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Previous issue date: 2014-08-29 === This thesis deals with the construction of the right to health care with the participation of and emphasis on the dialectic reading of the history of the public policies on health care in Brazil since the conception of the health movement, in a contextof State reforms and of the construction of the popular democratic project. Its goal is to analyze how the debate about SUS [Unified Health Care System] materializes as a model of universal care, in the public spaces as of the political participation of the collective actors of the popular field in the reform movement. Thus, the indicators which guided the analysis are: what political participation could have produced health care as a social right? and: how are the public spaces conformed within the institutional design of health care in RS? This was done based on the documental analysis of the CES [State Health Conferences] Resolutions/RS, the Conference Reports and State Health Plans which guided the historical path. Besides this, fourteen collective actors indicated based on the technique of the snow ball , through thematic oral narrative, contributed by explaining the main strategies, articulations, mobilizations and political education in this process. These actors are identified with the union movement (Fetag [Agricultural Workers Federation]/RS, the Rural Department of CUT [Worker s Unified Center] Fetraf [Family Agriculture Federation]/South), the Sindsepe [Public Servants Union]/RS, the Sindfarm [Pharmacists Union]/RS, the community Movement, the Fracab [Riograndense Federation of Community Associations and Neighborhood Associations] /RS, as well as CUT/RS, the NGOs (CAMP [Multi-professional Consultancy Center]/RS, CEAP [Center of Popular Education and Consultancy]/RS), the social movements (MMC [Rural Women s Movement]/RS), Mental Health Forum, the church (CEBs [Ecclesial Base Communities]), besides the professional representation (Cress [Regional Social Work Council]) and the Philanthropic Hospitals Federation of RS. The narratives were obtained through interviews collected and taped with authorization, transcribed and codified by the NVIVO Software, a system of qualitative analysis which makes possible a more rapid organization, presentation, interpretation and disclosure of the data. The content analysis according to Bardin (1977) was used. The results indicate that this movement or these movements defending the right to health care and the institution of SUS can be divided into three phases: the first occurred toward the end of the 70s and beginning of the 80s. During this period the mobilizing political agenda of the social movements was the construction and the guarantee of rights in the perspective of Social Security, land, work and access to health care. In the public spaces the struggle was for autonomy with regard to the traditional structures. And the strategies used by the collective actors were base organization, mobilization, political articulation and formation. These are tools potentialized by the strategy of Popular Education, through base nuclei, discussion groups, health care commissions and also the Seminars and the Congresses. It is a movement which forms its leaders as well as disputes spaces in society. In the second phase, now in the context of the 90s, one observes, on the one side, a movement for Political Democratization, with regulation of rights through legislation, a new conception of health care with participation in the public spaces, having as particularities the decentralization of the CES/RS in RS and, on the other side,a context of State Reforms with advancement of the Neoliberal Project, with an ebbing of the social movements and purposeful resistance in the public spaces, centrality in administration, allied to the advance of the Privatist Project . And a third phasewith an emphasis on the model of national development; in RS, however, the health care crisis deepens, one perceives the advance of the Public Foundations of Private Law and an increasing loss of deliberative power of the Health Councils. New resistance movements arise bringing into the scenario some historic struggles, the political representation , direct participation , representativeness and still other issues such as quality and access to health care actions and services, among others. One observes that, stemming from the political participation of the leader workers and their strategies of mobilization, organization, articulation and political education as a tool of popular education it was possible to construct the necessary mediations among the societal political forces (social movements, unions, churches, NGOs) and the state political forces (government and its institutions, workers, parties) for a Popular Project in the 80s. However, in the 90s, on the one side, we see the ebbing of the social movements, a participation of purposeful resistance in the public spaces and a loss of political strength in the popular field and, on the other side, the centralization of power in the administrations and the judicialization of rights. However, the public spaces of the Health Councils and Conferences still maintain some power in the mediation of the relations between the State and the society, but they need to include new collective actors and guarantee a plurality in the participation. === Esta tese trata da constru??o do direito ? sa?de com participa??o e ?nfase na leitura dial?tica da hist?ria das pol?ticas p?blicas de sa?de no Brasil a partir da concep??o do movimento sanit?rio, em um contexto de reformas do Estado e de constru??o do projeto democr?tico popular. Ela tem a finalidade de analisar como se materializa o debate do SUS, enquanto modelo de aten??o universal, nos espa?os p?blicos a partir da participa??o pol?tica dos atores coletivos do campo popular no movimento de reformas. Assim, os indicadores que orientaram a an?lise s?o: que participa??o pol?tica pode ter produzido a sa?de como direito social? e como se conformam os espa?os p?blicos no desenho institucional na sa?de no RS? Isso foi feito a partir da an?lise documental das Resolu??es do CES/RS, dos Relat?rios das Confer?ncias e dos Planos Estaduais de Sa?de, que orientou o caminho hist?rico. Ademais, quatorze atores coletivos indicados a partir da t?cnica da bola de neve, via narrativa oral tem?tica, contribu?ram explicitando as principais estrat?gias, as articula??es, as mobiliza??es e a educa??o pol?tica nesse processo. Esses atores est?o identificados com o movimento sindical (Fetag/RS, o Departamento Rural da CUT Fetraf/Sul), o Sindsepe/RS, o Sindfarm/RS, o Movimento comunit?rio, a Fracab/RS, bem como a CUT/RS, as ONGs (CAMP/RS, CEAP/RS), os movimentos sociais (MMC/RS), o F?rum de Sa?de Mental, a igreja (CEBs), al?m da representa??o profissional (Cress) e segmentos da Federa??o dos Hospitais Filantr?picos do RS. As narrativas foram obtidas por meio de entrevistas coletadas egravadas com autoriza??o, transcritas e codificadas pelo Software NVIVO, sistema de an?lise qualitativa que possibilita a organiza??o, apresenta??o, interpreta??o e divulga??o mais r?pida dos dados. Utilizou-se a an?lise de conte?do segundo Bardin (1977). Os resultados indicam que esse movimento ou esses movimentos em defesa do direito ? sa?de e da institui??o do SUS podem ser divididos em tr?s fases: a primeira ocorreu em fins dos anos de 1970 e in?cio dos anos de 1980. Nesse per?odo, a agenda pol?tica mobilizadora dos movimentos sociais era a constru??o e a garantia de direitos na perspectiva da Seguridade Social, terra, trabalho e acesso ? sa?de. J? nos espa?os p?blicos a luta era pela autonomia em rela??o ?s estruturas tradicionais. E as estrat?gias utilizadas pelos atores coletivos foram a organiza??o de base, a mobiliza??o, a articula??o e a forma??o pol?tica. Trata-se de ferramentas potencializadas pela estrat?gia da Educa??o Popular, via n?cleos de base, dos grupos de discuss?o, das comiss?es de sa?de e ainda dos Semin?rios e dos Congressos. ? um movimento que tanto forma seus dirigentes quanto disputa espa?os na sociedade. Na segunda fase, j? no contexto dos anos de 1990, constata-se, de um lado, um movimento de Democratiza??o Pol?tica, com regulamenta??o de direitos via legisla??o, nova concep??o de sa?de com participa??o nos espa?os p?blicos, tendo como particularidades a descentraliza??o do CES/RS no RS e, de outro, um contexto de Reformas do Estado com avan?o do Projeto Neoliberal, com refluxo dosmovimentos sociais e resist?ncia propositiva nos espa?os p?blicos, centralidade na gest?o, aliados ao avan?o do Projeto Privatista. E uma terceira fase 2003 com ?nfase no modelo de desenvolvimento nacional; no RS, por?m, aprofunda-se a crise na sa?de, percebe-se o avan?o das Funda??es P?blicas de Direito Privado e a crescente perda de poder deliberativo dos Conselhos de Sa?de. Surgem novos movimentos de resist?ncia, trazendo para o cen?rio algumas lutas hist?ricas, a representa??o pol?tica, a participa??o direta, a representatividade e ainda quest?es como qualidade e acesso a a??es e servi?os de sa?de, dentre outras. Constata-se que, a partir da participa??o pol?tica dos trabalhadores dirigentes e de suas estrat?gias de mobiliza??o, de organiza??o, de articula??o e de educa??o pol?tica ( fazer com ) enquanto ferramenta da educa??o popular foi poss?vel construir as media??es necess?rias entre as for?as pol?ticas societais (movimentos sociais, sindicais, igrejas, ONGs) e as for?as pol?ticas estatais (governo e suas institui??es, trabalhadores, partidos) para um Projeto popular nos anos de 1980. J? nos anos de 1990, de um lado, vemos o refluxo dos movimentos sociais, uma participa??o de resist?ncia propositiva nos espa?os p?blicos e a perda de for?a pol?tica do campo popular e, de outro, a centralidade do poder nas gest?es e a judicializa??o dos direitos. Entretanto, os espa?os p?blicos dos Conselhos e das Confer?ncias de Sa?de ainda mant?m certa pot?ncia na media??o das rela??es entre o Estado e a sociedade, mas necessitam incluir novos atores coletivos e garantir a pluralidade na participa??o.
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