Contribuições da Terapia Ocupacional na construção e legitimação do Sistema Único de Saúde (SUS)

Abstract

The redemocratization process is a milestone in Brazil's political and social history, in which, through the Brazilian Health Reform Movement and social struggles, great achievements were achieved, such as the 1988 constitution and the consolidation and legitimization of the Unified Health System This socio-historical process allowed many themes to be discussed by the population, followed by collective propositions that transformed Brazilian social reality. Along with this, Occupational Therapy begins to reflect critically on its professional performance in spaces of social exclusion such as mental hospitals and rehabilitation centers. Therefore, this work is based on the expectation of elucidating the following question: in the socio-historical scenario in which health was made official as a right for all, how did Occupational Therapy/occupational therapists contribute/contribute to the process of building the SUS? Its general objective was to identify whether there was an active participation of Occupational Therapy in the constitution of the SUS and if so, in what ways it occurred, and as specific objectives: to connect the history of Brazilian Occupational Therapy to the history of health in the country; understand the repercussions of the constitution of the SUS on paradigmatic changes in the profession and expand debates about the participation of occupational therapists in social struggles. This is a qualitative, descriptive and exploratory research, in which data collection occurred through semi-structured interviews, carried out virtually with four occupational therapists who actively participated in the construction of the SUS and/or the systematization of this process. The results were analyzed using content analysis, based on Bardin's formulations. After the analysis, six categories were created, accompanied by their main results: Contributions of Occupational Therapy in the construction of the SUS, where it was possible to identify among the profession's contributions are participation in municipal and state health plenary meetings, at the 8th National Health Conference and in the Brazilian Psychiatric Reform. Guiding principles for the participation of Occupational Therapy in the construction of the SUS, which highlighted essential themes to discuss and build a universal and free health system, which would dialogue with social security, deinstitutionalization, citizenship and the realization of rights through the creation of public policy; Motivators for the participation of Occupational Therapy in the construction of the SUS, which highlighted health conditions before the creation of the SUS, the integration of social movements and the student movement and the influences of Italian Democratic Psychiatry; Repercussions of the political-social situation of the military dictatorship on the formation and performance of Occupational Therapy, which addressed the consequences of political oppression, the restriction of civil rights and student experiences in this period of intense conflict; Repercussions of the political-social situation of redemocratization on the formation and performance of Occupational Therapy, in which changes in the care offered and the expansion of the areas of activity of the profession were described; Paradigmatic changes that occurred in the profession during the construction period of the SUS, which dealt with the influence of the SUS on these changes and the expansion of health care proposals in professional practice. The interviewees' reports constructed a composition of facts that shows us the context in which the SUS proposal was developed and based. By analyzing, in the reports, the health conditions experienced by the population before the creation of the SUS and the dissatisfaction with this scenario, the movement of professionals- including occupational therapists- in the fight for access to health, together with social movements, was understood. . The discussion of what was considered health, as well as the expansion of this concept, started from the collective construction of the people themselves and considered, in addition to social and environmental aspects, the perspective of individual autonomy. It is worth highlighting the importance attributed by occupational therapists to the 7 integration that occurred in these movements, which became a single collective, to carry out debates and defend what was being created and proposed in the process of politicization of social issues. The student movement was also identified as one of the main motivators for the participation of the professional category in the construction of the SUS, having the first discussions and actions that integrated it into the process of politicization of social issues based on student experiences. Furthermore, in parallel to the Brazilian Health Reform movement and the dialogues about the construction of health as a social right, the Psychiatric Reform movement emerged in Brazil in the mid-1970s, which sought transformations in the field of mental health care. For professionals engaged in this struggle, this transformation process would only be possible through citizenship, the recognition of rights and the implementation of deinstitutionalization practices. The perspectives of action and professional training were influenced by discussions about the expansion of the concept of health, with occupational therapists who worked in institutions such as psychiatric hospitals and rehabilitation centers beginning to critically reflect on their professional practice, realizing the opportunity to rebuild as a profession. She began to take a stand against the State's negligence towards society and to develop an ethical-political commitment with the interlocutors who were fighting for the reestablishment of democracy in the country. The facts elucidated by this research can contribute to the historicity of the profession, enabling reflections on the formation and performance of Occupational Therapy, with regard to the changes that occurred during the socio-historical period of redemocratization. They also enable reflections on the population's social protagonism in proposing and implementing health care, which must continually be achieved, as well as on the profession's participation in social struggles. Thus, some gaps could be filled and the scenes that make up the presented narrative must be observed, reevaluated and discussed.