Análise política da implementação da atenção básica no sistema de saúde do Distrito Federal

Abstract

There is a consensus on the importance of the Primary level of Health Care. However it only consolidates itself in the systems of care where it plays a demanding role of the network service and as a coordinator when caring for people and communities. The Political Analysis study was developed and guided by the methodology of condition analysis at two government periods. Between 2011 and 2014 and then from 2015 to 2018. Starting from the identification of relevant government initiatives, the next step was the characterization of the social and political contexts in which these initiatives were adopted or announced. A timeline was elaborated to record and guide the aspects related to the initiatives including governmental actions, reactions and the political scene federal and locally, which then made the design of the Conjuncture Map. The product or result was analyzed to understand the underlying games and power tensions through Mario Testa's theory of Strategic Thinking. The study allows us to state that there is no desirable linearity in the process, actions or initiatives for the implementation of PHC (Primary Health Care) in DF (Federal District). In the 2011 to 2014 management, despite the favorable national scenario for the expansion of the PHC, the government worked under an enormous pressure from corporate actors to review the Career Plans. Then the 2015 to 2018 management office in their early days presented some potent initiatives towards the PHC, but soon the government turned its priority to proposals for indirect hospital management. The resources of power were largely used by the social actors involved. The Syndicate of Physicians (SINDMÉDICO) and the Health Care Establishments Employees Union (SINDSAÚDE) were the representative actors with the greatest mobilization capacity. The Public Prosecution Service and the Legislative Chamber of DF played important roles in the health management process, mobilizing resources that institutional power gives them to influence and direct policies. The District Health Council was not characterized in its autonomy and is confused by the interests of managers weakening the expected role for social control of SUS (Universal Health Care System). Political Analysis Studies is important for the process of policy formulation and implementation, and from this perspective it is recommended to create a Health Policy Analysis Observatory at DF as a useful strategy to consolidate the PHC and SUS in DF.