为了确立评估标准、明确指南实施过程中的促进因素和障碍,并衡量指南与实际情况之间的差距,我们从市卫生部门的文件中获取了这一过程的历史和背景信息。评估采用了与利益相关者焦点小组进行定性研究的方法。结果表明,权力下放是根据当时的政治选择以及统一国家卫生系统(SUS)的原则来界定的。促进因素包括技术能力的提升和团队之间的整合,而障碍则包括规划过度集中、参与有限、资源不足以及各服务部门在角色和职责方面缺乏明确界定。与卫生系统管理人员、社会行为者以及参与其中的卫生专业人员对这些结果进行的讨论,有助于分析和组织工人健康监测区域公共实践中的变革性措施。