Mota Daniela Belchior, Ronzani Telmo Mota
Center for Research, Intervention and Evaluation for Alcohol & Drugs, Department of Psychology, Federal University of Juiz de Fora, Minas Gerais, Brazil.
Health Soc Care Community. 2016 Jul;24(4):507-18. doi: 10.1111/hsc.12240. Epub 2015 May 14.
One of the challenges with respect to public health and the abuse of alcohol and other drugs is to implement policies in support of greater co-ordination among various levels of government. In Brazil, policies are formulated by the Secretaria Nacional de Políticas sobre Drogas (SENAD - State Department for Policies on Drugs) and the Ministério da Saúde (MS - Ministry of Health). This study aims to compare implementation of policies adopted by SENAD and MS at the municipal level. Three municipalities were intentionally selected: Juiz de Fora having a larger network of treatment services for alcohol and drug users; Lima Duarte, a small municipality, which promotes the political participation of local actors (COMAD - Municipal Council on Alcohol and Drugs); and São João Nepomuceno, also a small municipality, chosen because it has neither public services specialised to assist alcohol and other drugs users, nor COMAD. Data collection was conducted through interviews with key informants (n = 19) and a review of key documents concerned with municipal policies. Data analysis was performed using content analysis. In Juiz de Fora, there are obstacles regarding the integration of the service network for alcohol and other drug users and also the articulation of local actors, who are predominant in the mental health sector. In Lima Duarte, while there is a link between local actors through COMAD, their actions within the local service network have not been effective. In São João Nepomuceno, there were no public actions in the area of alcohol and drugs, and consequently insufficient local debate. However, some voluntary, non-governmental work has been undertaken. There were weaknesses in the implementation of national-level policies by SENAD and the MS, due to the limited supply of available treatment, assistance and the lack of integration among local actors.
在公共卫生以及酒精和其他药物滥用方面面临的挑战之一，是实施有助于加强各级政府间协调的政策。在巴西，政策由国家毒品政策秘书处（SENAD——国家毒品政策部）和卫生部（MS）制定。本研究旨在比较SENAD和MS在市级层面所采纳政策的实施情况。特意选取了三个市：茹伊斯迪福拉有针对酒精和药物使用者的更大规模治疗服务网络；利马杜阿尔特是一个小市，它促进当地行为体（市酒精和毒品委员会——COMAD）的政治参与；圣若昂内波穆塞诺也是一个小市，之所以选择它是因为该市既没有专门协助酒精和其他药物使用者的公共服务，也没有市酒精和毒品委员会。通过与关键信息提供者进行访谈（n = 19）以及查阅与市级政策相关的关键文件来收集数据。使用内容分析法进行数据分析。在茹伊斯迪福拉，在酒精和其他药物使用者服务网络整合以及在心理健康领域占主导地位的当地行为体的衔接方面存在障碍。在利马杜阿尔特，虽然通过市酒精和毒品委员会当地行为体之间存在联系，但他们在当地服务网络内的行动并不有效。在圣若昂内波穆塞诺，在酒精和毒品领域没有公共行动，因此当地的辩论也不够充分。不过，开展了一些志愿性的非政府工作。由于可用治疗和援助的供应有限以及当地行为体之间缺乏整合，SENAD和卫生部在国家层面政策的实施方面存在不足。
