Garrido-Pinzón Johanna, Bernardo Marcia Hespanhol
Pontifícia Universidade Católica de Campinas, Campinas, Brasil.
Cad Saude Publica. 2017 Sep 28;33(9):e00050716. doi: 10.1590/0102-311X00050716.
: The aim of this study was to analyze the experiences of primary healthcare workers in the public health systems in Colombia and Brazil in relation to the neoliberal logic. These two cases are relevant to public health research, as examples of health systems that emerged from opposing guidelines: the Colombian system was created at the government level with a marked private-sector influence, while the Brazilian system was an important conquest by social movements. Based on the Social Psychology of Work, this was a qualitative and empirical study. In-depth reflexive interviews were conducted with two groups of primary healthcare and administrative workers: one in Bucaramanga, Colombia, and the other in Campinas (São Paulo State), Brazil. Content analysis was used in the analytical process. According to the study, in both countries the main experiences of healthcare workers involve the changes in working conditions, relations, and organization. In the Colombian context, we identified the central problems in the transition induced by the reform that established the country's current health system. These problems are expressed in the deterioration of relations with health system users, as well as in the configuration of healthcare teams, marked by conflicting employment arrangements in the healthcare staff. The latter condition also appears in the Brazilian context, as a result of outsourcing, which appears to have become an effective mechanism for undermining the Brazilian Unified National Health System (SUS), facilitating its dismantlement and pointing it in the same direction as the Colombian system.
本研究旨在分析哥伦比亚和巴西公共卫生系统中基层医疗工作者在新自由主义逻辑方面的经历。这两个案例与公共卫生研究相关，它们是源自相反指导方针的卫生系统的例子：哥伦比亚的卫生系统是在政府层面创建的，有明显的私营部门影响，而巴西的卫生系统是社会运动的一项重要成果。基于工作社会心理学，这是一项定性实证研究。对两组基层医疗和行政工作者进行了深入的反思性访谈：一组在哥伦比亚的布卡拉曼加，另一组在巴西圣保罗州的坎皮纳斯。分析过程采用了内容分析法。根据该研究，在这两个国家，医疗工作者的主要经历都涉及工作条件、关系和组织方面的变化。在哥伦比亚的背景下，我们确定了建立该国当前卫生系统的改革所引发的转型中的核心问题。这些问题表现为与卫生系统使用者关系的恶化，以及医疗团队的构成，其特点是医护人员的雇佣安排相互冲突。由于外包，后一种情况在巴西的背景下也出现了，外包似乎已成为破坏巴西统一国家卫生系统（SUS）的有效机制，促使其解体并使其朝着与哥伦比亚系统相同的方向发展。
