Dinâmicas da implantação do programa mais médicos na Paraíba: contribuições sociológicas para a análise de uma política pública

Abstract

This thesis deals with State-society relations through the "implementation" of a public health policy entitled Programa Mais Médicos (PMM). It emphasizes one of the elements of the policy that was the process of distribution of Brazilian and foreign physicians in Brazil and especially in Paraíba. My goal was to understand the processes of elaboration and implementation of a policy, considering the local dynamics of its implementation. The research process looks at politics in a given political and historical period, from the initial tensions that favor the formulation of the “Programa Mais Médicos”, to the policy developments after the change of government in the year 2016. Paraíba was chosen as the territory of observation because of the expressive coverage of Basic Attention, by the family health tradition, by the creation of instruments that favored the "implementation" of the policy at local and national level and by the approach of the researcher with the implementing actors. In order to be able to observe and analyze the multiplicity of phenomena coming from the field of research, a cartography was constructed, in the sense of Deleuze and Guattari, that aims to follow processes in movement. This movement means the relations between the various actors participating in the Programa Mais Médicos, such as physicians, supervisors, tutors, municipal and state managers, representatives of the ministries of health and education, workers of the Primary Care teams and users of the public health system. One of the fundamental elements of this cartography was the problematization of the insertion of the researcher with the actors, with the need for movements of distance and approach with the field of research to guarantee the objectivation of the phenomena observed. By means of the research process, it was possible to observe the reactions against the politics from the "official medical movement", which produced political facts and disseminated ideologies regarding the program, especially opposing changes in professional training and access to medical residences. In addition, it discusses the tactics to disqualify foreign professionals, especially Cuban doctors, by assigning to them what can be called outsiders, in the logic of Elias and Scotson. During the field work, the differences between the professional practices of Brazilian and Cuban physicians drew attention, with the observation of a greater involvement with the attendances and health team by the latter. In addition, observing the distribution of the professionals in the state, it was possible to perceive that in some regions, characterized as being more difficult to reach or those farther away from the large urban centers, it was only possible to guarantee medical assistance from the "cooperados" which may allow you to create a care vacuum if the program is finished. For the "implementation" of the PMM in the state, it was fundamental the relationship between actors that already had an approach before the program, in social and political movements, characterizing a group of militant actors in favor of the health system and the qualification of Basic Attention.