Relações de poder no contexto da estratégia de saúde da família.

Abstract

Power relations are present in the various levels of health care, since these are composed of a social web of individuals that interact with each other. Within the scope of the Family Health Strategy, power relations are the result of a historical, cultural and environmental accumulation that brings its care process closer to the practices of the curativist model. The aim of this study was to understand the power relations existing in the work context of the Family Health Strategy. It is a field study with a descriptive nature and qualitative approach performed with 20 health care professionals who make up the family health teams of the municipality of Nazarezinho-PB through a recorded interview guided by a semi-structured formulary. Nurses, doctors, dentists, nursing technicians and oral health assistants and the community health agents of the Family Health Strategies who were on the work scale during the period of data collection were established as inclusion criteria. Was considered as exclusion criteria only those professionals who were absent from the service and could not be contacted during the period of data collection, which occurred in the months of July to October 2017. The analysis of the objective data was done through descriptive statistics, and of the subjective ones took place in a categorical and thematic form through Laurence Bardin's Content Analysis. The study respected the ethical precepts set forth in Resolution 466/2012 of the National Health Council, and was approved by the Ethics Committee of the Universidade Federal de Campina Grande (Federal University of Campina Grande city) / Centro de Formação de Professores (Teacher Training Center), under opinion number 2.131.776. Five thematic categories were built: Category 1 - What is power in the Family Health Strategy; Category 2 - Exercise of power in the Family Health Strategy: perceptions of professionals; Category 3 - Factors involved in the genesis of power relations in the Family Health Strategy; Category 4 - The knowledge-power relationship in the Family Health Strategy and Category 5 - Reflections of the verticalization of power in health care. Different perceptions about power were found, which pass through the concept of autonomy and knowledge, the latter being an intrinsic perception of the understanding of power by the subjects of the study, which reflects the inseparability between knowledge and power discussed by Foucault. The higher valuation verified of the work process of certain professionals shows an unequal distribution of power in the studied scenario, which ends up operating in a medical-centered way, disregarding the interdisciplinarity that should exist in the health service, disarticulating the professional performance and approximating the Strategy of Health Family to the biomedical and curativist model, causing the construction of a health hierarchy that defines professionals that can more or less. Therefore was evidenced the need to overcome the power relations materialized in the Family Health Strategy, aiming to provide a horizontal health care, focusing on the demands of social actors, users of the service, based on interdisciplinarity and on team work.