Trabalho e autonomia dos trabalhadores em saúde : uma análise a partir da estratégia de saúde da família na Região 28 de Saúde (RS).

Abstract

The issues addressed in this thesis involve the theme work and autonomy at work in health. This is a study that attempts, on the one hand, the historical process of implementation of the Unified Health System (SUS) in Brazil and its implications on the work and the working conditions of health workers. On the other hand, given the transformations that, since the last decades of the twentieth century, occurring at work and forms of work organization as a result not only of an intense scientific-technical revolution and different organizational innovations, but fundamentally the how these technical-scientific and organizational changes are integrated into the historical dynamics of development of the capitalist social formations, particularly the Brazilian social formation. The implementation of SUS, from the 1990s, occurred in a historical context in which came to live side by side and not without humanization projects contradictions of health services, with a view to recovery of health workers and building spaces of professional autonomy, and projects of restructures in public services that are guided by the perspective not only of deregulation, privatization and flexibility of labor relations, but also the pursuit of efficiency and quality in health services guided by references that constituted within a logic of capital appreciation and therefore to intensify the forms of control over the work and on workers. Thus, the research problem is aimed at following question: how, from concrete contexts of organization of work of the Family Health Strategy, health workers face the existing dilemmas between professional autonomy and establishing control standards, standardization and standardization of work processes? The analysis of the autonomy of health workers was theoretically based on the contributions of the philosopher Cornelius Castoriadis and historian Edward Thompson and takes the category of experience as a central category in the analysis of the presented problem. The methodological approach that supports the thesis is historical materialism. The research subjects were health workers who work in the Family Health Strategy of the municipalities in Region 28 Health of Rio Grande do Sul and that make up the core team of Family Health, which are: doctor, nurse, nursing technician and Community health workers, totaling 266 participants. In addition to these health workers also participated in the three data collection municipal administrators and three members of the Municipal Health Councils in the municipalities of Santa Cruz do Sul, Venancio Aires and Vale do Sol; Finally, the manager of the 13th Regional Health Coordination was also the subject of research. The research techniques adopted are based on the "data triangulation," adopting the following research techniques: search form, semi-structured interviews and observations. Added to these techniques, there was a documentary and secondary data analysis, in particular by IBGE, DataSUS and CNES in order to check the structure of the labor market in the Region 28 Health. Through this theoretical and methodological contribution and performed field research the concrete health work spaces, the thesis that is defended is that there are macro-social conditions, but also linked to the own historical and regional experience of organization of health services that guide the action of the workers. These constraints limit the employee to act according to the principles recommended by the SUS. It is noticed that despite being limited the autonomy of spaces at work, they are not absent. In the contradictory movement and dialectic between subjectivity and objectivity worker builds spaces of autonomy, always conquered by active action, set in historical collective struggles of health workers in the country. Thus, the analysis of these issues has taken presupposed a possible autonomy, which can not be considered independent of internal and external constraints involved in health work process.