Saúde bucal no sistema prisional: estudo sobre a estrutura e o acesso de pessoas privadas de liberdade

Abstract

Ensuring healthcare for people deprived of liberty is essential to uphold human dignity and the right to health, while also contributing to disease prevention and the protection of public health. In this context, oral healthcare within the Brazilian prison system constitutes a strategic field for examining health inequities, given the numerous challenges involved in ensuring comprehensive care in correctional settings. Therefore, this thesis aimed to analyze the implementation of the National Policy for Comprehensive Healthcare for Persons Deprived of Liberty (PNAISP) and to understand the pathways followed by incarcerated individuals in their search for oral healthcare. To explore this issue, three studies were conducted. The first study employed a qualitative approach and involved men serving sentences in a state prison operating under a closed regime in the state of Minas Gerais, Brazil. For these individuals, barriers to accessing oral healthcare stem from State neglect, manifested through prison overcrowding and a shortage of qualified healthcare professionals. This context gives rise to a micropolitics of access that undermines the principle of equity. The second study, quantitative and cross-sectional in design, analyzed trends in dental services provided within the Brazilian prison system between 2014 and 2022. The findings revealed that the growth of the incarcerated population has not been accompanied by a proportional increase in the number of dentists, while a considerable rise in tooth extraction procedures was observed. Finally, the third study adopted a retrospective ecological design using data from the Primary Health Care Information System. Data from all municipalities reporting the productivity of Prison Primary Healthcare Teams between 2017 and 2022 were analyzed. The study compared the productivity of prison oral healthcare teams during the COVID-19 pandemic (2020–2022) with that observed in the preceding three-year period (2017–2019). The results revealed marked regional inequalities, with the productivity of several municipalities approaching or reaching zero. Emergency procedures and tooth extractions predominated over restorative and periodontal treatments. In summary, this thesis demonstrated that the implementation of PNAISP has neither expanded healthcare coverage nor reduced inequalities in access to care. These findings raise concerns about the effectiveness of the policy and highlight the need to strengthen its implementation, with an emphasis on expanding service provision and improving access to oral healthcare within the prison system, thereby overcoming the institutional barriers experienced by incarcerated individuals.