Olhares sobre as práticas de strategizing e de organizing com a inserção da medicina integrativa na saúde pública

Abstract

The National Policy on Integrative and Complementary Practices (PNPIC), approved in 2006, provides SUS users with access to practices like acupuncture and homeopathy, not offered by heath care system before. Heath managers need to deal with these changes originated from these new practices. The objective of this research is to analyze the configuration of the practices of strategizing and organizing with the insertion of IM in public health units of Uberlândia. The theoretical approach to this research is based on studies of strategy as practice and studies on public health and IM. Based on interpretative assumptions and a qualitative approach, the data were collected in three health units of Uberlândia, using documental research, non-participant observation and semi-structured interviews with coordinators, health professionals and users of the selected units. In addition, a member of the Regional Medical Council, a member of the Municipal Health Council and a member of the Consultative Committee of integrative practices were interviewed. After the data collection, the data were processed and analyzed according to the precepts of the content analysis. The results of the research pointed to the identification of an unbalanced and also interdependent relationship between strategizing and organizing. The unbalanced relationship may originate from the fact that health units follow general established strategies without considering their organizing practices, which may hinder or make it impossible to reach the strategic guidelines broadly defined by the Ministry of Health. Interdependent practices point to an alignment between organizing and strategizing and the established goals. The PNPIC is a relatively new policy and involves a break with many values and habits in the relationships and daily life of the professionals working in the analyzed organizations, as well as other strategic actors that may influence their insertion in this context. Therefore, it was noticed that the analyzed health units still lack planning with regard to PICS: to inform, to train and encourage their professionals. Regarding users, despite the positive results, it was noted a lack in the communication in order to clarify and disseminate these practices to the population. The results demonstrate the need of thinking about the specificities of each health unit, regarding the decisions of the insertion of new care practices; also demonstrate that organizing and strategizing practices can be configured from more than one mode of association, bringing up the advances and the gaps in the insertion of IM practices into SUS. The looks at the configuration modes of strategizing and organizing practices show that practitioners are using rules and resources according those available rules and resources, but also show practitioners creating alternatives and transforming rules and developing new resources.