Política municipal e regional do câncer de mama em Santa Cruz do Sul : um estudo de gestão territorial de uma política pública.

Abstract

The object of this study is the territorial administration analysis of a regional public policy: the policy of breast cancer in the 13th Health Coordination region, in Rio Grande do Sul State, with mortality taxes above the national average The analysis focuses actions taken by the municipal and state, managers and professionals from the 13ª Regional Health Coordination region, as well as the effects on the users. Starting from the dialectic conception for the study of public policies, the empiric material had as it source, the field observation, the systematic reading of institutional documents, questionnaires application, interviews with managers, technicians of the health system, health professionals not connected to SUS and with health services users. The regional calendar of public health and the dynamics of the territorial administration in the public actions toward the breast cancer prevention evidenced that the territorial administration of the policy assists partially the norms and guidelines of Ministry of Health. It highlighted the precarious space distributions of the services rendered involved in the strategy of breast cancer preventions, restricting the access. The flows and standard-procedures instituted by Ministry of Health have not been reaching their goals, to the extent that the users are subjected to attention logics clearly identified with market principles. The work criteria adopted by some of the more influential social actors – managers and physicians – showed non convergent interests with the production of a public good, whose conduct interferes in the execution of this public policy. The progresses obtained in this policy and the limits of its effectiveness are sustained in discursive field structured on legitimate values. For a matter situated in the heart of the conflict market/public health, the difficulty of incorporating the breast cancer public policy in the everyday of SUS (the public health system) has been perpetuating the passive acceptance of its inadequacies.