Social participation in the Family Health Strategy (ESF/SUS): a case study in the territory of Vila UniÃo, in the municipality of Sobral (State of CearÃ, Brazil)

A participaÃÃo social, enquanto processo de conquista e potÃncia, foi se construindo na sociedade brasileira em um cenÃrio de opressÃo e resistÃncia. à um dos princÃpios organizativos do Sistema Ãnico de SaÃde (SUS), garantido como direito pela ConstituiÃÃo Federal de 1988 e Lei n 8.142/1990 e institucionalizado por meio dos Conselhos e ConferÃncias de SaÃde. A EstratÃgia SaÃde da FamÃlia (ESF) tem buscado fomentar a participaÃÃo social, ainda permeada de entraves, mas com possibilidades de materializaÃÃo. A pesquisa objetivou analisar as percepÃÃes de lideranÃas comunitÃrias e profissionais de saÃde sobre a participaÃÃo social na ESF do territÃrio de Vila UniÃo em Sobral-CE. Teve abordagem qualitativa e foi desenvolvida no perÃodo de 2012 a 2014 por meio de estudo de caso e pesquisa de campo exploratÃrio-descritivo. Os dados foram coletados mediante Grupos Focais com lideranÃas comunitÃrias e profissionais de saÃde da ESF e submetidos à AnÃlise de ConteÃdo. Os resultados evidenciaram sentidos, expressÃes, conquistas, fragilidades e desafios da participaÃÃo social na ESF. Os sentidos apresentados estÃo associados: ao engajamento polÃtico, à transformaÃÃo social, à luta por polÃticas sociais, ao empoderamento, à construÃÃo coletiva, à solidariedade e à educaÃÃo libertadora. Quanto Ãs expressÃes, foram identificados espaÃos institucionalizados ou nÃo, que revelam as inÃmeras formas de participar na saÃde. Como conquistas, sobressaÃram: a atuaÃÃo de lÃderes comunitÃrios e profissionais de saÃde nos movimentos participativos, o Conselho Local de Desenvolvimento Social e SaÃde (CLDSS), a inserÃÃo comunitÃria no planejamento do Centro de SaÃde e ampliaÃÃo do acesso aos serviÃos de saÃde. Como fragilidades foram levantadas: a baixa adesÃo comunitÃria e de profissionais aos processos participativos, o sentimento de descrenÃa e falta de pertencimento ao coletivo, a pouca efetividade do CLDSS, a participaÃÃo vinculada a benefÃcios pessoais e o enfraquecimento de AssociaÃÃes ComunitÃrias. Os desafios enfrentados pela participaÃÃo social estÃo atrelados à universalizaÃÃo do direito à saÃde, à valorizaÃÃo dos sujeitos envolvidos nesse processo e ao fortalecimento de espaÃos de participaÃÃo. O estudo proporcionou reflexÃes relevantes sobre a interface da participaÃÃo e produÃÃo do cuidado à saÃde na ESF e apontou contribuiÃÃes para uma polÃtica democrÃtica e justa no Ãmbito do SUS.Social participation can be understood as a process of struggle for power and social achievements. This process has been developed within Brazilian society against a great backdrop of oppression and resistance. Concerning the public health in Brazil, given by the SUS (Brazilian National Health System), social participation is realized as a principle guaranteed by the Constitution of 1988 and the Law n. 8.142/1990, later institutionalized through the Health Councils and Conferences. The dissemination of the Family Health Strategy (ESF) has sought to enforce and promote social participation, but there are still many barriers for the materialization of this principle. The purpose of this study is to analyze perceptions among community leaders and health professionals about social participation and the health system in the territory of Vila UniÃo, in the municipality of Sobral (state of CearÃ). It was adopted a qualitative approach developed through a case study and the used of exploratory-descriptive research between 2012 and 2014. Data were collected through focus groups with community leaders and health professionals from the ESF and it was subjected to content analysis. The results showed some meanings, expressions, achievements, weaknesses and challenges to social participation in the ESF. The meanings presented can be associated with political engagement, social change, demands for social policies, empowerment, collective construction, solidarity and âliberating educationâ. As for expressions externalized, ESF was conceived as spaces, institutionalized or not, that allow several forms to participate in local health. As achievements, the highlights were the important role of health professionals and community leaders in participatory movements, the conception of Local Board of Health and Social Development (CLDSS), the community inclusion in the process of planning the Health Centre, and the expansion of access to health services. As weaknesses, it was reported the low adherence of health professional to participatory processes, the feeling of disbelief and lack of belonging to the community, some low effectiveness of CLDSS, participation linked to personal benefits, and the weakening of Community Associations. The challenges of social participation are direct linked to the universalization of the right to health, the appreciation of the actors involved in this process, and the strengthening of participatory arenas. Therefore, the study provides important insights about the interface of participation and the production of health care in the ESF, and it contributes to a fair and democratic policy in the SUS