Análise da implementação da rede de cuidados à saúde da pessoa com deficiência na 28ª região de saúde do Estado do Rio Grande do Sul.

Abstract

The healthcare network for disabled people was created within the scope of the Unified Health System with the objective to improve the care for people with disabilities. It seeks to contribute to a more universal, integral and equitable healthcare access through the articulation of different services and levels of carefulness. In this sense, the present thesis to the Graduate Program in Health Promotion - Masters, at University of Santa Cruz do Sul (UNISC), has as main objective to analyze the process of a healthcare implementation in the 28th Regional health system in the State of Rio Grande do Sul, under the perspective of its different actors. The research resulted in two articles: "Care for the Disabled: Movements in the Territories of a Living Healthcare Network" (Article 1) and "People with Disabilities: Significance and Implications in Health Care Processes" (Article 2). Article 1: The healthcare network for disabled people within the Unified Health System aims to guarantee the integrality of care and equity in the attention to people with disabilities. The objective of this study was to analyze the implementation process of this network in a regional health system in Rio Grande do Sul. An exploratory study was used to conduct a case study, with questionnaires and interviews of 49 individuals to map, describe and analyze (the context, relations and perceptions) the different actors involved in the implementation process of the network. Data of the questionnaires, considered in absolute and relative frequencies and the interviews were analyzed through Content Analysis. The results revealed the existence of movements that report a Living Healthcare Network in permanent construction, in a gradual process of incorporation of its guidelines, although specialized rehabilitation services are still emphasized as care centralizers. In order to effectively address the necessary healthcare for these people, it is important to strengthen the network according to the proposed guidelines in the ordinance and, at the same time, to respect and give visibility to the micropolitical movements already existing in the territories, as a Living Network. Article 2: Due to the heterogeneity of the needs of people with disabilities, health actions towards this segment of the population are based on a mosaic of different approaches of social representations and inferences attributed to disability. This study aimed to know and analyze the senses produced about disability and its implications in health care processes. From an exploratory and qualitative approach, 49 individuals were involved in the healthcare of people with disabilities in a Regional health system in Rio Grande do Sul. Questionnaires and interviews were conducted and data were analyzed through Word Cloud software and Sense Production technique. The data revealed a concept about disability that refers to the biomedical model, highlighting the senses of difficulty, incapacity, limitation and dependence. The insecurity of the staff and the health services in dealing with disabilities reflects difficulties in supporting and living with differences. At the same time, some senses have indicated a new way of conceiving disability, which is now seen as more of a characteristic of the human being with unique needs. The way to understand disability directly affects the care processes, impacting on the ways of organizing health care processes for these individuals. Thus, this study revealed the importance of knowing the implications of the disability to have a better understanding of people needs and care possibilities, thus providing a resolute, equitable and integral care. This research provided a better knowledge about the regional reality of the healthcare for disabled people, offering elements for action planning, definition of priorities and improvement of public policies for a qualified confrontation of the deficiencies.