National Cancer Institute and tobacco control: an analysis of federal management of smoking cessation in National Health System (BR)

A disserta????o apresenta a an??lise do modelo de gest??o federal do Programa Nacional de Controle do Tabagismo (PNCT) brasileiro, em especial do tratamento do tabagismo na rede do Sistema ??nico de Sa??de (SUS). O estudo partiu do reconhecimento do tabagismo como grave problema de sa??de p??blica, cujo enfrentamento exige estrat??gias governamentais abrangentes, e da considera????o das especificidades da pol??tica de sa??de, em suas dimens??es de prote????o social, econ??mica e de poder. A pesquisa teve como objetivo geral realizar um diagn??stico da situa????o da gest??o federal da estrat??gia de tratamento do tabagismo, visando identificar n??s cr??ticos e propor melhorias no processo de implementa????o do tratamento do tabagismo no SUS. A metodologia compreendeu o diagn??stico situacional da estrat??gia do tratamento do tabagismo no SUS, considerando as condi????es atuais da gest??o federal, estadual e municipal. Foram adotadas as seguintes estrat??gias metodol??gicas: an??lise de documentos oficiais; an??lise de dados prim??rios do Programa Nacional de Controle do Tabagismo; realiza????o de entrevistas com dirigentes do Instituto Nacional de C??ncer (INCA); e aplica????o e an??lise de question??rios dirigidos ??s coordena????es do programa de controle do tabagismo nos estados e nas capitais. O diagn??stico situacional realizado permitiu identificar como problema central a limitada oferta do tratamento do tabagismo no SUS, cuja origem tem rela????o com as dificuldades de gest??o da estrat??gia no ??mbito das tr??s esferas de governo. A fim de contribuir para o aprimoramento da gest??o federal, buscaram-se proposi????es voltadas para o enfrentamento de algumas causas do problema identificado, relacionadas ?? articula????o inter e intragovernamental, ao planejamento e ?? coordena????o dasa????es log??sticas e assistenciais relevantes para a consolida????o da estrat??gia de tratamento do tabagismo na rede de servi??os do SUS.The thesis presents an analysis of the federal management model of the National Tobacco Control Program (NTCP), especially with regard to the smoking cessation treatment within the network of the Universal Health System (Sistema ??nico de Sa??de ??? SUS). The study begins with the acknowledgement of the particularities of tobacco as a severe health public problem, whose confrontation demands comprehensive governmental strategies and considering the particularities of health policies, in their dimensions of social and economic protection and power. The general aim of the research was to perform a diagnosis of the situation of the smoking cessation treatment strategy, in order to identify critical nodes and propose improvements in the process of implementation of the smoking cessation treatment in the SUS. The methodology was based on the diagnosis of the situation of the smoking cessation treatment strategy in the SUS, considering the current conditions of federal, state and municipal management. The following methodological strategies were adopted: the analysis of institutional documents; the analysis of primary databases of NTPC; the carrying out of interviews with managers from the National Cancer Institute (Instituto Nacional de C??ncer ??? INCA); and the application and analysis of questionnaires directed towards the NTCP coordination of the state and capitals; The diagnosis of the situation performed has identified the limited offer of the smoking cessation treatment in the SUS as a central problem, whose origin is related to the difficulties of the management of strategy at the three levels of government. In order to contribute to the improvement of federal management, proposals were directed towards the confrontation of some causes of the problem identified related to the inter- and intra-government articulation, the planning and the coordination of logistic and assistance actions, relevant to the consolidation of the smoking cessation treatment strategy in the SUS