Estruturação de política municipal de práticas integrativas e complementares no SUS: uma pesquisa-ação

Abstract

The World Health Organization defines Traditional, Complementary, and Integrative Medicine (TCIM) as health care approaches based on theories, beliefs, and experiences originating from different cultures, used for health promotion, prevention, and recovery, considering the human being as a whole. These practices are present in nearly every country and show continuous and growing demand. In Brazil, therapeutic plurality within the Unified Health System (SUS) has been practiced since the 1980s, even before the establishment of the National Policy on Integrative and Complementary Practices (PNPIC), and has been positively evaluated by both health professionals and users. However, the lack of institutionalization of these approaches within the SUS still poses barriers that render their provision fragile and unstable, also hindering their monitoring and evaluation. This dissertation responds to the needs of a Working Group on Integrative and Complementary Practices (PIC WG) and aims to collectively develop a proposal for a Municipal Policy on Integrative and Complementary Practices (PMPIC) within the SUS by key actors involved in offering PIC. It also seeks to analyze the demands, challenges, and potentialities of this collective elaboration process. The study was conducted in six municipalities within DRS III, in the state of São Paulo, using Action Research as the main methodological framework. This is an exploratory, qualitative study developed through Action Research (DICK, 2023). The research strategies included document analysis of the PIC WG from 2023 and eight workshops held between March and September 2024, with 18 participants. Data were analyzed through the confirmation and disconfirmation process typical of action research, using a dialectical approach. The results revealed a collectively developed proposal for a Municipal Policy on Integrative and Complementary Practices in the SUS, along with the main demands, challenges, and potentialities of the elaboration process. Among the key demands were: strategies for implementing PICs and the Municipal Policy; dissemination of information about PICs and the policy itself; need for reports, indicators, and financial resources; access and care flow organization; and the creation of collective discussion spaces and SUS mechanisms such as the Municipal Health Council and the Inter-Managerial Commission. Challenges included cultural resistance to overcoming deeply rooted prejudices, the presence and support of health management, difficulties in scheduling for the definition of PMPIC guidelines, and the need to strengthen social control. The main potential identified was Permanent Health Education (PHE), as a cross-cutting, structuring, mobilizing, and transformative axis throughout the process. The research highlighted the political value of collective construction by producing a legitimate technical document sensitive to local realities and capable of triggering local actions for the institutionalization of PICs. The findings demonstrate that ethical and formative engagement of the actors can transform the SUS through integrated, horizontal, and culturally rooted practices. The institutionalization of the PMPIC through action research has the potential to strengthen the bond between health services, communities, universities, and management, aiming to build therapeutic projects that respect the cultural, social, and emotional singularities of individuals in their territories, while also challenging existing care models and understandings of health.