Alves Hayda, Escorel Sarah
Departamento Interdisciplinar, Instituto de Humanidades e Saúde, Universidade Federal Fluminense, Rio das Ostras, RJ, Brasil,
Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil.
Rev Panam Salud Publica. 2013 Dec;34(6):429-36.
To understand the impact of Bolsa Família (PBF), a federal cash transfer program, and to analyze its effects on social inclusion and exclusion processes experienced by low-income families in Brazil, with a focus on the program's potential to help overcome health inequity.
This qualitative investigation used a case study methodology including observant participation, review of documents, and semi-structured interviews with current and former PBF beneficiaries, as well as with the program's local managers. The study was conducted in a small city in the state of Rio de Janeiro with a high social exclusion index and 100% coverage by the Family Health Strategy (Estratégia Saúde da Família, ESF) program. The economic, political, social, and cultural dimensions of social exclusion and inclusion processes were used to guide data collection and analysis.
The program facilitated social inclusion of low-income families, especially in the economic and social dimensions. Nevertheless, it did not produce the changes desired by the beneficiaries in the work dimension. The effects on the political dimension were limited by the insufficient social engagement of the PBF. The interviewees underscored the positive effects of the ESF, which allowed them to exercise their right to health by granting them wider access to primary health care services. However, these effects appeared to be unrelated to the PBF.
The results reveal effects, limitations, and challenges of the PBF towards modifying the social determinants of health inequity, in order to promote more effective changes in the social exclusion/inclusion dynamics affecting low-income families.
了解联邦现金转移支付项目“家庭补助金计划”（Bolsa Família，PBF）的影响，并分析其对巴西低收入家庭所经历的社会包容和排斥过程的作用，重点关注该项目在帮助克服健康不平等方面的潜力。
这项定性研究采用了案例研究方法，包括参与观察、文件审查以及对PBF现任和前任受益人以及该项目的当地管理人员进行半结构化访谈。研究在里约热内卢州的一个小城市进行，该城市社会排斥指数较高，且家庭健康战略（Estratégia Saúde da Família，ESF）项目覆盖率达100%。社会排斥和包容过程的经济、政治、社会和文化层面被用于指导数据收集和分析。
该项目促进了低收入家庭的社会包容，尤其是在经济和社会层面。然而，它并未在工作层面产生受益人所期望的变化。对政治层面的影响因PBF的社会参与不足而受到限制。受访者强调了ESF的积极作用，该项目通过让他们更广泛地获得初级卫生保健服务，使他们能够行使健康权。然而，这些影响似乎与PBF无关。
研究结果揭示了PBF在改变健康不平等的社会决定因素方面的作用、局限性和挑战，以便在影响低收入家庭的社会排斥/包容动态方面促进更有效的变化。
