Vigilância em saúde do trabalhador na esfera municipal

Abstract

In Brazil, workers´ health policies were significantly developed based on the Federal Constitution, which consolidated health and work as citizenship rights. Workers´ health was included in the Unified Health System and structured by the National Network of Integral Attention to Workers' Health, connected to the Health Care Network through the Workers´ Health Reference Centers, which play a fundamental role in articulating actions. Workers' health is a broad and complex field and includes investigation and intervention, articulating interinstitutional and interdisciplinary knowledge and practices with a view to promoting health and preventing work-related risks and injuries. Occupational Health Surveillance is a priority strategy to ensure protection, prevention and promotion of workers´ health, through the integrality of actions, multiprofessional action and complementarity of various services. Considering that work plays a fundamental role in the formation of society and of humans as social beings, this study is based on the assumption that changes in labor relations affect workers' health and, consequently, their labor, families and social relations. Occupational Health Surveillance is implemented in Brazilian states and municipalities in a decentralized way according to the principles of the Unified Health System. Moreover, it is the municipalities´ decision, based on their realities, to establish criteria, goals and implementation systems. This study is based on the historical-dialectical materialism framework, which considers human consciousness as a social product, which is changeable and historical, and economic and social transformations, determined by the evolution of the means of production, as well as all the natural or historical things that are not static and finished facts, but are always in motion. It is aligned with the workers´ health framework, which seeks the integrality of care and surveillance in care for workers. Thus, this study aims to analyze Occupational Health Surveillance actions in the municipal sphere. A qualitative study was carried out in two stages: the first stage consisted of a documentary survey of the legislation related to workers' health at the municipal level, as well as other documents that consider the implementation process, information flows and processes concerning occupational health care in the Unified Health System. The second stage included interviews with 15 key professionals (managers and decision makers) linked to the various sectors of the municipal, regional and state health system and other organizations that interface with workers´ health. It was carried out in a medium-sized municipality in São Paulo state, linked to a Regional Workers´ Health Reference Center in conjunction with the Sanitary Surveillance Group and Regional Health Board, following the municipalization process of workers´ health actions in 24 municipalities. The documentary survey related to implementing the Occupational Health Surveillance actions in the municipal sphere showed evidence of a lack of information on the subject. Three legislations focusing on worker´s health resulted from this stage: Deliberation of the Intersectoral Committee on Male and Female Workers´ Health and two Health Plans. Keynote speeches highlighted various weaknesses when developing actions in Occupational Health Surveillance, pointing out that, despite advances in the municipalities in the area of workers´ health, actions are still fragmented and disjointed, there is a lack of knowledge about the roles and competencies of the sectors and actors involved, and there is a critical need for structuring that surpasses curative and palliative actions concerning the prevention of accidents and diseases related to work and health promotion. The findings also indicate that Occupational Health Surveillance is the result of a network in motion, which should be articulated with the principles of the Health Care Network and the Unified Health System. This study analyzed Occupational Health Surveillance in the municipal sphere from the perspective of the actors that are part of it, contributing with local contexts and also with other municipalities that experience similar situations, focusing on the transformation of reality and improvement of workers´ health.