Changing practices of dentists from its insertion on the staff of Family Health: between accommodations and ruptures. / Mudanças das práticas do cirurgião-dentista a partir de sua inserção na equipe de Saúde da Família: entre acomodações e rupturas.
AUTOR(ES)
Augusto Cesar Costa Cardoso
FONTE
IBICT - Instituto Brasileiro de Informação em Ciência e Tecnologia
DATA DE PUBLICAÇÃO
01/06/2011
RESUMO
The insertion of oral health in the National Health Service (SUS) has been highlighted by conflicts and contradictions from the start. The present thesis, presented in the format of three articles, is the result of an investigation performed in the municipality of Salvador-Bahia concerning health practices of dentists working at Family Health Strategy (ESF), focused on the challenges of the work in multi-professional teams. The data collection was carried out during 2009 and 2010. The first article, of a quantitative nature, had the purpose of describing and analyzing the profiles and perceptions of dentists with reference to working in multi-professional teams, the conduction of the work and the assistance offered in oral health by means of documental analysis, direct observation of the work and application of a semi-structured questionnaire to eighty professionals located in forty-five Family-Health Units (USF). The second one, of a qualitative nature, corresponded to an analysis of the narratives about this work in multi-professional teams (management, assistance and health promotion) obtained through sub-samples from eight dentists, through in - depth interviews, focal groups and direct observation of the work, considering symbolic and structural dimensions. The third article, also of a qualitative nature, aimed towards the focus on conceptions of autonomy, power and hierarchy which permeate the dynamics of this team work. The findings demonstrate that the welfare model taken on by ESF hardly influenced any changes in the oral health practices: priority continues to be emergency treatment and there is, also, emphasis on occupation of the agenda with curative welfare actions in detriment to actions towards individual and collective protection. It is also possible to identify hindrances in management, especially regarding limitations of planning and evaluation meetings of the teams under analysis, either for lack of frequency, or apparent deficiency in the recognition of these procedures as being for the construction and responsibility of the teams, or even for not valuing collective participation in these processes. Apart from the inefficiency and privation of human resources, insufficient financial and physical resources were also mentioned by most of those interviewed. Management by the Municipal Health Department (SMS) and Oral Health Coordination of the Municipality was one of the main difficulties regarding the development of oral health care in accordance with the interviewed parties. Other factors also pointed out were: precariousness in the modalities for contracting, irregularities in remuneration of professionals, lack of permanent education as well as infrastructure and maintenance problems. This research brings some elements for understanding the work of the dentists in the public service. It aims to contribute towards a reflection about the challenges and diversions in relation to the consolidation of oral health and possible articulation of promotion, protection, curative and rehabilitating actions in the daily practices.
ASSUNTO(S)
oral health equipe de saúde da família saúde bucal family health professional practice health management health policies saude publica health service evaluation planning and administration processo de trabalho
