Os espaços participativos na atenção primária brasileira

Abstract

This thesis analyzes social participation in the context of Brazilian Primary Health Care (PHC), for this purpose, we sought to map Brazilian empirical studies on formal experiences of social participation in PHC since the creation of the Health Unic System (SUS), in addition to understand the experiences of social participation in PHC in a municipality in the south of the country. The research had two methodological moments that gave rise to two scientific articles. The first one was a systematic review of the literature in the Lilacs, PubMed, PsycINFO and Sociological Abstracts databases, within the time frame from 1988 (creation of the SUS) to November 2020 (last search date), with 20 articles being located empirical studies addressing social participation and PHC. The second article was a qualitative, exploratory research using thematic content analysis, carried out in three Basic Health Units (BHU) through participant observation, interviews and a field diary, with its results discussed from the concept of social subject as an articulator of participatory actions. The articles produced revealed different experiences of social participation developed in the territories where PHC operates, highlighting the difficulties faced in the process of implementing the Local Health Councils (LHC). Based on the studies reviewed, most of which were qualitative, the profile of the participants and the competence to participate, the process of participating and the construction of participatory actions were discussed, in addition to the centrality of continuing education as a way of strengthening social participation in health. The second article described different arrangements in each BHU studied, especially about the plans of collective forces that were created, social organizations and partnerships and even the absence of these. In addition, the importance of legitimate representations within the spaces of the LHC, the role of health teams as promoters of participatory actions and the difficulties faced in the stoppage of the functioning of these spaces in the context of the Covid19 pandemic were discussed. The experiences of social participation in the PHC context studied here pointed to the relevance of a look that goes beyond the established spaces, involving the daily life of the territories and the micropolitics that are built in these specific and localized social relationships, being fundamental the continuity of research that go in the direction of rethinking the established practices of the SUS.